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.
Innovating MCHP Deliverables
Randall S, Mahar A, Green C, Soodeen RA
This project looked at the processes for deliverables and considered ways to improve them. This included options to develop a more collaborative approach for determining the deliverable descriptions and solutions to more fully engage end-users throughout the life of the deliverable and through to use of the new knowledge. It also explored the options for new deliverable products and ways of presenting information. This report makes recommendations for Manitoba Health, Seniors and Active Living and the Manitoba Centre for Health Policy to develop further for a redefined process.
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.
Methamphetamine Use in Manitoba: A Linked Administrative Data Study
Nickel NC, Chartier M, McDonald N, Sarkar J, Dragan R, McCulloch S, Burchill C, Reimer J, Green C, Jones J, Sanguins J
This study identified Manitobans who had their methamphetamine use documented in whole-population, administrative health data for the years 2013 to 2018. This was achieved using the following databases housed within the Manitoba Population Research Data Repository: Hospital Discharge Abstracts, Medical Claims, Emergency Department Information System (EDIS), Winnipeg Fire and Paramedic Service (WFPS), and Diagnostic Services Manitoba (DSM). The study results include demographic and geographic mapping information, prevalence and risk ratios for mental health comorbidities (e.g. mood or anxiety disorders, substance use disorders), and rates of health service use (e.g. fire and paramedic services, physician visits, emergency department visits).
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.
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.
Revisiting Primary Care Provider Projection Models
Katz A, Chateau D, Taylor C, Koseva I
The 2009 MCHP Deliverable, Physician Resource Projection Models, developed a novel methodology for predicting resource needs for family doctors for Manitoba. The projections were based on previous patterns of services provided by family physicians over 30 years and population projections for Manitoba as a whole for 2015 and 2020. This deliverable validated the methodology by comparing the projections to the current reality. Updated analyses add nurse practitioners to the models as well as analyses at the local level with projections to 2025.
The Overlap Between the Child Welfare and Youth Criminal Justice Systems: Documenting "Cross-Over Kids" in Manitoba
Brownell M, Nickel N, Turnbull L, Au W, Ekuma O, MacWilliam L, McCulloch S, Valdivia J, Boram Lee J, Wall-Wieler E, Enns J
This study investigated the relationship between the child welfare and the youth criminal justice systems. It included analyses of characteristics of children and youth involved in both systems, such as mental disorders, developmental disabilities, and school achievement. The main objectives of the project were to: 1). Quantify the overlap between involvement with the child welfare system and the youth criminal justice system; and 2). Identify the characteristics associated with involvement in both systems. For most analyses a 1994 birth cohort was followed to describe child welfare system involvement, youth justice system involvement, and health and social outcomes into young adulthood. Recognizing the over-representation of Indigenous children and youth in both systems, the report provides context on a description of that over-representation.
The Health Status of and Access to Healthcare by Registered First Nation Peoples in Manitoba.
Katz A, Avery Kinew K, Star L, Taylor C, Koseva I, Lavoie J, Burchill C, Urquia M, Basham A, Rajotte L, Ramayanam V, Jarmasz J, Burchill S
This deliverable is the product of a strong and developing relationship between MCHP and the First Nations Health and Social Secretariat of Manitoba. It looks at health and healthcare use patterns of First Nations people living in Manitoba. The analyses provide comparisons between First Nations and all other Manitobans, comparisons between on and off reserve First Nations, and regional comparisons by Regional Health Authority and by Tribal Council Areas. It is the first study to use the Regional Health Survey which includes on-reserve First Nation peoples. The results demonstrate the widening gap between the health of First Nations and all other Manitobans and point to inequities in service provision.
The 2019 RHA Indicators Atlas
Fransoo R, Mahar A, The Need to Know Team, Anderson A, Prior H, Koseva I, McCulloch S, Jarmasz J, Burchill S
All RHAs in Manitoba are working to complete the 2019 cycle of comprehensive community health assessment reports. To produce their reports, the RHAs require region- and district-specific data on a range of key indicators of health status and health care use. This deliverable updates and refines key indicators from the 2013 RHA Atlas and incorporates new indicators from other reports, including a number of indicators of maternal and child health.
The Health Status of Community-Dwelling Older Adults in Manitoba
Chateau D, Doupe M, Prior H, Soodeen RA, Sarkar J, Dragan R, Stevenson D, Rajotte L
This report focuses on the health status and health care use patterns for community-dwelling older adults in Manitoba (i.e., not a resident of a nursing home). Using both health system data and self-report data from the Canadian Community Health Survey, a large number of indicators were examined that addressed physical health and wellbeing, mental health status, health care use, drug use, and numerous social indicators (e.g., living in social housing, receipt of income assistance, victim of crime). The baby boom generation has started to become senior citizens, and this timely report looks at the changes they may have brought with them to the population of older adults. The youngest of the older adults (age 65-74) saw a dramatic growth in size during the study period (2005-2014), boosting the population of older adults in Manitoba by over 20,000 in just five years. Above and beyond the increased demand on services that would be expected from population growth, we can expect changes in the health status of this population, and in how older Manitobans might interact with the health care system. Results are reported by three age groups (65-74, 75-84. 85+), and at regional and sub-regional levels. This will allow planners and all Manitobans to understand what is happening at a local level, and to focus primary care resources and other services and resources to meet the changing demands of this population.
Strategies for Developing a Personal Care Home Report Card in Manitoba
Doupe M, Brownell M, McDougall C, Koseva I, Dik N, McCulloch S, Sarkar J
Personal care homes (PCHs) provide care to people who face significant and multiple challenges. Strategies are needed to help care providers continually improve the quality of the medical and social care in PCHs, and to help Manitobans identify facilities where they may like to live. The purpose of this study was two-fold. First, we identified clinical quality indicators (QIs) that providers and planners feel are most appropriate to use in PCHs. We compared these QIs across facilities in ways that help stakeholders identify residents for whom quality of care is good and also where improvements may be needed. Second, by reviewing existing websites and the academic literature, we developed a list of recommendations for developing a PCH report card website in Manitoba. This website should be designed to help people identify PCHs where they or their loved ones would like to live, and to facilitate discussions between residents and providers about the goals of PCH care
Exploring Tuberculosis Treatment, Management, and Prevention in Manitoba's Administrative Health Data
Lix LM, Plourde PJ, Larcombe L, Kinew KA, Basham CA, Derksen S, Srisakuldee W, Schultz J, McCulloch S
This report, produced in collaboration with First Nations partners, linked the Manitoba Tuberculosis (TB) Registry to other administrative health databases to investigate the health, healthcare use, and outcomes of people with active TB disease. In addition, we examined the health and outcomes of people receiving treatment for a latent (i.e., sleeping) TB infection; these people were identified from Manitoba’s prescription drug data. We looked at all active TB cases and treated latent TB cases in Manitoba spanning 15 years (1999-2014). People with active TB had high rates of health service use around the time of diagnosis. Persons with latent TB demonstrated treatment completion rates that may not be high enough to prevent TB from spreading, suggesting a need for better treatments that make it easier for patients to complete their treatment. The data tell us that there is still room for improvement in many areas to help identify persons with active and latent TB across Manitoba as early as possible. As well, funding for new technology and research is essential to help with monitoring new TB cases, so that healthcare providers can act quickly to curb the spread of TB. Manitoba has the highest rate of TB of all Canadian provinces. With adequate funding and the support of partners in TB monitoring and care, the goal of TB elimination in Manitoba is realistic.
