Healthy People 2000 Consortium Meeting November 7, 1997

Summary of Breakout Group Discussion Concerning Priority Area 22: Surveillance and Data Systems

Introductions

Group Goals

• Discuss the "fan" framework for the Healthy People 2010 objectives, formulating specific suggestions for possible changes to the content and format.
• Specify criteria for year 2010 health objectives.
• Develop goals for Healthy People 2010 focus area 18, Public Health Infrastructure, specifically the section dealing with Surveillance and Data Systems.

Discussion Highlights

Satisfaction with the "fan" framework-Participants proposed several ideas for the possible improvement of the Healthy People 2010 framework. Suggestions were made regarding the design, scope, grouping of objectives, and choice of verbiage.

Overall, the group recognized the effort put forth in developing the "fan" but felt that the emphasis of the framework should reflect communities to a larger extent. Participants felt that the design process of the 2010 framework provides an opportunity to influence a change in the way people think. The vision of the "fan" is well meaning. However, the proposed framework appears a bit complicated in design, yet limited in dimension and structure. The challenge, according to the group, is to think about how health is determined. The "fan" depicts a public health view of health, but it is not comparable with the way people in communities think. If the "fan" is intended to inform the world what Healthy People is all about, perhaps limit the focus of the framework.

One way of modifying the current framework is to measure more immediate outcomes. Some group members felt that the current objectives were a bit general and encompass too many factors. By focusing on processes, attitudes and factors that influence health, we could use local models to help measure more immediate outcomes (for program improvements).

Another suggestion that was well received by the group was to think of the framework in more three-dimensional terms compared to the proposed linear model. By doing so, the connections could be viewed at different levels, like a "web." The current fan associates each enabling goal with only certain focus areas. Using a "web" could help convey the message that the individual focus areas are related in many ways, and that certain characteristics of the population, such as life style and access to health care might exacerbate disease.

A proposed idea is to concentrate on specific focus areas. This can be achieved by devoting a single fan for each of the twenty plus areas, and their corresponding objectives. A simpler approach would be to focus on the enabling goals (that is, delete the outer band (focus areas) of the fan). The enabling goals, (found in the inner portion of the fan framework) embody the cornerstone of the Healthy People initiative. As such, it might pique the interest of the public by concentrating on "health for all," independently of the focus areas.

The only foreseen problems identified for this last approach dealt with specifying limitations. The term "strengthening community," as opposed to "strengthening community prevention," implies more than just health. Thoughts of education, family services, economic development, and other aspects related to health but not in the domain of public health were discussed. While most agreed that the linkage with a broader idea of community might be desirable, concern was also expressed regarding the wisdom of such an initiative.

Criteria for Healthy People 2010 Objectives—During this period, the group's discussion concentrated on three types of objectives: measurable, developmental, and sentinel.

It was agreed that both measurable and developmental objectives are needed for Healthy People 2010. Discussion focused on the importance of considering existing health objectives and measurement systems-such as the MCH block grants, GPRA, and HEDIS-and the possibility of using the same goals and methodology.

In setting measurable objectives, a common belief expressed was the importance of "pushing" the data systems to their limits, but to avoid producing a "laundry list" of everything collected. When the conversation switched to developmental objectives, several questions were raised such as:

• How can such a target be set?
• Why are these data necessary?
• How will the identified objectives get implemented?
• Can a standard be defined to allow for continuity?

After quite a bit of discussion, the only conclusion reached was that guidance needs to be provided to the workgroups regarding these topics. Additionally, the group agreed upon the need for broad-based support of the objectives. Support would include not only funding to States for data collection, but also an established national "master plan" that could develop into a multilevel surveillance plan.

Sentinel objectives were envisioned by the group as a type of all-encompassing report card. As such, the group felt the sentinel objectives should be measured by data that are obtainable at the State and county level and for minority groups. The data sources of the sentinel objectives should include systems that could be available (not just vital statistics). This would allow for the inclusion of developmental objectives as sentinel objectives. Caution should be used in choosing most objectives. Too many might be perceived as overwhelming.

Objectives for focus area 18, "surveillance and data systems"—The guiding principle for this part of the discussion was to set standards and criteria for a system that would result in objectives that are meaningful to those within the public health family and the larger community without minimizing the importance of the data.

A first step would be to continue the objectives that were not reached during Healthy People 2000. This would require evaluating why the Nation (or subpopulation) did not reach the objectives. Once a reason has been determined, new programs could be developed at the Federal, State, and local levels to rectify the problems.

Additionally, for 2010 the following surveillance and data related objectives should be adopted and achieved:

• Technical training in statistical analysis will be completed for every local health department that needs it.
• One hundred percent of the local health departments will have at least one computer that can access the Internet.
• Require a surveillance system of the local health care system which would provide measures such as:
• per capita emergency room visits
• physicians per capita
• The current data gap in population-based surveys for children 6 to 12 years will be filled.
• Consistency in geo-coding will be achieved between States.
• Population data and health data will be available electronically at Census tract levels by age, race and sex, and in "real time."
• Real time birth and death data will be available to 100 percent of the local health departments.
• One hundred percent of the local health departments will have the capacity to aggregate and finalize data at the local level. Thus, local, State and national data will be comparable.
• The reportable disease list will include diabetes, end stage renal disease, myocardial infarction, coronary artery disease, and incidence of other chronic diseases.
• More meaningful hospital discharge data by coding underlying cause-of-illness in standardized groupings.
• Establish a uniform, high standard of surveying and maintaining data, which ensures confidentiality at all levels of government.
• X percent of States will have Y percent of their budgets directed toward data collection and analysis activities.
• X number of States will have their surveillance data systems organized such that information collected can be linked, integrated, and utilized for projections, planning and budgeting.
• All 51 States will have an electronic data warehouse with the capacity for data queries and analysis.

Participants

Diane Wagener , Facilitator, National Center for Health Statistics
Elizabeth Jackson, Recorder, National Center for Health Statistics
Timothy Champney, Ohio Department of Health
Valda Crowder, Society for Academic Emergency Medicine
Ronald Eckoff, Iowa Department of Health
Kim Edelman, Minnesota Department of Health
Meridel Funk, Nebraska Department of Health and Human Services
Fred Jones, Meharry Medical College
Rose Marie Martin, New Jersey Department of Health and Senior Services
Michael Medvesky, New York State Department of Health
Nancy Miller, Missouri Department of Health
Fred Richards, California Department of Health Services
Robert Rolfs, Utah Department of Health
Kathleen Turczyn, National Center for Health Statistics