MANITOBA CENTRE FOR HEALTH POLICY
A Comparison of the Social
Complexities across the Models
of Primary Care Delivery in
Winnipeg
Alan Katz
CAHSPR May 2015
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Manitoba Centre for Health Policy
Research Team
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PI: Alan Katz
Co-PI: Dan Chateau
Investigator: Christian Becker
Data Analysts: Carole Taylor, Randy Walld
Research Coordinator: Jeff Valdivia
Research Support: Scott McCulloch
Manitoba Centre for Health Policy
MCHP Houses the Anonymized
Population Health Research Data Repository
Income
Assistance
CancerCare
Social
Housing
Education
Hospital
Pharmaceuticals
Home Care
PopulationBased
Health
Registry
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Immunization
Medical
Services
Lab
Emergency
Department
Manitoba Centre for Health Policy
Vital
Statistics
Provider
• Diagnostic
Services
• Cadham
Nursing
Home
Clinical
Health Links
Census
Data at Area
Level
• Family First
• Healthy Baby
• EDI
Healthy
Child MB
Justice
Family
Services
• K to Grade 12
• Post-Secondary
(UofM)
• ICU
• FASD
• Pediatric
Diabetes
Research Goals
1. Compare/evaluate quality of care indicators for five
models of primary care delivery in Winnipeg:
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Fee-for-service primary care providers (PIN sites)
Fee-for-service primary care providers (non-PIN sites)
Community Health clinics (salaried primary care providers)
WRHA Primary Care clinics (salaried primary care
providers; integrated social services model)
University-managed teaching clinics
2. Describe the impact of patient social complexity on
primary care provider roster/panel size
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Manitoba Centre for Health Policy
Methods
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Study period: April 1, 2010 to March 31, 2013
Allocate patients to one of 5 PC models
Develop definitions of social complexities
Describe patient social complexity across models
Manitoba Centre for Health Policy
Complexities
A Scoping review and thematic classification of patient
complexity: offering a unifying framework
– Complexities influence health outcomes
– Three kinds of complexity: multimorbidity, resource
utilization, and psychosocial
– 75% of factors influencing health outcomes lie outside
healthcare system
– Psychosocial complexities refer to social isolation,
psychiatric illness, socio-demographic vulnerabilities, etc.
Schaink et al. 2012. Journal of Comorbidity, 2:1–9
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Manitoba Centre for Health Policy
Social Complexities - Definitions (1)
1. Children in care
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having been removed—at any point in time—from their family of
origin and placed in the care of another adult due to concerns about
proper provision of care in the family of origin (1992-2013).
2. History of teen birth
• A female who first gave birth at age 19 or younger (1970-2013).
3. Children of teen mothers
• Person identified as being the child of a mother with a history of teen
birth (1970-2013).
4. Social housing resident
• A person having ever lived in social housing that is owned and directly
managed by Manitoba Housing and Community Development (19952013).
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Manitoba Centre for Health Policy
Social Complexities - Definitions (2)
5. Lowest Income Quintile
• Income quintile is a measure of neighbourhood socioeconomic
status that divides the population into 5 income groups so that
approximately 20% of the population is in each group; this
represents the lowest 20% (Q1)
6. Income assistance
• A person who has ever received income assistance (1995-2013).
7. Major mental health diagnosis
• Ever having a psychotic disorder (1995-2013).
8. Newcomer
• A probability of being an immigrant to Canada that is assigned to a
person based on the dissemination area in which they reside (20062011).
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Manitoba Centre for Health Policy
Social Complexities - Definitions (3)
9. Child of a newcomer
• A person identified as a child of newcomer (2006-2011).
10. High residential mobility
• A person who moved residences three or more times (20002013).
11. Involvement with the justice system
• A person who has had contact with the justice system as a
witness, victim, or accused (2005-2013).
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Manitoba Centre for Health Policy
Patient Demographics
Final patient cohort = 626,264
75+
65-74 6%
7%
46.9%
53.1%
0-5
8%
6-18
14%
45-64
28%
19-44
37%
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Newcomer
status
7%
Patient Demographics
50
Patient Distribution by Primary Care Model and Income Quintile
PIN FFS
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WRHA
40
Community
Teaching
35
Non-PIN FFS
Percent
30
25
20
15
10
5
0
Q1 (Lowest)
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Q2
Manitoba Centre for Health Policy
Q3
Q4
Q5 (Highest)
Patient Demographics
Patient Distribution by Primary Care Model and Sickness Level (RUB*)
50
45
40
Percent
35
30
25
PIN FFS
20
WRHA
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Community
Teaching
10
Non-PIN FFS
5
0
3-5
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2
0-1
Patient Social Complexities by Model of Primary Care Delivery
Percentage of Allocated Patients by Complexity
45
PIN FFS
40
WRHA Primary Care
Community Health Agency
35
Teaching
Non-PIN FFS
Percent
30
25
20
15
10
5
0
Low Income
High
Residential Quintile (Q1)
Mobility
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Housing
Income
Major Mental Newcomer
Assistance
Health
Disorder
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Teen Mom
Child of a Child in Care Contact with
Teen Mom
Justice
System
Proportion of Patients in each Model of Primary Care by Number of Complexities
70%
PIN FFS
60%
WRHA Primary Care
Community Health Clinic
50%
Teaching Clinics
Non-PIN FFS
40%
30%
20%
10%
0%
0
1
2
3
Number of Complexities
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4
5+
Limitations
• Administrative data based definitions
• Newcomers based on probability
• Patient allocation based patient
assignment algorithm
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PLEASE REMEMBER
Material in this presentation is
PRELIMINARY and CONFIDENTIAL
and is not for distribution or discussion
until the final report is released.
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Manitoba Centre for Health Policy