Deliverables Currently Underway

Last Updated: November 27, 2017

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.

The Overlap Between Child Welfare and the Justice System

Contact: Marni Brownell or Lorna Turnbull

This study will investigate the relationship between children in care and the justice system. This includes analyses of some of the overlapping issues facing these children, such as trauma, violence, mental disorders, developmental disabilities, and other health and social conditions.

The focus of this project will help to answer the following questions:

  1. What is the overlap between being in care as a child / adolescent and being involved in the justice system as an adolescent / young adult? For this, the plan is to follow a 1988 birth cohort and look at justice system involvement / outcomes (e.g.: as an accused, victim, or witness and the types of charges involved).
  2. What are the determinants of Justice system involvement for adolescents / young adults? For this, the plan is to to follow the same 1988 birth cohort and look at birth factors, individual and family factors.

An additional aim of this study is to identify and describe the youth who are involved in both systems - children in care and youth justice, using the most recent years of data available from the Child and Family Services and Justice databases.

First Nations Atlas Update

Contact: Alan Katz or Kathi Avery Kinew

The original First Nations (FN) Atlas was produced in 2001. Since that time, it is increasingly apparent to AMC and MFNs, that FNs people are becoming sicker. This would be a deliverable similar in scope to the original Atlas and to the Metis 2010 Atlas, looking at health and healthcare use patterns of First Nations people living in Manitoba. It has the potential to be the first of its kind in a true collaboration with AMC and MFNs, with context provided by reference to MFNs data from their Regional Health Survey (2008-2010), and MB First Nations Education Resource Centre and their involvement with 49 MFN schools. With plans for the AMC, the Province of Manitoba and Government of Canada pursuing tripartite discussions toward a unified health system, this report would lead to agreed upon data sets for evidence based planning and decision-making.

Manitoba Tuberculosis (TB) Prevention and Management Deliverable Situation

Contact: Lisa Lix

This deliverable will focus on TB prevention and management, applying an equity focus that includes the measurement of and description of relationships across defined TB-specific indicators with consideration to the strategic objectives of the Southern Chiefs' Organization (SCO), the Winnipeg Regional Health Authority's (WRHA) Framework for Health Adaptation, and the WRHA's Integrated Tuberculosis Services (ITBS) Strategic Plan.

Research Questions/Objectives

  • Characterize the epidemiology of TB over time in the province of Manitoba.
  • Review and refine a set of TB indicators across the spectrum of TB care, given available administrative/clinical/public health data.
  • Characterize TB care across Manitoba, given TB indicators.

Mental Illness in Manitoba - Update and Long-Term Study

Contact: Mariette Chartier

This deliverable will address two objectives:

  1. To update (from the 2004 report) our knowledge of Mental Illness in Manitoba - including prevalence of key disorders and rates of use of health services (hospitals, physicians, home care, PCH, prescription drugs). Given MCHP's ongoing report on the mental health of children (0-17), this new report will focus on adults (18+).
  2. To conduct a  longitudinal analysis comparing those diagnosed with Mental Illness in childhood to those without. This would build on the ongoing report noted above, but start further back in time to allow longer follow-up. Outcomes could include selected indicators in adolescence (e.g., child welfare or justice system involvement; high school graduation) and  numerous outcomes in adulthood - including indicators of mental and physical health status, involvement in the justice system and economic indicators like income level (area-based) and receipt of income assistance (related to employment and long-term disability issues).

Health Status of Older Adults and Seniors

Contact: Dan Chateau

Research Questions/Objectives:

  1. What are the health conditions and health service utilization patterns of older adults and seniors in Manitoba?
  2. This deliverable would provide comprehensive information on health status indicators and health service utilization patterns of older adults and senior citizens at regional and sub­ regional levels. A specific focus would be on the prevalence and determinants of social isolation and elder abuse.

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.

Alcohol and the Associated Health and Healthcare Burden in Manitoba

Contact: Nathan Nickel

The Chief Provincial Public Health Officer's 2011 report on the Health Status of Manitobans cites addictions and substance abuse as a primary health concern. In the report it is estimated that 14% of Canadians are high-risk drinkers meaning that their pattern of drinking is either currently harmful or significantly increases the likelihood of future harm. The Manitoba rate of high-risk drinkers, among adults, is higher at over 25%. At the same time, alcohol related harms also occur through episodic heavy drinking and moderate drinking.