Mental Illness Among Adult Manitobans
Chartier M, Bolton J, Mota N, MacWilliam L, Ekuma O, Nie Y, McDougall C, Srisakuldee W, McCulloch S
Mental illness is prevalent across Manitoba and Canada. Statistics Canada reports that 20% of Canadians will experience a mental illness in their lifetime. This Manitoba report provides valuable background information on the burden of mental illness in the province and some insight into the longer-term associations between childhood/adolescent mental illness and adverse adult outcomes. Specifically, we examined the diagnostic prevalence of mental illness among adults in Manitoba, as well as the healthcare use and justice system involvement of adults with mental illness. To address the mental health needs of certain populations who may be at higher risk of mental illness, this report presents the prevalence in specific populations of Manitoba. A cohort of Manitobans born in the province was also developed to examine the relationship between childhood/adolescent mental disorders and adverse adult outcomes. The findings of this report will be important for planning services and programs to diagnose and treat mental illness. Coordinating services among government departments, including health, social services, education and justice, will also go a long way towards ensuring better care for Manitobans at risk for and suffering from mental illness. Finally, supporting mental health research is an essential part of understanding what works and what is needed to strengthen mental health services for Manitobans.
Outpatient Oral Anticancer Agents in Manitoba
Raymond C, Leong C, Fransoo R, Geirnaert M, Dragan R, Yogendran M, Thomson T, Rajotte L, Koseva I, Schultz J, Burchill S
Most Manitobans who receive treatment for cancer do so with intravenous therapy at Cancer Care Manitoba. However, in recent years, the use of oral anticancer agents has increased. Traditionally, prescriptions for these medications are filled at community pharmacies through the usual system of prescription drug coverage, including a deductible for eligible Pharmacare prescriptions. In 2012, the Home Cancer Drug (HCD) Program was launched. This is a program for Manitobans diagnosed with cancer that allows access to eligible outpatient oral cancer and specific supportive care drugs at no cost to the patient (with no deductible). This research project sought to determine usage of oral medications in Manitoba, changes in patterns of use and prescription filling over time, and the impact of the HCD program on prescription filling patterns. Using prescription drug data for outpatients we examined prescription utilization trends, costs associated with such therapies and patterns of health services use.
Health and Social Outcomes Associated with High-Risk Alcohol Use
Nickel NC, Bolton J, MacWilliam L, Ekuma O, Prior H, Valdivia J, Leong C, Konrad G, Finlayson G, Nepon J, Singal D, Burchill S, Walld R, Rajotte L, Paille M
Alcohol is enjoyed by many Canadians and has special social and cultural significance in Canadian society. However, over-consumption of alcohol is linked with many, far-reaching harms. Recent data suggest that one in five Canadian drinkers exceed Canada’s low-risk drinking guidelines. This study examined high-risk drinking behaviours and associated outcomes among Manitobans. We used linked data housed in the Manitoba Population Research Data Repository to answer the following questions: (1) How many Manitobans are drinking more alcohol than is recommended by Canada’s low-risk drinking guidelines and has this number changed over time? (2) How many Manitobans have been diagnosed with an Alcohol Use Disorder over the past 20 years? (3) What are the patterns in healthcare utilization, social service use, and interactions with the justice system among individuals with a diagnosed Alcohol Use Disorder? Our analyses suggest several opportunities where supports can be put in place sooner to help Manitobans who are dealing with harmful consequences of high-risk drinking.
The PAX Program in Manitoba: A Population-Based Analysis of Children's Outcomes
Brownell M, Chartier M, Au W, Schultz J, Stevenson D, Mayer T, Young V, Thomson T, Towns D, Hong S, McCulloch S, Burchill S, Jarmasz J
PAX was piloted in almost 200 schools with close to 5000 Grade 1 students across the province in the 2011/12 school year in a cluster randomized controlled trial implemented by Healthy Child Manitoba. The first part of this deliverable involved transferring the PAX datasets to the Manitoba Population Research Data Repository where these data were assessed through the standard Data Quality Programs. The metadata (e.g. data model, data dictionary) for the databases were developed and an assessment of the content of fields completed. The second part of the deliverable involved linking the PAX datasets with other data in the Repository to evaluate the impact of PAX on outcomes at the end of grade 1, in grade 3 and up to grade 4.
Describing Patient Populations for the My Health Team Initiative
Chateau D, Katz A, Metge C, Taylor C, McDougall C, McCulloch S
The province of Manitoba is in the process of restructuring primary care through the development of My Health Teams, which are networks consisting of primary care providers (physicians and nurse practitioners) and other professionals from health or related disciplines (e.g., dieticians, mental health counsellors, social workers). This study describes the patient populations that current or future My Health Teams could expect to provide care to. We examined where patients access primary care in relation to where they live in order to provide a more accurate description of patient populations. We also examined if patients were high users of services, medically complex, or socially complex. The last category addresses the social determinants of health and this is the first study to apply these social complexity indicators across the province. In addition, we examined the overlap between these three types of patients to determine how distinct patients with social complexities and medical complexities were, and whether these patients were also high user of services.
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.
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)?
The Mental Health of Manitoba's Children
Chartier M, Brownell M, MacWilliam L, Valdivia J, Nie Y, Ekuma O, Burchill C, Hu M, Rajotte L, Kulbaba C
Canadian studies suggest that 1 in 7 children experience mental disorders at any given time, however less than a third of these children receive the clinical treatment services they require. This project examines the diagnostic prevalence of mental disorders in children according to diagnostic categories such as attention deficit hyperactivity disorder (ADHD), schizophrenia, mood and anxiety disorders and substance use disorder. Use of services for mental disorders, including hospitalizations, physician visits, justice system involvement, and child and family services for those identified with mental disorders are examined, as well as the relationship between mental health and educational outcomes. In addition, the project team is exploring factors that contribute to the development of mental disorders in children. Results from this report will inform ongoing work by the Healthy Child Manitoba Strategy, the Provincial Mental Health Strategy (Rising to the Challenge) and the implementation of a Child and Youth Mental Health Strategy.
A Comparison of Models of Primary Care Delivery in Winnipeg
Katz A, Valdivia J, Chateau D, Taylor C, Walld R, McCulloch S, Becker C, Ginter J
This deliverable compares the five models of primary care delivery that exist in Winnipeg: non-PIN FFS, PIN FFS, WRHA Primary Care, Community Health, and family medicine teaching clinics. The main objectives of this project are as follows: 1. Compare/evaluate quality of care indicators for the five models of primary care delivery 2. Discuss the impact of patient social complexity on service provider, quality of care and roster/ panel size Of particular interest is the development of social complexity indicators in this deliverable. Social complexities include patient characteristics such as living in social housing, involvement with the justice system, and having a major mental health diagnosis.
Supportive Housing for Seniors: Reform Implications for Manitoba's Older Adult Continuum of Care
Doupe M, Finlayson G, Khan S, Yogendran M, Schultz J, McDougall C, Kulbaba C
The older adult care continuum is generally comprised of home care services, community-based supportive housing, and personal care homes (PCHs). This research examines supportive housing and PCH use in the Winnipeg Health Region, first by identifying the proportion of newly admitted PCH residents who are clinically similar to most supportive housing tenants. We also compare some additional features of these groups, such as differences in user fees paid, differences in people’s informal support networks, and differences in their healthcare use patterns. Collectively, this research helps to define the potential for expanding supportive housing as an alternate to PCH use in Winnipeg, and identifies some of the more salient reform strategies required to help make this work.
