Reporting health data for large urban areas presents numerous challenges. In the case of Toronto, Ontario, amalgamation in 1998 merged six census subdivisions into one mega-city, resulting in the disappearance of standard reporting units. A population-based approach was used to define new health planning areas. Census tracts were used as building blocks and combined according to residential income homogeneity, respecting natural and man-made boundaries, forward sortation areas and the City of Toronto's community neighbourhoods whenever possible. Correlations and maps were used to establish area boundaries. The city was divided into 5 major planning areas which were further subdivided creating 15 minor areas. Both major and minor areas showed significant differences in population characteristics, health status and health service utilization. This commentary demonstrates the feasibility and describes the outcomes of one method for establishing planning and reporting areas in large urban centres. Next steps include the further generation of health data for these areas, comparisons with other Canadian urban areas, and application of these methods to recently announced Ontario Local Health Integration Networks. These areas can be used for planning and evaluating health service delivery, comparison with other Canadian urban areas and ongoing monitoring of and advocacy for equity in health.
To examine the potential effectiveness and efficiency of different guidelines for statin treatment to reduce deaths from coronary heart disease in the Canadian population.
Modelled outcomes of screening and treatment recommendations of six national or international guidelines--from Canada, Australia, New Zealand, the United States, joint British societies, and European societies.
Details for 6760 men and women aged 20-74 years from the Canadian Heart Health Survey (weighted sample of 12,300,000 people) that included physical measurements including a lipid profile.
The number of people recommended for treatment with statins, the potential number of deaths from coronary heart disease avoided, and the number needed to treat to avoid one coronary heart disease death with five years of statin treatment if the recommendations from each guideline were fully implemented.
When applied to the Canadian population, the Australian and British guidelines were the most effective, potentially avoiding the most deaths over five years (> 15,000 deaths). The New Zealand guideline was the most efficient, potentially avoiding almost as many deaths (14,700) while recommending treatment to the fewest number of people (12.9% of people v 17.3% with the Australian and British guidelines). If their "optional" recommendations are included, the US guidelines recommended treating about twice as many people as the New Zealand guidelines (24.5% of the population, an additional 1.4 million people) with almost no increase in the number of deaths avoided.
By focusing recommendations on people with the highest risk of coronary heart disease, the Canadian, US, and European societies guidelines could improve either their effectiveness (in terms of hundreds of avoided deaths) or efficiency (in terms of thousands of fewer people recommended treatment) in the Canadian population.
Cites: Int J Epidemiol. 2004 Apr;33(2):235-915082618
Cites: J Chronic Dis. 1985;38(4):339-513923014
Cites: N Engl J Med. 1988 Jun 30;318(26):1728-333374545
Cites: JAMA. 1999 Dec 22-29;282(24):2340-610612322
Cites: S Afr Med J. 2000 Feb;90(2 Pt 2):164-74, 176-810745972
Cites: JAMA. 2000 Jun 14;283(22):2935; author reply 293610865266
Cites: BMJ. 2000 Oct 14;321(7266):950-311030691
Cites: JAMA. 2001 Jul 11;286(2):180-711448281
Cites: Med J Aust. 2001 Nov 5;175 Suppl:S57-8511758552
Cites: Lancet. 2002 Jul 6;360(9326):7-2212114036
Cites: CMAJ. 1992 Jun 1;146(11):1969-741596846
Cites: Circulation. 1998 May 12;97(18):1837-479603539
Approximately 1.5% of ontario's population, represented by the top 5% highest cost-incurring users of ontario's hospital and home care services, account for 61% of hospital and home care costs. Similar studies from other jurisdictions also show that a relatively small number of people use a high proportion of health system resources. Understanding these high-cost users (hcus) can inform local healthcare planners in their efforts to improve the quality of care and reduce burden on patients and the healthcare system. To facilitate this understanding, we created a profile of hcus using demographic and clinical characteristics. The profile provides detailed information on hcus by care type, geography, age, sex and top clinical conditions.
Cites: J Health Serv Res Policy. 2003 Oct;8(4):215-2414596756
Variations in quality of care persist despite an increased understanding of optimal practice and an improved ability to monitor outcomes. The reporting of hospital standardized mortality ratios (HSMRs) is an important step in highlighting the need to improve quality; but, as with most measures, the HSMR is not without flaws. Intense debate in the United Kingdom and the United States, and now here in Canada, has focused too much on the shortcomings of this measure and not enough on the issue at hand. The Ontario Ministry of Health and Long-Term Care--assuming our commitment to steward the healthcare system--embraces the themes of transparency and accountability as key tools in focusing attention on system performance and quality. The analysis of HSMRs in Ontario has indicated limitations to its interpretation, similar to those observed in the Winnipeg Regional Health Authority. The HSMR may not be a specific measure of adverse events, but this does not negate its usefulness in tracking the impact of quality improvement initiatives over time; it may be considered a valuable tool among a suite of indicators. In light of this, there is an opportunity to develop better statistics, including better data and measurement frameworks, and to educate the public to facilitate accurate interpretation, which will drive improvements in practice, quality and patients' experiences.
The Child Health Network for the Greater Toronto Area (CHN), a network of 20 hospitals and 9 community care access centres, assessed one component of its early progress in building a regionalized system of perinatal care. Focusing on the relationship between hospital level of care and gestational age, the study showed that most births occurred at appropriately designated facilities. However, a quarter of newborns of gestational age
To examine unregistered births in Ontario and consider related factors, including adoption of administrative fees for birth registration.
Documents from both the parents and the attending physician are required for births to be entered into Ontario's live birth database. Our study used data from the Ontario Registrar General to look at the prevalence and characteristics of unregistered births, and a survey of municipal clerks to identify municipalities charging fees for parental documentation.
The percentage of births going unrecorded increased threefold from 1991 to 1997. The odds of an unregistered birth were higher for teenage mothers, low birthweight babies, and mothers residing in a municipality that charged birth registration fees.
The introduction of registration fees by some municipalities appears to account for an increase in unregistered births. It is recommended that the Ontario Registrar General work to remove financial and administrative barriers that compromise birth statistics.