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Evaluation of Health of a Population TH Tulchinsky MD MPH Braun School of Public Health Jerusalem, Jan 2006.

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Presentation on theme: "Evaluation of Health of a Population TH Tulchinsky MD MPH Braun School of Public Health Jerusalem, Jan 2006."— Presentation transcript:


2 Evaluation of Health of a Population TH Tulchinsky MD MPH Braun School of Public Health Jerusalem, Jan 2006

3 Goals of Public Health To eliminate or reduce health problems and their consequences To prevent their occurrence or recurrence To promote duration and quality of life

4 Public Health Methods 1. Describe the distribution and size of disease problems in human populations 2. Identify etiological (the cause of disease) factors in the pathogenesis of disease 3. Provide data essential to the planning, implementation and assessment of services for the prevention, control and treatment of disease and to establish priorities among these services Source: The International Epidemiologic Association, 1996.

5 Assessing Health of an Individual I Current chief complaint History of the present illness Personal data - age, sex, ethnicity, education, marital status, children, living situation Occupational history Family history Personal history Functional enquiry - systems review; Summary of risk factors Physical examination

6 Assessing Health of an Individual II Differential diagnosis Other medical problems Investigation: laboratory, cardiographic, imaging, other Presumptive or working diagnosis Treatment and its effects Definitive diagnosis Long term management

7 Assessing Population Health 1.Population, demography, geography 2.Socio economic and cultural background 3.Public health infrastructure – sanitation, nutrition 4.Health care prepayment system and equity 5.Health care resources 6.Utilization of services 7.Outcomes – morbidity, mortality, functionality 8.Quality of care – peer and external review 9.KABP – knowledge, attitudes, beliefs and practices 10.Costs and benefits

8 Basics of Evaluation No single measure Multi factorial Quantity, quality, cost and efficiency Input, process, outcome Direct and indirect measures Monitoring is integral part of health system

9 Population Health Measurements Descriptive, health status Evaluative,Process,outcomes Predictive, risk estimation Explanatory, Etiology, determinants AJPH March 2004 Etiologicepidemiology Evidence based policy Evidence based medicine Health services research

10 The Land of X Trinidad

11 Population and Society Population, demography Fertility, age distribution Geographic, ethnic, religion mix Socio economic conditions –GNP per capita –Average family income –Education Social security system e.g. pensions, workmans compensation, drug benefits

12 Public Health Infrastructure Ministry of Health – national, provincial Local Health Authority Sanitation, water, sewage, garbage Housing/urban planning, zoning Business licensing /regulation Professional licensing/regulation Laboratories NGOs Nutrition – fortification, supplememntation

13 Health Resources Total $$$ per capita spent on health all sources, all services % GNP spent on health % for hospitals % for primary care Hospital beds/1,000 Medical and nursing personnel/1,000 Primary, secondary, tertiary care facilities Organized preventive care, MCH, immunizations

14 Health System Organization Health care pre-payment system Universal Consumer co-payments Organization of health services –Preventive –Curative Distribution e.g. urban/rural Integration – vertical, lateral Regional services systems Population or individual based

15 Outcomes: Mortality Related Indicators Infant mortality rates (IMRs); Maternal mortality rates (MMRs); Crude mortality rates (CMRs); Age-specific mortality rates; Cause-specific mortality rates - infectious, non- infectious diseases, trauma; Life expectancy (LE) at age 0, age 1, total Years of potential life lost (YPLL), by cause

16 Outcomes or Burden of Disease Risk factors e.g. smoking, nutrition Morbidity Mortality Functional Physiologic Quality adjusted life years (QALYs) Disability adjusted life years (DALYs)

17 Morbidity Outcome Indicators Incidence of vaccine-preventable disease Incidence of waterborne disease Incidence of food-borne disease Incidence/prevalence of tuberculosis Incidence/prevalence of STDs/AIDS/hepatitis Incidence of malaria, other tropical diseases Prevalence of non-infectious diseases e.g. CVDs Prevalence of disabling conditions Birth defects registry Neurological disease registry Cancer registry

18 Functional Indicators: Risk Factor Prevalence Smoking - age specific rates Sexual behavior – unsafe sex High risk behavior re motor vehicles Violence and injury - domestic, homicide, suicide Alcohol use Drug use

19 Functional Indicators Work and school absence Psychomotor function Work capacity School attendance and performance Fitness test performance Activities of daily living (ADL)

20 Nutrition Status Food supply per person by type of food Food intake surveys (e.g. NHANES) Anthropometric indicators- –growth patterns of infants and children; –body mass index of adults Dietary patterns Biochemical - blood sugar, cholesterol, lipids Micronutrient deficiency conditions - vitamins A, B, C, D, iodine, iron status Hematologic indicators - anemia and lead among infants, children and women, environment pollutants

21 Utilization of Services: Performance Indicators Immunization rates Visits to doctors per person per year Hospitalization by cause/1,000, ALOS Surgical rates/1,000 Hysterectomy, tonsillectomy rates Caesarian rates Mammography rates Pap smear rates

22 Hospitalization Data Sentinel event in health and health economics Limited size of data ALOS Admission rates Days of care per 1,000 popualtion Measure of efficiency of health system Can identify special health problems E.g. amputation of lower limb, Beersheva Case reviews e.g AMI management Infection, incident rates Case mix

23 Knowledge, Attitudes, Beliefs and Practices (KABP) Community, patient and provider What do people know What do they think What do they believe What do they do Crucial for control of AIDS, TB, risk behavior reduction

24 Costs and Benefits How much is spent on health How is it spent or mis-allocated How are health issues monitored Value gained in reduced burden of disease for specific expenditures How are services paid for –Hospitals –Primary care –Health promotion

25 Regional Health Profiles Geographic medicine Geographic information system Monitor equity Small areas analysis Think global, act local Services are provided locally Need to know local health conditions Used for payment between national and local services e.g. Scandinavian countries, UK

26 Quality of Care Training Accreditation –Governmental –Non-governmental Research Publications Peer review Quality assurance organization Tracer conditions e.g. amputation of LL

27 Tracer Condition Peer review internal External review Common, treatable/preventable Marker for outcome measure Indicator of quality of care Appendectomy with positive pathology AMI/post AMI completeness of care Incident reviews Maternal and infant death reviews

28 Summary Population at risk – geographic or sample Multi-factorial Measures of input Measures of process Independent variables Measures of outcome or dependant variable Costs and benefits Monitoring population health is integral part of health system

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