Assessing the Value of the Manitoba Housing Data
Contact: Greg Finlayson or Mark Smith
Housing is well understood to be an important determinant of health. The Province of Manitoba, through Manitoba Family Services and Housing, Manitoba Housing and Renewal Corporation and the Manitoba Housing Authority, has data about Manitobans who receive subsidized housing support. These datasets have been recognized as potentially very valuable sources of information to inform population health assessment and program planning and evaluation. This deliverable will involve the transfer of de-identified housing data sets to MCHP for the purpose of assessing the quality and usefulness of the data. The deliverable will produce a limited set of analyses demonstrating the analytic and research potential of Manitoba's housing data.

Exploring the ICU Datasets:  A first look
Contact: Allan Garland or Randy Fransoo
Hospital care is the largest component of health resource use in the developed world, including Canada. It is widely believed that a large portion of hospital resources goes to caring for critically ill patients in Intensive Care Units (ICUs). The demand for ICU care is projected to rise as the population ages. However, there are no reliable, population-based data addressing care of the critically ill in Canada, or anywhere else. The two goals of this deliverable are to create the tool needed to accurately analyze critical care in Manitoba, and to begin those analyses. This tool will arise from merging two existing, population-based, ongoing, health care databases currently supported by Manitoba Health & Healthy Living: (a) the clinical Manitoba ICU database (MICUDB) held by the Division of Critical Care Medicine at the University of Manitoba, and (b) the Population Health Research Data Repository (Repository) held by the Manitoba Centre for Health Policy. 

Profile of Immigrant Health Status and Health Care Use Patterns
Contact: Bosu Seo or Randy Fransoo
According to a recently released Statistics Canada repot, 1 in 5 Canadians is an immigrant today, a proportion unequalled since the 1930s when the country's population had grown with waves of emigrating Europeans. Now, the newcomers are more likely to be speaking Chinese. The number of immigrants in Manitoba have doubled between 2001 and 2006 over the previous four years. Filipinos continue to lead the immigration to Manitoba but there are also substantial numbers from India, China and Germany.

MCHP has been made aware of the potential of a federal immigration database linkage to Manitoba Health & Healthy Living data. Discussions with some of the RHAs (including South Eastman RHA) have indicated the need for exploring the issue of immigrant health status, due to a high proportion of incoming immigrants to these regions. The national agency and Health Canada have been involved in the linkage of the immigrant dataset to three other provincial health data, and negotiations could begin to do a similar linkage in Manitoba. This deliverable would facilitate the linkage and would investigate preliminary patterns of health and health care use of immigrants compared to other Manitobans.

The Francophone Health and Health Care Use Atlas
Contact: Mariette Chartier or Greg Finlayson
According to the 2006 Census, 46,000 Manitobans' mother tongue is French and close to 104,000 Manitobans (9%) are bilingual. In recent discussions with Manitoba Health & Healthy Living, Health Information Management, Community Health Assessment Unit, and the Francophone community, the importance of an RHA Indicators Atlas type of deliverable focusing on Francophones living in Manitoba was discussed. Indicators will be selected to mirror previous work at MCHP, including the RHA Indicators Atlas Update. Extensive work will be required to identify "Francophone" populations in the administrative databases using linkages with the Canadian Community Health Survey. This deliverable would assist in laying the foundation for planning initiatives both provincially and at the RHA level.

Perinatal Services & Outcomes in Manitoba
Contact: Maureen Heaman or Malcolm Doupe
Further analyses are necessary to expand on the descriptive analyses done by the Ministerial Working Group on Maternal / Newborn Services in 2005 and to support the current work of the Maternal and Child Health Services (MACHS) Taskforce and the ongoing focus of the Healthy Child Committee of Cabinet (HCCC) on early childhood development. General rates of full-term and pre-term births, stillbirths, and neonatal death rates should be measured and compared across regions of Manitoba and subsequently compared to national rates. A more in depth analysis of the demographic characteristics of women giving birth in Manitoba, the types of deliveries they are experiencing (ex. caesarean section vs. vaginal delivery), the types of anesthesia utilized, and the rate at which women are induced, should be examined. Also, the place of birth (home vs. hospital), and the type and location of the hospital (relative to the mother's region of residence) should be further described, as well as consideration of key perinatal risk factors (ex. alcohol use during pregnancy).

