Manitoba Centre for Health Policy & Evaluation Winnipeg, Manitoba, Canada

1. Providing Information to Regional Health Care Planners:A Manitoba Case StudyRuth-Ann M. Soodeen, Patricia J. Martens, Leslie L. Roos, Jan Roberts, Randy Fransoo and Charlyn Black Manitoba Centre for Health Policy & Evaluation Winnipeg, Manitoba, Canada

2. Regionalization & Research The regionalization of health care in Canada refers to two related processes: • Decentralizing - “moving planning, budgeting and decision-making authority from the provincial or territorial level to certain regional bodies” • Centralizing - “moving the planning and the governance of health care and medical services from individual institutions or agencies to a regional body.” (CMA, 1998)2

3. Regional Health Authorities

4. An Ideal Administrative Data Base Hospital Medical Personal Care Home Home Care under development Population-Based Research Registry Provider Pharmaceuticals Cost Vital Statistics

5. Comparisons can be made across districts within RHAs, and with provincial and RHA averages for the following indicators: Information Please... • Health status • Health services • Demographic • Socio-economic status

6. 1. Regional demographics (e.g. age, gender) 2. Health indicators 3. Major disease profiles 4. How local residents use physician services 5. How local residents use hospital services 6. How local residents use nursing home services 7. Access to surgical procedures 8. Success of preventive programs Profiles to Develop

7. Using Regional Profiles * Indicates rate is statistically different from the Manitoba average. ‡ Physician claims for Churchill residents are not complete.

8. - Composition by age & gender 1. Regional Demographics: Who Are Your Neighbours?

9. Premature Mortality Rate (PMR) Life Expectancy ACG Case-Mix System 2.Indicators of Health

10. 3. Major Disease Profiles Diabetes Treatment Prevalence (adjusted) per 1000 residents aged 20-79 • Highlight rates of diagnoses and treatment for major diseases in one northern Regional Health Authority * Nor-Man Region Flin Flon Sub- regions * The Pas * Nor-Man Other Manitoba *- significantly different than Manitoba average 0 25 50 75 100 125 150

11. 4. How Local Residents UsePhysician Services • “In-area” physician supply • “Ambulatory” visit rate • Types of providers • Location of visits (i.e. in or out of region of residence)

12. 5. How Local Residents Use Hospital Services • Hospital bed supply • Separation rates • Number of hospital days, length of stay • Location of hospitalizations

13. 6. How Local Residents Use Nursing Home Services • Number of beds in region • Number of PCH residents • Number of annual admissions • Total days of care • Waiting times for admission

14. 7. Access to Surgical Procedures • “High profile” procedures • Associated with quality of life • e.g. angioplasty, coronary artery bypass, hip and knee replacement, cataract surgery • Discretionary procedures • e.g. tonsillectomy, hysterectomy, Caesarian surgery

15. 8. Success of Preventive Programs A successful program of prevention or early detection should: a) provide good population coverage b) target high-risk populations (e.g. low income residents) Evaluations should look at: a) who gets preventive care - considering time, area, income quintile, and treaty status b) who delivers the care - organized program, physicians, or public health nurses

16. Population-Based Information Amount of hospital care populations are using: Need for hospital services: Age Gender SES PMR Institutional Information Intensity of services: % of cases involving surgery or delivery Case Mix LOS >1 Discharge efficiency: Actual LOS Expected LOS Share of local hospitalizations: % of area hospitalizations in hospital Occupancy rates: # Occupied Beds # Hospital Beds Hospital Use Need for Service Indicators of Hospital Performance

17. Rural Hospitals - Characteristics • Capabilities - limited access to technologically advanced equipment • Major role in community • Personnel challenges - recruiting & retaining • Case mix - low intensity, low service volume

18. Dissemination Implementation

19. Keys to Success • Communication • between researchers & decision makers 1. Data - understandable, useable 2. Cohesiveness - among various groups • Training • for recipients of health data 1. Familiarize with health services research 2. Teach data management & interpretation skills

20. Dissemination of Information • Reports & report summaries • Project websites • Data spreadsheets • Lookup tables • Interactive software applications

21. Downloadable Health Data: Examples • Data Spreadsheets - RHA profiles • Lookup Tables - E-Stat (Statistics Canada), Census Analyser • Interactive Data Application - MassCHIP, ORC

22. Implementation: Training Training of the recipients of health data is necessary to ensure appropriate interpretation and implementation of research findings: • Workshops & courses • Site visits by researchers • Web-based tools

23. “Canada’s health researchers, and the people and communities they serve, recognize that they can learn from one another and can work together in pursuit of shared goals.” ~ Federal Budget Plan, p. 95 ~