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Report from the Third Consensus Conference on Health Indicators
Appendix 2 - The Third Consensus Conference - discussion notes
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Summary of suggested new indicators for priority areas identified during the 2009 Consensus Conference and through the consultation process:
1. Health care outcomes
Effectiveness
Clearly defined outcomes of health programs are necessary to determine if these desired outcomes are being met.
- ACSC prevalence ratio
- ACSC readmission rates
- Readmissions after psychiatric evaluation -To measure effectiveness of mental health treatment before and after crisis level
- Addiction and recovery rates - As a measure of how long patient has abstained from a substance
- Post-intervention functional health status (functional recovery?)
- Cancer remissions
- Stages of cancer
- Survival rates (or deaths) per cancer stage
Efficiency
- Long term care patients in acute-care beds (cross-cut under accessibility and appropriateness)
Patient safety
- HSMR
- in-hospital infection rates
- in-hospital hip fractures per separation day
- incidence of adverse events, medication reconciliation
- Surgical site infection, surgical misadventures, etc.
Accessibility
- Access to community health care services
Continuity
- Balanced scorecard approach. Need to connect across the disease and care process.
- Distribution across stages of disease
Financial aspect of health care system indicators
Add a standardized costing component, creating composite indicators that help decision makers.
- Influenza immunization coverage with hospitalizations for influenza and expenditures (for immunization and care) across the country
- How much immunization is enough to prevent a single incident of flu?
- Perceived health as it relates to health care expenditures
- Costs of acute care and ER visits
- Ontario, Alberta and British Columbia have some of these measures.
- Case-costing data needs to be linked to the outcome
- There are many sources which investigate case costs in th UK and Sweden.
2. Child and youth health
Health conditions
- Congenital anomalies, information is currently being collected through the Canadian Perinatal Surveillance System
- Blood lead levels in children, information on blood lead levels is being collected through the Canadian Health Measures Survey
- Neurodevelopmental disorders, information collection is being planned by PHAC (CPSS)
- ADD, ADHD, Autism, rates and access to support services
Health behaviour
- Adherence to sun safety guidelines, information is available in the Canadian Health Measures Survey and the Canadian Community Health Survey.
- Unintentional injuries (CIHI, Vital Statistics)
- Immunization rates
- Positive parenting (NLSCY)
Environmental factors
- Awareness of smog advisories or poor air quality alerts, information is being collected through the Households and the Environment Survey.
- Food insecurity/nutrition (Canadian Community Health Survey, National Longitudinal Survey of Children and Youth (NLSCY))
- Access to medical professionals
- Access to quality childcare
3. Mental health
Utilization of services
- Admissions & Readmissions (in hospital –> in DAD)
- Length of stay
- Cost (admin point of view)
- Type of services and where they are getting it
- ER visits
Disorders (prevalence)
- Anxiety
- Mood disorders
- Depression
- Seasonal depression
- Bipolarity
- Schizophrenia
- Psychological distress (precursors)
- Concurrent disorders or addictions (comorbidity)
Dependency
- Prescription drugs addictions (hospitalization from DAD)
- Gambling
- Alcohol
- Technology addictions
- Positive Mental Health
- Happiness
- Satisfaction with life
- Well-being Index
- Community belonging
- Distress
- DALY, QUALY - of people with mental health problems
Suicide
- Attempted suicide (through DAD)
- Thoughts of suicide
- Suicide death
Stigma / Discrimination
4. Social determinants of health
Three categories:
- Variables needed for reporting of discrete levels of social indicators
- Basket of variables that will together focus on a specific indicator
- Variables used for stratification for indicators
Discrimination index (analogous to work done in the USA)
- racialized discrimination
- will allow for link to aboriginal health and recent immigrants
- income and racialization in urban areas
Gender inequity index (analogous to work done in Sweden)
- stand alone - analogous to human development index
Equity sensitive indicators
- gender based
- Need to look at indicators themselves as to whether they are gender masking
- utilization versus need - access to health services
Social capital (need to look at the main drivers of social capital)
- social networks
- cohesion
- community resources
- citizen engagement
- trust in government
Reliance on social systems
- financial assistance
- transition of going on and off social systems and financial systems
- % of people unemployed that are eligible for EI (looking at system response)
Education
- school readiness
- proportion of population with certain academic achievement at certain ages
Housing affordability
- including waitlists for social housing
- core housing need index (from CMHC) which looks at affordability, suitability, and need for major repairs
- structural indicators - housing affordability, housing stock
Volunteering
Nutrition
- Nutritious Food basket
- Food security –– summary measure versus the factors that influence it
- cost, market basket measure through HRSDC
- proximity to stores where healthy food is available
Voter participation
- civic engagement
- sense of belonging
Employment
Income
Homelessness
Health benefit coverage for those employed
- dental care coverage
- prescription drug coverage
5. Environmental health
Built environment (refers to "man-made" surroundings)
- Housing quality/Crowding Indicator
- Walkability Indicators (availability of sidewalks, perceived safety, etc)
- Modal Split Indicator (commute to work - dual mode)
Environmental factors (need to investigate new data sources)
- Air quality indicators
- Boiled Water Advisories
- Exposure to contaminants
- Water-borne diseases and deaths
- Chemical Spills
- Cosmetic Pesticide Use
- Unintentional Injuries - including poisoning.
- Community Safety Index (sun safety behaviour, rates of melanoma)
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