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

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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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PUBLIC HEALTH - KNOWLEDGE AND INFORMATION
MANAGEMENT
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Mandatory Program Structure and Planning Approach
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Performance 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 Ontarians 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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Program-based Monitoring

• 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.

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Current health care information flows are bad and
getting worse
Analysis reporting
Databases
Data sources
Note Full size version will be available for
presentation
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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.

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Context Things were 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.

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Context Things were 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

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Context Things were 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)

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Context Things were 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

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Context Things were thinking of Chronic
Disease Surveillance Components

• Better support Rapid Risk Factor Surveillance
  System
• Provincial sample
• 36 health units
• lt100 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 gt 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, gt5 years
• Intentions to quit smoking (6 months and 30 days)
• Stages of Change

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Priorities Tobacco

• Cessation (Contd)
• 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 (Contd)
• 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