1. The Manitoba RHA Indicators Atlas: Population-based comparisons of health and health care use MCHP’s 10th annual Rural and Northern Health Care Day: October 7, 2003 MANITOBA CENTRE FOR HEALTH POLICY

2. Authors of the report: Principal Investigator: Patricia J. Martens PhD co-investigators: Randy Fransoo, The Need To Know Team, Elaine Burland, Laurel Jebamani, Charles Burchill, Charlyn Black, Natalia Dik, Leonard MacWilliam, Shelley Derksen, Randy Walld, Carmen Steinbach, Matt Dahl Manitoba Centre for Health Policy

3. Key findings Heterogeneity evident throughout the province amongst aggregate areas (North, Winnipeg, Brandon, Rural South) amongst RHAs amongst districts within each RHA useful as one aspect of the Community Health Assessment process

5. The Need To Know Research Project #1: RHA Indicators Atlas districts defined by the RHAs, refined by MCPH/Manitoba Health for geo-coding health indicators (RHA 1999 report) reviewed and revised by NTK Team a longitudinal “look” (approximately 1991-1995, 1996-2000 depending on indicator) no matter where a person received a service, the use is attributed back to the region of residence

6. Non-Winnipeg RHAs and districts used in this report (Figures 1.1, 1.2, 1.3)

7. The foundation of the report How do I interpret these numbers? Chapter 2, plus examples in each chapter Who lives in my region? (age, sex, SES) Chapter 3 What is their overall health status? Chapter 4 - global health status measures Chapter 5 - selected illnesses Chapter 7 - selected child health measures

8. The foundation of the report What are their patterns of health care use? Chapter 6 - preventive care Chapter 8 - physician services Chapter 9 - hospital services Chapter 10 - surgical and diagnostic services Chapter 11 - home care and PCH Chapter 12 - pharmaceutical use

9. Figure 4.2.1: Premature Mortality Rates by RHA 0123456789 South Eastman (1,2) South Westman (1) Brandon (1) Central (1,2,t) Marquette Parkland Interlake (1,t) North Eastman (2) Burntwood (1,2) Churchill (1,t) Nor-Man (1,2,t) Rural South (t) North (1,2,t) Winnipeg (t) Manitoba (t) 1991-1995 1996-2000 Mb Avg 91-95 Mb Avg 96-00 Age- & sex-adjusted rate of deaths per 1000 aged 0-74 '1' indicates area's rate was statistically different from Manitoba average in first time period shown '2' indicates area's rate was statistically different from Manitoba average in second time period shown 't' indicates change over time was statistically significant PMR 1996-2000 North Eastman is 3.67 (higher than MB at 3.32)

10. North Eastman (2)3.67 From the RHA to the district levels PMR 1996-2000 Springfield2.68 Winnipeg River3.08 Brokenhead3.68 Iron Rose3.38 Blue Water (2)4.33 Northern Remote (1,2)8.53 higher average

11. ???

12. South Eastman (1,2,t) “1” = South Eastman rate (shown in grey) for the early time period is statistically different (lower) than the Manitoba overall average rate for the early time period (shown as a grey vertical line on the graph). “2” = South Eastman rate (shown in black) for the later time period is statistically different (lower) than the Manitoba overall average rate for the later time period (shown as a black vertical line on the graph) “t” = South Eastman earlier rate (shown in grey) is statistically different (lower) than the South Eastman later rate (shown in black).

13. YIKES - give me another way to understand statistical significance

14. 01234567 Manitoba Churchill Norman Burntwood Interlake North Eastman Winnipeg Parkland Marquette Central Brandon South Westman South Eastman Confidence Intervals for PMR By RHA, 1991/92-1995/96 Adjusted Death per 1000, ages 0-74 years

15. 01234567 Manitoba Churchill Norman Burntwood Interlake North Eastman Winnipeg Parkland Marquette Central Brandon South Westman South Eastman Confidence Intervals for PMR By RHA, 1991/92-1995/96 Adjusted Death per 1000, ages 0-74 years S = statistically significant from Manitoba * * * * *

16. Rates Rates are age- and sex-adjusted to Manitoba 1996 population structure, with crude rates and annual numbers given in appendices –stroke rate for Burntwood crude rate is 1.52 per thousand age/sex adjusted rate is 3.2 per thousand!

17. Figure 3.3.9a: Age Profile of Burntwood, 2000 Population: 45,051 7%6%5%4%3%2%1%0%1%2%3%4%5%6%7% 0-4 10-14 20-24 30-34 40-44 50-54 60-64 70-74 80-84 90 + Burntwood 2000 Manitoba 2000 Males Females

18. Rates Each graph shows the rates by RHA/district see the executive summary for overall rate comparisons many “comparisons” your RHA and districts within the RHA to the Manitoba rate your aggregate area rate (North, Rural South, Brandon, Winnipeg)

19. Brandon Marquette Burntwood Nor-Man Parkland Interlake Central SouthWestman SouthEastman North Eastman Churchill Winnipeg Manitoba’s RHAs (up to July 1, 2002) “North” “Rural South” omitting Brandon and Winnipeg

20. MB rate = 0.49Rural South rate = 0.54

21. Prevalence mortality cure Incidence Incidence & Prevalence

22. Open homecare cases 16.1 around 1995 21.0 around 2000

23. Open home care cases 16.1 Closed 6.8 New home care cases 8.0 Incidence & Prevalence Expect an increase in the “prevalence”, ie, open cases Home Care Cases (p.196+) 1995

24. And now to just a few of my favourite … graphs! Top causes of death (page 66)page 66 Top diagnoses for physician visits (page 142)page 142 top causes of hospitalization (page 165)page 165 physician visit rates by age and gender (page 132)page 132

25. Heterogeneity within areas The need to “drill deeper” to find interesting exceptions –the North: lower consult rates –Churchill: highest consult rates in the province Thompson airport

26. Key findings is your RHA missing data? Look into it! Heterogeneity evident throughout the province look for the “stories” in the data useful as one aspect of the Community Health Assessment process

27. M anitoba C entre for H ealth P olicy M C H P www.umanitoba.ca/centres/mchp/ go to Reports, or to Data Extras

28. Chapter links Chapter 4: Health status and mortalityHealth status and mortality Chapter 5: The burden of illnessThe burden of illness Chapter 6: Preventive care measuresPreventive care measures Chapter 7: Child health indicatorsChild health indicators Chapter 8: Physician servicesPhysician services Chapter 9: Hospital servicesHospital services Chapter 10: Surgical proceduresSurgical procedures Chapter 11: Home Care and PCHHome Care and PCH Chapter 12: Pharmaceutical usePharmaceutical use