Ongoing Deliverables

Evaluation of the Healthy Baby Program
Contact: Marni Brownell 
In June 2001, Healthy Child Manitoba introduced the Healthy Baby Program – a 2-part benefit program to improve birth and early outcomes for infants born to low SES moms.  The program includes: a prenatal income supplement and community supports.  Some mothers received only the income supplement, some only the community supports and some both components of the program.  Preliminary analyses suggest that the prenatal income supplement alone did not improve outcomes for infants and their moms.  It is hypothesized that those receiving the income benefit as well as participating in the community support program will have significantly better outcomes than those receiving the income supplement alone, the community supports alone, or those not participating (using pre-Healthy Baby years for this final comparison).  Outcomes to be analyzed include: maternal indicators such as number of prenatal visits, month of initiation of prenatal visits, and maternal depression in year after birth; infant indicators such as birth weight, gestation, feeding status (breastfed or not), Apgar scores, hospitalizations in first year, immunizations in first year, continuity of care.

PIN Evaluation
Contact: Alan Katz
Long term implementation, evaluation and monitoring of the Physician Integrated Network (PIN) initiative will involve comparing changes in process and outcome indicators to a baseline of the same indicators over time. This will be essential in tracking practice changes in primary care consistent with the PIN objectives. This deliverable will build on the PIN initiative’s Evaluation Framework and determine long-term indicators for future application. This deliverable will establish baseline indicators.  Key questions to be answered include:

• How comparable are the EMR and administrative data for data fields that are common to both data sources?
• What are the feasible indicators to track? (Both process and outcome indicators). These indicators will rely primarily on administrative data. As well, indicators using EMR data will likely be suggested once the reliability and availability of the EMR data have been assessed.
• What other indicators are desirable? What additional mechanisms over and above the current administrative (and EMR) data will be required to track these indicators?
• Over what timeframes must indicators be measured to demonstrate meaningful change?
• How can other variables (than the planned change in practice) be factored out?

Metis Health
Contact: Pat Martens
It is widely known that the health of aboriginal populations in Canada lags behind that of other Canadians. In 2002, the Manitoba Centre for Health Policy (MCHP) published a report on titled The Health and Health Care Use of Registered First Nations People Living in Manitoba: A Population-Based Study. The research project demonstrated that Registered First Nations people have shorter life expectancy and higher morbidity than other Manitobans. However, little has been published on the health of aboriginals who do not have Status, such as Metis. This study will provide indicators of health status and health services utilization for the Metis population of Manitoba. It is a collaborative study between MCHP and the Manitoba Metis Federation (MMF). MCHP has produced several previous health atlases for the general population, as well as atlases for specific sub-groups, such as Registered First Nations, children and males vs. females. This deliverable will result in an atlas similar to the one completed in 2002.

Obesity and Healthy Living
Contact: Randy Fransoo
Obesity is a major public health concern. The association of obesity with a variety of risk factors related to nutrition, physical activity and social determinants of health has been well documented in the literature. Health care providers are already observing an increase in the incidence of chronic diseases (such as diabetes and hypertension) directly resulting from the increased prevalence of obesity in the population. In order to develop effective policy and intervention programs for obesity and related chronic diseases (including diabetes) information on risk and preventive factors related to obesity is crucial. Potential factors of interest are those shared by successive cycles of the cross-sectional component of the National Population Health Survey (1994, 1996, 1998) and in specific cycles of the Canadian Community Health Survey (2000, 2003, 2005). Risk/preventive factors may be drawn from broad themes such as alcohol use, body image, selected chronic conditions (e.g. diabetes, hypertension), food insecurity, health care utilization and access, mental health, nutrition, physical activity, smoking, preventive health behaviours, socio-demographic factors, and stress (e.g. mastery, self esteem, self-perceived stress). Associations between levels of BMI and risk/preventive factors may be examined using odds ratios, regression models, and other approaches. The scope of the deliverable is to include the analysis of provincial trends over a 10-year period (utilizing the 1995-2005 individual survey cycles), as well as the analysis of regional differences utilizing the combined cycles of the CCHS.

