Public Health, Chronic Disease Prevention and Health Promotion: the Role of the Rapid Risk Factor Surveillance System (RRFSS) Presentation by Michele Weidinger.

Public Health, Chronic Disease Prevention and Health Promotion:

the Role of the Rapid Risk Factor Surveillance System

(RRFSS)

Presentation by Michele Weidinger & Elizabeth Rael

to the RRFSS Workshop, June 22, 2005

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Overview

• Accountability and Performance Measurement• Chronic Disease Surveillance ideas

• Making a plan• Using available data• Better support Rapid Risk Factor Surveillance System

• Tobacco• Challenges• How to move forward… your ideas

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Accountability and Performance Measurement• To ensure that services provided by health units respond effectively to the needs of Ontarians, the

Ministry is undertaking a number of initiatives:

• program-based budgeting system

• including Planning Guidelines and Accountability Agreements

• program specific performance measures

• consistent with other government initiatives/programs

• based on Mandatory Health Programs and Services Guidelines

• public health performance report

• will build on above initiatives

• first report expected December, 2005

• The Ministry will work with health units to further develop and refine these accountability mechanisms to meet the needs of the government, the Ministry, health units and the public

• The Local Public Health Capacity Review Committee (CRC) has struck an Accountabilities Sub-committee to further explore the options available to public health

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UTILITY OF PERFORMANCE MEASURES

• Inform program and policy planning and development

• provides mechanism for demonstrating accountability

• enables benchmarking, best practices and research in public health

• informs reporting at multiple levels including: public health report card, Ontario within the national context, program specific reporting, etc.

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GOALS(Population Health)

LONG TERMOBJECTIVES/OUTCOMES

SHORT TERMOBJECTIVES/OUTCOMES

ACTIVITIES/OUTPUTS

Is workhappening?

Are strategies working?

Is society benefiting?

MonitoringPerformance

AnnualResults-based

Planning

Public HealthReport Card

to Legislature

F/P/TReport

PUBLIC HEALTH - KNOWLEDGE AND INFORMATION MANAGEMENT

6Mandatory Program Structure and Planning Approach

PerformanceMeasurement Reference

Panel(consortium)

Mandatory ProgramFramework

Data ModelingProgram-based

Monitoring

7Performance Measurement Reference Panel:

• Provide expert support/consultation for measurement initiatives underway as part of the public health transformation process including the development of appropriate measures and targets for Mandatory Health Programs and Services Guidelines

• Review and refine proposed performance measures and identify data collection requirements and issues as appropriate

• Recommend work plans for implementing performance measures data collection including timeframe vis-à-vis other public health transformation initiatives

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Mandatory Program Framework:

• Public Health Division will be initiating a review of the current MHPSG framework and scope with the goal of incorporating evidence-based performance measures

• Research questions will have to be answered (e.g. literature review of frameworks, core public health functions, jurisdictional review)

• Evidence-based measurement of the outcome/impact of public health programs and services on the health of Ontarian’s will be developed (integral component of the technical review process to be supported by a reference panel)

• Technical review of the Mandatory Programs will follow (there will be content areas for review once underway)

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• Meaningful, accurate and timely measurement of programs and services provided or overseen by public health

• Mandatory Program Indicator Questionnaire (MPIQ) was a pioneering effort by public health unmatched across the healthcare sector which has since lagged behind due to deficiencies in accuracy and consistency over time and across health units. It is being discontinued.

• Public Health Division is developing a Program-based Monitoring System which will incorporate the lessons learned from the MPIQ and segue into the framework of the new Mandatory Health Programs and Services Guidelines (MHPSG). It will support measurement at the output and short-term outcome level.

Program-based Monitoring:

10Current health care information flows are bad and getting worse

Data sources Databases Analysis & reporting

Note: Full size version will be available for presentation

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7Future flows will focus on sustainability, increased useof data, and reduced burden of assessment

Data sources Databases Analysis & reporting

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Data Modeling:

• Reliable data available to those who need it, when they need it (with security and privacy issues addressed)

• Public Health Division is initiating a Data Modeling process in parallel to the Ministry-wide transformation initiatives which will ensure that accurate and timely data is collected in a coordinated fashion to meet multiple needs

• Rapid Risk Factor Surveillance System (RRFSS)

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CMOH Report to Legislature:

• Performance rich reporting in public health

• As part of Operation Health Protection, we will initiate the development of an annual Public Health Performance Report beginning December 2005.

14Context: Things we’re thinking of… Chronic Disease Surveillance, Developing a Plan

• A Chronic Disease Surveillance Advisory Group to develop a plan that will iteratively inform the decision-making around chronic disease surveillance.

• Surveillance: “tracking and forecasting any health event or health determinant through the ongoing collection of data, the integration, analysis, and interpretation of that data into surveillance products and the dissemination of that resultant surveillance product to those who need to know.”

• Health Canada, Office of National Health Surveillance. Partnering for quality, timely surveillance leading to action for better health. Proposal to Develop a Network for Health Surveillance in Canada. Ottawa, May 1999.

