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Methods to quantify the burden of morbidity in populations and the resulting need for health care services have important applications in the management and financing of health systems. In the [...], Objectives. To assess the ability of an Adjusted Clinical Group (ACG)-based morbidity measure to assess the overall health service needs of populations. Data Sources/Study Setting. Three population-based secondary data sources: registration and health service utilization data from fiscal year 1995--1996; mortality data from vital statistics reports from 1996-1999; and Canadian census data. The study included all continuously enrolled residents in the universal health care plan in Manitoba. Study Design. Using 60 small geographic areas as the units of analysis, we compared a population-based 'ACG morbidity index,' derived from individual ACG assignments in fiscal year 1995-1996, with the standardized mortality ratio (ages Data Extraction Methods. The ACGs were assigned based on the complement of diagnoses assigned to persons on physician claims and hospital separation abstracts. The ACG index was created by weighting the ACGs using average health care expenditures. Principal Findings. The ACG morbidity index had a strong positive linear relationship with the subsequent rate of premature death in the small areas of Manitoba. The ACG index was able to explain the majority of the relationships between mortality and both socioeconomic status and physician utilization. Conclusions. In Manitoba, ACGs are closely related to premature mortality, commonly accepted as the best single indicator for health service need in populations. Issues in applying ACGs in settings where needs adjustment is a primary objective are discussed. Key Words. Case-mix adjustment, mortality, health status indicators, population, Canada, morbidity, health resources

Variations in hospital admission rates across small areas are ubiquitous, and it is increasingly assumed that high rates result from physicians' discretionary decisions. Data for elderly patients from the health [...]

Objective: To examine health services, social services, education, and justice system outcomes among First Nations children and youth with fetal alcohol spectrum disorder (FASD).Methods: In this retrospective cohort study, health and social services, education, and justice data were linked with clinical records on First Nations (FN) individuals aged 1 to 25 and diagnosed with FASD between 1999 and 2010 (n= 743). We compared the FN FASD group to non-FN individuals with FASD (non-FN FASD; n= 315) and to First Nations individuals (matched on age, sex, and income) not diagnosed with FASD (FN non-FASD; n= 2229). Rates and relative risks (RRs) were calculated using generalized linear models.Results: FN FASD individuals had similar health services use to non-FN FASD individuals but had greater involvement with child welfare (RR, 1.20; 95% confidence interval [CI], 1.02 to 1.41) and the justice system (RR, 1.37; 95% CI, 1.07 to 1.74) and were more likely to be charged with a crime (RR, 1.40; 95% CI, 1.05 to 1.86). There were no suicides/suicide attempts among the non-FN FASD individuals during the study, but the crude rate/100 person-years of suicides among FN FASD individuals (0.22 for females; 1.06 for males) was substantially higher than for FN non-FASD individuals (0.08 for females; 0.32 for males). There were no significant differences between groups in the education outcomes we measured.Conclusions: Young people with FASD are at risk for poor health, education, and social outcomes, but First Nations young people with FASD face comparably higher risks, particularly with child welfare and justice system involvement. The study emphasizes a critical need for appropriate resources for First Nations children with FASD.

Potential for inpatient-outpatient substitution with diagnosis-related groups Through analysis of data from the universal health insurance system in Manitoba, Canada, surgical diagnosis-related groups (DRG's) with the greatest potential for inpatient-outpatient [...]

Appointing a representative from the drug industry to the Canadian Institutes of Health Research (CIHR) governing council (1), and particularly a representative from Pfizer, seems inappropriate given that industry's, and [...]

Report some novel associations seen between maternal diabetes in pregnancy (DIP) and infant morbidity over the first year of life.

BACKGROUND: Few population studies have examined the psychiatric outcomes of children and adolescents in the child welfare system, and no studies have compared outcomes before and after entry into care. Our objective was to assess the relative rate (RR) of suicide, attempted suicide, admission to hospital and visits to physicians’ offices among children and adolescents in care compared with those not in care. We also examined these outcomes within the child welfare population before and after entry into care. METHODS: We used population-level data to identify children and adolescents 5 to 17 years of age who were in care in Manitoba for the first time between Apr. 1, 1997, and Mar. 31, 2006, and a comparison cohort not in care. We compared the two cohorts to obtain RRs for the specified outcomes. We also determined RRs within the child welfare population relative to the same population two years before entry into care. RESULTS: We identified 8279 children and adolescents in care for the first time and a comparison cohort of 353 050 children and adolescents not in care. Outcome rates were higher among those in care than in the comparison cohort for suicide (adjusted RR 3.54, 95% confidence interval [CI] 2.11–5.95), attempted suicide (adjusted RR 2.11, 95% CI 1.84–2.43) and all other outcomes. However, adjusted RRs for attempted suicide (RR 0.27, 95% CI 0.21–0.34), admissions to hospital and physician visits decreased after entry into care. INTERPRETATION: Children and adolescents in care were at greater risk of suicide and attempting suicide than those who were not in care. Rates of suicide attempts and hospital admissions within this population were highest before entry into care and decreased thereafter.