Cancer Data Linkage in Manitoba: Expanding the Infrastructure for Research
Lix L, Smith M, Pitz M, Ahmed R, Quon H, Griffith J, Turner D, Hong S, Prior H, Banerjee A, Koseva I, Kulbaba C
The linkage of cancer registry data to other administrative health databases improves opportunities for population health and health services research for individuals who have been diagnosed with cancer. The overall purpose of this deliverable was to bring the Manitoba Cancer Registry data into the Research Data Repository housed at the Manitoba Centre for Health Policy (MCHP), in order to establish a broader base for cancer research using linked administrative health databases in Manitoba. This deliverable applied routine data quality evaluation tools developed at MCHP to the Manitoba Cancer Registry and then looked at some new measures of data quality used the linked data housed in the Repository. By conducting two demonstration projects, we examined opportunities for new cancer research projects that involve linkage of cancer registry data to administrative data: we compared the performance of comorbidity measures for predicting healthcare utilization in populations with diagnosed cancers and we investigated emergency department (ED) utilization among individuals with a cancer diagnosis to test for differences in ED use before and after diagnosis and to predict time to death.
Care of Manitobans Living with Chronic Kidney Disease
Chartier M, Dart A, Tangri N, Komenda P, Walld R, Bogdanovic B, Burchill C, Koseva I, McGowan K-L, Rajotte L
Rates of kidney failure or end stage kidney disease (ESKD) have been steadily increasing with the prevalence of diabetes and the aging population in Manitoba. The purpose of this report was to gain a greater understanding of chronic kidney disease (CKD) and ESKD in adults and children in the province. The findings will provide background knowledge to prevent new cases of CKD, to intervene early to slow the progression to ESKD and to plan resources for kidney health services in the future. Manitoba Health, Healthy Living and Seniors asked Manitoba Centre for Health Policy to answer the following research questions: a) What are the future needs for kidney health services (peritoneal dialysis, home hemodialysis, in-centre dialysis and kidney transplant) in Manitoba? b) What is the geographic distribution of this population? c) What are the characteristics of the future population of Manitoba residents who will require renal replacement treatment? d) What preventive, screening, and education measures and affiliations with existing programs, might reduce the number of Manitobans who will require dialysis?
Long-Term Outcomes Of Manitoba's Insight Mentoring Program: A Comparative Statistical Analysis
Ruth C, Brownell M, Isbister J, MacWilliam L, Gammon H, Singal D, Soodeen R, McGowan K, Kulbaba C, Boriskewich E
The objective of this report is to examine the outcomes of women and their children who have been involved in the Manitoba InSight program, an intensive mentoring program for women at high risk of having children with Fetal Alcohol Spectrum Disorder (FASD). By linking the clinical data within the InSight program database to the MCHP Repository we examined outcomes both during and after the program, with over 10 years of outcomes for earlier participants. We evaluated the impact on the mental, physical and perinatal health of the women and their children and their involvement with services such as social housing, Families First, prenatal care and Child and Family Services. This report will allow for planning and support of ongoing services to this at risk population and act as a baseline for further studies into FASD and its prevention and management.
The Educational Outcomes of Children in Care in Manitoba
Brownell M, Chartier M, Au W, MacWilliam L, Schultz J, Guenette W, Valdivia J
This report presents descriptive and statistical analyses regarding children placed in the care of Manitoba Child and Family Services. The Manitoba Centre for Health Policy (MCHP) was asked to identify factors that contribute to the educational success of children in care in Manitoba and to make recommendations regarding what schools, school districts and the provincial Department of Education and Advanced Learning could to do to further contribute to the educational success of students in care. In order to fulfill this request, MCHP identified 5 main objectives for this report, and each of these will be addressed in this presentation: 1) describe the characteristics of children in care in Manitoba; 2) describe the educational outcomes of children in care in Manitoba; 3) identify factors that are associated with positive (and negative) educational outcomes for children in care in Manitoba; 4) provide information on programs that improve educational outcomes for children in care; and 5) provide recommendations on how educational outcomes for children in care can be improved in Manitoba.
The Cost of Smoking: A Manitoba Study
Martens P, Nickel N, Forget E, Lix L, Turner D, Prior H, Walld R, Soodeen RA, Rajotte L, Ekuma O
This study focused on estimating the excess burden that smoking places on the healthcare system. We used survey data (i.e., Manitoba Heart Health Survey, National Population Health Survey, and the Canadian Community Health Survey) from over 45,000 Manitobans to measure individuals' smoking behaviours. We then linked individuals' survey data with their administrative health data held in the Population Health Research Data Repository. We followed survey respondents for ten years after survey to measure the excess healthcare use and expenditures associated with smoking. Smoking rates have decreased from 1989 to 2011. The study found that smoking is associated with increased physician visits, hospitalizations, and prescription drugs. This increased healthcare use translates into excess annual costs: $39M in physician costs, $40M in prescription drugs, $147M in hospital-related expenses, and $18M in cancer-related costs for a total costs of $244 million a year.
Evaluation of the Manitoba IMPRxOVE Program
Chateau D, Enns M, Ekuma O, Koseva I, McDougall C, Kulbaba C, Allegro E
In June 2011 Manitoba Health launched the IMPRxOVE program (Improving Medication Prescribing and Outcomes Via medical Education). The program is a first of its kind in Canada and is expected to improve the safety and health outcomes for Manitobans receiving medications for mental-health conditions. IMPRxOVE is administered by Comprehensive Neurosciences of Canada (CNSC), using proprietary clinical algorithms and a proven audit-and-feedback intervention. CNSC conducts monthly reviews of Drug Program Information Network (DPIN) pharmacy claims data to evaluate the appropriateness of the prescriptions of psychiatric and related behavioral medications, in order to identify patients at risk due to potentially inappropriate prescriptions. If a potentially inappropriate pattern of prescriptions is identified, a feedback alert in the form of an educational mailing package is sent to the prescriber. Prior to launch, Provincial Drug Programs (PDP) obtained input from Dr. Murray Enns (Professor and Head, Department of Psychiatry, University of Manitoba), the Manitoba Centre for Health Policy (MCHP), and Dr. Harold Carmel (Vice President, Care Management Technologies) to establish preliminary research objectives and hypotheses, criteria for evaluation, and data requirements for a full evaluation of the IMPRxOVE's impact. As part of this process, 1,417 physicians eligible to receive the educational mailing packages were randomly assigned to a control group or an active mailing group. The purpose of this study was to evaluate IMPRxOVE by examining changes in prescribing practices of physicians, and what characteristics of physicians or their practices may be associated with a positive impact of the educational mailing packages.
Physician Integrated Network: A Second Look
Katz A, Chateau D, Bogdanovic B, Taylor C, McGowan K-L, Rajotte L, Dziadek J
This deliverable evaluates the impact of the Physician Integrated Network (PIN) initiative on health service provision and primary care. To do this, the study looks at the twelve PIN clinics and describes the patient population during the two years before implementation and two years after. The study uses 23 indicators to compare the care provided before PIN to that provided after the introduction of PIN. The study also compares PIN patient care to a matched group of Manitobans, and considers long-term follow-up at four clinics to see if any gains from PIN are sustained.
The 2013 RHA Indicators Atlas
Fransoo R, Martens P, The Need to Know Team, Prior H, Burchill C, Koseva I, Bailly A, Allegro E
The 2013 RHA Indicators Atlas measured the health of Manitobans and their use of healthcare services, and found that most Manitobans are living longer and the prevalence of many diseases has decreased, but the health gap between rich and poor has widened. Researchers analyzed data using more than 70 indicators of health status and healthcare use to compare results from previous studies. Representatives from all 5 Regional Heath Authorities (RHAs), Manitoba Health, and U of M researchers collaborated in the creation of this report. Information such as: rate of improvement or prevalence among chronic disease indicators, how many people are in nursing homes, how many people were hospitalized, how many visited a doctor and how many filled prescriptions are also available in this report. Together with similar reports published in 2009 and 2003, the data provides a picture of our province's health trends spanning almost 20 years.
