Title A multilevel approach to health systems analysis using RISS - PowerPoint PPT Presentation

Title A multilevel approach to health systems analysis using RISS (Reporting-by-Intranet Statistical System) Carinci F, Corrado D, Dettorre A, Pellegrini F Monash Institute of Health Services Research, Australia Consorzio Mario Negri Sud, Italy 23 September 2001 4TH INTERNATIONAL CONFERENCE ON THE SCIENTIFIC BASIS OF HEALTH SERVICES Sydney, New South Wales, Australia

e.health services research Health Economics Quality of Care Research Clinical Epidemiology Clinical Epidemiology Public Health Health Services Research y g o l o i m Evidence-Based Evidence-Based e d i p E h c n r a r e e s d e R Medicine Medicine o s M e m o c t u O s c Population-based Health Research i t s i t Computer-Intensive Methods a Neural Networks t S n a i s e s y c t i s a i t a t B s o B i x u n i L Meta-learning / g U Internet n CORBA Object Oriented Programming i N n r a G e Distributed Computing l e n i h c a M t Data Mining e n a r t n I A V A J C o d e r e u s a b Statistical Sciences i l i t y Open Source Connectivity

Population-based health research Information from multiple sources Multidisciplinary and Multidimensional Cross-sectional and Longitudinal Experimental and Observational Administrative and Ad Hoc Systematic and Non-Systematic “Data-Warehouse” Disease Registries Research Evidence Geographical Information Systems Health law/regulations Hospital Episodes Primary care Drug utilization Individual/aggregated socio-economic indicators Structures, Individual/aggregated Operators characteristics

Statistical Sciences Bias/Variance Sampling techniques Adjustment Correlation Subgroups analysis Causal pathways Sampling Techniques Markov Chains Monte Carlo Gibbs sampling Random Effects Models Generalized Mixed Models Bayesian Mixed Models Multilevel models Hierarchical Regression Models Multilevel linear models Marginal models Generalized Estimating Equations

Open source connectivity Public Access to Re-usable sources Software engineering Developers’ networks Standard browsing Remote access Free Software Foundation/ GNU’s not Unix (GNU) Language Compilers-C,C++ Linux Connectivity Web-server technology Java Browser technology Cross-platform applications

Population-based fallacies Ecological fallacy drawing inferences at the individual level based on group-level data Atomistic fallacy drawing inferences at the group level based on individual data Psychologistic fallacy assuming that individual-level outcomes can be explained only in terms of individual-level characteristics (opposite:sociologistic) “Confounding” Micro-macro level variables interaction !!

http://statbone.cmns.mnegri.it Reporting-by-Intranet Statistical System Objective: • Automating processes of data-warehousing and statistical analysis for complex and fragmented databases • Delivering results in the form of widely accessible and interpretable reports Procedures: • BROWSE • REPORT/LIST • REPORT/INDEX • STANDARD • MAPS • GENMOD • Supported by CMNS, Regione Puglia, SAS, SUN Microsystems • Version 6.12, modules AF, BASE, STAT, GRAPH • Standardized Browser Outputs (HTML+Javascript) • Designed for remote analysis through SAS/CONNECT

Open Source – Script “logic” ASCII files: Network Sites database: site code, description, IP+location address Script: Specifications for linked operational database (.db file) .net file Specifications for linked structure database (.st file) Operational Database CSV record (pre-formatted, analytical form) .db file Structure Database Formatted document (input field) with structure data .st file Environment Environment data (linked to operational variables) databases .env file SAS programs Version specific SAS programs (overlays) .mak file (main) .mak file (custom) SAS datasets: Population Datasets Population and geographical data .sd2 file

Cumulative meta-analysis f i m Operational Database N 1 Structure ( ) f , f ,..., f ϕ Data 1 2 n � f i N 2 Touch+Pile-Up+Meta-Analyze (TPA) Distributed/Fragmented, Multilevel Hierarchical Network

Parallel processing f i m N 1 ( ) f , f ,..., f ϕ � 1 2 n f i N 2

An ‘admin’ RISS version: RISS-H Regione Puglia – Southern Italy, 114 Hospitals Diabetes � List Hospitals x Diabetes � List Hospitals x Complications Complications Yes/No LOS classes AGE (Binary Variables ) (Categorical Variables ) (Continuous) Specialties (Nominal variables)

An ‘epi’ RISS version: RISS-Q QUED Network QuED Qualità ed esito in Diabetologia � List Clinical Variables QuED centers � Index SF-36 QuED centers RISS/MAPS

Service Mapping e.health systems Provider resources Medical databases CARDIAB Diabetes Ambulatory Data Register Diabetes Centres LAYER 3 Educational programs (MICRO-LEVEL) Diabetes Australia Implementation Implementation DHS Surveys Population-based Approach SHCN PRE: AusDiab - POST: Ad-hoc Vs Quality of Life in Diabetes (SF-36) Disease Management ln[ π (x)/(1- π (x)]= β 0 + β 1 x Clinical guidelines Scientific Associations Cochrane Library Patient outcomes LAYER 2 Medical records (META-LEVEL) Clinical Variability Intranet Shared Information Research Research NHMRC System Evidence-based Medicine SHCN Multilevel models Vs Clinical Practice Public Health Data Burden of Disease Census data, AusDiab Operational Databases LAYER 1 Hospital Databases (MACRO LEVEL) Pharmaceutical prescriptions Governance Governance Regulations DHS Health needs Case-Mix/DRG Vs SHCN Health services Geographical data Census, Boundaries