Transcript Slide 1

Epidemiology of Health Care
Using Administrative Data
To gain understanding re:
Health of populations and
Use of Health Services
Purpose of Course
• Primer in how/why to use Manitoba’s
natural research resource
• Gain insights which come from a
population focus
• Understand broader determinants of
health
Examples of Administrative Data??
What exactly are we talking
about??
Research Approach
Research driven by insights and
opportunities rather than hypotheses and
preformed research agendas
Administrative Data
Advantages
• Able to study entire population
• Longitudinal follow-up easy
• Pre and Post Event Histories Easy
• Avoids the selection and recall
biases
• Relatively low cost
• Can study rare outcomes
Limitations
• Data not collected to answer your
research questions
• Quality of data – needs validation
and decision-making
• Individual initiates contact
• Amount of data – overwhelming
• Access to data – varies
Where to find PopulationBased Administration Data
1. Several Canadian provinces
2. Rochester (Minnesota) Epidemiology
Project
3. Oxford Record Linkage Study
4. Scottish Record Linkage System
5. Western Australia Health Services
Research Linked Database Project
The Manitoba Centre
for Health Policy (MCHP): Who we are
• The Manitoba Centre for Health Policy
– University of Manitoba, Faculty of Medicine, Department
of Community Health Sciences since 1991
– Five-year contracts with Manitoba Health, 6 deliverables
a year mutually negotiated, all publicly available
– External funding of researchers (e.g. CPHI funding)
– Mission: To provide accurate and timely information to
health care decision-makers, analysts and providers, so
they in turn can offer services which are effective and
efficient in improving the health of Manitobans
The Manitoba Population Health Research Data Repository
Sleep Lab Clinical
Data
Alcoholism Panel
Surveys
Inflammatory Bowel
Disease Database
Hospital
Medical
Nursing
Home
Home Care
Cancer Registry
Research
Registry
Pharmaceutical
Provider
Immunization
Monitoring
Vital
Statistics
National Population
Health Survey
Heart Health Survey
Aging in Manitoba
Study
1 A similar
Educational and
Social Data
version of this figure appeared in Roos, Menec, and Currie 2004.
Respect for Privacy In Building
Database
• Canada Foundation for Innovation and
Manitoba Government funded Data Laboratory
• Highest standards of security, privacy &
confidentiality of data
• No names, no addresses
• Probabilistic linkages across files as needed
• Data for research not for administrative use
• Provincial privacy offices kept fully informed
Incrementally Added –
Gained Experience with Data Files:
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1970’s: Hospital and medical files
1980: Nursing home file
1981: Vital Statistics file
1990: Census file
1991: Mental Health Information System
1992: Physician Registry file
1993: Nursing home drugs
1994: Immunization histories
1995: Pharmaceutical file
1996: Ability to cost hospital stays; Manitoba Cost List
1997: Pilot with Social Assistance file
1999: Linked National Population Health Survey
2000: Home Care file
2002: Family Services, Education, Healthy Child
New Population Data Sets
Added to the Repository:
Education (Grades, Tests, Enrollment Data)
Income Assistance
Children in Care
Provincial Programs (Healthy Baby, Baby
First)
Genetic Screening
Community Resources
Number of Data Files in the Repository housed at MCHP
(from 1991 to 2005)
70
50
CFI Funding
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10
year
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number of data files
60
Research Registry
• Accurately defines coverage status for individuals since
1970
• Can help distinguish between "well" individuals from
those who left province or died
• Place of residence (merge to census data)
• Cohort identification
• Family identification
• Case controls / comparison groups
Validating the Registry
• Comparisons made with 1986, 1991, 1996, 2001 census
years by date of census.
• Registry populations are larger by 2-4% overall.
• Difference is greater for early census years and getting
smaller.
• Female registry population not as much difference as
males.
• Age 25-34 registry population is much higher 4-6% with
males being higher than females.
Web-based knowledge tools:
Data Dictionaries:
• Restricted to MCHP staff
• A comprehensive list of field names
and contents for the administrative data
files housed in the Repository
Concept Dictionary
Glossary
Research Resources
Medical/Research
Definitions
Research Protocol
Project Web Pages
Web-based knowledge tools:
Concept Dictionary:
• Provides details on how to
measure/calculate/define/validate
“something” such as a variable or
indicator
Concept Dictionary
SAS Macros: RATES
• Calculates event rates per 1000,
adjusting for key population
differences (e.g. age, sex)
• Suitable for comparisons across
time and space
Western Australia Data Linkage
System
– In 2005, Minister for Science declared it a national
centre of excellence in Australia
– Since 1995, more than 350 major health projects
primarily in the area of health care
– Between 1995 and 2004, out-of-state revenue from
research grants was $58.4 million (Australian)
– Child and youth topics (recent reports):
• Temporal variation in rates and causes of infant
mortality among aboriginal and non-aboriginal
• Health/ outcomes among children of mothers who
have schizophrenia and/or other affective
disorders
Massachusetts Pregnancy to Early
Life Longitudinal (PELL) Project
Birth
Certificate
Hospital
Discharge (HD)
Mothers Birth
Fetal Death
Hospital
Discharge (HD)
Child’s Birth
(Core Linkage)
Boston University School of Public Health
Maternal or Child Linked Longitudinal
Capacity
Subsequent Records
Child’s Hospital Discharges,
Observational Stay, ER Usage
Birth
Certificate
Mother’s Birth
Prior Information
Mother’s Pregnancy
Hospital Discharges,
Observational Stays,
Emergency Room Usage
1998, 1999
Hospital
Discharge (HD)
Fetal Death
Hospital
Discharge (HD)
Child’s Birth
(Core, 1999)
Mother’s Hospital Discharges,
Observational Stays, ER Usage
1999
Subsequent Records
Child’s Hospital Discharges,
Observational Stay, ER Usage
Mother’s Hospital Discharges,
Observational Stays, ER Usage
2000
Program Participation Data,
PNC Usage
(1998, 1999)
Program Participation Data
1999, 2000, …
Alberta
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Analysis of population registry and vital statistics
Analysis of hospital discharge data
Analysis of physician claims
Analysis of laboratory data
Analysis of drug data
Risk adjustment
Defining socio-demographic variables at
small geographic areas
A Tool for Population-Based
Analyses
Physicians
Utilization
Regional
population
- SES
- Health
Utilization
H
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Hospitals
Utilization
PCH
PCH
PCH
Personal
Care Homes
Principals for Population Focus
1. describe:
- supply
- access to care
- intensity of use
- differential use across areas
2. juxtapose indicators of:
-socioeconomic risk
- use
- health
Turning Data into Concepts
Counting
– objects
– events
Measurement
– concepts
Examples:
# times patient
# times patient
admitted to hospital admitted with MI
health/status
severity of illness
# admissions to a
given hospital
case-mix of a given
hospital
# admissions for
acute MI to a given
hospital
Examples of Concepts
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Individual: health status
Family: poverty, mobility
Community: neighbourhood level SES;
Health care: continuity of care; hospital
case mix
• Graduation, grade retention
Some Things Administrative Data
Cannot Do
•Radiology Services Review
•Province-wide coronary angiography,
adult MRI, BMD and screening
mammography data are captured
•For all other modalities, data are
incomplete (esp. outside Brandon and
Winnipeg)
Data Rich Environment
Provides Insights Re:
• Who has access to services
• Who is and who is not in system
• Those who are healthy and those
who are not