Exploring the Relationship Between Housing, Mental Health and Other Health and Social Factors
Contact: Alan Katz or Pat Martens
This deliverable will link the Manitoba Housing data at MCHP with mental health and other datasets to explore the relationship between housing, mental health and other health and social factors. It will be used to inform policy discussions and the development of policies and programs related to the homeless and other disadvantaged populations. It is understood that this deliverable is contingent upon the acquisition and validation of Manitoba's housing data.

Cadham Laboratory Data
Contact: Lisa Lix or Mark Smith
As the Provincial LIMS (Laboratory Information Management System) Project progresses, Cadham Lab’s historical datasets will no longer be used for recording current lab test results; these datasets will be archived. MCHP will receive the historical datasets and conduct a systematic study to validate and document the datasets and evaluate their quality for research purposes. The intended outcome of this project is a summary assessment of the feasibility of using these data for population-based investigations.

How are Manitoba’s Children Doing?
Contact: Marni Brownell
This is a deliverable for Manitoba Health and the Healthy Child Committee of Cabinet. It is meant to support or add value to the 2011 release of the legislated five-year Healthy Child Manitoba (HCM) report on the status of Manitoba's children with respect to the HCM Strategy. Priority will be accorded to identifying key indicators from the MCHP repository regarding the four cross-departmental outcome goals of The Healthy Child Manitoba Act: physical and emotional health, safety and security, successful learning, and social engagement and responsibility. Drawing from and building upon two recent MCHP children's deliverables, the Manitoba Child Health Atlas Update (CHA-CHA), and the Early Development Instrument (EDI), this deliverable will include following the longitudinal outcomes of several birth cohorts, including years 2000 and 2001 birth cohorts to Kindergarten and to Grade 3, and conducting extended EDI and CHA-CHA analyses. Child Health indicators developed in the first rapid release deliverable on Health Inequities in support of the 2010 release of the legislated five-year Public Health report, will also be extended and included. 

Understanding the Health System Use of Ambulatory Care Patients Referred for Specialist Consultation
Contact: Alan Katz
The primary care renewal initiatives across Canada have recognized that outcomes in primary care are heavily dependent on factors outside the control of primary care itself. This has lead to the use of process measures and related factors, which we will explore using statistical testing. For example, we plan to expand on previous MCHP research suggesting that access to and use of specialist care is highly dependent on area of residence. In addition, we plan to explore the factors surrounding implementation and support of inter disciplinary teams for the management of patients with chronic diseases. These inter disciplinary teams provide a key component of primary care renewal. Both of these realities are influenced by the type and frequency of specialist care patients receive. By understanding these relationships we hope to better understand primary care.

Defining the Capabilities of the Newly Implemented Emergency Use Data Systems in Winnipeg (aquiring the data)
Contact: Malcolme Doupe
While the new EDIS system captures more data than were previously available, it is imperative to assess the quality of these data and to provide recommendations for further optimizing their potential. From this perspective, the goals of this deliverable are to:

1. link the newly implemented EDIS data with traditional administrative files housed at MHCP;
2. obtain electronic data from the HSC Children's ED allowing for a complete picture of ED use in Winnipeg; and,
3. conduct some baseline analyses on these newly linked data that help to build on our current knowledge of ED use patterns in Winnipeg.

