A 21st Century Data Strategy for Health and Health Care Surveys: Their Unique Contribution to Improving Health Outcomes and Reducing Disparities Arlene S. Bierman MD MS OWHC Chair in Women’s Health St. Michael’s Hospital, University of Toronto A 21st Century Data Strategy for Health and Health Care Surveys: Their Unique Contribution to Improving Health Outcomes and Reducing Disparities Arlene S. Bierman MD MS OWHC Chair in Women’s Health St. Michael’s Hospital, University of Toronto AHRQ Annual Meeting September 29, 2010

2 Health and Health Care Surveys Essential Data for Improving Health Outcomes  Assessing, Improving, and Monitoring Health System PerformanceHealth System Performance Population HealthPopulation Health Health DisparitiesHealth Disparities  Identifying Individuals, Populations, and Communities at RiskIndividuals, Populations, and Communities at Risk  Benchmarking  Conducting International Comparisons

3 Health and Health Care Surveys Unique Contributions Patient Reported Outcomes  Patient Reported Outcomes Health and Functional StatusHealth and Functional Status Physical and Mental HealthPhysical and Mental Health  Health Behaviors and Risk Factors  Patient Experiences with Care  Non-Medical Determinants of Health  Health Needs of Diverse Populations

Actionable Data for Improvement 4 The POWER Study (Project for an Ontario Women’s Health Evidence-Based Report) is providing actionable data to help policymakers and providers to improve the health of and reduce inequities among the women of Ontario.

5 Community-Engaged Research  POWER Study Roundtables – Inform indicator selection and interpretation – Increase uptake of findings  Consumers: representatives of community based organizations and associations  Providers: Clinicians, Hospitals, Community Health Centres  Policymakers: Government, Regional Health Authorities, Public Health, Health Data Agencies

6 Overall Population Women Men Income Education Ethnicity Geography Ethnicity Education Income Assessing Equity

7 Patient Reported Outcomes

8 Age-specific percentage of adults aged > 25 years who reported activities were prevented due to pain or discomfort, by sex and annual household income, Ontario, 2000/01 Data source: Canadian Community Health Survey cycle, 1.1

Age-standardized percentage of adults age ≥ 25 with CVD who reported that their current health was somewhat or much worse than their health one year prior, by sex and annual household income, Data source: CCHS, Cycle 3.1 * Interpret with caution due to high sampling variability (coefficient of variation 16.6–33.3)

10 Risk Factors

11 Age-standardized percentage of women aged > 25 who reported health behaviors that increase the risk of chronic diseases, by education level, Ontario, 2005 Data source: Canadian Community Health Survey cycle, 3.1 *Physical activity index was less than 1.5 kcal/kg/day ** Less than five servings per day ***Body Mass Index (BMI) >greater than or equal to 25 (calculated from self-reported height and weight) ^Daily or occasional smokers

12 Age-standardized percentage of adults aged 25 years and older who reported being current smokers, by sex and ethnicity, Ontario, 2005 Data source: Canadian Community Health Survey 3.1 *Interpret with caution due to high sampling variability (coefficient of variation 16.6– 33.3) **Only includes off-reserve Aboriginals (North American Indian, Metis, Inuit) ***Includes Latin American, other racial and multiple racial origins.

Age-standardized percentage of adults aged 25 and older who reported being a daily or occasional smoker, by sex, education level and Local Health Integration Network, Ontario,

14 Age-standardized percentage of adults age ≥ 25 with CVD who reported health behaviors that increase risk for chronic diseases, by sex and risk behaviour, Ontario, 2005 Data source: CCHS, Cycle 3.1 ^ Physical Activity Index of < 1.5 kcal/kg/day ** Daily consumption of less than five servings of fruits and vegetables ¥ Body Mass Index (BMI) ≥25, calculated from self-reported height and weight $ Current smokers (daily or occasional)

15 Social Determinants of Health

16 Data source: Canadian Community Health Survey 3.1 ^ Refers to people who reported that they did not have enough to eat, worried about there Not being enough to eat or did not eat the quality or variety of foods desired due to a lack of money *Interpret with caution due to high sampling variability (coefficient of variation 16.6–33.3) Age-standardized percentage of adults aged 25 and older who reported food insecurity^, by sex and annual household income, Ontario, 2005

