Health information Flashcards
period life table
a table for a specific point in time (e.g. 2024). The age specific mortality rates for a given time point are applied – it does not make allowances for changes in mortality rates over time. Data is easier to collect but it doesn’t tell us much about the predicted survival of people over their life.
cohort life table
track a cohort of people born in the same year through life. It allows for changes in mortality rates. the cohort life table takes into account observed and projected improvements in mortality for the cohort throughout its lifetime. Cohort figures are therefore regarded as a more appropriate measure of how long a person of a given age would be expected to live on average.
Demographic transition
= theory that describes the transformation of a population’s age structure as it develops economically and socially. Five stages: pre-industrial, developing/industrialisation (population boom), urbanisation, developed, de-industrialisation/shift to service-based economy (future population change depends on fertility rate)
Epidemiological transition
changing patterns of population distributions in relation to changing patterns of mortality, fertility, life expectancy, and leading causes of death.
Two major components of the transition:
(1) changes in population growth trajectories and composition, especially in the age distribution from younger to older, and
(2) changes in patterns of mortality, including increasing life expectancy and reordering of the relative importance of different causes of death
phases:
1) pestilence and famine - low levels of NCDs and life expectancy
2) receding pandemics
3) degenerative and man made diseases (CVD, obesity, diabetes)
4) delayed degenerative disease
replacement fertility rate
the total fertility rate at which a population exactly replaces itself from on generation to the next - typically above 2 to account for the fact that not all children survive to reproductive age and the skewed birth ratio towards boys
crude fertility
(Number of live births in a year / Mid-year total population) × 1,000
general fertility rate
(Number of live births in a year / Number of women aged 15-49) × 1,000
infant mortaility rate
(number of deaths in children under 1 year / live births that year)*1000
perinatal mortality rate
(number of deaths in first seven days + still births) / (number of live births + still births) *1000
POSTNEONATAL MORTALITY RATE
(number of deaths in first 28 days of life) / (number of live births) * 1000
total fertility rate
Sum of age specific fertility rates (usually in 5-year age groups) at a given time point
average number of children that would be born to women during her lifetime if she experienced current fertility rates throughout her life
age specific fertility rate
(Number of live births to women in a specific age group / Number of women in that age group) × 1,000
health survey for England
– annual ~10k individuals. Measurements taken by a nurse + interviews with additional modules which vary year on year
health and health behaviours
ICF
= International classification of function, disability and health – classification system that provides a standard language and framework for describing health and health-related states. It shifts the focus from solely a medical or biological perspective to include the social aspects of disability. Provides an understanding the interaction between a person’s health condition and contextual factors (both environmental and personal).
ICD
globally recognised coding system for health conditions and disease
ICF
= International classification of function, disability and health – classification system that provides a standard language and framework for describing health and health-related states. It shifts the focus from solely a medical or biological perspective to include the social aspects of disability
key components:
- Body functions and structures – impairments
- Activities of people and activity limitations (disability)
- Participation in all areas of life and restrictions they experience (disability)
- Environmental factors – facilitators or barriers
ICHI
international classification of healthcare interventions. Codes built around the target + action + means (process/methods). In the UK we use OPCS4 to classify healthcare interventions – used for reimbursement for providers.
Healthcare resource groups (HRGs) =
grouping together similar interventions which consume similar levels of resource. Used for payment by results system for paying providers. National tariffs set for each HRG.
SNOMED codes
= coding used in general practice. A structured clinical vocabulary used to capture detail in digital health records. It used for QOF payments.
YLL
is a measure of premature mortality that takes into account both the frequency of deaths and the age at which it occurs. YLL estimates the years of potential life lost due to premature deaths. YLL takes into account the age at which deaths occur, giving greater weight to deaths at a younger age and lower weight to deaths at older age.
HEALTH-ADJUSTED (OR HEALTHY) LIFE EXPECTANCY:
Average number of years that a person can expect to live in “full health” by taking into account years lived in less than full health due to disease and/or injury. It incorporates information on mortality (such as life expectancy) and health status (such as morbidity) into a single estimate that can be considered not only a measure of quantity of life but also a measure of quality of life. measure of health status or disability could be disability weights used in GBD - create severity adjust estimates of proportion of people with disability in each age group
British national formulary =
comprehensive pharmaceutical reference book. Information on selection, prescribing, dispensing and administration of drugs – includes side effects, dose, contraindications.
Prescribing and dispensing data =
published by NHS BSA and NHS digital (secondary care). The denominator used for comparisons can be patient list size and adjust for case mix (ASTRO-PUs) units of measurement:
- Items = provide a count of the number of prescriptions or dispensed events i.e. the number of time a drug is prescribed. Does not account for the amount prescribed on the prescription.
- Quantity = gives the total number of individual units (such as tablets, millilitres, etc.) dispensed. It doesn’t account for strength of the medicine prescribed.
- Net Ingredient Cost (NIC) = represents the list price of the medication, focusing on the basic cost of the drugs. It doesn’t reflect the actual cost to the health system.
- Actual Cost = includes NIC along with all additional fees and adjustments, offering a complete picture of expenditure.
