Robust Data System Research Articles

Refining and expanding accountability policy for English learners to support Lau implementation: A critical policy analysis

ABSTRACT Title I accountability requirements under the Every Student Succeeds Act (ESSA) represent the present-day instantiation of Lau, which requires schools to provide a program for English learners (ELs) that supports their meaningful engagement and to provide transparent information about EL program quality. This study uses critical policy analysis to explore whether ESSA accomplishes what it intends. Employing a parallel mixed methods design, we first analyze longitudinal data from two states to examine whether their approaches to assessing EL students’ academic performance and progress support valid claims about EL achievement. Then, we analyze focus group and interview data from educators, advocates, and families in states to understand how they assess the quality of a school’s EL program. Taken together, our findings highlight the need for the incorporation of multiple perspectives into the design of state accountability systems and for the development of robust data systems that facilitate the sharing of accurate and nuanced information related to EL student outcomes and opportunities.

Learning from COVID-19: A roadmap for integrated risk assessment and management across shocks of pandemics, biodiversity loss, and climate change

The COVID-19 pandemic demonstrated the fragility of international, national, regional, and local risk management systems. It revealed an urgent need to improve risk planning, preparedness, and communication strategies. In parallel, it created an opportunity to drastically re-think and transform societal processes and policies to prevent future shocks originating not only from health, but also combined with those related to climate change and biodiversity loss. In this perspective, we examine how to improve integrated risk assessment and management (IRAM) capacities to address interconnected shocks. We present the results from a series of workshops within the framework of the University of Zurich and University of Geneva. Initiative "Shaping Resilient Societies: A Multi-Stakeholder Approach to Create a Responsive Society". This initiative gathered experts from multiple disciplines to discuss their perspectives on resilience; here we present the key messages of the "Pandemics, Climate and Sustainability” thinking group. We identify a roadmap and selected research areas concerning the improvement of IRAM analysis capacities, practices, policies. We recommend the development of robust data systems and science-policy advice systems to address combined shocks emerging from health, biodiversity loss and climate change. We posit that further developing the IRAM framework to include these recommendations will improve societal preparedness and response capacity and will provide more empirical evidence supporting decision-making and the selection of strategies and measures for integrated risk reduction.

We have an SEL policy! Now what?

States have made tremendous growth within the last decade developing and implementing statutory, regulatory, and non-regulatory policies and practices that center student and adult social, emotional, and academic development. Almost all states have some form of guidance or support for local education agencies (LEAs) to implement social and emotional learning (SEL) and over half of states have SEL standards or competencies. Even with this growth, empirical evidence is limited on how state SEL policies and practices influence local implementation. To begin to address this gap, the authors interviewed 16 state education agency (SEA) staff from 13 states to explore what they perceive as effective SEL implementation and any evidence that supports their claim. Through exploring the arc of the development, implementation, and evaluation of their state SEL policies and practices, SEA staff uplifted the significance of engaging with multiple stakeholders (e.g., educators, families, and communities), the critical lever that statutory and regulatory policies hold in supporting locally-driven SEL implementation, key non-regulatory policy and practice efforts (e.g. embedded and explicit instruction, adult SEL, and systemic SEL), the importance of SEL being both a standalone effort and embedded with other pertinent initiatives, and the need for more robust data systems that help determine which policies and practices best support student and adult social, emotional, and academic development.

The Post-COVID-19 Economic Recovery, Government Performance and Lived Poverty Conditions in Kenya

The post-COVID-19 era has witnessed intensive engagements on latest datasets on COVID-19 experiences and the need for robust data systems to understand emerging policy pathways. There have also been extensive deliberations on how public organisations can deliver beyond immediate concerns with economic recovery and improved livelihoods. This paper draws insights from the Afrobarometer round 9 dataset on how different African governments' economies have been recovering from COVID-19 and how this has affected citizens' well-being in Kenya. The results show that despite the good recovery progress, the government has yet to stabilise high food prices, inflation, debts, job creation, etc. While national policy priorities may explain how this situation plays out, these challenges remain complex and linked to external factors that African governments may have little control over.

