Epidemiology of Health Care

Using Administrative Data To gain understanding re:Health of populations and

Use of Health Services

Purpose of Course

• Primer in how/why to use Manitoba’s

natural research resource

• Gain insights which come from a population focus

• Understand broader determinants of health

Examples of Administrative Data?? What exactly are we talking

about??

Research Approach

Research driven by insights and opportunities rather than hypotheses and preformed research agendas

Administrative DataAdvantages

• Able to study entire population

• Longitudinal follow-up easy

• Pre and Post Event Histories Easy

• Avoids the selection and recall

biases

• Relatively low cost

• Can study rare outcomes

Limitations

• Data not collected to answer your

research questions

• Quality of data – needs validation

and decision-making

• Individual initiates contact

• Amount of data – overwhelming

• Access to data – varies

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

• The Manitoba Centre for Health Policy– University of Manitoba, Faculty of Medicine, Department

of Community Health Sciences since 1991

– Five-year contracts with Manitoba Health, 6 deliverables a year mutually negotiated, all publicly available

– External funding of researchers (e.g. CPHI funding)

– Mission: To provide accurate and timely information to health care decision-makers, analysts and providers, so they in turn can offer services which are effective and efficient in improving the health of Manitobans

The Manitoba Centre for Health Policy (MCHP): Who we are

ResearchRegistry

Medical

VitalStatistics

Home Care NursingHome

Hospital

ProviderPharmaceutical

Immunization Monitoring

The Manitoba Population Health Research Data Repository

1 A similar version of this figure appeared in Roos, Menec, and Currie 2004.

Inflammatory Bowel Disease Database

Sleep Lab Clinical Data

Alcoholism Panel Surveys

Cancer Registry Educational and Social Data

Heart Health Survey

Aging in Manitoba Study

National Population Health Survey

• Canada Foundation for Innovation and Manitoba Government funded Data Laboratory

• Highest standards of security, privacy & confidentiality of data

• No names, no addresses

• Probabilistic linkages across files as needed

• Data for research not for administrative use

• Provincial privacy offices kept fully informed

Respect for Privacy In Building Database

Incrementally Added –Gained Experience with Data Files:

• 1970’s: Hospital and medical files• 1980: Nursing home file• 1981: Vital Statistics file• 1990: Census file• 1991: Mental Health Information System• 1992: Physician Registry file• 1993: Nursing home drugs• 1994: Immunization histories• 1995: Pharmaceutical file• 1996: Ability to cost hospital stays; Manitoba Cost List• 1997: Pilot with Social Assistance file• 1999: Linked National Population Health Survey• 2000: Home Care file• 2002: Family Services, Education, Healthy Child

Education (Grades, Tests, Enrollment Data)

Income Assistance

Children in Care

Provincial Programs (Healthy Baby, Baby First)

Genetic Screening

Community Resources

New Population Data Sets Added to the Repository:

Number of Data Files in the Repository housed at MCHP (from 1991 to 2005)

0

10

20

30

40

50

60

70

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

year

nu

mb

er

of

dat

a fi

les

CFI Funding

Research Registry• Accurately defines coverage status for individuals since

1970• Can help distinguish between "well" individuals from

those who left province or died • Place of residence (merge to census data)• Cohort identification• Family identification• Case controls / comparison groups

Validating the Registry

• Comparisons made with 1986, 1991, 1996, 2001 census years by date of census.

• Registry populations are larger by 2-4% overall.• Difference is greater for early census years and getting

smaller.• Female registry population not as much difference as

males.• Age 25-34 registry population is much higher 4-6% with

males being higher than females.

Web-based knowledge tools:

Data Dictionaries:

• Restricted to MCHP staff• A comprehensive list of field names

and contents for the administrative data files housed in the Repository

Medical/Research Definitions

Glossary

Research Protocol

Research Resources

Project Web Pages

Concept Dictionary

Web-based knowledge tools:

Concept Dictionary:

• Provides details on how to measure/calculate/define/validate “something” such as a variable or indicator

Concept Dictionary

• Calculates event rates per 1000, adjusting for key population differences (e.g. age, sex)

• Suitable for comparisons across time and space

SAS Macros: RATES

Western Australia Data Linkage System

– In 2005, Minister for Science declared it a national centre of excellence in Australia

– Since 1995, more than 350 major health projects primarily in the area of health care

– Between 1995 and 2004, out-of-state revenue from research grants was $58.4 million (Australian)

– Child and youth topics (recent reports):• Temporal variation in rates and causes of infant

mortality among aboriginal and non-aboriginal• Health/ outcomes among children of mothers who

have schizophrenia and/or other affective disorders

Massachusetts Pregnancy to Early Life Longitudinal (PELL) Project

Boston University School of Public Health

Birth Certificate

Hospital Discharge (HD)

Mothers Birth

Fetal Death Hospital Discharge (HD)

Child’s Birth

(Core Linkage)

Maternal or Child Linked Longitudinal Capacity

Program Participation Data

1999, 2000, …

Program Participation Data,

PNC Usage

(1998, 1999)

Subsequent Records

Child’s Hospital Discharges, Observational Stay, ER Usage

Mother’s Hospital Discharges, Observational Stays, ER Usage

1999Prior Information

Mother’s Pregnancy Hospital Discharges, Observational Stays,

Emergency Room Usage 1998, 1999

Birth Certificate

Hospital Discharge (HD)

Mother’s Birth

Fetal Death Hospital Discharge (HD)

Child’s Birth

(Core, 1999)

Subsequent Records

Child’s Hospital Discharges, Observational Stay, ER Usage

Mother’s Hospital Discharges, Observational Stays, ER Usage

2000

Alberta

• Analysis of population registry and vital statistics • Analysis of hospital discharge data • Analysis of physician claims • Analysis of laboratory data • Analysis of drug data • Risk adjustment• Defining socio-demographic variables at

small geographic areas

HH

Utilization

Utilization

Utilization

Regionalpopulation - SES - Health

Physicians

PersonalCare Homes

Hospitals

PCHPCH

PCH

A Tool for Population-BasedAnalyses

Principals for Population Focus1. describe:

- supply

- access to care

- intensity of use

- differential use across areas

2. juxtapose indicators of: -socioeconomic risk

- use

- health

Turning Data into ConceptsCounting

– objects– events

Measurement– concepts

Examples:

# times patient admitted to hospital

# times patient admitted with MI

health/status severity of illness

# admissions to a given hospital

# admissions for acute MI to a given hospital

case-mix of a given hospital

Examples of Concepts

• Individual: health status

• Family: poverty, mobility

• Community: neighbourhood level SES;

• Health care: continuity of care; hospital case mix

• Graduation, grade retention

•Radiology Services Review

•Province-wide coronary angiography, adult MRI, BMD and screening mammography data are captured

•For all other modalities, data are incomplete (esp. outside Brandon and

Winnipeg)

Some Things Administrative Data Cannot Do

Data Rich Environment Provides Insights Re:

• Who has access to services

• Who is and who is not in system

• Those who are healthy and those who are not