A 21st Century Data Strategy for Health and Health Care Surveys: Their Unique Contribution to Improving Health Outcomes and Reducing Disparities

Slide presentation from the AHRQ 2010 conference.

On September 29, 2010, Arlene Bierman made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (3.3 MB). Free PowerPoint® Viewer (Plugin Software Help).


Slide 1

A 21st Century Data Strategy for Health and Health Care Surveys: Their Unique Contribution to Improving Health Outcomes and Reducing Disparities

A 21st Century Data Strategy for Health and Health Care Surveys: Their Unique Contribution to Improving Health Outcomes and Reducing Disparities

Arlene S. Bierman MD MS
OWHC Chair in Women's Health
St. Michael's Hospital, University of Toronto

AHRQ Annual Meeting
September 29, 2010

Image: The POWER (Project for Ontario Women's Health Evidence-based Report) logo appears at the top of the slide; this logo appears in the lower right corner of all subsequent slides.

Slide 2

Health and Health Care Surveys: Essential Data for Improving Health Outcomes

Health and Health Care Surveys: Essential Data for Improving Health Outcomes

  • Assessing, Improving, and Monitoring:
    • Health System Performance
    • Population Health
    • Health Disparities
  • Identifying:
    • Individuals, Populations, and Communities at Risk
  • Benchmarking
  • Conducting International Comparisons

Slide 3

Health and Health Care Surveys: Unique Contributions

Health and Health Care Surveys: Unique Contributions

  • Patient Reported Outcomes:
    • Health and Functional Status
    • Physical and Mental Health
  • Health Behaviors and Risk Factors
  • Patient Experiences with Care
  • Non-Medical Determinants of Health
  • Health Needs of Diverse Populations

Slide 4

Actionable Data for Improvement

Actionable Data for Improvement

The POWER Study (Project for an Ontario Women's Health Evidence-based Report) is providing actionable data to help policymakers and providers to improve the health of and reduce inequities among the women of Ontario.
www.powerstudy.ca

Image: An elderly woman doing exercises is shown; the caption reads "Cardiovascular Disease."

Slide 5

Community-Engaged Research

Community-Engaged Research

  • POWER Study Roundtables:
    • Inform indicator selection and interpretation
    • Increase uptake of findings
  • Consumers: representatives of community based organizations and associations
  • Providers: Clinicians, Hospitals, Community Health Centres
  • Policymakers: Government, Regional Health Authorities, Public Health, Health Data Agencies

Slide 6

Assessing Equity

Assessing Equity

Image: A chart depicts the following structure:

  • Overall Population:
    • Women:
      • Income
      • Education
      • Ethnicity
      • Geography
  • Overall Population:
    • Men:
      • Income
      • Education
      • Ethnicity
      • Geography

Slide 7

Patient Reported Outcomes

Patient Reported Outcomes

Slide 8

Age-specific percentage of adults aged > 25 years who reported activities were prevented due to pain or discomfort, by sex and annual household income, Ontario, 2000/01

Age-specific percentage of adults aged ≥ 25 years who reported activities were prevented due to pain or discomfort, by sex and annual household income, Ontario, 2000/01

Image: Four bar graphs display the following data:

Gender/ AgeLow incomeLower middle incomeMiddle incomeHigher income
Women 25-6426161510
Women 65+35272318
Men 25-642516117
Men 65+27261311

Data source: Canadian Community Health Survey cycle, 1.1.

Slide 9

Age-standardized percentage of adults age = 25 with CVD who reported that their current health was somewhat or much worse than their health one year prior, by sex and annual household income, 2005

Age-standardized percentage of adults age ≥ 25 with CVD who reported that their current health was somewhat or much worse than their health one year prior, by sex and annual household income, 2005

Image: Four bar graphs display the following data:

IncomeWomenMen
Low3533
Lower middle3128
Middle2722
Higher2019

Data source: CCHS, Cycle 3.1.
* Interpret with caution due to high sampling variability (coefficient of variation 16.6-33.3)

Slide 10

 Risk Factors

Risk Factors

Slide 11

 Age-standardized percentage of women aged > 25 who reported health behaviors that increase the risk of chronic diseases, by education level, Ontario, 2005

Age-standardized percentage of women aged ≥ 25 who reported health behaviors that increase the risk of chronic diseases, by education level, Ontario, 2005

Image: Bar graphs display the following data:

Women:

AdjustedPhysical inactivity*Inadequate fruit and vegetable intake**Overweight or obese***Smoking^
Less than secondary school graduation65605528
Secondary school graduation57564626
At least some post-secondary school51494621
Bachelor's degree or higher4842348
Men:
AdjustedPhysical inactivity*Inadequate fruit and vegetable intake**Overweight or obese***Smoking^
Less than secondary school graduation59696640
Secondary school graduation51686329
At least some post-secondary school49666426
Bachelor's degree or higher41575513

Data source: Canadian Community Health Survey cycle, 3.1.
* Physical activity index was less than 1.5 kcal/kg/day.
** Less than five servings per day.
*** Body Mass Index (BMI) >greater than or equal to 25 (calculated from self-reported height and weight).
^ Daily or occasional smokers.

Slide 12

Age-standardized percentage of adults aged 25 years and older who reported being current smokers, by sex and ethnicity, Ontario, 2005  

Age-standardized percentage of adults aged 25 years and older who reported being current smokers, by sex and ethnicity, Ontario, 2005

Image: Bar graphs display the following data:

SmokingWomenMen 
Aboriginal**3943
Black1019
South and West Asian, Arab518
East and Southeast Asian418
Other***1325
White2225

Data source: Canadian Community Health Survey 3.1.
*Interpret with caution due to high sampling variability (coefficient of variation 16.6-33.3).
** Only includes off-reserve Aboriginals (North American Indian, Metis, Inuit).
*** Includes Latin American, other racial and multiple racial origins.

Slide 13

 Age-standardized percentage of adults aged 25 and older who reported being a daily or occasional smoker, by sex, education level and Local Health Integration Network, Ontario, 2005

Age-standardized percentage of adults aged 25 and older who reported being a daily or occasional smoker, by sex, education level and Local Health Integration Network, Ontario, 2005

Image: Maps of Northern Ontario, Southern Ontario, and Toronto and surrounding areas compare men and women by educational status within Local Health Integration Networks (LHIN) sections of each mapped area. The following findings are noted:

  • There was variation across LHINs in the percentage of adults who reported being current smokers.
  • Reported smoking behavior varied with educational level, ranging from 11 percent in more educated to 38 percent in less educated women (in the Central and North West LHINs respectively) and 15 percent in more educated men to 47 percent in less educated men (in the Charaplain and Toronto Central LHINs respectively).
  • The magnitude of the difference between women and men with similar levels of education varied across LHINs.

Overall Ontario:

In Ontario, 27% of women with lower education, 12% of women with higher education, 24% of men with lower education, and 22% of men with higher education reported being current smokers. (Lower education is secondary school gradution or less.)

Notes: The Ontario Congestive Heart Failure Database (OCHFDB) identifies patients with CHF through an administrative data algorithm. Patients with two physician and/or emergency department claims for CHF within a two year period, one hospitalization for CHF or one hospitalization and one other claim for CHF are identified as having congestive heart failure. In the Ontario population 45 years and older 33,006 had been identified as an incident case of CHF in the 2005/06 fiscal year. These patients are followed for one full year to determine access to physician care.

Female CHF patients were less likely than male patients to have seen a cardiologist during the course of the year; 41.1% vs 53.3%.

Female CHF patients were more likely than male patients to have seen a GP/FP and not a cardiologist or an internist during the course of the year; 28.1% vs 21.0%.

Slide 14

 Age-standardized percentage of adults age = 25 with CVD who reported health behaviors that increase risk for chronic diseases, by sex and risk behaviour, Ontario, 2005

Age-standardized percentage of adults age ≥ 25 with CVD who reported health behaviors that increase risk for chronic diseases, by sex and risk behaviour, Ontario, 2005

Image: Bar graphs display the following data:

GenderPhysical inactivity^Inadequate fruit and vegetable intake**Overweight or obese¥Smoking$
Women67485414
Men51586616

Data source: CCHS, Cycle 3.1.
^ Physical Activity Index of < 1.5 kcal/kg/day.
** Daily consumption of less than five servings of fruits and vegetables.
¥ Body Mass Index (BMI) ≥25, calculated from self-reported height and weight.
$ Current smokers (daily or occasional).