PARTNERING TO DEVELOP COUNTY-LEVEL DATA PROFILES

Abstract Building robust data systems that include information on the health of older adults is crucial to developing programs and services that meet their health and social needs. Organizations and agencies can use this information to target resources and identify community partners, as well as using data to support grant applications. But there are challenges to building such systems, even within the public health system, due to lack of expertise, funding, and access to underlying data sources. Through its Age-Friendly Public Health Systems initiative, Trust for America’s Health’s has worked directly with several state public health departments to explore opportunities to develop and expand their county-level data profiles on older adults. This session will highlight the unique collaborations and partnerships between departments of health and other institutions, including academia, to develop data profiles. Through these innovative partnerships, departments of health have been able to develop dynamic data profiles that they share with aging services providers to discuss strategies to support their older adults in their communities. Best practices and lessons learned through the profile development process will also be discussed.

Debugging inequities: Data use, “gumshoe work,” and problem identification in district-wide computer science education initiatives

As districts across the United States move to implement comprehensive computer science education (CSed) initiatives, there is increasing interest in utilizing data-informed strategies such as continuous improvement to address systemic inequities. However, the specifics of how education institutions move from collecting and monitoring data into processes of systems improvement are not straightforward. This study explores the critical intermediary step of diagnostic problem framing which connects the collection of data to the identification of root causes of inequities so that adequate action can be taken to change an instructional system. Without taking the step of diagnostic problem framing, district leaders run the risk of using data to change systems in ways that simply reproduce or worsen existing inequities. Through four cases from three school districts implementing comprehensive (e.g. K12, at scale) CSed initiatives, we explore the dynamics of diagnostic problem framing around each of the four phenomena related to equitable CSed as specified in the CAPE framework: system and teacher capacity around CSed, student access to CS learning, participation rates in those opportunities by subgroups, and the quality of the experience of those participating. Our findings highlight five factors mediating diagnostic problem framing: conceptualization of equity as a multifaceted phenomenon, problem attribution to systems, not students, ability to analyze data for indicators of inequities, knowledge of local instructional systems, and embeddedness in instructional networks. Our results affirm the importance of developing robust data systems in CSed initiatives, but also show how attention to broader institutional factors can improve the capacity of these systems to address inequities.

Leveraging epidemiology as a decision support tool during the COVID-19 epidemic in South Africa.

By May 2021, South Africa (SA) had experienced two ‘waves’ of COVID-19 infections, with an initial peak of infections reached in July 2020, followed by a larger peak of infections in January 2021. Public health decisions rely on accurate and timely disease surveillance and epidemiological analyses, and accessibility of data at all levels of government is critical to inform stakeholders to respond effectively. In this paper, we describe the adaptation, development and operation of epidemiological surveillance and modelling systems in SA in response to the COVID-19 epidemic, including data systems for monitoring laboratory-confirmed COVID-19 cases, hospitalisations, mortality and recoveries at a national and provincial level, and how these systems were used to inform modelling projections and public health decisions. Detailed descriptions on the characteristics and completeness of individual datasets are not provided in this paper. Rapid development of robust data systems was necessary to support the response to the SA COVID-19 epidemic. These systems produced data streams that were used in decision-making at all levels of government. While much progress was made in producing epidemiological data, challenges remain to be overcome to address gaps to better prepare for future waves of COVID-19 and other health emergencies.

Addressing the void: firearm injury prevention in the USA

Addressing the void: firearm injury prevention in the USA

Challenges in Documenting Non-Fatal Drowning Disability in Bangladesh: A Community-Based Survey.

