1、 Reference number ISO 21667:2010(E) ISO 2010INTERNATIONAL STANDARD ISO 21667 First edition 2010-12-01 Health informatics Health indicators conceptual framework Informatique de sant Cadre conceptuel dindicateurs de sant ISO 21667:2010(E) PDF disclaimer This PDF file may contain embedded typefaces. In
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6、ht office Case postale 56 CH-1211 Geneva 20 Tel. + 41 22 749 01 11 Fax + 41 22 749 09 47 E-mail copyrightiso.org Web www.iso.org Published in Switzerland ii ISO 2010 All rights reservedISO 21667:2010(E) ISO 2010 All rights reserved iiiContents Page Foreword iv Introduction.v 1 Scope1 2 Terms and def
7、initions .1 3 Health indicators conceptual framework2 Annex A (informative) Correspondence with OECD health indicator initiatives7 Annex B (informative) Rationale for a common health indicators conceptual framework .9 Annex C (informative) Background on the health indicators conceptual framework10 A
8、nnex D (informative) Health status .12 Annex E (informative) Determinants of health.13 Annex F (informative) Health system performance.14 Annex G (informative) Community and health system characteristics (contextual indicators).15 Annex H (informative) Equity.16 Bibliography17 ISO 21667:2010(E) iv I
9、SO 2010 All rights reservedForeword ISO (the International Organization for Standardization) is a worldwide federation of national standards bodies (ISO member bodies). The work of preparing International Standards is normally carried out through ISO technical committees. Each member body interested
10、 in a subject for which a technical committee has been established has the right to be represented on that committee. International organizations, governmental and non-governmental, in liaison with ISO, also take part in the work. ISO collaborates closely with the International Electrotechnical Comm
11、ission (IEC) on all matters of electrotechnical standardization. International Standards are drafted in accordance with the rules given in the ISO/IEC Directives, Part 2. The main task of technical committees is to prepare International Standards. Draft International Standards adopted by the technic
12、al committees are circulated to the member bodies for voting. Publication as an International Standard requires approval by at least 75 % of the member bodies casting a vote. Attention is drawn to the possibility that some of the elements of this document may be the subject of patent rights. ISO sha
13、ll not be held responsible for identifying any or all such patent rights. ISO 21667 was prepared by Technical Committee ISO/TC 215, Health informatics. This first edition of ISO 21667 cancels and replaces ISO/TS 21667:2004, of which it constitutes a technical revision. ISO 21667:2010(E) ISO 2010 All
14、 rights reserved vIntroduction Heightened interest in the measurement and monitoring of the performance of health care systems, as well as accountability and responsiveness to payors and stakeholders is now evident on an international scale. Consequently, many countries have begun the systematic def
15、inition and collection of health information for monitoring health system performance. This trend has also concomitantly driven, and is driven by, an enhanced data infrastructure that allows for more explicit and rigorous examination of the health of populations and their health care systems. More o
16、ften than not, this has taken the form of the collection of specific health indicators with which to describe a variety of health and health system-related trends and factors. The term health indicator refers to a single summary measure, most often expressed in quantitative terms, that represents a
17、key dimension of health status, the health care system or related factors. A health indicator must be informative, and also must be sensitive to variations over time and across jurisdictions. Indicators are able to flag issues that require more in-depth examination to determine causes for variation,
18、 and to identify opportunities for improvement, as well as establishing the most effective use of research resources. They may also be used as a rapid means to evaluate the effects of interventions or to make comparisons as health systems evolve. In order for them to be useful for monitoring health
19、or health system performance, however, explicit criteria must be applied to choosing and defining health indicators. This framework is intended to inform the selection of health indicators that can be used to monitor and manage the health care system and overall performance improvements. The selecti
20、on must be based on some agreement about what is to be measured, and for what purpose, and be informed by a clear conceptual framework. This implies a common framework, to be used internationally, for structuring the way health and health system performance is measured. This International Standard d
21、escribes a comprehensive, high-level taxonomy of the key types of indicators that are useful for assessing population health and health services. While, in many cases, health indicators may be best constructed from readily available data, in other situations a health indicators conceptual framework
22、may inform additional data collection initiatives that are required for understanding health and health system performance. It is important to note that any data collection must be carried out according to privacy and confidentiality legislation and ethical principles. Working toward a standard heal
23、th indicators framework will undoubtedly foster a common language for communication between countries and ultimately lead to greater commonalities for indicator development. This ought to lead to greater potential for generating internationally comparable health data in the long term, and so permit
24、consistent reporting, dissemination and analysis. This initiative can also be seen as complementary to work currently underway in other organizations, such as the Organization for Economic Cooperation and Development (OECD). The adoption of a common health indicators conceptual framework will furthe
25、r stimulate efforts to develop and collect common health indicators internationally. Furthermore, a harmonized effort to develop an internationally accepted health indicators conceptual framework will not only foster increasingly robust cross-national comparisons and analyses, but may also facilitat
26、e the development of comparable data that can be used as a basis for the setting of international benchmarks. The results of such endeavours may be invaluable for informing national health policy related to health expenditures, health human resources requirements or the organization of health and so
27、cial systems. Ultimately, these developments may facilitate an improved global understanding about variations in health, variations in health care and the effect of other determinants of health in the context of other essential factors. Furthermore, indicator collection, benchmarking and analysis ca