Slide 15

 Social Determinants of Health

Social Determinants of Health

Slide 16

 Age-standardized percentage of adults aged 25 and older who reported food insecurity up, by sex and annual household income, Ontario, 2005

Age-standardized percentage of adults aged 25 and older who reported food insecurity^, by sex and annual household income, Ontario, 2005

Image: Bar graphs display the following data:

IncomeWomenMen 
Low2524
Lower middle1411
Middle64
Higher11

Data source: Canadian Community Health Survey 3.1.
^ Refers to people who reported that they did not have enough to eat, worried about there.
Not being enough to eat or did not eat the quality or variety of foods desired due to a lack of money.
*Interpret with caution due to high sampling variability (coefficient of variation 16.6-33.3).

Slide 17

 Access Patient Experiences with Care

Access: Patient Experiences with Care

Slide 18

 Percentage of adults aged 25 and older who reported no difficulties making an appointment for an urgent, non-emergent health problem, by sex and neighbourhood income quintile, Ontario, 2006-08

Percentage of adults aged 25 and older who reported no difficulties making an appointment for an urgent, non-emergent health problem, by sex and neighbourhood income quintile, Ontario, 2006-08^

Image: Bar graphs display the following data:

Quintile (Q)WomenMen
Q1 (Lowest)7677
Q28179
Q38584
Q47986
Q5 (Highest)8488

Data sources: Primary Care Access Survey (PCAS), Waves 4-11; Statistics Canada.
2006 Census.
^ October 2006-September 2008.

Slide 19

 Percentage of adults aged > 25 who reported being very satisfied with their experience of getting an appointment for a regular check-up, by sex and ethnicity, 2006-08

Percentage of adults aged ≥ 25 who reported being very satisfied with their experience of getting an appointment for a regular check-up, by sex and ethnicity, 2006-08^

Image: Bar graphs display the following data:

EthnicityWomenMen
Aboriginal**73X
Black5270
South and West Asian, Arab4750
East and Southeast Asian4940
Other***5869
White6165

Data source: Primary Care Access Survey (PCAS), Waves 4-11.
^ The survey period was from October 2006-September 2008.
X Suppressed due to small sample size.
** Includes North American Indian, Metis, Inuit.
*** Includes El Salvador, other European, other Central American, other South American, religion as ethnicity.

Slide 20

 Percentage of adults aged 25 and older who reported being very satisfied with their experience getting an appt for a regular check-up, by sex and length of time since immigration, 2006-08

Percentage of adults aged 25 and older who reported being very satisfied with their experience getting an appt for a regular check-up, by sex and length of time since immigration, 2006-08^

Image: Bar graphs display the following data:

Time since Immigration
(Years)
WomenMen
0—94142
10+ 6161
Canadian born6065

Data source: Primary Care Access Survey (PCAS), Waves 4-11.
^ October 2006-September 2008.

Slide 21

 Percentage of adults aged 25 and older who reported being very satisfied with their experience of getting appt for a regular check-up, by sex and language spoken most often at home, 2006-08

Percentage of adults aged 25 and older who reported being very satisfied with their experience of getting appt for a regular check-up, by sex and language spoken most often at home, 2006-08^

Image: Bar graphs display the following data:

Language Spoken at HomeWomenMen
English only, English with others6065
French only6871
Neither English nor French (other)4951

Data source: Primary Care Access Survey (PCAS), Waves 4-11.
^ October 2006-September 2008.

Slide 22

 Percentage of adults aged 25 and older who did not visit a dentist in the past 12 months, by sex and annual household income, Ontario, 2005

Percentage of adults aged 25 and older who did not visit a dentist in the past 12 months, by sex and annual household income, Ontario, 2005

Image: Bar graphs display the following data:

IncomeWomenMen
Low5657
Lower middle4855
Middle2940
Higher1623

Data source: Canadian Community Health Survey (CCHS), 2005 (Cycle 3.1 ).

Slide 23

Quality of Care  

Quality of Care

Slide 24

Percentage of Ontarians aged 15 and older with probable depression who had a physician visit for depression, by sex and age group  

Percentage of Ontarians aged 15 and older with probable depression who had a physician visit for depression, by sex and age group

Image: Bar graphs display the following data:

AgeWomenMenOverall womenOverall menCV MenCV women
15-242726*41.193720.6812.25
25-44433841.193710.486.14
45-64504741.193710.816.87
65+4628*41.193727.1615.73

Data sources: CCHS, Cycle 1.1; OHIP.
* Interpret with caution due to high sampling variability.

