Board of Scientific Counselors - Minutes

September 17-18, 2007

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All attendees are listed in Attachment 1.

September 17, 2007

Introductions and Welcome:

The meeting was called to order at 2:00 PM. Dr. Edward Sondik, Director, NCHS, introduced new members of the Board of Scientific Counselors (BSC), Ronald Angel, Lynn Blewett, Michael O' Grady, Kenneth Prewitt. Dr. Sondik updated the Committee on recent NCHS activities.

Discussion of BSC Reviews:

Dr. Irma Elo, the new chair of the BSC, presented information on how the Committee would function over the next two years particularly with respect to the intramural program reviews. Efforts would be made to involve BSC members more actively in the reviews throughout the process. Previously, BSC liaisons with the review committees didn't attend the meetings of the reviewers, but they should be included in the future. A preliminary report should be provided to the BSC and to NCHS to review before the final report is presented. This would allow the chance to engage the Board more effectively and also give NCHS chance to fix factual errors. Dr. Elo announced that for the next review, an NCHS staff contractor would prepare a draft of the written report to save the review group time and effort and allow them to focus on the recommendations. It was noted that while review committee members receive an honorarium and travel expenses, this activity is mostly voluntary.

Not all reviews need to be identical. Before each review gets underway, the BSC should consider the key questions for the review, and the review criteria specific to each review should be customized accordingly. The review process should begin with a short NCHS self-assessment and presentation to the BSC. A new subcommittee was formed to develop short criteria for the review process, to be chaired by Dr. Neil Powe, and including Drs. Mike O'Grady and Ronald Angel. Dr. Schwartz said that NCHS should be required to report back to the BSC on actions taken based upon recommendations. The next two NCHS programs to be reviewed will be the National Health Interview Survey (NHIS) and the National Health and Nutrition Examination Survey (NHANES). Drs. Tom Koepsell and Lynn Blewett volunteered to be BSC liaisons for the NHIS review committee and Drs. Irma Elo and Ruth Stein for the NHANES review. It was agreed that the BSC liaisons would serve as "discussants" when the review committees report back to the full Board. The NHIS review will be on the May BSC agenda and the NHANES the following January. Thus, the NHIS self- assessment will be scheduled for January. Dr. Elo asked BSC members to suggest reviewers for the NHIS and NHANES review committees.

National Immunization Survey & SLAITS:

(Michael O'Grady announced that he must recuse himself from the NIS/SLAITS review because his company, NORC, has a contract with the survey.) Jim Singleton, Marcie Cynamon and Stephen Blumberg provided an overview of NIS and SLAITS.

BSC Liaison response and discussion:

Dr. Ruth Stein said that SLAITS has been breath of fresh air in a system with little information about child health although she would like to see longitudinal data. While the SLAITS and the National Immunization survey are closely linked, the review questions posed by SLAITS and NIS are very different. The NIS is already undergoing CDC review, but this is not a methodological review.

The question arises "Should NIS and SLAITS be reviewed by separate committees?" Different questions apply to the two surveys: methods vs. types of questions to ask. Dr. Ken Prewitt said that the real issue is how to sustain the capacity in NCHS offered by SLAITS, even in the absence of NIS. It was agreed to combine the two reviews in one panel, with the understanding that we wouldn't expect it to solve all the phone methodology problems; rather it would address how NCHS can best continue getting the value of SLAITS. The panel should consider how SLAITS can respond to special population needs/policy recommendations. NCHS should think of topics for SLAITS in the future to initiate--not just react to needs of outside funders. Also, the panel should think of budget aspects--is this a cost-effective way of using staff time, etc? How does SLAITS fit in as part of an overall NCHS strategy for meeting needs of our clients? Is SLAITS the best mechanism for addressing children's health? (NHIS sample is too small to look at subgroups for kids). What about partnership with states and what role is there for state partnership with SLAITS?

National Committee on Vital and Health Statistics (NCVHS) Update:

Dr. Bill Scanlon, NCVHS liaison, updated the BSC on NCVHS activities.

