A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases (2011) / Chapter Skim
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5 Existing Surveillance Data Sources and Systems
5 Existing Surveillance Data Sources and Systems
Pages 65-90
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From page 65... ...
. While there is no single nationwide surveillance system for cardiovascular and chronic lung diseases, a number of surveys, registries, cohort studies, and vital statistics are used by different stakeholders to gather dif ferent kinds of information about these diseases.
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From page 66... ...
The BRFSS, nationally coordinated by the CDC and conducted by state health departments in all 50 states and the District of Columbia, is a state-based system of cross-sectional health surveys of adults. It collects information on health risk behaviors, preventive health practices, and healthcare access, primarily related to the areas of chronic disease and injuries.
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From page 67... ...
The prevention of CVD and chronic lung disease is a long-term effort that must address risk factors throughout the life course, and the absence of significant information collected about children and adolescents means that the BRFSS does not provide local surveillance of obesity, diet, and physical activity in these age groups. Although other surveys do collect such information on children and adolescents, not being able to link that information to parents' information is a handicap for prevention efforts.
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From page 68... ...
. Although the YRBSS has several strengths, its main shortcomings include its limited representativeness and lack of detailed questions on risk factors for CVD and other chronic diseases.
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From page 69... ...
Strengths and limitations The NHIS serves as the nation's benchmark health survey. The main strengths of the NHIS are its representativeness, large sample size, adequate sampling of minorities, good response rates, and data on CVD and chronic lung conditions and risk factors.
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From page 70... ...
The growth of state and local health surveys is a positive development, demonstrating that policy makers at those levels recognize and are responding to the need for population health data. Although these sur veys differ in the topics covered, measures used, and sample designs, many adopt designs and questions from the national surveys described above, and they have considerable use for tracking change and disparities in CVD and chronic lung disease within their target geographic areas.
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From page 71... ...
Questionnaires are translated and administered in English and Spanish. The questionnaires include three questions related to heart conditions (heart attacks, coronary heart disease, strokes, and congestive heart failure)
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From page 72... ...
The NYC CHS is a local health survey that col lects information on health risk behaviors, health conditions, preventive health practices, and healthcare access, primarily related to chronic disease and injuries. This survey was initiated in 2002 and is conducted annually.
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From page 73... ...
Examples of population health surveys that rely on respondent self-report include the NHIS, the YRBSS, the BRFSS, and many comprehensive state and local health surveys, such as the CHIS, the OFHS, and NYC CHS. Examples of population health surveys that employ both in-person clinical and laboratory examinations as well as respondent self-reports are the NHANES, SHOW, and NYC HANES.4 The CDC's BRFSS and YRBSS are two examples of surveys that have advanced chronic disease surveillance capacity at the state level through the efficient leverage of federal resources, and in some cases they include local sampling.
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From page 74... ...
Aftercare registries record information pertaining to care regimens, such as institutionalizations or hospitaliza tions. At-risk registries consolidate information on individuals with known or perceived risk factors for a disease, such as for those who smoke (creating risk for chronic pulmonary disease, cardiovascular disease, and cancer)
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From page 75... ...
Though acute lung disease registries and tissue banking (e.g., Acute Respiratory Distress Syndrome Clinical Network, or ARDS Net9) have become important tools to understand and combat acute pulmonary disease, registries are more limited in the area of chronic lung disease.
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From page 76... ...
. Not unlike the current patchwork of chronic disease surveillance systems in the United States, European registries are often diffuse, lack interconnectivity, and lack certain usefulness that might be better achieved through nationwide harmonization.
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From page 77... ...
An assess ment by D'Agostino and colleagues (2008) that included 8,491 participants from the original Framingham Heart Study and the Framingham Offspring Study demonstrated that a sex-specific multivariable risk factor algorithm could be easily used in primary care to quantify general CVD risk and specific CVD risk (coronary, cerebrovas cular, and peripheral arterial disease and heart failure)
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From page 78... ...
The RBS added the classic CVD risk factors, including diabetes, to the baseline visit; subsequently it broadened its scope to include many other common exposures and chronic disease outcomes. Most risk factors, including psychosocial variables, are measured at every visit.
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From page 79... ...
Health Services Data Data drawn from health services encounters or medical records can be used to understand healthcare access; identify services that people with chronic conditions receive, including patient visits, examinations, and laboratory and imaging studies; and examine healthcare quality and costs. These data are valuable in chronic disease surveil lance when they are based on systematic recording of information by trained professionals; they are less valuable when the recording of data is less uniform and is based more on subjective professional judgments regarding what to record about the person's condition.
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From page 80... ...
These limitations include coding errors, limited clinical information, and diagnostic misclas sification, which include underdiagnosis, overdiagnosis, and misdiagnosis common for cardiovascular and chronic lung diseases. Although the specificity of diagnostic algorithms shows promise for selected applications (Mapel et al., 2006; Yarger et al., 2008)
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From page 81... ...
. Currently hospitals provide data to the Joint Commission on 57 inpatient measures, including metrics on processes of care for acute myocardial infarction and congestive heart failure, but do not include metrics for chronic lung diseases.
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From page 82... ...
. A major gap in the current CMS/Joint Commission hospital reporting and feedback is the lack of measures for some chronic lung diseases.
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From page 83... ...
NHAMCS includes detailed questions on chronic diseases, including a checklist of chronic conditions, participation in disease management programs, and diagnostic and screening services. The survey also collects infor mation on each medication prescribed, as well as information on health education and non-medication treatment.
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From page 84... ...
Despite these limitations in misclassification, surveillance of CVD and chronic lung disease mortality is important to monitor reductions in the burden and impact of chronic diseases on population health and for assessing improvements in treatment and management. To increase their utility, cause of death recording needs to be improved.
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From page 85... ...
On the other hand, a number of national disease registries and chronic disease surveillance programs have been conducted in a more cost-efficient manner, through the use of a unique personal identifier. The use of a personal health identifier has allowed for the linking of different computerized databases and files for the express purpose of bringing together patient demographic, medical history, clinical, treatment, and outcomes data, which has greatly facilitated the design and conduct of population-based surveillance studies.
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From page 86... ...
However, like registry data, health services data exclude information extraneous to the healthcare delivery system. The strengths of the current data systems for cardiovascular disease and chronic lung disease surveillance relate to the multiple and diverse informants used to monitor care -- population-based surveys, patient-based surveys, provider-based surveys, and health services data.
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From page 87... ...
2000. Validation of death certificate diagnosis of out-of-hospital coronary heart disease deaths in Olmsted County, Minnesota.
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From page 88... ...
2002. Lifetime risk for developing congestive heart failure: The Framingham heart study.
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From page 89... ...
1996. Community surveillance of coronary heart disease in the Atherosclerosis Risk in Communities ( ARIC)
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