Limited access to health care and the lack of robust data systems means non-fatal drownings are largely missed in low-and middle-income countries. We report morbidity among individuals who experienced non-fatal drowning in the Barishal Division, Bangladesh. A representative household survey was conducted in the Barishal Division in southern Bangladesh between September 2016 and February 2017, covering a population of 386,016. The burden of non-fatal drowning was assessed using the WHODAS 2.0 disability assessment tool, a generic assessment instrument for health and disability. A total of 5164 non-fatal drowning events occurred in the one year preceding the survey. Among these 18% were multiple events. From these, 4235 people were administered the WHODAS 2.0 questionnaire. Non-fatal drowning incidence rates were highest in children aged 1–4 years at 5810 per 100,000 population, and among males. Non-fatal drowning was associated with lower socio-economic status and larger family sizes. Few respondents (6.5%; 95% CI: 4.5–8.4%) reported some level of disability (WHODAS-12 score > 8). Incidence of non-fatal drowning is high in the population, however limited impact on morbidity was found. There is a need to develop tools and methodologies for reliable and comparable data for non-fatal drowning, especially to capture post-event disability in children.

Housing as a Social Determinant of Health: Evidence from Singapore, the UK, and Kenya: the 3-D Commission.

Housing is a paradigmatic example of a social determinant of health, as it influences and is influenced by structural determinants, such as social, macroeconomic, and public policies, politics, education, income, and ethnicity/race, all intersecting to shaping the health and well-being of populations. It can therefore be argued that housing policy is critically linked to health policy. However, the extent to which this linkage is understood and addressed in public policies is limited and highly diverse across and within countries. This analysis seeks to describe the linkages between housing policies and health and well-being using examples from three countries at different levels of the wealth spectrum: Singapore, the UK, and Kenya.We conducted a comparative policy analysis across three country contexts (Singapore, the UK, and Kenya) to document the extent to which housing policies address health and well-being, highlighting commonalities and differences among them. To guide our analysis, we used the United Nations (UN) definition of adequate housing as it offers a broad framework to analyze the impact of housing on health and well-being.The anatomy of housing policies has a strong correlation to the provision of adequate housing across Singapore, the UK, and Kenya, especially for vulnerable groups. The paper demonstrates that contextual factors including population composition (i.e., aging versus youthful), political ideologies, legal frameworks (i.e., welfare versus market-based provision of housing), and presence (or absence) of adequate, quality, timely, reliable, robust data systems for decision-making, which are taken up by stakeholders/state, have strong implications of the type of housing policies developed and implemented, in turn directly and indirectly impacting the overall health and well-being of populations.This analysis demonstrates the value of viewing housing policies as public health policies that could significantly impact the health and well-being of populations, especially vulnerable groups. Moreover, the findings highlight the importance of the Health in All Policies approach to facilitate integrated policy responses to address social determinants of health such as housing. This is more critical than ever, given the context of the global pandemic that has led to worsening overall health and well-being.

Injury patterns among road traffic accidents: a hospital-based study in Ecuador

Traffic accidents are serious public health problems, account for profound economic costs to individuals, families, and societies. The social impacts range from physiological to economic causes, which could be a serious negative effect, especially in undeveloped countries. To further elucidate this problem, the prevalence of injuries caused by traffic accidents in a Santa Ana Health Centre, Portoviejo, Ecuador, was studied. This registry-based retrospective study analyzed data on Santa Ana, from Enero 2016 to Diciembre 2019, and the medical records of patients who had been admitted were extracted and analyzed. Passengers cars, motorcycles, and bicycles involved in collisions were included, and the information collected was relating to sex, age, and type of injuries. In total, 75%±6.34 patients victims of road traffic injuries were males, and their mean age was 20 and 49 years. There was a cooperative agreement between total injury occurrence (%) and type of vehicle. Bus and car accidents had lower relation (R2 = 0.44, 078) (p = 0.063, 0.005) with total occurrence. The highest relation was found in motorbikes (R2 = 0.98 p = 2e-05), since it's the primary or most popular means of transportation in the city. The best of our knowledge is the first study to reporting data on road traffic injuries in the Province of Manabí, the third-largest province in extension in Ecuador. Additional studies with larger populations are thus necessary to construct a robust data system in undeveloped countries that can facilitate the flow of reliable information about road traffic injuries.

