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
Director, MCHP; Associate Professor, Faculty of Medicine CIHR/PHAC Applied Public Health Chair
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.)
Population- Based Health Registry
Hospital Home Care Pharmaceuticals Cost Vital Statistics Provider Nursing Home Medical Family Services Education Immunization Census Data at EA level National surveys
www.umanitoba.ca/centres/mchp/
Website Full reports Four-pagers News releases Briefings
Health at top levels (Ministers, Deputy Minister)
Days, Winnipeg RHA Days, Manitoba Health Days) – Look for the STORIES!
Burntwood Nor-Man Interlake Parkland Assiniboine North Eastman Central South Eastman Brandon Winnipeg Churchill Burntwood Nor-Man Interlake Parkland Burntwood Nor-Man Interlake Parkland Assiniboine North Eastman Central South Eastman Brandon Winnipeg Churchill
– MCHP, RHAs, Manitoba Health – CIHR KT Award for Regional Impact in November 2005 – Lots of publications, presentations
Conceptual model of the MCHP/RHA/MH collaboration: The Need To Know knowledge translation model
New knowledge creation and development Development of RHA-relevant capacity Communication, dissemination and application
Accessible information Training of RHA team members Training of academics
Martens & Black 2001
The Need To Know Team (originally CIHR- funded): partnership of MCHP, Manitoba Health, and RHAs
reports, plus several publications:
June 2003
2004
health care use and
– RHA Indicators 2008 – -brainstorming ideas!
Degree of involvement of users / decision-makers Low High
Results sent to users Users given help to under- stand results Users are involved in “working group” to assist researchers in interpreting information Users collaborate to frame the research at the start, and to be involved throughout
Degree of involvement of users / decision-makers Strength and relevance of research Low Low High High
The basis of change! Good KT, evidence- based decisions Dangerous territory - the anecdote reigns supreme in decision-making Poor evidence, but it’s ignored (thank goodness) Evidence is there, but sits on a shelf
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
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
MANITOBA CENTRE FOR HEALTH POLICY
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
Figure 2.4.1: Percent of Residents (aged 10 years +) Within Each Category of Mental Illness Groupings 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
5 Major Disorders 'Cumulative' 24%
Residents with one or more of: Depression, Anxiety, Substance Abuse, Personality Disorders, or Schizophrenia
None 63%
Residents with no service use for mental illness disorders of any kind (This is the comparison group in all analyses) Residents with service use for mental illness disorders, but excluding people in the 'Cumulative' group
Other 13%
'Any' group = 'Cumulative' + 'Other' Percent of total Manitoba population
Page 38
Figure 4.2.9: All-Cause Physician Visit Rates by Sex and Cause Cumulative Disorders vs. No Disorders, 1997/98 - 2001/02
Respiratory Respiratory Circulatory Circulatory Musculoskeletal Musculoskeletal Ill-Defined Ill-Defined Nervous Nervous Endocrine/Metab Endocrine/Metab Genitourinary Injury & Poison All Others All Others Genitourinary Injury & Poison Pregnancy/Birth Respiratory Circulatory Musculo- skeletal Ill-Defined Nervous Endocrine/Metab Genitourinary Injury & Poison All Others Mental Pregnancy/Birth 1 2 3 4 5 6 7 8 9 10
Cumulative No Disorders Cumulative No Disorders
Age-adjusted annual rate of visits to all physicians, per resident
Males Females
Page 138
Respiratory Circulatory Musculo- skeletal Ill-Defined Endocrine/Metab Injury & Poison All Others Mental Genitourinary Nervous
Page 148
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
Income Not Found Lowest Rural R1 R2 R3 R4 Highest Rural R5 Lowest Urban U1 U2 U3 U4 Highest Urban U5 males females
Linear Trend Test Results Urban Male: Significant (p<.01) Urban Female: Significant (p<.01) Rural Male: Significant (p<.001) Rural Female: Significant (p<.001) Male: 2.4% Female: 1.4%
Figure 4.4.4: Visit Rates to Psychiatrists for Mental Illness Disorders for those with Cumulative Disorders by Income Quintile, 1997/98-2001/02
Age-adjusted annual rate of visits per resident aged 10 years +
5 years prior to PCH admission in 2002/03
cumulative mental illnesses 39%
illnesses 36% none 25%
Residents of PCH
cumulative mental illnesses 44%
illnesses 40% none 16%
Dementia: 46% Depression: 34% Dementia: 67% Depression: 35% Any mental illness: 75% Any mental illness: 83%
“This report has been very useful for the mental health community
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
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
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
strategies regarding screening and monitoring of hypertension
reasons for low rates of medical intervention
strategy to address key risk factors
women and men
than Manitoba rate
cardiac catheterization, angioplasty and coronary artery bypass graft surgery than the province & is one of the lowest when compared to
persons with at least one physician visit for hypertension than the province
How The Need to Know Team has informed Health Planning: CANCER SCREENING
below provincial average
– lowest of Rural South RHAs – For all age groups – Oldest age group has lowest rate – Variation among sub region geographies, 3 of 4 districts low
rates
late diagnosis
Addressing Cervical Cancer Screening
implementation and ongoing evaluation of organized screening programs
– Manitoba legislated Cervical Cancer Screening Program
influences related to lack of access to female screeners
– Implementation of Women's Health Clinics
– Questions of interest to the users, increases validity
– learning about the research findings – High tech is not as important as personal relationships
– district and RHA level
ACCESSIBLE, AND DISSEMINATED
EVIDENCE-INFORMED DECISION MAKING
representations)
how to overcome)
Effort (approach) Type of group you are addressing Uniform Indirect Diverse Direct
Political Leader
with it, emotionally resonant)
CEOs
more complex,
Scientists Public outreach
with it, emotionally resonant)
Based on Gardner H. Changing Minds – the Art and Science of Changing Our Own and Other People’s Minds. Boston: Harvard Business School Press, 2006.
To develop collaborative relationships, it takes:
this type of research team
Bowen S, Martens PJ. A model for collaborative evaluation of university-community partnerships.
Bowen S, Martens PJ, The Need To Know Team. Demystifying “Knowledge Translation”: Learning from the community. Journal of Health Services Research & Policy 2005;10(4):203-211.
www.umanitoba.ca/centres/mchp/