Making a Difference in the

Health of Canadians: CIHI's

Health Data and Information

Breakfast with the Chiefs

March 22, 2006

Glenda Yeates, President and CEO

Vision

• CIHI improves the health of Canadians and

strengthens their health system by:

developing, integrating and disseminating timely and

relevant health and health services information, and

by facilitating informed discussion and evidenced-

based decision-making

Our Mandate

• To serve as a national coordination mechanism for healthinformation in Canada

• To provide accurate and timely information that is requiredfor:

Sound health policy

Effective management of health caresystem

Public awareness of healthdeterminants

• Through the work carried out by the Canadian PopulationHealth Initiative (CPHI), CIHI aims to:

Foster a better understanding of factors that affect the healthof individuals and communities; and

Contribute to developing policies that reduce inequities andimprove the health and well being of Canadians

Governance

• 16-member Board, proportionally constituted to:

Create a balance among health sectors and regions

of Canada

Link F/P/T governments with non-government health

related groups

Provide strategic guidance to CIHI and Health

Statistics Division of Statistics Canada

Advise the Conference of Deputy Ministers of Health.

Toronto

OttawaVictoria

Edmonton

Our OfficesOver 500 employees across Cana

Regional offices in Western Canaand in Montreal

To be opening an office in theAtlantic region

Montreal

From Vision to Action

Premier Source of Information –Collaboration is key

• CIHI facilitates the collaboration of many different

groups of stakeholders, who collectively join to

form Canada’s health information infrastructure.

Statistics Canada

Ministries ofHealth

RegionalHealthAuthorities

Health facilities

Public andPrivate SectorOrganizations

ProfessionalAssociations

Advocates

Researchers

Who we serve –Our Target Audiences

• Policy-makers

• Health System Managers

• Members of the Public

Where we have made progress

• More Databases

• More analyses

• Timeliness

• Data Quality

Data Holdings - 1994

• Health ServicesDAD

Hospital Morbidity

Hospital Mental Health

Therapeutic Abortions

Organ Registry (CORR)

Trauma Registry (OTR)

• Health Professionals

Physician

– NPDB

– SMDB

Nursing

– RNDB

Health Personnel

• Health Expenditures

Provincial, regional,

and local (CMDB)

National (NHEX)

International (OECD)

Data Holdings - 2005Health Services

Discharge Abstract Database (DAD)Hospital MorbidityAmbulatory Care (NACRS)Hospital Mental HealthTherapeutic AbortionsOrgan Registry (CORR)Trauma Registry (NTR/OTR)Joint Replacement Registry (CJRR)Continuing Care (CCRS)Rehabilitation (NRS)Ontario Mental Health ReportingSystem (OMHRS)Medical Imaging Technology (MIT)

UNDER DEVELOPMENT

Home Care Reporting SystemPharmaceutical (NPDUIS)Medication Incident Reporting(CMIRPS)

Health Professionals

Physician

– NPDB, SMDB

Nursing

– RNDB, LPNDB

– RPNDB

Health Personnel

Five new HHR databasesunder development e.g.Pharmacists and O.T.

Health Expenditures

Provincial, regional, andlocal (CMDB)

National (NHEX)

International (OECD)

Publications

2000-2001:

• Total number of analytical reports released = 18

• CIHI released it first Annual Health Care in

Canada Report.

2005-2006:

• Total number of analytical reports

planned/released = 48

Media Citations

0

250

500

750

1000

1250

1500

1750

2000

2250

2500

2750

1996-

97

1997-

98

1998-

99

1999-

00

2000-

01

2001-

02

2002-

03

2003-

04

2004-

05

Broadcast

Newspaper

Journal Citations

0

20

40

60

80

100

120

2000-01 2002-03 2003-04 2004-05

Supporting Policy-makers

• Support for Income

Testing (e.g. in Fair

Pharmacare Program)

Inter-provincial

comparison data

presented in Health

Care in Canada used to

plan changes related to

the structure of

Pharmacare

Supporting Health Care Management

• Ministry of Health and RHA Performance

Agreements

Data based on CIHI data standards are used to

populate performance agreements between the MOH

and the RHAs

• Reference Based Drug Pricing in BC

CIHI data were used to evaluate the use of Reference

Drug Program (RDP). The evaluation indicated that

the use of RDP did not negatively affect health and

saved money

Looking Forward

• Enhanced analytical products

• Continued database development

• Increased emphasis on data quality

• New tools for better access to information

• Regional connections

Enhanced Analytical Products

• Access to care/Wait times

• Quality/Outcomes of health services

• Health Human Resources

• Population Health activities

• Costs/expenditures

New Indicator Development

• Safer Healthcare Now!

