Studying Health and

Health CareLeslie L. Roos, Noralou P. Roos

Charlyn D. Black, Ruth-Ann Soodeen, Eileen Pyke

MANITOBA CENTRE FOR HEALTH POLICY & EVALUATION

POPULATION HEALTH & HEALTH POLICY:

Using a Population Health Framework to Improve the

Delivery of Health Care

HH

Utilization

Utilization

Utilization

Regionalpopulation - SES - Health

Physicians

PersonalCare Homes

Hospitals

PCHPCH

PCH

POPULIS: A Tool for Population-BasedAnalyses

Organizing Principles of POPULIS1. 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 - BasedResearchRegistry

Medical

Vital Statistics

Home Care under development

PersonalCareHome

Hospital

ProviderPharmaceuticals

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

• Research Definitions - codes for surgical procedures, test and diagnoses

• Data Dictionaries - list and describe variables and file structure for databases.

Meta-Index - organizes concepts and definitions according to the Medical Sub-Heading (MeSH) system

Commonly Used Health Measures

Individual Health Status

Individual PersonalCharacteristics

CommunityIndicators

(Health, Socio-Economic)

Individual PhysicianPractice Patterns

CommunityHealth Care Supply

(Hospitals, Physicians,Nursing Homes,

etc.)

Individual Health CareUtilization

No slide - just text from notes page.

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?

0100200300400500600700800900

1000C

oro

nary

Art

ery

Byp

ass

An

gio

pla

sty

To

tal

Hip

Kn

ee

Rep

lacem

en

t

Cata

racts

0

1000

2000

3000

4000

5000

6000

7000

1989 1991 1993 1995 1997

Number of Procedures

0

5

10

15

20

25

1989 1990 1991 1992 1993 1994 1995 1996

A.M.I. Hip Fracture Cancer Surgery

Deaths per 100 Cases

0

1

2

3

4

5

6

7

8

1990 1991 1992 1993 1994 1995 1996

Death

s per

1,0

00 R

esi

dents

Male Deaths All (Overall)

Female Deaths Deaths Age 0-74

Selected Chronic All Cancers

Ischemic Heart Disease All Injuries

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 LevelNormalRange

700

750

800

850

900

950

1000

1050

700

750

800

850

900

950

1000

1050

Apr May June July Aug Sep Oct Nov Dec Jan Feb Mar

Flood

AVG. DAILY NUMBER OF INPATIENTSHigh Pressure Level

NormalRange

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

2651

2535

4016

2931

0 10 20 30 40 50 60

Carotid Endarterectomy

Prostate Removal

Varicose Veins

Hernia

Median wait in days after patient sees surgeon pre-op

0

5

10

15

20

Private

Procedures

Public

ProceduresPublic OnlySurgeons

Public

ProceduresPrivate/Public

Surgeons

Me

dia

n W

ait

in W

ee

ks

1992 93 94 95 96 1992 93 94 95 96 1992 93 94 95 96

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.

00.10.20.30.40.50.60.70.80.9

1

0 0.2 0.4 0.6 0.8 1 1.2

Q1/Q5 Ratio

Pro

port

ion C

overe

d

= 1992 Childhood Immunizations

= 1990 Screening Mammography

= 1996 Screening Mammography= 1996 Papanicolaou Testing

m

M

P

I

I

m

M

P

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 Manitoba13