Core Indicators for Public Health in Ontario: Orientation

1. Core Indicators for Public Health in Ontario:Orientation May, 2010

2. Presentation Outline History of the Core Indicators project What is the Core Indicators Work Group? What are sub-groups? What is in a Core Indicator? Where is the Project now? Advice for sub-groups

3. In the Beginning... Epidemiologists in Ontario recognized the need for consistency among health reports The Provincial Health Indicators Work Group (PHIWG) was established February, 1998 as an initiative of APHEO. PHIWG later renamed to Core Indicators Work Group (CIWG) Mandate: ... to systematically define and operationalize a core set of health indicators

4. Founders of Core Indicators ProjectInaugural Meeting February 1998 • Raili Cardinal, Algoma Health Unit • Terry Delmore, Halton Region • Vivek Goel, Institute of Clinical Evaluative Sciences • Hyewon Lee-Han, City of Toronto - North York • Ian Johnson, City of Toronto - North York • Mary-Anne Pietrusiak, Durham Region • Ruth Sanderson, Bruce-Grey-Owen Sound HU • Patrick Seliske, Waterloo Region • Julie Stratton, Perth District Health Unit

5. What is the Core Indicators Work Group? • Formerly called the Provincial Health Indicators Work Group (PHIWG) • Initially, PHIWG created and wrote the indicators and resources • Since 2006, the CIWG has had more of an advisory role and the topic-specific work groups have done the actual revision and creation of the indicators

6. Role of the CIWG • The purpose of the CIWG is: to ensure that the Core Indicators for Public Health in Ontario are accurate, up-to-date and reflect the Ontario Public Health Standards; to advocate for health unit access to good quality data in a timely manner; and to promote the use of the Core Indicators.

7. Members of the CIWG • Brenda Guarda (Acting Chair) - Simcoe Muskoka District Health Unit • Shanna Hoetmer (Chair) - York Region (currently on leave) • Nam Bains - MOHLTC • Susan Bondy - University of Toronto Dalla Lana School of Public Health • Sherri Deamond* - Durham Region • Popy Dimoulas-Graham* - Public Health Agency of Canada • JoAnn Heale - MOHLTC • Ahalya Mahendra* - Public Health Agency of Canada (currently on leave) • Peggy Patterson* - Renfrew County and District Health Unit • Mary-Anne Pietrusiak* - Durham Region Health Department • Nancy Ramuscak* - Peel Region Health Department • Katherine Russell - Ottawa Public Health • Suzanne Sinclair* - Kingston, Frontenac, Lennox & Addington Health Unit • Jennifer Skinner* - Haliburton, Kawartha, Pine Ridge District Health Unit • Julie Stratton - Peel Health Department • Brenda Wannell - Statistics Canada * Lead or Co-Lead of a sub-group

8. Role of the Sub-Groups • The purpose of the Core Indicators sub-groups is to revise existing indicators and resources and to create new indicators and resources based on direction from the Core Indicators Work Group (CIWG).

9. Sub-Groups Current Subgroups: Built Environment (Lead Popy Dimoulas-Graham while Ahalya Mahendra is on leave) Healthy Eating and Active Living (Co-Leads Peggy Patterson, Jennifer Skinner) Infectious Diseases(Lead: Sherri Deamond) Reproductive Health (Lead: Mary-Anne Pietrusiak) Injury and Substance Misuse (Lead: Suzanne Sinclair) Social Determinants of Health (Lead: Nancy Ramuscak) Former Subgroups: Cancer, Smoking and Sun Safety(Lead: Brenda Guarda) Leading Causes(Lead: JoAnn Heale)

10. Key Milestones Feb 1998 – Inaugural meeting at ICES 1999 – CPHA & OPHA presentations, PHERO article Nov 1999 – Binder of draft “Core Population Health Indicators for Ontario” sent to PHUs Feb 2000 – Release of Ontario Health Status Report Jan 2001 – Round 2 begins to revise and expand first draft Summer 2001 – Student hired by CEHIP to create Core Indicators website Fall 2001 – Website launch at APHEO conference 2005 – Completion of indicators

11. Key Milestones, Cont’d Feb 2006 – Formation of four subgroups (Round 3) March 2007 – Formation of HEAL subgroup (split) June 2007 – Submitted funding application to PHAC May 2008 – APHEO website converted to wiki style July 2008 – Harleen Sahota begins as Project Manager as part of PHAC project Nov 2008 – OPHS & PHAS protocol released Dec 2008 – Core Indicators strategic directions Jan 2009 – Formation of Built Environment subgroup July 2009 – Core Indicators PHAC project completed

12. Key Milestones, Cont’d Aug 2009 – CIWG Chair changes to Shanna Hoetmer from Mary-Anne Pietrusiak Sep/Oct 2009 – 2 New Sub-groups: Injury & Substance Misuse, and Social Determinants of Health Oct 2009 – Brenda Guarda becomes acting CIWG Chair while Shanna is on leave Jan 2010 – APHEO contingent approaches OAHPP for Core Indicators funding

13. http://www.apheo.ca/index.php?pid=55

14. Criteria for Selecting Indicators Relevant to the Ontario Public Health Standards Data generally available and accessible at the local level Indicator has to be useful and meaningful Indicator has to be relevant to health “Core” indicators Decision by consensus

15. What is in a Core Indicator? Name, Description, Specific indicators Corresponding outcomes from OPHS Corresponding indicators from Statcan, CIHI & other sources Data Sources (& alternative data sources) ICD codes, if applicable Survey questions, if applicable

16. What is in a Core Indicator? Analysis check-list Method of calculation Basic categories Indicator comments Definitions Cross-references to other indicators Cited references, Other references Changes made (with dates)

17. What is in a Core Indicator? Details included in the “Guide to Creating or Editing Core Indicators Pages” http://www.apheo.ca/index.php?pid=125

18. Resources to Support Indicators: Examples • Descriptions of Data Sources e.g. CCHS, RRFSS, Hospitalization • Standardization of rates paper • 3 Built Environment resources • How to calculate a moving average • Geography in Ontario • Who Chose what in the CCHS • SPSS syntax files for BMI, food insecurity, low risk drinking • PLUS MUCH MORE

19. Why are the Core Indicators Important? • Provide much more detailed information than other indicator projects • Geared to public health epidemiologists but are available to everyone • Databases are specific to Ontario • Referred to in the Population Health Assessment and Surveillance (PHAS) Protocol • Sub-groups involve a variety of members to seek consistency in indicator definitions across organizations

20. What is happening now? PHAC Project completed in summer 2009 Chronic disease & risk factor indicators revised Some Policies and procedures created Moving Forward: Working on a 3-year operational plan based on Strategic Directions session Revising and updating website Ongoing indicator development & revisions New areas identified: injury and substance misuse; social determinants of health; child health – no sub-group yet Seeking sustained funding from the OAHPP

21. Advice to Sub-Groups Be realistic Indicator development takes a long time Go at a steady pace Recognize that indicators are always more complicated than you thought Start simple Identify some relatively “simple” indicators Nail down wording on key pieces that will be consistent over your indicators

22. Advice to Sub-Groups Create teams of ~3 people to work on an indicator, mix of epidemiologists and content experts Recognize different roles of sub-group members Follow the template as provide in the “Guide” when revising and creating new indicators Focus on incremental improvements – The indicator doesn’t have to be perfect! Create partnerships with other people and organizations interested in this work Recognize this as a learning opportunity Have Fun!

23. Questions? Check the APHEO website under Core Indicators Project for lots of information. More Questions? Contact: Brenda Guarda −Brenda.Guarda@smdhu.org