Minutes
(Revised June 16, 1998)

Monday, May 25, 1998
10:00 am - 3:00 pm
North York Civic Centre
Committee Room #1

Present: Mary-Anne Pietrusiak, Durham Regional Health Unit (Chair)
                Terry Delmore, Halton Regional Health Department
                Julie Stratton, Perth District Health Unit
                Hyewon Lee-Han, Population Health Service, Public Health Branch
                Ian Johnson, Toronto Public Health, North York Office
                Jessie Wong, IPE Branch, Ministry of Health
                Carol Paul, IPE Branch, Ministry of Health
                Nam Bains, Health Information Partnership, Eastern Ontario Region
                Jo-Anne Peterson, Kingston, Frontenac and Lennox and Addington Health Unit

Others:   Anna Goral, Toronto Public Health, North York Office (recorder)
                Jill Mallon, Toronto Public Health, North York Office (recorder)
                Kinga David, MHSc Student, North York Office
                Karen Lee, Community Medicine Resident, North York Office

Corresponding Member: Dr. Vivek Goel, ICES

Regrets: Patrick Seliske, Waterloo Regional Community Health Department
                Ruth Sanderson, Bruce-Grey-Owen Sound Health Unit
                Vic Sahai, Northern Health Information Partnership
                Doug Manuel, Federal Field Epidemiologist

1.0 Introduction

2.0 Provincial Health Status Advisory Committee Meeting Update

(May 22, 1998) - see minutes

Ian updated the group on the major decisions from this meeting.

• Framework not restricted to Mandatory Guidelines
• Flexibility in interpretation is encouraged
• Creation of a PHRED report to MoH
• Air Quality Index - to be included even if data is limited
• Add Occupational Health and Safety chapter
• Behavior and Health - modified to a separate chapter
• Mental Health Section - keep as separate chapter
• Consequences of Health Problems chapter title should be changed
• Add section called Economic Impacts of Health Issues

Four focused reports:

1. Physical Activity -includes B.M.I
2. Nutrition (later dropped because of lack of data)
3. Tobacco
4. Alcohol

• Instead of Nutrition report, reports on PAR or injuries were suggested.
• Public Use File vs. Ontario sharing file - group wants to explore possible bias
• Francophone Report - work is being done on structure of report and identifying potential sources of data

Issues: definition of a Francophone, timing

• Agreement to create sub group to look at updating and including the raw data file from the Provincial health status report into HELPS
• Ian and Hyewon are in charge of the group
• Next PHS Advisory Committee Meeting: September 18, 1998.

3.0 Indicator Framework Discussion

The group discussed which indicators should be included as a part of the core set of indicators. More in-depth discussions occurred than at the last meeting, including limitations and definitions of the indicators. The group moved backwards through the framework.

Seniors - will be moved to Family Health section

Indicators to be used:

• Number of long-term care beds per population aged 65+ (Carol and Jessie will investigate)
• Number of seniors in households in the community (65+)

(Stats Can- may need special request for age 75+ cohort)

• Proportion of Seniors living alone
• Proportion of Seniors living below the poverty line

(Data may not be available for all areas - Stats Can may need special request)

• Social Participation (Social Support Questions)
• Leading causes of death and hospitalizations for seniors (can also be added to different sections of the report)
• Population projections - using Ministry data
• Dental indices (from OHS)

(access to dental care can be added to Consequences of Health Problems section)

Section name needs to be changed - the suggestion was made to rename the Section, Health Care Utilization or Disability and Utilization of Health Care Services

See handout Nam distributed during meeting:

• Prevalence of long-term disability -indicator does not look at the type or severity of the disability
• Medical Consultation Rate - delete Percent of people who had eye exam in past year indicator, add Percent of people who visited physician in the last year indicator (OHS, pg. 9)
• Rate of days of hospitalization by cause - add early discharge from hospital as an indicator.
• Cesarean rate and coronary bypass rate not to be included in core
  indicators
• Proportion of population who took medication in the past month-

(exclude vitamins and birth control pills)

See handout Ian distributed during meeting. As the group moved through this section, it was evident that some of the Mandatory Program indicators were problematic because of lack of data or definition problems. It was decided that these indicators would be grouped and discussed in one section so that comments could be directed towards the Ministry.