Early Development Instrument
Contact: Rob Santos
This deliverable will focus on the Early  Development Instrument (EDI), a population-based, community-level measure of children’s development (physical, social, emotional, language, and communication), at the transition to school entry in Kindergarten (age 5 years).  The EDI is collected province wide by all Manitoba public school divisions on behalf of the Healthy Child Manitoba Office (HCMO).  This deliverable will build on previous and current MCHP deliverables, and research related to children (e.g., child health atlas, SES and educational outcomes, inequalities in child health, vulnerable children).  It will include descriptive, correlational, and regression analysis using the EDI, such as SES gradients in EDI outcomes, predictors or EDI outcomes, and EDI trends over time.  Analyses will focus on both the population level as well as vulnerable subgroups of children.

Assessing the Value of the Manitoba Housing Data
Contact: Greg Finlayson or Mark Smith
Housing is well understood to be an important determinant of health. The Province of Manitoba, through Manitoba Family Services and Housing, Manitoba Housing and Renewal Corporation and the Manitoba Housing Authority, has data about Manitobans who receive subsidized housing support. These datasets have been recognized as potentially very valuable sources of information to inform population health assessment and program planning and evaluation. This deliverable will involve the transfer of de-identified housing data sets to MCHP for the purpose of assessing the quality and usefulness of the data. The deliverable will produce a limited set of analyses demonstrating the analytic and research potential of Manitoba's housing data.

Exploring the ICU Datasets:  A first look
Contact: Allan Garland or Randy Fransoo
Hospital care is the largest component of health resource use in the developed world, including Canada. It is widely believed that a large portion of hospital resources goes to caring for critically ill patients in Intensive Care Units (ICUs). The demand for ICU care is projected to rise as the population ages. However, there are no reliable, population-based data addressing care of the critically ill in Canada, or anywhere else. The two goals of this deliverable are to create the tool needed to accurately analyze critical care in Manitoba, and to begin those analyses. This tool will arise from merging two existing, population-based, ongoing, health care databases currently supported by Manitoba Health & Healthy Living: (a) the clinical Manitoba ICU database (MICUDB) held by the Division of Critical Care Medicine at the University of Manitoba, and (b) the Population Health Research Data Repository (Repository) held by the Manitoba Centre for Health Policy. 

Manitoba Immunization Study
Contact: Tim Hilderman or Alan Katz
There are now several years of data reflecting the efforts to reach high-risk groups - the elderly and those with chronic disease - through the adult influenza and pneumonia immunization program. Given this, it is possible to look at the coverage and impact of the immunization program. This deliverable would choose a subset of immunizations for adults and children (e.g., pneumonia and influenza; HIS and pertusis) and seek to more fully understand the scope and implications of coverage. The deliverable could ask questions such as:

• What is the MIMS data (as it exists today) telling us about coverage of target populations and outcomes? What health and health system outcomes are Manitoba's immunization programs having? Reduced mortality and morbidity? Reduced or increased health services utilization? Examples: fewer hospitalizations? Longer lengths of stay in personal care homes?
• What is potential power of the MIMS data, when linked with other administrative data, to conduct very sensitive adverse outcome analysis for rare events, which might be used to conduct vaccine safety analysis/research?
• How complete are children's MIMS data compared to the IMPACT database from the Health Sciences Centre?
• What are the implications of known data gaps in MIMS and which of those gaps might be most important to address from an outcomes, surveillance and research perspective?

There is an ongoing national initiative to examine adverse outcomes of flu immunization. This deliverable could be integrated into a Manitoba provincial/national initiative in the area of adverse outcomes.

Profile of Immigrant Health Status and Health Care Use Patterns
Contact: Bosu Seo or Randy Fransoo
According to a recently released Statistics Canada repot, 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.