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.
Social Housing in Manitoba. Part I: Manitoba Social Housing Data
Finlayson G, Smith M, Burchill C, Towns D, Peeler W, Soodeen RA, Prior H, Huq S, Guenette W
Part I of this report describes bringing in the Tenant Management System (TMS) data for the period 1995/96-2009/10) and integrating it into the Repository at MCHP. Tests were conducted to determine the amount of data which were missing, inconsistent, or out of range.
Social Housing in Manitoba. Part II: Social Housing and Health in Manitoba: A First Look
Smith M, Finlayson G, Martens P, Dunn J, Prior H, Taylor C, Soodeen RA, Burchill C, Guenette W, Hinds A
This "first look" at the health status and health care use of residents of Social Housing highlights some of the disparities they experience relative to other Manitobans. A selection of health care use, physical health, mental health and educational achievement indicators, with a particular focus on child and youth issues, chosen for their potential relevance to program and policy development are presented. Despite wide differences in health status, there are encouraging similarities for some health screening and preventative care measures.
Understanding the Health System Use of Ambulatory Care Patients
Katz A, Martens P, Chateau D, Bogdanovic B, Koseva I, McDougall C, Boriskewich E
This study originated in the desire to better understand which types of physicians are providing "primary care type services" to Manitobans and what impact this has on the quality of care received. This study is limited to ambulatory care services provided to Manitobans aged 19 and older over a three-year period between the fiscal years 2007/08 and 2009/10. Ambulatory care services are those provided in the community, outside of hospitals and personal care homes. In particular, the focus is on Manitobans with at least one of six chronic conditions. This group was chosen as the focus of the study because those with a chronic condition tend to use the healthcare system more frequently and they are more likely to benefit from continuity of care and high quality primary care services. This report provides new information about the use of ambulatory care services in Manitoba. This information places current primary care reform initiatives in context. The findings support the focus on reform related to primary care providers (physicians and nurse practitioners) as they provide the vast majority of primary care.
A Systematic Investigation of Manitoba's Provincial Laboratory Data
Lix L, Smith M, Azimaee M, Dahl M, Nicol P, Burchill C, Burland E, Goh C, Schultz J, Bailly A
As the Provincial LIMS (Laboratory Information Management System) Project progresses, Cadham Lab's historical datasets will no longer be used for recording current lab test results; these datasets will be archived. MCHP received these historical datasets and conducted a systematic study to validate, document, and evaluate their quality for research purposes. The outcome of this project is a summary assessment of the feasibility of using these data for population-based investigations. For the study, records for the entire population of Manitoba were looked at from 1992 to 2010. Information was compared by age, sex, income, and where people lived. By using Cadham Provincial Laboratory data linked to other administrative data, new opportunities could emerge in future studies to better understand the spread of diseases, identify facilities that are successful in avoiding outbreaks, and examine the cost effectiveness of immunization programs.
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.
How are Manitoba's Children Doing?
Brownell M, Chartier M, Santos R, Ekuma O, Au W, Sarkar J, MacWilliam L, Burland E, Koseva I, Guenette W
This study looked at nearly all children in the province 19 and under from the years 2000 to 2010. It measured children's well-being in four areas: physical and emotional health; safety and security; education; and social engagement and responsibility and found Manitoba children have been making some gains in health and social outcomes. Building on past research from MCHP, researchers found children from lower income areas generally experience poorer outcomes than children from high income areas. The study found differences in educational outcomes were not as great as those seen in areas of health however. Inequities tend to increase as children progress through school, suggesting that the early and middle years of childhood may present opportunities for programs and interventions that enables successful learning and reduce gaps.
Projecting Personal Care Home Bed Equivalent Needs in Manitoba Through 2036
Chateau D, Doupe M, Walld R, Soodeen R, Ouelette C, Rajotte L
Manitoba Health's Aging in Place initiative has created relatively new alternatives to care for aging adults, such as supportive housing and home care which has helped to keep the demand for personal care homes down. Expanding these services will be crucial for the future care of seniors in the province because, as more Manitobans age into their golden years, the need for long-term care also increases. By 2031, all Baby Boomers will be 65 or older and almost half will be older than 75, presenting a growing challenge for the healthcare system. The latest report from MCHP estimates how much the need for personal care home beds or equivalent alternatives such as supportive housing and extended home care is expected to rise. Researchers also looked into family structure - they found being married and having children lowers personal care home use. The study found the proportion of Manitobans using personal care homes has shrunk since 1985 however, by 3036 space for 5,100 more seniors will be needed in long-term care facilities. The extra capacity for care won't be needed all at once and won't be the same across the province, thus healthcare planners from across the province can use this report to prepare for future needs.
Health and Healthcare Utilization of Francophones in Manitoba
Chartier M, Finlayson G, Prior H, McGowan K, Chen H, de Rocquigny J, Walld R, Gousseau M
The purpose of this report is to gain a greater understanding of the health status and healthcare utilization of Francophones in Manitoba. By understanding the health and healthcare use of Francophones in the province, healthcare planners and policy makers can determine the effectiveness of services and can focus their efforts in specific areas. In addition, having better knowledge of the health status of a population contributes to our understanding of the vitality of a population. This report may also be useful to the one million Francophones living in Canada, but outside of Québec, since little is known regarding the health of this population.
La santé et l'utilisation des services de santé des francophones du Manitoba
Chartier M, Finlayson G, Prior H, McGowan K, Chen H, de Rocquigny J, Walld R, Gousseau M
L'objet du présent rapport est d'avoir une meilleure idée de l'état de santé des francophones du Manitoba et de leur utilisation des soins de santé. En comprenant mieux l'état de santé des francophones de la province et les soins qu'ils requièrent, les planifi cateurs des soins de santé et les décideurs peuvent déterminer l'effi cacité des services et concentrer leurs eff orts sur des secteurs en particulier. De plus, une meilleure connaissance de l'état de santé d'une population nous aide à mieux cerner sa vitalité. Ce rapport pourrait aussi s'avérer utile au million de francophones du Canada vivant à l'extérieur du Québec, car on sait très peu de choses à propos de la santé de cette population.
The Early Development Instrument (EDI) in Manitoba: Linking Socioeconomic Adversity and Biological Vulnerability at Birth to Children's Outcomes at Age 5
Santos R, Brownell M, Ekuma O, Mayer T, Soodeen R-A
This report shows differences in children's potential at school are apparent as early as when they're born and is also related to where they live. It focuses on the Early Development Instrument (EDI), a population-based, community-level measurement looking at children's physical, social, emotional, language, and communication skills. Information was collected from children who are entering Kindergarten (age 5 years) province-wide by all Manitoba public school divisions on behalf of the Healthy Child Manitoba Office (HCMO). The study looked deep into social circumstances and identified three factors associated with poor EDI scores. Children born to teen moms, in families on income assistance, or in the care of Child and Family Services, were found to be more at-risk. Anonymized results of the EDI surveys from 2005-2007 were linked with areas of residence. Out of nearly 22,000 children included, they found that EDI scores seemed to be strongly related to how rich or poor the area was. The results show that groups of children facing multiple risks require more attention, and as early in life as possible, to get the help they need to succeed at school and later in life. The report provides planners with insights about when and where resources should be applied.
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.
