Studying Health and Health Care

1. Studying Health and Health Care Leslie L. Roos, Noralou P. Roos Charlyn D. Black, Ruth-Ann Soodeen, Eileen Pyke MANITOBA CENTRE FOR HEALTH POLICY

2. POPULATION HEALTH & HEALTH POLICY:Using a Population Health Framework to Improve the Delivery of Health Care

3. POPULIS: A Tool for Population-Based Analyses Physicians Utilization Regional population - SES - Health H Utilization Hospitals H Utilization PCH Personal Care Homes PCH PCH

4. 1. It describes: - supply - access to care - intensity of use - differential use across areas 2.It juxtaposes indicators of: - socioeconomic risk - use - health Organizing Principles of POPULIS

5. 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

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

7. 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 Where to find Population-Based Administration Data

8. 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? Organizing and Accessing Information

9. Glossary - gateway to Concept Dictionary Data Dictionaries - list and describe variables and file structure for databases. Other On-line Dictionaries

10. Individual Health Status Individual Personal Characteristics Community Indicators (Health, Socio- Economic) Community Health Care Supply (Hospitals, Physicians, Nursing Homes, etc.) Individual Physician Practice Patterns Individual Health Care Utilization Commonly Used Health Measures

11. 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).

12. 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 Developing Indicators: Steps

13. 1. Demographic profile 2. Low weight births 3. Health care system sensitive indicators Community Indicators

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

15. 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 FLAGSHIP INDICATOR

16. 1. Have bed closures adversely affected: A. Manitobans’ access to care? B. The quality of care delivered? C. The health of the population? Questions Recently Addressed Using POPULIS

17. Number of Procedures

18. Deaths per 100 Cases

20. 2. When does seasonal hospital overcrowding occur? Why does it occur? Is it due to bed shortages?

21. AVG. DAILY NUMBER OF INPATIENTS High Pressure Level Normal Range Apr May June July Aug Sep Oct Nov Dec Jan Feb Mar

22. AVG. DAILY NUMBER OF INPATIENTS High Pressure Level Normal Range Flood Apr May June July Aug Sep Oct Nov Dec Jan Feb Mar

23. 3.How long are Manitobans waiting for surgery? Have waiting times changed? Do certain groups get surgery faster?

25. 1992 93 94 95 96 1992 93 94 95 96 1992 93 94 95 96

26. 4. Are there different ways of delivering preventive or screening programs that are successful in reaching all groups in the population?

27. 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.

28. I P M m I m M P

29. “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 Conclusions