While most Manitobans drink responsibly, there is evidence that several alcohol related health conditions contributes to, or causes morbidity and mortality including cancer, cardiovascular conditions, diabetes, infectious diseases and gastrointestinal conditions. Although moderate drinking does have cardio protective benefits for people in certain age groups, it is also linked to an increased risk to cancer and other diseases. While a significant number of injuries are alcohol related, alcohol misuse also contributes to mortality in such forms of impaired driving and suicide. On a global scale alcohol is alongside tobacco as one of the leading causes of preventable causes of death and disability (Babor et el. 2010).

In September 2013 Manitoba announced the development of an Alcohol Strategy with the objective of reducing or eliminating alcohol related harms through various population health prevention and intervention initiatives. The development of the strategy is in its early stages, work already done on the global level, national level and in other provinces suggest some of the interventions may include policy changes such as increasing the cost of alcohol products with high alcohol content, changes to minimum pricing, and increasing screening and brief intervention for alcohol abuse. To understand the effectiveness of the strategy, interventions need to be assessed against a reduction in alcohol related harm.
The scope of the deliverable will include the collection and analysis of provincial trends over a 10-year period of:

  1. emergency room and hospitalization injuries where alcohol was a major factor
  2. chronic disease associated with alcohol use
  3. mortality associated with alcohol use
  4. utilizing the CCHS

Outpatient Oral Cancer Medications in Manitoba

Contact: Colette Raymond

Most Manitobans who receive treatment for cancer do so with intravenous therapy at Cancer Care Manitoba. However, in recent years, the use of oral medications for cancer treatment has increased dramatically. Traditionally, prescriptions for these medications are filled at community pharmacies through the usual system of prescription drug coverage. This placed increased cost burden on patients. In 2012, the Home Cancer Drug (HCD) Program was launched. This is a program for Manitobans diagnosed with cancer that allows access to eligible outpatient oral cancer and specific supportive care drugs at no cost to the patient. This research project seeks to determine usage of oral medications for the treatment of different types of cancer, changes in patterns of use over time, and the impact of the HCD program on use of oral medications for the treatment of cancer. Using prescription drug data for outpatients we will examine prescription utilization trends, costs associated with such therapies and patterns of health services use.

Homecare: (a) Data Acquisition and Validity; (b) an Exploration of the use of Homecare by Manitobans

Contact: Dan Chateau or Malcolm Doupe

This will be one deliverable with two parts; the first would be the re-acquisition of the person level homecare data from Manitoba eHealth repository through Manitoba Health; the second would be high level descriptive information on what is seen in the data (e.g.: describe regional homecare service use). The questions that could be answered will depend upon the data available, but some examples could be: what is the prevalence and incidence of homecare use by RHA (and small areas), i.e., new and open home care cases? What is the wait time for homecare (if available)? What are the patterns and frequencies of homecare use by patient age, from pediatric cases to older adults? What "diseases" are being serviced through homecare (chronic disease management, palliative care etc.) - or if this is not available, what types of people (profiled from healthcare use data) are enrolled in home care? Are there geographical areas where homecare patterns of use appear to differ substantially?

Public Reporting Template for LTC Quality Indicators

Contact: Malcolm Doupe or Marni Brownell

There is a growing interest across Canada for greater accountability around personal care home standards and quality of care indicators through public reporting. Manitoba Health is in the midst of developing its Provincial Long Term Care strategy and a public 'report card' would support some of the goals and objectives of this strategy. As well, the WHRA recently organized a Public Accountability Working Group that is pursuing public reporting of Manitoba Health standards and MDS Quality Indicators and will be looking at the feasibility of including measures from the Translating Research in Elder Care (TREC) research project at some time in the future. Finally, recent OAG recommendations challenged the healthcare system to move to more public reporting of key PCH performance measures and both the department and the Winnipeg RHA would like to begin that work.

An MCHP deliverable to develop a template of PCH quality indicators using MDS data from the Winnipeg RHA, and incorporating both provincial standards and best practices from the literature would create a tool that would benefit Manitoba Health planners, the WRHA and a public reporting framework that could be rolled out to the rural regions when MDS-LTC is launched rurally.

For a list of upcoming Deliverables see: Upcoming Deliverables.

For a list of completed Deliverables see: Deliverables.