National health data for policy and planning.

The role of the National Center for Health Statistics (NCHS) in providing data for health policy and planning at the national and local level is discussed. Four specific examples are considered. First, data from the Hospital Discharge Survey are used to identify surgical procedures with large increases between 1965 and 1976: 30 percent rise in the incidence of hysterectomy, 169 percent increase in cesarean section, 100 percent increase in lens extraction, and 35 percent increase in orthopedic surgery. The extent to which such increases represent unnecessary utilization and their impact on costs are discussed. Second, the combination of data from two sources (Health Interview Survey and Health and Nutrition Examination Survey) is illustrated by considering selected policy issues related to hypertension. Next, the problem of designating medically underserved areas is discussed in relation to the difficulties in implementing federal policies at the local level without local data. The potential for national data systems to provide guidance for these policies is also considered. The final example discusses the use of vital statistics to provide small area data for local health planning. In conclusion several areas are considered which need development in order to maximize the use of data for policy and planning: research on measurement of health status, with particular emphasis on how health policy can affect health status; research on appropriate levels of health resources and services; development of shared data systems to reduce cost and respondent burden; and training, especially at the undergraduate level and in interdisciplinary graduate programs.     

Strengthening epidemiologic competencies among local health professionals in New York: teaching evidence-based public health

Starting in 2004, the New York State Department of Health and the University at Albany Prevention Research Center collaboratively developed a course entitled Evidence-Based Public Health for Local Health Practice to strengthen epidemiologic and other competencies of public health professionals in local health departments. This article describes the development of the course and its adaptation to the needs of local public health staff. The course utilizes didactic sessions, computer labs, and scenario-based exercises to demonstrate the use of data and evidence in the decision-making process. Follow-up surveys found that information and skills that emphasized epidemiologic competencies were likely to be used regularly or occasionally by the majority of participants. Half of the participants said that their agency's use of evidence-based public health practices had increased. Few respondents were trained as epidemiologists, yet most reported they used those skills in the workplace, suggesting a need to strengthen these competencies among non-epidemiologists.     

Expert systems in the health administration curriculum

With the growing use of computers and on-line hospital information systems, a need exists for health care managers trained in computing and computer applications. This article reviews the advances in health care computing and reports on the design and implementation of a new course in a specific computer application, known as expert systems, in a health administration curriculum. The specific course framework is described and several student projects are presented and discussed.     

Searching for evidence about health education and health behavior interventions.

Evidence is fundamental to science, but finding the right evidence in health education and health behavior (HEHB) is often a challenge. The authors discuss some of the controversies about the types of evidence that should be considered acceptable in HEHB, the tension between the use of qualitative versus quantitative data, the need for measures of important but neglected constructs, and interpretation of data from experimental and nonexperimental research. This article discusses some of the challenges to the use of evidence and describes a number of strategies and some forces encouraging the use of evidence-based interventions. Finally, the authors suggest ways to improve the practice and dissemination of evidence-based HEHB. Ultimately, if evidence-based interventions are not disseminated, the interventions will not achieve their potential. The goal should be to develop more effective interventions and disseminate them to improve the public's health.     

Maintaining the confidentiality of computerized mental health outcome data

The emergence of managed behavioral health care has increased the value of data describing outcomes of mental health treatment. At the same time, increased development of the national information infrastructure and other computer linkage systems has facilitated the flow of information among a wide network of data systems. These two developments create a dynamic tension between the need to share information and the need to protect the privacy of mental health clients and the confidentiality of their computerized records. This problem is exacerbated by the cost associated with potential solutions. Unfortunately, policy development in this area has lagged behind rapid developemnts in technology. The mental health administrator must balance the three components of this conflict (the increasing need for information transfer, the protection of confidentiality, and cost) without a great deal of guidance. This article offers recommendations that may help the mental health administrator manage this conflict.     

Computer use in allied health programs

This article presents a preliminary assessment of computer use in allied health programs. The findings of a survey among 60 allied health programs indicate that computer use in the classroom, in clinical education, and in simulation has increased. In preprofessional education, computers are used by less than 50% of the allied health programs. However, computers are used more in the professional phase for patient management, clinical simulations using branching and logic methods, physiological simulations, and therapeutic planning and management. Students in these programs are required to take three to six semester hours of computer literacy classes. In the classroom, computer-assisted instruction is used to provide remediation, reinforcement, enrichment, and test-taking drills in clinical and didactic learning. Students use microcomputers to gain application experience in health statistics, data bases, abstracting, and diagnosis-related group classifiers. Although progress has been made in computer use, greater efforts must be expended to ensure greater use of computer technology in the next decade in allied health disciplines. Recommendations for increased use of computer technology in allied health programs are provided.     

