Comparative Indicators of Health and Health Care Use for Manitoba’s Regional Health Authorities: A POPULIS Report Manitoba Centre for Health Policy and Evaluation Department of Community Health Sciences, University of Manitoba Rural and Northern Health Care Meeting November 1, 1999 SESSION II: KEY CONCEPTS Speaker: Patricia Martens PhD

Getting a “gut feel” Age structure? Major disease concerns? Need, physicians, acute care, long term care?

Fill out the “profile” for later use.

Baseline information 1996/1997 data compares inter-regionally and within each region baseline for comparing impact of RHA Board initiatives

The people of your region Population pyramids: age and gender picturesPopulation pyramids: age and gender pictures

Age Structure of Manitoba Population 1,136,249 -8%-6%-4%-2%0%2%4%6%8% Males Females Years Treaty Indians All Others

Age Structure

1995/96 Population By Age (page 129 of the document)

The geography of your region Subdivisions … what’s a PSA? –Physician service area (see page 135 for list and associated RMs) –typically consist of towns in which physicians practice, plus smaller nearby communities and districts whose residents seek care from these physicians

The healthiness of your region PMR = premature mortality rate SERI = socio-economic risk index life expectancy

PMR (page of document) best single indicator of health status capturing the need for health care associated with self-reported health high PMR … more likely to report … –poor health –higher number of symptoms –being sick more often death before the age of 75, ie, “premature”

So what’s the meaning of * “statistically significantly different” number of people in RHA or PSA may cause year-to-year fluctuations * = a similar difference would probably be seen from one year to the next

Premature Mortality Rates by RHA South Eastman South Westman Brandon Central Marquette Parkland Winnipeg North Eastman Interlake Burntwood Norman Churchill Manitoba Death rate per 1,000 population 0-74 years Most healthy Least healthy * * * * * ?

SERI (page 68-69) Composite index of 6 measures (from 23) –environmental, household, individual conditions (employment rates, single parent families, educational achievement, household dwelling value, participation of females in labour force) –risk for poor health –associated with higher need for health care

Socio-Economic Risk Index East Lake Winnipeg Springfield North Eastman Manitoba average lower risk higher risk

Disease profiles/procedures Adjusted rates:Adjusted rates: –disease burden: diabetes, hypertension, cancer –high profile procedures: cardiac catheterizations, coronary artery bypass surgery, angioplasty, hip and knee replacements, cataract surgery, prostatectomy –discretionary procedures: tonsillectomy, hysterectomy, caesarian section rates Crude rates (one age bracket):Crude rates (one age bracket): –immunization, screening mammography

Crude rate: 28 per per sick 10 sick 5 sick 10 sick 15 sick 3 sick 0 sick BA *What is a fair comparison? *Which population is “sicker” … A or B?

Adjusted rate of A is 41.2 per 1000 (adjusted to population B) 3 sick 10 sick 5 sick 10 sick 15 sick 3 sick 0 sick Adjusted vs. crude rates (cont’d) B A (6%) = 12 of the 200 (6.7%) = 16.7 of the 250 (3.3%) = 10 of 300 (1%) = 2.5 of 250 Crude rate: 28 per per 1000

Adjusted and Crude Rates: example of Burntwood (per 1000 residents)

Adjusted versus Crude Rates When is “adjusted” helpful? (charts) fair comparisons between regions adjusted for age and gender When is “crude” helpful? (appendix 2) how many people actually have the given condition (multiply crude rate by regional population)

Comparisons Most charts –Winnipeg, Non-Winnipeg, Manitoba “Manitoba” is largely affected by Winnipeg “Non-Winnipeg” is largely affected by Brandon developed a “rural average” profile excludes Winnipeg, Brandon, Churchill summarizes “need”, “physicians”, “acute care”, and “long term care for 75+”

Example of a rural profile comparison of using different “yardsticks”

Profile of South Westman - compared to rural average (page 43) Rural Average * * * * NEED PHYSICIANS ACUTE CARE LONG-TERM CARE

Manitoba Average Profile of South Westman - compared to Manitoba average NEED PHYSICIANS ACUTE CARE LONG-TERM CARE Much lower than Winnipeg

Interpreting YOUR data Group session with RHAs and facilitators Computer session in the afternoon Section 4 “Interpreting the data for local use” is a guide (pages 20 to 33) the people, their healthiness, disease profiles, prevention, use of physicians, hospitals and PCHs, level of access to high profile and discretionary procedures, a profile of your region between and within RHAs