Studying Health and Health Care

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Studying Health and Health Care
MANITOBA CENTRE FOR HEALTH POLICY

• Leslie L. Roos, Noralou P. Roos
• Charlyn D. Black, Ruth-Ann Soodeen, Eileen Pyke

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POPULATION HEALTH HEALTH POLICY Using a
Population Health Framework to Improve the
Delivery of Health Care
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POPULIS A Tool for Population-Based Analyses
Physicians
Utilization
Regional population - SES - Health
H
Utilization
Hospitals
H
Utilization
PCH
Personal Care Homes
PCH
PCH
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Organizing Principles of POPULIS

• 1. It describes
• - supply
• - access to care
• - intensity of use
• - differential use across areas
• 2. It juxtaposes indicators of -
  socioeconomic risk
• - use
• - health

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• 3. It assesses contributions to costs per capita
  of
• - differential access
• - dollars per service (visit, day of care)
• 4. It is relevant to system managers
• 5. It sums use across sectors
• 6. It creates regional profiles

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Figure 1. An Ideal Administrative Data Base
Medical
Hospital
PersonalCare Home
Home Care under development
Population - Based Research Registry
Provider
Pharmaceuticals
Vital Statistics
Cost
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Where to find Population-Based Administration Data

• 1. Several Canadian provinces
• 2. Rochester (Minnesota) Epidemiology Project
• 3. Oxford Record Linkage Study
• 4. Scottish Record Linkage System
• 5. Western Australia Health Services Research
  Linked Database Project

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Organizing and Accessing Information

• Since many researchers use the same
• data to answer different research
• questions, various methods of analysis
• may be applied to them.
• Problem How can an organization store
• its working knowledge for easy access
• and to guard against conflicting
• interpretations of the same data?

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Other On-line Dictionaries

• Glossary - gateway to Concept Dictionary
• Data Dictionaries - list and describe variables
  and file structure for databases.

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Commonly Used Health Measures
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• Indicator Selection
• The indicators included have been selected
  because of their potential value for health care
  system management
• Hospital indicators - distinguish between types
  of admissions, and use that occurs in-region vs.
  out-of-region.
• Physician Supply Indicators - distinguish
  between physicians available to area residents
  because they live in the area, and those
  available because residents travel (as do
  physicians sometimes).

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Developing Indicators Steps

• 1. Create meaningful geographical areas
• 2. Obtain denominator data for each area
• 3. Develop indicators of socioeconomic risk for
  each area
• 4. Develop indicators of health status
• 5. Describe utilization of health care by
  residents

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Community Indicators

• 1. Demographic profile
• 2. Low weight births
• 3. Health care system sensitive
  indicators

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• 4. Mortality indicators population
  cause-specific
• 5. Indicators based on rates of individuals
  hospitalized
• 6. Indicators based on rates of physician contact

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FLAGSHIP INDICATOR

• Premature Mortality Rate
• (Rate of death of persons 0-74)
• ? Best overall indicator of health status
  incorporating need for health care
• ? Well correlated with morbidity measures

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Questions Recently Addressed Using POPULIS

• 1. Have bed closures adversely affected
• A. Manitobans access to care?
• B. The quality of care delivered?
• C. The health of the population?

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Number of Procedures
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Deaths per 100 Cases
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(No Transcript)
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• 2. When does seasonal hospital overcrowding
  occur? Why does it occur? Is it due to bed
  shortages?

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AVG. DAILY NUMBER OF INPATIENTS
High Pressure Level
Normal Range
Apr May June July Aug Sep Oct
Nov Dec Jan Feb Mar
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AVG. DAILY NUMBER OF INPATIENTS
High Pressure Level
Normal Range
Flood
Apr May June July Aug Sep Oct
Nov Dec Jan Feb Mar
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3. How long are Manitobans waiting for surgery?
Have waiting times changed? Do certain groups get
surgery faster?
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(No Transcript)
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1992 93 94 95 96 1992 93
94 95 96 1992 93 94 95 96
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4. Are there different ways of delivering
preventive or screening programs that are
successful in reaching all groups in the
population?
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Research has shown that poor people tend to
have more health problems than the wealthy and
that they are less likely to make use of
preventive or screening programs, despite
universal free health care in Canada. Roos,
Traverse and Turner (1999)12 considered how such
services could successfully reach all groups in
the population. They used data from the research
registry and from files maintained by two
established provincial programs to examine
childhood immunization, screening mammography and
cervical cancer screening.
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I
P
M
m
I m M P
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Conclusions

• As we rethink health in the context of a
• population health framework, there is a need for
• an information system designed to provide
• evidence to support policy and health services
• decisions in managing the health care system.
• There is an equal need to communicate research
• findings with policymakers, providers, and the
• public.
• - Hon. Darren Praznik, Former Minister of
  Health, Province of Manitoba13