6. Discuss the uses, strengths and weaknesses of the following data sources a.

Health Insurance Statistics = Gives information for the understanding, monitoring, improving and planning the use of resource to improve the lives of people and provide them services and promote their well being. b. Data from medical clinics = Traditionally medical records were written on paper and maintained in folders often divided into sections for each type of note (progress note, order, test results), with new information added to each section chronologically. Active records are usually housed at the clinical site, but older records are often archived offsite. The advent of electronic medical records has not only changed the format of medical records, but has increased accessibility of files. The use of an individual dossier style medical record, where records are kept on each patient by name and illness type originated at the Mayo Clinic out of a desire to simplify patient tracking and to allow for medical research. Maintenance of medical records requires security measures to prevent from unauthorized access or tampering with the records. c. Special epidemiologic surveys, including morbidity surveys = Epidemiological surveys use various study designs and range widely in size. At one extreme a case-control investigation may include fewer than 50 subjects, while at the other; some large longitudinal studies follow up many thousands of people for several decades; The main study designs will be described in late chapters, but we here discuss important features that are common to the planning and execution of surveys, whatever their specific designs. d. Vital Statistics = Refers to the systematic study of vital events such as births, illnesses, marriages, divorce, separation and deaths. Uses of vital statistics: indices of the health status of the community and serves as bases for planning, implementing, monitoring and evaluating community health nursing programs and services e. Absenteeism data from schools or work settings = Absenteeism, which is the tendency not to show up for scheduled work. Absenteeism, a term used to refer to absences that are avoidable, habitual and unscheduled, is a source of irritation to employers and co-workers. Such absences are disruptive to proper work scheduling and output, and costly to an organization and the economy as a while. Although absenteeism is widely acknowledged to be a problem, it is not easy to quantify. The dividing line between avoidable and unavoidable is difficult to draw, and absenteeism generally masquerades as legitimate absence. The Labour Force Survey (LFS) can provide measures of time lost because of personal reasons-that is illness or disability, and personal or family responsibilities. However, within these categories, it is impossible to determine if an absence is avoidable or unscheduled. LFS data on absences for personal reasons can, however be analyzed to identify patterns or trends that indicate the effect of absenteeism. The usefulness of date on absence from work due to sickness (absenteeism) as an indicator of specific and detailed information of diagnoses is widely discussed in the international literature. In occupational health indicators for health risks (e.g. sickness absence of more than 1 4 days), details on diagnosis and workplace and very useful if analysed by epidemiological means. A pilot project, initiated by a high sickness system, which was abruptly stopped by data protection arguments.

the epidemiologic approach of an age-adjusted comparison of indices relies on the access to morbidity data of the health insurance system. With the diagnostic information at hand differences of incidences in one production branch (as recognized by the incidence ration SIR) are to be discovered if related to certain specific diagnoses. Thus, a direct comparison of comparable rates helps to identify specific reasons for increased absence from work. Practical solutions were found if the owner of the data, results showed as yet unknown associations of myocardial infarction and obstructive lung diseases in the metallurgical industry. In such cases bit only the validity of the results has to be verified, but also other epidemiological tools, such as a case-referent approach to determine risk rations, are required for the identification of any casually important relationship. f. Disease Registers = Are held in primary care and should be accurate and proactively used to improve the care of example, peoplewith COPD by duiding ongoing treatment and management. However, anecdotally it is widely acknowledged and there is evidence from NHS Improvement Lung projects to demonstrate that most registers are far from accurate and therefore cannot be used to proactively manage a patient with COPD. Accuracy is further compounded by variation in the information that is included on local GP templates. The consulatation COPD strategy suggests what should be included in a register which is over and above Quality and Outcome Framework requirements. If accurate and used proactively and systematically, registers could become a richer source of information in gauging the progeession of the disease and the impact on the health economy, ensuring treatment pathways are appropriate and that people are given appropriate support and advice. Uses: patient follow up, auditing treatment, comparing with other treatment outcomes, Evaluation of services, studies of causation, health service planning. Strengths: very rich, detailed source of information = updated over time Weaknesses: expensive to run updating is laborious, confidentiality issues, assessing completeness/under-coverage is not straightforward g. Hospital and clinic statistics = Used by health care provider and organizations, research and strategic planning firms, consulting and finance firms, academic organizations and hostpitals for comparative marketplace analysis and trend analysis and research. Hosp. Stats. Is also available with additional data on a CD. The CD includes tables from the book in MS Excel which allow the user to combine this data with other data sets, hone in on particular statistics, and create charts and graphs. And also involves easy data manipulation. - Create charts and graphs from eight Microsoft Excel tables of aggregated hospital data visually display utilization, personnel, finance, beds, admissions, inpatient and outpatient visits data. - Benchmark facilities of similar size and location for hospital data comparison and analysis - Gather industry intelligence to pinpoint emerging trends such as physician models, insurance products, and managed care contracts;

- Examine hospital data in utilization, finances, and staffing to identify opportunities and areas of potential growth - Incorporate other data sets such as census data, geographic information or company data, to focus health care market research on specific areas of interest.