Integrated Surveillance Systems
Policymakers require a range of information about health in order to make informed choices about programs and policies.
However, this information is rarely found in one place, and often there are formal barriers between different sources of information about the same individual, either because of existing infrastructure constraints, confidentiality considerations, or incomplete information systems.
Building a complete and formal tracking system takes an enormous amount of money and time, well beyond the resources of many countries, but without adequate tools to link different sources of information, policymakers may be vastly underutilizing the data that do exist in their countries.
Improving surveys and survey techniques, devising statistical methods to probabilistically link existing records, and developing better methods to undertake small area estimation all help to provide improved health information.
For example, understanding how to leverage cost-effective household surveys can provide a great deal of useful data to a health information system that might be strained to find the resources to implement large tracking systems.
The Integrated Surveillance Systems research team focuses on improving the timeliness, accuracy, and performance of health information systems by creating ways to use all available sources of data, including household surveys, administrative records, vital registration systems, disease registries, hospital records, and other clinical information.
The research team assesses the existing set of health information sources in a given country, determines how to use them in combination with one another to create the most complete picture possible of population health, and develops cost-effective and timely ways to gather and use health information at the national and subnational level to help decision-makers allocate resources in the most effective ways possible.
- Pilot a multisource surveillance system in King County, Washington
The goal of the Monitoring Disparities in Chronic Conditions Study is to better understand chronic disease disparities among whites, blacks, and Hispanics in the United States. King County, Washington, will be used as a pilot site for a novel multisource surveillance system that combines the use of existing information with household surveys. Six separate sources are used: a community survey, physical examinations, emergency medical records, hospital inpatient records, outpatient records, and pharmacy records.
For any given individual who is identified for the study, we will attempt to obtain information from all sources of data for them. In addition, the research team will use and validate probabilistic linking methods to some of the de-identified hospital records in order to tie them in with community surveys.
Using these sources, the project will be able to monitor a subset of chronic conditions (e.g., asthma, chronic obstructive pulmonary disease, diabetes) and risk factors (e.g., high cholesterol, high blood pressure).
Most importantly, the project will enable the team to determine the prevalence of diagnosed and undiagnosed conditions, controlled and uncontrolled conditions, the coverage and effective coverage of health interventions, and the duration from an event to an adequate intervention.
Finally, the project will measure essential pharmaceutical interventions and adherence by comparing pharmaceutical records to results from the analysis of blood samples.
Most of the information being utilized is also available in other communities in the US. If the project can demonstrate that these various data sources can be cost-effectively harnessed with new methods, then there is the potential for implementing it in many more communities. In doing so, we would gain a much better understanding of the impacts of chronic conditions, risk factors, and interventions in diverse communities.
If this information was available, policymakers would be much better positioned to reduce disparities and increase population health.
- Calculate municipal-level indicators and investigate infant mortality disparities in Brazil
The research team is collaborating with the Brazilian Ministry of Health to investigate disparities among key health indicators at the municipal level by applying small-area estimation methods to all available survey and administrative data.
The modeling framework combines the best of the various approaches traditionally used in small-area estimation, including pooling data over time, borrowing strength spatially, and using other measures of relatedness, as well as individual- and area-level covariates.
Municipal and micro-region estimates have been produced from 2000 to 2010, and researchers convened a workshop in Brasilia in July 2011 to present preliminary results before beginning publication of a report of the findings.
- Design and implement household and facility surveys in Mesoamerica to monitor improvements in health system performance
The research team is working with the Inter-American Development Bank (IDB) as part of the Salud Mesoamerica 2015 initiative. Mesoamerica is comprised of southern Mexico and eight countries: Belize, Colombia, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama.
The IDB will use household surveys and health facility surveys developed by IHME to measure the coverage of interventions and the performance of the health system in select subnational areas for evaluation purposes. Strategic areas of interest for interventions and coverage are nutrition, immunization, and maternal and child health.
The surveys, linked with available administrative data and drawing from other existing surveys of the relevant areas, will be used to establish a baseline of health performance in key areas. A select set of indicators will be monitored over time using these information sources.
Without these surveys, tracking the indicators of interest would be nearly impossible. Payments by the Salud Mesoamerica 2015 initiative will be linked, in part, to improvements in the indicators tracked through the surveys and analyzed alongside other available data.
This is an effort to help improve health system performance and build capacity.
The Integrated Surveillance Systems research team’s work can help fill gaps in national and subnational health information to provide policymakers with accurate, timely, and relevant information on the health of their populations.
In particular, the research team assesses the existing set of health information sources in a given country and determines how to use them in combination with one another to create the most complete picture possible of population health.