Table Of Content

Summary Report November 2002 WmSm IMCVHJ V/?0” This is a summary version of a more comprehensive report, of the same title. The full report can be accessed at http://www.ncvhs.hhs.gov/hsvison/ Shaping a Health Statistics Vision for the 21St Century PolicyMakers Summary November2002 NATIONAL INSTITUTESOFHEALTH NIHLIBRAIY OCT 4 2005 I aawn Health Llbrarjr 56sOTssssmi3-12 & 67 MO 2MK-1150 DepartmentofHealthL&ml , Centers forDisease Control and Prevention National Center forHealth Statistics National Committee onVital andHealth Statistics VjP\ Mk S52% £ very day, countless decisions are made concerningpublic and private health. Local, state, and federalbudgets are drawnup 2002 annuallythat committaxpayers’ dollars to, orwithdrawthem from, healthprograms. Legislaturesroutinelyconsiderhealth-relatedlaws with immense human, bureaucratic, andfinancial consequences.Yetoften, decision-makers have access to onlypartofthe informationtheyneedto make thebest decisions. Guiding the assessment, development, andevaluationofhealthpolicy is amajoruse ofhealth statistics, the numerical datathatcharacterizethe healthofapopulation andthe factors influencing it. Health statistics are used, as well, to create fundamentalknowledge andto guidepopulation healthprograms andpersonalhealthdecisions. Buttheirpotential for informing decision-makingwillberealizedonlywhenthe health statistics enterprise has adequate coordinationandresources andis guidedbyabroad view ofpopulationhealth. Itis notdifficultto imagineways inwhichbetterinformation could leadtobetterdecisions: • Coordinateddata collection and analysis wouldresultin more reliable statistics andmake itpossibleto draw conclusions from estimates to guide decision-making. For example, national and state surveys currentlyproducevarying estimates ofthe numberofpeoplewithouthealthinsurance, adding confusionto the efforts ofpolicy-makers to address this issue. • Information on allthe factors that influencepopulationhealth wouldmake itpossibletojudgewhich factors aremost significantforparticularpopulationhealthissues andtotarget appropriate interventions. Forexample, betterinformation on physician supplycouldenablepolicy-makersto understand whetherandhow anincrease inthenumberofspecialists inmedium and smallercities impacts uponthe functional status ofpersons withchronic disabilities. • Knowingtherelative contributions topopulationhealthof differentinvestments wouldmake itpossible to set evidence- basedpriorities forfixture investments. Forexample, better information could enablepolicy-makers to determine the relativereturn on investmentfrom increased funding ofskin cancerpreventionprograms comparedto increasedfunding of skin cancerscreening clinics. Shaping a Health StatisticsVision forthe 21st Century • Having access to timelydatawouldallowdecisionstobe made onthe latest evidence. Forexample, more timely datawould enablepolicymakers to considerthe impactofprograms beforethey arereauthorized, orprovide earlywarning signals ofnewhealth trends. • Comparable statistics across geographic levelswouldprovide state andlocal executives andlegislatorsthetoolstotarget problems ofparticularsignificance intheirareas, as well as to evaluate success intheirprogram interventions. Forexample, better informationcouldincreasethe capacityofthepublic healthand healthcare systemsto identifylowrates ofimmunizationininfants andchildreninspecificneighborhoods, enablingmore effective, efficient, andtimelytargetingofimmunizationprograms. A Vision for Realizing the Potential of Health Statistics Building ahealth statistics enterprisethatcanfully supportinformed decision-makingrequires anumberofinterconnectedconceptual, structural, andfunctional changes inourcurrentsystem. Theyare describedbriefly below anddiscussedmore fully inShapingaHealth Statistics Visionfor the21st Century anewreportdevelopedthrough atwo-year, national , consultativeprocess. Theprocess involvedmore than 200policymakers, publichealthandhealthcareprofessionals, health statisticspractitioners, researchers, andothers inawiderange oflocations intheUnited States. TheNational Committee onVital andHealth Statistics (NCVHS)*, the NationalCenterforHealth Statistics (CDC/NCHS), andthe DataCouncil oftheU.S. Department ofHealthandHuman Services (DHHS) coordinated theprocess andproducedthe report. NCVHS recommendations for translatingthe vision intopractice are attachedto the report. A view of population health and its determinants Thereportbegins bydefininghealthstatistics anddescribingthe health statistics enterprise. It stressesthatto be usefulto healthandhealth policydecision-makers, health statistics mustrepresent allthe factors influencingpopulationhealth. T—hatis, inadditiontorepresenting all dimensions ofhealthoutcomes includingmeasures offunctional status — andwellbeing as well as disease inthe population health statistics must *NCVHS isthe statutorily mandated public advisory body on health information policytothe Secretaryofthe U.S. DepartmentofHealth and Human Services. The NCVHSWorkgroup on the21stCenturyVisionforHealthStatisticsconductedthisprojectfortheCommittee. 