Introduction:Il est prouvé que les gradients socioéconomiques de la santé des adultes changent au fil du temps, mais on a peu étudié les changements temporels dans les gradients de la santé des enfants. Les hospitalisations d’enfants à la suite de blessures diminuent depuis 20 ans; on ignore cependant si le gradient socioéconomique des blessures chez les enfants a changé. Méthode:À l’aide des données en population sur les sorties des hôpitaux, nous avons calculé les taux d’hospitalisations à la suite de blessures de 1986-1987 à 2005-2006 chez tous les enfants de moins de 20 ans du Manitoba (nombre moyen d’hospitalisations par année = 326 357). Les renseignements sur le statut socioéconomique (SSE) proviennent des données régionales du Recensement et sont attribués selon le code postal résidentiel. Nous avons employé des modèles linéaires généralisés avec des équations d’estimation généralisées pour décrire la relation entre le SSE et les taux de blessures et pour déterminer si cette relation a changé au fil du temps. Nous avons examiné les blessures toutes causes confondues, ainsi que les blessures dues aux collisions entre véhicules automobiles (CVA), les autres blessures liées aux véhicules, les blessures auto-infligées, les voies de fait, les empoisonnements, les blessures causées par des machines, les blessures causées par la pratique d’un sport et les chutes. Résultats:Les hospitalisations d’enfants à la suite de blessures ont diminué de façon soutenue au cours de la période de l’étude, soit de 1,07 % à 0,51 %. Le SSE était un prédicteur significatif des hospitalisations à la suite de blessures (p<0,0001): les enfants de SSE inférieur présentaient des taux plus élevés. Une interaction significative du SSE et de l’année (p<0,0001) montre que le gradient SSE pour les hospitalisations à la suite de blessures s’est accru au fil du temps. L’analyse par type de blessure a mis au jour une interaction significative du SSE et de l’année pour les CVA, les blessures auto-infligées et les chutes; pour les CVA et les blessures auto-infligées, la tendance (gradient SSE croissant) était semblable à celle pour toutes les hospitalisations à la suite de blessures. La tendance pour les chutes était irrégulière. Conclusion:Malgré la diminution générale des hospitalisations à la suite de blessures au fil du temps, le gradient SSE des taux d’hospitalisations à la suite de blessures s’est accru.

We examined medical, educational and social risks to children of teen mothers and children of nonadolescent mothers with a history of teen birth (prior teen mothers) and considered these risks at both the individual and societal level.

Social risk factors are often less vigorously pursued in clinical assessments of infant risk than are biologic risk factors. We examined the relative importance of early social and biologic risk factors in predicting poor health and educational outcomes in children.

This study developed an index of physician hospitalization practice style distinguishing physicians more prone to hospitalize patients from physicians less prone to hospitalize. The patients of physicians with markedly differing hospitalization styles are shown to be similar in such important characteristics as age, access to physicians, number of reported health problems, amount of time spent ill in bed, etc. In multivariate analysis, only proximity to death is found to have a greater impact than physician practice style on an elderly patient's probability of being hospitalized.

