Deliverables Currently Underway

Home Care: (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?

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.

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.

Page Last Updated: September 24, 2020

For a list of upcoming Deliverables see: Upcoming Deliverables.

For a list of completed Deliverables see: Deliverables List.