Adult Obesity in Manitoba: Prevalence, Associations, and Outcomes
Fransoo R, Martens P, Prior H, Chateau D, McDougall C, Schultz J, McGowan K, Soodeen R, Bailly A
Obesity doesn't kill people directly but is related to the development of a number of poor health outcomes, including high blood pressure and diabetes. These are important because they cause serious problems themselves, and they're related to heart disease and stroke, which are leading causes of death. The scope of the deliverable is to include the analysis of provincial trends of obesity and related chronic diseases over a 10-year period. The findings indicate the impact on the healthcare system from obese and overweight people may not be as significant as expected. Using nationally-administered health surveys from 1989 to 2008 the study found obesity rates increased in Manitoba. Overall, more than a quarter of people in the province are now considered obese. This report also confirms what's been proven in the past - geography, marital status, employment, age, sex, education, smoking, and physical activity level can influence weight.
Manitoba Immunization Study
Hilderman T, Katz A, Derksen S, McGowan K, Chateau D, Kurbis C, Allison S, Reimer JN
Researchers from MCHP completed The Manitoba Immunization Study, the most comprehensive analysis of Manitoba's immunization programs ever performed. They looked at childhood and adult immunization rates in the province from April 1, 2000 to March 31, 2008, the impact of immunizations and the safety of vaccines. Overall, immunization rates for two-year-old children in Manitoba were stable over the eight years studied. The study looked at shots for flu and pneumonia in adults with a specific focus on three groups: pregnant women and women with a newborn, people older than 64, and people with chronic illness like diabetes. Manitobans 65 and over have the highest rate of immunizations and people with chronic illness have higher immunization rates than those without illness. Flu immunization reduced hospitalization and mortality in those over 65. The researchers also noted that nothing in the report was found to link vaccinations with rare disorders like Guillain-Barre Syndrome, a concern that prevents some people from getting vaccinations.
Population Aging and the Continuum of Older Adult Care in Manitoba
Doupe M, Fransoo R, Chateau D, Dik N, Burchill C, Soodeen R-A, Bozat-Emre S, Guenette W
Health regions in Manitoba are at various stages of population aging, and projected growth in the number of 75+ year-olds, the predominant personal care home (PCH) users, will vary tremendously across the province. The analyses in this report indicate PCH use will increase modestly in Manitoba until about 2020/21. Shortly after this time Baby Boomers will reach age 75 and by 2030/31, Manitoba may need 29.1% more PCH beds to cope with increasing older adult numbers. Manitoba has expanded its continuum of older adult care with supportive housing provided as an alternate to PCH use. This report provides a tool (LTCPEXP) for allocating people to these different areas. Using RAI-HC© data from Winnipeg, this tool correctly identifies, on average, 76.0% of home care, supportive housing, and PCH users. Use of this tool is important for ensuring that supportive housing fulfills its role as an alternate to PCH use, so people receive the best type of care to match their needs. Using a process called cluster analysis, this research creates a tool (LofCEXP) for describing PCH residents' needs, at least in the WRHA. By combining this strategy with provincial PCH projections, some evidence is also provided to help planners prepare for the future.
Evaluation of the Healthy Baby Program
Brownell M, Chartier M, Au W, Schultz J
In 2001 the Healthy Baby Program was introduced in Manitoba by the Healthy Child Manitoba Office. The goal of this program was to increase the health of Manitoba's most vulnerable babies with an income supplement and/or community support programs targeted towards low income mothers and families. This report evaluates the impact the program had on prenatal and perinatal health, as well as health outcomes of children in the program up to their first birthday.
Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing Over Time?
Martens P, Brownell M, Au W, MacWiliam L, Prior H, Schultz J, Guenette W, Elliott L, Buchan S, Anderson M, Caetano P, Metge C, Santos R, Serwonka K
This deliverable provides information on approximately 15 key indicators of health status, over time and by a measure of socioeconomic status (income quintiles). MCHP researchers looked at the distribution of disease, death and the use of preventive healthcare across income groups in Manitoba to provide useful information for various government reports on the health status of Manitobans in 2010. The research may also assist in laying a foundation for further work on inequities.
Physician Integrated Network Baseline Evaluation: Linking Electronic Medical Records and Administrative Data
Katz A, Bogdanovic B, Soodeen R
Electronic medical records (EMRs) help family doctors provide better care to their patients. Without these records it's difficult to measure what kind of care patients receive. Manitoba Health asked researchers at MCHP to look for patterns among groups of patients in the Physician Integrated Network (PIN). The PIN initiative aims to improve patients' access to doctors and interdisciplinary teams while creating a system to manage information more effectively so doctors can make better decisions. The study found improvements in the use of electronic medical records by helping to define criteria for the use of standard fields. This allows doctors to make better use of their own EMRs and helps manage chronic conditions and the overall health of their patients. Family doctors can use information from EMRs to graph patients' health by measuring weight, blood pressure, and so on with each visit. The same techniques can be used to monitor chronic conditions such as diabetes and more importantly, measurements can be taken on how patients respond to treatment.
Profile of Metis Health Status and Healthcare Utilization in Manitoba: A Population-Based Study
Martens PJ, Bartlett J, Burland E, Prior H, Burchill C, Huq S, Romphf L, Sanguins J, Carter S, Bailly A
It's widely known that the health of aboriginal populations in Canada lags behind that of other Canadians. In 2002, the Manitoba Centre for Health Policy (MCHP) published a report titled The Health and Health Care Use of Registered First Nations People Living in Manitoba: A Population-Based Study. The research project demonstrated that Registered First Nations people have shorter life expectancy and higher morbidity than other Manitobans, however, little has been published on the health of Aboriginals who do not have Status, such as Metis. This collaborative study between Manitoba Health, MCHP and the Manitoba Metis Federation (MMF) examines the health of the Metis population of Manitoba with indicators such as physical illness, hospital services, educational success, and the use of social services. There are some good findings and some that are troubling.
The Additional Cost of Chronic Disease in Manitoba
Finlayson G, Ekuma O, Yogendran M, Burland E, Forget E
Researchers at the University of Manitoba compared the costs of healthcare for people with arthritis, asthma and chronic obstructive pulmonary disease (COPD), coronary heart disease, diabetes, and stroke over a two-year period. The report compares what it costs the province to provide healthcare to individuals with one of these conditions with individuals who do not have the condition. Spending on average for all Manitobans without one of the chronic condition studied is about $4,000 per person over two years. Spending on Manitobans with a chronic condition is from twice as much for asthma and COPD to six times as much for people who have had a stroke. The report also breaks-down costs by looking at physician services, inpatient and day surgery, hospital care, prescription drugs, home care and nursing homes for each of these conditions. One of the most interesting findings of this research is that the cost of treating chronic disease is different throughout the province. After considering age, sex, and other influencing factors, people who were treated for similar conditions had different costs for healthcare depending upon where they lived. These differences are not caused by the actual cost of providing services because these values have been equalized - they're caused by using services differently. The report includes important information that will be useful for health and social policy makers in the province to determine the potential impact of healthcare costs for programs designed to reduce the incidence of chronic disease.
Pharmaceutical Use in Manitoba: Opportunities to Optimize Use
Raymond C, Metge C, Alessi-Severini S, Dahl M, Schultz J, Guenette W.
This report provides a snapshot of prescribing across several categories of medications for all Manitobans over an 11-year period (1997/98-2008/09). It describes a population-based profile of utilization for antipsychotics and benzodiazepines and the related medications in older adults; medications and glucose test strips for diabetes mellitus; inhalers for asthma and chronic obstructive lung disease; and biologic agents to treat rheumatoid arthritis, inflammatory bowel disease, ankylosing spondylitis, and psoriasis. The report assesses a range of influences on medication utilization, such as patient sociodemographic factors and prescriber characteristics. Some literature suggests that, for a variety of reasons, these groups of medications are not always prescribed optimally. The report evaluates the impact of patient and prescriber characteristics on measures of optimal medication use based on recent literature and guidelines including: the use of inhaled or oral corticosteroids prior to the use of inhaled long acting beta agonists (LABA) for asthma, the use of LABA with concomitant inhaled or oral corticosteroids, avoiding the use of high dose second generation antipsychotics (SGAs) in older adults, and reserving higher cost new medications for diabetes mellitus as second line therapy.
