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The Manitoba RHA Indicators Atlas: Population-based comparisons of health and health care use

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MANITOBA CENTRE FOR HEALTH POLICY. The Manitoba RHA Indicators Atlas: Population-based comparisons of health and health care use MCHP’s 10th annual Rural and Northern Health Care Day: October 7, 2003. Manitoba Centre for Health Policy. Authors of the report: - PowerPoint PPT Presentation
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The Manitoba RHA Indicators Atlas: Population-based comparisons of health and health care use MCHP’s 10th annual Rural and Northern Health Care Day: October 7, 2003 MANITOBA CENTRE FOR HEALTH POLICY
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Page 1: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

The Manitoba RHA Indicators Atlas: Population-based comparisons of health and health care use

MCHP’s 10th annual Rural and Northern Health Care Day: October 7, 2003

MANITOBA CENTRE FOR HEALTH POLICY

Page 2: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Authors of the report:

Principal Investigator: Patricia J. Martens PhD

co-investigators:Randy Fransoo, The Need To Know Team, Elaine Burland, Laurel Jebamani, Charles Burchill, Charlyn Black, Natalia Dik, Leonard MacWilliam, Shelley Derksen, Randy Walld, Carmen Steinbach, Matt Dahl

Manitoba Centre for Health Policy

Page 3: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Key findings

• Heterogeneity evident throughout the province

• amongst aggregate areas (North, Winnipeg, Brandon, Rural South)

• amongst RHAs

• amongst districts within each RHA

• useful as one aspect of the Community Health Assessment process

Page 4: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use
Page 5: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

The Need To Know Research Project #1: RHA Indicators Atlas

• districts defined by the RHAs, refined by MCPH/Manitoba Health for geo-coding

• health indicators (RHA 1999 report) reviewed and revised by NTK Team

• a longitudinal “look” (approximately 1991-1995, 1996-2000 depending on indicator)

• no matter where a person received a service, the use is attributed back to the region of residence

Page 6: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Non-WinnipegRHAs and districtsused in this report

(Figures 1.1, 1.2, 1.3)

Page 7: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

The foundation of the report

• How do I interpret these numbers? • Chapter 2, plus examples in each chapter

• Who lives in my region? (age, sex, SES)• Chapter 3

• What is their overall health status?• Chapter 4 - global health status measures• Chapter 5 - selected illnesses• Chapter 7 - selected child health measures

Page 8: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

The foundation of the report

• What are their patterns of health care use?• Chapter 6 - preventive care

• Chapter 8 - physician services

• Chapter 9 - hospital services

• Chapter 10 - surgical and diagnostic services

• Chapter 11 - home care and PCH

• Chapter 12 - pharmaceutical use

Page 9: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Figure 4.2.1: Premature Mortality Rates by RHA

0 1 2 3 4 5 6 7 8 9

South Eastman (1,2)

South Westman (1)

Brandon (1)

Central (1,2,t)

Marquette

Parkland

Interlake (1,t)

North Eastman (2)

Burntwood (1,2)

Churchill (1,t)

Nor-Man (1,2,t)

Rural South (t)

North (1,2,t)

Winnipeg (t)

Manitoba (t)

1991-1995

1996-2000

Mb Avg 91-95

Mb Avg 96-00

Age- & sex-adjusted rate of deaths per 1000 aged 0-74

'1' indicates area's rate was statistically different from Manitoba average in first time period shown'2' indicates area's rate was statistically different from Manitoba average in second time period shown't' indicates change over time was statistically significant

PMR 1996-2000North Eastman is 3.67 (higher than MB at 3.32)

Page 10: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Figure 4.2.2: Premature Mortality Rates by District

0 1 2 3 4 5 6 7 8 9

SE Northern (1,2)

SE Central (2)

SE Western

SE Southern

SW District # 3 (1)

SW District # 1

SW District # 2

Bdn West (1,2)

Bdn Rural

Bdn East

MacDonald/Cartier (2,t)

Morden/Winkler (1,2)

Altona (2,t)

Carman

Morris/Montcalm

Lorne/Louise/Pem

Seven Regions

Portage (1)

MQ District # 4

MQ District # 3

MQ District # 2

MQ District # 1

PL West

PL Central

PL East

PL North (2)

IL Southwest

IL Southeast

IL Northeast (1,t)

IL Northwest (1,t)