To assess the effects of health status at birth and health status in the preschool years on educational outcomes to age 9 in a population-based birth cohort. Administrative data were used to follow all children born to Winnipeg mothers in 1990, and remaining in Manitoba until September 2004 (N=5,873). A structural equation model was used, incorporating latent variables to represent Health Status at Birth, Major Illness and Minor Illness during the preschool years. The model also included the child’s sex and exact age, along with a number of social, economic, and demographic characteristics of the child’s family. The outcome was a combination of marks on Grade 3 Standards Tests and enrolment in the appropriate grade for age. Major Illness in the preschool years had a significant influence on progress and performance in school (p=0.0003), predicting 1.26% of the variation in the outcome. Minor Illness was weaker but still significant (p<0.01). Health Status at Birth was not directly related to the outcome; its effect was mediated by Major and Minor Illness in childhood. Overall, the strongest predictors were the child’s age and the area-level income, followed by the mother’s age, family receipt of income assistance, the sex of the child, breastfeeding initiation (all p<0.0001), and Major Illness. Health status plays a statistically significant but substantively small role in explaining progress and performance in school among a population-based cohort. Major Illness was more important than Minor Illness, and these two factors completely mediated the influence of Health Status at Birth on the outcome. The strength of the social, economic, and demographic variables underscores the importance of the broader factors that affect both health and educational outcomes. Évaluer les effets de l’état de santé à la naissance et au cours des années préscolaires sur les résultats pédagogiques jusqu’à 9 ans au sein d’une cohorte de naissance représentative. À l’aide de données administratives, nous avons suivi tous les enfants nés de mères vivant à Winnipeg en 1990 et habitant encore au Manitoba en septembre 2004 (N=5 873). Nous avons utilisé un modèle d’équations structurelles incorporant des variables latentes pour représenter l’état de santé à la naissance, et les maladies graves et bénignes contractées durant les années préscolaires. Le modèle indiquait aussi le sexe et l’âge exact de l’enfant, ainsi que certaines caractéristiques sociales, économiques et démographiques de sa famille. Le résultat final était la combinaison des notes obtenues aux examens standardisés de la 3eannée et de l’inscription dans une classe correspondant à l’âge de l’enfant. Les maladies graves contractées au cours des années préscolaires avaient une influence significative sur le cheminement et le rendement scolaires (p=0,0003), en prédisant 1,26 % de l’écart dans le résultat final. L’influence des maladies bénignes était plus faible, mais encore significative (p<0,01). L’état de santé à la naissance n’était pas directement lié au résultat; son effet était atténué par les maladies graves et bénignes durant l’enfance. Globalement, les prédicteurs les plus forts étaient l’âge de l’enfant et le revenu dans la région, suivis de l’âge de la mère, du fait que la famille touche une aide au revenu, du sexe de l’enfant, de l’allaitement maternel (tous ces facteurs, p<0,0001) et de l’existence d’une maladie grave. L’état de santé jouait un rôle significatif, mais tout de même assez faible, dans le cheminement et le rendement scolaires au sein d’une cohorte représentative. L’effet des maladies graves était plus important que celui des maladies bénignes, et ces deux facteurs compensaient entièrement l’influence de l’état de santé à la naissance sur le résultat. La force des variables sociales, économiques et démographiques souligne l’importance des facteurs généraux qui touchent à la fois la santé et les résultats pédagogiques.

Data from a population-based repository in Manitoba showed that students who are male, young for grade, and in Grades 1, 2, 7, and 8 were the most likely to be retained. After controlling for key student factors including socioeconomic status, school changes, and key school characteristics including stability of the student body, retention was a strong predictor of high school withdrawal rates. The odds of student withdrawal were 3 times higher for students who have been retained once and almost 8 times higher for students who had been retained more than once. Not only do withdrawal rates suggest that retention is potentially harmful, but also Grade 3 standards test results taken in consecutive years by retained students indicate that only one in four retained students improve their score. These results generally replicate the research done in the United States.

