characteristics of users with a high morbidity in montreal

Characteristics of users with a high morbidity in Montreal

Mamadou Bamba HANNE, Ph.D. Candidate – Public Health. Groupe de Recherche Interdisciplinaire en Santé (GRIS)

Faculté de médecine, Université de Montréal,CANADA

[email protected]

Tuesday 3 June 2008 Suite 304,WTCC

Canadian Public Health Association 2008 Annual ConferenceHalifax, Nova Scotia, CANADA

Reducing Health Inequalities through Evidence and Action

On the Move: Neighbourhoods and Networks

by

2008 Conference for CPHA. Mamadou Bamba Hanne

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PresentationContext and research questions

Framework

Method

Data

Prevalence of the morbidity in Montreal

Morbidity and use of the health services

Clustering of the users aged 65 years and +

Limits

Conclusions


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Context

Epidemiological definition: morbidity as the number of persons with a given condition (disease) within a given period – one year.

Three types of morbidity :

Objective morbidity

Perceived morbidity

Established morbidity

Classification of morbidity levels: best predictors of the use of health services

Focus of the existence of specific conditions : not a global vision of resources to build on (Adams et al., 2002).


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Questions

Main goal : description of the high morbidity in Montreal by using the ACG system

What are the characteristics of users with a high morbidity ?

How do they use the health services ?

Can me make a clustering of elder users ?

Issue:- To approach central problems in the management and the organization of the resources intended to dam up morbidity.

- best knowledge of the profile of challenging users and their localization: anticipation of the request for care and the expenditure


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Framework

Weiner (2003).


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MethodLevels of the morbidity: use of the ACG system software

Use of the International Classification of Disease (ICD-9)

Cataloging the patients into 93 different categorries of AGG (Adjusted Clinical Groups) according to the type of morbidity characterized by:

1. Likely persistence of the condition2. severity of the condition3. Aetiology 4. Diagnostic certaintly5. Needs for speciality care

Gathering the 93 ACG codes into6 major categories [0-5]: integration of the morbidity indicator RUB (Resource Utilization Bands)

0: nonusers 3: moderate morbidity1: healthy users 4:high morbidity2: low morbidity 5: very high morbidity


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Typology of the patient’s profile of 65 years old and over :

Process of cluster analysis (clustering)

Usage of the Euclidian Distance in a multi-dimensional space created by the variables specified

K-means methods: K groups, or "clusters"

Minimal distance

Constitution of homogenious group and differentiate one another

Methodology


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Data

iCLSC

Med-Echo

RAMQ - Actes médicaux

RAMQ - Médicaments

Info-Admission

Décès

medical-administratives data base

‘‘Agence de la Santé de Montréal’’

‘‘Banque de données jumelées’’

Junction of data bases

linkHealth Insurance Number

encrypted

confidentiality


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Très grande morbidité

Grande morbidité

Morbidité modérée

Morbidité faible

Sans morbidité

niveau de morbidité (RUB)

50

40

30

20

10

0

pré

va

len

ce (

%)

14,9

3,16,8

32,7

42,5

Prévalence de la morbidité chez les bénéficiaires des soins, 2005-2006


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Prevalence of high and very high morbidity within age group, by sex

1,9

0,2

8,1

1,0

12,2

9,0

1,60,3

3,7

1,5

11,3

13,6

0,0

2,0

4,0

6,0

8,0

10,0

12,0

14,0

Grandemorbidité

Très grandemorbidité

Grandemorbidité


Grandemorbidité


moins de 20 ans 20 à 64 ans 65 ans et plus

prévalence (%)

femmes hommes CMIS, 2007



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Prevalence of the morbidity in MontrealPrevalence of the morbidity within quintile of deprivation

Pampalon’s Indicators quintiles High morbidity Very high morbidity

Social deprivation 1 (more favored) 5,9 2,4

2 6,5 2,8

3 6,8 3,1

4 7,0 3,2

5 7,0 3,3

Material deprivation 1 (more favored) 6,5 2,9

2 6,8 3,1

3 6,8 3,2

4 7,1 3,3

5 6,9 3,0

Relationship between the morbidity and Pampalon’s indicators

Relationship sex N γ p-value

Morbidity and deprivation

Social deprivationfemales 779272 -0,028 0,000

males 625947 -0,003 0,025

Material deprivationfemales 779272 -0,008 0,000

males 625947 +0,013 0,000

Significatives Associations between dimensions of deprivation and the levels of morbidity

Very low values of γ

Positive sign of γ for males: the more material-favored have the higher level of morbidity.


