Priority MICA Documentation

Background

The purpose of the Priority MICA is to provide a structured process to determine the priority health needs of a community. The Priority MICA allows a user to prioritize from a list of diseases or risk factors available in the application. The diseases/risk factors were selected for inclusion in the application based upon the Department of Health and Senior Services (DHSS) strategic plan, Healthy People 2010 and available data. Funding agencies can use the Priority MICA to determine priority areas for funding in an area or a community can use the Priority MICA as part of a community assessment process.

The Priority MICA provides an objective method for establishing priorities. While an objective methodology provides a rational basis for priority setting one should not assume that a purely objective process is always the preferred approach. There can be situations in which other non- objective criteria are important to the priority setting process. A community should not ignore other criteria of community importance not included in the Priority MICA.

The Priority MICA is meant only as a tool. It should be used along with other information that is available in a community. There may be other diseases/risk factors that are important to a community that are not part of the Priority MICA. The fact that a disease/risk factor is not in the Priority MICA does not mean a community should ignore the disease/factor.

Diseases versus Risk Factors

The Priority MICA allows a user to prioritize diseases or risk factors independently. The system was designed to separate diseases from risk factors because we could not use the same criteria for prioritizing diseases that we used to prioritize risk factors. For example, there are no death data for the risk factors "high cholesterol" or "mother underweight", and there are no incidence or prevalence data for most diseases.

Recommended Process for Using the Priority MICA

If the Priority MICA is used, as part of a community needs assessment process it is recommended that the community planning committee use the, Priority MICA as part of a group process. The committee can decide what, diseases/risk factors will be selected for prioritization. Next, the committee, can decide as a group what criteria will be used for prioritization. If "community support" is selected as one of the criteria, then the planning committee can determine through a group process what level of community support exists for addressing each of the selected diseases/risk factors. Finally, the committee can set the level of importance of each priority criterion. Upon completion of this group process the committee can review the results. The committee may want to change some of the criteria or weigh the criteria differently to determine how those changes would alter the final list of priorities.

Interpreting the List of Priorities (Rank)

The Priority MICA lists each of the diseases/risk factors in priority order based upon the criteria that were selected. For each criterion selected, the diseases/risk factors are ordered in magnitude and given a ranking from 1 to 42 with 42 being the disease with the highest magnitude. For example, for the criterion "number of deaths" the disease that has the highest number of deaths received the highest ranking and the disease that had the lowest number of deaths received the lowest ranking.

The ranking for each criterion is multiplied by the level of importance weight assigned by the user. If level of importance for the criterion is high the ranking for a disease/risk factor is multiplied by two. If level of importance for the criterion is average the ranking for a disease/risk factor is multiplied by one. If level of importance for the criterion is low, the ranking for a disease/risk factor is multiplied by one-half. The ranking times the level of importance weight gives the weighted ranking for each criterion or disease/risk factor.

The weighted rankings for each disease/risk factor are summed across all criteria to obtain a total score for each disease. The total scores for the diseases/risk factors are then ranked. The disease/risk factor having the highest total score is shown as the highest priority disease/risk factor.

The final total score for each disease/risk factor does not have any inherent mathematical value. The scores cannot be tested for statistical significance. The scores only provide a general sense of the rank ordering of diseases/risk factors. One should not over-interpret the ranking. For example, if two diseases have different but close scores, one should not place a high value on the relative rankings. In this case the diseases should be considered of similar importance. It is best to arbitrarily group the diseases/risk factors that are ranked into groups of high, medium and low priority and plan accordingly.

Criteria Data Sources

Amenability to Change

This criterion measures the scientific knowledge of known community interventions that have been shown to prevent or reduce a given disease. This is a measure of known successful community interventions as opposed to known successful clinical interventions.

  1. Interventions not evaluated in the literature for outcomes or published evaluations show inconsistent or negative results.
  2. Published evaluations of outcomes of interventions show positive results.
  3. Interventions recommended by a federal agency on a federal agency best practice list.
  4. Interventions recommended by Community Preventive Services Task Force (CPSTF).

Community Support

This is a subjective measure determined by the user of the current level of support in the community to address the disease/risk factor. The highest level of community support for each disease is given a score of 4 and the lowest level of support (i.e., active opposition) is given a score of 1.

