Comparative Indicators of Health and Health Care Use

Comparative Indicators of Health and Health Care Use for Manitoba’s Regional Health Authorities: A POPULIS Report Rural and Northern Health Care Meeting November 1, 1999 SESSION II: KEY CONCEPTS Speaker: Patricia Martens Ph. D Manitoba Centre for Health Policy and Evaluation Department of Community Health Sciences, University of Manitoba

Getting a “gut feel” • Age structure? • Major disease concerns? • Need, physicians, acute care, long term care?

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 pictures

Age Structure of Manitoba Population 1, 136, 249 Years Females Males 100+ 90 -94 Treaty Indians 80 -84 All Others 70 -74 60 -64 50 -54 40 -44 30 -34 20 -24 10 -14 0 -4 -8% -6% -4% -2% 0% 2% 4% 6% 8%

Age Structure

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

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 * * * South Eastman South Westman Brandon Most healthy Central Marquette Parkland Winnipeg North Eastman Interlake Least ? healthy * * Burntwood Norman Churchill Manitoba 0 1 2 3 4 5 Death rate per 1, 000 population 0 -74 years 6 7

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 North Eastman lower risk Springfield higher risk East Lake Winnipeg -0. 5 0 0. 5 Manitoba average 1 1. 5 2

Disease profiles/procedures • 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): – immunization, screening mammography

*Which population is “sicker” … A or B? *What is a fair comparison? A 50 150 300 B 200 3 sick Crude rate: 250 10 sick 500 28 per 1000 10 sick 5 sick 300 250 28 per 1000 15 sick 3 sick 0 sick

Adjusted vs. crude rates (cont’d) A 3 sick 10 sick 50 150 300 500 Crude rate: B (6%) = 12 of the 200 (6. 7%) = 16. 7 of the 250 (3. 3%) = 10 of 300 (1%) = 2. 5 of 250 28 per 1000 200 10 sick 250 300 250 28 per 1000 Adjusted rate of A is 41. 2 per 1000 (adjusted to population B) 15 sick 3 sick 0 sick

Adjusted and Crude Rates: example of Burntwood (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”

PHYSICIANS * * LONG-TERM CARE NEED ACUTE CARE Profile of South Westman compared to rural average (page 43) Rural Average

PHYSICIANS LONG-TERM CARE ACUTE CARE NEED Profile of South Westman compared to Manitoba average Much lower than Winnipeg Manitoba Average

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