H H I H I 134 Monitoring System Change: A New Need For An Old Tool A modest proposal to integrate public health surveillance with health services research BY DAVID E. NELSON, BETSY THOMPSON, SUZANNE M. SMITH, JEFFREY R. HARRIS, JENNIFER MADANS, AND EDWARD L. HUNTER T HE IMPACT OF CHANGES in health care delivery on the public's health is difficult to determine. State and local areas differ in their programs and policies, and existing sources of data are inadequate for monitoring rapid changes. Ongoing routine data collection at the state and local levels would help to measure the effects of system change and to support the unique health pol- icy decisions that are made at these levels. However, such a comprehensive assessment of local trends in health and health care would require an interdisciplinary approach that in- tegrates public health surveillance with other data collection and analysis efforts. EXISTING SOURCES OF DATA Most of the data we have about the effects of the changing health care system come from five types of sources. Each data source has spe- cific information objectives, but no one source provides enough information to satisfy all data needs. In addition, each source has important limitations for measuring the impact of changes in health care delivery on the public. • HEALTH PLAN ADMINISTRATIVE DATA. Although most health plans gather ad- ministrative data, data collection is not stand- ardized across plans, and basic demographic information such as race or ethnicity may be missing. Administrative data sets also do not contain information on items such as receipt of preventive counseling services and barriers to care. In addition, these data cannot be used to estimate services received by individuals outside their health plans, to measure the im- pact of changes on uninsured persons, or to measure access problems. • PERFORMANCE MEASUREMENT SYS- TEMS. Health plan performance measure- ment systems such as the Health Plan Em- ployer Data and Information Set (HEDIS) 3.0 provide information to purchasers and licens- ing bodies about selected indicators related to quality of care. These systems have limited utility for monitoring population-based con- cerns because data from the systems are not comprehensive and data collection methods are not standard. • NATIONAL SURVEYS. National surveys have provided important information about the effects of health care delivery methods. The National Health Interview Survey (NHIS), an in-person household survey, has David Nelson is chief of the Behavioral Surveillance Branch of the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC) in Atlanta. Betsy Thompson is the managed care coordinator and Suzanne Smith is chief of the Health Care and Aging Studies Branch at the CDC's National Center for Chronic Disease Prevention and Health Promotion. Jeffrey Harris is director of the CDCs Office of Program Planning and Evaluation. Jennifer Madans is acting associate director of the Office of Vital and Health Statistics Systems at the CDCs National Center for Health Statistics (NCHS) in Hyattsville, Maryland. Edward Hunter is associate direc- tor of the Office of Planning, Budget, and Legislation at the NCHS. H E A L T H A F F A I R S - Volume 16, Number 5 © 1997 The People-toPeople Health Foundation, Inc. Downloaded from HealthAffairs.org on May 20, 2020. Copyright Project HOPE—The People-to-People Health Foundation, Inc. For personal use only. All rights reserved. Reuse permissions at HealthAffairs.org.