Slide 25

 Age-standardized percentage of screen-eligible women who had at least one Pap test in the last three years, by neighbourhood income quintile, 2004/05

Age-standardized percentage of screen-eligible^ women who had at least one Pap test in the last three years, by neighbourhood income quintile, 2004/05

Image: Bar graph displays the following data:

Income QuintilePercentage
Q1(lowest)61
Q266
Q369
Q472
Q5(highest)75

Data sources: CytoBase; OCR; OHIP; RPDB; Canadian Institute for Health Information Discharge Abstracts Database (CIHI-DAD); Statistics Canada 2001 Census.
^ Women aged 18-70 with no history of cervical cancer or prior hysterectomy.

Slide 26

Age-standardized percentage of women who had a Pap test that showed a low grade lesion who had a repeat Pap test or colposcopy within 6 months of the initial abnormal test, by neighbourhood income quintile, 2004/05  

Age-standardized percentage of women who had a Pap test that showed a low grade lesion^ who had a repeat Pap test or colposcopy within 6 months of the initial abnormal test, by neighbourhood income quintile, 2004/05

Image: Bar graph displays the following data:

Income QuintilePercentage
Q1 (lowest)42
Q243
Q344
Q445
Q5(highest)47

Data sources: CytoBase; OCR; OHIP; RPDB; CIHI-DAD; Statistics Canada 2001 Census.
^ Atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LGSIL).

Slide 27

 Quality of Care: Medicare Health Outcomes Survey

Quality of Care: Medicare Health Outcomes Survey

  • Plan-level HEDIS diabetes indicators linked to patient-level HOS data.
  • Hierarchical linear models estimated the relationship between plan HEDIS performance on diabetes QIs and 2-year change in HOS physical and mental health scores.
  • Each 10% point improvement in plan performance on intermediate outcomes (i.e., the proportion of well-controlled diabetes) was related to significant increase in the probability of being healthy for physical health scores (7 percentage point increase, P 0.05) and mental health scores (11 percentage point increase, P 0.01).

Source: Harman et al. Medical Care 2010

Slide 28

 Identifying Populations at Risk CART Analysis

Identifying Populations at Risk CART Analysis

Slide 29

 Sample CART Tree Profile

Sample CART Tree Profile

Image: A Sample CART Tree Profile is shown.

Slide 30

 CART Risk Profiles

CART Risk Profiles

Sample Groups Formed by CART Analysis CART:

  • Health + Socio-Economic Determinants
  • (Health Very Good to Excellent Age < 50) Middle to High Income Employed
  • (Health Very Good to Excellent  Age < 50) Lower to Middle to  Income Not Employed
  • (Health Good to Excellent Age ≥ 50) Low Income
  • (Health Poor to Average Age ≥ 50) Working Part Time Household Size 2 or less Language-Non English
  • (Health Poor to Average Age ≥ 50) Working Part Time Household Size 3 or more Language-Non English

Slide 31

 Data Linkages

Data Linkages

  • Physician Claims
  • Pathology Data
  • Hospital Discharge Data
  • Performance Data
  • Other:
    • Census
    • Other Surveys
    • Lab Data
    • EMR?
    • All Payer Databases?

Slide 32

 Future Directions: A 21st Century Data Strategy

Future Directions: A 21st Century Data Strategy

  • Survey Development: Asking What Matters
  • Fostering Data Linkages
  • Oversampling of Diverse Populations
  • Knowledge Translation (Translating Research into Practice)
  • Support Priority Setting, Inform Policy and Practice, Monitor Progress
  • Innovative Analyses and Pragmatic Trials
  • Community Engagement

Slide 33

For More Information  

For more information, please contact us:

POWER Study
St Michael's Hospital
30 Bond Street (193 Yonge Street, 6th Floor)
Toronto, ON M5B 1W8
Telephone: (416) 864-6060, Ext. 3946
Fax: (416) 864-6057

www.powerstudy.ca
powerstudy@smh.toronto.on.ca

The POWER Study is funded by Echo: Improving Women's Health in Ontario, an agency of the Ministry of Health and Long-Term Care. This presentation does not necessarily reflect the views of Echo or the Ministry.

Current as of December 2010
Internet Citation: A 21st Century Data Strategy for Health and Health Care Surveys: Their Unique Contribution to Improving Health Outcomes and Reducing Disparities. December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2010/bierman/index.html