Identifying New York City Neighborhoods with High Rates of Co-Occurrence of Infectious Disease to Advance Integrated Testing at Federally Qualified Health Centers (FQHCs)

BACKGROUND:  As part of the CDC-funded Program Collaboration and Service integration initiative at the New York City Department of Health and Mental Hygiene (DOHMH), we sought to use infectious disease data to better target the delivery of integrated services to the public. We analyzed surveillance data to identify neighborhoods with high rates of HIV, chlamydia, gonorrhea, syphilis, hepatitis B, hepatitis C and tuberculosis, and to partner with FQHCs in high-morbidity neighborhoods to improve screening rates of these key diseases, including screening for co-morbidity.  

METHODS:  We calculated diagnosis rates per 100,000 persons by zip code using data reported to DOHMH for 2010.  Zip codes were scored by the number of diseases for which they were in the top quintile (20%) of all NYC zip codes, with 7 being the highest possible score. Using ArcGIS, we created maps based on the zip code scores, and mapped NYC FQHCs to identify those located the highest scoring zip codes. Working with 11 FQHC sites, we collected baseline data from each clinic’s electronic health records (EHR), and implemented a quality improvement project to increase testing through EHR modification.

RESULTS:  Of 181 zip codes, 60 (33%) have more than one disease in the top quintile, and, of these, 15 (25%) have high morbidity for HIV, hepatitis C, and chlamydia. FQHCs selected were located in the South Bronx, Harlem, and North-Central Brooklyn, neighborhoods where morbidity was highest. Baseline data from partner FQHCs showed that 16% of those with a positive chlamydia test, 83% of those with a positive syphilis test, 79% of those with a positive gonorrhea test, and 38% of those with another STD were tested for HIV, while 34% of those with a positive HIV test were tested for hepatitis C.

CONCLUSIONS:  Mapping infectious disease data allowed us to identify specific neighborhoods in NYC that have high rates of infectious disease and might benefit from increased testing for HIV, hepatitis C, and chlamydia. FQHCs are important partners for health departments, because of their utilization of electronic health records for patient tracking and location in neighborhoods where infectious disease services are needed.