Springfield

Winnipeg River

Brokenhead

Iron Rose

Blue Water (2)

Northern Remote (1,2)

Thompson

Oxford H & Gods (t)

Cross Lake (2)

Lynn/Leaf/SIL

Island Lake (2)

Tad/Broch/Lac Br

Gillam/Fox Lake

Thick Por/Pik/Wab

Norway House (1,2,t)

Sha/York/Split/War (1,2)

Nelson House (1,2)

Churchill (1,t)

F Flon/Snow L/Cran (1,t)

The Pas/OCN/Kelsey (1,2)

Nor-Man Other (1,2)

1991-1995

1996-2000

Mb Avg 91-95

Mb Avg 96-00

Age- & sex-adjusted rate of deaths per 1000 aged 0-74

North Eastman (2) 3.67

From the RHA to the district levels

PMR 1996-2000

PMR 1996-2000Springfield 2.68Winnipeg River 3.08Brokenhead 3.68Iron Rose 3.38Blue Water (2) 4.33Northern Remote (1,2) 8.53 higher

average

Page 11: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Figure 8.3.1: Ambulatory Visit Rates by RHA

0 1 2 3 4 5 6 7

South Eastman (1,2,t)

South Westman (1,2,t)

Brandon (2,t)

Central (1,2)

Marquette (1,2,t)

Parkland (1,t)

Interlake (1,2,t)

North Eastman (1,2,t)

Burntwood (1,2,t)

Churchill (2)

Nor-Man

Rural South (1,2)

North (1,2,t)

Winnipeg (1,2,t)

Manitoba (t)

1995/96

2000/01

Mb Avg 1995/96

Mb Avg 2000/01

Age & sex adjusted rate of visits to all physicians (annual average per resident)

'1' indicates area's rate was statistically different from Manitoba average in first time period shown'2' indicates area's rate was statistically different from Manitoba average in second time period shown't' indicates change over time was statistically significant

???

Page 12: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Figure 8.3.1: Ambulatory Visit Rates by RHA

0 1 2 3 4 5 6 7

South Eastman (1,2,t)

South Westman (1,2,t)

Brandon (2,t)

Central (1,2)

Marquette (1,2,t)

Parkland (1,t)

Interlake (1,2,t)

North Eastman (1,2,t)

Burntwood (1,2,t)

Churchill (2)

Nor-Man

Rural South (1,2)

North (1,2,t)

Winnipeg (1,2,t)

Manitoba (t)

1995/96

2000/01

Mb Avg 1995/96

Mb Avg 2000/01

Age & sex adjusted rate of visits to all physicians (annual average per resident)

'1' indicates area's rate was statistically different from Manitoba average in first time period shown'2' indicates area's rate was statistically different from Manitoba average in second time period shown't' indicates change over time was statistically significant

South Eastman (1,2,t)

“1” = South Eastman rate (shown in grey) for the early time period is statistically different (lower) than the Manitoba overall average rate for the early time period (shown as a grey vertical line on the graph).

“2” = South Eastman rate (shown in black) for the later time period is statistically different (lower) than the Manitoba overall average rate for the later time period (shown as a black vertical line on the graph)

“t” = South Eastman earlier rate (shown in grey) is statistically different (lower) than the South Eastman later rate (shown in black).

Page 13: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

YIKES - give me another way to understand statistical significance

Page 14: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

0 1 2 3 4 5 6

Manitoba

Churchill

Norman

Burntwood

Interlake

North Eastman

Winnipeg

Parkland

Marquette

Central

Brandon

South Westman

South Eastman

Confidence Intervals for PMR By RHA, 1991/92-1995/96

•••

••

••

••

Adjusted Death per 1000, ages 0-74 years

Page 15: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

0 1 2 3 4 5 6

Manitoba

Churchill

Norman

Burntwood

Interlake

North Eastman

Winnipeg

Parkland

Marquette

Central

Brandon

South Westman

South Eastman

Confidence Intervals for PMR By RHA, 1991/92-1995/96

•••

••

••

••

Adjusted Death per 1000, ages 0-74 yearsS = statistically significant from Manitoba

***

**

Page 16: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Rates

• Rates are age- and sex-adjusted to Manitoba 1996 population structure, with crude rates and annual numbers given in appendices

– stroke rate for Burntwood • crude rate is 1.52 per thousand

• age/sex adjusted rate is 3.2 per thousand!