  1. Active community opposition
  2. No groups/persons showing interest
  3. Some interest groups/persons showing interest but not organized
  4. Community coalition organized or support by elected official(s) or private business

Death Trend Statistically Significant

This is a measure of the urgency of the disease. If the number of deaths is increasing over time, it is a more urgent disease than one for which the death rate is decreasing. The measure used is the coefficient of the slope of the regression line for the time period. If the regression coefficient is not significantly different from 0 (the regression line is parallel to the x axis), then the trend is not significantly increasing or decreasing. All diseases that have a non-significant slope coefficient are set at 0 since it is not meaningful to rank diseases where the slope coefficients are statistically the same.

Disability Burden

The disability burden for each disease is measured by the number of years lived with disability taken from Revised Global Burden of Disease 2002 Estimates. Estimates are from reports for WHO subregions for 2002 as reported in the World Health Report 2004. Tables are taken from GBD 2002: YLDs ('000) by age, sex, and cause for the year 2000 Region 3: AMRO A. Numbers are divided by an additional 1000.

Hospital Days of Care

Hospital days of care is another measure of the severity of a disease and its potential impact on financial resources due to the cost of hospital care and time unavailable to normal duties. The hospital days of care data are obtained from the patient abstract data system (PAS).

Number of Deaths

The number of deaths is a measure of the severity of the disease.

Number of Deaths Under Age 65

This is another measure of the severity of a disease.

Number of Hospitalizations and ER Visits

The number of hospitalizations and emergency room (ER) visits is used to measure the magnitude of the disease. For most diseases, data are not available on incidence or prevalence; therefore, hospitalization and ER data are used instead. Further documentation of the hospital discharge data and ER data are available. The data come from acute care hospitals and hospitals operated by the Department of Mental Health.

Racial Disparity for ER Visits

Because racial disparity data are not routinely available on the incidence or prevalence of diseases, ER visits are used as a proxy to determine racial disparities. ER data were selected over hospital discharge data because there may be barriers for inpatient care due to the lack of insurance. These barriers are not as much of a factor for care in an emergency room. The primary minority population in Missouri is African-American; therefore, the measure is computed as the ratio of the African-American age-adjusted ER visit rate for a specific disease divided by the White age-adjusted ER visit rate for the same disease.

Racial Disparity for Deaths

This is a second measure of racial disparity. The measure is computed as the ratio of the African-American age-adjusted death rate for a specific disease divided by the White age-adjusted death rate for the same disease.

Prevalence/Incidence

Prevalence is the number of people who have a condition at a specific point in time. Incidence is the number of new people who get the condition during a specified time period. The Behavioral Risk Factor Surveillance System (BRFSS) is used to obtain the prevalence of high cholesterol, obesity, smoking, high blood pressure, no cervical cancer screening, no exercise, no health insurance for ER visits and no mammography. Incidence data is drawn from birth certificate data for low birth weight, mother overweight, prenatal care inadequate, very low birth weight not delivered in level III center, mother under weight, out-of-wedlock births, repeated births under age 18, smoking during pregnancy and very low birth weight. Other data files include pregnancy, abortion and child abuse/neglect from the Department of Social Services, Division of Family Services for teenage pregnancy under age 18, abortions and child abuse and neglect.

Prevalence/Incidence Trend

This is a measure of the urgency of the risk factor. If the prevalence/incidence is increasing over time, it is a more urgent risk factor than one for which the prevalence/incidence is decreasing. The measure used is the coefficient of the slope of the regression line for the time period. If the regression coefficient is not significantly different from 0 (the regression line is parallel to the x axis), then the trend is not significantly increasing or decreasing. All risk factors that have a non-significant slope coefficient are set at 0 since it is not meaningful to rank risk factor where the slope coefficients are statistically the same.

Data Sources

The data sources are Death Certificates, Emergency Room Visits, Hospital Discharges, Behavioral Risk Factor Surveillance System (BRFSS), Birth Certificates, Abortions, Pregnancies and Child Abuse/Neglect. We only used data sources that are available for all diseases or risk factors. For example, cancer register data and communicable disease reports were not used because there are no comparable incidence data for other diseases. BRFSS questions were only used if they were asked on the county 2001 BRFSS survey.