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Characteristics of users with a high morbidity in Montreal

Canadian Public Health Association 2008 Annual Conference Halifax, Nova Scotia, CANADA. Characteristics of users with a high morbidity in Montreal. Reducing Health Inequalities through Evidence and Action On the Move: Neighbourhoods and Networks.

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Characteristics of users with a high morbidity in Montreal

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  1. Canadian Public Health Association 2008 Annual Conference Halifax, Nova Scotia, CANADA Characteristics of users with a high morbidity in Montreal Reducing Health Inequalities through Evidence and Action On the Move: Neighbourhoods and Networks Mamadou Bamba HANNE, Ph.D. Candidate – Public Health. Groupe de Recherche Interdisciplinaire en Santé (GRIS) Faculté de médecine, Université de Montréal, CANADA mamadou.bamba.hanne@umontreal.ca by Tuesday 3 June 2008 Suite 304,WTCC

  2. Presentation • Context and research questions • Framework • Method • Data • Prevalence of the morbidity in Montreal • Morbidity and use of the health services • Clustering of the users aged 65 years and + • Limits • Conclusions 2008 Conference for CPHA. Mamadou Bamba Hanne

  3. Context • Epidemiological definition: morbidity as the number of persons with a given condition (disease) within a given period – one year. • Three types of morbidity : • Objective morbidity • Perceived morbidity • Established morbidity • Classification of morbidity levels: best predictors of the use of health services • Focus of the existence of specific conditions : not a global vision of resources to build on (Adams et al., 2002). 2008 Conference for CPHA. Mamadou Bamba Hanne

  4. Questions • Main goal : description of the high morbidity in Montreal by using the ACG system • What are the characteristics of users with a high morbidity ? • How do they use the health services ? • Can me make a clustering of elder users ? • Issue: - To approach central problems in the management and the organization of the resources intended to dam up morbidity. - best knowledge of the profile of challenging users and their localization: anticipation of the request for care and the expenditure 2008 Conference for CPHA. Mamadou Bamba Hanne

  5. Framework Weiner (2003). 2008 Conference for CPHA. Mamadou Bamba Hanne

  6. Method Levels of the morbidity: use of the ACG system software • Use of the International Classification of Disease (ICD-9) • Cataloging the patients into 93 different categorries of AGG (Adjusted Clinical Groups) according to the type of morbidity characterized by: • Likely persistence of the condition • severity of the condition • Aetiology • Diagnostic certaintly • Needs for speciality care • Gathering the 93 ACG codes into6 major categories [0-5]: integration of the morbidity indicator RUB (Resource Utilization Bands) 0: nonuser s 3: moderate morbidity 1: healthy users 4:high morbidity 2: low morbidity 5: very high morbidity 2008 Conference for CPHA. Mamadou Bamba Hanne

  7. Methodology Typology of the patient’s profile of 65 years old and over : • Process of cluster analysis (clustering) • Usage of the EuclidianDistancein a multi-dimensionalspacecreated by the variables specified • K-means methods: K groups, or "clusters" • Minimal distance • Constitution of homogenious group and differentiate one another 2008 Conference for CPHA. Mamadou Bamba Hanne

  8. medical-administratives data base ‘‘Agence de la Santé de Montréal’’ iCLSC confidentiality Med-Echo HealthInsurance Number encrypted ‘‘Banque de données jumelées’’ RAMQ - Actes médicaux link RAMQ - Médicaments Info-Admission Junction of data bases Décès Data 2008 Conference for CPHA. Mamadou Bamba Hanne

  9. Prevalence of the morbidity in Montreal 2008 Conference for CPHA. Mamadou Bamba Hanne

  10. Prevalence of the morbidity in Montreal • Prevalenceofhigh and veryhigh morbidity within age group, by sex 2008 Conference for CPHA. Mamadou Bamba Hanne

  11. Prevalence of the morbidity in Montreal • Prevalence of the morbidity within quintile of deprivation • Significatives Associations between dimensions of deprivation and the levels of morbidity • Verylow values of γ • Positive sign of γ for males: the more material-favored have the higher level of morbidity. • Relationship between the morbidity and Pampalon’sindicators 2008 Conference for CPHA. Mamadou Bamba Hanne

  12. Morbidity and use of the health services • Morbidity levels and some information about health services usage, 2005-2006 • Positive assiociation between levels of morbidity and volume of health services usage • Exception for the length of inpatient stay in CHLSD (Centre d’Hébergement et de Soins de Longue Durée): difference of 14% in favour of the very high morbidty • Explanation: high mortality induced by the very high mortality 2008 Conference for CPHA. Mamadou Bamba Hanne

  13. Morbidity and use of the health services • Share of (%) patient of each level of morbidity in the total of prescriptions, medical acts, interventions in CLSC and emergency ambulance transport • 10% of the population of Montreal • Third of the annual total number of prescriptions • Quarter of the whole of medical acts passed through the general practioner • 40% of the whole of medical acts passed through the the specialist Impact of the two higher levels of morbidity 2008 Conference for CPHA. Mamadou Bamba Hanne

  14. Clustering of the users aged 65 years and + • Classification according to the means of use of the services • Characteristics of elder patients • Class 1: profile of hospitalization • Class 2: profile of great customer of CLSC • Class 3: profile of average user 2008 Conference for CPHA. Mamadou Bamba Hanne

  15. Clustering of the users aged 65 years and + • Validation of the classification: distribution (%) of patients of each class according to their degree of real heaviness • Three last ACG codes: patients living with at least ten combinaisons of diagnostics including at least two majors • 79% of the patients with the profile hospitalization (class 1) • 47% of the patients with the profile great customer of CLSC (class 2) • 22% of the patients with the profile average user (class 3) 2008 Conference for CPHA. Mamadou Bamba Hanne

  16. Clustering of the users aged 65 years and + Distribution (%) of patients aged 65 years and + , according to their residence 2008 Conference for CPHA. Mamadou Bamba Hanne

  17. Limits • Connection of AGG system with - the number of medical visits registered - the administration registrars of diagnostics - the errors in diagnostic’s identification • Weakness of pharmaceutical data comparability : - differentiation of prescription volumes - Beneficiates of previous prescription from the current fiscal year 2008 Conference for CPHA. Mamadou Bamba Hanne

  18. Conclusions • High and very high morbidity levels : 10% of the population in Montreal • Characteristics of patients with higher morbidity: elderly • More stroked by the two extreme morbidity levels • Heterogeneous group, with three profiles • Vulnerability defined by the Quebec Health Insurance office : only 52% of patients with avery high morbidity…what happened ? • Positive association between the level of health services usage and the degree of morbidity • ACG System: facilitation of data process related to diagnostics • Best anticipation of care seekers • Allocation of resources and services organisation according to the profiles of expected patients 2008 Conference for CPHA. Mamadou Bamba Hanne

  19. Thank you for your attention ! 2008 Conference for CPHA. Mamadou Bamba Hanne

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