Quantitative evaluation of the effects of environmental factors on health status indices

The article is devoted to the problem of improving the methods of data collection and processing in solving the question of evaluating the health effect of environmental factors. Circumstances are pointed out which hamper the acquisition of reliable and operative data. The ways of improving the effectiveness of computer use are considered.     

Public health informatics: improving and transforming public health in the information age.

Development of effective public health information systems requires understanding public health informatics (PHI), the systematic application of information and computer science and technology to public health practice, research, and learning. PHI is distinguished from other informatics specialties by its focus on prevention in populations, use of a wide range of interventions to achieve its goals, and the constraints of operating in a governmental context. The current need for PHI arises from dramatic improvements in information technology, new pressures on the public health system, and changes in medical care delivery. Application of PHI principles provides unprecedented opportunities to build healthier communities.     

A survey of the applications of computersin the community health services-community health systems

In November 1984 a questionnaire survey was circulated to discover the current stateof the art with regard to computer applications in the community health services across the U.K. This survey was combined with a more traditional literature search for relevant information, making much use of computerized on-line techniques for access to bibliographic databases such as Medline. This paper summarizes many of the applications discovered wich make up the “state-of-the-art” such as the many recall systems and nurse workload analysis packages reported, and also presents a selection from the numerous “results” obtained following computer analysis of the responses collected.It is interesting to note the extremely widespread use of microcomputers withincommunity health departments, and the enormously varied applications to which they are put. There is a whole proliferation of computer applications in the community, but only a small number of authorities when considering the country as a whole make any where near full use of the new technology. This is the only attempt that has been made as far as I am aware to collect together national data, regarding community health computer applications and make available a register of the applications reported on.     

Health and social factors for health visitor caseload weighting: reliability,accuracy and current and potential use

The reliability and validity of data collection and recording for a health visitor caseload weighting system operating in a large combined acute and community trust in Bristol was examined. Client families were recruited from all participating (service) health visitors and were interviewed by a research health visitor attached to the project. The presence or absence of 28 health needs factors, selected for their known impact on health in the longer term, was subsequently compared with the service health visitor's own caseload records and with the computer record derived from them. Substantial differences were determined in the records obtained between the service and research health visitors and between the written and computerised records. Whilst the mean total score recorded for each family by the service health visitor was 2.0, the average of the differences in the total number of health factors recorded by the service and research health visitors was 1.9. Discrepancies were mostly associated with differences in interpretation of definitions, knowledge of recent events, changing circumstances and issues of confidentiality. Health factors at particular risk of being misinterpreted and those associated with other health factors were identified in order to propose a reduced factor set with greater inherent reliability and validity. At the level of the ward, the caseload weighting score, as currently defined, is highly correlated with standard deprivation indices in widespread common use. The results of this study indicate the need for users of the caseload weighting data to decide on the primary function of this data set - area-based community profiling or identification of at-risk client families in the community. This decision will inform further efforts to identify the most useful factors, tighten definitions, streamline data collection and train health visitors in their use. Interpretation of data will be facilitated by a scientifically developed scoring system. This work will assist trusts, both locally and nationally, in rationalising their allocation of health visiting activities to areas of greatest need.     

Rapid evaluation methods (REM) of health services performance: methodological observations.

The rapid evaluation method (REM) was developed by WHO in order to assess the performance and quality of health care services, identify operational problems, and assist in taking managerial action. It was tested in five developing countries (Botswana, Madagascar, Papua New Guinea, Uganda and Zambia) between 1988 and 1991. REM consists of a set of observation- and survey-based diagnostic activities, carried out mainly in health care facilities. The article describes the various steps of REM, methodological issues such as setting objectives and using an issue-information matrix, preparation of survey instruments, use of computer software (Epi Info), data quality control, fieldwork, and the use of data to produce useful information for decision-makers. REM aims at bringing prompt and relevant information to planners and decision-makers who need it for a specific purpose. In the present examples, REM provided information for preparing a programme proposal for external funding, for establishing baseline data for a situation analysis, and for assessing staff performance after extensive training in order to improve the curriculum.     

