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Raymond R. Arons, DrPH, MPH

Correspondence: Requests for reprints should be sent to Raymond R. Arons, DrPH, MPH, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 600 W 168th St, 5th Floor, New York, NY 10032 (e-mail: rra1{at}columbia.edu).

	INTRODUCTION

TOP INTRODUCTION A COURSE IN POINT THE BASICS OF LARGE-SCALE... THE DESIRED OUTCOME References

 
RIEGELMAN AND PERSILY propose revising the core curriculum in schools of public health to include applied research and technology.¹ The skills they stress are core competencies that are increasingly required of public health practitioners as well as researchers.

The concepts Riegelman and Persily present have more than 30 years' historical support.^1–3 Their position is further strengthened by the technologic revolution of the past decade. At present, relatively low-cost and powerful personal computers (PCs) and PC-based statistical research packages may be used to access databases from private, state, and federal agencies.^4–6 These databases include health care encounters at the patient level and individual responses to national surveys of, for example, nutrition and health. Census data are readily available on the Internet, albeit in formats that require training to use and interpret meaningfully.

	A COURSE IN POINT

TOP INTRODUCTION A COURSE IN POINT THE BASICS OF LARGE-SCALE... THE DESIRED OUTCOME References

 
When offered the opportunity, students in schools of public health are choosing to learn to apply technology. Since 1998, I have taught a course at the Mailman School of Public Health of Columbia University titled "The Use of Large Scale Health Care Data." Student interest in the course started strong and shows no signs of abating. As of spring 2001, more than 150 students in 10 different sessions had completed the course (individual attention and instruction at the computer is mandatory, necessarily limiting class size). In reviewing the required papers the students have submitted to date, I found that the overwhelming majority had the potential to become research articles in peer-reviewed journals.

The course is not limited to students majoring in epidemiology or biostatistics. Indeed, students from the other 4 divisions at the Mailman School of Public Health (sociomedical sciences, environmental health sciences, population and family health, health policy and management) have completed the course, as have students from the schools of medicine, dentistry, nursing, social work, and international affairs.

Students in this course receive 8 weeks of hands-on computer experience, followed by 6 weeks of conducting an analysis project of their own choosing. Over the course of the semester, students hone their computer, data analysis, and statistical skills while gaining familiarity with the research interests of their classmates and faculty. Frameworks for conceptualizing research questions are considered as fundamentally important as the technologic skills gained, and during the course we critically analyze the way in which the chosen frameworks influence the results obtained and the attendant interpretations.

Following the goals and objectives outlined by Riegelman and Persily, a student may pose a particular research question regarding, say, bone densities in older adults. Do older African American women have higher bone densities than older White women? How do the bone densities of older adults born abroad differ from the bone densities of older adults born in the United States? How does the current body mass index of older adults relate to their measured bone densities? To answer such questions, a student may choose to work with the most recent National Health and Nutrition and Examination Survey (NHANES III).⁷ After writing lines of code to specify the analysis of interest, the student places the corresponding CD-ROM containing 260 million weighted patient interviews in the computer's CD drive.

Thorough analysis and thoughtful interpretation of the results obtained may take more time than allotted during the semester. Thus, students are encouraged to continue their exploration outside the confines of the classroom. Most students select analysis questions of immediate research interest or drawn from personal experience. This helps provide a fuller context within which to place the findings obtained.

	THE BASICS OF LARGE-SCALE DATA ANALYSIS

TOP INTRODUCTION A COURSE IN POINT THE BASICS OF LARGE-SCALE... THE DESIRED OUTCOME References

 
To make use of large-scale health care data sets, students need to be provided with the following: identification and definition of all variables; record layouts; data set sizes; analysis restrictions; sampling method used; and coding methods. They must know ways to manipulate data on PCs and, less frequently nowadays, mainframes, and they must have an applied knowledge of the syntax of the statistical package of choice. They should be given an opportunity to participate in workshops featuring hands-on instruction.

	THE DESIRED OUTCOME

TOP INTRODUCTION A COURSE IN POINT THE BASICS OF LARGE-SCALE... THE DESIRED OUTCOME References

 
A core course as envisioned by Riegelman and Persily would use up-to-date information and a range of available technology to provide public health students with skills in applied data methods. The data sources available to students are the same ones that government agencies use to set health care research agendas and policies^8,9 and that are used by practicing health service researchers.¹⁰

To facilitate this fundamental change in the core curriculum, significant financial commitments are needed in the form of computer laboratories, faculty support, and strengthening of data repositories. If future health practitioners and researchers are to advance the public's health, they must be equipped with the technical skills and tools needed to help reduce suffering, cure illness, and promote health for all.

	Footnotes

 
Peer Reviewed

Accepted for publication April 6, 2001.

	References

TOP INTRODUCTION A COURSE IN POINT THE BASICS OF LARGE-SCALE... THE DESIRED OUTCOME References

 
1. Riegelman R, Persily NA. Health information systems and health communications: narrowband and broadband technologies as core public health competencies. Am J Public Health.2001;91:1180–1183.

2. Murnaghan JH, White KL. Hospital discharge data: report of the conference on hospital discharge abstracts systems held at Airlie House, Warrenton, Virginia. Med Care. 1970;8(4 suppl):1–11.[Medline]

3. Eng TR, Gustafson DH, eds. Wired for Health and Well-Being: The Emergence of Interactive Health Communication. Washington, DC: Office of Disease Prevention and Health Promotion, US Dept of Health and Human Services; 1999.

4. Arons RR. The New Economics of Health Care: DRGs, Case Mix, and Length of Stay. New York: Praeger Publishers; 1984.

5. National Hospital Discharge Survey, 1992. Public use data tape documentation. Hyattsville, Md: National Center for Health Statistics; 1994. Available at: http://www.ntis.gov. Accessed May 29, 2001. National Technical Information Service No. PB94141736.

6. SPARCS Inpatient Output Data Dictionary. Albany: New York State Department of Health; 2000.

7. Data User Support Group. 1996 discharge data tape format documentation. Sacramento: Office of Statewide Health Planning and Development, State of California; 1997.

8. National Health and Nutrition Examination Survey Fact Sheet. Hyattsville, Md: National Center for Health Statistics; 1999. Publication 90026.

9. Woodwell DA. National Ambulatory Medical Care Survey: 1997 Summary. Hyattsville, Md: National Center for Health Statistics; 1999. Advance Data From Vital and Health Statistics, No. 305.

10. Sorlie PD, Backlund E, Keller JB. US mortality by economic, demographic, and social characteristics: the National Longitudinal Mortality Study. Am J Public Health.1995;85:949–956.[Abstract/Free Full Text]

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