September 18, 2007

Dr. Elo recapped the decisions that had been made the previous day. Reviews will start with a self-assessment by NCHS to the BSC. Two BSC members will serve as LIAISONS. Presentations of staff will be sent 2 weeks in advance. BSC will provide guidance to staff on self-assessment based on criteria developed by Dr. Powe's subcommittee. Guidelines should be short. Powe's group will circulate draft guidelines to the BSC for review by the end of October. Before the review committee provides their final report, they will present a preliminary report that will be reviewed by the full Board. NCHS will set up a blog or blackboard so that all BSC members can review all the comments.

Budget Outlook:

Dr. Sondik provided an overview of the NCHS budget situation. Congress has not yet passed a budget for Fiscal Year 2008, so NCHS must make plans based on the most likely situation. The adoption of cost savings and other budgeting strategies NCHS will likely be able to continue activities through FY 08. While NCHS is aware of efforts to increase the NCHS budget for FY 08 and FY 09, tough decisions will need to be made before possible increases would be finalized.

Discussion on Budget:

Dr. IRMA Elo asked when we need to make FY 09 program decisions. Dr. Sondik said in the next two months for NHANES and next three to four months for NHIS. Ed said he'd want to discuss options within the department before being more specific with the BSC about NCHS thinking about cuts; Dr. Sondik expressed the need to discuss options within the Department of Health and Human Services. Drs. Mike O'Grady and Ken Prewitt suggested that the BSC send a general letter right now about the value of NCHS and concern about impact of budget problems on NCHS programs. They want NCHS to report back to BSC about specific recommendations after Dr. Sondik discusses options internally. The BSC letter would be sent to Dr. Sondik, Dr. Julie Gerberding and Secretary Leavitt, but not to Congress. The letter would state that even short term cuts can have long term consequences and give specific examples. The letter should emphasize the BSC role as scientific counselors--not as an advocacy body.

BSC/NCVHS liaison:

Dr. Mike O'Grady volunteered to be the NCVHS liaison --at least to go to next meeting. Since Dr. Jim Lepkowski had previously expressed interest in that role, Drs. O'Grady and Lepkowski may share the role of NCVHS liaison especially with the level of activity of the NCVHS.

DNA & NHANES Issue:

Dr. Ed Sondik raised an issue of data release that is increasingly a concern of NCHS. The release of NCHS genetic data to the National Institutes of Health (NIH) for distribution is a very complex issue. A meeting with NCHS and NIH to further discuss this will be held in December. If possible, Dr. Sondik would like some members of the BSC members to attend. Dr. Prewitt and Dr. Matt Snipp both stated how important it is for NCHS as a statistical agency--with both legislation and a "culture" to protect confidentiality-- to maintain control of the release of the DNS data.

Vital Statistics Mortality Review Update:

Dr. Bob Anderson, Chief Mortality Statistics Branch, presented an update highlighting actions taken in accordance with BSC Mortality Program review recommendations.

BSC Discussion about Mortality Review presentation:

Dr. Schwartz asked what NCHS is doing to provide leadership in collecting cause-of-death data in electronic environment. Dr. Anderson said that the ICD 10 form was not evaluated for electronic reporting. Dr. Schwartz expressed concern that the states have electronic systems that will be extremely expensive to re-tool and that NCHS needs to take the lead at making sure that in the states' development of electronic systems, they'll be able to best transition from reporting systems using paper. Dr. O'Grady suggested that NCVHS set up subcommittee to look at the intersection of electronic death records and EMR. Dr. Elo recommended that NCHS take the lead at looking at linkage of Electronic Medical Records and Electronic Death Records. Dr. Schwartz would like something more specific such as how to improve cause-of-death reporting in an electronic environment.