Numerous studies have established that socio-economic position is positively related to health status, but we know little about the real costs of these differences across an entire population. This paper estimates the potential savings in morbidity and dollars from reducing the inequalities in health among Winnipeg residents. We measure excess morbidity by examining rates of premature death, hip fracture, and heart attack according to the relative affluence of the Winnipeg neighbourhood. We also assess the total expenditures on physician and hospital care by neighbourhood of residence. We then estimate the savings that could have been achieved if 1) the health of the two poorest quintiles had been raised to the level of the middle quintile, and 2) the health of the poorest four quintiles had been raised to the level of the top quintile. Thirty-seven percent of Winnipeg’s premature deaths, 22% of the heart attacks, 20% of the hip fractures and 15% of total expenditures on hospitals and physicians ($62 million in 1 999 dollars) could have been avoided if residents of the less wealthy 80% of neighbourhoods enjoyed health similar to those in the wealthiest neighbourhoods. The potential savings from reducing the socio-economic-related differences in health are high, whether they are measured in terms of morbidity or dollars. Research is needed to determine the extent to which these potential savings are achievable. De nombreuses études ont confirmé l’existence d’un lien positif entre le statut socio-économique et l’état de santé, mais on sait très peu de choses sur les coûts réels des écarts socio-économiques à l’échelle d’une population. Nous avons voulu évaluer les économies possibles, en morbidité et en argent, d’une réduction des inégalités sur le plan de la santé dans la population de Winnipeg. Nous avons mesuré la surmorbidité en examinant les taux de décès prématurés, de fractures de la hanche et de crises cardiaques selon l’aisance relative des quartiers de Winnipeg. Nous avons aussi analysé les dépenses totales en soins médicaux et hospitaliers selon le quartier de résidence. Enfin, nous avons évalué les économies qui auraient pu être réalisées: 1) si la santé dans les deux quintiles les plus pauvres était haussée au niveau de celle du quintile intermédiaire et 2) si la santé dans les quatre quintiles les plus pauvres était haussée au niveau de celle du quintile supérieur. À Winnipeg, 37 % des décès prématurés, 22 % des crises cardiaques, 20 % des fractures de la hanche et 15 % des dépenses totales en soins hospitaliers et médicaux (62 millions, en dollars de 1999) auraient pu être évités si l’état de santé des résidents des quartiers les moins aisés (80 %) était le même que dans les quartiers les plus aisés. Il serait possible de réaliser d’importantes économies (qu’elles soient mesurées en morbidité ou en argent) en réduisant les écarts sur le plan de la santé liés au statut socio-économique. Il faudrait pousser la recherche pour déterminer la mesure dans laquelle de telles économies seraient réalisables.

This study examined whether Winnipeg hospitals experience predictable “high-volume periods” in order to determine whether hospital overcrowding might be anticipated and, therefore, avoided. We found that high-volume periods among medical patients occurred during all but one year between 1987 and 1998. Most high-volume periods occurred during influenza seasons. Preventing such recurrent bed pressures requires a multi-faceted approach, involving preventive efforts to reduce hospital admissions (influenza vaccination) and alternatives to managing the hospital system.

Trends in health status and healthcare utilization were examined for regions of Manitoba from 1985 to 2000. While the provincial premature mortality rate decreased, the difference between the northern and southern regions increased. Hospital admissions remained stable despite major bed closures and an aging population; a decrease in hospital days per capita was observed in all regions. Physician contact rates also remained constant despite a 40% increase in the number of seniors.

The use of healthcare services in Winnipeg is examined to determine whether groups who appear to have a higher need for medical care actually get more care. Despite universal coverage, considerable variation in service use rates exists. Most of the basic healthcare services are provided in accordance with need as measured by premature mortality rates. Nevertheless, visits to specialist physicians, a variety of high profile procedures, and screening and preventative services appear not to be provided in accordance with need.

To compare physician and hospital utilization rates by children across subregions of Manitoba. 1998/99 data for physician visits and hospitalizations for children aged 0 to 19 were extracted from the Population Health Research Data Repository. Rates of utilization were compared across 12 regions (RHAs) within Manitoba, and 12 community areas within Winnipeg. Rates were also compared across premature mortality rates (PMR) and area income levels. Substantial regional variation was found for utilization rates. The hospitalization rate for children from the three northern RHAs (highest PMRs) (114/1000) was almost four times the Winnipeg rate (30/1000) and almost double the rate for the rural south RHAs (lowest PMRs) (59/1000). The variation among regions in physician visits ranged from under 2 visits in 2 of the northern RHAs to almost 4 visits in urban areas. However, the low visit rates in rural RHAs are offset somewhat by greater use of nurses. Hospitalizations and physician visits were also related to area income level. Findings are discussed in terms of health care need. Comparer les taux d’hospitalisation et de visites chez le médecin pour les enfants des sous-régions du Manitoba. les données de 1998–1999 sur les visites chez le médecin et les hospitalisations des enfants (de 0 à 19 ans), proviennent du Population Health Research Data Repository. On a comparé les taux respectifs dans 12 ORS du Manitoba et 12 CR de Winnipeg, et comparés ces taux aux TMP et aux niveaux de revenu régionaux. D’importants écarts régionaux ont été observés. Le taux d’hospitalisation des enfants des trois ORS nordiques (dont les TMP étaient les plus élevés) (114/1 000) était près de quatre fois celui de Winnipeg (30/1 000) et près du double de celui des ORS du Sud rural (dont les TMP étaient les moins élevés) (59/1 000). Pour ce qui est des visites chez le médecin, elles étaient inférieures à deux dans deux des ORS nordiques, mais allaient jusqu’à quatre dans les agglomérations urbaines. Toutefois, le faible taux des visites chez le médecin dans les ORS ruraux était compensé dans une certaine mesure par le recours accru aux infirmières. Les hospitalisations et les visites chez le médecin présentaient aussi un lien avec le niveau de revenu. Ces constatations sont examinées dans l’optique des besoins en soins de santé.

