Communities seeking to adequately address important health problems must develop innovative strategies which link health services research, the medical care delivery system and public health, thereby providing a scientific framework for health planning. The proposed project is a collaborative effort which applies such a strategy to coronary artery disease (CAD) in Monroe County, New York.
It aims to better define the burden of illness in the community and formally engage key health systems representatives in a strategic planning process. The project will be conducted in three progressive phases: 1. Examination of community-level data to better define patterns of illness, mortality and service utilization within the County; 2. Multi-level analysis of patient-specific and aggregate variables as predictors of in-hospital myocardial infarction (Ml) mortality and procedure utilization; 3. Formal integration and dissemination of the results to motivate and inform a community-oriented process of consensus building and program planning. The first phase, which will employ the techniques of small area analysis to evaluate morbidity, mortality and service utilization patterns within hospital market areas (HMAs), will generate hypotheses for further study in the second phase and in subsequent studies. The second phase will expand on the first, utilizing logistic regression analytic techniques to better define problem areas and illuminate community-oriented intervention and evaluation planning. The third phase will synthesize and integrate data from the first two for presentation in the context of a critical path analysis model of CAD in Monroe County. It will thus be an integral part of scientifically-based future research, intervention and surveillance. In conjunction with other local initiatives, this project will be a model for critical path analysis of a specific disease, which will be applicable to other high- priority public health problems and other health systems.
