Provincial Health Indicators Work Group (PHIWG) Minutes of September 17-18, 2001 Meeting Ministry of Health and Long-Term Care 5700 Yonge Street, Room M3 & M4, Toronto, Ontario Attendants: Mary-Anne Pietrusiak, Durham Region Health Department Julie Stratton, Peel Regional Health Department Brenda Guarda, Simcoe County District Health Unit Sherri Ennis, Central East Health Information Partnership Carol Paul, Health Information Products and Services Unit, MOHLTC Jessie Wong, Health Information Products and Services Unit, MOHLTC Chee Wong, Public Health Branch, MOHLTC Brenda Coleman, Elgin-St. Thomas Health Unit Nam Bains, Health Information Partnership, Eastern Ontario Region – by teleconference for selected parts Ruth Sanderson, Middlesex-London Health Unit Heather Schouten, Toronto Public Health Jennifer Pennock, City of Ottawa – Public Health and Long-Term Care Evelyn Crosse, Perth District Health Unit Carla Troy, Centre for Surveillance Coordination, Health Canada Catalina Yokingco, Toronto Public Health Regrets: Jo-Anne Peterson, PHRED – KFLA Kingston Vic Sahai, Northern Health Information Partnership Doug Manuel, Institute for Clinical Evaluative Sciences Jane Hohenadel, Porcupine Health Unit Susan Bondy, Institute for Clinical Evaluative Sciences 1. Introductions 2. Minutes of July 16-17, 2001 The minutes were accepted with no changes as moved by Brenda Guarda and seconded by Ruth Sanderson. 3. Business Arising from the Minutes 3.1 Terms of reference Mary-Anne Pietrusiak did not yet edit the terms of reference. Discussion was deferred. 3.2 Template The draft template had been distributed by e-mail earlier. Further suggestions and clarification: A brief sentence will be included to explain when to use the crude rate vs. SMR vs. SRATE Under “Data Sources”, the wording “Original source” will replace “Created by”. Under “Analysis Check List”, include any syntax, variable names or wording for queries for the Data Warehouse, where appropriate. The HIUs can assist with this information. 3.3 Name for the indicators After much discussion, the preferred name is: Core Indicators for Public Health in Ontario. This will hopefully shorten in conversation to the “Core Indicators”. 3.4 Web site search function The Eastern Ontario Health Information Partnership is still working on the search function that we are hoping to use in our web site. 3.5 Help from public health librarians Ruth discussed the project with Yvonne Tyml, librarian from Middlesex-London. She expressed interest in helping us, noting that the public health librarians meet on a regular basis. It was decided that we will ask the librarians to review the keywords in the draft report but that we will have a first go at formulating them using MeSH terms (for a MeSH browser, see the website of the U.S. National Library of Medicine: http://www.nlm.nih.gov/mesh/MBrowser.html). Action: Ruth Sanderson to verify the process for the librarians to review the draft. 3.6 Citation for the PHPDB Jessie Wong drafted a table of suggested citations for all of the indicators. There was a lot of discussion and it was recognized that we need to reference the original source as well as where we got the data from (data distributor). For HELPS and Cubes, the release dates should be documented. For the data warehouse, the date that the data were extracted should be documented as this is a good indication of which model was in use at that time. Action: Ruth Sanderson to check with the public health librarians about any rules for citing the data, such as the order of the information. Action: Carla Troy to check with Health Canada about how they are citing data sources for their national “data warehouse”. Action: Jessie Wong will pull this information together to produce a second draft of citations. 3.7 ICD-10 Mary-Anne has been in contact with Jason Gilmore at Statistics Canada to find out what work they have done on determining the appropriate ICD-10 codes. Work was just beginning and he will pass the results on to Mary-Anne. 3.8 HELPS Chee informed the group that the roll out of HELPS2 will occur in October. Documentation will be on the web. File names will change to a new systematic format. Cancer data will hopefully include 1988-1998. 