Deliverables Currently Underway

Transitions from Pediatric to Adult Services

Contact: Dan Chateau

This deliverable would study the transition from pediatric to adult services for those who turn 18 years of age. This will be discussed with The Need to Know Team for clarification, but those ·services that are of most interest are: transition of those with mental illnesses; transition from foster care to being on their own; transition of those with developmental disability; transition of those with diabetes. What types of services do the 18+ year olds use, compared to their pediatric experiences? Where indicators are possible (for example, in treatment of diabetes), is the quality of care comparable after transition? Is there a drop in health services use after they turn 18, and if so, how long does it take to see health services use return to previous levels.

Can we Reduce ICU use by Identifying Patients at Risk?

Contact: Allan Garland or Dan Chateau

This proposed project is a first step towards the goal of avoiding critical illness before it occurs. Critical illness cared for in Intensive Care Units (ICUs) is important to people and to society. It is common, expensive and associated with much human suffering and heath. We have recently shown that every year more the 0.6% of adult Manitoba become critically ill and require admission to ICUs; this number exceeds 2% years for people over 75 years of age. In addition, recurrent episodes of critical illness account for 15% of all ICU care in the province.

For health services research, success in this study would represent an important advance in understanding and modeling ICU utilization. But the potential implications for patients and our healthcare system are even more important. Even if only a modest portion of all ICU admissions could be predicted, this would provide an opportunity for delivering interventions that might avoid them altogether, thereby improving the health of those patients, and reducing the burden on the health system.

Prospective Audit and Feedback of Outpatient Antibiotic Prescribing by Manitoba Primary Care Clinicians

Contact: Chelsea Ruth or Sergio Fanella

Antibiotics are the most common prescription drugs given to children, and are frequently prescribed to adults. Unfortunately, at least 40-50% of these treatments are inappropriate. Misuse of antibiotics harms patients in terms of adverse drug events, economic impacts, promotion of resistant organisms, and risk of opportunistic infections such as C. difficile diarrhea.

Antimicrobial stewardship programs (ASP) are systems-based approaches to promote the optimal use of antibiotics and safe patient care. Most often this is via a prospective approach where prescriptions are reviewed and audited and results fed back to prescribers to allow reflection and education. Studies have shown that even the act of review and peer comparison of one's own practice can be enough to motivate change in antibiotic prescribing practice. The bulk of the previous research is in inpatient settings, but the outpatient setting is where the vast bulk of antibiotic prescriptions occur.

This deliverable would focus on advancing the capacity to perform antibiotic stewardship activities targeting primary care clinicians. The specific objective would be to provide regular feedback to primary care providers comparing their patterns to similar provincial cohorts. This type of ASP could be a cornerstone of one of several low-cost, simple approaches to protect the health of Manitobans against the long-term effects of inappropriate antibiotic prescribing.

Diabetes in Manitoba

Contact: Chelsea Ruth

This deliverable would provide a scoping epidemiologic analysis of major trends in Type 2 Diabetes Mellitus (T2DM) prevalence, incidence, complications, and mortality in Manitoba from 1979 to 2015. It would include analyses of health service use rates: physician visits, hospitalization, prescription drug use and the impact of new drugs on laboratory related tests and outcomes. Sub-analyses could examine changes over time, across income quintiles, and regions of the province.

There would also be a number of analyses of early-onset T2DM, which is a particular issue in Manitoba. It is also connected to the increase in "Diabetes in Pregnancy", which would prompt analyses of consequences for these mothers and their children. The fact that the DER-CA clinical database is already linked into the repository at MCHP would allow for a novel assessment of health outcomes in the medium and long term.

Gastrointestinal Endoscopy Utilization in Manitoba

Contact: Lisa Lix or Harminder Singh

Endoscopies of gastrointestinal tract (which includes colonoscopy, flexible sigmoidoscopy, ERCP and EUS) have become some of the most common medical procedures performed each year. With aging of the population, the demand and use of gastrointestinal endoscopy (GIE) has been increasing with associated increasing costs to the healthcare system and increasing wait times for services. Studies from other jurisdictions have reported under and over utilization and variation in outcomes after endoscopy. In Manitoba, there is no set certification required to perform endoscopy, and providers of this service may have varying levels of training and expertise, and there is also likely a great variation in the number of procedures performed per year among different providers.

First Nations Children Atlas

Contact: Mariette Chartier or Marni Brownell

This deliverable would focus specifically on First Nations children in the province - providing important information on perinatal, child and adolescent health outcomes, educational achievement and social services use. MCHP will partner with Nanaandawewigamig and the Manitoba First Nations Education Resource Centre to identify health, education and social indicators of greatest relevance to First Nations and to produce an Atlas that could be used for planning and decision-making. Potential outcomes include infant mortality rates and causes of infant mortality; prevalence of diabetes among adolescents; readiness for school learning in kindergarten; high school completion rates; and justice system involvement among adolescents. Comparison groups could include on- and off-reserve First Nations, as well as non-First Nations children. Similar to the First Nations Atlas produced by MCHP in 2002, this study could examine regional differences in order to explore 'what works' to improve child health and well-being. The DEVOTION (DEVelOpmenTal Origins of chronic diseases in children Network) team has expressed an interest in developing a chapter in the Atlas in partnership with Nanaandawewigamig based on data from the First Nations Regional Health Survey (RHS) and the First Nations Regional Early Childhood Education and Employment Survey (REEES) on 'Why we're thriving', a strength-based look at child health in Manitoba.

Immigration Data Linkage

Contact: Marcelo Urquia or Randy Fransoo

Immigration is a key dimension of the Canadian population dynamics. However, little is known about the characteristics of immigrants to Manitoba, as well as their social and health outcomes. The addition of the Immigration, Refugees and Citizenship Canada permanent resident database into the Manitoba Population Research Data Repository (Repository) at MCHP is the first step in addressing these gaps. This deliverable will document the linkage methodology used, evaluate potential biases in the linkage, and illustrate the potential for research using these data. Finally, basic primary care and death indicators will be used to compare immigrants versus non-immigrants.

Methamphetamine Consumption in Manitoba: A Population Descriptive Study

Contact: Nathan Nickel

MCHP is currently in the process of acquiring additional data which could be used to construct a cohort of Manitobans who have had contacts with the healthcare / social services system due to their methamphetamine consumption. We will use data from the Hospital Discharge Abstract Database and the Winnipeg First Responders Database to identify individuals who have been hospitalized due to their consumption of methamphetamine.

Specific goals for this new Deliverable are:

  1. Explore whether the EDIS (Emergency Department Information System) contains data which can be used to identify individuals who used methamphetamine;
  2. Explore the Winnipeg First Responders Data and its contents with respect to identifying individuals who have consumed methamphetamine;
  3. Develop a cohort of individuals who have documented methamphetamine use in the administrative data; and
  4. Describe the cohort of methamphetamine users who come into contact with the healthcare system.

Page Last Updated: June 8, 2020

For a list of upcoming Deliverables see: Upcoming Deliverables.

For a list of completed Deliverables see: Deliverables List.