1. Roger’s Fortune Cookie (July 1988) Put the data you have gathered to beneficial use. Roger Gollub, MD Albuquerque Area IHS (505) 248-4539 rgollub@albmail.albuquerque.ihs.gov

2. QUALITY ASSURANCE EPIDEMIOLOGY STRATEGIC PLANNING SERVICESCIENCEPOLICY Parallel Tracks

3. The Medical Model (Service) SICK WELL Treatment

4. The Quality Assurance Model (Process) NOT SO GOOD BETTER Q TQM CQI

5. The Planning Model (Regulation) PROBLEM NO PROBLEM Policy

6. The Research Model (Science) PROBLEM KNOWLEDGE FUNDING ResearchPublish

7. The Epidemiolgy Model (Modified Science) PROBLEM DATA PROBLEM WITH DATA COLLECTION LOTS MORE PROBLEMS MORE LOTS MORE... Collect data Collect more data Collect more problems Collect lots more data

8. The Public Health Model (Classic Version) PROBLEM OUTCOME NEW RATE RATE Study Intervention Surveillance

9. The New Public Health Model? EPIDEMIOLOGY QUALITY ASSURANCE STRATEGIC PLANNING PUBLIC HEALTH

10. Use Data Persuasion Assessment Monitoring Planning Evaluation Research

11. Sources of Information CDC, NCHS State Health Departments IHS Headquarters East IHS Area Offices Tribes

12. Existing sources: US Census +Reservation and Tribal community data +Includes social and economic indicators –1990 Census data are old and inaccurate –2000 Census data not yet available

13. Percent of Population Below Poverty Level 1990 Census State-level Indian Data U.S. All Races = 13.1 24.0 24.7 24.0 27.0 29.2 33.0 41.8 42.1 44.6 46.8 49.6 IHS Total = 31.6 NOTE:Includes data for 35 Reservation States (South Carolina and Indiana were added as Reservation States in 1994 and 1995, respectively). Regional Differences in Indian Health - 1998- 1999 Chart 2.10

14. Existing sources: Tribal Census +More complete than US Census +Includes members away from community –?May miss members of other Tribes living in community

15. Existing sources: Vital Statistics (birth and death records) +Rarely specific to Indian communities +Rarely Tribe specific –Indian identification may be inaccurate –Only superficial view of community’s health

17. Infant Mortality Rates, 1973-1993 Source: Trends in Indian Health, 1997 Figure 1

18. NM AI/AN Infant Mortality 1993-1997 (communities with > 200 births/5 years) Source: NM Bureau of Vital Records Figure 2

19. Existing sources: IHS Clinical Data +Tribe and community specific +Reports on people and health problems –Data only on patient visits to IHS –Cost accounting not yet available

21. Existing sources: IHS Program Data +Specific data on specific issues +Similar reports available at many sites –Sometimes narrowly technical –Sometimes bureaucratic

23. Existing sources: Tribal Programs +Local perspective +Data and reports for the Tribe –May need to develop capacity +Capacity for statistics and analysis are developing

24. Existing sources: Special Surveys +Can only be performed by community +You can get what you really want –Lots of work difficult, time consuming –Requires developing expertise

25. Surveillance Data Adapt data that already exists Pay someone to collect data Collect data yourself Require someone to fill out a form

26. Parting Shots  No data are perfect. Make it better. Use it anyway.  Data don’t make decisions. People do.  Data may be lacking. Use common sense, imagination, and good science to fill in the blanks. Data is as data does. (Forrest Gump-ian.)  Use data to make a difference. Do public health.  Success in prevention comes in small victories. Persistence is very powerful.