Observers' reactions to genetic testing: the role of hindsight bias and judgements of responsibility.

In 3 studies, we examined the effect of birth outcome on observers' reactions to genetic testing. Participants read a scenario in which a woman declined to take a genetic screening test and subsequently gave birth to a child with a genetic disorder (negative outcome) or a healthy child (positive outcome). Retrospective judgments of the likelihood that the child would have a genetic disorder were higher given negative than positive outcome knowledge under conditions of high genetic risk.

Characteristics of patients with a regular source of care.

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.

The effect of breastfeeding education on adolescent beliefs and attitudes: a randomized school intervention in the Canadian Ojibwa community of Sagkeeng.

Sagkeeng First Nation's adolescent breastfeeding educational session was evaluated using a randomized pretest-posttest control group design. The intervention group received the session first; the control group received the session following the posttest. A retention test to measure overall retained learning was given to all students 10 days later.

Use of pharmaceuticals by inflammatory bowel disease patients: a population-based study.

Objectives: In 1996 we created the population-based University of Manitoba Inflammatory Bowel Disease (IBD) Database. In 1994, Manitoba Health established the Drug Program Information Network (DPIN), which identified all ambulatory prescription drugs dispensed to each individual resident of the province. All residents have a personal health identification number, and use of this number allowed linkage of the IBD database with the DPIN database.

Socioeconomic status, drug insurance benefits, and new prescriptions for inhaled corticosteroids in schoolchildren with asthma.

Background: Low-income children with asthma are less likely to receive inhaled corticosteroid prescriptions that can prevent asthma morbidity.

Objective: To determine whether the receipt of inhaled corticosteroids in children with asthma is related to household socioeconomic status and type of drug insurance.

Design: Using population-based prescription and health care data from Manitoba, a cohort study of the determinants of receiving new prescriptions for inhaled corticosteroids was conducted in children treated with asthma drugs.

Organizing the present, looking to the future: an online knowledge repository to facilitate collaboration.

Background: Comprehensive data available in the Canadian province of Manitoba since 1970 have aided study of the interaction between population health, health care utilization, and structural features of the health care system. Given a complex linked database and many ongoing projects, better organization of available epidemiological, institutional, and technical information was needed.

Objective: The Manitoba Centre for Health Policy and Evaluation wished to develop a knowledge repository to handle data, document research Methods, and facilitate both internal communication and collaboration with other sites.

Assessing socioeconomic effects on different sized populations: to weight or not to weight?

Objective: Researchers in health care often use ecological data from population aggregates of different sizes. This paper deals with a fundamental methodological issue relating to the use of such data. This study investigates the question of whether, in doing analyses involving different areas, the estimating equations should be weighted by the populations of those areas.

What is the potential for formal patient registration in Canadian primary care? The scale of 'informal registration' in Manitoba.

Objectives: Registration of patients with a physician is increasingly being considered across Canada as part of a reform of the primary health care system. This study aims to determine how much 'informal registration' currently exists; that is, to identify the number/proportion of patients who, given existing utilization patterns, already receive the majority of their care from one practice, in order to assess the potential for formal registration.

Methods: Administrative data were used to classify patients (n = 528,905) as being informally registered with a clinic if they received the majority of their care (75% or more of their total ambulatory visits) from the same practice over a three-year period (1994-1996).

Income-based drug benefit policy: impact on receipt of inhaled corticosteroid prescriptions by Manitoba children with asthma.

Background: Drug benefit policies are an important determinant of a population's use of prescription drugs. This study was undertaken to determine whether a change in a provincial drug benefit policy, from a fixed deductible and copayment system to an income-based deductible system, resulted in changes in receipt of prescriptions for inhaled corticosteroids by Manitoba children with asthma.

Methods: Using Manitoba's health care administrative databases, we identified a population-based cohort of 10,703 school-aged children who met our case definition for asthma treatment before and after the province's drug benefit policy was changed in April 1996.

Prevalence and determinants of diabetes mellitus among the Métis of western Canada.

Diabetes and its complications are major contributors to morbidity and mortality among Canada's Aboriginal populations. The epidemiology of diabetes among the Métis has not yet been investigated. The purpose of this study was to determine the prevalence of diabetes among the Métis, to identify diabetes risk factors, and to test hypotheses related to diabetes etiology.

Attention-deficit hyperactivity disorder in Manitoba children: medical diagnosis and psychostimulant treatment rates.

Objective: To describe physicians' diagnosis rates for attention-deficit hyperactivity disorder (ADHD) for children in the province of Manitoba and to describe the rate of psychostimulant medication use by these children.

Methods: This descriptive study reviewed the computerized administrative records of physician visits and prescriptions dispensed to examine a population-based, cross-sectional cohort of children diagnosed with ADHD or prescribed stimulant medication, or both. We found 4787 children with a diagnosis of ADHD over a 24-month period or a prescription for stimulant medication over a 12-month period, or both.

Health reform and technological change: shifting hospitalization patterns for four procedures in Manitoba.

This study used Manitoba data from 1991 to 1996 to assess the effects of health reforms and technological advances on hospitalization patterns, patient mortality, and readmission rates. Cholecystectomy and hernia repair served as indicators of response to both new technology and health reforms, while appendectomy and hysterectomy helped gauge the impact of health reforms alone. Neither the introduction of new technology (i.

