11

Core Indicators for Public Core Indicators for Public Health in Ontario:Health in Ontario:

OrientationOrientation

May, 2010May, 2010

22

Presentation OutlinePresentation Outline

• History of the Core Indicators project• What is the Core Indicators Work Group?• What are sub-groups?• What is in a Core Indicator?• Where is the Project now? • Advice for sub-groups

33

In the Beginning...In the Beginning...

• Epidemiologists in Ontario recognized the need for consistency among health reports

• The Provincial Health Indicators Work Group (PHIWG) was established February, 1998 as an initiative of APHEO. PHIWG later renamed to Core Indicators Work Group (CIWG)

• Mandate: ... to systematically define and operationalize a core

set of health indicators

44

Founders of Core Indicators ProjectFounders of Core Indicators ProjectInaugural Meeting February 1998Inaugural Meeting February 1998

• Raili Cardinal, Algoma Health Unit• Terry Delmore, Halton Region• Vivek Goel, Institute of Clinical Evaluative Sciences• Hyewon Lee-Han, City of Toronto - North York• Ian Johnson, City of Toronto - North York• Mary-Anne Pietrusiak, Durham Region• Ruth Sanderson, Bruce-Grey-Owen Sound HU• Patrick Seliske, Waterloo Region• Julie Stratton, Perth District Health Unit

55

What is the Core Indicators Work Group?What is the Core Indicators Work Group?

• Formerly called the Provincial Health Indicators Work Group (PHIWG)

• Initially, PHIWG created and wrote the indicators and resources

• Since 2006, the CIWG has had more of an advisory role and the topic-specific work groups have done the actual revision and creation of the indicators

66

Role of the CIWGRole of the CIWG

• The purpose of the CIWG is: to ensure that the Core Indicators for Public Health in Ontario are accurate, up-to-date and reflect the Ontario Public Health Standards; to advocate for health unit access to good quality data in a timely manner; and to promote the use of the Core Indicators.

77

Members of the CIWGMembers of the CIWG• Brenda Guarda (Acting Chair) - Simcoe Muskoka District Health Unit • Shanna Hoetmer (Chair) - York Region (currently on leave)• Nam Bains - MOHLTC• Susan Bondy - University of Toronto Dalla Lana School of Public Health• Sherri Deamond* - Durham Region• Popy Dimoulas-Graham* - Public Health Agency of Canada • JoAnn Heale - MOHLTC• Ahalya Mahendra* - Public Health Agency of Canada (currently on leave)• Peggy Patterson* - Renfrew County and District Health Unit• Mary-Anne Pietrusiak* - Durham Region Health Department• Nancy Ramuscak* - Peel Region Health Department • Katherine Russell - Ottawa Public Health• Suzanne Sinclair* - Kingston, Frontenac, Lennox & Addington Health Unit• Jennifer Skinner* - Haliburton, Kawartha, Pine Ridge District Health Unit• Julie Stratton - Peel Health Department• Brenda Wannell - Statistics Canada

* Lead or Co-Lead of a sub-group

88

Role of the Sub-GroupsRole of the Sub-Groups

• The purpose of the Core Indicators sub-groups is to revise existing indicators and resources and to create new indicators and resources based on direction from the Core Indicators Work Group (CIWG).

99

Sub-GroupsSub-Groups• Current Subgroups:

– Built Environment (Lead Popy Dimoulas-Graham while Ahalya Mahendra is on leave)

– Healthy Eating and Active Living (Co-Leads Peggy Patterson, Jennifer Skinner)

– Infectious Diseases (Lead: Sherri Deamond)– Reproductive Health (Lead: Mary-Anne Pietrusiak)– Injury and Substance Misuse (Lead: Suzanne Sinclair)– Social Determinants of Health (Lead: Nancy Ramuscak)

• Former Subgroups:– Cancer, Smoking and Sun Safety (Lead: Brenda Guarda)– Leading Causes (Lead: JoAnn Heale)

1010

Key MilestonesKey Milestones

• Feb 1998 – Inaugural meeting at ICESFeb 1998 – Inaugural meeting at ICES• 1999 – CPHA & OPHA presentations, PHERO article1999 – CPHA & OPHA presentations, PHERO article• Nov 1999Nov 1999 – Binder of draft “Core – Binder of draft “Core Population Health Health

Indicators for Ontario” sent to PHUsIndicators for Ontario” sent to PHUs• Feb 2000 – Release of Ontario Health Status ReportFeb 2000 – Release of Ontario Health Status Report• Jan 2001 – Round 2 begins to revise and expand first Jan 2001 – Round 2 begins to revise and expand first

draftdraft• Summer 2001 – Student hired by CEHIP to create Core Summer 2001 – Student hired by CEHIP to create Core

Indicators websiteIndicators website• Fall 2001Fall 2001 – Website launch at APHEO conference – Website launch at APHEO conference• 2005 – Completion of indicators2005 – Completion of indicators

