POWER: Project for an Ontario Women’s

Health Evidence-Based Report Card

Asma RazzaqAcademy Health Annual

Research MeetingJune 3, 2007

www.powerstudy.ca

Goals & Deliverables Tool to help policymakers and providers improve health

and equity among women of Ontario

Report card 1: Fall 2007 – 5 chapters

Access to Health Care, Burden of Illness, Cancer, Cardiovascular Disease, Depression

Report card 2: Fall 2008 – 11 chapters

Update of 5 chapters + Diabetes, Reproductive Health, HIV, Musculoskeletal Disorders, Populations at Risk, and Social Determinants of Health

Web-based interactive data cube

Why is POWER Unique?Equity is integral to the process

Input from stakeholders, providers and community groups, from the outset

Spans the continuum of care and is not sector specific

E-tool will increase dissemination and ensure uptake of the measures by others

Creates linkages between clinical and population health measures

Objectives

To illustrate the project, using the cancer chapter as an example

Value of the process

Challenges & lessons learned

Process for Indicator SelectionLiterature review of published articles and grey literature

Stakeholder Consultations • Identify and

discuss priority issues in each

chapter• Perspectives of

providers andconsumers

Data Analysis• Administrative and survey data

• Stratify by sex, age, SES, and regional level

Expert Panels• Review and finalize indicators using selection criteria

• Modified Delphi Process (online survey & face-to-face meeting).

Working Groups• Identify key issues to be

addressed in each chapter• Shortlist indicators

according to importance and feasibility

Example - Cancer

General indicators Incidence 5 year survival Wait time for surgery

Non sex-specific cancers Colorectal Lung

Sex-specific cancers Breast Cervical Ovarian Uterine

End of Life care

Literature ReviewPublished and grey literature internationally

Librarian: Developed a standardized search strategy

for all chapters Conducted comprehensive searches Extracted articles of interest

Conducted a separate search for each tumor site/area

Result: 427 indicators

Working Group10 members: clinical and/or research expertise

Includes Lead Investigator, Analyst, and Research Coordinator

Reviewed the 427 indicators and short-listed them according to: Feasibility Importance (equity issue, actionable, key information

on women’s health)

Result: 47 indicators

Expert Panel8-12 experts: medical, radiation, surgical

oncologists

Recommended by working group members

Sent invitations by email with follow up phone calls

Modified Delphi process, 2-step: On-line rating of indicators (Survey Monkey tool) Face-to-face meeting to finalize indicators

Result: 31 indicators

Sample of Indicators Chosen

1. % of women with a history of breast cancer who have a yearly mammogram

2. % of screen eligible patients receiving one or more FOBTs in the last 2 years

3. % of women with an unsatisfactory Pap result who receive a repeat Pap test within 2-4 months of the original result

4. Proportion of cancer patients who had one or more home care services in the last 6 months of life

Data Analysis Ontario Cancer Registry (OCR) for identification of cancer

cases by tumor site 2 fiscal years 2002-2004 = 47,867 cases For some indicators such as 5 year survival, we will go

back to 2000/01

9 additional administrative databases including registry, inpatient, ambulatory, home care, and provincial breast and cervical screening databases

Stratify all indicators first by sex and then by age group, socioeconomic status, and ethnicity

Use established definitions and methods

Value of the Process Rigorous and collaborative

Stakeholders: providers and consumers Experts in the field

Advantages of Delphi process: Clarification of definitions Operationalization of indicators Introduction to new and unexplored databases

Result: Set of comprehensive performance measurement and quality of

care indicators for women’s health that spans the continuum of care

Challenges & Lessons Learned

Challenge: Reconciling what is important with what is measurable

Lesson: Contextualize quantitative content and include list of important but not

currently measurable indicators

Challenge: Presenting enough information to expert panel members to allow for informed

responsesLesson: Develop reference manuals

Challenge: Meeting timelinesLesson: This is a very time intensive phase of the

project…allow enough lead time!

Thank YouAcknowledgements

Arlene Bierman – Principal InvestigatorJocalyn Clark – Director of Knowledge TranslationMonika Krzyzanowska – Lead InvestigatorCo-authors – Cynthia Damba, Mandana Vahabi

Funded by the Ontario Ministry of Health & Long Term Care and Ontario Women’s

Health Council

www.powerstudy.ca

Contact:

Asma Razzaq, MPHInstitute for Clinical Evaluative SciencesG106 – 2075 Bayview Ave.Toronto, ON M4N 3M5Tel: 416-480-4055 ext. 7460Email: asma.razzaq@ices.on.ca