Dallas County Community Health Dashboards Parkland Health & Hospital System

Available Dashboards

Community Health Dashboard Disparities Dashboard Social Health Dashboard Service Area Dashboards

Mortality

Years of Potential Life Lost

Model for Determining Community Health Dashboard

Mammogram

Health Outcomes

Infant Mortality Low Birth Weight Births Morbidity Mental Health Status Cancer Screening

Pap Test Colon Cancer Screening Flu Shots for Adults 65+

Vaccinations

Child ages 19-35 months Mortality

Health Risk Behaviors

Violence and Injury Prevention High Risk Sexual Behavior Tobacco Use Alcohol Use

Ed Visits fro Injury HIV/STD Rates Teen Birth Rate

Health Factors
Access to Clinical Care

Diet and Exercise Percent Uninsured Percent with Personal Physician Physician-to-Population Ratio Non-Emergent Emergency Department Use

Quality of Clinical Care

Prevention Quality Indicators 3

Access: Percent Without Health Insurance age 0-64, 2006 to 2009 Other Peer Counties include:
Maricopa, Los Angeles, MiamiDade, Cook Other Peer Counties Range, 2009
Percent
40.0%

Healthy People 2020 goal is to decrease the portion of persons without health insurance to 0% (target based on total coverage )

Dallas County Trend, Percent Uninsured, Ages 0-64, 2005, 2006, 2008 and 2009
Percent
2009 2008 32.9% 33.2% 30.8% 29.1% 10.0% 20.0% 30.0% 40.0%

35.0%

30.0%

2006

25.0%

18.8% - 33.8%

2005 0.0%

20.0%

Dallas Co.
15.0%

Percent with no health insurance trend, City of Dallas, all ages

Percent
2009 36.1% 34.0% 42.5% 39.9% 31.0% 28.7% 20.0% 40.0% 60.0%

10.0%

23.0%

24.6%

26.3%

33.4%

17.2%

29.1%

25.0%

17.9%

25.9%

5.0%

27.6%

2008 2007 2006

0.0%
2009 % Uninsured under 65
U.S. Bexar County Harris County

2006 % Uninsured under 65

Tarrant County Dallas County Texas

2005 2004 0.0%

2008 and 2009 data is from: US Census American Community Survey, 2008 and 2009 2005 and 2006 data is from: US Census Small Area Health Insurance Estimates 2005-6, accessed from the following web site http://www.census.gov/did/www/sahie/data/2006/tables.html Healthy People 2020 Objective AHS 1.1 http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=1 City of Dallas, EBRI, Special run by Ken McDonnell, EBRI and ASEC Program Director, 2004-2009 202-775-6367, 2009 data is from : US Census American Community Survey, 2009

City of Dallas 4

Access to care
Doing better than the benchmark
Same as/not significantly different from the benchmark Worse than the benchmark

Dallas County Compared to Healthy People 2020 Goal

Dallas County Compared to 8 Peer Counties (Quartiles)

Dallas County Compared to Past Years Data (CI)

Percent Uninsured Percent with Personal Physician Physician-toPopulation Ratio Non-emergent Emergency Department Use

Access to Clinical Care

N/A

N/A

N/A

Access: Percent Without Health Insurance Ages 18+, 2009-10

Percent
70.0 64.6 60.0 53.9 50.0 37.2 33.0 30.0 27.0 21.8 20.7 20.0 11.5 10.0 5.6 12.1 12.9 8.5 28.7 25.2 25.2 24.0 24.3 20.4 24.1 47.3

Disparity Ratios for 2009-2010 Combined Dallas County Percent Without Health Insurance Disparity Ratio
55.7

Healthy People 2020 Goal 0.0

Letter Grade*

White African American Hispanic Other

Reference 2.35 4.69 Not Enough Data Reference D F

40.0

Male

Female
0.0 White White Some college Less than HS African American African American Less than HS Female Other HS diploma Female some college college grad Dallas County HS diploma Hispanic Hispanic College grad Texas

1.32

< High School High School Grad Some College College Grad

Male

Male

11.54

6.64

Dallas County, 2009-2010 Combined

State of Texas, 2009-2010 Combined

3.70

Source: Rates from Texas Department of State Health Services, Behavioral Risk Factor Surveillance Program.

Dallas County Compared to Healthy People 2020 Goal

Dallas County Compared to 8 Peer Counties (Quartiles)

Dallas County Compared to Past Years Data (CI)

Better than the benchmark Same as/not significantly different from the benchmark Worse than the benchmark

Reference 6 6

*Letter grade based on New Mexico Department of Health Guidelines, see slide 4 for legend.

