Concept: Health Status Indicators - Recommended for Monitoring Regional Health Authority (RHA) Performance and Planning Delivery of Service

Introduction

MCHP research has found that the following measures are the most useful and can be reported on an annual basis for regional health authorities as well as for sub-areas within the RHAs.

Health and Ill-health Measures

• Premature mortality is defined as deaths among the population 0-74. Three to five years of data is routinely used to ensure stability of rates. Organizing all subsequent data containing the regional association data according to the areas position on this measure (i.e. ranked high to low) is recommended. This is generally accepted as the best single measure of population health and correlates well with interview based measures from area residents.
  
  
• Life Expectancy at birth may be calculated separately for males and females. Some prefer to use the similar indicator, potential years of life lost.
  
  
• Rate of low birth weight may be used, although, we find this measure not very sensitive, perhaps because the overall rate may have fallen too low.
  
  
• Disease specific measures such as rate of individuals who have common chronic diseases is recommended. By using 3 years of physician claims and hospital data, it is possible to reliably identify rates of individuals with hypertension, rates of individuals with diabetes and rates of individuals with serious mental disorders. Rates of individuals with cancer should be calculated using CancerCare Manitoba data (administrative data cannot be used here because of "rule out" diagnoses). Developing these indicators from physician claims may tend to slightly overestimate the rate of disease in Winnipeg residents and underestimate the rate in rural residents.
  
  
• Data Extras information on premature mortality, socio-economic and life expectancy measures - from the RHA Indicators Atlas (2002).

Rates at Which Elective Preventive Interventions are Undertaken

• Rate of women aged 18-69 (previously we used 15-64) who have at least one Papanicolaou smear over a three year period.
  
  
• Rate of elderly and individuals with chronic disease who have a flu shot during the year (this should be operationalized as during the appropriate months).
  
  
• Rate of children who receive full immunization.
  
  
• Rate of mammography for women ages 50-69 (with at least one mammogram in two years) might be used (despite the controversies here).

Characteristics of the Population Reflecting Socioeconomic Risk

These data come from the public use census tapes.


• High school completion rates among population aged 25-34.
  
  
• Unemployment rate among population aged 25-34; 35-54.
  
  
• Mean Household income (this is not very useful for comparisons across regions).
  
  
• Percent female headed households with children.
  
  
• Percent of births to women under 20 years.
  
  
• Socio-economic risk index (this is a summary measure developed at Manitoba Centre for Health Policy and Evaluation). For more detailed information see socio-economic characteristics in the Socio-Economic Risk Index (SERI) concept.

Indicators Reflecting How Hospital Resources are Used By Area Residents

These are important indicators of how area residents use the most extensive health care resource, and also, as benchmarks to reflect improving efficiency in use of resources or as reflecting improvements in resident's health. It will be possible to distinguish between high use driven by excess supply versus high use driven by poor health by referring to the health and supply indicators.


• Beds per 1000 residents in the area.
  
  
• Days per 1000 residents; Days of stay in 1-59 day stays (short stays).
  
  
• Days per 1000 pediatric residents.
  
  
• Separations per 1000.
  
  
• Separations for conditions thought to be:
  
  
  • avoidable with good medical care -- see the Avoidable Hospitalizations concept for more information.
    
  • amenable to good medical treatment -- see the Amenable Hospitalizations concept for more information.
    
  • sensitive to good ambulatory care -- see the Ambulatory Care Sensitive (ACS) Conditions concept for more information.

These are all indicators suggested in the literature as important to monitor.

Indicators of Quality of Care

• Mortality rates within 30 days of discharge from hospital -- see the Mortality Rate Calculation concept for more information.
  
  
• Rates of readmission to hospital within 30 days of discharge -- see the Readmissions to Hospital concept for more information.
  
  
• Rates of physician contact within 30 days of discharge for medical conditions.

Rates of surgical procedures found to be discretionary, or about which there is disagreement as to effectiveness, include: hysterectomy, caesarean section, gallbladder surgery, radical prostate, psa testing, tonsillectomy and tympanostomy -- (see the Discretionary, Non-discretionary and Intermediate Procedures concept for more information).

Rates of surgical procedures in which there is public concern around access include: coronary artery bypass, cataract removal (including procedures done in private clinics), hip and knee replacement. As with other indicators, it will be critical to track rates overtime, adjust for the aging of the population, and present rates specific to the regional associations to assure the public that there is reasonably equitable access to care across the system.

Data Reflecting Access to Physicians

• Full time equivalent physicians (practicing in the area) per 1000 residents -- (see the Full Time Equivalent Physicians - Calculations concept for more information).
  
  
• Percent of residents with 1 or more physician contact within the last year
  
  
• Visits per 1000 residents.

Data Reflecting Access to Nursing Homes (Personal Care Home in Manitoba)

• PCH beds/1000 population.
  
  
• Residents of PCH per 1000 population.
  
  
• Admissions to PCH per 1000 in the last year.
  
  
• Median length of waiting time before admission.
  
  
• Median length of waiting time in hospital before admission.

We have also developed indicators of quality of care which might be incorporated including: risk of death, risk of hospitalization for anemia, dehydration, pneumonia and urinary tract infection. These analyses are performed after adjusting for characteristics of PCH residents including level of care and age.

Demographic Changes

Indicators also can be derived from public use census data or directly from Manitoba Health registry files; we have done both.


• Regional in-migration in the past 5 years.

In-migration/out-migration by important age groups (elderly, young) and possibly by socioeconomic characteristics (as obtained from postal code level data).