Mortality

• investigate 5 year moving average rate for pneumonia and Influenza
• Use age-adjusted rate for annual mortality rate

Vaccine Preventable Diseases

• Add incidence rates of mumps
• Add HiB incidence rates for under 5 years of age
• Investigate follow up of infants with Hep B

Immunization

• Need to create historical cohorts, as complete data is only available once child enters school.
• May have to use 97-98 school data as previous years are not complete

This indicator needs more work.

• Immunization data for Hep B among infants is not readily available, only information on mothers immunization status can be obtained (flag to Ministry as problematic)
• Influenza vaccination rate of residents of long term care facilities
• Influenza vaccination rate of persons aged 65+ and persons with high risk conditions (flag to Ministry as problematic)
• Influenza vaccination rate of health care workers in contact with high risk individuals (flag to Ministry as problematic)
• Investigate the definition of high risk
• Progression of latent TB infection to active TB (flag to Ministry as problematic)
• proportion of individuals on chemoprophylaxis (flag to Ministry as problematic)
• Exclude Wastage of provincially-funded vaccines as an indicator.
• Investigate Monitoring adverse events associated with provincially- funded vaccines.

STDs

• AIDS- listed as reportable; anonymous testing sites may not report cases. Add hospitalization rates for HIV to core set of indicators.

TB

• Progression of latent TB infection to active TB indicator is not feasible.
• Incidence rates for drug resistant TB

Clarification needed on definition of secondary drug-resistant

• Exclude Proportion of active TB cases that complete treatment as prescribed.
• Proportion of individuals on Chemoprophylaxis - add to problem list.

Enteric Illness and Food Safety

• Ian will investigate Hospitalization for enteric illness and Enteritis N.O.S.
• Exclude the indicators on food storage and sale or distribution of contaminated food because these are process indicators that will be captured under monitoring.

Rabies

• Include incidence of rabies - animal and human rates

(Ian will investigate)

Control of Infectious Diseases/Infection Control - delete section

Emerging Infections

• Cryptosporidium, E.coli and Group A Streptococcal infections are reportable - include as core indicators. (Cyclospora to be excluded because not reportable).

3.4 Section 8 - Mental Health (Jessie Wong)

• Include depression prevalence which is in the OHS96
• Delete percent of population showing high levels of psychological distress - no ongoing data
• Delete Percent of population contemplating suicide - no ongoing data
• Include Suicide Mortality Rate
• Delete Satisfaction of social life - no ongoing data
• Include hospitalization for suicide attempts as core indicator
• Include - Did you ever talk to a health professional about problems during the past 12 months question (OHS 96, Q1K, pg.9)
• ICD- 9 categories of disorders to be reviewed for most common diagnosis (Jessie to investigate)
• Inquire about psychiatric hospital databases vs. general hospital databases

3.5 Section 7b - Reproductive Health (Mary-Anne Pietrusiak)

• Total Fertility Rate - use 15 to 49 years as the cohort (Same for General Fertility Rate)
• Age Specific Fertility Rate - age groupings 15 to 49 by 5 year age groups
• The teen fertility rate will be defined as 15 to 19 years old but a separate indicator for live births to mothers less than 14 years old will be investigated further.
• Prevalence of Low Birth Weight (follow mandatory guidelines, include babies less than 500g, multiple births, and less than 20 weeks gestation)
• Rate of Neural Tube Defects - use Canadian Congenital Surveillance System (spina bifida, encephalocele, and anencephalus to be the categories to be used)
• Therapeutic Abortion Rate - age-specific rates with both clinic and hospital data to be used from 1992 onward.