Legend for Disparity Ratios and Letter Grades

Letter Grade A B C D F Reference Group Not Enough Data Disparity Ratio 1.0-1.4 1.5-1.9 2.0-2.4 2.5-2.9 3.0 Little or no disparity. A disparity exists and should be monitored, and may require intervention. The disparity requires intervention. Major interventions are needed. Urgent interventions are needed. The group with the best rates (and 20 or more cases). It is the group to which all other groups are compared and therefore will not receive a rating. Groups with less than 20 cases or events during time period. Disparity ratios and ratings are not calculated for populations with less than 20 cases pr events during the comparison time period. Interpretation

The Disparities Ratio is the score for the disparate group over the reference group. The reference group is the group with the best rates. For example, if Hispanics have the best rate for a measure, with 150 cases per 1000 (making them the reference group), and Whites have a rate of 300 per 1000, 300/150=2.0, so the disparity ratio for Whites would be 2.0, meaning their rate is twice as high as the lowest rate.
Source: New Mexico Department of Health, 2010 Racial and Ethnic Health Disparities Report Card, http://www.health.state.nm.us/dpp/DPPR.htm accessed 9-15-11

7 7

Access to Care

White

African American

Hispanic

Other Race

Male

Female

< HS

HS Grad

Some College

College Grad

Percent Without Health Insurance Coverage

Reference

Not Enough Data

Reference

Reference

Access To Clinical Care

Percent of Adults With a Personal Doctor Non-Emergent Use of Emergency Departments

Reference

Not Enough Data

Reference

Reference

Reference

Reference

N/A

N/A

N/A

N/A

N/A

N/A

Quality of care
Doing better than the benchmark
Same as/not significantly different from the benchmark Worse than the benchmark Diabetes Short
Term Comp Diabetes Long Term Comp Diabetes Lower Extremity Amputations Uncontrolled Diabetes Hypertension Preventable Hospitalizations Cardiovascular PQIs Congestive Heart Failure Angina w/o Procedure Preventable Hospitalizations Chronic Pulmonary PQIs Adult Asthma COPD Urinary Tract Infection Preventable Hospitalizations Acute/Infectious Disease PQIs Bacterial Pneumonia Dehydration Perforated Appendix 9

Dallas County Compared to Four Peer Counties (Quartiles)

Dallas County Compared to Past Years Data

Preventable Hospitalizations Diabetes PQIs

Quality of Clinical Care

Prevention Quality Indicators

Quality of Care
White African American
F F

Hispanic

Other Race
Reference A Reference C B A Not Enough Data A Reference Reference A A A

Male

Female

Diabetes Short Term Comp Diabetes Long Term Comp

B Reference Reference Reference Reference Reference Reference B F A A B A

A C

Reference A

A Reference Reference A A Reference A

Preventable Hospitalizations Diabetes PQIs

Diabetes Lower Extremity Amputations Uncontrolled Diabetes Hypertension

B Reference Reference A Reference Reference Reference Reference Reference Reference Reference

F F D

B A A

Quality of Clinical Care

Prevention Quality Indicators

Preventable Hospitalizations Cardiovascular PQIs

Congestive Heart Failure Angina w/o Procedure

A Reference A A Reference Reference Reference

Preventable Hospitalizations Chronic Pulmonary PQIs

Adult Asthma COPD Urinary Tract Infection

D F A A C A

D A B A A A 10

Preventable Hospitalizations Acute/Infectious Disease PQIs

Bacterial Pneumonia Dehydration Perforated Appendix

Quality of Care
White African American Hispanic Other Race

Pediatric Asthma Pediatric Diabetes Short Term Comp

Reference

Reference

Not Enough Data

Quality of Clinical Care

Prevention Quality Indicators

Preventable Hospitalizations Pediatric PQIs

Pediatric Gastroenteritis Pediatric Perforated Appendix Percentage Pediatric Urinary Tract Infection

Reference

Not Enough Data

Reference

Reference

Not Enough Data

11

Health Risk Behaviors Cancer Screening

Doing better than the benchmark
Same as/not significantly different from the benchmark Worse than the benchmark

Dallas County Compared to Healthy People 2020 Goal

Dallas County Compared to 8 Peer Counties (Quartiles)

Dallas County Compared to Past Years Data (CI)

