Building local decision-making competencies during COVID-19: Accelerating the transition from learning healthcare systems to learning health communities

Introduction

The persisting and evolving COVID-19 pandemic has made apparent that no singular policy of mitigation at a regional, national or global level has achieved satisfactory and universally acceptable results. In the United States, carefully planned and executed pandemic policies have been neither effective nor popular and COVID-19 risk management decisions have been relegated to individual citizens and communities. In this paper, we argue that a more effective approach is to equip and strengthen community coalitions to become local learning health communities (LLHCs) that use data over time to make adaptive decisions that can optimize the equity and well-being in their communities.

Methods

We used data from the North Carolina (NC) county and zip code levels from May to August 2020 to demonstrate how a LLHC could use statistical process control (SPC) charts and simple statistical analysis to make local decisions about how to respond to COVID-19.

Results

We found many patterns of COVID-19 progression at the local (county and zip code) levels during the same time period within the state that were completely different from the aggregate NC state level data used for policy making.

Conclusions

Systematic approaches to learning from local data to support effective decisions have promise well beyond the current pandemic. These tools can help address other complex public health issues, and advance outcomes and equity. Building this capacity requires investment in data infrastructure and the strengthening of data competencies in community coalitions to better interpret data with limited need for advanced statistical expertise. Additional incentives that build trust, support data transparency, encourage truth-telling and promote meaningful teamwork are also critical. These must be carefully designed, contextually appropriate and multifaceted to motivate citizens to create and sustain an effective learning system that works for their communities.

Physical activity influences in a disadvantaged African American community and the communities' proposed solutions

The purpose of this assessment is to increase our understanding of how safety and environmental factors influence physical activity among African American residents living in a low-income, high-crime neighborhood and to get input from these residents about how to best design physical activity interventions for their neighborhood. Twenty-seven African American adult residents of a low-income, high-crime neighborhood in a suburban southeastern community participated in three focus groups. Participants were asked questions about perceptions of what would help them, their families, and their neighbors be more physically active. Two independent raters coded the responses into themes. Participants suggested three environmental approaches in an effort to increase physical activity: increasing law enforcement, community connectedness and social support, and structured programs. Findings suggest that safety issues are an important factor for residents living in disadvantaged conditions and that the residents know how they want to make their neighborhoods healthier.