Providing Information to Providing Information to Regional Health Care Planners:Regional Health Care Planners:

A Manitoba Case StudyA 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 & Evaluation

Winnipeg, Manitoba, Canada

Regionalization & ResearchThe 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

Regional Health Authorities

Population-Based Research Registry

Medical

Vital Statistics

Home Care under development

Personal Care Home

Hospital

ProviderPharmaceuticals

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 services

Profiles to Develop

1. Regional demographics (e.g. age, gender)

2. Health 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 programs

Diabetes Treatment Prevalence

0 20 40 60 80 100 120 140

South Eastman

South Westman

Brandon

Central

Marquette

Parkland

Winnipeg

North Eastman

Interlake

Burntwood

Norman

Churchill

Winnipeg

Non-Winnipeg

Manitoba

Adjusted prevalence of diabetes, per 1000 residents aged 20-79

*

*

*

*

*

*

*

*

*

*

‡

*

*

* Indicates rate is statistically different from the Manitoba average.‡ Physician claims for Churchill residents are not complete.

Using Regional Profiles

Supply of Hospital Beds, 1995/96 (excluding Churchill)

0 1 2 3 4 5 6 7 8

South Eastman

South Westman

Brandon

Central

Marquette

Parkland

Winnipeg

North Eastman

Interlake

Burntwood

Norman

Winnipeg

Non-Winnipeg

Manitoba

Beds per 1000 residents

1. Regional Demographics: Who Are Your Neighbours?

- Composition by age & gender

Age Structure of BurntwoodPopulation 44,535

-8% -6% -4% -2% 0% 2% 4% 6% 8%

0-4

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80-84

90-94

100+ Males Females

Treaty Indians

All Others

Age Structure of ManitobaPopulation 1,136,249

-8% -6% -4% -2% 0% 2% 4% 6% 8%

0-4

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80-84

90-94

100+

Males FemalesYears

Treaty Indians

All Others

2. Indicators of Health

• 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 AuthorityDiabetes Treatment Prevalence (adjusted)

per 1000 residents aged 20-79

*

* - significantly different than Manitoba average

Manitoba

Flin Flon

The Pas

Nor-Man Other

Nor-Man

0 25 50 75 100 125 150

*

*Sub- regions

Region

4. How Local Residents Use Physician Services

• “In-area” physician supply

• “Ambulatory” 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 supply

• Separation rates

• Number of hospital days, length 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 procedures

e.g. tonsillectomy, hysterectomy, Caesarian surgery

8. Success of Preventive Programs

A successful program of prevention or early detection should:

a) provide good population coverageb) 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 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 volume

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 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 ~