Effects of Manitoba Pharmacare Formulary Policy on Utilization of Prescription Medications
Kozyrskyj A, Raymond C, Dahl M, Ekuma O, Schultz J, Sklepowich M, Bond R
Prescription drug coverage policies vary widely across Canada and drug benefit managers are frequently searching for good quality evidence on real-world medication cost-effectiveness and safety, in order to make informed decisions on formulary listing policies. Manitoba Health offers a province-wide, income-based drug insurance program, according to a published list of prescription benefits in its Pharmacare Formulary that are reimbursed as open listing (Part 1), according to established criteria (Part 2) or with prior approval (Part 3). This MCHP deliverable evaluated the impact of Manitoba's Pharmacare Formulary policies and other societal factors on the utilization of prescription medications in Manitoba.
Manitoba RHA Indicators Atlas 2009
Fransoo R, Martens P, Burland E, The Need to Know Team, Prior H, Burchill C
Life expectancy in Manitoba is up to 76.3 years for men and 81.5 years for women. That's the average length of life from birth, and it's based on Manitoba data for 2001 to 2005. According to the Manitoba Centre for Health Policy's Manitoba RHA Indicators Atlas 2009, the figures are up over the previous five years by more than half a year for both men and women.
Composite Measures/Indices of Health and Health System Performance
Metge C, Chateau D, Prior H, Soodeen R, De Coster C, Barre L
While hundreds of indicators exist that measure specific aspects of health, use of health services, and health system performance, there is a lack of high quality composite measures in key strategic areas. For example, within the province of Manitoba there is no single measure that tells us what is happening overall for chronic diseases, waiting times, or patient safety? Indicators at the population/system-wide level would be useful for strategic planning and reporting. This project, constructs composite indicators that compare differences in healthcare delivery and health outcomes across Manitoba's Regional Health Authorities (RHAs) and Winnipeg Community Areas (CAs), and allow planners to track them over time. The findings suggest however, that the effort required to develop, validate, and update composite indices is disproportionate to the value of the information they yield.
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?
Physician Resource Projection Models
Katz A, Bogdanovic B, Ekuma O, Soodeen RA, Chateau D, Burnett C
This project will provide scenarios that incorporate different assumptions that have an impact on the demand for physicians in four key areas identified by Manitoba Health: Family Medicine, Pediatrics, General Surgery and Orthopedic Surgery. Two sets of models will be developed: (1) models that will project the service needs of the population given various characteristics, e.g., age, sex, socioeconomic status, comorbidities; (2) models that will project the number of services that can be provided by the physician workforce given their characteristics, e.g., age, sex, number of years since graduation, average workloads, etc. MCHP will use historical data housed in the Population Health Research Data Repository to develop and test these models. The output of the project will not be a definitive answer to the question: "How many physicians are needed in Manitoba?" but will provide tools that can be used by Manitoba Health and potentially other organizations, such as the University of Manitoba's Faculty of Medicine to project supply and demand under different conditions.
Manitoba Child Health Atlas Update
Brownell M, De Coster C, Penfold R, Derksen S, Au W, Schultz J, Dahl M
It has often been said that one can measure how advanced a society is by how well it meets the needs of its weakest and most frail members. In Manitoba, we are fortunate to live in a society where considerable time and effort has been spent to improve the health of children. Policies and programs have been designed and put into place so that in theory, all children are born with an equal chance of being healthy. And for those children born into circumstances resulting in poorer health, programs exist which try to ensure that they eventually get onto a level playing field. All this work has resulted in children, for the most part, being healthy in Manitoba.
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.
What Works? A First Look at Evaluating Manitoba's Regional Health Programs and Policies at the Population Level
Martens P, Fransoo R, The Need to Know Team, Burland E, Prior H, Burchill C, Romphf L, Chateau D, Bailly A, Ouelette C
Decision-makers and planners in Manitoba have access to plenty of research describing the health of the population. What has been missing until now is information that starts to connect the dots between the health of residents and the programs and policies that may be contributing to good health outcomes.
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)
Allocating Funds for Healthcare in Manitoba Regional Health Authorities: A First Step--Population-Based Funding
Finlayson GS, Forget E, Ekuma O, Derksen S, Bond R, Martens P, De Coster C
Imagine you are put in charge of Manitoba's annual healthcare budget. How would you allocate those funds across Manitoba's Regional Health Authorities? This report takes a look at a population-based approach to allocating healthcare funds.
Next Steps in the Provincial Evaluation of the BabyFirst Program: Measuring Early Impacts on Outcomes Associated with Child Maltreatment
Brownell M, Santos R, Kozyrskyj A, Roos N, Au W, Dik N, Chartier M, Girard D, Ekuma O, Sirski M, Tonn N, Schultz J
With recent child deaths in Manitoba caused by maltreatment, the question being asked is how can we prevent this from happening again? This study evaluates the provincial BabyFirst program (now Families First) and its impact on child maltreatment.
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?
Using Administrative Data to Develop Indicators of Quality Care in Personal Care Homes
Doupe M, Brownell M, Kozyrskyj A, Dik N, Burchill C, Dahl M, Chateau D, De Coster C, Hinds A, Bodnarchuk J
How does the care Manitoba nursing home residents receive compare from one RHA to the next, or from one PCH to the next? MCHP has developed ten Quality Indicators to find the answers.
Profiling Primary Care Physician Practice in Manitoba
Frohlich N, Katz A, De Coster C, Dik N, Soodeen RA, Watson D, Bogdanovic B
This is an initial exploration of a new methodolgy designed to compare family practices in Manitoba. Five measures (indicators) cover three main aspects of family practice: type of care (1 indicator), volume (2 indicators) and quality (2 indicators).
Defining and Validating Chronic Diseases: An Administrative Data Approach
Lix L, Yogendran M, Burchill C, Metge C, McKeen N, Moore D, Bond R
Six out of ten Canadians have a chronic disease, such as high blood pressure, diabetes or asthma.To prevent chronic diseases in Manitoba, we need to know how widespread they are, who is at risk of getting a them, and how disease patterns are changing over time. The tools developed in this report provide some answers.
Sex Differences in Health Status, Health Care Use, and Quality of Care: A Population-Based Analysis for Manitoba's Regional Health Authorities
Fransoo R, Martens P, The Need to Know Team, Burland E, Prior H, Burchill C, Chateau D, Walld R
Very little has been known about the differences between the sexes in Manitoba when it came to health-related issues. This report changes that. It offers Manitobans a fact-based, sex-specific, region-by-region look at health in our province.
High-cost Users of Pharmaceuticals: Who are They?
Kozyrskyj A, Lix L, Dahl M, Soodeen R
In Manitoba, over 40% of prescription dollars get consumed by only 5% of the Manitobans taking prescription drugs. This study looks at these "high-cost" users and compares them to other Manitobans taking prescriptions. What drug categories account for higher prescription costs? What explains the higher drug costs? Are there signs or predictors that someone will become a high-cost user?
Primary Prevention: An Examination of Data Capabilities in Manitoba (January 2005)
Lix L, Finlayson G, Yogendran M, Bond R, Bodnarchuk J, Soodeen R
Different initiatives are offered across Manitoba designed to promote good health�??called primary prevention�??rather than to treat poor health. In this study we look at primary prevention data. Is it sufficient for research purposes? Can we relate it to data we do have on health and the use of health care services?
