Population health monitoring: an essential public health field in motion

Business intelligence systems for population health management: a scoping review

Objective

Population health management (PHM) is a promising data-driven approach to address the challenges faced by health care systems worldwide. Although Business Intelligence (BI) systems are known to be relevant for a data-driven approach, the usage for PHM is limited in its elaboration. To explore available scientific publications, a systematic review guided by PRISMA was conducted of mature BI initiatives to investigate their decision contexts and BI capabilities.

Materials and Methods

PubMed, Embase, and Web of Science were searched for articles published from January 2012 through November 2023. Articles were included if they described a (potential) BI system for PHM goals. Additional relevant publications were identified through snowballing. Technological Readiness Levels were evaluated to select mature initiatives from the 29 initiatives found. From the 11 most mature systems the decision context (eg, patient identification, risk stratification) and BI capabilities (eg, data warehouse, linked biobank) were extracted.

Results

The initiatives found are highly fragmented in decision context and BI capabilities. Varied terminology is used and much information is missing. Impact on population's health is currently limited for most initiatives. Care Link, CommunityRx, and Gesundes Kinzigtal currently stand out in aligning BI capabilities with their decision contexts.

Discussion and Conclusion

PHM is a data-driven approach that requires a coherent data strategy and understanding of decision contexts and user needs. Effective BI capabilities depend on this understanding. Designing public-private partnerships to protect intellectual property while enabling rapid knowledge development is crucial. Development of a framework is proposed for systematic knowledge building.

The Development of the Municipal Registry of People with Diabetes in Porto Alegre, Brazil

Background/Objective: Diabetes registries that enhance surveillance and improve medical care are uncommon in low- and middle-income countries, where most of the diabetes burden lies. We aimed to describe the methodological and technical aspects adopted in the development of a municipal registry of people with diabetes using local and national Brazilian National Health System databases. Methods: We obtained data between July 2018 and June 2021 based on eight databases covering primary care, specialty and emergency consultations, medication dispensing, outpatient exam management, hospitalizations, and deaths. We identified diabetes using the International Classification of Disease (ICD), International Classification of Primary Care (ICPC), medications for diabetes, hospital codes for the treatment of diabetes complications, and exams for diabetes management. Results: After data processing and database merging using deterministic and probabilistic linkage, we identified 73,185 people with diabetes. Considering that 1.33 million people live in Porto Alegre, the registry captured 5.5% of the population. Conclusions: With additional data processing, the registry can reveal information on the treatment and outcomes of people with diabetes who are receiving publicly financed care in Porto Alegre. It will provide metrics for epidemiologic surveillance, such as the incidence, prevalence, rates, and trends of complications and causes of mortality; identify inadequacies; and provide information. It will enable healthcare providers to monitor the quality of care, identify inadequacies, and provide feedback as needed.

Infrastructure- and workforce capacity for the provision of health care to people with invasive home mechanical ventilation: A scoping review of indicators and norms

INTRODUCTION

Both the availability and adequacy of infrastructure- and workforce capacity are critical to provide integrated and continuing care, especially to people with complex care needs such as those with invasive home mechanical ventilation (HMV). This review aims to synthesise indicators and norms that are available for assessing this infrastructure- and workforce capacity.

METHODS

A scoping review was conducted by searching PubMed, Livivo, the grey literature, specific registries, and the websites of relevant professional societies for international publications on specific infrastructure- and workforce capacity indicators or norms on HMV from January 2000 up to and including March 2021. Exclusion criteria comprised missing indicator/norm information, differing populations/care settings, and secondary literature. Indicators and norms were extracted, clustered, and analysed by applying the WHO Monitoring and Evaluation Framework and qualitative content analysis.

RESULTS

Fifteen publications met the inclusion criteria. Forty-five indicators and 44 norms on HMV-related infrastructure- and workforce capacity were synthesised. The synthesis revealed a heterogeneous set of indicators and norms (mainly from cross-sectional surveys and guidelines). The methodological information on their definition, rationales, disaggregation, and evidence is scarce.

CONCLUSION

To enable integrated care in HMV and comparable populations with complex care needs, the identified limitations in assessing infrastructure- and workforce capacity should be addressed.

[Health in All Policies Within Local Public Health Reporting in Public Health Service]

OBJECTIVES

The Public Health Service, as an administrative policy-oriented actor, can be essential for the implementation of Health in All Policies at the county level. Local Public Health Reporting, anchored in the federal state laws, as basis for planning processes can play a potentially central role in this regard. This study will investigate to what extent local health reports fulfill such an overarching role through integration and administrative intersectorality.

METHODS

A quantitative document analysis of published reports (random sample; n=53) was conducted based on a nationwide nonreactive data collection of Local Public Health Reporting. The degree of integration was classified in terms of methodological, content and intersectoral aspects. A stratified analysis was performed according to the type of regional authority, the administrative location of the Public Health Service and the type of report.

RESULTS

Integration in the form of data from at least two other subject areas was found in 29 reports (55%). Intersectorality was explicitly recognizable in nine reports (17%), and with an above-average frequency in district-free cities and children/youth reports. Integration of reports on infection protection/vaccination was below average. The organizational location with the social and/or youth fields of action was positively associated with the degree of integration.

CONCLUSIONS

From the perspective of Health in All Policies, the degree of integration and intersectorality of Local Public Health Reporting assessed so far is too low. There is potential for development through a beneficial organizational structure and the choice of topics, especially in the field of child and youth health.

Health data collection methods and procedures across EU member states: findings from the InfAct Joint Action on health information

Background

Health-related data are collected from a variety of sources for different purposes, including secondary use for population health monitoring (HM) and health system performance assessment (HSPA). Most of these data sources are not included in databases of international organizations (e.g., WHO, OECD, Eurostat), limiting their use for research activities and policy making. This study aims at identifying and describing collection methods, quality assessment procedures, availability and accessibility of health data across EU Member States (MS) for HM and HSPA.

Methods

A structured questionnaire was developed and administered through an online platform to partners of the InfAct consortium form EU MS to investigate data collections applied in HM and HSPA projects, as well as their methods and procedures. A descriptive analysis of the questionnaire results was performed.

Results

Information on 91 projects from 18 EU MS was collected. In these projects, data were mainly collected through administrative sources, population health interview or health examination surveys and from electronic medical records. Tools and methods used for data collection were mostly mandatory reports, self-administered questionnaires, or record linkage of various data sources. One-third of the projects shared data with EU research networks and less than one-third performed quality assessment of their data collection procedures using international standardized criteria. Macrodata were accessible via open access and reusable in 22 projects. Microdata were accessible upon specific request and reusable in 15 projects based on data usage licenses. Metadata was available for the majority of the projects, but followed reporting standards only in 29 projects. Overall, compliance to FAIR Data principles (Findable, Accessible, Interoperable, and Reusable) was not optimal across the EU projects.

Conclusions

Data collection and exchange procedures differ across EU MS and research data are not always available, accessible, comparable or reusable for further research and evidence-based policy making. There is a need for an EU-level health information infrastructure and governance to promote and facilitate sharing and dissemination of standardized and comparable health data, following FAIR Data principles, across the EU.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-021-00780-4.