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Towards a Unified Taxonomy of Health Indicators: Academic Health Centers and Communities Working Together to Improve Population Health

Aguilar-Gaxiola, Sergio MD, PhD; Ahmed, Syed MD, MPH, DrPH; Franco, Zeno PhD; Kissack, Anne MPH; Gabriel, Davera RN; Hurd, Thelma MD; Ziegahn, Linda PhD; Bates, Nancy J. DrPH; Calhoun, Karen; Carter-Edwards, Lori PhD; Corbie-Smith, Giselle MD, MSc; Eder, Milton “Mickey PhD”; Ferrans, Carol PhD, RN; Hacker, Karen MD, MPH; Rumala, Bernice B. PhD, MEd; Strelnick, A. Hal MD; Wallerstein, Nina DrPH

Academic Medicine:
doi: 10.1097/ACM.0000000000000198
Articles
Abstract

The Clinical and Translational Science Awards (CTSA) program represents a significant public investment. To realize its major goal of improving the public’s health and reducing health disparities, the CTSA Consortium’s Community Engagement Key Function Committee has undertaken the challenge of developing a taxonomy of community health indicators. The objective is to initiate a unified approach for monitoring progress in improving population health outcomes. Such outcomes include, importantly, the interests and priorities of community stakeholders, plus the multiple, overlapping interests of universities and of the public health and health care professions involved in the development and use of local health care indicators.

The emerging taxonomy of community health indicators that the authors propose supports alignment of CTSA activities and facilitates comparative effectiveness research across CTSAs, thereby improving the health of communities and reducing health disparities. The proposed taxonomy starts at the broadest level, determinants of health; subsequently moves to more finite categories of community health indicators; and, finally, addresses specific quantifiable measures. To illustrate the taxonomy’s application, the authors have synthesized 21 health indicator projects from the literature and categorized them into international, national, or local/special jurisdictions. They furthered categorized the projects within the taxonomy by ranking indicators with the greatest representation among projects and by ranking the frequency of specific measures. They intend for the taxonomy to provide common metrics for measuring changes to population health and, thus, extend the utility of the CTSA Community Engagement Logic Model. The input of community partners will ultimately improve population health.

Author Information

Dr. Aguilar-Gaxiola is professor of clinical internal medicine; director, Center for Reducing Health Disparities; director, Community Engagement Program, Clinical and Translational Science Center; and codirector, Latino Aging Research and Resource Center, University of California, Davis School of Medicine, Sacramento, California.

Dr. Ahmed is senior associate dean for community engagement; director, Community Engagement Key Function, Clinical and Translational Science Institute of Southeast Wisconsin; professor, Department of Family and Community Medicine; professor, Institute for Health and Society; and director, Healthier Wisconsin Partnership Program, Medical College of Wisconsin, Milwaukee, Wisconsin.

Dr. Franco is assistant professor, Community Engagement Key Function, Clinical and Translational Science Institute of Southeast Wisconsin, Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.

Ms. Kissack is program manager, Community Engagement Key Function, Clinical and Translational Science Institute of Southeast Wisconsin, Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.

Ms. Gabriel is data integration and interoperability manager, Biomedical Informatics, Clinical and Translational Science Center, University of California, Davis School of Medicine, Sacramento, California.

Dr. Hurd is associate professor of surgery, Division of Surgical Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.

Dr. Ziegahn is community engagement and research program manager, Clinical and Translational Science Center, University of California Davis School of Medicine, Sacramento, California.

Dr. Bates is senior evaluation specialist, Evaluation and Tracking Program, Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, Illinois.

Ms. Calhoun is clinical research associate and cofacilitator, Community Engagement Program, Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan.

Dr. Carter-Edwards is deputy director for research and operations, Center for Health Promotion and Disease Prevention, and research associate professor of health behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina.

Dr. Corbie-Smith is professor of social medicine and medicine, and director, Community Engagement Core, North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Dr. Eder is director of research and evaluation programs, Access Community Health Network (a network of Federally Qualified Health Centers), Chicago, Illinois.