3.9 Standardization Sub-Group Brenda Coleman has distributed files to the sub-group of Mary-Anne Pietrusiak, Sue Bondy, Julie Stratton, and Jennifer Pennock. She also pointed out to Statistics Canada that they are standardizing by both age and sex. They have acknowledged and adjusted their documentation. We need to do the same. Brenda’s files examine the standard errors and compare confidence interval calculations of Armitage vs. Chiang. The group has not had time to review the files. The question of the standard population was addressed: it will still be the 1991 Canadian population. Action: The sub-group will develop recommendations about standardization methods. 4.0 Sub-Group Reports List of Data Gaps and Requests to Public Health Branch Indoor air quality – mould OBSP data need to be part of HELPS or sent out to health units from CCO in a systematic way. Cervical screening – data from the program Smoking in pregnancy – to be part of the Parkyn? Action: Mary-Anne will find out the status of the smoking question study on the Parkyn from Dr. Donna Reynolds. Smoking in public places Drinking and driving on boats and recreational vehicles Nutrition variables Developmental milestones at 18 months Pre-schoolers well-nourished – development of a screening tool for nutrition needs of pre-schoolers School readiness – part of National Longitudinal Survey on Children and Youth Pediatric BMI – could be a derived variable on the CCHS Action: Julie to send URL for CDC’s calculation of pediatric BMI Action: Carol to look into derivation on CCHS Action: Mary-Anne will list data gaps and distribute to PHIWG members to aid in CCHS consultation. 4.1 Potential Years of Life Lost (Doug Manuel, Sherri Ennis) 4.2 Health-Related Quality of Life (Doug Manuel, Brian Laundry, Richard Alvarez) Because Doug was ill and unable to attend the meeting, discussion was deferred. 4.3 Physical Environment and Health (Vic Sahai) Since Vic has been unable to continue working on PHIWG, Mary-Anne has taken over the physical environment section. Air Quality Index (AQI) Mary-Anne received very helpful feedback about this indicator from Jane Ying on behalf of the Health Promotion and Environmental Protection Office, Toronto Public Health. Keep the indicator but add in other categories, including particulates and nitrogen oxides. Action: Heather will send Mary-Anne a City of Toronto document about environmental data sources. Ultraviolet (UV) Radiation Index Because of the questionable nature of this indicator at the local level, it was dropped. Trihalomethanes (THMs) in Drinking Water Expand indicator to consider other facets of drinking water such as microbiological safety (proportion of positive e-coli/coliform tests), fluoride. Posted Bathing Beaches Expand commentary. New Indicators Consider an indicator on boil water advisories, looking at number of person-days affected. Consider RRFSS as a source of data – number of households on private wells. Identify information on mould as a data gap. Action: Mary-Anne will consult with the Public Health Branch and the MOE on development of new indicators. Action: Carla will check with the Environmental Health Directorate of Health Canada for resources that might be useful. 4.4 Cancer Incidence and Early Detection of Cancer (Heather Schouten, Jennifer Pennock) Incidence of Selected Cancers Keep Mortality from Selected Cancers Keep PYLL from Selected Cancers To be determined Hospital Separations for Selected Cancers Keep OBSP Mammography Rates Change description from ever screened to screened in past 2 years with ever screen as an “Other Category”. Change age group to 50-74 years. Add that diagnostic mammograms are not included under comments on OBSP data. Mammography Rates for Women Aged 50-69 Change age group to 50-74 years. Consider pulling out screening mammograms – need to verify that this is feasible in CCHS. Clinical Breast Exam Rates Keep Cervical Cancer Screening Rates Keep 4.5 Smoking (Brenda Guarda, Carol Paul, Jessie Wong, Susan Bondy) Daily Cigarette Smoking Keep Population Living in Smoke-Free Homes Check wording on CCHS New Indicators Smoke-free Public Places – considers workplaces, restaurants, bars that are 100% smoke-free. The Ontario Tobacco Research Unit is a possible source of data. Minor Access to Tobacco – proportion of establishments that sell to minors according to health unit compliance checks. Proportion of Non-Smokers Exposed to Second-Hand Smoke – CCHS 4.6 Alcohol (Brenda Guarda, Carol Paul, Jessie Wong, Susan Bondy) Proportion of Current Drinkers Keep Proportion Consuming 15 or more alcoholic drinks per week Drop since it is no longer an objective in the Mandatory Programs Proportion of Low-Risk Drinkers Basic categories: low risk, at risk Frequency of Heavy Drinking Episodes Same definition in CCHS. Prevalence of Drinking and Driving Expand on caveats New Indicators Add supplementary indicator of Drinking on Boats and Recreational Vehicles – RRFSS is source. 