Epidemiological Databases and Registries: Functions and Applications

1. Public Health IT Unit 5: Epidemiological Databases and Registries Lecture a This material (Comp13_Unit5a) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003. This material was updated by Columbia University under Award Number 90WT0004. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

2. Epidemiological Databases and Registries Learning Objectives • Objective 1: Identify the functions and key issues of epidemiology compared to clinical practice • Objective 2: Define and distinguish among the components that make up epidemiology • Objective 3: Identify the difference between environmental and mechanistic causes of disease • Objective 4: Describe the components of epidemiological reasoning

3. Epidemiological Databases and Registries Learning Objectives (Cont’d – 1) • Objective 5: List the different types of epidemiology • Objective 6: Define clinical epidemiology and its relationship with evidence – based practice • Objective 7: Explain the current applications of epidemiology and how the results influence evidence – based practice

4. Epidemiological Databases and Registries Learning Objectives (Cont’d – 2) • Objective 8: Identify different sources of epidemiological databases and how information is updated and exchanged with clinical entities • Objective 9: Describe the purpose of a registry, the types of information contained within public health registries and how this information can be used • Objective 10: Identify the defining characteristics of epidemiological registries

5. Epidemiological Databases and Registries Learning Objectives (Cont’d – 3) • Objective 11: Identify different entities that operate registries and how information from clinical practice gets imported into these registries • Objective 12: Identify security and access issues in the information exchange between communities, clinical institutions, public health departments and federal agencies involved in public health prevention and control

6. Epidemiology – definition • Scientific study of the frequency, distribution and determinants of health and disease in human populations

7. Epidemiology and clinical practice • Epidemiology • Targets communities and population health to prevent disease and maintain health • Clinical practice • Treats individuals in order to restore health

8. Epidemiology and clinical practice (Cont’d – 1) • Separation of population prevention and health care • Facilitates focus in clinical practice on: • Individualized care for which they are trained • Improving effectiveness and efficiency at the public health and clinical practice levels

9. Health sciences 5.1 Table (Primary Care Information Project, 2010).

10. Components of epidemiology • The science of a systematic methodology to understand the causal relationships between: • Determinants and disease • Health of populations and subgroups of populations as a collective system rather than individual components • Analysis of prevalence, incidence, and risk

11. Causes of disease • Environmental: • Potential behavioral, social, cultural influences on routine lifestyle choices • Exposure to drugs and situational contaminants that influence the frequency of the disease within a population • Mechanistic: • Potential biological factors, such as genetic mutations

12. Populations and samples 5.1 Figure (Fletcher, 2005).

13. Epidemiological reasoning • An observation raises a research question that is formed into a hypothesis about potential causes for disease

14. Epidemiological reasoning (Cont’d – 1) • An epidemiological study: • Examines statistical association between potential environmental and / or mechanistic causes of disease • A causal inference as a result of an epidemiological study • Can be used to develop prevention programs for the community

15. Types of epidemiology • Classic types of epidemiology: • Field – based • Descriptive • Modern forms: • Analytic • Experimental • Clinical • Molecular

16. Clinical epidemiology • Clinical epidemiology relies on observations of individual patients within clinical practice to provide evidence for decision – making concerning diagnostic and health interventions

17. Epidemiology in evidence – based clinical practice • By relying on experience with health outcomes observed in previous patients • Evidence – based practice strives to improve the effectiveness and reduce the costs of patient care

18. Current applications of epidemiology • Identification of emerging health issues and causes • Assessment of risks from environmental exposures • Identification of population subgroups with high risk for disease • Measuring effectiveness of new intervention programs • Mapping geographic movement of emerging disease for clinical preparation • Identification of variations among health practitioners and patient usage of heath services

19. Unit 5: Epidemiological Databases and Registries, Summary – Lecture a • This presentation defined different types of epidemiology and illustrated methods for understanding how epidemiological reasoning is utilized to understand the causes of diseases in populations

20. Epidemiological Databases and RegistriesReferences – Lecture a References: Causation and Causal Inference in Epidemiology. Kenneth J. Rothman, DrPH and Sander Greenland, MA, MS, DrPH, C Stat. July 2005, Vol 95, No. S1 | American Journal of Public Health S144-S150 Editorial: Clinical Epidemiology – a fast new way to publish important research, HenrikToftSørensen. Published Date February 2009 , Volume 2009:1 Pages 17 – 18 Fletcher, H. R., & Fletcher, S. W. (2005). Clinical Epidemiology: The Essentials chapter 1. Retrieved on September 8th, 2011 Health Affairs, 28, no. 2 (2009): 428-434. Fletcher R. Clinical epidemiology : the essentials. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.Improving the Effectiveness of Health Care and Public Health: A Multiscale Complex Systems Analysis Rizk, S., & Dimitropoulos, L. (2007). A State-Based Approach To Privacy And Security For Interoperable Health Information Exchange. Retrieved on September 8th, 2011 YaneerBar-Yam, PhD, March 2006, Vol 96, No. 3 | American Journal of Public Health 459-466

21. Epidemiological Databases and RegistriesReferences – Lecture a (Cont’d – 1) Chart, Tables and Figures 5.1 Table: Fletcher R.(2005). Clinical epidemiology : the essentials. 4th ed. Lippincott Williams & Wilkins. Philadelphia, PA. 5.1 Figure: Primary Care Information Project, 2010.

22. Unit 5: Epidemiological Databases and Registries, Lecture a This material (Comp 13 Unit 5a) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000013. This material was updated in 2016 by Columbia University under Award Number 90WT0005.