How Do Educational Outcomes Vary With Socioeconomic Status? Key Findings from the Manitoba Child Health Atlas 2004
Brownell M, Roos NP, Fransoo R, Guevremont A, MacWilliam L, Derksen S, Dik N, Bogdanovic B, Sirski M
The poorer their neighbourhood, the more likely children are to have difficulties in school, fail standards tests, fail a grade, quit school and have shorter lives. And when do these kids start falling behind? high school? elementary school? grade one? What are the implications? What can be done to change this trend?
Diagnostic Imaging Data in Manitoba: Assessment and Applications
Finlayson G, Leslie WD, MacWilliam L
Diagnostic imaging plays a prominent role in the health of Manitobans, from both a health and cost perspective. Technology-driven as it is, diagnostic imaging data is evolving. How much of the current data is useful for research? How much can it tell us about what these services are contributing to the health of Manitobans?
Using Administrative Data to Develop Indicators of Quality in Family Practice
Katz A, De Coster C, Bogdanovic B, Soodeen R, Chateau D
Is there a way to know how family physicians in Manitoba measure up to each other? Or to physcians outside of the province? MCHP developed a set of thirteen indicators that were used to assess the quality of care Manitoba doctors deliver.
Patterns of Regional Mental Illness Disorder Diagnoses and Service Use in Manitoba: A Population-Based Study
Martens PJ, Fransoo R, McKeen N, The Need to Know Team, Burland E, Jebamani L, Burchill C, De Coster C, Ekuma O, Prior H, Chateau D, Robinson R, Metge C
Mental illness can have a devastating effect on people's lives. It also has a staggering impact on Manitoba's use of hospitals, physicians, home care, nursing homes and pharmaceuticals. This report by MCHP offers RHAs a comprehensive look at mental illness and its demands on their health care services.
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?
Why is the Health Status of Some Manitobans Not Improving? The Widening Gap in the Health Status of Manitobans
Brownell M, Lix L, Ekuma O, Derksen S, Dehaney S, Bond R, Fransoo R, MacWilliam L, Bodnarchuk J
An earlier MCHP report (Roos NP et al. 2001) found that the gap in health between the least and most healthy Manitobans was getting wider; this study investigates the reasons why.
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.
The Manitoba RHA Indicators Atlas: Population-Based Comparison of Health and Health Care Use
Martens PJ, Fransoo R, The Need to Know Team, Burland E, Jebamani L, Burchill C, Black C, Dik N, MacWilliam L, Derksen S, Walld R, Steinbach C, Dahl M
Our 1999 RHA health indicator report established a baseline; this report upates those indicators and adds several new ones, enabling RHA manager, planners and providers to track changes.
Pharmaceuticals: Focussing on Appropriate Utilization
Metge C, Kozyrskyj A, Dahl M, Yogendran M, Roos NP
Public spending on prescription drugs has increased 58% in only five years to $170 million. Yet little is known about the appropriateness of drug prescribing. This study uses administrative data to assess appropriateness for two drug classes: antihypertensives and cholesterol-lowering drugs. (
Pharmaceuticals: Therapeutic interchange and pricing policies
Morgan SG, Kozyrskyj A, Metge C, Roos NP
How much would Manitobans and the government save if generic drugs were prescribed or substituted instead of name brands? This project looks at policies designed to improve the cost-effectiveness of prescription drugs.
Supply, Availability and Use of Family Physicians in Winnipeg
Watson D, Bogdanovic B, Heppner P, Katz A, Reid RJ, Roos NP
In just over a decade, Manitobans have gone from concerns about having too many doctors to anxieties about a possible shortage. What changed? To find out, this report looks at family physicians in Winnipeg over the last ten years.(
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.
Estimating Personal Care Home Bed Requirements
Frohlich N, De Coster C, Dik N
As Manitoba's population ages, there is concern about how many nursing home beds we should have in the future. This project uses historical data to answer that question for the year 2020.
The Health and Health Care Use of Registered First Nations People Living in Manitoba: A Population-Based Study
Martens PJ, Bond R, Jebamani L, Burchill C, Roos NP, Derksen S, Beaulieu M, Steinbach C, MacWilliam L, Walld R, Dik N, Sanderson D, Health Information and Research Committee AoMC, Tanner-Spence M, Leader A, Elias B, O'Neil J
MCHP worked collaboratively with the Health Information and Research Committee of the Assembly of Manitoba Chiefs to provide indicators about the health of Registered First Nations people in Manitoba. Unique to this study was the opportunity to work with updated and complete information on all persons having band membership in a Manitoba First Nations community.
The Health and Health Care Use of Manitoba's Seniors: Have They Changed Over Time?
Menec V, MacWilliam L, Soodeen R, Mitchell L
This study looks at the impact the province's aging population has had on the health care system, in order to anticipate what might happen in the future.
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.
Assessing the Health of Children in Manitoba: A Population-Based Study
Brownell M, Martens PJ, Kozyrskyj A, Fergusson P, Lerfald J, Mayer T, Derksen S, Friesen D
Produced in consultation with other groups doing research in this area, MCHP's child-health encyclopaedia gives numerous details on the health of Manitoba's 325,000 children. Included are: physical health status, patterns of health care use, and social determinants of health, such as socioeconomic status and educational achievement.
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.
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.
A Comparison of Preliminary and Adjusted Cost per Weighted Case Determinations for Manitoba Hospitals: Impact for Evaluation and Report Cards
Finlayson G, Jacobs P, Watson D, Bogdanovic B
In previous reports we made adjustments to routinely-prepared hospital financial records and discharge reports to make sure that per-patient costs could be fairly compared. This report investigates whether these time-consuming adjustments are necessary.
Indicators of Health Status and Health Service Use for the Winnipeg Regional Health Authority
Frohlich N, Fransoo R, Roos NP
This report explores the relationship between health status in the different areas of Winnipeg, and residents use of health care services.
The Impact of Influenza-Like Illness on the Winnipeg Health Care System: Is an Early Warning System Possible?
Menec V, Black C, MacWilliam L, Aoki F, Peterson S, Friesen D
The project addresses four questions: (1) What is the impact of influenza on the health of Manitobans and on the health care system? (2) What are the characteristics of patients hospitalized for flu-like illnesses? (3) Are preventive strategies optimal? (4) Is an early warning system possible?
Changes in Health and Health Care Use of Manitobans: 1985-1998
Roos NP, Shapiro E, Bond R, Black C, Finlayson G, Newburn-Cook C, MacWilliam L, Steinbach C, Yogendran M, Walld R
Changes in Manitoban's health and the health care system over a fourteen-year period from 1985 to 1998 are reviewed in this report. Areas discussed include health status, use and availability of health services, spending, and the aging of the population.
Perspectives on Home Care Data Requirements
Roos NP, Mitchell L, Peterson S, Shapiro E
The strengths and weaknesses of the data currently collected in Manitoba's home care program were evaluated, with recommendations for improvement.
A Look at Home Care in Manitoba
Roos NP, Stranc L, Peterson S, Mitchell L, Bogdanovic B, Shapiro E
This project adds routine provincial records on home care to POPULIS, thus permitting for the first time a description of how home care is used in Manitoba.
Do Some Physician Groups See Sicker Patients Than Others? Implications for Primary Care Policy in Manitoba
Reid RJ, Bogdanovic B, Roos NP, Black C, MacWilliam L, Menec V
Do some Manitoba clinics treat healthier patients while others treat sicker ones? That is the question we asked in this study. The answer is relevant in the consideration of alternative models of physician reimbursement.
