Deliverables: Hospital

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2021

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Using Administrative Data to Predict Near-Future Critical Illness
Garland A, Chateau D, Marrie RA, Wunsch H, Yogendran M, Soodeen RA

Critically ill people are cared for in hospital intensive care units. Many die in hospital, and many who survive experience long-term problems. If we could identify people at high risk of developing critical illness before it occurs, we might be able to delay or prevent it from happening, allowing them to remain healthy in the community. This study aimed to identify adult Manitobans with a high probability of developing critical illness in the near future. The research team applied advanced statistical methods to the data in the Manitoba Population Research Data Repository at the Manitoba Centre for Health Policy. The results showed that instead of the stated goal of identifying people with at least a 1 in 3 chance of developing critical illness, the team was only able to identify people with at least a 1 in 20 chance. However, additional study may be warranted to assess the value of alerting primary care providers to such individuals on their patient rosters. Also, the finding that frail people are much more likely to develop critical illness suggests that it might be valuable to have physicians routinely measure frailty in the people they care for.

Report (PDF)

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2020

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Our Children, Our Future: The Health and Well-being of First Nations Children in Manitoba
Chartier M, Brownell M, Star L, Murdock N, Campbell R, Phillips-Beck W, Meade C, Au W, Schultz J, Bowes JM, Cochrane B

The purpose of this report is to provide a sound baseline measure of how First Nations children are doing in order to determine if children’s lives are improving as a result of the Truth and Reconciliation Commission’s Calls to Action. The present report was requested by the Healthy Child Committee of Cabinet to focus on First Nations children in Manitoba and to provide valuable information on their health and well-being – similar to Child Health Atlas reports previously prepared by Manitoba Centre for Health Policy (MCHP). The research team includes members from MCHP, First Nations Health and Social Secretariat of Manitoba (FNHSSM) and Manitoba First Nations Education Resource Centre (MFNERC). The analyses provide comparisons between First Nations children and all other Manitoba children, comparisons between on and off reserve First Nations, and regional comparisons by Regional Health Authority and by Tribal Council Areas. Large disparities between First Nations children and other Manitoba children were found in birth outcomes, physical health, mental health, health & prevention services, education, social services, justice system involvement and mortality. These results must be understood within the broader historical, social, legal and political context.

Report (PDF)
Summary (PDF)
Updates and Errata (PDF)
Additional Materials

The Diversity of Immigrants to Manitoba, Migration Dynamics and Basic Healthcare Service Use
Urquia M, Walld R, Prior H, Detillieux G, Eze N, Koseva I

Immigration is a key part of the Canadian social fabric. However, little is known about the characteristics of immigrants to Manitoba, as well as their social and health needs. The addition of the Immigration, Refugees and Citizenship Canada (IRCC) permanent resident database into the Manitoba Population Research Data Repository (Repository) at MCHP is the first step in addressing these gaps. This deliverable describes the linkage and the characteristics of international and interprovincial migrants. It also compares their basic primary care use and mortality with those of non-immigrants.

Report (PDF)
Summary (PDF)
Additional Materials

Type 2 Diabetes in Manitoba
Ruth C, Sellers E, Chartrand C, McLeod L, Prior H, Sirski M, Dragan R, Chen H, McDougall C, Schultz J

This deliverable, undertaken in partnership with The First Nation Health and Social Secretariat of Manitoba provides an analysis of trends in incidence and prevalence of for all types of non-gestational diabetes from the 1985 to 2017 allowing comparison to national and international statistics. Then, using the wealth of data within the Repository, especially the Diabetes Education Resource for Children and Adolescents (DER-CA) clinical database, Manitobans diagnosed with type 2 diabetes mellitus (T2DM) were identified and their outcomes over the last 6 years were described. This includes diabetes control, complications, mortality and health service use including hospitalizations, continuity of primary care and specialist care. Multiple analyses were undertaken to examine whether the care received by Manitobans living with T2DM met current guidelines. There are also a number of special analyses in cohorts of people matched to those without diabetes for childhood onset T2DM, T2DM in pregnancy, and for mental health outcomes in adults. Information is presented for different age groups, by sex, by health region and by Tribal Council Area and results were compared between registered First Nation Manitobans and all other Manitobans.

