The objective of this study was to estimate the impact of the First Nations and Inuit Home and Community Care Program (FNIHCCP) on the rates of hospitalization for ambulatory care sensitive conditions (ACSCs) in the province of Manitoba. A population-based time trend analysis was conducted using the de-identified administrative data housed at the Manitoba Centre for Health Policy, including data from 1984/85 to 2004/05. Findings show a significant decline in the rates of hospitalization (all conditions) following the introduction of the FNIHCCP in communities served by health offices (p<0.0001), health centres (p<0.0001) and nursing stations (p=0.0022). Communities served by health offices or health centres also experienced a significant reduction in rates of hospitalization for chronic conditions (p<0.0001).The results of this study suggest that investment in home care resulted in a significant decline in rates of avoidable hospitalization, especially in communities that otherwise had limited access to primary healthcare.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.
[Show abstract][Hide abstract]ABSTRACT: This paper describes a web-based resource (http://www.umanitoba.ca/centres/mchp/concept/) that contains a series of tools for working with administrative data. This work in knowledge management represents an effort to document, find, and transfer concepts and techniques, both within the local research group and to a more broadly defined user community. Concepts and associated computer programs are made as "modular" as possible to facilitate easy transfer from one project to another.
Tools to work with a registry, longitudinal administrative data, and special files (survey and clinical) from the Province of Manitoba, Canada in the 1990-2003 period.
Literature review and analyses of web site utilization were used to generate the findings.
The Internet-based Concept Dictionary and SAS macros developed in Manitoba are being used in a growing number of research centers. Nearly 32,000 hits from more than 10,200 hosts in a recent month demonstrate broad interest in the Concept Dictionary.
The tools, taken together, make up a knowledge repository and research production system that aid local work and have great potential internationally. Modular software provides considerable efficiency. The merging of documentation and researcher-to-researcher dissemination keeps costs manageable.
Preview · Article · Nov 2003 · Health Services Research
[Show abstract][Hide abstract]ABSTRACT: To compare health status and health services use of Registered First Nations to all other Manitobans (AOM). If the Canadian health care system is meeting underlying need, those experiencing the greatest burden of morbidity and mortality should show the highest rates of health service use.
Registered First Nations' (n = 85,959) hospitalization and physician visit rates were compared to rates of all other Manitobans (n = 1,054,422) for fiscal year 1998/99. The underlying "need" for health care was measured using premature mortality (PMR), an age- and sex-adjusted rate of death before age 75. Data were derived from Manitoba's Population Health Research Data Repository, linked to federal Status Verification System files to determine Registered First Nations status.
Registered First Nations' PMR was double the rate of all other Manitobans (6.61 vs. 3.30 deaths per thousand, p < 0.05). Registered First Nations ambulatory physician visit rates (6.13 vs. 4.85 visits per person, p < 0.05), hospital separation rates (0.348 vs. 0.156 separations per person, p < 0.05) and total days of hospital care (1.75 vs. 1.05 days per person, p < 0.05) were higher than AOM rates. Consultation rates (first visit to a specialist) were slightly higher for Registered First Nations (0.29 vs. 0.27 visits per person, p < 0.05), and overall specialist visit rates were lower (0.895 vs. 1.284 visits per person, p < 0.05) compared with AOM.
Although hospitalization and ambulatory physician visit rates for First Nations reflect their poorer health status, consult and specialist rates do not reflect the underlying need for health care services.
Full-text · Article · Jan 2005 · Canadian journal of public health. Revue canadienne de santé publique
[Show abstract][Hide abstract]ABSTRACT: Many studies of population health, clinical epidemiology, and health services can be supported by a population-based research registry. Such a registry accurately defines the health insurance status for each individual over many years, magnifying the effectiveness of a cross-sectional registry (typically relevant for only a short duration) used in the administration of a health insurance plan. A research registry can distinguish between "well" individuals (no contact with the health care system), loss to follow-up (ineligibility associated with leaving the insurance plan), loss of continuity (two or more unlinked registrations over time for the same person), and mortality. The Manitoba research registry was developed to facilitate longitudinal studies; working within strict confidentiality controls, identifiers for each individual known to Manitoba Health since 1970 can be retrieved and a single unique identifier assigned. Careful reporting of changes in family registration numbers has enabled tracing area of residence, marital status, and family characteristics; results are equivalent to a daily census of the province. This article provides details on source materials, design, and quality of the registry, highlighting its value both for the development of integrated population health information systems and for research in general.