Page 17: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Figure 3.3.9a: Age Profile of Burntwood, 2000Population: 45,051

7% 6% 5% 4% 3% 2% 1% 0% 1% 2% 3% 4% 5% 6% 7%

0-4

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80-84

90 +Burntwood 2000

Manitoba 2000

Males Females

Page 18: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Rates

• Each graph shows the rates by RHA/district• see the executive summary for overall rate

comparisons

• many “comparisons”• your RHA and districts within the RHA• to the Manitoba rate• your aggregate area rate (North, Rural South, Brandon,

Winnipeg)

Page 19: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Brandon

Marquette

Burntwood

Nor-Man

Parkland

Interlake

CentralSouthWestman South Eastman

NorthEastman

Churchill

Winnipeg

Manitoba’sRHAs(up to July 1, 2002) “North”

“Rural South”omittingBrandon andWinnipeg

Page 20: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Figure 4.6.1: Injury Mortality Rates by RHA

0.0 0.2 0.4 0.6 0.8 1.0 1.2

South Eastman

South Westman

Brandon

Central

Marquette

Parkland (2,t)

Interlake (1)

North Eastman (2)

Burntwood (1,2)

Churchill (s)

Nor-Man (1,2)

Rural South (2,t)

North (1,2)

Winnipeg (1,2,t)

Manitoba (t)

1990-1994

1995-1999

Mb Avg 90-94

Mb Avg 95-99

Age- & sex-adjusted rate of deaths from all injuries per 1000 residents

''1' indicates area's rate was statistically different from Manitoba average in first time period shown'2' indicates area's rate was statistically different from Manitoba average in second time period shown't' indicates change over time was statistically significant's' indicates data suppressed due to small numbers

1990-1994: 2.14; 1995-1999: suppressed

MB rate = 0.49

Rural South rate = 0.54

Page 21: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Prevalence

mortalitycure

Incidence

Incidence & Prevalence

Page 22: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Figure 11.3.1: Open Home Care Cases by RHA

0 5 10 15 20 25 30 35 40 45

South Eastman (1,2,t)

South Westman (1,2,t)

Brandon (1,2,t)

Central (1,2,t)

Marquette (1,2,t)

Parkland (1,2,t)

Interlake (1,2,t)

North Eastman (t)

Burntwood (1,2,t)

Churchill

Nor-Man (1,2,t)

Rural South (1,2,t)

North (1,t)

Winnipeg (1,2,t)

Manitoba (t)

1994/95-1995/96

1999/00-2000/01

Mb Avg 94/95-95/96

Mb Avg 99/00-00/01

Age- & sex-adjusted rate of open home care cases over period (prevalence) per 1000 residents

''1' indicates area's rate was statistically different from Manitoba average in first time period shown'2' indicates area's rate was statistically different from Manitoba average in second time period shown't' indicates change over time was statistically significant's' indicates data suppressed due to small numbers

Open homecare cases16.1 around 199521.0 around 2000

Page 23: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Open home care cases 16.1

Closed 6.8

New home care cases 8.0

Incidence & Prevalence

Expect anincrease in the “prevalence”, ie,open cases

Home CareCases (p.196+)

1995

Page 24: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

And now to just a few of my favourite … graphs!

• Top causes of death (page 66)

• Top diagnoses for physician visits (page 142)

• top causes of hospitalization (page 165)

• physician visit rates by age and gender (page 132)

Page 25: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Heterogeneity within areas

• The need to “drill deeper” to find interesting exceptions

– the North: lower consult rates

– Churchill: highest consult rates in the province

Thompson airport

Page 26: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Key findings

• is your RHA missing data? Look into it!

• Heterogeneity evident throughout the province

• look for the “stories” in the data

• useful as one aspect of the Community Health Assessment process

Page 27: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

ManitobaCentre forHealth Policy

MCHP

www.umanitoba.ca/centres/mchp/

go to Reports, or to Data Extras

Page 28: The Manitoba RHA Indicators Atlas:  Population-based comparisons of health and health care use

Chapter links

Chapter 4: Health status and mortality

Chapter 5: The burden of illness

Chapter 6: Preventive care measures

Chapter 7: Child health indicators

Chapter 8: Physician services

Chapter 9: Hospital services

Chapter 10: Surgical procedures

Chapter 11: Home Care and PCH

Chapter 12: Pharmaceutical use


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