HMIS Components and National indicator datasets
Components of indicators • Result from survey datasets which are used to develop an indicator set around two headline measures of personal well-being and social well-being • The two are crucial aspects of how people experience their lives.
Components of indicators • Each headline indicator is broken down into component indicators (and in places also subcomponent indicators) which reflect the different aspects which together comprise experienced well-being.
Components of indicators • The seven main components of personal and social well-being are also the elements used to create national Well-being Profiles (with emotional well-being split into its subcomponents).
Components of indicators • The indicators were created by standardising and transforming the survey data so that all results are presented on 0–10 scales, with a score of 5 always representing the average score
Components of indicators • Scores above 5 therefore show that well-being is higher than this average level and scores below 5 that is below the average.
Calculating indicator scores • The subcomponent and component indicatorswithin the framework are a set of composites which each combine responses to several questions (apart from two single item subcomponents). Subcomponents and components are then aggregated to create overall personal and social well-being scores.
Calculating indicator scores • The groupings in which measures are combined derive from an iterative process based on analysis of well-being theory, the substantive content of the question wordings, and the statistical structure of the data.
Calculating indicator scores • After deciding on the groupings, indicators are calculated in a three-stage process. • Firstly, scores for the original survey questions are standardised to allow meaningful comparison using standardised z-scores, measured in standard deviation units.
Calculating indicator scores • Secondly, questions were aggregated to produce subcomponent and component scores by taking the unweighted mean of the z-scores for the lower level indicators or questions.
Calculating indicator scores • Thirdly, the results were transformed on to 0–10 scales, calibrated so that 5 always represents the average score for respondents. In order to achieve this, the transformation was carried out using a curvilinear relationship
Steps in Designing an Indicator System • The development of even a single indicator is an iterative process that de Neufville (1975) estimates takes about ten years to complete. The process is time-consuming because indicators are developed in a policy context; thus, their interpretation goes beyond the traditional canons of science and enters the realm of politics.
Steps in Designing an Indicator System • With this caveat, we can enumerate some steps to identify an initial set of indicators and to develop alternative indicator systems. • CONCEPTUALIZE POTENTIAL INDICATORS: HOW?
CONCEPTUALIZE POTENTIAL INDICATORS • A reasonable first step is to determine which components (constructs) and their indicators adequately specify a comprehensive monitoring system.
CONCEPTUALIZE POTENTIAL INDICATORS • Based on an extensive review of literature about social indicators and health research, a model of the health care system and the potential indicators for measuring each component were formulated.
CONCEPTUALIZE POTENTIAL INDICATORS • inputs (the human and financial resources available to the health system) • processes (a set of nested systems that create the healthy environment that clients/patients experience in health care facilities, e.g. hospital organization, care quality) and
CONCEPTUALIZE POTENTIAL INDICATORS • outputs (the consequences of health care for clients/patients from different backgrounds).
REFINE THE INDICATOR POOL • No indicator system could accommodate all of the potentially important indicators identified by such a comprehensive process and still remain manageable. • The second step, then, is to develop a valid, useful, and parsimonious set of indicators.
REFINE THE INDICATOR POOL • The purposes the indicator system serves (e.g., description of trends, information for accountability purposes) constitute one criterion for reducing the initial pool of potential indicators.
REFINE THE INDICATOR POOL • System designers need to consult potential users to determine what those purposes should be, because the purposes will dictate the type of information that must be collected and the level to which it should be disaggregated.
REFINE THE INDICATOR POOL We assumed that indicators should: • reflect the central features of health care services and the health system • provide information pertinent to current or potential problems in the system.
REFINE THE INDICATOR POOL • measure factors that policy can influence • measure observed behavior rather than perceptions • be reliable and valid
REFINE THE INDICATOR POOL • provide analytical links • be feasible to implement and • address a broad range of audiences.
Developing indicators • The criteria used to select indicators that reflect the major components of health are reliable and valid (to some minimal extent) and meet basic standards of usefulness to the policy community. • These measures then became the core around which different indicator system options were generated.
Developing indicators • some highly desirable indicators may have to be eliminated because they cannot be measured reliably.
Developing indicators • The exercise suggests that some potential indicators which are not sufficiently developed to be included in an indicator system at this time are critical to a better understanding of the health care system and services.