Report (PDF)
Summary (PDF)
Updates and Errata (PDF)
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2017

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Variations in Resource Use and Costs of Hospital Care in Manitoba
Nickel N, Finlayson G, Fransoo R, Dragan R, Burchill C, Ekuma O, Thomson T, Rajotte L, Ginter J, Soodeen R-A, Burchill S

Hospital expenditures comprise over 40% of provincial healthcare spending. As well, hospital expenditures have increased over the past several years. This study aimed to identify drivers of hospital expenditures, over time. The study team used hospital expenditure data along with administrative health records to examine several factors, which may be related costs; for example, whether costs are being driven by sociodemographic changes in the patient population. As well, this project took an in-depth exploration of the financial data recorded across the province.

Report (PDF)

Factors Affecting Emergency Department Waiting Room Times in Winnipeg
Doupe M, Chateau D, Derksen S, Sarkar J, Lobato de Faria R, Strome T, Soodeen R-A, McCulloch S, Dahl M

Improving Emergency Department (ED) wait times is a major priority in Winnipeg, and this topic receives much attention both locally and nationally. What factors most strongly influence ED waiting room times? Should reform strategies focus on input factors (finding ways to reduce the number of ED visits), throughput factors (related to care strategies in the ED) or output factors (e.g., freeing up hospital beds so that ED patients can be transferred into hospital sooner)?

Report (PDF)
Summary (PDF)
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2013

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Who is in our Hospitals...and why?
Fransoo R, Martens P, The Need to Know Team, Prior H, Burchill C, Koseva I, Rajotte L

This deliverable describes who is occupying acute care hospital beds in Manitoba: where they are from, what they are there for, how long they stay, and their demographic profile. This research also identifies individuals who are 'Alternate Level of Care' (ALC) patients, and report on the number of hospital days used by these people while waiting for personal care admission, home care acceptance, etc. Results are provided for each hospital in Manitoba and are also summarized by RHA and hospital type. The report also provides some descriptive results regarding 'heavy users' of the acute care system, for example, patients in the top 5% of hospital day use.

Report (PDF)
Summary (PDF)
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2012

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Perinatal Services and Outcomes in Manitoba
Heaman M, Kingston D, Helewa M, Brownell M, Derksen S, Bogdanovic B, McGowan K, Bailly A

This report expands on the analyses by the Ministerial Working Group on Maternal/Newborn Services in 2005 and provides information to support the current work of the Maternal and Child Health Services (MACHS) Taskforce and the ongoing focus of the Healthy Child Committee of Cabinet (HCCC) on maternal health and early childhood development. The report focused on all births to Manitoba women from 2001/02 to 2008/09 and found that generally, women who live in poverty are more likely to have less healthy pregnancies and deliveries. Their babies are more likely to have serious health problems such as premature births and to die within the first year of life. Over 45 indicators of maternal and newborn health and health service use were analyzed in five main areas: a profile of women giving birth in Manitoba, maternal prenatal health, giving birth, maternal postpartum health, and fetal/newborn health. In addition, the report also analyzed several new indicators of maternal and newborn health. Many of the new and old measurements were then compared with national rates.

Report (PDF)
Summary (PDF)
Updates and Errata (PDF)

The Epidemiology and Outcomes of Critical Illness in Manitoba
Garland A, Fransoo R, Olafson K, Ramsey C, Yogendran M, Chateau D, McGowan K

This report provides a comprehensive, population-based evaluation of the epidemiology and outcomes of care provided in Intensive Care Units (ICUs) among people aged 17 and older in Manitoba, over from 1999/2000 to 2007/08. The care of critically ill patients occurs primarily in ICUs, and the report concentrates on that care. The report is organized into six Specific Aims; the first three aims describe the process of creating the data infrastructure needed to assess ICU use and outcomes, which are detailed in the final three aims. The value of this report derives from the importance of ICU care, the assessment of a broad range of endpoints relevant to patients and to society, and the nature of the data. Unlike the data used in most studies of critical illness or ICU care, our population-based data allow determination of incidence (not just number of cases) and mortality (as compared to case-fatality rates or the percent of people with a certain condition who die over a certain period of time); it eliminates concerns about selection bias. In addition, age- and sex-standardization can be performed to allow like-comparison among different regions and time periods.

Report (PDF)
Summary (PDF)

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2009

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The Direct Cost of Hospitalizations in Manitoba, 2005/06
Finlayson G, Reimer J, Dahl M, Stargardter M, McGowan K

Have you ever wondered which type of hospitalization the Manitoba government spends the most on? If you were to guess, would you say hip or knee replacements? Heart attacks? Or perhaps treating people for pneumonia?

