Orthopedic and ophthalmology surgical service forecast modelling in Manitoba: Research approach for a data linkage study.

Background: The healthcare system in Manitoba, Canada has faced long wait times for many surgical procedures and investigations, including orthopedic and ophthalmology surgeries. Wait times for surgical procedures is considered a significant barrier to accessing healthcare in Canada and can have negative health outcomes for patients. We developed models to forecast anticipated surgical procedure demands up to 2027. This paper explores the opportunities and challenges of using administrative data to describe forecasts of surgical service delivery. Methods: This study used whole population linked administrative health data to predict future orthopedic and ophthalmology surgical procedure demands up to 2027. Procedure codes (CCI) from hospital discharge abstracts and medical claims data were used in the modelling. A Seasonal Autoregressive Integrated Moving Average model provided the best fit to the data from April 1, 2004 to March 31, 2020. Results: Initial analyses of only hospital-based procedures excluded a significant portion of provider workload, namely those services provided in clinics. We identified 500,732 orthopedic procedures completed between April 1, 2004 and March 31, 2020 (349,171 procedures identified from hospital discharge abstracts and 151,561 procedures from medical claims). Procedure volumes for these services are expected to rise 17.7% from 2020 (36,542) to 2027 (43,011), including the forecasted 43.9% increase in clinic-based procedures. Of the 660,127 ophthalmology procedures completed between April 1, 2004 and March 31, 2020, 230,717 procedures were identified from hospital discharge abstracts and 429,410 from medical claims. Models forecasted a 27.7% increase from 2020 (69,598) to 2027 (88,893) with most procedures being performed in clinics. Conclusion: Researchers should consider including multiple datasets to add information that may have been missing from the presumed data source in their research approach. Confirming the completeness of the data is critical in modelling accurate predictions. Forecast modelling techniques have evolved but still require validation.

Comparing the Effect of Throughput and Output Factors on Emergency Department Crowding: A Retrospective Observational Cohort Study.

STUDY OBJECTIVE: This study compares how throughput and output factors affect emergency department (ED) median waiting room time. METHODS: Administrative health care use records were used to identify all daytime (8 am to 8 pm) visits made to adult EDs in Winnipeg, Canada, between April 1, 2012, and March 31, 2013. First, we measured the waiting room time (from patient registration until transfer into the ED) of each index visit (incoming patient). We then linked each index visit to a group of existing patients surrounding it and counted the number of existing patients engaged in throughput processes (radiographs, computed tomography [CT] scans, advanced diagnostic tests) and one output process (waiting to be hospitalized). Regression analysis was used to measure how strongly each factor uniquely affected incoming patient median waiting room time, stratified by the acuity level. RESULTS: Analyses were performed on 143,172 index visits. On average, 153.4 radiographs and 48.5 CT scans were conducted daily, whereas 45.3 patients were admitted daily to hospital. Median waiting room time was shortest (8.0 minutes) for the highest-acuity index visits and was not influenced by these throughput or output factors. For all other index visits, median waiting room time was associated strongly with the number of existing patients receiving radiographs, and, to a lesser extent, with the number of existing patients receiving CT scans and waiting for hospital admission. CONCLUSION: Both throughput and output factors affect how long newly arriving ED patients remain in the waiting room. This suggests that a range of strategies may help to reduce ED wait time, each requiring stronger ED and hospital partnerships.

Pediatric primary care services in Manitoba: is the health of the next generation of children at risk?

OBJECTIVES: Physician resource planning is an important part of health policy, but to date there are no studies measuring the primary care service needs of a particular population. The aim of this study was to project the expected provision of physician services for the pediatric population of one Canadian province for 2020. METHODS: A novel standardized measure of physician service provision, the equivalent services measure, was developed using mathematical modeling. Population projections and past use of services were used to calculate the projected service needs for the pediatric population of Manitoba. RESULTS: Despite projecting a small increase in the pediatric population (2.8%), our model predicted a decrease of 13.4% in the services that would be provided. CONCLUSIONS: The findings of this study indicate that the health of future generations of children may be at risk. Further research is needed to determine the effect of the reduction in pediatric service provision on the health of the pediatric population.

