What Gets Measured Gets Done: An Assessment of Local Data Uses and Needs in Large Urban Health Departments

Context: The epidemiologic shift in the leading causes of mortality from infectious disease to chronic disease has created significant challenges for public health surveillance at the local level. Objective: We describe how the largest US city health departments identify and use data to inform their work and we identify the data and information that local public health leaders have specified as being necessary to help better address specific problems in their communities. Design: We used a mixed-methods design that included key informant interviews, as well as a smaller embedded survey to quantify organizational characteristics related to data capacity. Interview data were independently coded and analyzed for major themes around data needs, barriers, and achievements. Participants: Forty-five public health leaders from each of 3 specific positions-local health official, chief of policy, and chief science or medical officer-in 16 large urban health departments. Results: Public health leaders in large urban local health departments reported that timely data and data on chronic disease that are available at smaller geographical units are difficult to obtain without additional resources. Despite departments' successes in creating ad hoc sources of local data to effect policy change, all participants described the need for more timely data that could be geocoded at a neighborhood or census tract level to more effectively target their resources. Electronic health records, claims data, and hospital discharge data were identified as sources of data that could be used to augment the data currently available to local public health leaders. Conclusions: Monitoring the status of community health indicators and using the information to identify priority issues are core functions of all public health departments. Public health professionals must have access to timely "hyperlocal" data to detect trends, allocate resources to areas of greatest priority, and measure the effectiveness of interventions. Although innovations in the largest local health departments in large urban areas have established some methods to obtain local data on chronic disease, leaders recognize that there is an urgent need for more timely and more geographically specific data at the neighborhood or census tract level to efficiently and effectively address the most pressing problems in public health.