POPULIS: Providing Health Information to RHA Planners

THE CENTRE FOR HEALTH POLICY AND EVALUATION

JUNE 1999 Suppose we were to tell you that the peo- Churchill. is not an RHA; it has ple of South Eastman are the healthiest two different authorities. in Manitoba. Or that Burntwood has the Now when we say “in order” what we highest proportion of people aged 0-4. Or mean is how they rank from the healthi- that has one of our province’s est to the least healthy populations. And lowest premature mortality rates, yet is in ultimately, that’s the sort of informa- the region with one of the highest. Or tion—how healthy are the people in a that the residents of Pine Creek see a particular region—that POPULIS was doctor more often than anywhere else in uniquely designed for. Manitoba, yet they have no doctors there. POPULIS focusses on the relationship What would it mean? (or lack thereof) between health and the To most Manitobans, not much—at use of health care services. Through it, least not directly. But for RHA managers MCHPE has been able to provide infor- in those regions, such information means mation to help RHAs assess and respond a great deal. It may help answer the ques- to questions like the following: tion of whether to build a nursing home, Ì Do residents receive care in our area, or expand obstetrics or develop social or do they travel for care? programs. And that’s precisely the sort of Ì Does high use of hospitals represent information that MCHPE (the Manitoba overuse, or is use related to need? Centre for Health Policy and Evaluation) Ì Do patterns of surgery correspond to has put together in a new report, using needs of the area? their Population Health Information Ì Do areas with fewer nursing home beds System—otherwise known as POPULIS. use hospital beds instead? But before we go any further, if you are Ì Do high-risk groups have poor access not a manager of an RHA, your questions to health care? Or can health be poor are likely much more fundamental, such despite high use of health care ser- as what is an RHA? Or for that matter, vices? where exactly is South Eastman? Ì Does low use of physicians suggest a RHA stands for Regional Health healthy population or a shortage of Authority. There are 11 in Manitoba. They physicians? were established in 1997, each responsi- ble for the planning, integration and monitoring of health care services in How POPULIS works their region. South Eastman is one RHA. POPULIS's strength is that it is popula- Listed in order they are: South Eastman, tion based. It tracks all the health care South Westman, Brandon, Central, services used by the people of an area— Marquette, Parkland, North Eastman, regardless of where the use took place. Interlake, Burntwood, Norman, and Since people often travel elsewhere to access health care services (remember Pine Another advantage of POPULIS is that its Creek with no doctors), especially in rural rates are age/sex-adjusted. What this means is areas, this makes POPULIS particularly useful regardless of the population make-up of the to RHAs. This is unlike other reporting various RHAs—proportionately more men? methods that focus not on the people, but on more women? more young? more old?— the health care services themselves. POPULIS makes essentially an “all things To illustrate this population-based differ- being equal” comparison. So an RHA with, say, ence, let’s look at an example using Parkland a large proportion of elderly residents could RHA. There are no hip replacements per- have a crude (unadjusted) hospitalization rate formed in Parkland; most residents travel to above the provincial rate, but an age-adjusted Brandon or Winnipeg for hip surgery. So if you rate that is below it. were a health care planner in the region, what information would be more useful to you: that A Focus on Health there were no hip replacements performed in So what makes us say South Eastman is the Parkland? Or, as POPULIS would report, that healthiest RHA? Well, three things mainly, but Parkland residents had more hip replacements the key measure used is PMR—Premature per capita than the provincial average? (And if Mortality Rate or death before age 75 (Fig.1). you want to know where, POPULIS tells you PMR is a widely used measure of health that too.) because populations with higher rates also report more sickness and more symptoms of 1. Premature Mortality Rates illness. The healthiness ranking mentioned Manitoba RHAs and Winnipeg earlier is based on this most important mea- SOUTH EASTMAN sure. All figures in the report list RHAs in that same order. SOUTH WESTMAN Along with PMR, there are two other key measures that help give a more complete BRANDON health picture. One of them is Socioeconomic CENTRAL Status; simply put: the poorer and less educat- ed you are, the sicker you are likely to be, and MARQUETTE the greater your need for health care. So for PARKLAND each RHA, we provide census information on influences like: unemployment, education, WINNIPEG percentage of single mothers, and housing costs. NORTH EASTMAN The other important measure of “healthi- INTERLAKE ness” included in our report is life expectancy. Where people live longer, it follows that their BURNTWOOD health is generally better. So one of the things NORMAN that makes, for example, South Westman one of the healthiest RHAs is its relatively high life CHURCHILL expectancy—in fact the highest for Manitoba males. Health status, then, is the focal point of our WINNIPEG report. The report begins by informing RHAs how relatively healthy they are. That is, how NON-WINNIPEG the health of their residents compares to that MANITOBA of other RHAs.

