Studying Health and Health Care Leslie L. Roos, Noralou P. Roos Charlyn D. Black, Ruth-Ann Soodeen,...
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Transcript of Studying Health and Health Care Leslie L. Roos, Noralou P. Roos Charlyn D. Black, Ruth-Ann Soodeen,...
Studying Health and
Health CareLeslie L. Roos, Noralou P. Roos
Charlyn D. Black, Ruth-Ann Soodeen, Eileen Pyke
MANITOBA CENTRE FOR HEALTH POLICY & EVALUATION
POPULATION HEALTH & HEALTH POLICY:
Using a Population Health Framework to Improve the
Delivery of Health Care
HH
Utilization
Utilization
Utilization
Regionalpopulation - SES - Health
Physicians
PersonalCare Homes
Hospitals
PCHPCH
PCH
POPULIS: A Tool for Population-BasedAnalyses
Organizing Principles of POPULIS1. It describes:
- supply
- access to care
- intensity of use
- differential use across areas
2. It juxtaposes indicators of: - socioeconomic risk
- use
- health
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
Figure 1. An Ideal Administrative Data Base
Population - BasedResearchRegistry
Medical
Vital Statistics
Home Care under development
PersonalCareHome
Hospital
ProviderPharmaceuticals
Cost
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
Organizing and Accessing Information
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?
Other On-line Dictionaries
• Glossary - gateway to Concept Dictionary
• Research Definitions - codes for surgical procedures, test and diagnoses
• Data Dictionaries - list and describe variables and file structure for databases.
Meta-Index - organizes concepts and definitions according to the Medical Sub-Heading (MeSH) system
Commonly Used Health Measures
Individual Health Status
Individual PersonalCharacteristics
CommunityIndicators
(Health, Socio-Economic)
Individual PhysicianPractice Patterns
CommunityHealth Care Supply
(Hospitals, Physicians,Nursing Homes,
etc.)
Individual Health CareUtilization
No slide - just text from notes page.
Developing Indicators: Steps
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
Community Indicators
1. Demographic profile
2. Low weight births
3. Health care system sensitive indicators
4. Mortality indicators: population & cause-specific
5. Indicators based on rates of individuals hospitalized
6. Indicators based on rates of physician contact
FLAGSHIP INDICATOR
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
Questions Recently Addressed Using POPULIS
1. Have bed closures adversely affected:
A. Manitobans’ access to care?
B. The quality of care delivered?
C. The health of the population?
0100200300400500600700800900
1000C
oro
nary
Art
ery
Byp
ass
An
gio
pla
sty
To
tal
Hip
Kn
ee
Rep
lacem
en
t
Cata
racts
0
1000
2000
3000
4000
5000
6000
7000
1989 1991 1993 1995 1997
Number of Procedures
0
5
10
15
20
25
1989 1990 1991 1992 1993 1994 1995 1996
A.M.I. Hip Fracture Cancer Surgery
Deaths per 100 Cases
0
1
2
3
4
5
6
7
8
1990 1991 1992 1993 1994 1995 1996
Death
s per
1,0
00 R
esi
dents
Male Deaths All (Overall)
Female Deaths Deaths Age 0-74
Selected Chronic All Cancers
Ischemic Heart Disease All Injuries
2. When does seasonal hospital overcrowding occur? Why does it occur? Is it due to bed shortages?
Apr May June July Aug Sep Oct Nov Dec Jan Feb Mar
AVG. DAILY NUMBER OF INPATIENTS
High Pressure LevelNormalRange
700
750
800
850
900
950
1000
1050
700
750
800
850
900
950
1000
1050
Apr May June July Aug Sep Oct Nov Dec Jan Feb Mar
Flood
AVG. DAILY NUMBER OF INPATIENTSHigh Pressure Level
NormalRange
3. How long are Manitobans waiting for surgery? Have waiting times changed? Do certain groups get surgery faster?
2651
2535
4016
2931
0 10 20 30 40 50 60
Carotid Endarterectomy
Prostate Removal
Varicose Veins
Hernia
Median wait in days after patient sees surgeon pre-op
0
5
10
15
20
Private
Procedures
Public
ProceduresPublic OnlySurgeons
Public
ProceduresPrivate/Public
Surgeons
Me
dia
n W
ait
in W
ee
ks
1992 93 94 95 96 1992 93 94 95 96 1992 93 94 95 96
4. Are there different ways of delivering preventive or screening programs that are successful in reaching all groups in the population?
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.
00.10.20.30.40.50.60.70.80.9
1
0 0.2 0.4 0.6 0.8 1 1.2
Q1/Q5 Ratio
Pro
port
ion C
overe
d
= 1992 Childhood Immunizations
= 1990 Screening Mammography
= 1996 Screening Mammography= 1996 Papanicolaou Testing
m
M
P
I
I
m
M
P
Conclusions“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