This study examined the relative contribution of hypertensive patients and their physicians in selecting total annual physician visit frequencies and made regional comparisons between two Canadian cities. We found that the frequency of physician visits was primarily influenced by physician referrals and physician practice patterns, which accounted for about 80 percent of the total explainable variance in physician visits. The relative contribution of other available patient and physician characteristics in determining visit frequency was rather small.

This study was designed to describe patient characteristics associated with having a regular source of care among all patients who received care from large urban clinics in Manitoba over a three-year period (N = 298,222). Using administrative data, patients were classified as having a regular source of care if they made 75% or more of their total ambulatory visits to the same clinic. Overall, 44.2% of patients had a regular source of care. A logistic regression showed that children and adults aged 45 and older were more likely to have a regular source of care than patients aged 18–44. Moreover, patients with a regular source of care tended to live in more affluent neighbourhoods and were healthier than individuals with no regular source of care. Systemic changes might be needed to enhance continuity of care (e.g., mechanisms to enhance access) among vulnerable segments of the population like the poor. L’étude compare les caractéristiques des patients recevant des soins d’une source régulière et celles de tous les patients soignés dans de grandes cliniques urbaines du Manitoba sur une période de trois ans (n=298 222). À l’aide de données administratives, nous avons classé parmi les patients ayant une source de soins régulière ceux qui s’étaient rendus dans la même clinique pour au moins 75 % de leurs visites ambulatoires. Dans l’ensemble, 44,2 % des patients avaient une source de soins régulière. L’analyse de régression logistique montre que les enfants et les adultes de 45 ans et plus étaient plus susceptibles d’avoir une source de soins régulière que ceux de 18 à 44 ans. En outre, ils avaient davantage tendance à vivre dans des quartiers aisés et étaient en meilleure santé que ceux qui n’avaient pas de source de soins régulière. Il faudrait peut-être apporter des changements systémiques pour améliorer la continuité des soins (p. ex., des mécanismes facilitant l’accès) chez les segments vulnérables de la population, comme les pauvres.

The study compared each province's supply of surgeons in three specialities (ophthalmologists, orthopedic surgeons, and cardiac and thoracic surgeons) with the rates of key procedures (cataract removal, hip and knee replacement, and coronary artery bypass) that residents received. We found little or no relationship between the supply of surgeons and a population's surgery rate. We conclude that the supply of surgical specialists is the wrong focus for health care resource planning.

L'étude a comparé le nombre de chirurgiens de chaque province de trois spécialités (ophtalmologie, orthopédie et chirurgie thoracique et cardiologie) avec les taux d'interventions clés (cataracte, remplacement du genou et de la hanche, et pontage aortocoronarien) que les habitants subissent. Nous avons trouvé peu ou pas de lien entre le nombre de chirurgiens et les taux d'interventions subies par les habitants. Nous concluons donc que le nombre de chirurgiens spécialisés ne constitue pas une mesure pertinente pour la planification des ressources en soins de la santé.

While the adjusted clinical group (ACG) system has been extensively validated in the United States, its use in other developed nations has been limited. This article examines the performance of the system in 2 Canadian provinces and assesses the extent to which ACGs can account for same-year and next-year health care expenditures.

This article discusses methods of organizing and checking administrative data banks to increase their usefulness for research and evaluation. Examples are drawn from the studies using the Manitoba Health Services Commission data bank. The various uses of both manual and computerized checks are explained. A problem profile is presented for the Manitoba data bank; this profile summarizes different specific problems, incor porating new threats to internal validity associated with the use of data banks. The improvements in data collection represented by data banks are discussed in terms of developing multiple control group designs.

