- Email: [email protected]
Research Notes
H E A L T H C A R E M,ANAGEMENT
Manitoba Centre for Health Policy and Evaluation Contact: Carolyn DeCoster, phone (204) 789-3666; e-mail: [email protected] As Manitoba regionalizes its health care system, appropriate and equitable funding has become a paramount concern. The MCHPE has recently completed the following three projects that deal with this issue for the Manitoba government. A project t o investigate provincial expenditures on health care to Manitobans, by M . Shanahan, C. Steinbach, C. Burchill, D. Friesen, and C. Black, takes a historical perspective, estimating the 1993-94 per capita health care expenditures of hospitals, nursing homes, mental health institutions, home care and physicians for residents of the newly formed regional health authorities and subareas of Winnipeg. The study documents substantial regional differences in the use of resources to provide health care services to residents. Issues in developing indicators f o r needs-based funding, by N . Frohlich and K. C. Carriere, considers methods to factor need into regional funding for a single sector - physician services. The project focuses on the theoretical question of how to distribute resources for a sector in which the data are good but services are not currently distributed according to need. It was conducted as a precursor to the third and following project.
FORUM -
Needs-base, funding f o r regional health authorities: A p r o p o s e d f r a m e w o r k , by C. Mustard and S. Derksen, recommends an approach to regional funding across a much broader set of services. This report describes work carried out by the MCHPE in support of a methodology committee established to develop a framework for allocating resources to regional health authorities. Its recommendations take into account not only the findings of the previous two reports, but also the serious limitations in utilization data for some health care services.
Centre for Health Economics and Policy Analysis, McMaster University Contact: (905) 525-9140 (ext. 22122) Casting the screening net: Separating big fish from little fish (CHEPA Working Paper #97-3) by B. Markham, B. Hutchison, S. Birch, L. Goldsmith and C. E. Evans Screening tests are a rapidly growing part of medicak practice that need to be appraised for effectiveness, efficiency and equity. In this paper, the authors present a framework to assist in appraising screening programs. The framework expands on existing literature that recognizes degree of aggressiveness for targeting priority groups, with two categories resulting: universal screening and opportunistic screening. A second principle is then introduced - selectivity - resulting in four categories of screening: active non-selective (universal or SUMMER 1997, VOL. 10, NO. 2
GESTION DES SOINS D E SANTC
mass screening); active selective; opportunistic non-selective; and opportunistic selective. The framework is illustrated using screening for high serum cholesterol levels. The authors conclude with observations about screening strategies and their potential limitations. A matter of fact: Evidencebased decision-making “unplugged” (CHEPA Working Paper #97-2) by Stephen Birch Evidence-based approaches to health care decision making have emerged in recent years as ways of improving the performance of health care providers as well as that of health care systems. This interest in establishing “evidence” of the outcomes of health care interventions, and the models of research developed to satisfy this interest, involve departures from the underlying concept of multiple determinants of health and illness and the population context in which decision making takes place. The use of “evidence” in this way risks using health care resources inefficiently and in ways that systematically favour those groups in society with favourable health prospects and the conditions from which they tend to suffer. Attempts by researchers to support better informed decisions must consider ways of developing research methods to better reflect the contextual nature of decision makers’ problems. Two broad directions for change are presented: (1) Current research
methods cou 1 be enhanced by exploring the role of social determinants of health in determining the outcomes of interventions; and (2) the focus could be shifted from providers and their activities toward the health problems of population groups that are more homogeneous in the social determinants of health.
Institute for Clinical Evaluative Sciences in Ontario To obtain a copy of the complete report at a cost of $5.35 (including GST), contact: Kathy Knowles Chapeskie, phone (416) 480-4055 (ext. 3890); fax (416) 480-6048; e-mail: [email protected] Accuracy of Canadian health administrative databases, by J. Ivan Williams and Wendy Young Originally organized for documentation and payment purposes, health administrative databases facilitate tracking of what is happening in our health care system and examining how the system is being used. The fact that administrative databases were not originally intended to be used for research purposes has caused debate on the issues of data quality, patient privacy and consent. In an inventory of the studies that have been conducted to examine the quality of the information in administrative databases, ICES found that these databases are appropriate for health services research, but that improvementsin recording, collecting and maintaining
continued on page 46 E T t 1997, VOL. 10, NO. 2
HEALTHCARE MANAGEMENT
FORUM -
GESTION DES SOINS DE SANTC
MEMBERS ON THE MOVE NOUVELLES ORIENTATIONS
Peter John Andru, CHE, has accepted the position of Business Analyst, Health Information Network, Manitoba Health, where he will be working on provincial health care information systems. Marilyn J. Bruner, CHE, accepted the position of President and CEO of St. Joseph’s Health Centre in Toronto. Hy Eliasoph, CHE, has assumed the position of Director, Hospital Relations and Health Policy, with the Ontario Hospital Association in Toronto. His new responsibilities include all of Ontario’s teaching hospitals and more than 50 hospitals in the Greater Toronto area.
