Consultation with Customers and Data Users. Before finalizing consolidation plans or moving to implementation, HHS will engage in an open, balanced process to gain input from the customers and data users described earlier in this document. HHS data systems are highly complex, and it has not been possible to address all potential implications of changes in survey design within the REGO II time frame.
Research Required to Develop Consolidated Designs. HHS will develop a more detailed research agenda to answer critical methodological questions that need to be resolved before new designs can be implemented. The agenda will include research addressing:
• effects of using the NHIS as a sampling frame for other surveys on response rates and other data quality measures;
• evaluation of alternative procedures and designs for obtaining data now obtained through the Drug Abuse Warning Network;
• refinement of an overall framework for a balanced health survey program that addresses health status, health risks, the health and public health system, and health care costs and utilization;
• development of a framework, or typology, of the health system that can be used in rationalizing inventories and other measures of the health care and public health infrastructure;
• optimum sampling/screening strategies to accommodate multiple population surveys, particularly when multiple surveys have demands for the same subpopulations;
• development of modeling techniques that would enhance the value of national surveys for State purposes;
• issues in determining whether it is possible to move from providing assurances of anonymity to guarantees of confidentiality in surveys of sensitive topics, such as the National Household Survey on Drug Abuse;
• operational aspects of consolidating field operations for provider surveys;
• approaches to improving data on managed care;
• approaches to capitalize on standardization of Federal programmatic data;
• continuing evaluation of the effect in changes in mode and frequency of data collection on costs and data quality; and
• research on approaches to capitalizing on emerging State health information systems, including those that focus on enrollment and encounter data.
Short term priorities also include assuring that the 1996 NHIS is implemented using Computer Assisted Personal Interview technology, and conducting a systematic review of existing and planned questionnaires in HHS surveys to achieve maximum analytic coordination and burden reduction.
Data Policy Development. In order to maximize the benefits from consolidation, HHS will develop more detailed policy statements in several areas including:
• more uniform policies regarding protection of privacy, data access, release, and sharing among agencies;
• improved coordination and decision making mechanisms within HHS, since the inter-dependency of various elements of HHS data systems will be greatly increased; and
• development of HHS policy for encouraging agencies to use the newly consolidated data mechanisms to the extent possible, rather than initiating new, independent data systems; a part of this policy will be a review and reissuance of HHS guidelines on the appropriateness of using extramural grants to support large scale survey activities.
HHS is addressing the process for development of consensus data standards in a related REGO II activity.
Maintaining Momentum for Survey Coordination and Consolidation. This report addresses the preponderance of HHS' large scale surveys, and creates a consolidated framework in which much of HHS' data needs can be met through a more rational and coordinated system of surveys. However, even if fully implemented, it is not the final step in the process. Additional steps include:
• identifying other data systems within HHS that might be potential candidates for consolidation, based on commonality of data sources, content, or field operations;
• continuing to identify data gaps that can be addressed efficiently within the consolidated framework, and developing proposals for enhancement of the designs proposed in this report;
• moving beyond HHS data systems to consider the relationship of HHS systems to systems at Census, BLS, and elsewhere in the Federal statistical system, including the potential that a continuous measurement program at Census has for efficiencies in HHS survey designs; and
• establishing approaches to partnerships with State and local agencies to maximize the utility of HHS surveys for State policy purposes, and to maximize HHS' use of data collected in State health information systems.