Prioritizing and implementing HPV vaccination quality improvement programs in healthcare systems: the perspective of quality improvement leaders

ABSTRACT Human papillomavirus (HPV) vaccination could prevent most of the ~34,000 HPV-attributable cancers diagnosed annually in the US, but uptake remains suboptimal. Healthcare systems are key partners in implementing HPV vaccination quality improvement (QI) programs. To inform future system-level HPV vaccine initiatives, we sought to understand HPV vaccine QI from the perspective of QI program leaders in healthcare systems. We conducted telephone interviews with a multi-state sample of 17 QI leaders in 15 systems. We analyzed data qualitatively via thematic analysis to describe QI leaders’ perspectives on prioritizing and implementing HPV vaccine QI. All QI leaders endorsed HPV vaccination as beneficial, and some had already prioritized increasing uptake to improve adolescent health and meet payor reimbursement standards. Those not prioritizing HPV vaccination cited concerns including the relatively small size of adolescent patient populations, lack of buy-in among providers, and the need to focus on health services perceived as more profitable or urgent. When implementing HPV vaccine QI programs, QI leaders reported key barriers to be the lack of robust data systems and acceptable QI metrics, limited time, and pressures of a fee-for-service clinical environment. Facilitators included automation and standardization in QI efforts and passionate vaccine champions. Almost all QI leaders reported future plans to implement HPV vaccine QI projects. Findings suggest that many healthcare systems are motivated to improve HPV vaccination. However, resistance to guideline-consistent quality metrics, the narrow target of one vaccine in the adolescent patient population, payment structures, and constrained time of providers are key barriers to practice improvements.

Using Targets to Reduce Waiting Times for Elective Care: What Can We Learn from the Russian Experience?

ABSTRACT This article explores the potential for maximum waiting times targets to improve access to healthcare in a country with limited financial resources. The study combines policy analysis, off-the-record communications, face-to-face interviews, public opinion surveys and open access patient complaints to create a rich picture of how waiting time targets are monitored and implemented in theory and practice. The study found that most waiting time targets in the Russian Federation are unrealistically low, while institutional and operational arrangements for their implementation have not been built in most regions. Estimates of actual waiting times are fragmented and unreliable. The lack of meaningful regulation and monitoring encourages opportunistic behavior among health providers to meet the targets while there is growing uncertainty among patients. Maximum waiting times targets alone are insufficient to reduce excessive waiting times. Successful implementation relies on robust data systems and standardized measurements for waiting times as well as meaningful regulation and monitoring.

Systems Integration: The Next Frontier in Newborn-Screening Timeliness.

In 2015, the United States Federal Advisory Committee on Heritable Disorders in Newborns and Children issued recommendations for state-based newborn screening programs to benchmark improvements in newborn-screening timeliness. Newborn screening (NBS) timeliness encompasses the efficient collection, transportation, testing, and reporting of results. Nearly all state programs fail to achieve recommended timeliness benchmarks. Our study explored the processes and procedures that accelerate or hamper progress toward improving NBS timeliness from a public health laboratory program perspective. We conducted semistructured interviews to elicit public health laboratory perspectives on NBS specimen delivery, laboratory testing and processing, communication of results to birthing providers, program staffing, and quality measures and data sharing. A content analysis explored practices, processes, and procedures related to NBS timeliness. A secondary analysis examined interorganizational strategies to enhance timeliness outcomes among NBS stakeholders. Ten laboratories participated in the study (n = 21 personnel). Participants included public health laboratory directors, NBS program managers, and NBS follow-up program staff. Efforts to improve NBS timeliness included engaging birthing providers, expanding courier services, extending operating hours, modifying staffing schedules, and implementing cross-training schedules to facilitate prompt collection, transport, and processing of NBS specimens. Sustained improvements will require implementing robust data systems, integrating laboratory and follow-up processes, and improving communication among all NBS stakeholders. Programs expressed a desire to refine timeliness metric definitions to ensure useful comparisons across states. Efforts to improve timeliness have accelerated in recent years; sustained progress will require increased coordination and integration among stakeholders in the NBS delivery system.

