Comparative Indicators of Health and Health Care Use for Manitoba’s Regional Health

Authorities: A POPULIS Report

Manitoba Centre for Health Policy and Evaluation

Department of Community Health Sciences, University of Manitoba

Rural and Northern Health Care MeetingRural and Northern Health Care MeetingNovember 1, 1999November 1, 1999

SESSION II: KEY CONCEPTSSESSION II: KEY CONCEPTSSpeaker: Patricia Martens PhDSpeaker: Patricia Martens PhD

Getting a “gut feel”

• Age structure?

• Major disease concerns?

• Need, physicians, acute care, long term care?

In your RHA . . .compared to other rural RHAs of Manitoba(or compared to Winnipeg)

Lowerthan

average

Aboutaverage

Higherthan

averageThe age of the peopleThe healthiness of the peopleThe visit rate to all physiciansThe in-area supply of physicians (GP/FPs)The hospital visit rate (separation rate)The number of hospital beds per 1000residentsThe days of hospital care per 1000 residentsSupply of PCH beds (per 1000 residents 75+)

Tonsillectomy/adenoidectomy ratesCardiac catheterization rates

Fill out the “profile” for later use.

Baseline information

• 1996/1997 data compares inter-regionally and within each region

• baseline for comparing impact of RHA Board initiatives

The people of your region

• Population pyramids: age and gender Population pyramids: age and gender picturespictures

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

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 Females

Years

Treaty Indians

All Others

MarquettePopulation 37,774

-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

1995/96 Population By Age(page 129 of the document)

Age Groups 0-4 5-14 15-44 45-64 65-74 75+ Total

Marquette 2,324 5,465 14,648 7,822 3,786 3,729 37,774

The geography of your region

• Subdivisions … what’s a PSA?– Physician service area (see page 135 for list and

associated RMs)

– typically consist of towns in which physicians practice, plus smaller nearby communities and districts whose residents seek care from these physicians

The healthiness of your region

• PMR = premature mortality rate

• SERI = socio-economic risk index

• life expectancy

PMR(page 70-71 of document)

• best single indicator of health status capturing the need for health care

• associated with self-reported health• high PMR … more likely to report …

– poor health

– higher number of symptoms

– being sick more often

• death before the age of 75, ie, “premature”

So what’s the meaning of *

• “statistically significantly different”

• number of people in RHA or PSA may cause year-to-year fluctuations

• * = a similar difference would probably be seen from one year to the next

Premature Mortality Rates by RHA

0 1 2 3 4 5 6 7

South Eastman

South Westman

Brandon

Central

Marquette

Parkland

Winnipeg

North Eastman

Interlake

Burntwood

Norman

Churchill

Manitoba

Death rate per 1,000 population 0-74 years

Most healthy

Leasthealthy

***

**

?

SERI(page 68-69)

• Composite index of 6 measures (from 23)– environmental, household, individual

conditions (employment rates, single parent families, educational achievement, household dwelling value, participation of females in labour force)

– risk for poor health – associated with higher need for health care

Socio-Economic Risk Index

East Lake Winnipeg

Springfield

North Eastman

-0.5 0 0.5 1 1.5 2

Manitoba average

lowerrisk

higherrisk

Disease profiles/procedures

• Adjusted rates:Adjusted rates:– disease burden: diabetes, hypertension, cancer

– high profile procedures: cardiac catheterizations, coronary artery bypass surgery, angioplasty, hip and knee replacements, cataract surgery, prostatectomy

– discretionary procedures: tonsillectomy, hysterectomy, caesarian section rates

• Crude rates (one age bracket):Crude rates (one age bracket):– immunization, screening mammography

500

300

150

50

250

300

250

200

Crude rate: 28 per 1000 28 per 1000

3 sick

10 sick

10 sick

5 sick

10 sick

15 sick

3 sick

0 sick

BA

*What is a fair comparison?

*Which population is “sicker” … A or B?

500

300

150

50

250

300

250

200

Adjusted rate of A is 41.2 per 1000 (adjusted to population B)

3 sick

10 sick

10 sick

5 sick

10 sick

15 sick

3 sick

0 sick

Adjusted vs. crude rates (cont’d)

BA

(6%) = 12 of the 200

(6.7%) = 16.7 of the 250

(3.3%) = 10 of 300

(1%) = 2.5 of 250

Crude rate: 28 per 1000 28 per 1000

Adjusted and Crude Rates: example of Burntwood

Diabetes Cancer Bypass surgery Hysterectomycrude 86.3 2.1 0.1 5.2adjusted 118 4.2 0.2 6.6

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 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

(per 1000 residents)

Adjusted versus Crude Rates

• When is “adjusted” helpful? (charts)• fair comparisons between regions

• adjusted for age and gender

• When is “crude” helpful? (appendix 2)• how many people actually have the given condition

(multiply crude rate by regional population)

Comparisons

• Most charts – Winnipeg, Non-Winnipeg, Manitoba

• “Manitoba” is largely affected by Winnipeg

• “Non-Winnipeg” is largely affected by Brandon

• developed a “rural average” profile• excludes Winnipeg, Brandon, Churchill

• summarizes “need”, “physicians”, “acute care”, and “long term care for 75+”

Example of a rural profile

• comparison of using different “yardsticks”

Profile of South Westman - compared to rural average (page 43)

-100% -75% -50% -25% 0% 25% 50% 75% 100%

Premature Mortality

Ambulatory Visits

Consultations

In-Area Supply

Short Stay Separations

Short Stay Days

Acute Bed Supply

Long Stay Days

PCH Days

PCH Beds

Rural Average

*

*

*

*

NE

ED

PH

YSI

CIA

NS

AC

UT

E C

AR

E

LO

NG

-TE

RM

CA

RE

-100% -75% -50% -25% 0% 25% 50% 75% 100%

Premature Mortality

Ambulatory Visits

Consultations

In-Area Supply

Short Stay Separations

Short Stay Days

Acute Bed Supply

Long Stay Days

PCH Days

PCH Beds

Manitoba Average

Profile of South Westman - compared to Manitoba average

NE

ED

PH

YSI

CIA

NS

AC

UT

E C

AR

E

LO

NG

-TE

RM

CA

RE

Much lower than Winnipeg

Much lower than Winnipeg

Interpreting YOUR data

• Group session with RHAs and facilitators

• Computer session in the afternoon

• Section 4 “Interpreting the data for local use” is a guide (pages 20 to 33)

• the people, their healthiness, disease profiles, prevention, use of physicians, hospitals and PCHs, level of access to high profile and discretionary procedures, a profile of your region

• between and within RHAs