Health indicators and information systems for the year 2000.

PIP: Report focus is on the general problem of designing and developing information systems equal to the task of promoting and monitoring "Health for All by the Year 2000." Attempting to bridge the gap between theory and practice, this 2-part report proposes some priorities and guidelines for organizing and focusing the efforts of the many agencies, groups, and individuals working on health statistics worldwide; and concentrates on the situation in less developed countries where health information networks in support of the decision making process continue to be very weak and their content and organization need reappraisal. An illustrative set of health indicators for national health planning in a developing country is used to take stock of available concepts of measurement, to test their relevance and feasibility, and to consider the steps necessary to translate these concepts into operational health information systems. There are numerous advantages in concentrating on what are commonly termed "health indicators" and using them as a point of departure for collecting data and building information networks. Indicators define the content of data systems, a step that should logically precede decisions regarding data series, methods, staffing, and organizations. If properly designed to reflect the primary objectives of national or community health policy, a set of indicators serves as the minimum specifications of the information support system and describes its overall task. Health indicators are also an excellent way to promote statistical comparability within and among health care systems. Health indicators in the model presented are defined as statistics selected from the larger pool because they have the power to summarize, to represent a larger body of statistics, or to serve as indirect or proxy measures for information that is lacking. It would be both self-defeating and contrary to World Health Organization (WHO) goals to adopt a narrow perspective on health indicators and information systems. Those working on health indicators need to be in close touch with developments in the social indicators field. The following are among the major points made in the review and evaluation of some of the concepts and methods available to developing countries in designing health information systems for the year 2000: utility of proposed indicators, primarily for planning, monitoring, and evaluation at the national level, but also to some extent at the community level; state of readiness; validity, reliability, specificity, sensitivity, and economy or efficiency of proposed measures; feasibility, i.e., have practical and affordable methods of data acquisition been demonstrated; basic subcategories and disaggregations; compatibility with socioeconomic concerns and indicators; comparability with concepts of measurement used in more developed countries; and principal areas in need of further research and development.^ieng

Uniform basic data sets for health statistical systems.

The United States approach to coordinating health statistics involves introduction of multipurpose basic data sets describing health status and the health care system. Standard reporting procedures have been used for many years for vital statistics. Recently designated data sets cover health manpower, inpatient facilities, short-stay hospital discharges, and use of ambulatory care services. A data set for long-term health care is in the design stage. Advantages of this approach in the United States and internationally are: basic comparisons can be made between health care settings are geographic areas while maintaining the variety and flexibility of existing public and private information systems; shared local, regional, and national data systems can be set up; and better coordination can be achieved between government-sponsored general-purpose and administrative data systems. Problem areas are: avoiding undue proliferation, e.g. of disease-specific data sets; adhering to the principle of minimal requirements; linking data sets and coordinating them with census and other social indicators; promoting widespread use; assuring data quality; establishing mechanisms for review and revision; and extending the concept internationally.