Empowerment evaluation of worker safety and health education programs

BACKGROUND: The need to expand the use of evaluation to learn how education programs contribute to workers' occupational safety and health is well documented. Similarly recognized is the need to expand workers' involvement as primary stakeholders in program evaluation. METHODS: Articles for this review were identified through computer database and manual searches related to: intervention research and evaluation; occupational safety, health training, and education; and worker participation and empowerment. RESULTS: After identifying empowerment as a multilevel and multidimensional concept, this review used a theoretical framework of evaluation to show how various participatory and empowering approaches can affect evaluation studies and their use. CONCLUSIONS: The field of occupational safety and health has a unique historical opportunity to further expand workers' involvement in their own education through the use of participatory and empowering approaches to evaluation. Use of these approaches has the potential to strengthen capacities for organizational learning and improve both program theory and practice.     

Planning health education: Internet and computer resources in southwestern Nigeria. 2000-2001

The use of the Internet as a health education tool and as a resource in health education planning is widely accepted as the norm in industrialized countries. Unfortunately, access to computers and the Internet is quite limited in developing countries. Not all licensed service providers operate, many users are actually foreign nationals, telephone connections are unreliable, and electricity supplies are intermittent. In this context, computer, e-mail, Internet, and CD-Rom use by health and health education program officers in five states in southwestern Nigeria were assessed to document their present access and use. Eight of the 30 organizations visited were government health ministry departments, while the remainder were non-governmental organizations (NGOs). Six NGOs and four State Ministry of Health (MOH) departments had no computers, but nearly two-thirds of both types of agency had e-mail, less than one-third had Web browsing facilities, and six had CD-Roms, all of whom were NGOs. Only 25 of the 48 individual respondents had computer use skills. Narrative responses from individual employees showed a qualitative difference between computer and Internet access and use and type of agency. NGO staff in organizations with computers indicated having relatively free access to a computer and the Internet and used these for both program planning and administrative purposes. In government offices it appeared that computers were more likely to be located in administrative or statistics offices and used for management tasks like salaries and correspondence, limiting the access of individual health staff. These two different organizational cultures must be considered when plans are made for increasing computer availability and skills for health education planning.     

Shipyard health problems

Shipyard health problems are similar to those of construction generally with the modification created by the inherent need to work in confined spaces. It is the latter fact that creates special conditions aggravating the hazard for occupational diseases and accidents.We have considered some special problems (welding and asbestosis exposure) studied by colleagues at our Institution in the past and have brought some of these data up-to-date.     

Competencies for graduate curricula in health, medical and biomedical informatics: a framework

The rapid emergence of programmes in health informatics, medical informatics and biomedical informatics implies a need for core curricula in these diverse disciplines. This study investigated the recommended competencies for health and medical informatics, aiming to develop a framework for use in curricular development. Current health and medical programmes around the world were analysed to assess how these competencies are reflected in current curricula and to identify new competencies. Several preferred skills and knowledge sets were identified and 40 programs were analysed. Diverse curricular designs were found in these programmes. Competencies such as research skills, knowledge in health information systems and methods for informatics/computer science were the most frequently taught. Knowledge or skills in interpersonal communications, social impact of IT on health, and data mining may represent important skills for future informaticians. The suggested framework and the data analysed may be important for developing a competency-based modular curriculum.     

Computer learning strategies and outcomes: a field test in health services administration.

Decisions in the changing, competitive and highly complex health care market must be arrived at faster. The argument for the extensive use of computers by modern health care executives and the inclusion of computer training in the health administration curriculum rests on the fact that the survival and growth of health care institutions is vitally tied to the capacity of their managers to absorb increasingly complex data and turn it rapidly into usable information. Although educators cannot solve all health care industry implementation problems either as consultants or as analysis in implementation studies, they must provide clear direction in the analytical training of future managers concerning computer utilization and management information systems generally. Without the basic foundation in knowledge, attitude, and behavior reinforcement, the risk of improper and insufficient computer utilization in the industry is large. This article examines the curricular structure, learning theory, and preliminary student learning and behavior outcomes of a course developed in 1985 for health administration students at Sangamon State University.     

The mental health orientation of juvenile courts

Effective systems of care for youth with emotional disorders require shared values among stakeholders toward a variety of mental health issues. Juvenile courts represent one stakeholder group whose values can affect the delivery of services to young offenders with or at risk of emotional disturbances. This research uses statewide data from Tennessee to assess the mental health orientation (MHO) of juvenile courts, their use of treatment options for offenders, and whether MHO influences the treatment referral decision. Results show that courts have a positive MHO, but this subjective orientation does not correspond to higher treatment referral rates. Moreover, service referrals are at a considerably lower rate than estimates of need for this population of youth would predict. While positive MHO suggests a basis for nurturing the shared vision required for effective systems of care, other factors must be considered to account for courts' underutilization of treatment options for juvenile offenders.