Report (PDF)
Summary (PDF)
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2008

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An Initial Analysis of Emergency Departments and Urgent Care in Winnipeg
Doupe M, Kozyrskyj A, Soodeen R, Derksen S, Burchill C, Huq S

It is late at night. You've fallen, hurt your wrist and fear it may be broken. A friend offers you a ride to an emergency department(ED), and reminds you that Urgent Care (UC) at the Misericordia Health Centre is also available. Is an ED the right place for you to go to? Should you go to UC or wait to see your family doctor in the morning? How long will you have to wait to receive care? Every day, hundreds of people in Winnipeg are faced with these questions.

Report (PDF)
Summary (PDF)
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2007

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Waiting Times for Surgery, Manitoba 1999/2000 to 2003/04
De Coster C, Chateau D, Dahl M, Soodeen RA, McKeen N

Waiting times for surgery are an ongoing concern. Are things improving? Staying the same? worsening? How is Manitoba doing? MCHP has looked at surgical wait times in Manitoba for the five-year period April 1, 1999 to March 31, 2004. (June 2007)

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2006

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Application of Patient Safety Indicators in Manitoba: A First Look
Bruce S, Prior H, Katz A, Taylor M, Latosinsky S, Martens P, De Coster C, Brownell M, Soodeen R, Steinbach C

48,000 to almost 100,000 patients die each year in US hospitals due to medical error. An "adverse event" (not always fatal) occurs in 5% to almost 20% of hospitalizations in North America. What is the patient safety record in Manitoba? Are some hospitals "safer" than others?

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2004

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Patterns of Health Care Use and Cost at the End of Life
Menec V, Lix L, Steinbach C, Ekuma O, Sirski M, Dahl M, Soodeen R

This study tries to answer end-of-life questions: Are most people dying in hospital? Are they using a disproportionate share of health care services in their final months? Are the resulting costs threatening to bankrupt our health care system?

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2003

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Discharge Outcomes for Long-Stay Patients in Winnipeg Acute Care Hospitals
Kozyrskyj A, Black C, Dunn E, Steinbach C, Chateau D

An earlier MCHP study found 5% of patients in Winnipeg hospitals use 40% of hospital days. This follow-up study looked at what risk factors can help to predict which long-stay patients are more likely to go home, to die, or to be discharged to another institution.

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2002

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Profile of Medical Patients who were Assessed as Requiring Observation-Level Services at Winnipeg Acute Care Hospitals in 1998/99
Bruce S, Black C, Burchill C, De Haney S

In 1998/99, one-fifth of medical patients were found to need observation-level services on the day of admission to hospital. This study explores the characteristics of these patients further.

Report (PDF)
Summary (PDF)

Projecting Hospital Bed Needs for 2020
Stewart D, Finlayson G, MacWilliam L, Roos NP

Will the aging of the population put intolerable strains on our health care system? This study develops two models of hospital use and combines them with population projections to predict hospital bed days to the year 2020.

Report (PDF)
Summary (PDF)

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2001

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Acuity of Patients Hospitalized for Medical Conditions at Winnipeg Acute Care Hospitals
Bruce S, De Coster C, Trumble-Waddell J, Burchill C, De Haney S

For each Winnipeg acute care hospital, a representative sample of medical records was reviewed, using the InterQual ISD (Intensity- Severity- Discharge) Level of Care Criteria to determine the appropriateness of admission and continued services. This was a collaborative project with WRHA.

Report (PDF)
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Using the Manitoba Hospital Management Information System: Comparing Average Cost Per Weighted Case and Financial Ratios of Manitoba Hospitals. The Next Step
Finlayson G, Roos NP, Jacobs P, Watson D

Cleaned data from the Management Information System were used to develop financial and statistical indicators, as well as an average cost per weighted case for each Manitoba hospital. Comparisons were made between hospitals, between Regional Health Authorities, and between hospital categories.

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2000

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Waiting Times for Surgery Report: 1997/98 and 1998/99 Update
De Coster C, MacWilliam L, Walld R

This is the second report monitoring surgical waiting times, defined as the time between a pre-op visit to the surgeon and the date of surgery. Here, we compared waiting times for 1997/98 and 1998/99 with the findings of our earlier report.

Report (PDF)
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Long-stay Patients in Winnipeg Acute Care Hospitals
De Coster C, Kozyrskyj A

This study describes the characteristics associated with long-stay patients in Winnipeg acute care hospitals. Long-stay patients are defined as those staying over 30 days.