17 Access Patient Experiences with Care

Percentage of adults aged 25 and older who reported no difficulties making an appointment for an urgent, non-emergent health problem, by sex and neighbourhood income quintile, Ontario, 2006–08^ 18 Data sources: Primary Care Access Survey (PCAS), Waves 4–11; Statistics Canada 2006 Census ^ October 2006–September 2008

Percentage of adults aged > 25 who reported being very satisfied with their experience of getting an appointment for a regular check-up, by sex and ethnicity, 2006–08^ 19 Data source: Primary Care Access Survey (PCAS), Waves 4–11 ^ The survey period was from October 2006–September 2008 X Suppressed due to small sample size ** Includes North American Indian, Metis, Inuit *** Includes El Salvador, other European, other Central American, other South American, religion as ethnicity

Percentage of adults aged 25 and older who reported being very satisfied with their experience getting an appt for a regular check-up, by sex and length of time since immigration, 2006–08 Percentage of adults aged 25 and older who reported being very satisfied with their experience getting an appt for a regular check-up, by sex and length of time since immigration, 2006–08^ 20 Data source: Primary Care Access Survey (PCAS), Waves 4–11 ^ October 2006–September 2008

Percentage of adults aged 25 and older who reported being very satisfied with their experience of getting appt for a regular check-up, by sex and language spoken most often at home, 2006–08^ 21 Data source: Primary Care Access Survey (PCAS), Waves 4–11 ^ October 2006–September 2008

Percentage of adults aged 25 and older who did not visit a dentist in the past 12 months, by sex and annual household income, Ontario, Data source: Canadian Community Health Survey (CCHS), 2005 (Cycle 3.1 )

23 Quality of Care

Percentage of Ontarians aged 15 and older with probable depression who had a physician visit for depression, by sex and age group 24 Data sources: CCHS, Cycle 1.1; OHIP * Interpret with caution due to high sampling variability

25 Age-standardized percentage of screen-eligible^ women who had at least one Pap test in the last three years, by neighbourhood income quintile, 2004/05 Data sources: CytoBase; OCR; OHIP; RPDB; Canadian Institute for Health Information Discharge Abstracts Database (CIHI-DAD); Statistics Canada 2001 Census ^Women aged with no history of cervical cancer or prior hysterectomy

26 Age-standardized percentage of women who had a Pap test that showed a low grade lesion^ who had a repeat Pap test or colposcopy within 6 months of the initial abnormal test, by neighbourhood income quintile, 2004/05 Data sources: CytoBase; OCR; OHIP; RPDB; CIHI-DAD; Statistics Canada 2001Census ^Atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LGSIL)

27 Quality of Care: Medicare Health Outcomes Survey  Plan-level HEDIS diabetes indicators linked to patient-level HOS data.  Hierarchical linear models estimated the relationship between plan HEDIS performance on diabetes QIs and 2-year change in HOS physical and mental health scores.  Each 10% point improvement in plan performance on intermediate outcomes (ie, the proportion of well-controlled diabetes) was related to significant increase in the probability of being healthy for physical health scores (7 percentage point increase, P 0.05) and mental health scores (11 percentage point increase, P 0.01). Source: Harman et al. Medical Care 2010

28 Identifying Populations at Risk CART Analysis

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CART Risk Profiles 30 Sample Groups Formed by CART Analysis Health + Socio-EconomicDeterminants (Health Very Good to Excellent Age < 50) Middle to High Income Employed (Health Very Good to Excellent Age < 50) Age < 50) Lower to Middle to Income Not Employed (Health Good to Excellent (Health Good to Excellent Age >= 50) Low Income (Health Poor to Average Age >= 50) Working Part Time Household Size 2 or less Language- Non English (Health Poor to Average Age >= 50) Working Part Time Household Size 3 or more Language- Non English

31 Data Linkages  Physician Claims  Pathology Data  Hospital Discharge Data  Performance Data  Other –Census –Other Surveys –Lab Data –EMR? –All Payer Databases?

32 Future Directions: A 21st Century Data Strategy  Survey Development: Asking What Matters  Fostering Data Linkages  Oversampling of Diverse Populations  Knowledge Translation (Translating Research into Practice)  Support Priority Setting, Inform Policy and Practice, Monitor Progress  Innovative Analyses and Pragmatic Trials  Community Engagement

For more information, please contact us: 33 The POWER Study is funded by Echo: Improving Women's Health in Ontario, an agency of the Ministry of Health and Long-Term Care. This presentation does not necessarily reflect the views of Echo or the Ministry.