Defined daily dose (WHO) =
assumed average maintenance does per day for a drug used for its main purpose. This is based on the prescribing activity not the recommended dose – can compare prescribing across countries or regions or providers. In the UK it is the average daily quantity – a typical daily dose of a medicine that a GP prescribe to an adult.
Medicines possession ratio
sum of days supplied/number of days in the period
can be >100%
proportion of days covered
sum of days covered by medication/total number of days in the period
uses of prescribing and dispensing data
- ICB monitoring spending and setting budgets
- medicines optimisation targets
- PNA
- adherence to guidelines
- identify outliers
pharmacovigilence
= science and activities related to detecting, assessing and preventing adverse effects of medicines. MHRA responsible for pharmacovigilance.
Pharmacoepidemiology =
study of uses and side effects of drugs in a population and how these are distributed. Studies can be descriptive (patterns of use, incidence of side effects) or analytical (investigate relationships – case control, cohort)
Information systems =
integrated set of component which collect, store, process and distribute data. Transforms raw data into meaningful information. Input (raw data) -> processing -> output (info for decision making).
digital health examples
EHR
NHS app and patient portals
clinical guidance and evidence access
information exchange systems
tele health - remote appts, triage, scheduling
AI
remote monitoring - diabetes, CVD
health promotion apps
NHS app
wearable devices - e.g. drug overdoses
measures of healthcare usage and provision - use PNA as example
- Healthcare provision: number and distribution of providers, nurses/GPs per capita, waiting times (in absence of increased demand), hospital beds, ambulance response times, opening hours, GP practice size list, travel times
- Healthcare use: admissions and length of stay, number of patients seen, bed occupancy, readmission rate, GP consultations per patient, referral rates, wait times (alongside patient numbers), A&E visits, prescriptions, screening and vaccination uptake
Mathematical modelling =
using algorithm and equations to represent real world systems to predict, analyse, describe and solve problems. E.g. outbreak modelling, Markov models, predictive models, system dynamics models , queue modelling.
Predictive risk modelling =
used to predict the likelihood of a future event based on historical data - used for risk stratification. E.g. health outcomes, triple fail event, readmission – assign risk scores to patients e.g. Q covid risk prediction model
information governance =
policies, processes and standards which ensure the effective, secure and ethical management of information
IG legislation
- Data protection act 2018 – UK implementation of GDPR and ensures PI is processed lawfully
o Principles for managing and using data
o Individuals have the right to request all personal data held by organisations - Human rights act – right to privacy
- FOI Act 2000 – provide public access to info held by public authorities
- Health and social care act – legal basis for sharing of health information
- Public health act – legal basis for sharing information for outbreak control
GDPR principles
1 Lawfulness, fairness and transparency
2 Purpose limitation
3 Data minimisation
4 Accuracy
5 Storage limitation
6 Integrity and confidentiality (security)
7 Accountability
stronger legal protection for special data e.g. health, genetics
Caldicott standards
guidelines for handling patient identifiable data in the NHS. Seven principles:
1) Justify purpose for use
2) Use only when necessary
3) Use minimum required
4) Access only on need to know basis
5) Everyone must understand responsibilities
6) Comply with the law
7) Duty to share information can be as important as duty to protect confidentiality
life expectancy calculation
The average number of additional years a person can be expected to live for if he or she experiences the age-specific mortality rates of the given area and time period for the rest of his or her life. (uses period life table)
A cohort life table uses a combination of observed mortality rates for the cohort for past years and projections about mortality rates for the cohort for future years.
Life expectancy will differ depending on the use of current (period) mortality rates or historic (cohort) mortality rates. Cohort life expectancy takes account of future trends in mortality rates.
ideal specifications of an information system
Record linkage and aggregation of person-based data
Handling of information at different geographical levels
Automated data feeds into system to avoid need for manual entry
Timeliness of data (users generally want near real time)
Ease of access to information for analysis
Ability of system to automate some routine analysis
information governance
how would you estimate projected levels of disease in a population
Estimate disease prevalence in subpopulations (age and sex) - robust baseline data
Assume that the estimated values will remain the same or change in a predetermined pattern in the future.
Multiply the estimates of prevalence by the projected population groups’ size (census projections) to calculate the number of people with the disease in each group
assumes:
- accuracy of current prevalence estimates
- no change in incidence or duration of disease across age groups (P =I *D )
- projections are accurate - no dramatic changes in population demographics
- no changes in dementia treatment
what is casemix
reflects make up of patient population - complexity, age, etc.
must adjust for case mix if comparing across hospitals or over tim e
casemix groupings e.g. HRGs . These groupings can be based on age, diagnosis, procedure,
elective/emergency/maternity or a mixture of all.
what are data artefact examples and how might they affect data
coding errors or changes in coding which mean you might make incorrect conclusions from looking at data
for example coding missing data as 0 or 999 may make it look like there are outliers in the data set or that the data is skewed
can deal with this by using cut offs for impossible values
length of stay data
reflect how health care is delivered e.g. in hospital vs in the community (shorter Los)
challenges in discharging - e.g. delays due to lack of social care capacity
should be adjusted for with casemix
‘excess mortality’
defined as the all-cause crude mortality rate over and above that from the baseline average e.g. comparing pre and post pandemic
