A building block for population- based research and KT: MCHP, and - PowerPoint PPT Presentation

MANITOBA CENTRE FOR HEALTH POLICY A building block for population- based research and KT: MCHP, and The Need To Know Team model in Manitoba Patricia J. Martens PhD Director, MCHP; Associate Professor, Faculty of Medicine CIHR/PHAC Applied Public Health Chair

Manitoba Centre for Health Policy (MCHP) • The Manitoba Centre for Health Policy » University of Manitoba: Department of Community Health Sciences, Faculty of Medicine » anonymized administrative health claims database » 6 “deliverables”/yr on contract with Manitoba Health » Reports, four-pagers, website, concept dictionary » More than half our funding from peer-reviewed granting agencies (CIHR etc.)

MCHP uses a data laboratory … “paperclips” Family Education Services Immunization Hospital Medical Population- Home Care Based Health Nursing Registry Home Pharmaceuticals Provider Cost Vital Census Data Statistics at EA level National surveys

www.umanitoba.ca/centres/mchp/ Website Full reports Four-pagers News releases Briefings

Involvement and influencing health policy • At the RHA and provincial levels • 1991 onward – briefings with Ministry of Health at top levels (Ministers, Deputy Minister) • MCHP’s Annual Workshop Days (Rural Days, Winnipeg RHA Days, Manitoba Health Days) – Look for the STORIES!

MCHP’s involvement in influencing health policy • The Need To Know Team (2001+) – MCHP, RHAs, Manitoba Health Churchill Churchill – CIHR KT Award for Regional Impact in November 2005 – Lots of publications, presentations Burntwood Burntwood Burntwood Nor-Man Nor-Man Nor-Man North North Eastman Eastman Parkland Parkland Parkland Interlake Interlake Interlake Brandon Brandon Winnipeg Winnipeg Central Central Assiniboine Assiniboine South Eastman South Eastman

Conceptual model of the MCHP/RHA/MH collaboration: The Need To Know knowledge translation model Communication, New knowledge Development of dissemination creation and RHA-relevant and application development capacity of the research Accessible Training of information academics Training of RHA team members Martens & Black 2001

The Need To Know Team (originally CIHR- funded): partnership of MCHP, Manitoba Health, and RHAs • 3 projects & 3 evaluation reports, plus several publications: • RHA Indicators Atlas, June 2003 • Mental Illness in Manitoba, 2004 • Sex differences in health, health care use and outcomes, 2005 • What Works, 2008 • 3 evaluation reports • In progress: – RHA Indicators 2008 – -brainstorming ideas!

of Crowds (Surowiecki) The Wisdom

KT: degree of user involvement High Low Degree of involvement of users / decision-makers Results Users Users are involved Users sent to given in “working group” collaborate to users help to to assist frame the under- researchers in research at stand interpreting the start, and information results to be involved throughout

Influencing policy and planning? The basis of High Evidence is change! there, but Good KT, sits on a Strength and relevance of research evidence- shelf based decisions High Low Degree of involvement of users / decision-makers Dangerous Poor evidence, territory - the but it’s ignored anecdote reigns (thank goodness) supreme in decision-making Low Martens and Roos, Healthcare Policy September 2005

Healthcare Policy 2005;1(1):72-84

J Epidemiol Community Health 2006;60:902-907

Journal of Health Services Research & Policy 2005;10(4):203-211

Healthcare Policy 2006;2(1):108-127

Canadian Journal of Psychiatry 2007;52(9):581-590

MANITOBA CENTRE FOR HEALTH POLICY Patterns of Regional Mental Illness Disorder Diagnoses and Service Use in Manitoba: A Population-Based Study Patricia J. Martens, Randy Fransoo, Nancy McKeen, The Need To Know Team, Elaine Burland, Laurel Jebamani, Charles Burchill, Carolyn DeCoster, Okechukwu Ekuma, Heather Prior, Dan Chateau, Renee Robinson, Colleen Metge Thanks to the Working Group: Christine Ogaranko, Eckhard Goerz, John Walker, Marni Brownell, Renee Robinson September 2004

