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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
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
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
Diabetes Treatment Prevalence
Supply of Hospital Beds
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
Age Structure of Manitoba Age Structure of Burntwood
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 ~
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