Dr. Ferrans is professor and associate dean for research; codirector, Center of Excellence in Eliminating Health Disparities; and director, Community Engagement and Research Core, University of Illinois at Chicago Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, Illinois.

Dr. Hacker is associate professor of medicine; senior medical director, Public and Community Health, Cambridge Health Alliance; executive director, Institute for Community Health; and director, Safety Net Initiative, Community Innovation and Research Program (CHIRP) for Harvard Catalyst, Harvard Medical School, Boston, Massachusetts.

Dr. Rumala was, at the time of the health indicators taxonomy project, Community Engagement Specialist, Center for Clinical and Translational Science, and codirector, Successful and Productive Academic Research Careers (SPARC) Diversity Program, Rockefeller University, Rockefeller University, New York, New York; she is currently assistant professor of medicine, Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut.

Dr. Strelnick is professor of family and social medicine; assistant dean for community engagement; chief, Division of Community Health, Department of Family and Social Medicine; director, Institute of Community and Collaborative Health; and director, Hispanic Center of Excellence, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.

Dr. Wallerstein is professor, Public Health Program, Department of Family and Community Medicine; director, Center for Participatory Research, Office of Community Health; and senior fellow, Robert Wood Johnson Foundation Center for Health Policy, University of New Mexico, Albuquerque, New Mexico.

Funding/Support: This project has been funded in whole or in part with federal funds from the National Center for Research Resources (NCRR), the National Center for Advancing Translational Sciences, and the National Institutes of Health through the Clinical and Translational Science Award Program. Support was also provided by the Clinical and Translational Science Center, University of California, Davis (#UL1 TR000002); the Latino Aging Research and Resource Center, University of California, Davis (#1 P30AG043097-01); the Clinical and Translational Science Institute of Southeast Wisconsin (#8UL1TR000055); and the Advancing a Healthier Wisconsin Research and Education Initiative Fund, a component of the Advancing a Healthier Wisconsin endowment at the Medical College of Wisconsin (#5520190). Support also came from the Center for Clinical and Translational Science, University of Illinois at Chicago (UL1TR000050); the Michigan Institute for Clinical and Health Research (#RC4RR031358, #UL1RR024986, and #UL1TR000433); a cooperative agreement from the Centers for Disease Control and Prevention (U48-DP001944); the North Carolina Translational and Clinical Sciences Institute (#UL1TR000083 and #K24 HL 105493); the Institute for Translational Medicine, University of Chicago (#UL1RR024999); the Center for Clinical and Translational Science, University of Illinois at Chicago (UL1TR000050); the Center for Excellence in Eliminating Health Disparities, University of Illinois at Chicago (P60 MD003424); and the Harvard Catalyst | The Harvard Clinical and Translational Science Center (# 8UL1TR000170-05). Financial contributions also came from Harvard University and its affiliated academic health care centers; the Institute for Integration of Medicine and Science, University of Texas Health Science Center at San Antonio (#UL1RR025767); the Rockefeller University Center for Clinical and Translational Science (#UL1 TR000043); the Einstein-Montefiore Institute for Clinical and Translational Research (ICTR) (3UL1RR025750-05); the Clinical and Translational Science Center (#UL1RR031977); and the New Mexico Center for Advancement of Research, Engagement, and Science on Health Disparities, NIMHD (#P20MD004811), University of New Mexico.

Other disclosures: The manuscript was approved by the Clinical and Translational Science Award consortium publications committee prior to submission.

Ethical approval: Reported as not applicable.

Disclaimers: The views in this article are those of the authors—and not of their institutions or funding agencies.

Correspondence should be addressed to Dr. Aguilar-Gaxiola, UC Davis Center for Reducing Health Disparities, Clinical Translational Science Center and Latino Aging Research and Resource Center, 2921 Stockton Blvd., Suite 1400, Sacramento, CA 95817; telephone: (916) 703-9211; e-mail: sergio.aguilargaxiola@ucdmc.ucdavis.edu.

© 2014 by the Association of American Medical Colleges