Opioid Overdose Ambulance Runs: How Wisconsin Uses Free Text Data

Objective: 1. Develop an understanding of the benefits and challenges of analyzing free text fields on a population level.2. Observe how a complex surveillance definition can be created from free text fields.3. Observe how an ambulance data system can be used to describe the opioid epidemic.Introduction: In 2016, twelve states received Center for Disease Control and Prevention (CDC) Enhanced State Opioid Overdose Surveillance grants. The purpose of the grant is to explore enhanced data sources to track nonfatal opioid overdoses. One data source is ambulance runs. Wisconsin collects ambulance run information within the Wisconsin Ambulance Runs Data System (WARDS). Around 84% of all Wisconsin administrative services report into this electronic system. This is a timely, robust data system that has not been used previously to examine drug overdoses and presents an analytical challenge as it contains many free text fields.Methods: Wisconsin’s ambulance data system is robust, well-populated, and includes the majority of Emergency Medical Services (EMS) within the state. The analytic challenge with this data is that most of the reported fields are free text, which can be difficult to analyze on a population level. Wisconsin created a case definition using SAS regular expressions to take advantage of the free text fields. A combination of fields (chief complaint, secondary complaint, medications given, and the EMS narrative) were used to determine if the ambulance run was due to an opioid overdose. It was necessary to create a definition that used a diverse combination of phrases as free text fields are prone to spelling errors and there are many phrases used to identify opioid overdoses. It was also necessary to create a definition for unwanted phrases that signal a false positive, for example, “withdrawal”.Results: Wisconsin’s opioid definition uses regular expressions to search for the words “heroin”, “opioid”, “narcan”, or “methadone” (including various spellings). The overdose definition searches for words and phrases like “drug abuse”, “drug use”, “poisoning”, “drug ingestion”, and “overdose”. The medication administered fields are examined for “narcan”. In Wisconsin, the medication is listed every time it is used, so it is possible to determine the number of times Narcan was administered to a single person as well as how many ambulance runs used at least one dose of Narcan. False positives are identified with words and phrases like “withdrawal”, “detox”, and if Narcan was given but there is no indication that the ambulance run was due to drugs. From January 2016 – June 2017, Wisconsin had over 917,000 ambulance runs for people aged 11 years and older. We excluded non-emergency ambulance runs, like medical transports, and so our final denominator was 627,536 runs (32% of all runs were classified as non-emergencies). Suspected opioid overdoses were determined to be 1% of emergency ambulance runs. Narcan was administered in a total of 5,900 runs and the false positive flag picked up 10,399 runs that may not have been due to suspected opioid overdoses. Applying all of these components together, it was determined that in Wisconsin from January 2016 – June 2017, there were 4,041 emergency ambulance runs due to suspected, unintentional opioid overdoses for people 11 years and older (rate of 6 per 1,000 people).Conclusions: The use of regular expressions enables Wisconsin to extend analyses to data systems that contain robust information within free text fields. Within Wisconsin, this has been utilized to enhance opioid overdose surveillance with the use of a rapid data system previously not examined. Ambulance run information is a valuable resource to Wisconsin with the opioid epidemic. By creating case definitions with free text fields, we can quantify ambulance runs on a population level and create linkable analytic data sets to provide a more complete picture of the health of Wisconsin.

Development of a wellness trust to improve population health: Case-study of a United States urban center.