Developing indicators • They are part of a developmental research agenda. After these indicators meet our criteria, they can be incorporated into the indicator system.
Developing indicators • Once a model of the health system is defined and indicators are selected, the next step is to identify alternative data collection strategies that could be used to build the system.
Developing indicators • Surveyed existing databases to determine what information was already being collected, and we identified areas where new indicator data were needed.
Developing indicators • Identified generic options that range from simply relying on whatever data are available at the time a report is produced or policy issue is considered (status quo) to developing and fielding a comprehensive data collection system that spans the major components of health (independent).
EVALUATE THE OPTIONS • If indicator system alternatives are to be considered seriously by policymakers, they need to be evaluated on a number of criteria. Each option was evaluated according to its: • Utility • Feasibility • Cost.
EVALUATE THE OPTIONS Whether each option could: • Describe national trends (e.g., in achievement, professionals quality and curriculum quality), • Describe those trends region by region. • Identify problems emerging on the horizon.
EVALUATE THE OPTIONS • Link health professionals and curriculum quality to achievement, thus enabling policymakers to target reforms • Enable the sponsor to provide leadership by monitoring curricular and achievement areas that are currently ignored.
BEGIN DEVELOPING OR REFINING INDIVIDUAL INDICATORS • After one of the alternative indicator systems is selected, the process of developing or refining the individual indicators begins with an evaluation of the technical adequacy and usefulness of existing indicators.
BEGIN DEVELOPING OR REFINING INDIVIDUAL INDICATORS • Advantages and disadvantages of each major potential indicator in the model must be evaluated, using currently available data and analyses.
BEGIN DEVELOPING OR REFINING INDIVIDUAL INDICATORS • Systematically synthesizing and contrasting information from a variety of databases will allow the usefulness of current indicators to be assessed and will lay the groundwork for developing and implementing new indicators.
BEGIN DEVELOPING OR REFINING INDIVIDUAL INDICATORS • It is important to identify the shortcomings in existing data and analyses and where these gaps and inconsistencies exist, to specify what work is needed to obtain reliable, valid, and useful indicators
BEGIN DEVELOPING OR REFINING INDIVIDUAL INDICATORS • It is therefore necessary to identify a research agenda directed toward improving an indicator system. This agenda should become a research component of the indicator system itself that enables researchers to piggyback on monitoring activities and test alternatives to indicators currently in use.
BEGIN DEVELOPING OR REFINING INDIVIDUAL INDICATORS • With increasing confidence in research findings, new indicator technologies can be incorporated into the system.
Community Health Status Indicators (CHSI) • The goal of Community Health Status Indicators (CHSI) is to provide an overview of key health indicators for local communities and to encourage dialogue about actions that can be taken to improve a community’s health
Community Health Status Indicators (CHSI) • This was designed not only for public health professionals but also for members of the community who are interested in the health of their community.
Community Health Status Indicators (CHSI) • Although CHSI presents indicators like deaths due to heart disease and cancer, it is imperative to understand that behavioral factors such as tobacco use, diet, physical activity, alcohol and drug use, sexual behavior and others substantially contribute to these deaths
CHSI • The CHSI report provides a tool for community advocates to see, react and act upon creating a healthy community. • The report can serve as a starting point for community assessment of needs, quantification of vulnerable populations and measurement of preventable diseases, disabilities and deaths.
CHSI • The CHSI report is accompanied by a companion document entitled Data Sources, Definitions and Notes. • This document gives detailed descriptions on data estimations, definitions, caveats, methodology and sources.
CHSI • Specific data items related to: • chronic and infectious diseases • birth characteristics or outcomes • causes of death • environmental health • availability of health services
CHSI • behavioral risk factors • health-related quality of life • vulnerable populations • summary measures of health and health disparities.
CHSI • The CHSI, was originally initiated in 2000, provides county-level health profiles for all U.S. counties so that programs addressing community health can readily access community health indicators. • Under the leadership of a public–private partnership
CHSI • The CHSI 2000 reports were developed primarily for public health professionals and community planners to use as a tool for setting priorities and targeting resources to improve community health.
CHSI • To eliminate health disparities and improve length and quality of life has become the central focus of many public health activities, increasing the emphasis on community-based approaches to health improvement.
CHSI • This shift to broader and more local approaches requires the development of new strategies, tools and resources that are responsive to the needs of communities.