162 3 45 Relating Health to Health Care Age/sex adjusted deaths per 1000 residents age 0-74 The report also provides decision-makers with a great deal of data about health care services in their RHAs. Indicators such as: Ì Preventive care, including immunization have Leaf Rapids, one of the healthiest PSAs in for children and mammography screening Manitoba. So what can be learned from that for women area? Is it healthy because employment is Ì Aspects of physician service use: in-area sup- high? Or because preventive programs like ply, visits, consultations, provider type immunization are working? What would bene- (GP/FP vs specialist) and location of visits fit other areas?” (in/out of region) To further define the health and health care Ì Acute care hospitals: bed supply, admissions picture, most figures also include a provincial and days, location of hospitalizations rate, a Winnipeg rate, and a non-Winnipeg rate Ì Long term care: supply and use of personal (RHA average). In addition, RHA Profiles— care (nursing) homes, days of chronic care individual graphs of each RHA—compare their (45 or more days in hospital) health and supply/use of health care services to Ì Access to high profile procedures, such as a rural average. This is different than the specialized cardiac and orthopedic proce- other rates because it does not include dures or cataract surgery Winnipeg or Brandon—which drive the provincial rate—or Churchill, where data are With this information, comparisons can be incomplete. made not only between RHAs, but also within them. Each is subdivided into 2 to 8 smaller How RHAs might use this information PSAs (physician service areas): communities in Most of the information in this report has been which physicians practice, plus the smaller generated from 1995/1996 and 1996/1997 nearby towns and districts whose residents records, a point just prior to when the RHAs seek care from these physicians (Fig. 2 and 3). were formed. Therefore, it offers a baseline Just because a region is “healthy” doesn’t assessment before RHAs made changes to their mean all the communities within it are health care delivery system, and a reference healthy. This enables RHAs to pinpoint areas, point against which future policy or program targeting possible concerns and/or possible decisions can be measured. solutions. MCHPE has not focussed on providing a For example, Burntwood planners might detailed understanding of the data. We believe say, “compared to other RHAs, our residents that much of this interpretation should come have poorer health; yet within our region we from the RHAs themselves, based on their

2. Premature Mortality Rates 3. Days of Hospital Care Sub-Areas of Parkland Region Sub-Areas of Parkland Region

GILBERT PLAINS

DAUPHIN DAUPHIN

ALONSA ALONSA

SWAN RIVER SWAN RIVER

ROBLIN ROBLIN

PINE CREEK PINE CREEK

PARKLAND AVERAGE PARKLAND AVERAGE

162 3 45 5001000 1500 2000 2500 Age/sex adjusted deaths per 1000 residents age 0-74 Age/sex adjusted hospital days per 1000 residents Health can be poor despite high use of health care services understanding of local circumstances. But, to While they have one of the healthiest popula- confirm decision-makers’ understanding of the tions in the province, one area within their information, the report offers some sample RHA is one of the least healthy. That PSA’s interpretations and questions that might arise. mortality rate is higher than the provincial We’ve included some here. average, and much higher than South The population pyramid is a cornerstone of Eastman’s. Why? the information MCHPE provides to the RHAs. A look at socioeconomic factors in the area It’s a picture of a region showing what percent- offers some insight: high unemployment and age of the population is distributed in each roughly 1/3 of residents with a grade 9 or less five-year age and gender group. This alone education. Here we see the link between might suggest possible directions to take. socioeconomic status and health. So what’s An RHA with a young population, such as needed? More health care services? Or job Churchill, might decide their emphasis should creation strategies and education? Or both? be on prenatal care or early childhood develop- South Eastman RHA is currently looking at ment programs. Meanwhile, an RHA with an this issue. older population might want to look at health What this report underscores is the fact that care services for seniors. the relationship between health and health But when you start putting together all the care is not straightforward. What makes one pieces, a “look” can get complicated. For exam- RHA healthier than another, or the residents of ple, in Marquette, 10% of people are seventy- one town healthier than those in another? five years of age or older. That’s higher than What impact will an aging population have? the provincial average of 6%. Yet their number Why does a place with no physicians have the of PCH beds per thousand, 114, is below the highest physician visit rate? Why aren’t areas provincial average of 128. with good access to physicians always the So, it looks simple: Marquette needs more healthiest? How many people can we expect to personal care homes. Or do they? “walk through the door” of the various health From a population-based point of view, for care facilities? every 1000 people in Marquette aged 75 or There are many such questions—at times older, 138 live in a PCH. This is above the almost mysteries—facing decision-makers in provincial average of 134. And Marquette’s res- each RHA. In a sense, they often find them- idents wait 31 days less than the Manitoba selves as sort of “health detectives,” looking for average for a PCH bed. answers. And in that sense, MCHPE is the So it isn’t so simple. Do we need more PCH informant, trying to provide them with as beds? How can access be higher than average many clues as possible. And while information when supply is lower? If there is a bed short- like population pyramids may not mean much age, why aren’t waits longer? Are people using to many Manitobans, indirectly, if it leads to beds outside of Marquette? If so, does that take improving their health or the health of their them farther from family? Closer to family? community, it means a lot. For planners in Marquette and nearby RHAs, these are but some of the questions. Our report doesn’t provide all the answers. Summary by RJ Currie, based on the report: It simply makes the analysis each RHA under- Comparative Profiles of Health and Health takes as informed as it can be. Care Use for Manitoba’s Regional At a recent presentation, a representative Health Authorities: A POPULIS Report, of South Eastman showed how POPULIS data by Charlyn Black, Noralou Roos, can help RHAs identify areas of greater need. Randy Fransoo and Patricia Martens.

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