4.7 Physical Activity (Brenda Guarda, Carol Paul, Jessie Wong, Susan Bondy) Frequency of Physical Activity Keep, check for consistent definition on CCHS Energy Expenditure Rename to Physical Activity Index Incorporate comments about Health Canada’s Physical Activity Guide New Indicators Sedentary Activities – in leisure and at work 4.8 Nutrition (Brenda Guarda, Carol Paul, Jessie Wong, Susan Bondy) Body Mass Index Be consistent with the National Indicators and the CCHS so the categories will be: under 20 (underweight), 20-24.9 (acceptable weight), 25-26.9 (some excess weight), 27 or higher (overweight) In the current new draft of Mandatory, the overweight category should be BMI >= 27 not > 27. Action: Mary-Anne will contact Dr. Robert Kyle, Chair of Chronic Diseases Technical Review Committee about this adjustment. An additional category of obese: BMI >= 30 will be added. Discrepancies between some of these definitions and categories will be noted. Average Fat Intake as Percent of Energy Drop since only source of data is the 1990 Ontario Health Survey. Percent of Population Consuming Five or More Servings of Vegetables and Fruit Daily Rename to Fruit and Vegetable Consumption Use CCHS data Percent of Adolescent Population Aged 12 to 17 Consuming Three or More Servings of Milk Products Daily Drop since only source of data is the 1990 Ontario Health Survey. Percent of Population Aged 18 and Over Consuming Two or More Servings of Milk Products Daily Drop since only source of data is the 1990 Ontario Health Survey. Percent of Population Aged 12 and Over Consuming Five or More Servings of Grain Products Daily Drop since only source of data is the 1990 Ontario Health Survey. 4.9 Mental Health (Jessie Wong) Prevalence of Depression Keep, national indicator Suicide Mortality Rate Keep, national indicator Hospitalization for Attempted Suicide Keep New Indicators Suicidal Thoughts – optional from CCHS Suicide Attempts – optional from CCHS Work Stress – scale from CCHS Self-Perceived Life Stress – from CCHS 4.10 Dental Portion of Child and Adolescent Health (Ruth Sanderson) DMF/def Index In description, deleted “or tooth services” and replace “in kindergarten” with “at school entry”. Add more caveats and detail about data quality, including the inconsistency across the province. Review with Dr. Sandra Bennett from the Public Health Branch. Proportion of Caries-Resistant Children Rename to Proportion of Caries-Free Children and use that wording throughout. Replace “in kindergarten” with “at time of survey”. In comments, state that this indicator is a proxy for early childhood tooth decay, and that caries-free means current prevalence=0 and lifetime incidence=0. New Indicators Proportion of Children with Treatment Needs – those requiring treatment, urgent and non-urgent. Fluorosis Fissure Sealants Action: Ruth is to ask Dr. Bennett whether the indicator Percentage of High Risk Schools is a population indicator. 4.11 Sexual Health (Evelyn Crosse) Youth Sexual Activity From CCHS Age of Sexual Debut From CCHS Number of Sexual Partners From CCHS Condom Frequency among those at Risk for STDs From CCHS Cross-reference to STD indicators in Infectious Diseases Indicate in comments that for high non-response, report as separate category Condom Use the Last Time Among those at Risk for STDs From CCHS 4.12 Reproductive Health (Brenda Coleman) Brenda talked about follow-up to the teleconference on developing indicators from the ISCIS database that took place on July 12, 2001. The teleconference included Brenda, Ruth and Mary-Anne from PHIWG as well as Alanna Leffley from Grey Bruce Health Unit and Faye Brooks from Leeds, Grenville, Lanark HU, and staff from the Public Health Branch and Integrated Services for Children. A number of data issues need to be made clear as well as the type of indicators we would like to see from ISCIS. There is also a lot of urgency since Leann Wagner, Acting Manager of ISCIS, will soon be going on maternity leave. We would like her to begin the process of developing these indicators before she leaves so that the work can be continued by her replacement. Action: Brenda Coleman will draft a letter to Leann Wagner. The draft will be reviewed by