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Comparative Indicators of Health and Health Care Use for Manitoba’s Regional Health Authorities: A POPULIS Report. Rural and Northern Health Care Meeting November 1, 1999 SESSION II: KEY CONCEPTS Speaker: Patricia Martens PhD. Manitoba Centre for Health Policy and Evaluation
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Comparative Indicators of Health and Health Care Use for Manitoba’s Regional Health Authorities: A POPULIS Report Rural and Northern Health Care Meeting November 1, 1999 SESSION II: KEY CONCEPTS Speaker: Patricia Martens PhD Manitoba Centre for Health Policy and Evaluation Department of Community Health Sciences, University of Manitoba
Getting a “gut feel” • Age structure? • Major disease concerns? • Need, physicians, acute care, long term care?
Baseline information • 1996/1997 data compares inter-regionally and within each region • baseline for comparing impact of RHA Board initiatives
The people of your region • Population pyramids: age and gender pictures
Age Structure of Manitoba Population 1,136,249 Years Females Males 100+ 90-94 Treaty Indians 80-84 All Others 70-74 60-64 50-54 40-44 30-34 20-24 10-14 0-4 -8% -6% -4% -2% 0% 2% 4% 6% 8%
The geography of your region • Subdivisions … what’s a PSA? • Physician service area (see page 135 for list and associated RMs) • typically consist of towns in which physicians practice, plus smaller nearby communities and districts whose residents seek care from these physicians
The healthiness of your region • PMR = premature mortality rate • SERI = socio-economic risk index • life expectancy
PMR(page 70-71 of document) • best single indicator of health status capturing the need for health care • associated with self-reported health • high PMR … more likely to report … • poor health • higher number of symptoms • being sick more often • death before the age of 75, ie, “premature”
So what’s the meaning of * • “statistically significantly different” • number of people in RHA or PSA may cause year-to-year fluctuations • * = a similar difference would probably be seen from one year to the next
Premature Mortality Rates by RHA * South Eastman Most healthy * South Westman * Brandon Central Marquette Parkland Winnipeg North Eastman Interlake Least healthy * Burntwood * Norman ? Churchill Manitoba 0 1 2 3 4 5 6 7 Death rate per 1,000 population 0-74 years
SERI(page 68-69) • Composite index of 6 measures (from 23) • environmental, household, individual conditions (employment rates, single parent families, educational achievement, household dwelling value, participation of females in labour force) • risk for poor health • associated with higher need for health care
Socio-Economic Risk Index North Eastman lower risk Springfield higher risk East Lake Winnipeg -0.5 0 0.5 1 1.5 2 Manitoba average
Disease profiles/procedures • Adjusted rates: • disease burden: diabetes, hypertension, cancer • high profile procedures: cardiac catheterizations, coronary artery bypass surgery, angioplasty, hip and knee replacements, cataract surgery, prostatectomy • discretionary procedures: tonsillectomy, hysterectomy, caesarian section rates • Crude rates (one age bracket): • immunization, screening mammography
*Which population is “sicker” … A or B? *What is a fair comparison? A B 50 200 10 sick 3 sick 150 250 10 sick 15 sick 300 300 3 sick 10 sick 500 250 5 sick 0 sick Crude rate: 28 per 1000 28 per 1000
Adjusted vs. crude rates (cont’d) A B 50 (6%) = 12 of the 200 200 10 sick 3 sick 150 250 (6.7%) = 16.7 of the 250 10 sick 15 sick 300 (3.3%) = 10 of 300 300 10 sick 3 sick 500 250 (1%) = 2.5 of 250 0 sick 5 sick Crude rate: 28 per 1000 28 per 1000 Adjusted rate of A is 41.2 per 1000 (adjusted to population B)
Adjusted and Crude Rates: example of Burntwood (per 1000 residents)
Adjusted versus Crude Rates • When is “adjusted” helpful? (charts) • fair comparisons between regions • adjusted for age and gender • When is “crude” helpful? (appendix 2) • how many people actually have the given condition (multiply crude rate by regional population)
Comparisons • Most charts • Winnipeg, Non-Winnipeg, Manitoba • “Manitoba” is largely affected by Winnipeg • “Non-Winnipeg” is largely affected by Brandon • developed a “rural average” profile • excludes Winnipeg, Brandon, Churchill • summarizes “need”, “physicians”, “acute care”, and “long term care for 75+”
Example of a rural profile • comparison of using different “yardsticks”
Profile of South Westman - compared to rural average (page 43) * NEED * * PHYSICIANS * ACUTE CARE LONG-TERM CARE Rural Average
Profile of South Westman - compared to Manitoba average NEED PHYSICIANS Much lower than Winnipeg ACUTE CARE Much lower than Winnipeg LONG-TERM CARE Manitoba Average
Interpreting YOUR data • Group session with RHAs and facilitators • Computer session in the afternoon • Section 4 “Interpreting the data for local use” is a guide (pages 20 to 33) • the people, their healthiness, disease profiles, prevention, use of physicians, hospitals and PCHs, level of access to high profile and discretionary procedures, a profile of your region • between and within RHAs