Page 38 Figure 2.4.1: Percent of Residents (aged 10 years +) Within Each Category of Mental Illness Groupings 5 Major Disorders Other None 'Cumulative' 24% 13% 63% Residents with one or Residents with no service use for more of: Depression, mental illness disorders of any kind Residents Anxiety, Substance with service Abuse, Personality use for Disorders, or (This is the comparison group in all analyses) mental illness Schizophrenia disorders, but excluding people in the 'Cumulative' group 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percent of total Manitoba population 'Any' group = 'Cumulative' + 'Other' Five-year treatment prevalence by sex: Males: 18.8% cumulative; 11.5% other; 69.7% none Females: 29.1% cumulative; 14.0% other; 56.9% none

Page 138 Age-adjusted annual rate of visits to all physicians, per resident Figure 4.2.9: All-Cause Physician Visit Rates by Sex and Cause Cumulative Disorders vs. No Disorders, 1997/98 - 2001/02 10 9 Pregnancy/Birth 8 Mental 7 Mental All Others 6 Injury & Poison 5 All Others Genitourinary Endocrine/Metab Pregnancy/Birth Injury & Poison 4 Genitourinary Nervous All Others Endocrine/Metab Injury & Poison Nervous Ill-Defined 3 Genitourinary All Others Musculo- Ill-Defined Endocrine/Metab Injury & Poison skeletal Genitourinary Nervous Musculo- 2 Endocrine/Metab Ill-Defined skeletal Nervous Circulatory Musculoskeletal Ill-Defined Circulatory Musculoskeletal 1 Circulatory Circulatory Respiratory Respiratory Respiratory Respiratory 0 Cumulative No Disorders Cumulative No Disorders Females Males

Figure 4.4.4: Visit Rates to Psychiatrists for Mental Illness Disorders for those with Cumulative Disorders by Income Quintile, 1997/98-2001/02 Page 148 Age-adjusted annual rate of visits per resident aged 10 years + Highest Urban U5 males U4 females U3 U2 Lowest Urban U1 Highest Rural R5 R4 R3 R2 Lowest Rural R1 Income Not Found Male: 2.4% Female: 1.4% 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0 Linear Trend Test Results Urban Male: Significant (p<.01) Urban Female: Significant (p<.01) Rural Male: Significant (p<.001) Rural Female: Significant (p<.001)

Residents of PCH 5 years prior to PCH admission in 2002/03 none none cumulative 16% 25% mental cumulative illnesses mental 39% illnesses 44% other mental other mental illnesses illnesses 40% 36% Any mental Any mental illness: 75% illness: 83% Dementia: 67% Dementia: 46% Depression: 35% Depression: 34%

KT in action: Mental Illness Report “This report has been very useful for the mental health community broadly. We have presented and discussed it with a few key groups including the Provincial Mental Health Management Network (RHA mental health managers and our Branch) and the Provincial Mental Health Advisory Council (consumers and family members appointed by Minister of Health). The self-help groups have been asking about it, referring to it in their advocacy. Our Branch has specifically used it to work in four key areas: (a) It is informing the Provincial Suicide Prevention Strategy ; (b) we are using it as further evidence for the need for a new mental health (and addictions) data system - and this is moving along; (c) we have used it to pull together a planning group to look at current and future needs in the area of access to psychiatrists ; (d) we are using it as further evidence for the need for collaboration between mental health and primary health care initiatives. Personally the piece that stood out for me is the whole thing about how all health concerns are increased when there is a mental illness diagnosis. This is a piece that I pull out frequently in briefings, meetings etc.” Yvonne Block, Director of Mental Health, Addictions and Agency Relations, Manitoba Health January 2005

How The Need to Know Team has informed Health Planning: CARDIOVASCULAR DISEASE Brandon RHA • Leading cause of death for both women and men • Public education & awareness • Heart attack rates are higher strategies regarding screening than Manitoba rate and monitoring of hypertension • Significantly lower rates of cardiac catheterization, • A chart audit to determine angioplasty and coronary reasons for low rates of artery bypass graft surgery medical intervention than the province & is one of the lowest when compared to • Chronic disease prevention other regions strategy to address key risk • Significantly lower % of factors persons with at least one physician visit for hypertension than the province