Providing Information to Regional Health Care Planners: A Manitoba Case Study Providing Information to Regional Health Care Planners: A Manitoba Case Study Ruth-Ann M. Soodeen, Patricia J. Martens, Leslie L. Roos, Jan Roberts, Randy Fransoo and Charlyn Black Manitoba Centre for Health Policy Winnipeg, Manitoba, Canada

Regionalization & Research The regionalization of health care in Canada refers to two related processes: Decentralizing - “moving planning, budgeting and decision-making authority from the provincial or territorial level to certain regional bodies” Centralizing - “moving the planning and the governance of health care and medical services from individual institutions or agencies to a regional body.” (CMA, 1998) 2 2

Regional Health Authorities

Population-Based Research Registry Medical Vital Statistics Home Care under development Personal Care Home Hospital Provider Pharmaceuticals Cost An Ideal Administrative Data Base

Information Please... Comparisons can be made across districts within RHAs, and with provincial and RHA averages for the following indicators: Demographic Socio-economic status Health status Health status Health services

Profiles to Develop 1. Regional demographics (e.g. age, gender) 2. Health indicatorsHealth indicators 3. Major disease profiles 4. How local residents use physician services 5. How local residents use hospital services 6. How local residents use nursing home services 7. Access to surgical procedures 8. Success of preventive programspreventive programs

* Indicates rate is statistically different from the Manitoba average. ‡ Physician claims for Churchill residents are not complete. Using Regional Profiles Diabetes Treatment Prevalence Supply of Hospital Beds

1. Regional Demographics: Who Are Your Neighbours? -Composition by age & gender Age Structure of ManitobaAge Structure of Burntwood

2. Indicators of Health Premature Mortality Rate (PMR)Premature Mortality Rate (PMR) Life Expectancy ACG Case-Mix System

3. Major Disease Profiles Highlight rates of diagnoses and treatment for major diseases in one northern Regional Health Authority Diabetes Treatment Prevalence (adjusted)Treatment Prevalence per 1000 residents aged * * - significantly different than Manitoba average Manitoba Flin Flon The Pas Nor-Man Other Nor-Man * * Sub- regions Region

4. How Local Residents Use Physician Services “In-area” physician supply“In-area” physician supply “Ambulatory” visit rateAmbulatory” visit rate Types of providers Location of visits (i.e. in or out of region of residence)

5. How Local Residents Use Hospital Services Hospital bed supplybed supply Separation ratesSeparation Number of hospital days, length of stayhospital dayslength of stay Location of hospitalizations

6. How Local Residents Use Nursing Home Services Number of beds in region Number of PCH residents Number of annual admissions Total days of care Waiting times for admission

7. Access to Surgical Procedures “High profile” procedures  Associated with quality of life  e.g. angioplasty, coronary artery bypass, hip and knee replacement, cataract surgery Discretionary proceduresDiscretionary  e.g. tonsillectomy, hysterectomy, Caesarian surgery

8. Success of Preventive Programs A successful program of prevention or early detection should: a) provide good population coverage b) target high-risk populations (e.g. low income residents) Evaluations should look at: a) who gets preventive care - considering time, area, income quintile, and treaty statusincome quintiletreaty status b) who delivers the care - organized program, physicians, or public health nurses

Population-Based Information Amount of hospital care populations are using: Need for hospital services: Age Gender SES PMR Indicators of Hospital Performance Institutional Information Intensity of services: % of cases involving surgery or delivery Case Mix LOS >1 Discharge efficiency: Actual LOS Expected LOS Share of local hospitalizations: % of area hospitalizations in hospital Occupancy rates: # Occupied Beds # Hospital Beds Hospital Use Need for Service

Rural Hospitals - Characteristics Capabilities - limited access to technologically advanced equipment Major role in community Personnel challenges - recruiting & retaining Case mix - low intensity, low service volumeCase mix

Dissemination Implementation

Keys to Success  Communication  between researchers & decision makers 1. Data - understandable, useable 2. Cohesiveness - among various groups  Training  for recipients of health data 1. Familiarize with health services research 2. Teach data management & interpretation skills

Dissemination of Information Reports & report summaries Project websites Data spreadsheets Lookup tables Interactive software applications

Downloadable Health Data: Examples Data Spreadsheets - RHA profilesRHA profiles Lookup Tables - E-Stat (Statistics Canada), Census Analyser Interactive Data Application - MassCHIP, ORC

Implementation: Training Training of the recipients of health data is necessary to ensure appropriate interpretation and implementation of research findings: Workshops & courses Site visits by researchers Web-based tools

“Canada’s health researchers, and the people and communities they serve, recognize that they can learn from one another and can work together in pursuit of shared goals.” ~ Federal Budget Plan, p. 95 ~