Report (PDF)
Summary (PDF)

Assessing the Performance of Rural and Northern Hospitals in Manitoba: A First Look
Stewart D, Black C, Martens PJ, Peterson S, Friesen D

A set of performance indicators tailored especially for rural and northern hospitals were developed. A key feature of the method is the inclusion of a population-based perspective, comparing an area's need for hospitalization against the amount actually used. Other measures include intensity of services, discharge efficiency and occupancy.

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1999

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Monitoring the Winnipeg Hospital System: 1990/91 Through 1996/97
Brownell M, Roos NP, Burchill C

This is the third report monitoring the effects of Winnipeg hospital bed closures on access to care, quality of care and health status. Here, we incorporate data starting from the year before bed closures, then up to and including April 1998.

Report (PDF)
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Hospital Case-Mix Costing Project: Using the Manitoba Management Information System: A first step
Finlayson G, Nowicki D, Roos NP, Shanahan M, Black C

MIS is the national statistical and financial reporting system recently adopted by Manitoba hospitals. This feasibility study explored the issues in using MIS data to estimate the average cost of providing inpatient care.

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Seasonal Patterns of Winnipeg Hospital Use
Menec V, Roos NP, Nowicki D, MacWilliam L, Finlayson G, Black C

Seasonal fluctuations in hospital use were examined over an eleven-year period (1987/88 to 1997/98). Periods of overcrowding have occurred even before hospital downsizing began and they are often related to flu and its associated illnesses.

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1998

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Surgical Waiting Times in Manitoba
De Coster C, Carriere KC, Peterson S, Walld R, MacWilliam L

Have the waiting times for surgery increased as health care funding has been reduced? Are some groups given preference in the queue? Is private health care the answer to long waits?

Report (PDF)
Summary (PDF)

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1996

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Patterns of Tonsillectomy in Manitoba 1989-1993
Black C, Peterson S, Mansfield J, Thliveris M

Tonsillectomies were examined for the Clinical Guidelines and Analysis Program (CGAP), a collaborative project of the College of Physicians and Surgeons and MCHP, funded by Manitoba Health.

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Monitoring the Winnipeg Hospital System: The Update Report 1993/1994
Brownell M, Roos NP

As for the first report, the effects of urban hospital bed closures on access to care, quality of care and health status are analyzed. This report incorporates data for one full year after the first major bed closures in Winnipeg hospitals.

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Alternatives to Acute Care
De Coster C, Peterson S, Kasian P

This study identified the extent to which Manitoba hospitals are used for medical patients whose needs could be met in an alternative health care setting, such as long term-term, outpatient or home care.

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Update Hospital Case Mix Costing: 1993/94
Shanahan M, Lloyd M

This report compares the cost of providing inpatient care at each Manitoba hospital for 1993/94, using our previously developed case mix costing methodology.

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1995

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Hospital Case Mix Costing Project 1991/92: Methodological Appendix
Lloyd M, Shanahan M, Brownell M, Roos NP

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1994

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Monitoring the Winnipeg Hospital System: The First Report. 1990-1992
Roos NP, Shapiro E

The use of hospitals and personal care homes, along with patterns of physician contact, during and after bed closures in Manitoba are compared with patterns prior to bed closures. The relationship between use of health care services and socio-economic status is also discussed.

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Hospital Case Mix Costing Project 1991/92
Shanahan M, Lloyd M, Roos NP, Brownell M

To compare how hospitals use resources, a measure of case mix adjustment has been developed by MCHP called Hospital Case Mix Costing. Using this approach, MCHP compares the costliness of Manitoba hospitals in 1992.

Report (PDF)

Estimating Per Diem Costs for Manitoba Hospitals: A First Step
Wall R, De Coster C, Roos NP

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Redirecting Care from Winnipeg Hospitals to Ten Large Rural Facilities: Estimated Number of Cases, Feasibility and Implications
Black C, Burchill C

This report estimates the number of patients currently coming to Winnipeg that could be cared for in ten major rural health care facilities, thus reducing the need for rural residents to travel to Winnipeg.

Report (PDF)
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1993

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Utilization of Hospital Resources. Volume I: Key Findings
Black C, Roos NP, Burchill CA

Report (PDF)

Utilization of Hospital Resources. Volume II: Methods and Tables
Black C, Roos NP, Burchill CA

Report (PDF)

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1992

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An Assessment of How Efficiently Manitoba's Major Hospitals Discharge Their Patients (Report #92-10)
Brownell M, Roos NP

Report (PDF)

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1991

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Hospital Funding within the Health Care System: Moving Towards Effectiveness (Report #91-05-02)
Black C, Frohlich N

Report (PDF)