 Hotspotting: Mapping our way to healthier neighborhoods Marina Del Rios, MD, MSc Illinois Heart Rescue Community Sphere Leader Assistant Professor Department of Emergency Medicine

Cardiac arrest

How to save a life

Geographic variation

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 State wide quality improvement project  Purpose: to double neurologically intact out of hospital cardiac arrest (OHCA) survival  Vision: Every OHCA victim will receive life-saving, state- of-the-art care at the scene, en route to, and in the hospital.  Data driven activities

Data is your friend  Cardiac Arrest Registry to Enhance Survival (CARES)  Data to improve  Bystander actions  EMS and hospital actions  Allocation of resources

Hospital  Disparity in post cardiac arrest care:  Post Rosc protocols  Therapeutic Hypothermia  IDPH support  CARES report cards

Pre-Hospital  Resuscitation Academy  Dispatch Assisted CPR training  New protocol development: Incident Command for Cardiac Arrest, field termination, and ROSC protocols  Targeted allocation of new ambulances

 Community

Three phase program approach

 Association of neighborhood characteristics with incidence of out-of- hospital cardiac arrest and bystander response in Chicago

Background  Neighborhood disparities in out-of-hospital cardiac arrest (OHCA) incidence and bystander CPR provision make it a major health equity challenge  The most recent study on OHCA in Chicago analyzed data obtained in the 1980s and found:  The lowest rate of bystander-initiated CPR was in predominantly black neighborhoods  This association was independent of socioeconomic status.  It’s time for an update

First step: Needs assessment  To conduct a geospatial analysis of variations in OHCA incidence and bystander CPR provision to guide allocation of resources to neighborhoods in greatest need  As a secondary objective, we aimed to determine whether racial and socioeconomic disparities in bystander CPR persist in Chicago.

Methods  OHCAs were aggregated to census tracts  Incidence rates were calculated based on population density  Each incident was linked to census tract information, including demographic and economic factors.

Results

Conclusion  The incidence of cardiac arrest is disproportionately higher in minority and low-income census tracts in Chicago  Bystander CPR rates are overall low in Chicago  Bystander CPR is especially lower in high incidence neighborhoods and in minority and low-income neighborhoods

Disclaimer  Bystander CPR rates may have been underreported  This database only captures cardiac arrests where EMS was called – are there cases missed by the 911 call system?

Targeted mass CPR training

Target Neighborhoods

School Based Initiatives: Garfield Park 71 high schools students 347 family and friends 4.88 per peer trainer

Faith-based initiatives: Englewood HANDDS

Community engagement  Targets “high risk” neighborhoods to increase bystander CPR  Performance report cards  Community ENGAGEMENT  Pay it forward model / peer coaching  Prevention ?

Implications  "The sources of these disparities are complex, are rooted in historic and contemporary inequities, and involve many participants at several levels...”  “Unequal Treatment” IOM 2003  In order to narrow and eventually eliminate disparities in survival it is important to recognize where in the continuum of treatment of OHCA these disparities exist

Implications  These disparities are of predominant concern and are major issues to be addressed when designing interventions to reduce the burden of OHCA  Coordinated efforts to improve bystander response complemented by approaches to prevent OHCA can lead to health equity in Chicago

Conclusions  Hotspotting paired with targeted community engagement efforts and follow-up can better address community needs and bring us closer to health equity 32