2 Shaping a Health StatisticsVision forthe 21st Century represent communitycharacteristics, the natural environment, andcultural andpolitical contexts. This view ofpopulationhealth and its determinants, shown inthe model inFigure 1 below, defines the scope ofinformationthehealth statistics enterprise shouldobtainandmake available. Themodel canbe usedto identifygaps incurrentdata and inthe enterprise’s capacityto providethe data. Health Population’s the on Influences 1. Figure Shaping a Health StatisticsVision forthe 21st Century A strengthened hub for the health statistics enterprise Anothermodel developedforthe report(Figure 2) shows the stages and components ofan idealhealth statistics cycle and specifies the activities of thehealth statistics enterprise andtheirinteractions. u u>* <o/> CM OJ CD 4 Shaping a Health StatisticsVision forthe 21st Century A major difference betweenthis idealizedview and current conditions is thatthe components ofthis health statistics cycle are tiedtogetherby an integrating “hub.”As envisioned, the hub coordinates the activities ofthe health statistics enterprise, stimulates collaborative efforts, sets standards, reviews andrevises the vision, generates newmethods and approaches, and protects privacy, confidentiality and security. The needto strengthenthe hub to carry outthese functions was amajoremphasis ofthe visioningprocess. Participants conveyed a strong message thatnew approaches to enterprise-wide coordination and integration are neededbecause existing ones are largely ineffective, causing fragmentation and inefficiency. Conceptual framework, core values, and guiding principles The reportproposes thatthe mission ofthe health statistics enterprise is to efficientlyprovide timely, accurate, andrelevant informationthat can be usedto improve the population’s health. It outlines the attributes ofthe needed conceptual framework, and specifies core values andprinciples to guide the enterprise in realizing the vision forhealth statistics. The overarching conceptualframeworkenvisioned forthe health statistics enterprise has these characteristics: it focuses onhealth, the population, andthe community; it emphasizes distribution and level of health; it delineates major influences on health; and it guides aresearch agenda for improving the health ofthe population. The use ofan overarching conceptual frameworkwill remindpolicy-makers andpublic healthpractitioners ofthe myriad offactors that mustbe considered and addressed in designing and implementingprograms to improvepopulation health, andhelp to reduce narrow, disease-specific, and categorically- focusedprograms. Fourcore values are envisioned forthe health statistics enterprise: • Maintainingthe confidentiality andsecurity ofindividually identifiable health information • Maximizingthescientific integrity ofall aspects ofhealth statistics while acknowledging the specific ways inwhichthe political, cultural, andbusiness contexts may affect data collection, analysis, and interpretation • Optimizing the enterprise’s accountabilityto its users to ensure the availability ofthe informationthat is needed for improving the nation’s health Shaping a Health StatisticsVision forthe 21st Century • Ensuring the enterprise’s accountabilityto its data suppliers to minimize theirburden andto provide themwith timelyfeedback The report concludes by identifying tenguidingprinciples for actualizing the core values: 1. Enterprise-wideplanningandcoordination to ensure relevance to local, state, andnationalpolicy andprogram decision-making andto an overall conceptual frameworkofthe influences onthe health ofpopulations 2. Broadcollaboration among datausers, producers, and suppliers at local, state, andnational levels to ensure efficiency ofthe health statistics enterprise andusefulness ofthe datathat itproduces 3. Rigorous policies andprocedures forprotectingtheprivacy of individuals andthe confidentiality and security ofdata 4. Flexibilityto identify and address emergenthealth issues andneeds 5. Use ofdatastandards to facilitate sharing and comparability of 10. data 6. Sufficientdetailat different levels ofaggregationto support local, state, andnational policy andprogrammatic decision-making 7. Integrated, streamlineddata collection formultiple purposes 8. Timelyproduction ofvalid and reliable health statistics 9. Appropriate access to andease ofuse ofhealth statistics Continuous evaluation ofthe completeness, accuracy, and timeliness ofhealth statistics and ofthe ability ofthe health statistics enterprise to support theirproduction The NCVHS Recommendations Afterworking closelywith its partners to create a vision forhealth statistics reflecting the views and concerns ofconsultationparticipants, the National Committee onVital and Health Statistics developed 36 recommendations forrealizing the vision. Thirty relate to andflesh out the guiding principles, and six move toward the adoption ofan overarching conceptual framework. The recommendations are summarized in the Appendix. NCVHS believes that the top priority forrealizing the vision is to buildthe integrating and coordinating hub forthe health statistics enterprise. This priority is expressed in guidingprinciple 1, regarding enterprise-wide planning and coordination. FourNCVHS recommendations relate to this priority: 6 Shaping a Health StatisticsVision forthe 21st Century