• Hospital Standardized Mortality Rates

(HSMR)

• Primary Health Care Indicators

Continued Database Development

• Drug Utilization Database

• Medication Incident Reporting

• Health Human Resources

• Focus on adding new jurisdictions to

existing databases e.g.

Ambulatory Care/E.R.

Home Care Reporting System

Addressing Data Quality

• Timeliness

• Data Quality Strategy including

re-abstraction studies

• Data Quality Progress Reports to

Deputy Ministers of Health

CIHI’s Evolving External Electronic Data Access& Analytical Sophistication

QuickStats (2002)

eReports (2001)

CIHI Portal (2005)

Public View

Aggregate, Static Repor for Health Care

Stakeholders

Detailed, ad hoc reportfor authorized

Health Care Stakeholde

Portal Features

• Secure access to pan-Canadian CIHI data

• Powerful web-based analytical tools

• Custom facility comparisons

• Patient de-identified analysis

• Standardized templates

• Peer collaboration

• User-specific e-Learning

On Quality and Outcomes-Health Care in Canada

• This report was

released in June 2005

and focused on

volumes and

outcomes

Low VolumesWhat Are The Odds?

Mortality by Hospital Volume Quintile:Abdominal Aortic Aneurysm Repair

3.0% 3.0%

2.2%2.4%

1.8%

0%

1%

2%

3%

4%

Lowest HighestHospital Volume

Ad

jus

ted

30

-Da

y I

n-H

os

pit

al

Mo

rta

lity

On Access to Care/Wait timesWaiting for Health Care in Canada

• Waiting for Health Care in

Canada: What We Know

and What We Don’t Know

is the first report of this

kind

• Released on March 7,

2006

Leading Reasons Cited forAccess Problems Differ

• Routine/on-going care

Difficulties getting an appointment

• Pap smear/mammography

Didn’t think it was necessary

• Specialist care for new health problem & selected

non-emergency tests (MRI, CT, angio)

Waited too long for an appointment

• Non-emergency surgery

Waited too long

What Type of Care you Need

next day (day after admission)Hip Fracture

Months(with knees > hips)

Joint Replacement

a few monthsCataract

days to weeksCardiac

Median WaitType of Surgery

Waits for Angioplasty or BypassSurgery Following a New Heart Attac

Waited 137days or lesWaited 23 days or less90% of patients

Waited 18 days or lesWaited 4 days or lessMedian

Waited 6 days or lesWaited 0 days10% of patients

CABGAngioplasty

Medical Imaging in Canada, 2005

• Third annual report

• Information on

supply, distribution,

utilization, costs

and personnel

• New this year was

the information on

utilization

Number of MRI Exams per 1,000 Population, byJurisdiction and Canada, 2003–2004 and 2004–2005

0

1 0

2 0

3 0

4 0

5 0

6 0

N.L. P.E.I. N.B. Que. Ont. Man. Sask. Alta. B.C. Can.

2003–2004 2004–2005

Average Number of MRI and CT Exams per 1,000Population, Per Scanner, US, England & Canada, 2004-2005

7,745

--

5,298

CT

87.3

43.0

172.5

CT MRIMRI

4,66625.5Canada

3,51319.0England

3,41283.2United States

Exams per ScannerExams per 1,000population

Country

Number of MRI Scanners in Hospitals and Free-Standing Imaging Facilities, Canada, 1998 to2005.

38

69

115119 121

130

2 4 715 19

25 27 28

148

46

0

20

40

60

80

100

120

140

160

1998 1999 2000 2001 2002 2003 2004 2005

Year

Nu

mb

er o

f M

RI S

can

ners

Hospitals

Free Standing

Facility-Based Continuing Care in

Canada

• Report is being

released today

• First report that sheds

some light on a sector

of the health care

system that until now,

we have known very

little about.

Five Most Common DiseaseCategories/Diagnoses on Admission,Residential Continuing Care

19%Psychiatric/Mood

34%Endocrine/Metabolic/Nutritional

40%Musculoskeletal

65%Heart/Circulation

77%Neurological

% of residents with MDSAssessments

DiseaseCategories/Diagnoses

On Health Human ResourcesGeographic Distribution of Physicians

in Canada

• Report co-authored byRoger Pitblado and RayPong, Centre for Rural andNorthern Health Research,Laurentian University

• 1999 report described thedistribution of Canada’sphysicians in 1991 and1996

• New in this report is anexamination of the types ofservices family doctorsprovide in urban and ruralsettings

Urban-Rural Distribution of Family Physicianand Specialist Physicians, Canada, 2004

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Rural 16.0% 2.4%

Urban 84.0% 97.6%

Family Physicians Specialist Physicians

N t C iti ith f th 10 000 l d fi d “ l”

Percent of Large City and Small Town FamilyPhysicians Who Provide Various Types ofHealth Care Service, Canada, 2004