National Death Index (NDI) and Intelligence Reform and Implications for Vital Statistics:

Mr. Charlie Rothwell, Director of the Division of Vital Statistics (DVS), described the NDI. Dr. Elo asked if the NDI would be threatened by possible cuts in mortality data collection. His response was that we can still maintain the NDI but without the cause-of-death information. Dr. O'Grady said we should look at opportunities for "leveraging" NDI with other Departmental agencies (CMS, SSA) that benefit from the NDI. Mr. Rothwell provided background on birth certificate improvements and intelligence reform. He said that a potential outcome of this activity could be improvements in the vital statistics system. He said that regulations are still in draft form.

CNSTAT Update:

Dr. Ken Prewitt announced that National Academy of Sciences Committee on National Statistics (CNSTAT) would be conducting a one-day workshop, probably in January of 2008, on "Vital Data for Vital Needs". Topics will include: 1) health policy/health research; 2) uses of vital statistics system; 3) how to use vital statistics to make population projections; 4) where are we now and what are the methodological challenges and needs; 5) role of the states; 6) what can we do? 7) federal/state cooperative systems, best practices including in other countries; 8) where to go from here. He asked for BSC advice for possible speakers. Dr. Bill Scanlon's name was raised as possible speaker.

VitalStats:

Paul Sutton, Ph.D., a Statistician / Geographer, in the Reproductive Statistics Branch, DVS, presented VitalStats, a new program for accessing vital statistics data online which is user friendly and will increase access to the data among a variety of users.

Data Linkage and Data Release:

Dr. Linda Bilheimer, Associate Director for Analysis and Epidemiology, NCHS reported on recent advances that had been made in linking the NHIS and NHANES to the NDI. The release of these linked files is designed to maximize the scientific value of the NCHS population-based surveys. They will enable researchers to examine the association of a variety of health factors with mortality, using the richness of NCHS health surveys.

NHIS Anniversary:

Dr. Jane Gentleman, Director of the Division of Health Interview Statistics, reported on the series of events during 2007 held in commemoration of the 50th anniversary of the Health Interview Survey. BSC members were encouraged to view the posters in the room that highlight research using the NHIS.

OMB Directive on Data Dissemination and Discussion:

Ms. Sandy Smith, MPH, Communications Consultant for NCHS, presented on the OMB directive that is open for public comment until October 1, 2007. The directive would give increased authority to the statistical agencies for releasing their data publicly. The BSC decided to prepare a letter in support of the directive to be submitted pending guidance from the Department of Health and Human Services about the appropriateness of this type of activity for BSCs.

No public comment.

Adjourned 1:30.

I hereby confirm that these minutes are accurate to the best of my knowledge.

/s/
Irma E. Elo, Ph.D.

Attachment 1

Attendance at BSC meeting: September 17, 2007

Board Members

Irma Elo
Ronald Angel
Lynn Blewett
Michael Grossman
Graham Kalton
Thomas Koepsell
Michael O'Grady
Neil Powe
Kenneth Prewitt
Steve Schwartz
Matthew Snipp
Ruth Stein
Katherine Wallman, Ex Officio
Bill Scanlon, NCVHS Liaison
Virginia Cain, Executive Secretary

Other NCHS staff

Ed Sondik
Jennifer Madans
Catherine Simile
Kathy O'Connor
Barbara Stussman
Heather McAdoo
Marcie Cynamon
Robert Weinzimer
Stephen Blumberg
Brenda LaRochelle
Diane Makuc
Peter Meyer
Jane Gentleman
Alan Simon
Linda Bilheimer

Attendance at BSC meeting: September 18, 2007

Board Members

Irma Elo
Ronald Angel
Lynn Blewett
Michael Grossman
Graham Kalton
Thomas Koepsell
Michael O'Grady
Neil Powe
Kenneth Prewitt
Steve Schwartz
Matthew Snipp
Ruth Stein
Virginia Cain, Executive Secretary

Other NCHS Staff

Ed Sondik
Heather McAdoo
Traci Cook
Cliff Johnson
Stephanie Ventura
Raymond Eldridge
Peter Meyer
Nathaniel Schenker
Jane Gentleman
Marty Munson
Bob Anderson
Catherine Simile
Brenda LaRochelle