Understanding ED use patterns has important policy implications in Manitoba. This research will measure the completeness of the current ED IS data system by assessing how consistently data are inputted into various fields, and in doing so will make recommendations for further optimizing the utility of these data. This type of methodological analysis will also assess the accuracy of EDIS by making comparisons to traditional administrative files housed at MCHP (e.g., ensuring that reported trends in ED are comparable using different systems, comparing rates of specialist consult visits in EDIS with data currently housed at MCHP, ensuring that data quality is comparable across all ED sites, etc). Similar types of analyses will be conducted using the traditional HSC Children's ED data. Using these newly acquired EDIS data, descriptive analyses will also be conducted to further our understanding of ED use patterns in Winnipeg. These analyses will answer fundamental but essential ED use pattern questions such as: What are the wait times for ED patients according to their triage score and how long do patients wait before they leave without being seen? What is the typical length of time that patients spend in an ED before being admitted to a hospital? What types of health care practices (blood work, diagnostic tests, specialist consults, etc) do patients typically receive in an ED? The findings to these and other questions will be compared across the individual adult and children's ED sites in Winnipeg.

The Cost of Publicly Supported Housing for Seniors - Implications for Future Funding Approaches
Contact: Greg Finlayson
Canada's population is rapidly aging and we can expect that by 2030 about one in five Manitobans will be 65 years or older. Older adults are the predominant users of nursing homes in Canada, and policy makers have recently implemented various Aging in Place initiatives as a community-based alternative to nursing home care. Within Manitoba, the majority of these initiatives are currently being piloted in Winnipeg, and Supportive Housing for Seniors is designed as the major strategy to offset future nursing home demands. While research at MCHP estimates that this will be at least partially successful, client payment structures for supportive housing (where clients pay for rent, meals, laundry, housekeeping and drugs) and nursing homes (where per diem fees cover all services) are currently very different. Client affordability may therefore impact use of supportive housing care. There is also limited evidence comparing the government funded operational costs and additional health care use costs (e.g., for clients who are transferred to emergency room visits, are hospitalized, etc) of these two services. This type of information is essential to ensure that supportive housing strategies are a cost effective alternative to nursing home use.

This study will compare the costs of supportive housing versus nursing homes in Winnipeg, Manitoba, to ensure that supportive housing is a viable financial alternative to nursing home care. Knowledge developed from this research can be used to help plan future Aging in Place initiatives in Winnipeg and other health regions.

Who is in our Hospitals
Contact: Randy Fransoo or Patricia Martens
This deliverable would paint a picture of who is occupying acute care hospitals in Manitoba.  The purpose of this deliverable is to help with planning. Are there things the system can do outside the hospital or in different environments (home care, personal care homes, etc.), to offset the need for acute care beds? Do we need a sub-acute system? The basic information required for each hospital in Manitoba would be: who is there (i.e., from what geographical location); why they are there (i.e., the diagnoses or services); what is their level of acuity (ALC) and the ALC "reason" (which may give insight into such things as waiting for home). This is a province-wide approach, to help planners see how services are provided throughout the province and how patient flows could be managed.

Physician Integrated Network (PIN) Long-term Change Analysis (PIN Phase 2)
Contact: Alan Katz
The PIN Phase 2 deliverable will evaluate both health service provision (processes) and health outcomes associated with primary care at PIN clinics. The analysis will examine the study outcomes of the following groups including changes
within each group over time:

• core patients of PIN sites (patients for whom primary care home has been confirmed)
• patients who have visited PIN sites, but are not core patients
• Other primary care clinics using advanced access
• Other patients not included in the above

Health outcomes will include:

• ER visits
• Hospitalizations
• Outcomes of select PIN indicators (e.g. diabetes)

This deliverable will use the Repository data for all analyses. The EMR extracts will only be used to identify the core clinic patient cohort.