Mammogram

Cancer Screening

Pap Test Colon Cancer Screening

12

Health Risk Behaviors Cancer Screening

White

African American

Hispanic

Other

Male

Female

< HS

HS Grad

Some College

College Grad

Mammogram

Reference

Not Enough Data

Not Enough Data

N/A

N/A

Not Enough Data

Reference

Cancer Screening

Pap Test

Reference

Not Enough Data

N/A

N/A

Reference

Colon Cancer Screening

Reference

Not Enough Data

Not Enough Data

Reference

Reference

13

 Doing better than the benchmark

Same as/not significantly different from the benchmark Worse than the benchmark

Health Risk Behaviors Vaccinations

Dallas County Compared to Healthy People 2020 Goal Dallas County Compared to 8 Peer Counties (Quartiles) Dallas County Compared to Past Years Data (CI)

Adult Vaccinations Child age 1935 months

14

 Doing better than the benchmark

Health Risk Behaviors Violence and Injury Prevention

Dallas County Compared to Healthy People 2020 Goal Dallas County Compared to 8 Peer Counties Dallas County Compared to Past Years Data (CI)

Same as/not significantly different from the benchmark Worse than the benchmark

All Unintentional Injuries Death Rate Motor Vehicle Crash Death Rate Falls Death Rate Violence Mortality and ED Visits for Injury Falls Death Rate Age 65+ Unintentional Poisoning Death Rate Suicide Death Rate Homicide Death Rate ED Visits for Injuries

N/A

N/A
15

Health Risk Behaviors Violence and Injury Prevention

White African American Reference Hispanic Other Not Enough Data Not Enough Data Not Enough Data Not Enough Data Not Enough Data Not Enough Data Not Enough Data A
16

All Unintentional Injuries Death Rate Motor Vehicle Crash Death Rate

Reference Not Enough Data Not Enough Data Not Enough Data A

A Not Enough Data Not Enough Data Not Enough Data Reference

Falls Death Rate

Reference

Violence and Injury Prevention

Mortality and Injury

Falls Death Rate Age 65+

Reference

Unintentional Poisoning Death Rate

Reference

Suicide Death Rate Homicide Death Rate ED Visits for Injuries

Reference

Reference

 Doing better than the benchmark

Health Risk Behaviors High Risk Sexual Behaviors

Dallas County Compared to Healthy People 2020 Goal Dallas County Compared to 8 Peer Counties (Quartiles) Dallas County Compared to Past Years Data (CI)

Same as/not significantly different from the benchmark Worse than the benchmark

HIV Incidence Chlamydia Incidence

N/A N/A N/A N/A N/A

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High Risk Sexual Behavior

HIV/STD Rates

Gonorrhea Incidence Primary/ Secondary Syphilis

Teen Birth Rates

Health Risk Behaviors HighRisk Sexual Behavior

White African American Hispanic Other

New HIV Cases

Reference

Chlamydia Incidence Rates

Reference

HIV/STD Rates

Gonorrhea Incidence Rates

Reference

High Risk Sexual Behavior

Primary and Secondary Syphilis Incidence Rates

Reference

Teen Birth Rates

Reference

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 Doing better than the benchmark

Health Risk Behaviors Other High Risk Behaviors

Dallas County Compared to Healthy People 2020 Goal Dallas County Compared to 8 Peer Counties (Quartiles) Dallas County Compared to Past Years Data (CI)

Same as/not significantly different from the benchmark Worse than the benchmark

Tobacco Use Alcohol Use

Current Smokers Binge Drinking Overweight and Obese

Health Risks
Diet and Exercise

Recommended Physical Activity Frequency of Five Fruits/ Vegetables per Day

N/A

19

Health Risk Behaviors High Other Risk Behaviors

White African American Hispanic Other Male Female < HS HS Grad Some College College Grad

Physical Activity

Reference

Reference Reference

Reference

Health Risk Behaviors

Five Fruits/ Vegetables a Day Current Smoker

Reference Reference

A Not Enough Data

Reference

Reference

Reference

 Doing better than the benchmark

Same as/not significantly different from the benchmark Worse than the benchmark

Health Outcomes Mortality

Dallas County Compared to Healthy People 2020 Goal Dallas County Compared to 8 Peer Counties (Quartiles) Dallas County Compared to Past Years Data (CI)

