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How to organize and fund a national HES

How to organize and fund a national HES. Päivikki Koponen 11.4.2008. 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

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How to organize and fund a national HES

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  1. How to organize and fund a national HES Päivikki Koponen 11.4.2008

  2. Standardized but locally adapted • Several issues need to be taken into account in health care systems, professional qualifications, roles, practices and culture

  3. 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

  4. Organizational responsibilities • Conceptualization and planning • Objectives, scope • Operation • Fieldwork, data processing • Quality control • Independent authority

  5. 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 participation • Testing timing (average duration/participant), needed personnel resources • Testing the use of equipment, computer programmes, data management etc.

  6. Budgeting • Planning • Coordination • Training • Piloting • Sampling • Recruitment • Fieldwork • Laboratory analysis • Data entry and cleaning • Quality assurance • Analysis and reporting

  7. Budgeting • Personnel costs • Costs for equipment and materials • Costs for premises • Transfer/mailing costs

  8. Sources of funding • International funding • National funding • Ministries and other governmental organizations • National and regional health care, research & development organizations • Insurance companies • Foundations and professional organizations • Commercial enterprises

  9. Survey siteGeneral requirements • Easy access • Issues that may affect the measurements and survey results • Privacy • Room temperature • Measurement specific requirements

  10. 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

  11. 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

  12. 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

  13. Survey site option 4 • Mobile clinics + Less travel costs + Standard environments - High cost

  14. Fieldwork staffgeneral requirements • Legal rights to practice • Motivation • General appearance and conduct (cultural aspects) • Willingness and ability to travel

  15. Fieldwork staff options • Physicians + Professional respect increases participation + Acute situations and interpreting results - High cost - Independent decisions and adapting protocols - White coat/observer effect • Nurses + Following standards + Lower cost - Professional dependency and lower respect • Others + Specific qualifications needed for measurements - Restricted roles/tasks

  16. Frequency and timing • About 5 year intervals • Adjusting variation caused by season, week-days and time of the day • Availability of appointment times • Special requirements (e.g. fasting)

  17. Questionnaire administration mode • Before, during and after examinations • Self 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

  18. 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

  19. Order of measurements • Importance • Sensitivity • Stressfulness • Comparability and standardization

  20. Instructions to participants • Invitation letter • Average and maximum length • Activities that may affect the survey results (eating & drinking, smoking, use of medicines, physical activity) • Clothing • Access to survey site • Reimbursement of travel expences

  21. Logistics • Requirements for transportation of equipment • Requirements for personnel travel • Requirements for transportation of samples and data • Privacy • Quality of samples and data • Data management

  22. Conclusion • Small practical issues may have major impact in quality

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