putting data to work evidence-based health programming and management sustainable management...
TRANSCRIPT
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Putting Data to WorkEvidence-based health programming and management
Sustainable Management Development Program
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Learning ObjectivesDescribe how data are used in health
organizations and programsIdentify methods for summarizing
dataExplain how data analysis and
interpretation can improve decisionsPrepare and apply tables, graphs, and
charts such as line graphs, bar charts, pie charts, and spot (dot) maps
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How do you use data?Simple vs. complicated decisions
Decisions can significantly impact a community
Use of timely & accurate
data analysis
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Scenario Imagine that you are a medical
superintendent of a district hospital and part of your job is to manage resources.
Each month your employees submit a receipt for their fuel usage. Instead of just approving the bills, you can study the data they provide.
Collecting and analyzing these simple data will allow you to better track and understand trends in fuel usage.
Consider the following graph.
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Exercise 1: Is there a problem?
Janu
ary
Febr
uary
Mar
chAp
rilMay
June Ju
ly
Augu
st
Sept
embe
r
Octob
er
Novem
ber
Decem
ber
0200400600800
100012001400
District Hospital monthly fuel usage, 2007
Month
Fu
el (L
iters
)
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Why use data?Data provides evidence and guidance for
successful programming and resource management
Collecting data is only one step
Accurate data analysis, interpretation and application is also an important step
As the medical director of this hospital, what else would you want to keep track of besides fuel usage?
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Kinds of DataIndividual - focus on one person’s
health issues, e.g. patient’s medical record
Population - focus on communities, districts, etc. ,to obtain an overall picture of health
Management- focus on tracking, monitoring and evaluating the use and distribution of resources
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Types of DataQuantitative
◦Who◦What◦When ◦Where
Qualitative◦Why◦How
Can you think of data that crosses your path? What data are available to you?
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Data Collection- Counts
Actual number of events (in a specific population, place and time)
Used for:◦Program planning and monitoring:
Describe the magnitude of the problemLimitations
◦No indication of problem in relation to size of population
◦No information on risks
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Exercise 2: Using a check sheet
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Exercise 2: Using a check sheet
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Interpreting Data
Most commonly used measures of frequency◦Counts
◦Ratios 1:2◦Proportions 1/2◦Percents 15%◦Rates
33.3 per 100,000
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Ratios
A ratio is a comparison of two dissimilar things
8:16 or 1:2
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Two types of ratios:Proportion and PercentsA proportion or a
percentage = special kind of ratio◦ A part is compared to the
whole◦ Multiply by 100, 1,000 or
100,000◦ Proportions and
percentages are essentially the same measure
854 =
0.15
Proportion: 15 per 100Percent: 15%
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Percents
Standardize data and make comparable
Remember to report numbers or counts to put the percentage in contextClinic
% pregnant women whose partner gets tested
# of pregnant women whose partner gets tested
A 50% 3 out of 6
B 21% 38 out of 181
C 17% 121 out of 712
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Rates
Rate: often a proportion, with an added dimension of time
Measures the frequency at which a health event occurs over a period of time
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Risk and Persons at Risk
Risk = the probability or likelihood that an event will occur
All people to whom the event could have happened
Everyone in the geographic area during the time period of interest
Rates compare the risk of health events across different groups of people, places, and time periods
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Rates
K = A standard unit of the population (per100, 1,000, or 100,000)
Remember both numerator and denominator must represent the same time and place
Number of personsexperiencing the event
Number of persons “at risk” ofexperiencing the event over
a specified time period
x K
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Rates Example
K = 100,000
Cases Total population
# cases Total pop.
Rate
20 ÷ 1,000 0.02 2,000 per
100,000
20 ÷ 1,000,000 0.00002 2 per
100,000
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Rates Exercise
What is the mortality rate from HIV/AIDS per 100,000 women in Panama?
What is the mortality rate from HIV/AIDS per 100,000 women in Guatemala?
Based on the rates we have calculated which country has a higher rate of women dying from the disease?
Which country has the higher number of women dying from HIV/AIDS?
Country HIV/AIDS Deaths
Female Population
Panama 114 1,573,289
Guatemala 167 6,342,703
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Why Use Rates?Describe the frequency of a
health event or health status relative to the size of a population
To target interventionsTo manage resources
◦Employee turnover rate◦Vaccination coverage rate◦Hospital admissions
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Exercise 3: Calculate Ratios and RatesUse the counts from the check sheet
on page 7 to answer the questions below.
1. What is the ratio of total missed appointments between Clinic C and Clinic D?
2. What is the proportion of missed appointments in Week 5 for Clinic E?
3. What is the rate of missed appointments over the 7 week period?
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Summarizing DataTo analyze data
To explore patterns and trends, and identify variations from trends
To provide a useful way of communicating information to others
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Basic Methods for Organizing and Presenting DataData can be organized through
creation of:◦Tables
◦Graphs
◦Charts
◦Maps
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Tables
Deceased Living Total
Diabetics 100 89 189
Non diabetics
811 2,340 3,151
Total 911 2,429 3,340
Follow-up status of a group of men with and without diabetes, Medical examination survey
follow-up study, 2005-2010
Clear, concise labels
Totals to accompan
y rows
Quantitative data Column (vertical)
Row (horizontal)
Totals to accompany columns
Footnote: Used to explain codes, abbreviations, symbols, exclusions or data sources used.