Heart Disease Death Rate Cancer Death Rate

Health Outcomes

Mortality

Stroke Death Rate COPD Death Rate Diabetes Death Rate

N/A

21

Outcomes Age-Adjusted Mortality Rates

White African American C Hispanic Other Male Female

Heart Disease Cancer Stroke and Cerebrovascular Disease

Reference A

A Reference

Reference Reference

Reference

Reference

Outcomes

Mortality

Chronic Obstructive Pulmonary Disease Diabetes

Reference

Not Enough Data Not Enough Data Not Enough Data Reference

Reference Reference

Reference

Infant Mortality Rate Years of Potential Life Lost Rate

Reference

N/A

N/A

Reference

22

 Doing better than the benchmark

Health Outcomes Other Outcomes

Dallas County Compared to Healthy People 2020 Goal Dallas County Compared to 8 Peer Counties (Quartiles) Dallas County Compared to Past Years Data (CI)

Same as/not significantly different from the benchmark Worse than the benchmark

Years of Potential Life Lost Infant Mortality Very Low Birth Weight Births
Campylobacteriosis

N/A

N/A N/A N/A N/A N/A

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Health Outcomes

Notifiable Communicable Diseases

Aseptic Meningitis Pertussis Salmonellosis

General Health Status

Mental Health Status

Outcomes Health Status and Disease Incidence Rates

White African American Hispanic Other Male Female < HS HS Grad Some College College Grad

Very Low Birth Weight Births Aseptic Meningitis Incidence Rate Campylobacteriosis Incidence Rate Pertussis Incidence Rate Salmonellosis Incidence Rate Mental Health General Health

Reference Not Enough Data

N/A

N/A

N/A

N/A

N/A

N/A

Reference

N/A

N/A

N/A

N/A

N/A

N/A

Disease Incidence

Not Enough Data Not Enough Data

Reference

Not Enough Data Not Enough Data Not Enough Data Not Enough Data Not Enough Data

N/A

N/A

N/A

N/A

N/A

N/A

Reference

N/A

N/A

N/A

N/A

N/A

N/A

Outcomes

Reference

N/A

N/A

N/A

N/A

N/A

N/A

Health Status

Reference Reference

Reference Reference

Reference

Reference
24

Model for Determining Social/Community Dashboard

Health Behaviors
Literacy

Diet and Exercise

Adult Fruit and Vegetable Consumption Adult Overweight and Obesity Rate Sufficient Physical Activity Current Smokers Binge Drinkers

Education Employment

Health Literacy High School Diploma Unemployment Rate Weekly Wages Children in Poverty Income Inequality

Income

Per Capita Income Median Household Income

Health Factors

Social and Economic Factors

Households and Social Support Housing Affordability & Supply Community Safety

Social and Emotional Support Single Parent Households Minimum Wage Work Hours to Afford a 2-Bedroom Apartment Renters Spending 30% or More of Household Income on Rent Pedestrian Death Rate All Injury Fatalities Motor Vehicle Accident Fatalities Suicide Rate Homicide Rate People 65+ Living Below Poverty Level

Poverty

People Living Below 200% of Poverty Level People Living Below Poverty Level Food Desert Grocery Store Density

Physical Environment

Built Environment

Convenience Store Density SNAP Participants

25

Percent of the children under the age of 6 living below the poverty level 2005-2009

Percent of Children Under the Age of 6 Living Below the Poverty Level, 2005-2009 data

Source: American Community Survey, 2005-2009 data download 26

Social and Economic Factors

Doing better than the benchmark
Same as/not significantly different from the benchmark Worse than the benchmark

Dallas County Compared to 8 Peer Counties (Quartiles)

Dallas County Compared to Past Years Data (CI)

Literacy Rates

Education
High School Diploma

27

Social and Economic Factors

Doing better than the benchmark
Same as/not significantly different from the benchmark Worse than the benchmark

Dallas County Compared to 8 Peer Counties (Quartiles)

Dallas County Compared to Past Years Data (CI)

Unemployment Rate

Employment
Weekly Wages

28

Social and Economic Factors

Doing better than the benchmark
Same as/not significantly different from the benchmark Worse than the benchmark

Dallas County Compared to 8 Peer Counties (Quartiles)

Dallas County Compared to Past Years Data (CI)

Children in Poverty Income Inequality

Income

Per Capita Income Median Household Income

29

Social and Economic Factors

Doing better than the benchmark
Same as/not significantly different from the benchmark Worse than the benchmark

Dallas County Compared to 4 Peer Counties (Quartiles)

Dallas County Compared to Past Years Data (CI)

