Sentara Healthcare Uses GIS in the Distribution of $50 Million in Funds for Healthier Communities

Equity in the context of health has never had as much attention as it does today. Health and human services organizations are shifting their focus to addressing social determinants of health. Factors like income, housing, and education are known predictors of health outcomes and can help us understand how service gaps within a community can be addressed.

Sentara Healthcare is an integrated, not-for-profit health-care delivery system with more than 29,000 employees and 12 hospitals in Virginia and northeastern North Carolina. The Sentara Health Plans division serves over 900,000 members.

Equity has always been a significant focus for Sentara. In 2019, the system established the Office of Health Equity to design and develop initiatives and programs to reduce health disparities and further strengthen the bonds within the Virginia and northeastern North Carolina communities. Sentara committed $50 million to its Sentara Healthier Communities Fund in 2021 to address health disparities magnified by the impact of COVID-19 and bolster regional health sciences programs.

Sentara's Office of Health Equity—in collaboration with colleagues across multiple divisions—utilized geographic information system (GIS) technology to identify at-risk communities and find opportunities for greater care, such as mobile clinics, education, and innovative services. 

Location plays a significant role in our lives, as social and environmental factors account for nearly 80 percent of health outcomes. Data shows that a person's ZIP code is a stronger predictor of their health outcomes than their genetic code. This means that where people live is the root of many health disparities. Keeping this in mind, Sentara recognized that such health disparities could not be solved solely in the organization's exam rooms.

Sentara utilizes location data to prioritize and customize care for each individual community's needs. The advanced analytics and actionable information that GIS provided helped Sentara staff members secure a budget for their work. 

Iris Lundy, Sentara's senior director of health equity, was introduced to location-based solutions just before the beginning of the pandemic and recognized the value in using GIS to turn information into easy-to-read data visualizations. In order to identify communities with problems—such as food insecurity and economic instability—that cause health disparities, Sentara turned to ArcGIS Business Analyst, which applies GIS technology to extensive demographic, business, and consumer spending data to deliver on-demand analysis, presentation-ready reports, and maps

Through these geospatial analytics products, Sentara identified areas in its communities that had a high Emergency Department (ED) utilization rate. Based on a review of academic literature and biostatistical support by Dr. Ralitsa Maduro, Sentara's enterprise analytics consultant, a high ED utilizer was defined as any patient who has four or more visits to the ED within a 12-month period. 

Sentara took the high-ED-utilization analytics a step further in ArcGIS Pro, desktop software that allows the user to transform data into actionable information by mapping the ED visits based on the health conditions treated.

Sentara's Geospatial Data Services (GDS) team transformed the maps into an interactive dashboard to highlight the population and various demographic and socioeconomic factors that provide insight into the community. The team then used this information as an opportunity to offer customized care to the populations highlighted in the findings.

"By utilizing the ArcGIS technology, we have been able to provide support for health equity initiatives," said Stephen Grassia, Sentara geospatial developing analyst. "The Generate Tessellation tool allows for polygon creation to ensure the privacy of patient information, but also maintains granularity while aggregating the data. Utilizing the honeycomb selection and input of a .2-square-mile area, we can see how ED utilization varies over space."

Lundy presented the ED utilization data to internal leaders. "A picture is worth 1,000 words, so seeing this data transformed into visualizations was just the message we needed for our executive team," said Lundy. Map visualization with ArcGIS Pro and data integration from multiple sources allowed decision-makers to understand how community-centered strategies could reduce ED utilization for nonemergent care.

"It also helped them make data-driven budget allocation decisions toward increasing access to preventative care in the communities with identified high ED utilization," said Heather Strock, executive director for Sentara's practice management services.

Specific data-driven solutions include the following:

• Collaborating with local food banks to provide fresh fruits and vegetables where there is a high concentration of patients with chronic conditions, such as diabetes
• Implementing nontraditional models of care to increase access in under resourced communities
• Educating, activating, and engaging community members about health, nutrition, exercise, and lifestyle

"GIS allowed us to visualize and show to leadership how social factors impacted our communities," stated Lundy. "We're implementing solutions that were merely a thought a couple of years ago. This tool is a game changer." 

Sentara Healthcare is advancing health equity in its communities through the power of spatial analytics and location-based solutions. The Geospatial Data Services team engages with various departments throughout the organization to advance collaboration by blending data into actionable information.

"The responsibility of the GDS team is to build upon previous initiatives, using spatial granularity and visualization to advance our understanding and make informed decisions," said Loretta Smith, senior business system analyst and GDS project manager at Sentara.

Sentara will continue its efforts to increase access to care and improve residents' health by partnering with food banks, faith-based leaders, pharmacies, and community centers and other nonprofit organizations to make an immediate and long-lasting impact in Sentara's most at-risk communities.