Robert G. Zed, CHE, President of Morrison-CrothallSupport Services, was recently recognized for professional leadership, community volunteerism and accomplishments. Mr. Zed was one of the recipients of Canada’s Top 40 Under 40 Award for 1997. The award is sponsored by the Caldwell Partners, The Financial Post, CTV, Canadian Airlines International and CIBC. @
William B. MacLeod, CHE, has joined Toronto-based Motion Works Group Limited as a partner-consultant.
Research Notes, continued from p . 43 them would further improve health services research findings. The inventory identified three criteria to assess data quality: completeness, agreement when comparing databases, and agreement of diagnosis when compared with expert criteria.
Falzal Nurdln Nanji, a final year MHA student at Dalhousie University, has been awarded the 1997 Postgraduate Fellowship. We look forward to welcoming Faizal to the national office in the fall.
The conclusions of the project were that: (1) based on existing studies on the quality and accuracy of administrative data, the transcription and translation of clinical events would appear to be accurate; and (2) the findings of these studies should encourage other researchers to include methodological details in their papers and devise validity and consistency checks for each study they conduct.
Alfred G. O’Rourke, CHE, is now Corporate Facilitator, Internal Support Services, at the London Health Sciences Centre, in London, Ontario.
S U M M E R 1 9 9 7 , V O L . 1 0 , NO. 2
Furthermore, as health services research and the data on which it relies become increasingly important to health reform and the evaluation of efficiencies of interventions, the existing data sources must be improved. Substantial benefit could be gained from an investment to improve the quality and compatibility of databases. A considerable investment is required in quality control, however, to improve data accuracy. @
@
fTE 1997, VOL. 10, NO. 2
Manitoba Centre for Health Policy and Evaluation Contact: Carolyn DeCoster, phone (204) 789-3666; e-mail: [email protected] As Manitoba regionalizes its health care system, appropriate and equitable funding has become a paramount concern. The MCHPE has recently completed the following three projects that deal with this issue for the Manitoba government. A project t o investigate provincial expenditures on health care to Manitobans, by M . Shanahan, C. Steinbach, C. Burchill, D. Friesen, and C. Black, takes a historical perspective, estimating the 1993-94 per capita health care expenditures of hospitals, nursing homes, mental health institutions, home care and physicians for residents of the newly formed regional health authorities and subareas of Winnipeg. The study documents substantial regional differences in the use of resources to provide health care services to residents. Issues in developing indicators f o r needs-based funding, by N . Frohlich and K. C. Carriere, considers methods to factor need into regional funding for a single sector - physician services. The project focuses on the theoretical question of how to distribute resources for a sector in which the data are good but services are not currently distributed according to need. It was conducted as a precursor to the third and following project.
FORUM -
Needs-base, funding f o r regional health authorities: A p r o p o s e d f r a m e w o r k , by C. Mustard and S. Derksen, recommends an approach to regional funding across a much broader set of services. This report describes work carried out by the MCHPE in support of a methodology committee established to develop a framework for allocating resources to regional health authorities. Its recommendations take into account not only the findings of the previous two reports, but also the serious limitations in utilization data for some health care services.
