“Notes from the Field” is a special newsroom feature highlighting industry professionals working to transform healthcare. In this edition, we spoke with Teresita Oaks, MPH, Director of Community Health Programs at Parkland Health in Dallas, Texas.
1. Tell us about your role.
I am fortunate to hold the position of Director of Community Health Programs at Parkland Health. My role involves integrating clinical and public health data. I use that information to lead the execution of our community health needs assessment reports that we must conduct every three years.
These reports guide our strategic planning and serve as a beacon for numerous organizations in Dallas County. We closely monitor 44 metrics to track progress toward our goals and adjust our strategies when necessary.
In addition, I’m responsible for providing strategic direction for 11 programs developed in response to the assessment findings. As part of my role, I actively foster collaboration among community partners to enhance public health initiatives within Dallas County. This collaborative effort is guided by the collective impact model, aiming to strengthen the overall public health system.
2. What is one thing you've learned from these community health needs assessments that is particularly notable?
It is widely acknowledged that there are disparities in healthcare delivery. What has been particularly striking is the depth and persistence of these disparities and their geographical distribution. For instance, if we take I-30 as a reference point, running from east to west, we have found that living south of this highway is associated with a higher likelihood of residing in a zip code with elevated chronic disease and social need indices. There is a 22-year life expectancy gap in these communities when comparing life expectancy north of I-30 and south of I-30.
Moreover, when considering race and ethnicity, this life expectancy gap can widen to 30 years, with African American men experiencing the most significant disparity in life expectancy. Our agency's report includes a map illustrating the distance between these two regions, which is just five miles, highlighting the stark contrast in health outcomes by location. The data effectively conveys the story of persistent health disparities.
3. What inspired you to pursue a career in healthcare?
I pursued a career in healthcare because I found the human body fascinating and wanted to understand how it responds to various stimuli, such as injuries or illnesses. However, what truly ignited my passion was the experience of working in a refugee camp run by the International Red Cross in Central America. Witnessing the impact of public policy on healthcare while interacting with individuals from war-torn countries who had never received proper medical care was truly eye-opening for me.
Subsequently, I worked with migrant farmworker communities in harsh conditions in Arizona. It became clear that immersing ourselves in these communities is essential for truly grasping their needs, implementing appropriate interventions, and informing public health policy.
4. What do you consider is the most significant opportunity to improve healthcare?
The biggest opportunity in healthcare lies in utilizing technology to identify high-risk communities down to a census block level, using system data, clinical public health data, and social determinants of health data. By integrating these sources of information, we can understand that different census blocks exhibit individual-like behavior, with varying demographic compositions affecting health outcomes. This understanding allows for developing tailored strategies and programs to address specific community needs.
We have discovered a correlation between census block data and the impact on pediatric asthma when mothers are experiencing depression, for instance. By addressing the mother's depression, we can improve the child's health outcomes.
Housing issues may also play a role or perhaps another factor. Additionally, we have observed a connection to secondhand smoke. This highlights the importance of addressing broader health issues within communities that lead to poor outcomes.
5. What is the greatest challenge facing healthcare?
One of the biggest challenges in healthcare is the significant financial strain that patients face caused by healthcare expenses. Approximately 100 million adults in the country are burdened with healthcare-related debt, with a quarter owing more than $5,000. This burden poses a severe threat as it could push individuals into bankruptcy, leading to the potential loss of assets such as their homes and cars. Furthermore, it diminishes their ability to access further healthcare due to their financial history.
This factor exacerbates existing social determinants of health and places extra burdens on safety net hospitals like Parkland, which may lack the resources to accommodate a larger influx of patients. The disparities in access to healthcare based on income, insurance coverage, and geographic location are already prevalent, and this additional financial burden at the patient level, along with rising healthcare costs, only serves to compound these issues further.
6. How do you envision technology playing a role in addressing this challenge in healthcare?
Healthcare technology is already playing a critical role and will continue to evolve as a permanent fixture in the industry. It's important to use this technology wisely to improve access to care in underserved communities, particularly those with significant disparities like Dallas County in the southeast.
By partnering with local organizations with internet access, we've established healthcare hubs to provide screenings and assess eligibility for coverage. These screenings cover a range of health issues, from hypertension and diabetes to HIV and sexually transmitted infections (STIs).
Leveraging internet access, we've developed a community screening tool for real-time information recording and follow-up appointments. Community members now have access to virtual care booths for private appointments with providers. Additionally, mobile units are being used to reach these communities and track their information in real-time, making it easier for them to access necessary care. Our goal is to continue using digital technology to bridge the gap and bring essential care to underserved communities.
7. How are you leveraging new technologies, such as augmented intelligence, to enhance productivity/efficiency, quality, and outcomes?
We are utilizing AI to pinpoint risk factors in our data stratification process. We are integrating this technology to identify high-risk patients and then employing notifications and data technology to monitor these individuals and ensure they receive necessary interventions. Importantly, this two-way communication program allows users to provide feedback via secure text messaging.
For example, the results of this program enable us to identify children with asthma who may be at risk of requiring emergency care. We relay this information to clinicians and follow up accordingly, assessing whether changes in medication are needed. The ultimate goal is to reduce emergency department (ED) visits, which has proven successful so far.
We are currently in the process of applying a similar approach with modifications for individuals with hypertension. Early evidence shows that using this technology, combined with actively engaged patients, will lead to improved control of hypertension.
