German Jashalynn C, Stirling Andrew, Gorgone Patti, Brucker Amanda R, Huang Angel, Dash Shwetha, Halpern David J, Bhavsar Nrupen A, McPeek Hinz Eugenia R, Shannon Richard P, Spratt Susan E, Goldstein Benjamin A
Department of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Duke University School of Medicine, Durham, NC, USA.
Duke Health Technology Solutions, Duke University Health System, Durham, NC, USA.
J Clin Transl Sci. 2024 May 17;8(1):e102. doi: 10.1017/cts.2024.542. eCollection 2024.
Type 2 diabetes (T2DM) poses a significant public health challenge, with pronounced disparities in control and outcomes. Social determinants of health (SDoH) significantly contribute to these disparities, affecting healthcare access, neighborhood environments, and social context. We discuss the design, development, and use of an innovative web-based application integrating real-world data (electronic health record and geospatial files), to enhance comprehension of the impact of SDoH on T2 DM health disparities.
We identified a patient cohort with diabetes from the institutional Diabetes Registry ( = 67,699) within the Duke University Health System. Patient-level information (demographics, comorbidities, service utilization, laboratory results, and medications) was extracted to Tableau. Neighborhood-level socioeconomic status was assessed via the Area Deprivation Index (ADI), and geospatial files incorporated additional data related to points of interest (i.e., parks/green space). Interactive Tableau dashboards were developed to understand risk and contextual factors affecting diabetes management at the individual, group, neighborhood, and population levels.
The Tableau-powered digital health tool offers dynamic visualizations, identifying T2DM-related disparities. The dashboard allows for the exploration of contextual factors affecting diabetes management (e.g., food insecurity, built environment) and possesses capabilities to generate targeted patient lists for personalized diabetes care planning.
As part of a broader health equity initiative, this application meets the needs of a diverse range of users. The interactive dashboard, incorporating clinical, sociodemographic, and environmental factors, enhances understanding at various levels and facilitates targeted interventions to address disparities in diabetes care and outcomes. Ultimately, this transformative approach aims to manage SDoH and improve patient care.
2型糖尿病（T2DM）对公共卫生构成重大挑战，在控制和结局方面存在显著差异。健康的社会决定因素（SDoH）对这些差异有重大影响，涉及医疗保健可及性、社区环境和社会背景。我们讨论了一种创新的基于网络的应用程序的设计、开发和使用，该应用程序整合了真实世界数据（电子健康记录和地理空间文件），以增强对SDoH对T2DM健康差异影响的理解。
我们从杜克大学健康系统的机构糖尿病登记处（n = 67,699）中确定了一个糖尿病患者队列。将患者层面的信息（人口统计学、合并症、服务利用情况、实验室检查结果和用药情况）提取到Tableau中。通过地区贫困指数（ADI）评估社区层面的社会经济地位，并将地理空间文件纳入与兴趣点（如公园/绿地）相关的其他数据。开发了交互式Tableau仪表板，以了解影响个体、群体、社区和人群层面糖尿病管理的风险和背景因素。
由Tableau驱动的数字健康工具提供动态可视化，识别与T2DM相关的差异。该仪表板允许探索影响糖尿病管理的背景因素（如粮食不安全、建筑环境），并具备为个性化糖尿病护理计划生成目标患者列表的能力。
作为更广泛的健康公平倡议的一部分，该应用程序满足了不同用户的需求。结合临床、社会人口统计学和环境因素的交互式仪表板增强了各级的理解，并促进了有针对性的干预措施，以解决糖尿病护理和结局方面的差异。最终，这种变革性方法旨在管理SDoH并改善患者护理。