The Francophone Health and Health Care Use Atlas
Contact: Mariette Chartier or Greg Finlayson
According to the 2006 Census, 46,000 Manitobans' mother tongue is French and close to 104,000 Manitobans (9%) are bilingual. In recent discussions with Manitoba Health & Healthy Living, Health Information Management, Community Health Assessment Unit, and the Francophone community, the importance of an RHA Indicators Atlas type of deliverable focusing on Francophones living in Manitoba was discussed. Indicators will be selected to mirror previous work at MCHP, including the RHA Indicators Atlas Update. Extensive work will be required to identify "Francophone" populations in the administrative databases using linkages with the Canadian Community Health Survey. This deliverable would assist in laying the foundation for planning initiatives both provincially and at the RHA level.

Perinatal Services & Outcomes in Manitoba
Contact: Maureen Heaman or Malcolm Doupe
Further analyses are necessary to expand on the descriptive analyses done by the Ministerial Working Group on Maternal / Newborn Services in 2005 and to support the current work of the Maternal and Child Health Services (MACHS) Taskforce and the ongoing focus of the Healthy Child Committee of Cabinet (HCCC) on early childhood development. General rates of full-term and pre-term births, stillbirths, and neonatal death rates should be measured and compared across regions of Manitoba and subsequently compared to national rates. A more in depth analysis of the demographic characteristics of women giving birth in Manitoba, the types of deliveries they are experiencing (ex. caesarean section vs. vaginal delivery), the types of anesthesia utilized, and the rate at which women are induced, should be examined. Also, the place of birth (home vs. hospital), and the type and location of the hospital (relative to the mother's region of residence) should be further described, as well as consideration of key perinatal risk factors (ex. alcohol use during pregnancy).

Pharmaceutical Use in Manitoba:  Opportunities to Optimize Use
Contact: Colette Raymond or Colleen Metge
This deliverable will focus on four areas of pharmaceutical use in Manitoba with the objective of exploring opportunities for intervention to optimize that use. It will include an in depth exploration of the usage and prescribing patterns of each -area with a view to understanding the potential factors influencing use from multiple perspectives. The four areas are:

• Psychoactive drug use in the elderly focusing on the use of the atypical anti psychotics
• Benzodiazepine in both personal care homes and the community.
• Drugs used to treat asthma and COPD in adults focusing on combination drugs
• Drugs used to treat diabetes mellitus, andbiologic agents

The analyses will explore the factors impacting on usage including but not limited to the following:

• Patient characteristics: region, socioeconomic status, age, gender, co-morbidity, doctor and pharmacy "shopping";
• Provider (initiator of the drug) characteristics: specialist status, country of training, group vs solo practice, continuity of care in practice, funding mechanism;
• Policy environment: Propriety vs non-propriety personal care home, access to pharmacy professionals; and – Pharmacare reimbursement policy.

Exploring the Relationship Between Housing, Mental Health and Other Health and Social Factors
Contact: Alan Katz or Pat Martens
This deliverable will link the Manitoba Housing data at MCHP with mental health and other datasets to explore the relationship between housing, mental health and other health and social factors. It will be used to inform policy discussions and the development of policies and programs related to the homeless and other disadvantaged populations. It is understood that this deliverable is contingent upon the acquisition and validation of Manitoba's housing data.

Health Inequalities in Manitoba: Is the socioeconomic gap widening or lessening over time?
Contact: Patricia Martens and Marni Brownell
This deliverable will provide information on approximately 15 key indicators of health status, over time and by a measure of socioeconomic status (income quintiles). The purpose of this deliverable is to provide useful information for various government reports on the health status of Manitobans in 2010 which may also assist in laying some foundational work for further work on inequities. Selection of indicators will be guided by the Sir Michael Marmot WHO report on “Closing the Gap in a Generation” (Commission on Social Determinants of Health, 2008). The income quintile information will provide insight both into SES status and health behaviours by derivation of information from Census descriptions.