This article illustrates how administrative data can be used to improve population health in an environment of fiscal constraint. In our universal single-payer health system, health care providers submit standardized data. This allows provinces to create health information utilities that generate population-based data that can be used for research and health care delivery. Although more study is needed to determine the cost-effectiveness of using such data to raise the rates of primary and secondary prevention, it appears that appropriately designed information systems could improve population health with relatively little additional cost.
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References
1.
EvansRGBarerMLMarmorTR (eds). Why Are Some People Healthy and Others Not? The Determinants of Health of Populations. Hawthorne, New York, Aldine De Gruyter Press, 1994.
2.
WelchWPWelchHG. Medicare analysis: Fee-for-data. A strategy to open the HMO black box. Health Affairs (Millwood) 1995; 14(Winter): 104–116.
3.
CohenMMRoosNPDeCosterCBlackCDeckerKM. Manitoba's population-based databases and long-term planning: Beyond the hospital databases. Health Care Management Forum1995; 8: 5–13.
4.
RoosLLMustardCANicolJPMcLerranDFMalenkaDJYoungTKCohenMM. Registries and administrative data: Organization and accuracy. Medical Care1993; 31(3): 201–212.
5.
RoosLLWalldRRomanoPRobereckiS. Short-term mortality after repair of hip fracture: Do Manitobans do worse?Medical Care1996; 34: 310–326.
6.
FedsonDSWajdaANicolJPHammondGWKaiserDLRoosLL. Clinical effectiveness of influenza vaccination in Manitoba in 1982–1983 and 1985–1986. Journal of the American Medical Association1993; 270(16): 1956–1961.
7.
Health Services Research Group.Small-area variations: What are they and what do they mean?Canadian Medical Association Journal1992; 146(4): 467–470.
8.
RobertsJDPoffenrothLARoosLLBebchukJDCarterAO. Monitoring childhood immunizations: A Canadian approach. American Journal of Public Health1994; 84: 1666–1668.
9.
RobertsJDRoosLLPoffenrothLAHassardTHBebchukJDCarterAOLawB. Surveillance of vaccine-related adverse events in the first year of life: A Manitoba cohort study. Journal of Clinical Epidemiology1996; 49: 51–58.
10.
RussellLB. Educated Guesses: Making Policy About Medical Screening Tests. Los Angeles, University of California Press, 1994.
11.
TengsTOAdamsMEPliskinJSSafranDGSiegelJEWeinsteinMCGrahamJD. Five hundred life-saving interventions and their cost-effectiveness. Risk Analysis1995; 15: 369–390.
12.
LeutwylerK. The price of prevention. Scientific American1995; 272: 124–129.
13.
FedsonDSWajdaANicolJPRoosLL. Disparity between influenza vaccination rates and risks of influenza-associated hospital discharge and death in Manitoba in 1982–1983. Annals of Internal Medicine1992; 116: 550–555.
14.
FedsonDS. Influenza and pneumococcal vaccination in Canada and the United States, 1980–1993. What can the two countries learn from each other?Clinical Infectious Diseases1995; 20: 1371–1376.
15.
MullerCMandelblattJSchechterCBPowerEJDuffyBMWagnerJL. Costs and Effectiveness of Cervical Cancer Screening in Elderly Women — Background Paper (OTA-BP-H-65). Washington, DC, US Government Printing Office, 1990.
16.
FahsMCMandelblattJSchechterCMullerC. Cost effectiveness of cervical cancer screening for the elderly. Annals of Internal Medicine1992; 117: 520–527.
17.
RussellLB. The role of prevention in health reform. New England Journal of Medicine1993; 329(5): 352–354.
18.
CohenMMRoosNPMacWilliamLWajdaA. Assessing physician's compliance with guidelines for papanicolaou testing. Medical Care1992; 30(6): 514–528.
19.
O'ConnorA. A women's cancer prevention practices, in StephensTFowlerGD (eds). Canada's Health Promotion Survey 1990 Technical Report (Cat. No. H39-263/2-1990E). Ottawa, Supply and Services Canada, 1993.
20.
GoelV. Factors associated with cervical cancer screening: Results from the Ontario Health Survey. Canadian Journal of Public Health1994; 85: 125–127.
21.
CohenMMHammarstrandKM. Papanicolaou test coverage without a cytology registry. American Journal of Epidemiology1989; 129: 388–394.
22.
AndersonGHBoyesDABenedetJLLeRicheJCMatisicJPSuenKC. Organisation and results of the cervical cytology screening programme in British Columbia, 1955–85. British Medical Journal1988; 296: 975–978.
23.
AndersonGH. The British Columbia experience. Chronic Diseases in Canada1992; 13(4) Suppl: S5.
24.
HakamaMLouhivuoriK. A screening programme for cervical cancer that worked. Cancer Surveys1988; 7(3): 403–416.