8.5%

12.1%

19.5%

15.3%

32.9%

40.4%

41.8%

73.9%

0% 20% 40% 60% 80% 100%

Delivering Babies

Hospitalist Care

Cancer Care &

Oncology

Emergency

Medicine

Large City Small Town

Note: “Large cities” are cities with one mill ion or more people “Small towns” have populations of less than 10 000 where

Average Distance to Physicians forResidents of Large Cities and Small Towns,Canada, 2004

2.1

2.5

3.2

0.7

91.9

103.3

100.5

10.5

0 20 40 60 80 100 120

Psychiatrist

Pediatrician

OB/GYN

Family Physician

Kilometers

Large Cities Small Towns

Note: “Large cities” are cities with one mill ion or more people “Small towns” have populations of less than 10 000 where

Number of Physicians Moving Abroad andReturning From Abroad, Canada, 1969-2004

0

100

200

300

400

500

600

700

800

900

1969

1970

1971

1972

1973

1974

1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Moved Abroad Returned From Abroad

Source: Southam Medical Database CIHI

On Population HealthImproving the Health of Canadians:

Promoting Healthy Weights

• Focus: how where welive, learn, work and playcan make it easier – orharder – to make choicesthat promote healthyweights.

• Reviews research andpresents analyses

• Reviews relevantprograms and policies

• Presents information onthe Canadian public’sviews on options topromote healthy weights

Adults Living in the Urban Core ReportLower BMIs (< 25)

Source: CPHI analyses of CCHS 2.2 (2004) and Census 2001, Custom Tabulation.

* Significantly different from Urban Core p < 05

52%45%* 45%* 44%* 46%* 43%*

0%

25%

50%

75%

100%

Urban

Core

Urban

Fringe

Urban

Area

Outside

CMA/CA

Secondary

Urban

Core

Rural

Fringe

Rural Area

Outside

CMA/CA

Physical Inactivity and Income(% Adults age 18+)

Source: CPHI analyses of CCHS 2.2 (2004), Custom Tabulation.

66%* 67%* 64%*58%*

50%

0%

25%

50%

75%

100%

Q1

(Lowest)

Q2 Q3 Q4 Q5

(Highest)

On Costs and ExpendituresExploring the 70/30 Split: How Canada's

Health Care System Is Financed

• Today, about 70% oftotal Canadian healthexpenditures comes fromthe public purse. Theremainder (about 30%)comes from privatesources.

• This report, which wasreleased in September2005 looks at trends infinancing and atvariations in this 70/30split across provinces

d t it i

Total Health Expenditure Per Capita, 15 SelectedCountries, 2003

684

705

1,535

1,960

2,031

2,450

2,669

2,967

3,088

3,204

3,534

4,976

5,041

5,635

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000

Hungary (e)

South Korea

Spain

Australia (a)

United Kingdom (a)

Japan (e)

CANADA (e)

France (e)

Netherlands

Germany

Denmark

Norway (e)

Switzerland (e)

United States

$ Per Capita ($US Exchange Rate)

Source: OECD Health Data 2005

OECD Average - $2349

Total Health Expenditure as a Percent of GDP, 15Selected Countries, 2003

5.6%

6.2%

7.7%

7.7%

7.9%

8.4%

9.3%

9.8%

9.9%

10.1%

10.3%

11.1%

11.5%

15.0%

9.0%

0.0% 3.0% 6.0% 9.0% 12.0% 15.0% 18.0%

Korea

Mexico

Spain

United Kingdom (a)

Japan (e)

Hungary (e)

Denmark

Australia (a)

Netherlands

CANADA (e)

France (e)

Norway (e)

Germany

Switzerland (e)

United States

OECD Average – 8.7%

Source: OECD Health Data 2005

Sources of Health Spendingin Canada 2003

14%

12%

3%

70%

Public Out-of-Pocket

Private Insurance All Other Private Funds

Public Spending in 2003

0

10

20

30

40

50

60

70

80

90

100

Hospitals Physicians Drugs Dental

France

Germany

Canada

Percentage of Services Covered by Public Funds

Source: OECD Health Data 2005

Per Capita Health Spending

$291$2,214$2,903France

$312$2,343$2,996Germany

$793$2,503$5,635U.S.

$448$2,098$3,001Canada

Out-of-pocket spendingcapita (in U.S.$)

Public-sector health spendingper capita (in U.S.$)

Health spending percapita (in U.S.$)

Note: All numbers represent 2003 data unless otherwise noted. Spending percapita was converted to U.S. dollars using purchasing power parities for GDP.

Source: Health at a Glance—OECD Indicators 2005.

Where we need your help

• Identifying priority information needs

• Timeliness of our data

reliance on providers to supply timely data

• Data Quality

Support with our data quality strategies

The Road Ahead. . .