Last Updated: September 21, 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: Colette Raymond 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 would include analyses of some of the overlapping issues facing these children: trauma, violence, mental disorders, developmental disabilities, etc.
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.
Mental Illness in Manitoba - Update and Long-Term Study
Contact: Mariette Chartier
This deliverable will address two objectives:
Health Status of Older Adults and Seniors
Contact: Dan Chateau
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:
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.
Profile of Immigrant Health Status and Health Care Use Patterns
Contact: Marcelo Urquia or Randy Fransoo
According to a recently released Statistics Canada report, 1 in 5 Canadians is an immigrant today, a proportion unequalled since the 1930s when the country's population had grown with waves of emigrating Europeans. Now, the newcomers are more likely to be speaking Chinese. The number of immigrants in Manitoba have doubled between 2001 and 2006 over the previous four years. Filipinos continue to lead the immigration to Manitoba but there are also substantial numbers from India, China and Germany.
MCHP has been made aware of the potential of a federal immigration database linkage to Manitoba Health & Healthy Living data. Discussions with some of the RHAs (including South Eastman RHA) have indicated the need for exploring the issue of immigrant health status, due to a high proportion of incoming immigrants to these regions. The national agency and Health Canada have been involved in the linkage of the immigrant dataset to three other provincial health data, and negotiations could begin to do a similar linkage in Manitoba. This deliverable would facilitate the linkage and would investigate preliminary patterns of health and health care use of immigrants compared to other Manitobans.