Households and Social Support

Social and Emotional Support Single Parent Households

30

Social and Economic Factors

Doing better than the benchmark
Same as/not significantly different from the benchmark Worse than the benchmark

Dallas County Compared to 8 Peer Counties (Quartiles)

Dallas County Compared to Past Years Data (CI)

Housing Affordability and Supply

Minimum Wage Hours Worked to Afford the Median Rent for a TwoBedroom Dwelling Percentage of Renters That Pay More Than 30% of Income in Rent

31

Social and Economic Factors

Doing better than the benchmark
Same as/not significantly different from the benchmark Worse than the benchmark

Dallas County Compared to 8 Peer Counties (Quartiles)

Dallas County Compared to Past Years Data (CI)

People Over 65 Living Below the Poverty Level

Poverty

People Living Below 200% of the Federal Poverty Level People Living Below the Poverty Level

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USDA Food Deserts

The Healthy Food Financing Initiative (HFFI) Working Group defines a food desert as a low-income census tract where a substantial number or share of residents has low access to a supermarket or large grocery store. To qualify as low-income, census tracts must meet the Treasury Department's New Markets Tax Credit (NMTC) program eligibility criteria. Furthermore, to qualify as a food desert tract, at least 33 percent of the tract's population or a minimum of 500 people in the tract must have low access to a supermarket or large grocery store. The NMTC program defines a low-income census tract as: any census tract where (1) the poverty rate for that tract is at least 20 percent, or (2) for tracts located within a metropolitan area, the median family income for the tract does not exceed 80 percent of the greater of statewide median family income or the metropolitan area median family income. Low access to a healthy food retail outlet is defined as more than 1 mile from a supermarket or large grocery store in urban areas. The distance to supermarkets and large grocery stores is measured by the distance between the geographic center of the 1-km square grid that contains information on the population (number of people and other characteristics) and the nearest supermarket or large grocery store. Once the distance to the nearest supermarket or large grocery store is calculated for each grid cell, the number of people or housing units more than one mile from a supermarket or large grocery store in urban tracts is aggregated to the census tract level. If the aggregate number of people in the census tract with low access is at least 500 or the percentage of people in the census tract with low access is at least 33 percent, then the census tract is considered a food desert.

Source: http://www.ers.usda.gov/data/fooddesert/

33

Community Health Assessment

South Dallas Service Area

34

Access to Healthcare: Percent Without Healthcare Insurance

South Dallas Service Area
Percent Uninsured
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Wilmer/Hutch/Seag Wilmer/Hutch/Seag NE Dallas South Dallas NE Dallas South Dallas Irving Cedar Hill Cedar Hill Irving SW Dallas NW Dallas North Dallas North Dallas NW Dallas SW Dallas SE Dallas SE Dallas Stemmons Corr Dallas County 09 Stemmons Corr Dallas County Outer NE Grand Prairie Grand Prairie DeSoto Lanc DeSoto Lanc Outer NE Texas 09 Texas
24% 26% 21% 21% 19% 11% 47% 44% 36% 32%

Healthy People 2020 Goal 0% uninsured

Percent Without Health Insurance, South Dallas Service Area

2010 2009 2008
31% 28%

47.4% 47.3% 42.7% 41.1% 44.0% 43.9% 43.1% 20.0% 40.0% 60.0%

30% 24% 19% 18% 18% 17% 15% 8% 9% 9%

25% 21%

31% 27%

2007 2006 2005 2004 0.0%

12% 11%

20% 17%

2010

2006

Source: 2006 Solucient, Inc.; 2010 Market Planner Plus; Denominator population data from Claritas, Inc.; except 2010 from Nielson/Claritas, Inc. Pop-Facts mid 2010 version; Dallas County and Texas rates from US Census Bureaus American Community Survey 2009

35
35

Deviations from the Dallas County mean

South Dallas Wilmer Hutchins Seagoville Southwest Dallas Southeast Dallas Stemmons Corridor DeSoto Lancaster Cedar Hill Northwest Dallas Irving Northeast Dallas Grand Prairie North Dallas Outer Northeast More Unfavorable NOTE: All data are from the years 2007-2010, years available varies by topic. Mortality Very Low Birth Weight High Risk Sexual Behavior Socioeconomic More Favorable
Each vertical line represents 100% difference from the Dallas County average.