Across the United States health systems are recognizing the urgency of addressing the social determinants of health in order to improve population health. Wellness trusts, modeled after financial trusts support primary health prevention in community settings, provide an innovative opportunity for better community-clinical linkages, collaboration, and impact. This study aimed to understand the necessary tenets for a wellness trust in Brooklyn, New York (USA) and examined community interest and political will; administrative, financing, and leadership structures; and metrics and data sources to monitor and assess impact. We employed a multi-method design. Key informant interviews (KIIs) (n = 15) were conducted from 7/2016 to 1/2017. A content analysis of grey literature was used to analyze community interest and political will (n = 38). Extant datasets, such as New York City Community District profiles, were reviewed, and a narrative review was used to assess cost-effectiveness of prevention interventions (n = 33). The KIIs and grey literature underwent thematic analysis. Findings indicated healthcare issues dominated the health agenda despite recognition of social determinants of health. Braided funding (discrete funds that are coordinated but tracked separately) and blended funding (funds pooled from multiple sources tracked together) are common funding mechanisms. Robust data systems exist to assess impact. Indicators should address social determinants, performance and impact, be measurable, geographically specific, and include communities. Wellness trusts should be sustainable, engage communities, foster collaboration, and have adequate capacity. The Collective Impact Framework, a mechanism to coordinate and maximize efforts, offers this organizational structure. Wellness trusts are promising mechanisms to advance population health.

Targeting improved patient outcomes using innovative product listing agreements: a survey of Canadian and international key opinion leaders.

ObjectivesTo address the uncertainty associated with procuring pharmaceutical products, product listing agreements (PLAs) are increasingly being used to support responsible funding decisions in Canada and elsewhere. These agreements typically involve financial-based rebating initiatives or, less frequently, outcome-based contracts. A qualitative survey was conducted to improve the understanding of outcome-based and more innovative PLAs (IPLAs) based on input from Canadian and international key opinion leaders in the areas of drug manufacturing and reimbursement.MethodsResults from a structured literature review were used to inform survey development. Potential participants were invited via email to partake in the survey, which was conducted over phone or in person. Responses were compiled anonymously for review and reporting.ResultsTwenty-one individuals participated in the survey, including health technology assessment (HTA) key opinion leaders (38%), pharmaceutical industry chief executive officers/vice presidents (29%), ex-payers (19%), and current payers/drug plan managers/HTA (14%). The participants suggested that ~80%–95% of Canadian PLAs are financial-based rather than outcomes-based. They indicated that IPLAs offer important benefits to patients, payers, and manufacturers; however, several challenges limit their use (eg, administrative burden, lack of agreed-upon endpoint). They noted that IPLAs are useful in rapidly evolving therapeutic areas and those associated with high unmet need, a quantifiable endpoint, and/or robust data systems. The Canadian Agency for Drugs and Technologies in Health, the pan-Canadian Pharmaceutical Alliance, and other arms-length organizations could play important roles in identifying uncertainty and endpoints and brokering pan-Canadian PLAs. Industry should work collaboratively with payers to identify uncertainty and develop innovative mechanisms to address it.ConclusionThe survey results indicated that while challenging, use of IPLAs may be associated with various benefits. Collaboration among stakeholders remains key: Canadian agencies could play an important role in the success of these agreements, while industry should be proactive in offering solutions that will help improve outcomes across the entire health care system.

Leveraging Effective Clinical Registries to Advance Medical Care Quality and Transparency

Policy makers, payers, and the general public are increasingly focused on health care quality improvement. Measuring quality requires robust data systems that collect data over time, can be integrated with other systems, and can be analyzed easily for trends. The goal of this project was to study effective tools and strategies in the design and use of clinical registries with the potential to facilitate quality improvement, value-based purchasing, and public reporting on the quality of care. The research team worked with an expert panel to define characteristics of effectiveness, and studied examples of effective registries in cancer, cardiovascular care, maternity, and joint replacement. The research team found that effective registries were successful in 1 or more of 6 key areas: data standardization, transparency, accuracy/completeness of data, participation by providers, financial sustainability, and/or providing feedback to providers. The findings from this work can assist registry designers, sponsors, and researchers in implementing strategies to increase the use of clinical registries to improve patient care and outcomes.