PH 251 Management of Health Information Systems and Epidemiology

Course Description:
This course is designed to promote the management of information systems and the use of epidemiological methods in planning, implementation and evaluation of health services. Students will learn to use epidemiology when developing evidence-based health care services and policies. This course will be useful to all health workers at any level of the health service, especially those working in health statistics sections.

• Prerequisite Courses: PH 111 or Instructor’s permission

A. PROGRAM LEARNING OUTCOMES (PLOS):
The student will be able to:

1. Recognize, describe, discuss and research about the basic public health science facts and principles;
2. List, discuss and demonstrate the essential public health functions and their interrelationships at community and district level;
3. Describe, discuss and research adult, children and family health issues;
4. Discuss and demonstrate an understanding and practice of some generic public health competencies;
5. Demonstrate proper public health skills for public health practice in the community as a national public health officer;
6. Discuss and demonstrate community and cultural sensitivity in the health care environment;
7. Describe, discuss and research the determinants and problems of the health of adults, children and families;
8. Demonstrate proper cardio-pulmonary resuscitation (CPR), first aid techniques, and other healing and patient care abilities;
9. Demonstrate the ability and discuss how to make a community diagnosis based on the determinants of health in a community;
10. Identify and demonstrate good public health practice;
11. Have had work experience at a public health facility at community and national levels.

B. STUDENT LEARNING OUTCOMES (SLOS) - GENERAL
The student will be able to:

1. Use the epidemiological sequence to define problems, provide methods of intervention, and evaluate outcomes in the health services
2. Design and perform an epidemiological study to answer health related questions
3. Employ the epidemiological approach to assess the quality of published information
4. Describe and discuss the fundamental characteristics of health information and health information systems
5. Apply basic epidemiological principles and skills to organize and manage a health information system (H.I.S.) and the health evidence reporting (H.E.R.)

I = Introduced
D = Demonstrated
M = Mastered

C. STUDENT LEARNING OUTCOMES (SLOS) – SPECIFIC
The student will be able to:

General SLO 1: Use the epidemiological sequence to define problems, provide methods of intervention, and evaluate outcomes in the health services.

General SLO 2: Design and perform an epidemiological study to answer health related questions.

General SLO 3: Employ the epidemiological approach to assess the quality of published information.

General SLO 4: Describe and discuss the fundamental characteristics of health information and health information services.

General SLO 5. Apply basic epidemiological principles and skills to organize and manage a Health information system (H.I.S.) and the health evidence reporting (H.E.R.)

D. COURSE CONTENT

1. Epidemiology and health
   
   1. Epidemiology: meaning, nature and uses
      
      1. Different components of epidemiology
      2. Characteristics and uses of epidemiology
      3. Epidemiological approach: observational and experimental research
      4. Limitations of epidemiology
   2. Epidemiological concepts of health
      
      1. Health and disease
      2. Clinical medicine and epidemiology
      3. Natural history of disease
      4. Levels of prevention
      5. Confounding factors: definition, characteristics, and coping strategies
   3. Measures of health
      
      1. Rates: unadjusted (crude) and adjusted rates
      2. Rates in common use: morbidity (incidence and prevalence rates) and mortality
      3. Standardization: direct and indirect standardizations
      4. Errors in disease measurements: random errors and systematic errors (bias)
2. Epidemiological applications in health services
   1. Epidemiological methods
      
      1. Observational studies
         
         • -Case-control study, cross-sectional (prevalence) study
         • -Longitudinal (incidence) study
         • -Comparison of case-control and cohort studies
      2. Experimental (intervention) studies
         
         • -Clinical trials
         • -Field trials
         • -Community trials
      3. Application of these study methods in health interventions and in the evaluation of outcomes in health services
   2. Statistics for epidemiological studies
      
      1. Descriptive statistics: measures of central value, measures of dispersion
      2. Data classification: nominal scale, ordinal scale, ranked scale, continuous scale
      3. Choice of central tendency measurements: mode, median, mean
      4. Population and samples
      5. Sampling methods
      6. Statistical inference
      7. Probability
   3. Causal relationship in epidemiology
      
      1. Types of associations: spurious association, indirect association, causal association
      2. Criteria for causal association: specificity of association, strength of association, dose-response effect, consistent with present knowledge, temporally correct association, relationship between the presumed causative factor and the disease
3. Designing epidemiological studies
   
