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USE OF THE STANDARDIZATION METHOD IN ASSESSING POPULATION HEALTH AND PERFORMANCE INDICATORS OF HEALTH INSTITUTIONS
LESSON OBJECTIVE: To master the direct method of standardization. To be able to calculate intensive, expected (conditional) and standardized indicators, analyze and compare intensive and standardized indicators, draw a conclusion.
LESSON METHODOLOGY: Students independently prepare for a practical lesson in the recommended literature and complete their individual homework. The teacher within 10 minutes checks the correctness of homework and indicates the mistakes made, checks the degree of preparation using testing and an oral survey. Then the students independently master the direct method of standardization, calculate the intensive, expected and standardized (hypothetical) indicators. Analyze and compare intensive and standardized indicators, evaluate the data obtained and formulate a conclusion. At the end of the lesson, the teacher checks the students' independent work.
1. In what cases is the standardization method used?
2. What is the essence of the direct method of standardization.
3. In which cases the direct method of standardization is used, and in which the indirect and inverse.
4. What are the stages of the direct method of standardization.
5. What is the methodology for calculating intensive, expected and standardized indicators.
6. What is the methodology for comparing and analyzing intensive and standardized indicators.
SUMMARY OF TOPIC
In many medical and social, as well as in clinical studies, as a rule, the possibility of obtaining homogeneous groups for comparing certain indicators is excluded. This applies primarily to indicators of morbidity, general mortality, fertility by city, region, country, with a different population by age, gender, etc. In such cases, the standardization method is widely used, which makes it possible to exclude the influence on the general indicator of different composition of populations on one, two or more grounds.
The standardization method is used in assessing health indicators only when comparing their levels. This method of calculating conditional values is used to eliminate the heterogeneity of the composition of the compared teams. It shows what would be the level of morbidity (injuries, mortality, disability, etc.) in each team (institution, city), if its composition (by age, gender, length of service, etc.) was the same. Standardized indicators are used, if necessary, to compare mortality (morbidity) levels from malignant diseases (diseases of the digestive system, etc.) in different cities, regional centers, if the compared population groups are heterogeneous by age or gender; comparing the incidence rates (injuries) at different industries if the professional composition of workers is heterogeneous; comparison of mortality levels in different hospitals (departments), with the heterogeneity of patients of these hospitals according to the severity of the disease. The method allows you to establish the influence of one of the factors (gender, age, disease severity, working conditions, lifestyle, environmental factors), on the difference in morbidity or other health indicators. There are 3 ways to standardize: direct, indirect and reverse. The direct method is used when there are subgroup (age) indicators of morbidity (mortality, injuries) or they can be calculated (in the presence of a subgroup of the population and patients). Indirect method is used if indicators for groups are absent and cannot be calculated due to the lack of the number of cases. The reverse method is used in the absence of group values of the population. The general step in calculating standardized coefficients is the choice of a standard for age-sex composition (the percentage distribution of the composition of any of the compared groups or their total value). When choosing the standard composition of the incidence rate, you can use literature data or indicators of previous studies.
TASK FOR INDEPENDENT WORK:
Calculate standardized indicators, compare them with derived values, draw appropriate conclusions
Compare mortality rates in two groups of AIDS patients who received different drugs with indicators standardized by the severity of the disease.
For the standard, take the sum of the compositions of patients who received various treatment.
Compare mortality rates in two pediatric wards of the hospital with rates standardized by age. For the standard, take the sum of the compositions of the children treated in the hospital.
Compare the incidence rates of plant workers and the main workshops of the enterprise with indicators standardized by income. For the standard, take the sum of the staff of the plant management and the main shops of the enterprise.
Compare injuries at two engineering enterprises with indicators standardized by the nature of labor. For the standard, take the sum of the composition of workers at two enterprises.
Compare fertility rates in two cities of the Stavropol Territory with those standardized by age. For the standard, take half the sum of the age composition of women in two cities.
Compare the birth rate of small children in urban and rural areas with indicators standardized for social risk factors. For the standard, take the number of children born in urban areas
Compare mortality rates in the city of Mineralnye Vody and Mineralovodsk District with indicators standardized by the age composition of the population. For the standard, take the age composition of the population of Mineralovodsk district
Compare the incidence rates in the two workshops of the enterprise with indicators standardized by the age composition of workers. For the standard to accept the age composition of workers in both workshops.
Compare the incidence rates of children attending pre-school institutions and brought up at home with indicators standardized by age. For the standard, take the age composition of children in both groups.
Compare the incidence rates of caries in children brought up at home and in a boarding school with rates standardized by age. For the standard, take the sum of the compositions of children in the two examined groups.
Compare the prevalence of periodontal disease in urban and rural areas with indicators standardized by age. For the standard accept the age composition of the urban population
• V.K. Yuryev, G.I. Kutsenko. Public health and healthcare. St. Petersburg. 2000 (textbook for students, interns, graduate students, residents of pediatric faculties). - from. 201-204.
• Yu.P. Lisitsyn. Social medicine and healthcare organization. Kazan, 1999.
• A guide to practical exercises in social hygiene and healthcare. Edited by Yu.P. Lisitsin. M. "Medicine", 1984. –p. 101-111
• Yu.P. Lisitsyn. Public health and healthcare. Textbook for high schools. Moscow. 2002. - p. 305-307.
• Serenko A.F., Ermakov V.V. Social hygiene and healthcare organization. M. 1984. –s. 164-168.
• Public health and healthcare. Ed. V.A. Minyaeva, N.I. Vishnyakova. M. "MEDpress-inform", 2002.
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