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Task Force on institutionalised people

Task Force on institutionalised people. Terms of reference - Mandate. TF on sampling issue Recommendation on the inclusion of institutions in the EHIS Why ? inclusion or exclusion broadly modify results for health issues

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Task Force on institutionalised people

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  1. Task Force on institutionalised people Technical Group HIS

  2. Terms of reference - Mandate • TF on sampling issue • Recommendation on the inclusion of institutions in the EHIS • Why ? • inclusion or exclusion broadly modify results for health issues • frequencies of people living in households/institutions broadly differ between MS comparison purpose • Health status and health services consumption may strongly differ between individuals living in institutions and in households • inclusion = major impact on several indicators such as activities of daily living (ADL) or for the indicators requested by OMC. • Cross cutting issue  special TF set up in June 2008 Technical Group HIS

  3. Terms of reference - Mandate • Aim of the new TF : provide guidelines (with recommendations, definitions, methods) for data collection in institutions in order to get representativity for the whole population • characteristics of the EHIS (sensitivity of the questions, interview means • which types of institutions should be covered by the EHIS? • should the whole "households questionnaire" or only part of it, be adjusted in order to collect data in institutions for only some main health indicators? And if yes, which questions? • how to create a sampling frame for institutions? • need to adapt the data collections methods? Technical Group HIS

  4. Task Force • Membership • Neville Calleja (MT- Chairman) • Christian Maggiori (CH) • Paivikki Koponen (FI) • Dirkjan Beukenhorst (NL) • Christa Scheidt-Nave (DE) • Giulia Milan (IT) • Linda Vike (LV) • 2 meetings this year (January and May) Technical Group HIS

  5. Special objectives • Related to sampling matters • How to find sampling frame available • Linked to the interview in general • Definition of institutions • Way to contact the institutions • Re-design the question • Resort to proxy, who ? • Deliverable : report with recommendations, definitions, methods to be used for data collection in institutions Technical Group HIS

  6. Contents of the report • Overview of the situation in MS • Base the guidelines on a realistic assessment of national situations • Information from the HIS/HES database • Questionnaire on CIRCA • 24 answers • Background document for the meeting (n°10) • Some results: • sampling frame EHIS: population or residence • type of sampling frame available: majority population register , some census • some countries with survey in institutions • Legal status to access institution required in 17 MS Technical Group HIS

  7. HIS/HES database & questionnaire response Technical Group HIS

  8. Contents of the report • Statistical matters • Sampling frame available to contact people living in institutions • frequence of updates? • pre-survey if household sampling frame? • Method 1: draw a sample in census • Method 2: build a list of institutions and draw the sample in it • Reflexion on definitions • What is an institution? • Take MS definitions but use SHA code for EU purposes • Elderly and nursing homes at least Technical Group HIS

  9. Contents of the report • Interview context – use of proxy • 2 groups of impairment • sensory impairment  direct interview • cognitive impairment  proxy allowed but who? relatives/care taker? • problem: freedom left to institutions on the type of impairment, perhaps blowing up of the cognitively impaired proportion • Solution 1/give priority to direct interviews 2/if problem, ask respondent’s agreement for using a proxy 3/proxy interview (record the nature of the proxy - relatives or carer) Technical Group HIS

  10. Adaption of EHIS • Some questions cannot be asked from proxies. • Exclusion of some questions entirely for institutionalised persons • Adaptation of other questions Technical Group HIS

  11. Recommendations: sampling frame • Toughest challenge is the harmonisation of the sampling frame between MSs. • Most viable option - running EHIS close to harmonised census (applicable in a no of MSs) • MSs with an updated population register can draw the sample from among the citizens flagged as resident in institutions. • Other MSs may be provided assistance on: • oversampling of certain age groups • applying inverse weights in order to get population level prevalence figures. Technical Group HIS

  12. Recommendations: included institutions • A decision may have to be taken whether to: • include all institutions in such a survey, or • include only those involved in the provision of care and therefore likely to influence the prevalence of selected chronic conditions. • This may also be required in view of the inaccessibility of certain institutions in different countries for interviewers. Technical Group HIS

  13. Recommendations: adaptations • Adaptation of EHIS to fit better with the requirements of an institutionalised population, (see Section 4.2) • Minimise use of proxies and restrict only to respondents with severe cognitive impairment • Specialised training to be provided to interviewers enable direct interviews in different kinds of sensory impairments. • The list of required chronic conditions may also have to be decided at ESTAT/SANCO level. Technical Group HIS

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