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Morbidity and use of the health services

Quelques informations sur l’utilisation des services*

Grande morbidité Très grande morbidité Tous niveaux confondus

N Moyenne N Moyenne N Moyenne

prescriptions 59 569 64,7 33 563 108,1 601 945 37,8

renouvellement d'ordonnance 59 569 49,3 33 563 82,8 601 945 28,4

actes médicaux chez l'omni 86 354 11,8 42 105 27,8 1 192 054 6,1

actes médicaux chez le spécialiste 94 052 20,3 43 040 49,7 1 081 738 9,5

interventions en CLSC 42 059 11,4 23 726 30,2 321 820 8,3

recours au transport ambulancier 15 093 1,6 21 063 2,3 70 588 1,6

durée de séjour(s) en courte durée 48 742 7,6 34 763 270 150 565 10,49

durée séjour(s) en longue durée 48 742 0,4 34 763 20 150 565 0,6

durée séjour(s) en CHLSD 997 228,6 3 509 201,4 4 896 213,6

Morbidity levels and some information about health services usage, 2005-2006

Positive assiociation between levels of morbidity and volume of health services usage

Exception for the length of inpatient stay in CHLSD (Centre d’Hébergement et de Soins de Longue Durée): difference of 14% in favour of the very high morbidty

Explanation: high mortality induced by the very high mortality


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Morbidity and use of the health servicesShare of (%) patient of each level of morbidity in the total of prescriptions, medical acts, interventions in CLSC and emergency ambulance transport

17

14

19

18

21

23

20

22

16

16

21

27

42

59

73

68

0 10 20 30 40 50 60 70

prescriptions

actes médicaux chez l'omni

actes médicaux chez lespécialiste

interventions en CLSC

recours au transportambulancier

durée totale des séjours encourte durée

durée totale des séjours enlongue durée

durée totale des séjours enCHLD

part des patients (%)Grande morbidité Très grande morbidité CMIS, 2007

10% of the population of Montreal

Third of the annual total number of prescriptions

Quarter of the whole of medical acts passed through the general practioner

40% of the whole of medical acts passed through the the specialist

Impact of the two higher levels of morbidity


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Characteristics of elder patients

Variables de classification Classes Total

1 2 3

durée de séjour en courte durée 59,0 23,7 6,6 11,3

actes médicaux chez l'omni 51,1 28,5 16,4 19,5

actes médicaux chez le spécialiste 124,3 38,7 23,7 32,3

interventions en CLSC 17,6 189,9 5,4 10,6

recours au transport ambulancier 1,8 1,6 0,5 0,6

Proportion (%) 8,23 2,27 89,50 100,00

Classification according to the means of use of the services

Class 1: profile of hospitalization

Class 2: profile of great customer of CLSC

Class 3: profile of average user


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Validation of the classification: distribution (%) of patients of each class according to their degree of real heaviness

Class and profiles ACG codes (degree of real heaviness) Total

4430 4920 4930 4940 5040 5050 5060 5070

1 : hospitalization 2,07 5,54 7,22 5,60 0,47 3,39 10,74 64,95 100

2 : great customer of CLSC 11,52 17,22 15,09 8,08 0,94 4,45 11,27 31,43 100

3 : average user 24,37 30,52 15,39 5,04 2,85 5,47 6,99 9,37 100

Total 22,24 28,16 14,71 5,16 2,61 5,27 7,39 14,45 100

Three last ACG codes: patients living with at least ten combinaisons of diagnostics including at least two majors

79% of the patients with the profile hospitalization (class 1)

47% of the patients with the profile great customer of CLSC (class 2)

22% of the patients with the profile average user (class 3)


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Residence (RLS) Class Total

profilehospitalization

profilegreat customer of CLSC

profile

average user

Ahuntsic/Montréal-Nord 7,23 1,70 91,07 100,00

Côte-des-Neiges/Métro/Parc-Extension 8,60 2,51 88,89 100,00

Côte-Saint-Luc/NDG/Montréal-Ouest 9,19 2,40 88,41 100,00

Faubourgs/Plateau Mont-Royal/Saint-Louis-du-Parc 8,53 3,72 87,74 100,00

Hochelaga/Mercier-Ouest/Rosemont 9,47 2,35 88,18 100,00

LaSalle/Vieux-Lachine 6,78 1,97 91,25 100,00

Nord-de-l'île/Saint-Laurent 7,44 2,21 90,35 100,00

Petite-Patrie/Villeray 7,66 2,41 89,93 100,00

Pierrefonds/Lac Saint-Louis 7,16 2,07 90,77 100,00

RDPR/Anjou/Montréal-Est 8,25 2,31 89,44 100,00

Saint-Léonard/Saint-Michel 9,22 1,85 88,92 100,00

Verdun/Côte Saint-Paul/Saint-Henri 9,52 2,34 88,14 100,00

Total 8,23 2,27 89,50 100,00

max 9,52 3,72 91,25

min 6,78 1,70 87,74

Distribution (%) of patients aged 65 years and + , according to their residence


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Limits

Connection of AGG system with

- the number of medical visits registered

- the administration registrars of diagnostics

- the errors in diagnostic’s identification

Weakness of pharmaceutical data comparability :

- differentiation of prescription volumes

- Beneficiates of previous prescription from the current fiscal year


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ConclusionsHigh and very high morbidity levels : 10% of the population in Montreal

Characteristics of patients with higher morbidity: elderly• More stroked by the two extreme morbidity levels• Heterogeneous group, with three profiles

Vulnerability defined by the Quebec Health Insurance office : only 52% of patients with a very high morbidity… what happened ?

Positive association between the level of health services usage and the degree of morbidity

ACG System: facilitation of data process related to diagnostics

Best anticipation of care seekers

Allocation of resources and services organisation according to the profiles of expected patients


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Thank you for your attention !

characteristics of users with a high morbidity in montreal

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