Considering the Health Care Needs of Children Living in Households Receiving Income Assistance in Manitoba: Family Services and Manitoba Health Pilot Project
Kozyrskyj A, Mustard CA, Derksen S
The primary purpose of this study was to test the feasibility of using anonymized data from the Ministries of Health and Family Services to understand more about the relationship between poverty and health.
Defining Practice Populations for Primary Care: Methods and Issues
Menec V, Black C, Roos NP, Bogdanovic B
Who is your doctor? Is there a family physician or clinic that you go to most of the time? What does "most of the time" mean? 50% of the time? 65%? 80%? These are the questions that this study explores.
A Description of the Use of Insured Health Care Services by Income Assistance Recipients in the Province of Manitoba: A Pilot Study. Recipients of Income Assistance for Mental Health Disability
Mustard CA, Derksen S, Kozyrskyj A
The primary purpose of this study was to test the feasibility of using anonymized data from the Ministries of Health and Family Services to understand more about the relationship between poverty and health.
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.
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.
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.
Comparative Indicators of Population Health and Health Care use for Manitoba's Regional Health Authorities: A POPULIS Project
Black C, Roos NP, Fransoo R, Martens PJ
MCHP compiled a series of indicators, designed to assist Regional Health Authorities as they plan and deliver health care services in their regions. We first measured health status of RHA residents; we then related it to their use of health care services.
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.
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.
Cost List for Manitoba Health Services
Jacobs P, Shanahan M, Roos NP, Farnworth M
The Cost List is an important tool for researchers and others who are interested in the costs of health care. The Winnipeg and Regional Health Authorities, and groups that want to compare the costs of health care will find it a valuable resource.
Analysis of Patterns of Pharmaceutical Use in Manitoba, 1996: Key Findings - A POPULIS Project
Metge C, Black C, Peterson S, Kozyrskyj A, Roos NP, Bogdanovic B
This study marks the first time we've had information about one of the fastest growing areas of health care spending: prescription drugs. Retail pharmacy data were analyzed to answer questions like: What kinds of drugs are Manitobans prescribed? How often? At what cost?
Seasonal Patterns of Use 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.
Measuring Morbidity in Populations: Performance of the Johns Hopkins Adjusted Clinical Group (ACG) Case-Mix Adjustment System in Manitoba
Reid RJ, MacWilliam L, Roos NP, Bogdanovic B, Black C
The Johns Hopkins Adjusted Clinical Group system is a new case-mix tool, which uses ambulatory and hospital diagnostic information, in addition to demographics, to measure the burden of illness in a population. This report explores its capabilities using Manitoba administrative data.
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?
Issues in Developing Indicators for Needs-Based Funding
Frohlich N, Carriere KC
Here we focus on the theoretical question of how to distribute resources for a single sector - physician services - in which the data are good but services are not currently distributed according to need.
A Needs-Based Funding Methodology for Regional Health Authorities: A Proposed Framework
Mustard CA, Derksen S
This report describes a method that central governments could use to allocate funding to Regional Health Authorities based on the need for health care. The report also discusses critical issues that would need to be resolved before the method could be implemented.
Interprovincial Comparisons of Health Care Expenditures
Shanahan M, Gousseau C
Is the level of provincial health care spending across the country related to the health needs of Canadians? Do provinces with sicker residents, lower socioeconomic circumstances or a higher proportion of elderly people spend more per person on health care?
A Project to Investigate Provincial Expenditures on Health Care to Manitobans: A POPULIS Project
Shanahan M, Steinbach C, Burchill C, Friesen D, Black C
How much does Manitoba Health spend per capita for health care? We developed a method to allocate 1993/94 health care expenditures for hospitals, nursing homes, physicians, mental health hospitals and home care for each Regional Health Authority and nine socioeconomic areas of Winnipeg.
Issues in the Management of Specialist Physician Resources for Manitoba
Roos NP, Fransoo R, Bogdanovic B, Friesen D, MacWilliam L
In this report, we examine the current supply of specialist physicians in Manitoba, incorporate Statistics Canada data to help project future requirements, and analyze access to specialists by area of residence and socioeconomic status. .
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.
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.
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.
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.
Needs-Based Planning for Manitoba's Generalist Physicians
Roos NP, Fransoo R, Bogdanovic B, Friesen D, Frohlich N, Carriere KC, Patton D, Wall R
How many doctors does Manitoba have and how many does it need? We estimated the need for physicians, based on the population's age, gender, health and socio-economic mix, and then compared need with supply.
Hospital Case Mix Costing Project 1991/92: Methodological Appendix
Lloyd M, Shanahan M, Brownell M, Roos NP
Socioeconomic Gradients in Mortality and the Use of Health Care Services at Different Stages in the Life Course
Mustard CA, Derksen S, Berthelot J, Wolfson MC, Roos LL, Carriere KC
Statistics Canada and Manitoba Health Research data were linked to create a robust and unique data set that allowed this examination of how our health is affected by socioeconomic status.
Population Health: Health Status Indicators. Volume I: Key Findings
Cohen MM, MacWilliam L
Population Health: Health Status Indicators. Volume II: Tables and Figures
Cohen MM, MacWilliam L
Socio-Economic Characteristics (Population Health Information System 1991/92 - 1986 Census Version)
Frohlich N, Mustard CA
A Report on the Health Status, Socio-Economic Risk and Health Care Use of the Manitoba Population, 1992-93 and Overview of the 1990-91 to 1992-93 Findings
Frohlich N, Markesteyn T, Roos NP, Carriere KC, Black C, De Coster C, Burchill CA, MacWilliam L
POPULIS is a population-based information system developed by MCHP. It provides data on current health and illness profiles, including socio-economic risk factors and patterns of health care use across Manitoba.
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.
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.
Utilization of Physician Resources. Volume I: Key Findings
Tataryn DJ, Roos NP, Black C
Utilization of Physician Resources. Volume II: Methods and Tables
Tataryn DJ, Roos NP, Black C
Estimating Per Diem Costs for Manitoba Hospitals: A First Step
Wall R, De Coster C, Roos NP
The Utilization of Medical Services for Mental Health Disorders, Manitoba: 1991 - 1992
Tataryn DJ, Mustard CA, Derksen S
A report on the use of mental health care services in Manitoba. Prevalence estimates of mild and severe mental health problems across regions and their relationship to socio-economic status are also examined.
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.
Utilization of Hospital Resources. Volume I: Key Findings
Black C, Roos NP, Burchill CA
Utilization of Hospital Resources. Volume II: Methods and Tables
Black C, Roos NP, Burchill CA
Utilization of Personal Care Home Resources. Volume I: Key Findings
De Coster C, Roos NP, Bogdanovic B
Utilization of Personal Care Home Resources. Volume II: Methods and Tables
De Coster C, Roos NP, Bogdanovic B
The Utilization of Prenatal Care and Relationship to Birthweight Outcome in Winnipeg, 1987-88 (Report #93-01)
Assessing Quality of Care in Manitoba Personal Care Homes by Using Administrative Data to Monitor Outcomes (Report #93-02)
Shapiro E, Tate RB
An Assessment of How Efficiently Manitoba's Major Hospitals Discharge Their Patients (Report #92-10)
Brownell M, Roos NP
Hospital Funding within the Health Care System: Moving Towards Effectiveness (Report #91-05-02)
Black C, Frohlich N
Units of Observation and Measures of Socio-Economic Status (Manitoba Population Health Project)
Maternal Demographic Risk Factors and the Incidence of Low Birthweight, Manitoba 1979-1989 (Report #91-11-04)
Manitoba Health Care Studies and their Policy Implications (Report #91-04-01)