Sherri, Mary-Anne, Ruth and Elizabeth. Crude Birth Rate Keep Age-Specific Fertility Rates and General Fertility Rate Under alternative sources, list ISCIS and CIHI. The numbers obtained from CIHI, through the data warehouse, uses CMG codes. Sherri Ennis has done some analysis and is writing a report about the method used. Total Fertility Rate Keep Age-Specific Therapeutic Abortion Rates Keep Age-Specific Therapeutic Abortion Ratios After lots of discussion, we decided to keep the indicator as is. Age-Specific Pregnancy Rates Including Teenage Pregnancy Rate Keep Rate of Multiple Births Keep Low Birth Weight Rate Rename to Birth Weight Rate Basic categories of preterm, singleton vs. multiple, large for gestational age Rate of Neural Tube Defects Keep Stillbirth Rate Include as a category under Perinatal Mortality Rate since the number at local level is small Perinatal Mortality Rate Stillbirths under Basic Categories Infant Mortality Rate Keep, cross-reference to Selected Cause of Death in Children and Adolescents New Indicators Age of First Births – mean age and median age Congenital Infections Folic acid supplementation – from CCHS Smoking during Pregnancy – cross-reference to smoking section Note: Add maternal mortality to selected cause of mortality and cross-reference. 4.13 Seniors Health (Brenda Coleman) It was decided to omit this section and move the indicators to other sections. Long-Term Care Bed Ratio Drop, more of a concern for DHCs than public health. Population Projections for Seniors Include in Population section Living Arrangements for Seniors Include in Social Environment section Selected Causes of Hospitalization Among Seniors This would already be covered under the Hospitalization section. Fall-Related Deaths Among Seniors Include in the Injury section Fall-Related Hospitalizations Among Seniors Include in the Injury section Activity Limitations Among Seniors Include in the Health-Related Quality of Life Section 4.14 Use of Health Services and Medications (Nam Bains) Rename to Use of Health Services Visits to General Practitioner From CCHS Visits to Dentist From CCHS Use of Emergency Services Drop, this question is difficult to work with in the CCHS because of the skip patterns. Medication Use Drop, too much mix of different medications that the indicator is not useful. Taking Three or More Medications in Past Two Days Move this to the Injury section and change to include only those aged 65+ Rate of Days of Hospitalization Move to the Hospitalization section. There were questions about how to use and interpret this indicator. Action: Nam and Sherri will take a closer look at this indicator to see how it can be used in public health. New Indicators Add Average Length of Stay to Hospitalization section. 4.15 Appendices Appendix 1: Members of PHIWG Mary-Anne will list all members to date and include the dates they were on PHIWG. Appendix 2: Direct standardization (SRATES) Appendix 3: Indirect standardization (SMRs, SIRs) The Sub-group on standardization will expand these. Appendix 4: Standard population: Canada 1991 Will remain the same. Appendix 5: PYLL calculation Should be reviewed. Appendix 6: Public health units and health areas sampled in the 1990 OHS and 1996/97 OHS Add in CCHS. Appendix 7: Methods for age standardizing the Ontario Health Survey Information on bootstrapping will be added by Carol and Jessie. Appendix 8: Avoidable mortality from specific diseases Doug Manual will review to ensure it is up to date. Appendix 9 How to calculate a moving average Should be reviewed. Appendix 10: Mandatory Health Programs and Services Guidelines: Objectives and Indicators Needs to be updated. Appendix 11: Summary of Notes on Data Sources Needs to be updated List each source separately (a, b, c, etc.) so that it is easier to search on one particular data source. New Appendices References Methodology for life expectancy National and Provincial Case Definitions for Infectious Diseases Adverse Vaccine Events Fact Sheet on RRFSS Methodology for Life Expectancy 5.0 Next Steps Each group is to edit the indicators they are responsible for using the new template. Mary-Anne will revise the template and send it out. The deadline for completing the indicators is February 1, 2002. Another meeting will then be scheduled to consider this next draft, with emphasis on reviewing the new indicators. The goal will be to hire a student in web design for the summer to overhaul the web site and put on the new indicators.