1111

Key Milestones, Cont’dKey Milestones, Cont’d

• Feb 2006 – Formation of four subgroups (Round 3)Feb 2006 – Formation of four subgroups (Round 3)• March 2007 – Formation of HEAL subgroup (split)March 2007 – Formation of HEAL subgroup (split)• June 2007 – Submitted funding application to PHACJune 2007 – Submitted funding application to PHAC• May 2008 – APHEO website converted to wiki styleMay 2008 – APHEO website converted to wiki style• July 2008July 2008 – Harleen Sahota begins as Project Manager – Harleen Sahota begins as Project Manager

as part of PHAC projectas part of PHAC project• Nov 2008 – OPHS & PHAS protocol releasedNov 2008 – OPHS & PHAS protocol released• Dec 2008 – Core Indicators strategic directionsDec 2008 – Core Indicators strategic directions• Jan 2009 – Formation of Built Environment subgroupJan 2009 – Formation of Built Environment subgroup• July 2009 – Core Indicators PHAC project completedJuly 2009 – Core Indicators PHAC project completed

1212

Key Milestones, Cont’dKey Milestones, Cont’d

• Aug 2009 – CIWG Chair changes to Shanna Hoetmer Aug 2009 – CIWG Chair changes to Shanna Hoetmer from Mary-Anne Pietrusiakfrom Mary-Anne Pietrusiak

• Sep/Oct 2009 – 2 New Sub-groups: Injury & Substance Sep/Oct 2009 – 2 New Sub-groups: Injury & Substance Misuse, and Social Determinants of HealthMisuse, and Social Determinants of Health

• Oct 2009 – Brenda Guarda becomes acting CIWG Chair Oct 2009 – Brenda Guarda becomes acting CIWG Chair while Shanna is on leavewhile Shanna is on leave

• Jan 2010 – APHEO contingent approaches OAHPP for Jan 2010 – APHEO contingent approaches OAHPP for Core Indicators fundingCore Indicators funding

http://www.apheo.ca/index.php?pid=55

1414

Criteria for Selecting IndicatorsCriteria for Selecting Indicators

• Relevant to the Ontario Public Health StandardsRelevant to the Ontario Public Health Standards• Data generally available and accessible at the Data generally available and accessible at the

local levellocal level• Indicator has to be useful and meaningfulIndicator has to be useful and meaningful• Indicator has to be relevant to healthIndicator has to be relevant to health• ““Core” indicatorsCore” indicators• Decision by consensusDecision by consensus

1515

What is in a Core Indicator?What is in a Core Indicator?

• Name, Name, Description, Specific indicators, Specific indicators• Corresponding outcomes from OPHSCorresponding outcomes from OPHS• Corresponding indicators from Statcan, Corresponding indicators from Statcan,

CIHI & other sourcesCIHI & other sources• Data Sources (& alternative data sources)Data Sources (& alternative data sources)• ICD codes, if applicableICD codes, if applicable• Survey questions, if applicableSurvey questions, if applicable

1616

What is in a Core Indicator?What is in a Core Indicator?• Analysis check-listAnalysis check-list• Method of calculationMethod of calculation• Basic categoriesBasic categories• Indicator commentsIndicator comments• DefinitionsDefinitions• Cross-references to other indicatorsCross-references to other indicators• Cited references, Other referencesCited references, Other references• Changes made (with dates)Changes made (with dates)

1717

What is in a Core Indicator?What is in a Core Indicator?

• Details Details included in the in the “Guide to Creating “Guide to Creating or Editing Core Indicators Pages”or Editing Core Indicators Pages”http://www.apheo.ca/index.php?pid=125

1818

Resources to Support Indicators: Resources to Support Indicators: ExamplesExamples

• Descriptions of Data Sources

e.g. CCHS, RRFSS, Hospitalization • Standardization of rates paper• 3 Built Environment resources• How to calculate a moving average• Geography in Ontario• Who Chose what in the CCHS• SPSS syntax files for BMI, food insecurity, low risk

drinking┼ PLUS MUCH MORE

1919

Why are the Core Indicators Important?Why are the Core Indicators Important?

• Provide much more detailed information than other indicator projects

• Geared to public health epidemiologists but are available to everyone

• Databases are specific to Ontario• Referred to in the Population Health Assessment

and Surveillance (PHAS) Protocol• Sub-groups involve a variety of members to

seek consistency in indicator definitions across organizations

2020

What is happening now?What is happening now?• PHAC Project completed in summer 2009

– Chronic disease & risk factor indicators revised– Some Policies and procedures created

• Moving Forward:– Working on a 3-year operational plan based on Strategic

Directions session– Revising and updating website– Ongoing indicator development & revisions– New areas identified: injury and substance misuse; social

determinants of health; child health – no sub-group yet– Seeking sustained funding from the OAHPP

2121

Advice to Sub-GroupsAdvice to Sub-Groups

• Be realistic– Indicator development takes a long time– Go at a steady pace– Recognize that indicators are always more

complicated than you thought

• Start simple– Identify some relatively “simple” indicators – Nail down wording on key pieces that will be

consistent over your indicators

2222

Advice to Sub-GroupsAdvice to Sub-Groups• Create teams of ~3 people to work on an indicator, mix

of epidemiologists and content experts• Recognize different roles of sub-group members• Follow the template as provide in the “Guide” when

revising and creating new indicators• Focus on incremental improvements – The indicator

doesn’t have to be perfect!• Create partnerships with other people and organizations

interested in this work• Recognize this as a learning opportunity• Have Fun!

2323

Questions?

Check the APHEO website under Core Indicators Project for lots of information.

More Questions? Contact:Brenda Guarda − Brenda.Guarda@smdhu.org