Percent Difference from the Dallas County Average

Years of Potential Life Lost Morbidity Access to Clinical Care Infant Mortality Violence and Injury Preventable Hospitalizations
36

Demographics:
The demographic composition of Dallas taken in the context of the state and the nation, profoundly influences the service size, scope and priorities for Parkland Health & Hospital System. This section examines the significant demographic drivers outlined below:
Market Demographic Characteristics Population size and growth trends Population age distribution and trends Population ethnic composition and trends Per capita income and trends Poverty and unemployment trends Population educational attainment and trends

37

General Dallas County Demographic Trends

The Texas population has grown at a rate substantially outpacing that of the United States. Also growing at a very fast pace, Dallas County has expanded by over 20%, or more than 500,000 thousand people, from 1990 to 2010. The Dallas-Fort Worth area is one of the largest in the nation. Dallas-Fort Worth, the fourth largest metro area in the country, grew by 23.4% in the past decade. Dallas County is the 9th largest county in the country, growing by over 20% from 2000 to 2010. The city of Dallas is the 9th largest city in the country, but only grew by a modest 0.8% in the 2000s.
2010 Population by Age and Sex 0-4 5-14 15-17 18-24 25-44 45-64 65 years and up Total Female 97,726 182,640 53,191 120,636 378,296 289,348 124,699 1,246,536 %* 7.8% 14.7% 4.3% 9.7% 30.3% 23.2% 10.0% 100.0% Male 102,409 190,073 55,977 125,897 379,219 275,602 89,791 1,218,968 %** 8.4% 15.6% 4.6% 10.3% 31.1% 22.6% 7.4% 100.0% Ethnicity 2010 White African American Asian American Indians Two or More Other Hispanic Total % change 2000-2010 10.0% 9.4% 1.4% 34.7% 19.9% 11.1% Population 831,272 538,767 124,555 7,705 31,068 4,441 927,696 2,465,504 % of the Total Population 33.7% 21.9% 5.1% 0.3% 1.3% 0.2% 37.6% 100.0%

*: % of female population in Dallas County **: % of male population in Dallas County

Population Trend by Age 0-4 5-14 15-44 45-64 65 and up Total

1990 156,059 266,095 968,906 309,236 152,514 1,852,810

2000 181,951 340,788 1,098,009 419,279 178,872 2,218,899

2010 200,135 372,713 1,113,216 564,950 214,490 2,465,504

Household Income 2010 less than $25,000 $25,000 to $74,999 $75,000 to $99,999 $100,000 and over Totals

County 25.5% 45.4% 10.9% 18.3% 100.0% 38

Sources: U.S. Census, PO11 Age Data Set, 1990 Summary Tape File 1 (STF 1) 100 Percent data; U.S. Department of Commerce, Economics and Statistics Administration. W.s. CENSUS BUREAU Population Distribution and Change; 2000 to2010. Income 2010 American Community Survey 1-year est

Community Health Needs Assessment

Dallas County Health & Human Services and Parkland Community Health Institute Community Coalition
Other hospitals Other social service providers Federally Qualified Health Centers Community Coalitions and Organizations such as the Health Industry Council and the Dallas Fort Worth Hospital Council

Baseline Data for the work being done from DCHHS

39

Assumptions
Green Doing better than the benchmark Yellow Same as/not significantly different from the benchmark Red Worse than the benchmark Healthy People 2010 benchmark higher, lower or same Peer County Comparison benchmark if Dallas County is in first or second quartile, green; third quartile, yellow; fourth quartile, red (method used for county rankings by Health Matters). Dallas County Trend benchmark if only 1-3 years of previous Dallas County data are available, calculate percent difference from earliest years data to most recent, assign red/yellow/green for worse/same/better; if 4 or more years of previous Dallas County data are available, calculate 95% Confidence Interval (see next page for notes about this procedure) and assign green for statistically significantly better, red for statistically significantly worse, or yellow for no significant difference.

40

Assumptions
Confidence Intervals For common events (such as ED visits for Injuries, non-emergent ED visits, percent of population under 200% FPL) 95% Confidence Intervals were calculated on previous years data using a binomial approach. For uncommon events (rates less than 5%), which includes many of these measures, 95% Confidence Intervals were calculated on previous years data using a Poisson formula. This approach does not use population size. For survey data, such as BRFSS data, where possible the 95% Confidence Interval of the most recent years survey was compared with the 95% Confidence Interval of the previous years survey, to determine whether there was significant change. Because BRFSS surveys include a fairly small percentage of the Dallas County population, these 95% CIs are fairly wide, and few show statistically significant improvement from one year to the next for Dallas County data.

41