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Daniel J. Friedman The NAPHSIS/NCHS Collaboration— Past Successes and Future Challenges

Who’s Keeping Score? Changes in the Vital Records and Statistics Infrastructure in the Computer Age. Daniel J. Friedman The NAPHSIS/NCHS Collaboration— Past Successes and Future Challenges Salt Lake City 4 June 2007. Topics. Purpose Definitions Historical perspective Methods Findings

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Daniel J. Friedman The NAPHSIS/NCHS Collaboration— Past Successes and Future Challenges

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  1. Who’s Keeping Score? Changes in theVital Records and Statistics Infrastructure in the Computer Age Daniel J. Friedman The NAPHSIS/NCHS Collaboration— Past Successes and Future Challenges Salt Lake City 4 June 2007

  2. Topics • Purpose • Definitions • Historical perspective • Methods • Findings • Reflections

  3. But first, thanks to. . . • NAPHSIS executive committee • Advisory committee • NAPHSIS membership • NCHS • Former NCHS and NAPHSIS seniors

  4. Purpose To assess changes in the vital records and statistics infrastructure at state and national levels since ~1980 • Performance • Uses • Resources Focus primarily upon public health statistics applications of birth and death records, not civil registration

  5. Definitions • Vital records functions include: • Registration • Certification • Issuance • Corrections • Amendments • Quality control and information systems activities directly supporting vital records

  6. Definitions • Vital statistics functions include: • Statistical analysis • Compilation of vital records data • Quality control and information systems activities directly supporting vital statistics Other health statistics functions not included

  7. Definitions • “States”=52 jurisdictions • 50 states • New York City and Washington, D.C.

  8. Historical perspective Stages of U.S. vital records and statistics infrastructure • Colonial mandating of reporting (1632) • Central state collection (1842) • National establishment of registration areas (1880) • Integral component of public health structure

  9. Historical perspective • Increased computerization and cooperation (1968) • Computerization • ACME (1968) • Computer tapes to NCHS (1971) • Changing relationship between NCHS and states • VSCP (1973) • Enhanced emphasis on analysis • State centers for health statistics (1969) • Expanded use for administrative purposes • SSA EAB (1987)

  10. Methods--Indicators • Quantitative • State and national levels • Selection via D-S-L indicator decision funnel

  11. D-S-L indicator decision funnel #1. Potential indicators #2. Indicators with data available #3. Indicators with data available and meaningful a. valid b. inter-state consistency c. over-time consistency d. actionable #4. Ratio of meaningfulness to data collection effort #5. Final selected indicators

  12. Methods—Data sources • National Center for Health Statistics • Published data • Unpublished data • National Library of Medicine—PubMed • New York Times archives • Delphi survey

  13. Methods—Data sources • Web surveys of state vital records and statistics offices • Survey #1 • Assess if states provide or estimate data • 73 indicators • 1980-2005 for six selected years • 28 responding jurisdictions • Survey #2 • States provide or estimate data • 31 indicators • 1980-2005, with selected years varying among questions • 31 responding jurisdictions

  14. Methods--Limitations • Gap between needed potential indicators and indicators with data available • Varying • Data sources • Data quality • Some self-reported • Actual data • Estimated data • Sample sizes and generalizability • Start dates

  15. Findings--Performance

  16. Findings--Performance

  17. Findings--Uses

  18. Findings--Uses

  19. Findings--Resources

  20. Findings--Resources

  21. Findings—Central themes • Computerization improved performance for both vital records and vital statistics • EBC has helped to improve births performance much more than deaths • National system threatened by dramatic decline in implementation of revised standard certificates • Administrative and research uses greatly increased • Huge increase in uses not accompanied by concomitant increases in resources

  22. Reflections • U.S. vital records • Essential • Ubiquitous • U.S. vital statistics • Essential • Ubiquitous

  23. Reflections • BUT. . . minimal attention to health and well-being of vital records and vital statistics infrastructure

  24. Reflections • Our colleagues in infrastructure improvement • Henry Chadwick (1824-1908) • W. Edwards Deming (1900-1993) • “There is no substitute for knowledge” • “You can expect what you inspect” • “A system must be managed. It will not manage itself.” • “The problem is at the top; management is the problem.”

  25. AL—East Standings (May 21st)

  26. AL—East Standings (May 21st)

  27. AL—East Standings (May 21st)

  28. Reflections HELP WANTED . . . A few good metrics

  29. Reflections

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