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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

    Idea was raised that there is a need to show economic/financial relevance in these areas: what are the costs of the indicator measurements (i.e. what are the costs associated with the efficiency 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:

    1. Variables needed for reporting of discrete levels of social indicators
    2. Basket of variables that will together focus on a specific indicator
    3. 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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