The impact of diabetes mellitus among the Métis of western Canada.

Objectives: To examine the impact of diabetes mellitus on the lives of the Métis of western Canada, and to determine the extent of co-morbidity among Métis with diabetes.

Design: The source of data was the Aboriginal Peoples Survey (APS), conducted by Statistics Canada in 1991. The survey was administered to a representative sample of Aboriginal peoples throughout Canada.

Restless legs syndrome in 218 patients: associated disorders.

Background: Restless legs syndrome (RLS) is a disorder characterized by disagreeable sensations in the legs that occur at rest and are relieved by movement. These symptoms, which are worse at night, may result in sleep onset or sleep maintenance insomnia. Most patients are found on polysomnography (PSG) to have periodic limb movements in sleep (PLMS).

Assessing ecologic proxies for household income: a comparison of household and neighbourhood level income measures in the study of population health status.

This paper examines the validity of using ecologic measures of socioeconomic status as proxies for individual-level measures in the study of population health. Based on a representative 5% sample of households in a Canadian province, the study integrated three sources of information: administrative records of individual health care utilization, records of deaths and 1986 census records which contained information on household income and average neighbourhood income. Thirteen measures of health status were developed from these sources of information.

What determines the need for nursing home admission in a universally insured population?

Objectives: People in lower socio-economic groups are more likely to experience disability and cognitive impairments at earlier ages than those in higher status groups. As a result, the need for nursing home care would be expected to be greater among older people of lower socio-economic status. This study examines the effects of income and education on the probability of nursing home entry in a universally insured elderly population.

From research to policy: what have we learned?

The Manitoba Centre for Health Policy and Evaluation has now had eight years of experience as an academic research unit interfacing with policymakers. Most of our research has focused on the determinants of health and on the delivery of health care from a population perspective. Each project that we have undertaken has made its own contribution and reinforced or built on the contribution of others.

Managing health services: how the Population Health Information System (POPULIS) works for policymakers.

University-based researchers in Manitoba, Canada, have used administrative data routinely collected as part of the national health insurance plan to design an integrated database and population-based health information system. This information system is proving useful to policymakers for answering such questions as: Which populations need more physician services? Which need fewer? Are high-risk populations poorly served? or do they have poor health outcomes despite being well served? Does high utilization represent overuse? or is it related to high need? More specifically, this system provides decision makers with the capability to make critical comparisons across regions and subregions of residents' health status, socioeconomic risk characteristics and use of hospitals, nursing homes, and physicians. The system permits analyses of demographic changes, expenditure patterns, and hospital performance in relation to the population served.

Using population-based data to enhance clinical practice guideline development.

Objectives: Working with the College of Physicians and Surgeons of Manitoba, and using tonsillectomies as a basis of inquiry, MCHPE examined surgical rates and patterns of practice. This project had three major aims: to review whether current patterns of delivery provide optimal care; to enhance the development of clinical guidelines; and to inform and influence physician practice.

Research Design: Both a population-based method of inquiry (which permits comparisons across population groups) and a provider-based approach (which offers insights into differences in the nature of care offered by different types of hospitals and physicians) were used.

Issues in planning for specialist physicians.

Objectives: The Manitoba Centre for Health Policy and Evaluation worked in support of a provincial Physician Resource Committee to address questions pertinent to assessing Manitoba's supply of specialist physicians.

Research Design: Because there was no direct method of determining whether the province's supply of specialists was adequate, three types of evidence were reviewed: the supply of specialists relative to recommended population/physician ratios; the supply of specialists relative to other Canadian provinces; and the level of care delivered by specialists in Manitoba relative to other provinces. Four additional questions were addressed: is a problem developing from the aging of Manitoba's specialist physicians? and will the supply of specialists be sufficient to keep up with the aging of the population? How well do specialists serve as a provincial resource? and how well do specialists serve high-need populations?

An assessment of the potential for repatriating care from urban to rural Manitoba.

Objectives: Following the closure of Manitoba hospital beds, the Manitoba government adopted a strategy of shifting hospital care from more expensive urban hospitals to less expensive rural facilities. With this project, Manitoba Centre for Health Policy and Evaluation (MCHPE) studied the implications of the stated policy of "repatriation."

Research Design: The project first involved examining population-based patterns of hospital utilization to define hospital service areas for 10 large rural hospitals.

Establishing a population data-based policy unit.

The Manitoba Centre for Health Policy and Evaluation (MCHPE) developed POPULIS, a population-based health information system, as a vehicle for changing the way we think about the role of health care as a determinant of health. Serving as a bridge between analysts who produce research and politicians and policymakers who use it, MCHPE has developed a research infrastructure that can transform routinely collected administrative data into policy-relevant information. This paper provides a description of Manitoba and its health care system, as well as how MCHPE was started and how it functions.

A research registry: uses, development, and accuracy.

Many studies of population health, clinical epidemiology, and health services can be supported by a population-based research registry. Such a registry accurately defines the health insurance status for each individual over many years, magnifying the effectiveness of a cross-sectional registry (typically relevant for only a short duration) used in the administration of a health insurance plan. A research registry can distinguish between "well" individuals (no contact with the health care system), loss to follow-up (ineligibility associated with leaving the insurance plan), loss of continuity (two or more unlinked registrations over time for the same person), and mortality.