1. Evidence-Based Public Health Practice: Using Research and Data to Improve Your Programs Week 1, Part 2: Data Sources Helena VonVille Library Director University of Texas School of Public Health This project has been funded in part with Federal funds from the National Library of Medicine National lnstitutes of Health, Department of Health and Human Services, under Contract No NO1-LM-6-3505.

2. Week 1, Part 2: Agenda Week 1, Part 2 – Data Sources ◦ Types of data sources ◦ Working with data sources  How to access  How to use  How to display ◦ Using data sources for community assessments  Healthy People 2010

3. Step 2: Quantify the Issue Public Health Surveillance ◦ “..continuous and systematic process of collection, analysis, interpretation, and dissemination of descriptive information for monitoring health problems.” 1 ◦ “…for use in public health action to reduce morbidity and mortality and to improve health.” 2 1 Buehler, J.W. (1998). Surveillance. In: Rothman KJ, Greenland S. Modern epidemiology (3rd ed., 435-57). Philadelphia, PA: Lippencott-Raven. 2 Guidelines Working Group. (2001). Updated guidelines for evaluating public health surveillance systems. MMWR 50(RR13):1-35. Retrieved March 2, 2008 from: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5013a1.htm

4. Vital Statistics Reportable diseases Screening surveys Disease registries Morbidity surveys Hospital Data Focus groups Interviews Other Step 2: Quantify the Issue Types of Data Sources

5. Step 2: Quantify the Issue Data Sources ◦ National Center for Education Statistics ◦ National Center for Health Statistics ◦ Bureau of Labor Statistics ◦ Census Bureau ◦ FBI ◦ Housing & Urban Development ◦ EPA ◦ SAMHSA ◦ NCI ◦ Medicare/Medicaid National Data from Federal Agencies State government agencies Non-profit organizations Colleges and universities Other research organizations

6. Step 2: Quantify the Issue Information Systems Systems designed to store, organize, and retrieve data Standards based in some but not all cases ◦ Internet protocols ◦ PHIN (Public Health Information Network)  National initiative, improve capacity of PH to use and exchange information electronically ◦ Electronic medical records  Vendor specific so transfer between systems can be difficult

7. Step 2: Quantify the Issue Where do we stand? What do we track well? ◦ Births & deaths ◦ Infectious disease ◦ Cancer ◦ Population What don’t we track well? ◦ Chronic diseases ◦ Linking certain types of conditions  Asthma & environment

8. Step 2: Quantify the Issue Confidentiality Public data ◦ County level typically  Census Bureau exceptions Hospital discharge data ◦ IRB approval from state & home institution  TX charges for the data Surveys that you instigate ◦ IRB approval from your institution?

9. Step 2: Quantify the Issue Types of Data Sources Vital Statistics ◦ Birth and death statistics ◦ Reported to CDC & compiled regularly ◦ Limitations to mortality data  Chronic illnesses  Multiple cases of death  Lack of standardization of diagnosis criteria  Stigmas attached to certain diseases  Completeness of records  Changes in ICD codes over time

10. Vital Statistics (cont’d) ◦ Limitations to birth data  Birth certificates have changed over time  Ex: 1993-1994 birth data  http://www.sph.uth.tmc.edu/charting/caveats.htm http://www.sph.uth.tmc.edu/charting/caveats.htm  Incomplete birth certificates  Midwives in south Texas?  Self-reported data  Alcohol/smoking during pregnancy Step 2: Quantify the Issue Types of Data Sources

11. Vital Statistics Reportable diseases ◦ Lists of notifiable diseases at http://www.cdc.gov/epo/dphsi/phs/infdis.ht m http://www.cdc.gov/epo/dphsi/phs/infdis.ht m ◦ Limitations  Changes throughout the years  Chlamydia Chlamydia  Data only as good as reporting  Medical attention not always sought

12. Step 2: Quantify the Issue Types of Data Sources Registries ◦ Tracks all occurrences of type of disease or condition or category of disease or condition  Birth defects  Cancer  SEER  Limitation  Cooperation of agencies and medical facilities as well as adequate funding.