   1. Steps in an epidemiological study
      
      1. Preliminary steps
      2. Planning:
         
         • ­Definition of objectives, choice of study design, choice of study population
         • ­Sampling
         • ­Selection of variables to be measured and of measurement instruments
         • ­Planning the records and the analysis
         • ­Planning for time, personnel, space, supplies and equipment
         • ­Consolidation of plans in a written protocol
         • Preparing for data collection
           
           • ­Identification of the study population
           • ­Recruitment and training of staff
           • ­Pilot test of methods and procedures
           • ­Field organization
         • Collecting the data
           
           • ­Supervision of staff
           • ­Ensuring cooperation of the study population
           • ­Special issues in experimental studies
           • -Special issues in experimental studies
         • Processing the data and interpretation
           
           • ­On-going data analysis
           • ­Organizing outputs of data analysis and interpretation of results
         • Writing a report
         • Dissemination of results
   2. Choice of epidemiological studies in assessing health status in a community (demographic indices, patterns and common causes of morbidity and mortality, food availability and security, housing standard, water supply).
   3. Possible constraints in conducting epidemiological studies
4. Critical appraisal of health literature
   
   1. How to decide what the paper is about
   2. Preliminary questions in assessing what the paper is about
   3. The traditional hierarchy of evidence
   4. The broad topics of research and their method of work: screening, diagnosis, causation, prognosis, and therapy
   5. Misuses and mistakes in epidemiological applications
      
      1. Logical and extra-logical processes
      2. Traps and pitfalls of epidemiological applications
      3. Semantic problems
      4. Misuses of epidemiology
   6. Fallacies in medical reasoning
      
      1. Numerator and denominator, identifying appropriate denominator
      2. Comparison groups and follow-up group
      3. Age standardization
      4. Normal limits
5. Health information and health information systems
   
   1. Definitions
   2. Health information versus health information systems
   3. Health information and planning
   4. Data collection
      
      1. Aspects of data collection
      2. Data and information availability
      3. Methods of data collection
      4. Surveillance and monitoring
      5. Types and sources of data and information
         
         • ­Census
         • ­Vital statistics
         • ­Morbidity data
         • ­Linked health records of persons and patients
   5. Managing health information systems
      
      • ­The human component
      • ­Quality control
      • ­Confidentiality
      • ­Record linkage
      • ­Technical innovation, the role of information technology (IT)
   6. Managerial process for national health development
6. valuation of health services
   
   1. The role of epidemiological studies in the evaluation of health services
   2. Who is to carry out the evaluation?
   3. Health indices
   4. The systems approach
      
      • ­Process measures
      • ­Intermediate measures
      • ­Output (outcome) measures: why do we need feedback?
   5. Evaluation – what it should, can and can’t do
   6. Evaluation of preventive services
   7. Evaluation of curative services
7. Informatics and management of Health Information System (H.I.S.) and Health Evidence Systems (H.E.R.)
   
   1. Health informatics
   2. Health care services and information systems
   3. Standards in health informatics
   4. Health information systems (H.I.S.)
   5. Health evidence reporting (H.E.R.)
   6. Managing H.I.S. and H.E.R.

1. Lectures: in-class lectures
2. Group discussions and exercise on appraisal of medical literature on causation, diagnostic tests, treatment and prognosis.

F. REQUIRED TEXT AND COURSE MATERIALS

1. Joseph KH., Tan PhD. (2001) Health Management Information Systems: Methods and Practical Applications. Jones & Bartlett Publisher: 2nd edition or most recent edition.
2. Bonita R., Beaglehole R., KjellstrÖm T. (2007) Basic Epidemiology, World Health Organization, Geneva: 2nd edition or most recent edition.

G. REFERENCE MATERIALS

1. Wager KA., Lee FW., Glaser JP. (2005) Managing Health Care Information Systems – A practical approach for health care executives: 1st edition or most recent edition.
2. Jossey Wiley & Sons, Inc. Hovenga E., Kidd M., Cesnik B. (1996) Health Informatics: An Overview. Churchill Livingstone or latest edition.
3. Knox EG. (1979) Epidemiology in Health Care Planning: A Guide to the Uses of a Scientific Method. Oxford University Press – USA or latest edition.
4. Greenhalgh T. (2006) How to Read A Paper: The Basics of Evidence-based Medicine: 3rd edition or latest edition.
5. Barker DJP., Cooper C., Rose G. (1997) Epidemiology in Medical Practice. Churchill Livingstone: 5th edition or latest edition.

H. INSTRUCTIONAL COST
none

I. EVALUATION
The student must achieve 70% mastery or a “C” grade to pass this course

J. CREDIT BY EXAMINATION
None