No preview · Article · Feb 1999 · Journal of Clinical Epidemiology
[Show abstract][Hide abstract]ABSTRACT: The pressure on our health-care system to deliver efficient, quality and cost-effective care is increasing. The debate on its sustainability is also expanding. These challenges can be managed with revisions to our health-care policy frameworks governing how and what public health-care services are delivered. Chronic disease management and home care can together ease many of the present and future pressures facing the health-care system. However, the current level of investment and the present policy are not effectively supporting movement in this direction. Updating the Canada Health Act to reflect the realities of our health-care system, and developing policies to support the areas of interdisciplinary teamwork and system integration are needed to facilitate chronic disease management and home care in Canada. This article lays out the challenges, highlights the impending issues and suggests a framework for moving forward.
No preview · Article · Sep 2009 · Health Services Management Research
[Show abstract][Hide abstract]ABSTRACT: To examine the postulated relationship between Ambulatory Care Sensitive Conditions (ACSC) and Primary Health Care (PHC) in the US context for the European context, in order to develop an ACSC list as markers of PHC effectiveness and to specify which PHC activities are primarily responsible for reducing hospitalization rates.
To apply the criteria proposed by Solberg and Weissman to obtain a list of codes of ACSC and to consider the PHC intervention according to a panel of experts. Five selection criteria: i) existence of prior studies; ii) hospitalization rate at least 1/10,000 or 'risky health problem'; iii) clarity in definition and coding; iv) potentially avoidable hospitalization through PHC; v) hospitalization necessary when health problem occurs. Fulfilment of all criteria was required for developing the final ACSC list. A sample of 248,050 discharges corresponding to 2,248,976 inhabitants of Catalonia in 1996 provided hospitalization rate data. A Delphi survey was performed with a group of 44 experts reviewing 113 ICD diagnostic codes (International Classification of Diseases, 9th Revision, Clinical Modification), previously considered to be ACSC.
The five criteria selected 61 ICD as a core list of ACSC codes and 90 ICD for an expanded list.
A core list of ACSC as markers of PHC effectiveness identifies health conditions amenable to specific aspects of PHC and minimizes the limitations attributable to variations in hospital admission policies. An expanded list should be useful to evaluate global PHC performance and to analyse market responsibility for ACSC by PHC and Specialist Care.
Full-text · Article · Oct 2004 · The European Journal of Public Health
[Show abstract][Hide abstract]ABSTRACT: To assess the contribution of primary care systems to a variety of health outcomes in 18 wealthy Organization for Economic Cooperation and Development (OECD) countries over three decades.
Data were primarily derived from OECD Health Data 2001 and from published literature. The unit of analysis is each of 18 wealthy OECD countries from 1970 to 1998 (total n = 504).
Pooled, cross-sectional, time-series analysis of secondary data using fixed effects regression.
Secondary analysis of public-use datasets. Primary care system characteristics were assessed using a common set of indicators derived from secondary datasets, published literature, technical documents, and consultation with in-country experts.
The strength of a country's primary care system was negatively associated with (a) all-cause mortality, (b) all-cause premature mortality, and (c) cause-specific premature mortality from asthma and bronchitis, emphysema and pneumonia, cardiovascular disease, and heart disease (p<0.05 in fixed effects, multivariate regression analyses). This relationship was significant, albeit reduced in magnitude, even while controlling for macro-level (GDP per capita, total physicians per one thousand population, percent of elderly) and micro-level (average number of ambulatory care visits, per capita income, alcohol and tobacco consumption) determinants of population health.
(1) Strong primary care system and practice characteristics such as geographic regulation, longitudinality, coordination, and community orientation were associated with improved population health. (2) Despite health reform efforts, few OECD countries have improved essential features of their primary care systems as assessed by the scale used here. (3) The proposed scale can also be used to monitor health reform efforts intended to improve primary care.
Full-text · Article · Jun 2003 · Health Services Research