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State-wide Surveillance - Dr. Eduardo Sanchez
After noting that not all state health departments share the same set of responsibilities and activities, Dr. Sanchez described the breadth of relevant data collection efforts at the Texas State Department of Health, including those concerning emergency medical services (EMS), hospital care, vital statistics, and chronic disease measures. The state has numerous data sources, though many are disparate. These include mortality data (inpatient and outpatient); hospital discharge and cost data from more than 80% of the state’s hospitals; behavioral data and trends from the Behavioral Risk Factor Surveillance System, the Youth Tobacco Survey, and the Youth Risk Factor Surveillance System; Health Plan Employer Data and Information Set; the Texas EMS/Trauma Registry; Medicaid and Medicare data; and the national voluntary hospital reporting initiative data available from CMS. Texas’ quality improvement organization (QIO) has focused on the outpatient setting and has not looked at cardiovascular disease or stroke but these diseases could potentially be added.
Dr. Sanchez identified several gaps and opportunities to improve the applicability of these databases for CVD research. Integration of data collected from various sources is needed, as is application of collected data from such sources into information that can direct policy making and program development. He suggested analyzing hospital discharge and cost data to determine the cost of achieving the decline in MI rates in recent years. He also emphasized the importance of tying local data to national standards. Our definition of health care should be broadened to include public health as well as health care delivery when collecting and interpreting data as well as when using the results to inform policies and programs. Outpatient health care delivery should include diverse community settings such as churches, the workplace, and lay health worker settings for data gathering as well as for health promotion. Greater adoption of electronic medical records is expected to be very helpful in improving data collection and linking among databases.