28、n lead to continuous quality improvement, the identification of factors requiring further analysis and, ultimately, improvements in health within countries and internationally. NOTE See Annex A for more information regarding the OECD initiative and its relationship to this International Standards he
29、alth indicators conceptual framework. INTERNATIONAL STANDARD ISO 21667:2010(E) ISO 2010 All rights reserved 1Health informatics Health indicators conceptual framework 1 Scope This International Standard establishes a common health indicators conceptual framework and is intended to foster a common vo
30、cabulary and conceptual definitions for the resultant framework. The framework a) defines the appropriate dimensions and sub-dimensions required to describe the health of the population and performance of a health care system, b) is sufficiently broad (high-level) to accommodate a variety of health
31、care systems, and c) is comprehensive, encapsulating all of the factors related to health outcomes and health system performance and utilization, as well as regional and national variations. NOTE 1 See Annex B for a more complete discussion of the underlying rationale for this framework. NOTE 2 Many
32、 countries have already developed their own models for directing the collection and analysis of health indicators. For the purposes of national reporting, these existing frameworks are not expected to change. Rather, this framework can be viewed as a complement to currently existing frameworks. For
33、example, if a particular health indicators framework currently focuses only on health system performance, the comprehensive approach proposed here can serve to augment and/or supplement the currently used model or models. NOTE 3 Individual jurisdictions may elect to operationalize the conceptual fra
34、mework differently. Because the conceptual dimensions represent a high-level taxonomy, this provides considerable discretion and leeway in the selection of specific indicators by individual countries. This focus on a high-level taxonomy also allows for sufficient flexibility for the inclusion of new
35、 indicators in the future, as new issues emerge and additional data become available. Because specific data elements are not defined, jurisdictions have the freedom to populate this framework with the most relevant, and available, indicators for their specific situations. This International Standard
36、 does not identify or describe individual indicators or specific data elements for the health indicators conceptual framework; nor does it address needs analysis, demand analysis or the range of activities that need to be supported for health system management. The definition of benchmarks and/or ap
37、proaches used in the definition of benchmarks is outside the scope of this International Standard. 2 Terms and definitions For the purposes of this document, the following terms and definitions apply. 2.1 health resource for everyday life, not the objective of living, and a positive concept emphasiz
38、ing social and personal resources, as well as physical capacities Ottawa Charter for Health Promotion, World Health Organization (WHO), 1986 ISO 21667:2010(E) 2 ISO 2010 All rights reserved2.2 health indicator single summary measure, most often expressed in quantitative terms, that represents a key
39、dimension of health status, the health care system, or related factors NOTE A health indicator must be informative, and also be sensitive to variations over time and across jurisdictions. 3 Health indicators conceptual framework 3.1 Framework The health indicators conceptual framework shall be as ou
40、tlined in Table 1. See Annex C for background information relating to the framework outlined in Table 1. Table 1 Health indicators conceptual framework Dimensions Sub-dimensions Health status Well-being Health conditions Human function Deaths Determinants of health Health behaviours Socio-economic f
41、actors Social and community factors Environmental factors Genetic factors Acceptability Accessibility Appropriateness Competence Health system performance Continuity Effectiveness Efficiency Safety Community and health system characteristics Resources Population Health system characteristics 3.2 Fra
42、mework dimensions 3.2.1 Health status The dimension of health status is described in Table 2. See Annex D for further information. ISO 21667:2010(E) ISO 2010 All rights reserved 3Table 2 Health status dimension Sub-dimensions Description Examples of indicators Well-being Broad measures of the physic
43、al, mental and social well-being Self-rated health Self-esteem Health conditions Alterations or attributes of health status which may lead to distress, interference with daily activities, or contact with health services; it may be a disease (acute or chronic), disorder, injury or trauma, or reflect
44、other health-related states such as pregnancy, ageing, stress, congenital anomaly, or genetic predisposition 50Prevalence of: arthritis diabetes chronic pain depression food and waterborne diseases injury hospitalization Human function Levels of human function are associated with the consequences of
45、 disease, disorder, injury and other health conditions; they include body function/structure (impairments), activities (activity limitations and participation (restrictions in participation)50 Functional health Disability days Activity limitation Health expectancy Disability-free life expectancy Dea
46、ths A range of age-specific and condition-specific mortality rates, as well as derived indicators Infant mortality Life expectancy Potential years of life lost Circulatory deaths Unintentional injury deaths 3.2.2 Determinants of health The dimension of determinants of health is described in Table 3.
47、 See Annex E for further information. NOTE 1 In order to better understand geographic or temporal variations in health status and health system performance, a variety of determinants of health have been included in the framework. NOTE 2 Determinants of health are those that fall outside the sphere o
48、f medical/health care, generally speaking, but that have been shown to affect health status and, in some cases, access to health care services. ISO 21667:2010(E) 4 ISO 2010 All rights reservedTable 3 Determinants of health dimension Sub-dimensions Description Examples of indicators Health behaviours
49、 Aspects of personal behaviour, and risk factors and protective factors that epidemiological studies have shown to influence health status Smoking rate Physical activity Socio-economic factors Indicators related to the socio-economic characteristics of the population that epidemiological studies have shown to be related to health Unemployment rate Low-income rate High-school graduation Social and community factors Measures the prevalence of social and community factors, such as social sup