25.
RobertsonAJReidGSStokerCABissettCWaughNFentonI. Evaluation of a call programme for cervical cytology screening in women aged 50–60. British Medical Journal1989; 299: 163–166.
26.
Health and Welfare Canada. Proceedings of the Second National Workshop on Cervical Cancer Screening, Edmonton, Alberta, 24–25 November 1992. Chronic Diseases in Canada1992; 13(4) Suppl: S1–S41.
27.
FaheyMTIrwigLMacAskillP. Meta-analysis of pap test accuracy. American Journal of Epidemiology1995; 141: 680–689.
28.
CohenMM. Using administrative data for case-control studies: The case of the Papanicolaou smear. Annals of Epidemiology1993; 3(1): 93–98.
29.
MillerAB. Editorial: Failures of cervical cancer screening. American Journal of Public Health1995; 85: 761–762.
30.
ParboosinghEJAndersonGClarkeEACervical cancer screening: Are the 1989 recommendations still valid?Canadian Medical Association Journal1996; 154: 1847–1853.
31.
JohnstonMELangtonKBHaynesRBMathieuA. Effects of computer-based clinical decision support systems on clinician performance and patient outcome: A critical appraisal of research. Annals of Internal Medicine1994; 120: 135–142.
32.
SullivanFMitchellE. Has general practitioner computing made a difference to patient care? A systematic review of published reports. British Medical Journal1995; 311: 848–852.
33.
TannenbaumTNGyorkosTWAbrahamowiczMBedardLCarsleyJFrancoED. Immunization delivery methods: Practice recommendations. Canadian Journal of Public Health1994; 85 (Suppl1): S37–S40.
34.
MosseyJMRoosLL. Using insurance claims to measure health status: The illness scale. Journal of Chronic Diseases1987; (Suppl) 40: 41S–50S.
35.
RoosNPShapiroE. Using the information system to assess change: The impact of downsizing the acute sector. Medical Care1995; 33 (Suppl): DS109–DS126.
36.
RoosNP. Hospitalization style of physicians in Manitoba: The disturbing lack of logic in medical practice. Health Services Research1992; 27(3): 361–384.
37.
RoosNP. Linking patients to hospitals: Defining urban hospital service populations. Medical Care1993; 31(5) (Suppl): YS6–YS15.
38.
FedsonDSWajdaANicolJPHarwardMPKaiserDLRoosLL. Linked record studies of influenza and its control. In: KendalAPHannonnCKleukHDRubenFL (eds). Options for the Control of Influenza II. Amsterdam, Elsevier Science Publishing Company Inc, 1993.
39.
FinePEMChenRT. Confounding in studies of adverse reactions to vaccines. American Journal of Epidemiology1992; 136(2): 121–135.
40.
RayWAGriffinMR. Letter re: “Confounding in studies of adverse reactions to vaccines.”American Journal of Epidemiology1994; 139: 229.
41.
EdwardsKMDeckerMD. Acellular pertussis vaccines for infants. New England Journal of Medicine1996; 334: 391–392.
42.
OrnsteinSMGarrDRJenkinsRGRustPFArnonA. Computer-generated physician and patient reminders: Tools to improve population adherence to selected preventive services. Journal of Family Practice1991; 32: 82–90.
43.
MillerABAndersonGBrissonJLaidlawJLePitreNMirwaldtP. Report of a national workshop on screening for cancer of the cervix. Canadian Medical Association Journal1991; 145 (10): 1301–1325.
44.
RoosLL. Nonexperimental data systems in surgery. International Journal of Technology Assessment in Health Care1989; 5: 341–356.
45.
BarerMLWelchWPAntiochL. Canadian/U.S. health care: Reflections on the HIAA's analysis. Health Affairs (Millwood) 1991; 10(Fall): 229–239.
46.
SchieberGJPoullierJPGreenwaldLM. Health system performance in OECD countries, 1980–1992. Health Affairs (Millwood) 1994; 13(Fall): 100–112.
47.
DrummondMFBloomBSCarrinGHillmanALHutchingsHCKnill-JonesRP. Issues in the cross-national assessment of health technology. International Journal of Technology Assessment in Health Care1992; 8(4): 671–682.
48.
FreedGL. The comprehensive childhood immunization act of 1993: Toward a more rational approach. New England Journal of Medicine1993; 329(26): 1957–1960.
49.
MoonMHolahanJ. Can states take the lead in health care reform?Journal of the American Medical Association1992; 268(12): 1588–1594.
50.
ShowstackJAFeinOFordDKaufmanACrossAMadoffM. Health of the public: The academic response. Journal of the American Medical Association1992; 267(18): 2497–2502.
51.
WhiteheadMDahlgrenG. What can be done about inequalities in health?Lancet1991; 338: 1059–1063.
