Carolyn DeCoster

Waiting times for surgical procedures.

OBJECTIVES Polls show that nearly two thirds of Canadians believe that waiting times prior to surgery have increased in recent years. A study was undertaken in Manitoba to determine whether public perceptions about long and increasing waits were valid. RESEARCH DESIGN Using administrative data, waiting times for 10 types of surgery-ranging from coronary artery bypass surgery and mastectomy to cataract surgery and hernia repairs-were studied over a 5-year period. RESULTS Using each patients preoperative visit to the surgeon as the beginning of the waiting time, median waiting times for most of the procedures studied were found to have, in fact, remained stable or fallen slightly over the period studied. CONCLUSIONS Further, an examination of waiting times for cataract surgery demonstrated that allowing surgeons to practice in both public and private arenas seems to be counterproductive to providing good public service.

A Population-Based Health Information System

The authors introduce the Population Health Information System, its conceptual framework, and the data elements required to implement such a system in other jurisdictions. Among other innovations, the Population Health Information System distinguishes between indicators of health status (outcomes measures) and indicators of need for health care (socioeconomic measures of risk for poor health). The system also can be used to perform needs-based planning and challenge delivery patterns.

Assessing the extent to which hospitals are used for acute care purposes.

OBJECTIVES The degree to which Manitobans were appropriately hospitalized for medical conditions was assessed using a retrospective chart review of a sample of patients in 26 hospitals. RESEARCH DESIGN A standardized set of object-based, nondiagnostic criteria (Inter-Qual) was used by trained abstractors to assess the patient at admission and for each day of stay. RESULTS A high percentage of admissions and days of care were inappropriate. Overall, 49.5% of medical patients were acute at the time of admission, 1.6% required no health care services, and 48.9% could have received care through alternate methods or facilities. Only 33.4% of the subsequent days of stay were appropriate. For patients assessed as acute at the time of admission, by the 8th day of stay, only 47% were still acute and by day 30, only 27% were acute. Patients aged 75 years or older were just as likely to be acute at the time of admission as were younger patients; however, they accounted for 54% of the days in the study, and fewer than 30% of these days were acute. Our data suggest that despite their high use of hospitals, disadvantaged groups (the poor, aboriginal Manitobans), have the same levels of appropriateness as others. CONCLUSIONS We conclude that alternatives to hospital care must first be established and made known and available before a shift in health care resources can occur.

Utilization of nursing home resources.

The total use and cost of nursing homes in Manitoba, for the fiscal year 1991/1992 were analyzed using a population-based health information system. The use of hospital beds by elderly patients for stays of 60 days or more was also analyzed to see if long hospital stays were substituting for nursing home beds. More than one in ten Manitobans 75 years of age and older and one in three who were 85 years and older resided in a nursing home for some time during the study period. The nursing home sector is characterized by none of the marked differences previously found in hospital use across the southern regions of the province, whose residents are similar in health and need characteristics. A single entry system, combined with a population-based planning approach, appears to provide equitable access to care across the province.

Patients Hospitalized for Medical Conditions in Winnipeg, Canada: Appropriateness and Level of Care

A medical record review of patients hospitalized for medical conditions in Winnipeg, Canada during 1998/99 was completed using InterQual utilization review instruments. On admission, 95% of patients required the services provided in an acute care facility. Fifty-eight percent of days in hospital following the day of admission required an acute care setting, and 42% required an alternate level of care. Our results suggest there is room for treating more acute patients within the existing system.

Manitoba's Population-Based Databases and Long-Term Planning: Beyond the Hospital Databases:

The Manitoba Centre for Health Policy and Evaluation (MCHPE) conducts health services research focusing on Manitobas administrative databases. Administrative databases contain information which is routinely and systematically collected for administrative purposes such as hospital and physician claims and funding requirements. This article describes the MCHPEs five major databases, their strengths and limitations, and the development of the Population Health Information System (PHIS). Four modules from PHIS illustrate how the data are used to provide useful information for health care planners, administrators and policy analysts. Finally, future projects and directions for using administrative databases are explored.

A comparison of ambulatory care and selected procedure rates in the health care systems of the Province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States.

To determine if there are differences in physician services in different health care systems, we compared ambulatory visit rates and procedure rates for three surgical procedures in the province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States. The KP system, with its single payer and low financial barriers, is not unlike the Canadian system. But, for most of the United States, the primary payment mechanism is fee-for-service, with the patient paying a significant amount, thereby militating against preventive and early primary care. Manitoba and KP data were extracted from computerized administrative records. U.S. data were obtained from publicly available reports, Manitoba provides 1.8 times and KP 1.2 times (1.4 when allied health visits are included) as many primary care physician visits as the United States. For the surgical procedures studied, U.S. rates were higher than those in either the KP HMO or in Manitoba. We conclude that (1) the U.S. system leads to more surgical intervention, and (2) removal of financial barriers leads to higher use of primary care services where more preventive and ameliorative care can occur.

Measuring and managing waiting times: what's to be done?

On September 11, 2000, the First Ministers of Canada issued a communiqué pledging to develop and report on waiting times for a number of diagnostic and treatment services. Reporting is to begin by September 2002. Given this commitment, what are the ideal characteristics of such a data collection system? This article defines and evaluates methods of measuring waiting times, and recommends a prioritized waiting-time information system to permit both measurement and management.

STABILITY AND TRENDS OVER 3 YEARS OF DATA

&NA; Because the health status of a population does not usually respond immediately to interventions, whether social or medical, the ability to analyze change over time is important. Therefore, patterns of change and stability in health status and health care use of Manitoba residents during a 3‐year period from 1990 to 1992 were analyzed using the Population‐based Health Information System. This article presents summary findings and discusses methodological and policy issues arising from the analyses. A small but significant decrease in premature mortality (the primary health status indicator) was observed in most regions of the province, but two remote, northern regions, those whose residents scored at high socioeconomic risk, remained distinguished for their poor health status. These “poor health” regions also had the highest contact rates with primary caregivers, raising questions about the role of the health care system in improving the health of the population. A persistent increase in surgery was observed in several regions, led by increases in outpatient surgery over and above increases in the elderly population and beyond substitution for inpatient procedures. This trend (not obvious before these analyses) is important as hospitals move to expand their outpatient facilities in response to restraints on inpatient care.