Understanding the Determinants of Emergency Department Volumes (using the data for further analysis
Contact: Malcolm Doupe
Emergency department (ED) volumes is a prominent health care delivery issue both locally and nationally in Canada, and proper strategies to address this issue first require that the determinants of ED volumes are better understood. In general these determinants can be divided into input (e.g., the number of patients arriving at an ED at any given time); throughput (strategies within an ED that affect patient flow); and output (e.g., difficulties transferring ED patients to a hospital bed) factors. Understanding how these different determinants affect ED volumes is an essential first step in addressing this phenomenon.

This deliverable will assess how various input, throughput and output factors affect ED volumes and results will help to direct strategies to improve ED patient flow. Some ED sites in Winnipeg have implemented strategies to improve patient flow. Examples of these strategies include the provision of nurse practitioner care and use of outpatient services for diagnostic tests. These and other processes will be assessed to define strategies within EDs that best help to improve patient flow.

Long-term Outcomes of Manitoba's Stop FASD Program
Contact: Chelsea Ruth or Marnie Brownell
Identified as an evaluation priority by the Government of Manitoba's Fetal Alcohol Spectrum Disorder (FFASD) Interdepartmental Committee, the province's Stop FASD mentoring program has collected a decade's worth of primary data on program participants, including outcome data not available elsewhere on this population of women at elevated risk for having children affected by FASD. Following the transfer of this data into the MCHP repository in 2010/11, this deliverable would focus on the long-term health, social and learning outcomes of Stop FASD participants and their children over the past 10 years, drawing on key indicators from the MCHP repository, and set the stage for later FASD focused MCHP deliverables to support Manitoba's life course FASD Strategy.

Assessment of Personal Care Home Bed Projections
Contact: Dan Chateau or Malcolm Doupe
MCHP previously completed a PCH Bed Projections deliverable in 2002, based on relatively 'old' data from the Manitoba Bureau of Statistics 1998 population projections. This needs to be revisited, since more recent pilot work indicated that these projections understated the population size of 85+ year olds substantially. As well, advancements in medicine or different options (such as higher levels of care in PCHs) could have changed the picture. Because of recent MCHP work on the supportive housing and PCH datasets, this projections research is more feasible than it was previously. This is a critical area for planners and requires a rapid deliverable to plan for long-term facilities by Regional Health Authorities (RHAs).

Identification of Factors and Supports that Contribute to the Educational Success of Students in Foster Care (Healthy Child Committee of Cabinet Deliverable)
Contact: Marni Brownell or Mariette Chartier
The study will attempt to identify the major factors and supports present in schools that contribute to the educational success of students in the care of foster families. Such factors and supports would include not only those pertaining to individual students but, as well, those pertaining to foster families. The study will make recommends regarding how to ensure that such positive factors and supports are present in all schools. It will also identify further areas of research regarding what schools, school divisions and the Department of Education might be able to do to further contribute to the educational success of students in foster care.

RHA Indicators Atlas 2013
Contact: Randy Fransoo or The Need to Know Team
RHAs will be required to produce comprehensive community health assessments by September 2014. To complete these assessments, the RHAs will require region- and district-specific data on a range of key indicators of health status and health care use. This deliverable will update and refine key indicators from the 2009 RHA Atlas and incorporate any new indicators from more recent reports that fit within the criteria of "core indicators."

The Future of Treatment and Care of Manitobans Living with Kidney Failure
Contact: Mariette Chartier or Allison Dart
In January 2011, the Canadian Institute for Health Information (CIHI) released the Canadian Organ Replacement Register (CORR) Annual Report: Treatment of End-Stage Organ Failure in Canada, 2000-2009 which included information about kidney failure. According to the CIHI CORR report, the number of Canadians living with kidney failure (also referred to as end stage renal disease (ESRD)) has been increasing for 20 years, but it suggests that rates appear to be stabilizing since 2005. Manitoba Health (MH) does not agree with the statement that the rate of people living with kidney failure is declining and the Manitoba Renal Program (MRP) projects that 2010/11 will see at least a 7%-8% increase in patients diagnosed with kidney failure and requiring dialysis. The MRP further advises that there will be a need for more dialysis stations, home haemodialysis, peritoneal dialysis, and funding for human resources to deliver the MRP service in the future. Understanding what the true need in Manitoba is will be important to future planning of equipment and resources. An MCHP deliverable could assist in answering these key questions:

• What are the future needs for the renal health services (peritoneal dialysis, home haemodialysis and in-centre dialysis in Manitoba? 
• What are the characteristics of the future population of Manitoba residents who will require renal replacement treatment (RRT) by dialysis (peritoneal, home haemodialysis or in-centre haemodialysis)? 
• What is the geographic distribution of this population? 
• What preventive, screening education measures/affiliations with existing programs might reduce the number of Manitobans who will require dialysis? (Description of modifiable risk factors)

Public Reporting Template for LTC Quality Indicators
Contact: Malcolm Doupe and Marni Brownell
There is a growing interest across Canada for greater accountability around personal care home standards and quality of care indicators through public reporting. Manitoba Health is in the midst of developing its Provincial Long Term Care strategy and a public 'report card' would support some of the goals and objectives of this strategy. As well, the WHRA recently organized a Public Accountability Working Group that is pursuing public reporting of Manitoba Health standards and MDS Quality Indicators and will be looking at the feasibility of including measures from the Translating Research in Elder Care (TREC) research project at some time in the future. Finally, recent OAG recommendations challenged the healthcare system to move to more public reporting of key PCH performance measures and both the department and the Winnipeg RHA would like to begin that work.

An MCHP deliverable to develop a template of PCHquality indicators using MDS data from the Winnipeg RHA, and incorporating both provincial standards and best practices from the literature would create a tool that would benefit Manitoba Health planners, the WRHA and a public reporting framework that could be rolled out to the rural regions when MDS-L TC is launched rurally.

Evaluation of the Manitoba Health Program IMPRxOVE
Contact: Dan Chateau or Murray Enns
In June, 2011 the Improving Medication Prescribing and Outcomes Via Medical Education (IMPRxOVE) Program was launched. The MANITOBA IMPRxOVE™ program is a first in Canada initiative that is expected to improve the safety and health outcomes for Manitobans receiving medications for mental health disorders. The MANITOBA IMPRxOVE™ Program uses Comprehensive Neurosciences of Canada's proprietary clinical algorithms and follows a proven "audit and feedback" based intervention. Under the program, CNSC conducts monthly reviews of Drug Program Information Network (DPIN) pharmacy claims data to evaluate the quality and appropriateness of the prescription of psychiatric and related behavioral medications and to identify patients at risk due to inappropriate use. If a pattern of practice that places a patient at high risk of a negative health outcome is identified, a feedback alert in the form of an educational mailing will be sent to the prescriber. Prior to launch, Provincial Drug Programs (PDP) obtained input from Dr. Murray Enns (Professor and Head, Department of Psychiatry, University of Manitoba), the Manitoba Centre for Health Policy (MCHP), and Dr. Harold Carmel (Vice President, Care Management Technologies) to delineate preliminary research objectives/hypotheses, criteria for evaluation and data requirements to fully evaluate the impact of the MANITOBA IMPRxOVE™ program. In consideration of the preliminary research framework, Dan Chateau of MCHP randomized the 1417 physicians eligible to receive a mailing into a control and active mailing group. It was proposed that the randomization would be maintained for a 12 month period after which time data analysis would begin (September 2012).

Due to the innovative nature of the MANITOBA IMPRxOVE™ Program, PDP remains committed to evaluating the health outcome impacts of the program on various parameters including, but not limited to, medication usage, changes in prescribing practices, physician visits, and hospitalization rates. PDP notes that the involvement of MCHP in the randomization and initial research discussions, combined with their expertise in working with Manitoba Health administrative data makes MCHP the best option for coordinating the research plan to evaluate the MANITOBA IMPRxOVE™ Program.