How to organize and fund a national HES

Päivikki Koponen11.4.2008

Standardized but locally adapted

Several issues need to be taken into account in health care systems, professional qualifications, roles, practices and culture

European HES models

Building up a new national HES European standards taken into account

Incorporating European HES module(s) into an existing national HES

Balancing national time trends and European comparability (specific studies if needed)

Incorporating European HES module(s) into an existing national HIS

Invitation to HES not depending on HIS participation

Organizational responsibilities

Conceptualization and planningObjectives, scope

OperationFieldwork, data processing

Quality controlIndependent authority

Piloting

One or several pilots are always recommended to assess feasibility and to ensure quality e.g. by

Showing critical issues for standardization: training, measurement manuals etc.Testing willingness to participate, develop ways to motivate participationTesting timing (average duration/participant), needed personnel resourcesTesting the use of equipment, computer programmes, data management etc.

Budgeting

PlanningCoordinationTrainingPilotingSamplingRecruitmentFieldworkLaboratory analysisData entry and cleaningQuality assuranceAnalysis and reporting

Budgeting

Personnel costsCosts for equipment and materialsCosts for premisesTransfer/mailing costs

Sources of funding

International fundingNational funding

Ministries and other governmental organizationsNational and regional health care, research & development organizationsInsurance companiesFoundations and professional organizationsCommercial enterprises

Survey siteGeneral requirements

Easy accessIssues that may affect the measurements and survey results

PrivacyRoom temperatureMeasurement specific requirements

Survey site option 1

Home visit (institution, workplace)+ Easy access, less travel costs for participants+ Relaxed environment, less ”clinic effect”- Unwillingness to allow access/privacy- Lack of safety for personnel- Personnel travel (time and cost)- Restrictions to measurement devices,

calibration- No control of environment

Survey site option 2

Clinic visits in temporary clinics and specific survey personnel+ Less personnel travel costs+ Availability of measurement devices+ Control of environment- Travel costs and difficulties in access to

participants, requires activity- Setting up the clinic

Survey site option 3

Clinic visits within the existing health care system using the regular personnel

+ Less time needed to select personnel and set up the survey site

- Difficulties in standardization- Public attitudes

Survey site option 4

Mobile clinics+ Less travel costs+ Standard environments- High cost

Fieldwork staffgeneral requirements

Legal rights to practiceMotivationGeneral appearance and conduct (cultural aspects)Willingness and ability to travel

Fieldwork staff options

1. Physicians+ Professional respect increases participation+ Acute situations and interpreting results- High cost- Independent decisions and adapting protocols- White coat/observer effect

2. Nurses+ Following standards+ Lower cost- Professional dependency and lower respect

3. Others+ Specific qualifications needed for measurements- Restricted roles/tasks

Frequency and timing

About 5 year intervalsAdjusting variation caused by season, week-days and time of the day Availability of appointment timesSpecial requirements (e.g. fasting)

Questionnaire administration mode

Before, during and after examinationsSelf administration: to be checked and supplemented by personnel if needed+ Lower cost+ No interviewer effect, privacy- Missing data due to literacy level and

impairments- Short and easy format needed

Questionnaire administration

Interviews (personal/telephone, computer assisted)+ Opportunity for clarification+ Longer and more complex format

(”jump-rules” and screening questions)- Personnel costs- Bias affected by personnel

Order of measurements

ImportanceSensitivityStressfulnessComparability and standardization

Instructions to participants

Invitation letterAverage and maximum lengthActivities that may affect the survey results (eating & drinking, smoking, use of medicines, physical activity)ClothingAccess to survey siteReimbursement of travel expences

Logistics

Requirements for transportation of equipment Requirements for personnel travelRequirements for transportation of samples and data

PrivacyQuality of samples and dataData management

Conclusion

Small practical issues may have major impact in quality