Health information

Question 1

period life table

Answer 1

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.

Question 2

cohort life table

Answer 2

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.

Question 3

Demographic transition

Answer 3

= 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)

Question 4

Epidemiological transition

Answer 4

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

Question 5

replacement fertility rate

Answer 5

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

Question 6

crude fertility

Answer 6

(Number of live births in a year / Mid-year total population) × 1,000

Question 7

general fertility rate

Answer 7

(Number of live births in a year / Number of women aged 15-49) × 1,000

Question 8

infant mortaility rate

Answer 8

(number of deaths in children under 1 year / live births that year)*1000

Question 9

perinatal mortality rate

Answer 9

(number of deaths in first seven days + still births) / (number of live births + still births) *1000

Question 10

POSTNEONATAL MORTALITY RATE

Answer 10

(number of deaths in first 28 days of life) / (number of live births) * 1000

Question 11

total fertility rate

Answer 11

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

Question 12

age specific fertility rate

Answer 12

(Number of live births to women in a specific age group / Number of women in that age group) × 1,000

Question 13

health survey for England

Answer 13

– annual ~10k individuals. Measurements taken by a nurse + interviews with additional modules which vary year on year
health and health behaviours

Question 14

ICF

Answer 14

= 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).

Question 15

ICD

Answer 15

globally recognised coding system for health conditions and disease

Question 16

ICF

Answer 16

= 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

Question 17

ICHI

Answer 17

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.

Question 18

Healthcare resource groups (HRGs) =

Answer 18

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.

Question 19

SNOMED codes

Answer 19

= coding used in general practice. A structured clinical vocabulary used to capture detail in digital health records. It used for QOF payments.

Question 20

YLL

Answer 20

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.

Question 21

HEALTH-ADJUSTED (OR HEALTHY) LIFE EXPECTANCY:

Answer 21

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

Question 22

British national formulary =

Answer 22

comprehensive pharmaceutical reference book. Information on selection, prescribing, dispensing and administration of drugs – includes side effects, dose, contraindications.

Question 23

Prescribing and dispensing data =

Answer 23

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.

Question 24

Defined daily dose (WHO) =

Answer 24

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.

Question 25

Medicines possession ratio

Answer 25

sum of days supplied/number of days in the period can be >100%

Question 26

proportion of days covered

Answer 26

sum of days covered by medication/total number of days in the period

Question 27

uses of prescribing and dispensing data

Answer 27

- ICB monitoring spending and setting budgets - medicines optimisation targets - PNA - adherence to guidelines - identify outliers

Question 28

pharmacovigilence

Answer 28

= science and activities related to detecting, assessing and preventing adverse effects of medicines. MHRA responsible for pharmacovigilance.

Question 29

Pharmacoepidemiology =

Answer 29

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)

Question 30

Information systems =

Answer 30

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).

Question 31

digital health examples

Answer 31

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

Question 32

measures of healthcare usage and provision - use PNA as example

Answer 32

- 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

Question 33

Mathematical modelling =

Answer 33

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.

Question 34

Predictive risk modelling =

Answer 34

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

Question 35

information governance =

Answer 35

policies, processes and standards which ensure the effective, secure and ethical management of information

Question 36

IG legislation

Answer 36

- 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

Question 37

GDPR principles

Answer 37

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

Question 38

Caldicott standards

Answer 38

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

Question 39

life expectancy calculation

Answer 39

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.

Question 40

ideal specifications of an information system

Answer 40

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

Question 41

how would you estimate projected levels of disease in a population

Answer 41

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

Question 42

what is casemix

Answer 42

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.

Question 43

what are data artefact examples and how might they affect data

Answer 43

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

Question 44

length of stay data

Answer 44

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

Question 45

‘excess mortality’

Answer 45

defined as the all-cause crude mortality rate over and above that from the baseline average e.g. comparing pre and post pandemic