Studying Health and Health Care Leslie L. Roos, Noralou P. Roos Charlyn D. Black, Ruth-Ann Soodeen, Eileen Pyke MANITOBA CENTRE FOR HEALTH POLICY

POPULATION HEALTH & HEALTH POLICY: Using a Population Health Framework to Improve the Delivery of Health Care

H H Utilization Regional population - SES - Health Physicians Personal Care Homes Hospitals PCH POPULIS: A Tool for Population-BasedPOPULIS Analyses

Organizing Principles of POPULIS 1. 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 - Based Research Registry Medical Vital Statistics Home Care under development Personal Care Home Hospital Provider Pharmaceuticals 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 Data Dictionaries - list and describe variables and file structure for databases.

Commonly Used Health Measures Individual Health Status Individual Personal Characteristics Community Indicators (Health, Socio- Economic) Individual Physician Practice Patterns Community Health Care Supply (Hospitals, Physicians, Nursing Homes, etc.) Individual Health Care Utilization

Indicator Selection The indicators included have been selected because of their potential value for health care system management: Hospital indicators - distinguish between types of admissions, and use that occurs in-region vs. out-of- region. Physician Supply Indicators - distinguish between physicians available to area residents because they live in the area, and those available because residents travel (as do physicians sometimes).Physician Supply Indicators

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?

Number of Procedures

Deaths per 100 Cases

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 Level Normal Range

Apr May June July Aug Sep Oct Nov Dec Jan Feb Mar Flood AVG. DAILY NUMBER OF INPATIENTS High Pressure Level Normal Range

3. How long are Manitobans waiting for surgery? Have waiting times changed? Do certain groups get surgery faster?

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. 12

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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 Manitoba 13 13