15Context: Things we’re thinking of… Chronic Disease Surveillance, Developing a Plan

• Possible Scope• Existing administrative records (e.g., building on the National

Diabetes Surveillance System developments)• Enhancements to administrative records (e.g., include smoking

status, height and weight with OHIP billing records)• Electronic health records• New surveillance (e.g. congenital anomalies?)• i-PHIS adaptations to accommodate chronic disease• Laboratory data• Peer review by content specialists

• Bearing in mind pan-Canadian interest in these matters

16Context: Things we’re thinking of… Chronic Disease Surveillance, Using Available Data

• Available data already used by Public Health Division on an ad hoc basis

• Vital statistics (live births, stillbirths, deaths)• Census• Community health surveys (e.g., Canadian Community Health

Survey)• Hospitalization data (Discharge Abstract Database)• National Ambulatory Care Reporting System (NACRS)• Canadian Congenital Anomalies Surveillance System (CCASS)

17Context: Things we’re thinking of… Chronic Disease Surveillance, Using Available Data

• Data now available to Public Health Division• Physician billings (OHIP data on PHPDB)

• Challenges• Surveillance requires resources

18Context: Things we’re thinking of… Chronic Disease Surveillance Components

• Better support Rapid Risk Factor Surveillance System • Provincial sample

• 36 health units • <=100 interviews / month • 100% funded

• Local / regional capacity e.g., epidemiologists at Public Health Research, Evaluation and Development (PHRED) programs

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Priorities: Overall

• Provincial surveillance system for chronic diseases • Collects & analyzes data, interprets and disseminates• Ensure indicators are based on rationale and priorities • Risk factors / determinants, knowledge, attitudes and behaviours • Enough power to report at the level of a health unit area, a region

e.g. a LHIN as well as the entire province. • Data reported to health units in both raw and analyzed form• As timely as RRFSS• Whatever resources individual health units are providing would still

be needed for surveillance and evaluation• Develop survey questions based on qualitative research• Do validation studies = > know limitations of data

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Priorities: Tobacco

• Goals• Cessation among current smokers• Protection from secondhand smoke• Prevention of tobacco uptake among youth & young adults

• Objectives• Develop measures for a proposed Performance Evaluation

Indicator System• Help validate the efforts expended by OTS partners including

PHU

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Priorities: Tobacco

• Cessation Outcomes and Indicators (Draft)• Decreased Consumption

• Average number of cigarettes smoked per day by daily smokers

• Reduced Smoking Prevalence

• Proportion of the population who are current smokers, daily smokers, occasional smokers, former smokers, never smokers

• Increased Quit Attempts and Quit Intentions• Rate of quit attempt for 1 day or longer• Proportion of former smokers quitting for specified duration (1-11

months, 1-2 years, 3-5 years, >5 years• Intentions to quit smoking (6 months and 30 days)• Stages of Change

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Priorities: Tobacco

• Cessation (Cont’d) • Increased Knowledge of Health Risks of Smoking• Increased Implementation of Cessation Policies & Programs

• Program exposure• Cessation programs, quitlines, websites, contests, mass media,

etc.• Proportion of smokers who have been advised to reduce or quit

smoking by a health care professional (doctor, dentist, nurse, pharmacist

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Priorities: Tobacco

• Protection Outcomes and Indicators (Draft)• Reduced Exposure to Secondhand Smoke (SHS)

• Proportion of adults employed outside of the home reporting exposure to SHS in the workplace

• Proportion of adults reporting exposure to SHS in public places• Proportion of adults reporting exposure to SHS at home and in vehicles• Proportion of adults reporting regular exposure to SHS

• Increased Implementation of Smokefree Policies• Proportion of adults employed outside of home reporting that they work

in environments with a smokefree policy• Proportion of adults who report their home is smokefree• Proportion of adults who report their personal vehicle is smokefree

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Priorities: Tobacco

• Protection (Cont’d)• Increased Compliance with Smokefree Policies

• Perceived compliance with smokefree policies (workplace, public places, schools)

• Increased Support for Smokefree Policies• Level of support for creating smokefree policies in workplaces, public

place, restaurants, bars, homes, vehicles

• Increased Knowledge of Health Risks of SHS• Proportion of population who believe that SHS is harmful

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Priorities: Tobacco

• Prevention Outcomes and Indicators (Draft)• Reduced Uptake of Smoking

• Proportion of young people who are never smokers, puffers, non-current experimenters, current experimenters, non-current established smokers, current established smokers

• Delayed Smoking Initiation• Average age at which young people smoked their first cigarette

• Decreased Susceptibility to Smoking• Among young adults, proportion of Never Smokers or Puffers who are

susceptible to smoking

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Priorities: Tobacco

• Increased Support for Prevention Policies• Level of support for policies, and enforcement of policies, to

reduce youth access to tobacco products (e.g., display bans, youth access)

• Level of support for increasing taxes on cigarettes

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Challenges: Tobacco

• Challenge: Myriad of definitions, needs developmental work done up-front to agree on definitions

• Smoker• Quit attempt• Successful quit attempt• Relapse

• Challenge: Sample size restrictions • There will be few folks who have actually quit in the past year or past 6

months.

• Opportunity: Other surveys• Cessation items and the help they have received is less important in the

RRFSS if it can be included in the (for example) CTUMs or the CAMH Monitor for a provincial estimate.

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Challenges

• Module development• Currently achieved by consensus; need to maintain local

commitment once provincial participation begins. • Need program staff involvement from the outset• Complex concepts need to be explained e.g., FOBT

• Comparability • Measures may need to be modified e.g. food insecurity • Differences across surveys; need to have the same questions

• Lack of validation of modules in Canadian context• e.g., fruits and vegetables module

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Challenges

• Currently core and optional modules are selected by participating health units.

• Priorities may differ for program areas within a health unit, or between province and health units.

• Need mechanism for accommodating provincial and health unit priorities in module choices.

• Generalizability • Need representative respondents e.g., from low socioeconomic

status

• Survey fatigue • Need to sustain response rates (e.g., restrict length of survey)

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Challenges

• Data handling & cleaning• Need standardized, documented approaches

• Currently data sharing agreements are negotiated on a case-by-case basis, separately with each participating health unit

• Need arrangements for ongoing access to data.

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How to move forward… your ideas

•