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Continuous vs. Discrete Data
Continuous data can be assigned an infinite number of values between whole numbers
- weight, height, time
Discrete data is data that can be counted.- gender, race
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Graphs
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
0100200300400500600700800900
Measles by year of notification, 1950-1990
YearRep
ort
ed
cases (
per
1,0
00
)
Y-axis
Fre
qu
en
cy m
easu
re
A set of coordinates (i.e. year, # of cases) make up a data point
Method of classification
X-axis
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Creating Line GraphsShow patterns or trends over some
variable, usually time
Good for comparing 2 or more sets of data
Example:◦Number of staff members hired to worked at district health facilities from 1975 to 2010
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Tip 1Mark off each axis at equal intervals
Y-axis
X-axis
(vertical)
(horizontal)
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Tip 2
Match x-axis scale to intervals used during data collection
Time period shown on X-axis
1975 1980 1985 1990 1995 2000 2005 2010
YEAR
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1975 1980 1985 1990 1995 2000 2005 2010
Tip 3Make the x-axis longer than the y-axisAlways start y-axis with 0
X-axis longer than Y-axis
YEAR
0 cases
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1975 1980 1985 1990 1995 2000 2005 2010
Tip 4Select interval size for y-axis that will provide
enough intervals to illustrate data in adequate detail
Determine range of values on y-axis by identifying the largest value
Number of staff members shown on Y-axis
Time period shown on X-axis
YEAR
9000
STA
FF
MEM
BER
S
8000
7000
6000
5000
4000
3000
2000
1000
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Completed Line Graph
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Bar Charts
Method of organizing and illustrating data using only one coordinate
Quick way to show big differences in dataBar charts are used to compare data and
show relationshipsBest used for comparing data with
discrete categories◦ Gender, race, marital status and trained and
untrained
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Example: Horizontal Bar Chart
Warangal
Kadapa
Chittoor
Adilabad
Nalgonda
0 10 20 30 40 50 60 70
Average clinic wait times per District, 2008
Minutes
Dis
tric
t
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Creating a Simple Bar Chart
Bar Characteristics:◦May be horizontal or vertical◦Bars are all equal width and are
separated◦Each bar represents one value of the
variable◦Length or height of each bar is
proportional to frequency of the event in that category
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Example: Vertical Bar Chart
Number of Reported Polio Cases, Worldwide
0
5,000
10,000
15,000
20,000
25,000
1990 1991 1992 1993 1994 1995
Year
Case
s
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Exercise 4: which method for displaying data would you use?
Sub districts Number of trips
Dodowa 5Prampram 3Osudoku 2Ningo 1
Number of Mobile Clinic Trips
0
1
2
3
4
5
6
Dodowa Prampram Osudoku Ningo
Sub-districts
Num
ber o
f tri
ps
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Pie ChartsPie charts show how part of
something relates to the whole. A circle with slices that represent
percentages of the different categories of the variable.
Pie charts are a way to effectively present percentages in which the “slices” of the pie add up to 100%.
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Pie Chart
Traffic ac-cident50%
Burn30%
Fall9%
Drowning8%
Poisoning2%
Other1%
Distribution of accidental deaths for children aged 1–19 years, 2005-2010
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MapsA visual display of geographical
or spatial patternsPowerful tool for looking at
clusters of disease or eventsCan be used for management
purposes Types include
◦Spot or dot maps◦Area maps◦Geographic information systems
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Creating a Spot MapUse dots or other symbols
to show geographic distribution of an event or a disease/condition
Famous spot map- John Snow tracking cholera deaths in London
Spot maps can be used to track operations information
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Example: Spot Map
DO NOT take into account size of population at risk
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Example: Dot Maps
Key:
Dengue fever -
Malaria -
Chagas -Source: http://www.worldmapsonline.com/images/OutlineMaps/Guatemala.jpg
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Example: Area MapCountries at risk of yellow fever and countries that have reported at least one outbreak of yellow fever, 1985-1999
http://www.who.int/csr/resources/publications/yellowfev/CSR_ISR_2000_1/en/
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StratificationBreakdown results into smaller
groups◦Age◦Gender◦Place◦Time◦Geographic location
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Stratification
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Stratification
1 2 3 4 5 6 70
5
10
15
20
25
Percent of people who missed ap-pointments by clinic
Clinic A
Clinic B
Clinic C
Clinic D
Clinic E
Week
Perc
en
t (%
)
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Summary
The purpose of organizing and presenting data is to analyze it, to explore patterns and trends, and to communicate information to others.
Data can be organized through the creation of tables, graphs, charts, and maps.
Tables can illustrate the number of people who share a certain
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Summary
Line graphs are useful for showing patterns or trends over some variable, usually time.
Bar charts are used to display countable or discrete data, such as race or gender, and make it easy to see differences among the categories.
Pie charts are useful for showing the component parts of a single group or variable.
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Summary
Maps are an excellent way to display geographic information, and make it easier to identify geographical patterns in data.
Spot (dot) maps use dots or other symbols to show geographic distribution of an event or a disease/condition.
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Exercise 5: Summarizing Data
What method would you use?
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ConclusionKnow how to read, understand and interpret
data
These processes can help with decision making for health programming and management
Frequent data analysis helps to detect problems
Data can be organized through tables, graphs, charts, and maps.
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What’s next?
Think about how data can help you make stronger management and public health policy decisions
Practice data analysis and presentation and share your reports with colleagues.