Frequent users of emergency departments: developing standard definitions and defining prominent risk factors.

STUDY OBJECTIVE: We identify factors that define frequent and highly frequent emergency department (ED) users. METHODS: Administrative health care records were used to define less frequent (1 to 6 visits), frequent (7 to 17 visits), and highly frequent (≥18 visits) ED users. Analyses were conducted to determine the most unique demographic, disease, and health care use features of these groups. RESULTS: Frequent users composed 9.9% of all ED visits, whereas highly frequent users composed 3.6% of visits. Compared with less frequent users, frequent users were defined most strongly by their substance abuse challenges and by their many visits to primary care and specialist physicians. Substance abuse also distinguished highly frequent from frequent ED users strongly; 67.3% versus 35.9% of these patient groups were substance abusers, respectively. Also, 70% of highly frequent versus only 17.8% of frequent users had a long history of frequent ED use. Last, highly frequent users did not use other health care services proportionally more than their frequent user counterparts, suggesting that these former patients use EDs as a main source of care. CONCLUSION: This research develops objective thresholds of frequent and highly frequent ED use. Although substance abuse is prominent in both groups, only highly frequent users seem to visit EDs in place of other health care services. Future analyses can investigate these patterns of health care use more closely, including how timely access to primary care affects ED use. Cluster analysis also has value for defining frequent user subgroups who may benefit from different yet equally effective treatment options.

Learning from the census: the Socio-economic Factor Index (SEFI) and health outcomes in Manitoba.

OBJECTIVES: Using data from the Canadian census, researchers at the Manitoba Centre for Health Policy sought to create an area-based socio-economic measure (ABSM). The degree of association between the ABSM and health was evaluated. METHODS: Values on several census variables (including income, education, employment and family structure) were captured at the enumeration-area or dissemination-area level and submitted to a principal components factor analysis to create three ABSMs: an updated version of the Socio-economic Factor Index (SEFI-2) and modified versions of Pampalon's material deprivation and social deprivation indices. Factor scores from these analyses were then compared with several population health measures: Premature Mortality Rate (PMR), Potential Years of Life Lost (PYLL), life expectancy, and self-rated health. RESULTS: SEFI-2 scores were strongly related not only to the other ABSMs but also to every measure of health status. The strongest correlations between an ABSM and health measure were for SEFI-2 and PYLL(r=0.85), and SEFI-2 and PMR (r=0.80). The weakest correlations were found with the social deprivation ABSM measure and the self-rated health measure. CONCLUSIONS: ABSMs based on measures from the Canadian census are a valuable resource to population health researchers. Importantly, depending on the research question and reason for the inclusion of an ABSM, these composite measures may perform better than a simple measure of income alone. The ability to adjust for socio-economic status when assessing population health status or population health interventions contributes to the validity of conclusions drawn when conducting this type of research, and ABSMs may be able to substitute for area health status where it may not be easily determined.

Home care for older couples: "it feels like a security blanket . . .".

In this article, the authors explore the home care experience as described by older physically impaired individuals and their caregiving spouses. Separate face-to-face semistructured interviews were carried out with each spouse from nine couples. Analysis of the interview data revealed four themes. For care receivers the themes were Independence and Developing a Trusting Relationship With Home Care Workers. Relief and Continuity were voiced by the caregiving spouses. The authors show how these themes relate to the participants' sense of security, which emerged as a key underlying concept in the home care experience. This study adds to the home care and caregiving literature as it expands our understanding of the relationship between formal and informal caregiving, highlights issues and concerns older couples face as they receive home-based care, and includes both older spouse caregivers and their direct-care recipients.