13. Screening surveys ◦ Ad hoc basis ◦ Health fairs (community or employer- based) ◦ Limitations  Consistency of data gathering  Permission for data use Step 2: Quantify the Issue Types of Data Sources

14. Morbidity Surveys ◦ Sample data ◦ National Health And Nutrition Examination Survey, National Health Interview Survey, BRFSS, YRBSS, National Survey on Drug Use & Health Step 2: Quantify the Issue Types of Data Sources

15. Hospital Discharge Data ◦ Track chronic conditions that lead to hospital stays without mortality  Strokes, asthma, heart attacks, etc. ◦ Limitations  Purchase from the state  http://www.dshs.state.tx.us/thcic/hospitals/Hospita lData.shtm http://www.dshs.state.tx.us/thcic/hospitals/Hospita lData.shtm  Confidentiality issues Step 2: Quantify the Issue Types of Data Sources

16. Volunteer Providers ◦ Can be just-in-time for non-notifiable diseases ◦ “Task force” oriented, i.e. system created to meet a specific need during a specific time Other ◦ Linked records  Birth/infant death Step 2: Quantify the Issue Types of Data Sources

17. Step 2: Quantify the Issue Sources Consulted Buehler, J.W. (1998). Surveillance. In: Rothman KJ, Greenland S. Modern epidemiology (3rd ed., 435-57). Philadelphia, PA: Lippencott-Raven. Friis, R.H. and Sellers, T.A. (2009). Sources of Data for Use in Epidemiology. Epidemiology for Public Health Practice. (4th ed.). Boston: Jones & Bartlett.

18. CHARTing Health Information for Texas ◦ Links to county level data covering a broad variety of data Step 2: Quantify the Issue How to Access Data Sources http://www.sph.uth.tmc.edu/charting

19. Step 2: Quantify the Issue CHARTing: Data for Cause of Illness

21. Big 3 for mortality ◦ CDC Wonder ◦ Texas Health Data: Death Data  TDSHS ◦ VitalWeb All cover underlying (i.e. single) cause Multiple cause data difficult to get ◦ HP2010 target for diabetes mortality  All-cause mortality Step 2: Quantify the Issue CHARTing: Mortality Data

22. Big 3 birth data sources ◦ CDC Wonder ◦ Texas Health Data: Birth Data  TDSHS ◦ VitalWeb Other types of data ◦ Birth defects ◦ Fetal mortality ◦ Linked birth/death data Step 2: Quantify the Issue CHARTing: Birth Data

23. Step 2: Quantify the Issue HP2010 Workbook Excel Spreadsheet (1997-2003 format) Includes select focus areas (out of 28) from select HP 2010 objectives (out of 467) Has data for HP2010 target, US, & Texas Links to source of county-level data

24. Create an overview of county health issues Links to HP2010 objectives information ◦ Help set realistic program goals Quickly determine information gaps Sources of comparison ◦ US  Texas  County Step 2: Quantify the Issue HP2010 Workbook-- Benefits

25. Table of Contents ◦ About Your County ◦ Census Links and Tables ◦ Neighborhood Demographics ◦ Access to Health Care ◦ Cancer ◦ Diabetes ◦ Environmental Health ◦ Heart Disease and Stroke Step 2: Quantify the Issue HP2010 Workbook

26. Table of Contents (cont’d) ◦ HIV ◦ Immunization and Disease ◦ Injury & Violence Prevention ◦ Mental Health and Disorders ◦ Nutrition & Overweight ◦ Occupational Safety &Health ◦ Oral Health ◦ Sexually Transmitted Disease ◦ Substance Abuse ◦ Tobacco Use Step 2: Quantify the Issue HP2010 Workbook

27. Questions? http://www.sph.uth.tmc.edu/charting