Although tonsillectomy-adenoidectomy rates are declining across North America, this paper suggests they are not falling fast enough. More than half the cases coming to surgery fail to meet accepted standards regardless of who performs the surgery, or where it takes place. Family surgery is still fairly common and is almost never indicated. While younger physicians have higher standards of selection, they are not doing any less T and A surgery than their older colleagues; in fact younger general surgeons are doing more. This study concludes that nonindicated T and A surgery is still a prevalent problem, deserving of widespread attention.

To determine if there are differences in physician services in different health care systems, we compared ambulatory visit rates and procedure rates for three surgical procedures in the province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States. The KP system, with its single payer and low financial barriers, is not unlike the Canadian system. But, for most of the United States, the primary payment mechanism is fee-for-service, with the patient paying a significant amount, thereby militating against preventive and early primary care. Manitoba and KP data were extracted from computerized administrative records. U.S. data were obtained from publicly available reports, Manitoba provides 1.8 times and KP 1.2 times (1.4 when allied health visits are included) as many primary care physician visits as the United States. For the surgical procedures studied, U.S. rates were higher than those in either the KP HMO or in Manitoba. We conclude that (1) the U.S. system leads to more surgical intervention, and (2) removal of financial barriers leads to higher use of primary care services where more preventive and ameliorative care can occur.

This paper explores outcomes associated with the tonsillectomy operation using multiple control groups and a large claims-based data bank from the Canadian province of Manitoba. Given the difficulty of conducting large-scale clinical trials of common surgical procedures, the use of multiple methods for evaluating such interventions is both advocated and implemented in this study.

Continuity of care is defined and measured in tenns of care received from a single physician, from several physicians practicing as a group and from physicians seen through referrals. All patients receiving tonsillectomy and adenoidectomy (T and As) in Manitoba for one year, as well as a group of similar individuals treated for respiratory illnesses but not having T and As, were studied. Several patient and physician characteristics were examined to determine their relationship to continuity of care. Continuity consistently increased with patient age, but appeared unrelated to several other variables. The links between continuity of care and quality of care were explored using process and outcome measures of quality. A cross-lagged panel analysis suggested no causal relationship between continuity and quality. These results contradict those of several other studies; they are important in that continuity of care is shown not to reduce one type of error of commission made by practitioners.

The association between group practice, on the one hand, and productivityand quality, on the other, is reviewed using data from a universal health insurance system. Although different patterns of practice were observed, only members of very small groups had higher patient volume than did solo practitioners. Diseconomies of scale in large groups are found. Patients were shown to visit group practitioners for somewhat more serious problems. Finally, group and solo physicians were compared both according to their standards of patient selection for tonsiladenoid surgery and according to the outcomes of this surgery. No differences in these measures of qualityof care were found.

Sociodemographic, health, and health care utilization data on a large representative sample of elderly and multiple logistic regression were used to compare persons making no visits to physicians for 2 years with those making few (one to three) visits but in contact with health practitioners. Results suggest that elderly nonusers are more likely than low users to be single, to have some degree of mental impairment, and to have low educational attainment. Using Cox's proportional hazards model to compare outcomes over the next 7 years, no differences were found in the subsequent hospitalization rate of the two groups, but nonusers were at greater risk of a hospitalization episode of 16+ days and appeared to die sooner than low users. However, they were at no greater risk of poor health outcomes than elderly making four or more physician visits in 2 years. The policy implications of the findings are discussed.

This study applies data from the Manitoba Longitudinal Study on Aging for two purposes. First examined were the hospital-utilization patterns of elderly nursing home admissions during the 2 years before and 2 years after entrance into a facility. In addition, use of the hospital by these new admissions and by long-term nursing home residents was compared with that of the use by the elderly living in the community. When age, sex, and mortality rate are taken into account, the results indicate that, although both new admissions and longterm nursing home residents are sicker than their community counterparts, they are significantly less frequently hospitalized.

This paper assesses our ability to use administrative data for developing indicators of health status. Traditionally, measures of health status have been derived from interviews. Here indicators from administrative data and from interviews are compared, i.e., their ability to predict important health outcomes for a large representative sample of elderly residents of Manitoba, Canada. Indicators of health status derived from an administrative data system and from health interviews are shown to provide roughly similar predictions of nursing-home entry. Administrative data provide significantly better predictions of death and future hospital entry than do variables from interview data.