Can the quality of care in family practice be measured using administrative data?

OBJECTIVE: To explore the feasibility of using administrative data to develop process indicators for measuring quality in primary care. DATA SOURCES/STUDY SETTING: The Population Health Research Data Repository (Repository) housed at the Manitoba Centre for Health Policy which includes physician claims, hospital discharge abstracts, pharmaceutical use (Drug Program Information Network (DPIN)), and the Manitoba Immunization Monitoring Program (MIMS) for all residents of Manitoba, Canada who used the health care system during the 2001/02 fiscal year. Family physicians were identified from the Physician Resource Database. Indicators were developed based on a literature review and focus group validation. DATA COLLECTION/EXTRACTION METHODS: Data files were extracted from administrative data available in the Repository. We extracted data based on the ICD-9-CM codes and ATC-class drugs prescribed and then linked them to the Physician Resource Database. Physician practices were defined by allocating patients to their most responsible physician. Every family physician in Manitoba that met the inclusion criteria (having either 5 or 10 eligible patients depending on the indicator) was 'scored' on each indicator. Physicians were then grouped according to the proportion of the patients allocated to their practice who received the recommended care for the specific indicator. PRINCIPAL FINDINGS: Using administrative health data we were able to develop and measure eight indicators of quality of care covering both preventive care services and chronic disease management. The number of eligible physicians and patients varied for each indicator as did the percent of patients with recommended care, per physician. For example, the childhood immunization indicator included 544 physicians who, on average, provided immunization for 65 percent of their patients. CONCLUSIONS: Quality of care provided by family physicians can be measured using administrative data. Despite the limitations addressed in this paper, this work establishes a practical methodology to measure quality of care provided by family physicians that can be used for quality improvement initiatives.

Data quality in an information-rich environment: Canada as an example.

This review evaluates the quality of available administrative data in the Canadian provinces, emphasizing the information needed to create integrated systems. We explicitly compare approaches to quality measurement, indicating where record linkage can and cannot substitute for more expensive record re-abstraction. Forty-nine original studies evaluating Canadian administrative data (registries, hospital abstracts, physician claims, and prescription drugs) are summarized in a structured manner. Registries, hospital abstracts, and physician files appear to be generally of satisfactory quality, though much work remains to be done. Data quality did not vary systematically among provinces. Primary data collection to check place of residence and longitudinal follow-up in provincial registries is needed. Promising initial checks of pharmaceutical data should be expanded. Because record linkage studies were ''conservative'' in reporting reliability, the reduction of time-consuming record re-abstraction appears feasible in many cases. Finally, expanding the scope of administrative data to study health, as well as health care, seems possible for some chronic conditions. The research potential of the information-rich environments being created highlights the importance of data quality.

Working more productively: tools for administrative data.

OBJECTIVE: This paper describes a web-based resource (http://www.umanitoba.ca/centres/mchp/concept/) that contains a series of tools for working with administrative data. This work in knowledge management represents an effort to document, find, and transfer concepts and techniques, both within the local research group and to a more broadly defined user community. Concepts and associated computer programs are made as "modular" as possible to facilitate easy transfer from one project to another. STUDY SETTING/DATA SOURCES: Tools to work with a registry, longitudinal administrative data, and special files (survey and clinical) from the Province of Manitoba, Canada in the 1990-2003 period. DATA COLLECTION: Literature review and analyses of web site utilization were used to generate the findings. PRINCIPAL FINDINGS: The Internet-based Concept Dictionary and SAS macros developed in Manitoba are being used in a growing number of research centers. Nearly 32,000 hits from more than 10,200 hosts in a recent month demonstrate broad interest in the Concept Dictionary. CONCLUSIONS: The tools, taken together, make up a knowledge repository and research production system that aid local work and have great potential internationally. Modular software provides considerable efficiency. The merging of documentation and researcher-to-researcher dissemination keeps costs manageable.