In association with Simon Fraser University & Vancouver Coastal Health... Simon Fraser University
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In association with Simon Fraser University & Vancouver Coastal Health Research Institute Simon Fraser University Great Northern Way Campus 555 Great Northern Way Vancouver, BC, Canada V5T 1E2 tel: 1.604.268.7306 fax: 1.604.268.7309 email: act4hlth@sfu.ca website: www.sfu.ca/act4hlth The Social and Technological Life of an Indicator: Indicators that include women’s occupational health (Theme II) Investigators: Ellen Balka, Hugh Armstrong, Pat Armstrong and Karen Messing Project Description The Indicators Study hopes to provide answers to the question of how to build better indicators than those presently available, while also critically assessing the place of indicators as health care instruments. In reviewing occupational health and safety indicators for health sector workers, we will specifically address challenges related to information technology systems that are used as a means of collecting health indicator data, combining data from multiple sources, and performing analysis of data. The indicators project comprises several sub-projects, studying various aspects of the role of information technologies in the production and use of indicators related to health care occupational health and safety. The project addresses the double question of: What are the current indicators? How can they be made better? In addressing these issues, we will highlight the role of information systems in data collection, data merging for development of indicators, and data use. These sub-projects share an epistemological interest in understanding what kinds of knowledge are incorporated into indicators, and how this knowledge is represented and used in medical practice and health policy. Following this agenda, the project aims to document and expose practical and epistemological barriers and limitations to current practices around health indicator development and use, in order to enlarge what is taken into account by indicators (and thereby to help improve their integrity and usefulness). As an additional component to these queries into the quality of indicators currently available, the projects also aims to analyze the quality of indicators as quality measuring devices more generally: Are quantitative indicators the best or only means by which to achieve knowledge about health care? Are there qualities or relationships that are not easily captured by indicators? Do complementary kinds of knowledge need to be added to indicators, for them to be as useful as possible? Methods Methods vary across sub-projects. They include: literature reviews of the current literature about indicators within a variety of disciplines; an analysis of the content and quality of available indicators, both at the national level (Statistics Canada) and in British Columbia (the BC-linked health database); and a database ethnography of the construction of a set of new indicators (see the Cohort Study). This latter sub-project makes use of semi-structured interviews with key participants, as well as analysis of written documentation. Background The introduction of information technology into the health sector is often undertaken with an eye towards improving administrative efficiency (e.g., by eliminating the need to have records retyped), and improving the evidentiary-base on which decisions are made in the health sector (e.g., by providing decisions makers with improved data sets for use in allocation of resources). As emphasis on evidence-based medicine and evidenced-based decision-making increases, In association with Simon Fraser University & Vancouver Coastal Health Research Institute Simon Fraser University Great Northern Way Campus 555 Great Northern Way Vancouver, BC, Canada V5T 1E2 tel: 1.604.268.7306 fax: 1.604.268.7309 email: act4hlth@sfu.ca website: www.sfu.ca/act4hlth information systems, which are put in place to facilitate the collection and analysis of data, play an increasingly important role. Although often taken for granted, the structure of such systems influences what we are ultimately in a position to know about health. In many ways, the architecture of information systems determines which data are available, and the extent to which data from multiple sources can be combined to create expanded data sets. Although attention has increasingly been focussed on the generation of data, most data sets available in health settings are administrative, rather than health-oriented, in nature. As increased emphasis is placed on evidence-based decisions, in the absence of data that is focused on understanding health outcomes, administrative data – complete with whatever limitations that were built into legacy data collection systems – is currently used as the basis for decision-making on health issues.