Covariance and regression techniques are used to determine whether student career preferences and choices are influenced by medical school characteristics. The results indicate that academic factors (full-time teaching and research components) have more influence on career preference and choice than clinical factors (part-time fa culty and residency programs) but also that the internship year and first few years of practice are important determinants of ultimate career choice. This raises several important questions about what the objec tives of a medical school should be—to direct graduates into careers where the highest need exists, to develop areas of strength so as to improve the quality of training, or to provide as much exposure as possible to a number of different careers.

IN MAINE, the efforts of practicing urologists to understand how their clinical decisions contribute to the striking variations in rates of prostatectomy from one community to another led to a critical evaluation of the theories underSee also pp 3010 and 3018. lying the decision to operate. Specific aspects of our work have been described elsewhere.1-3 The purpose of this report is to provide an overview of the prostatectomy assessment project—its background and relevance, the methods used, the principal findings and recommendations—and to comment on the applicability of the approach to the evaluation of other common medical practices.BACKGROUNDThe project was an initiative of the Maine Medical Assessment Program,4,5 an ongoing program sponsored by the Maine Medical Association to respond to the small-area variations in medical practice patterns seen among Maine communities. Striking geographic variations in use are characteristic of many operations, diagnostic procedures, and causes of

A unique medical audit procedure has been employed to combine the scope of population data with the detail of case histories. All tonsillectomy and adenoidectomy (T&As) in Manitoba for one year were studied. A group of individuals treated for respiratory illness but not having T&As were also identified. Individual histories were reconstructed from medical insurance claims. These cases were reviewed to test conformity between practice and authoritative standards for surgical intervention.

Research on adverse outcomes following common surgical procedures has suggested the importance of hospital and surgeon variables. Policy directions depend on which factors are important in influencing patient outcomes and what sorts of policies are feasible. Focusing on where a given procedure is performed highlights a concern for centralization; emphasizing who should perform a particular operation implies physician certification. Finally, monitoring involves identifying particular hospitals that appear to have relatively poor (or relatively good) results.

Previous studies using large administrative databases found an elevated relative risk of reoperation and death after transurethral resection of the prostate compared to open prostatectomy. To investigate whether differences in case-mix unmeasured by administrative data explained this finding, we reviewed the charts of 485 patients who had undergone prostatectomy (236 open and 249 transurethral) at the Health Science Centre, Winnipeg, Manitoba, Canada between 1974 and 1980. Data from patient histories, physical examinations and laboratory evaluations were abstracted and used to control for case-mix in models comparing the rates of reoperation and mortality after transurethral versus open prostatectomy. Several models were specified. In all models the relative risk of dying after transurethral prostatectomy remained elevated (1.36 to 1.89), as did the risk for reoperation (3.62). A prospective trial is needed to establish the relative safety and effectiveness of transurethral and open prostatectomy.

The Manitoba Centre for Health Policy and Evaluation (MCHPE) is a university-based centre funded by the provincial government to provide analyses for use in policy development and management of the health care system. At the government's request, the MCHPE undertook an analysis of bed use in the major hospitals in the province. This article reviews the formulation, execution and delivery of the project to illustrate how health services researchers, administrative data and key actors in the health care system can interact in the policy process.

Le Manitoba Centre for Health Policy and Evaluation (MCHPE) fait une recherche sur les services de santé concentrée sur les bases de données administratives du Manitoba. Les bases de données administratives contiennent de l'information qui est recueillie de façon constante et systématique pour les besoins de l'administration, comme les demandes de remboursement des hôpitaux et des médecins, et les exigences de financement. On décrit dans cet article les cinq principales bases de données du MCHPE, leurs points forts et leurs points faibles, ainsi que le fonctionnement du Population Health Information System (PHIS). Quatre modules du PHIS illustrent comment les données sont utilisées pour fournir de l'information utile aux planificateurs de soins de santé, aux administrateurs et aux analystes de politiques. Enfin, on explore les projets et les orientations futurs pour l'utilisation de bases de données administratives.

The Manitoba Centre for Health Policy and Evaluation (MCHPE) conducts health services research focusing on Manitoba's administrative databases. Administrative databases contain information which is routinely and systematically collected for administrative purposes such as hospital and physician claims and funding requirements. This article describes the MCHPE's five major databases, their strengths and limitations, and the development of the Population Health Information System (PHIS). Four modules from PHIS illustrate how the data are used to provide useful information for health care planners, administrators and policy analysts. Finally, future projects and directions for using administrative databases are explored.