1. How to organize and fund a national HES Päivikki Koponen 11.4.2008

2. Standardized but locally adapted Several issues need to be taken into account in health care systems, professional qualifications, roles, practices and culture

3. European HES models Building up a new national HES European standards taken into account Incorporating European HES module(s) into an existing national HES Balancing national time trends and European comparability (specific studies if needed) Incorporating European HES module(s) into an existing national HIS Invitation to HES not depending on HIS participation

4. Organizational responsibilities Conceptualization and planning Objectives, scope Operation Fieldwork, data processing Quality control Independent authority

5. Piloting One or several pilots are always recommended to assess feasibility and to ensure quality e.g. by Showing critical issues for standardization: training, measurement manuals etc. Testing willingness to participate, develop ways to motivate participation Testing timing (average duration/participant), needed personnel resources Testing the use of equipment, computer programmes, data management etc.

6. Budgeting Planning Coordination Training Piloting Sampling Recruitment Fieldwork Laboratory analysis Data entry and cleaning Quality assurance Analysis and reporting

7. Budgeting Personnel costs Costs for equipment and materials Costs for premises Transfer/mailing costs

8. Sources of funding International funding National funding Ministries and other governmental organizations National and regional health care, research & development organizations Insurance companies Foundations and professional organizations Commercial enterprises

9. Survey site General requirements Easy access Issues that may affect the measurements and survey results Privacy Room temperature Measurement specific requirements

10. Survey site option 1 Home visit (institution, workplace) + Easy access, less travel costs for participants + Relaxed environment, less ”clinic effect” -Unwillingness to allow access/privacy -Lack of safety for personnel -Personnel travel (time and cost) -Restrictions to measurement devices, calibration -No control of environment

11. Survey site option 2 Clinic visits in temporary clinics and specific survey personnel + Less personnel travel costs + Availability of measurement devices + Control of environment -Travel costs and difficulties in access to participants, requires activity -Setting up the clinic

12. Survey site option 3 Clinic visits within the existing health care system using the regular personnel + Less time needed to select personnel and set up the survey site -Difficulties in standardization -Public attitudes

13. Survey site option 4 Mobile clinics + Less travel costs + Standard environments - High cost

14. Fieldwork staff general requirements Legal rights to practice Motivation General appearance and conduct (cultural aspects) Willingness and ability to travel

15. Fieldwork staff options 1.Physicians + Professional respect increases participation + Acute situations and interpreting results - High cost - Independent decisions and adapting protocols - White coat/observer effect 2.Nurses + Following standards + Lower cost - Professional dependency and lower respect 3.Others + Specific qualifications needed for measurements - Restricted roles/tasks

16. Frequency and timing About 5 year intervals Adjusting variation caused by season, week-days and time of the day Availability of appointment times Special requirements (e.g. fasting)

17. Questionnaire administration mode Before, during and after examinations Self administration: to be checked and supplemented by personnel if needed + Lower cost + No interviewer effect, privacy -Missing data due to literacy level and impairments -Short and easy format needed

18. Questionnaire administration Interviews (personal/telephone, computer assisted) + Opportunity for clarification + Longer and more complex format (”jump-rules” and screening questions) -Personnel costs -Bias affected by personnel

19. Order of measurements Importance Sensitivity Stressfulness Comparability and standardization

20. Instructions to participants Invitation letter Average and maximum length Activities that may affect the survey results (eating & drinking, smoking, use of medicines, physical activity) Clothing Access to survey site Reimbursement of travel expences

21. Logistics Requirements for transportation of equipment Requirements for personnel travel Requirements for transportation of samples and data Privacy Quality of samples and data Data management

22. Conclusion Small practical issues may have major impact in quality