Centre for Health Economics and Policy Analysis, McMaster University Contact: (905) 525-9140 (ext. 22122) Casting the screening net: Separating big fish from little fish (CHEPA Working Paper #97-3) by B. Markham, B. Hutchison, S. Birch, L. Goldsmith and C. E. Evans Screening tests are a rapidly growing part of medicak practice that need to be appraised for effectiveness, efficiency and equity. In this paper, the authors present a framework to assist in appraising screening programs. The framework expands on existing literature that recognizes degree of aggressiveness for targeting priority groups, with two categories resulting: universal screening and opportunistic screening. A second principle is then introduced - selectivity - resulting in four categories of screening: active non-selective (universal or SUMMER 1997, VOL. 10, NO. 2
GESTION DES SOINS D E SANTC
mass screening); active selective; opportunistic non-selective; and opportunistic selective. The framework is illustrated using screening for high serum cholesterol levels. The authors conclude with observations about screening strategies and their potential limitations. A matter of fact: Evidencebased decision-making “unplugged” (CHEPA Working Paper #97-2) by Stephen Birch Evidence-based approaches to health care decision making have emerged in recent years as ways of improving the performance of health care providers as well as that of health care systems. This interest in establishing “evidence” of the outcomes of health care interventions, and the models of research developed to satisfy this interest, involve departures from the underlying concept of multiple determinants of health and illness and the population context in which decision making takes place. The use of “evidence” in this way risks using health care resources inefficiently and in ways that systematically favour those groups in society with favourable health prospects and the conditions from which they tend to suffer. Attempts by researchers to support better informed decisions must consider ways of developing research methods to better reflect the contextual nature of decision makers’ problems. Two broad directions for change are presented: (1) Current research
methods cou 1 be enhanced by exploring the role of social determinants of health in determining the outcomes of interventions; and (2) the focus could be shifted from providers and their activities toward the health problems of population groups that are more homogeneous in the social determinants of health.
Institute for Clinical Evaluative Sciences in Ontario To obtain a copy of the complete report at a cost of $5.35 (including GST), contact: Kathy Knowles Chapeskie, phone (416) 480-4055 (ext. 3890); fax (416) 480-6048; e-mail: [email protected] Accuracy of Canadian health administrative databases, by J. Ivan Williams and Wendy Young Originally organized for documentation and payment purposes, health administrative databases facilitate tracking of what is happening in our health care system and examining how the system is being used. The fact that administrative databases were not originally intended to be used for research purposes has caused debate on the issues of data quality, patient privacy and consent. In an inventory of the studies that have been conducted to examine the quality of the information in administrative databases, ICES found that these databases are appropriate for health services research, but that improvementsin recording, collecting and maintaining
continued on page 46 E T t 1997, VOL. 10, NO. 2
HEALTHCARE MANAGEMENT
FORUM -
GESTION DES SOINS DE SANTC
MEMBERS ON THE MOVE NOUVELLES ORIENTATIONS
Peter John Andru, CHE, has accepted the position of Business Analyst, Health Information Network, Manitoba Health, where he will be working on provincial health care information systems. Marilyn J. Bruner, CHE, accepted the position of President and CEO of St. Joseph’s Health Centre in Toronto. Hy Eliasoph, CHE, has assumed the position of Director, Hospital Relations and Health Policy, with the Ontario Hospital Association in Toronto. His new responsibilities include all of Ontario’s teaching hospitals and more than 50 hospitals in the Greater Toronto area.
Robert G. Zed, CHE, President of Morrison-CrothallSupport Services, was recently recognized for professional leadership, community volunteerism and accomplishments. Mr. Zed was one of the recipients of Canada’s Top 40 Under 40 Award for 1997. The award is sponsored by the Caldwell Partners, The Financial Post, CTV, Canadian Airlines International and CIBC. @
William B. MacLeod, CHE, has joined Toronto-based Motion Works Group Limited as a partner-consultant.
Research Notes, continued from p . 43 them would further improve health services research findings. The inventory identified three criteria to assess data quality: completeness, agreement when comparing databases, and agreement of diagnosis when compared with expert criteria.
Falzal Nurdln Nanji, a final year MHA student at Dalhousie University, has been awarded the 1997 Postgraduate Fellowship. We look forward to welcoming Faizal to the national office in the fall.
The conclusions of the project were that: (1) based on existing studies on the quality and accuracy of administrative data, the transcription and translation of clinical events would appear to be accurate; and (2) the findings of these studies should encourage other researchers to include methodological details in their papers and devise validity and consistency checks for each study they conduct.
Alfred G. O’Rourke, CHE, is now Corporate Facilitator, Internal Support Services, at the London Health Sciences Centre, in London, Ontario.
S U M M E R 1 9 9 7 , V O L . 1 0 , NO. 2
Furthermore, as health services research and the data on which it relies become increasingly important to health reform and the evaluation of efficiencies of interventions, the existing data sources must be improved. Substantial benefit could be gained from an investment to improve the quality and compatibility of databases. A considerable investment is required in quality control, however, to improve data accuracy. @
@
fTE 1997, VOL. 10, NO. 2