1. POWER: Project for an Ontario Women’s Health Evidence-Based Report Card Asma Razzaq Academy Health Annual Research Meeting June 3, 2007 www.powerstudy.ca

2. Goals & Deliverables  Tool to help policymakers and providers improve health and equity among women of Ontario  Report card 1: Fall 2007 – 5 chapters  Access to Health Care, Burden of Illness, Cancer, Cardiovascular Disease, Depression  Report card 2: Fall 2008 – 11 chapters  Update of 5 chapters + Diabetes, Reproductive Health, HIV, Musculoskeletal Disorders, Populations at Risk, and Social Determinants of Health  Web-based interactive data cube

3. Why is POWER Unique?  Equity is integral to the process  Input from stakeholders, providers and community groups, from the outset  Spans the continuum of care and is not sector specific  E-tool will increase dissemination and ensure uptake of the measures by others  Creates linkages between clinical and population health measures

4. Objectives  To illustrate the project, using the cancer chapter as an example  Value of the process  Challenges & lessons learned

5. Process for Indicator Selection

6. Example - Cancer  General indicators  Incidence  5 year survival  Wait time for surgery  Non sex-specific cancers  Colorectal  Lung  Sex-specific cancers  Breast  Cervical  Ovarian  Uterine  End of Life care

7. Literature Review  Published and grey literature internationally  Librarian:  Developed a standardized search strategy for all chapters  Conducted comprehensive searches  Extracted articles of interest  Conducted a separate search for each tumor site/area Result: 427 indicators

8. Working Group  10 members: clinical and/or research expertise  Includes Lead Investigator, Analyst, and Research Coordinator  Reviewed the 427 indicators and short-listed them according to:  Feasibility  Importance (equity issue, actionable, key information on women’s health) Result: 47 indicators

9. Expert Panel  8-12 experts: medical, radiation, surgical oncologists  Recommended by working group members  Sent invitations by email with follow up phone calls  Modified Delphi process, 2-step:  On-line rating of indicators (Survey Monkey tool)  Face-to-face meeting to finalize indicators Result: 31 indicators

10. Sample of Indicators Chosen 1.% of women with a history of breast cancer who have a yearly mammogram 2.% of screen eligible patients receiving one or more FOBTs in the last 2 years 3.% of women with an unsatisfactory Pap result who receive a repeat Pap test within 2-4 months of the original result 4.Proportion of cancer patients who had one or more home care services in the last 6 months of life

11. Data Analysis  Ontario Cancer Registry (OCR) for identification of cancer cases by tumor site  2 fiscal years 2002-2004 = 47,867 cases  For some indicators such as 5 year survival, we will go back to 2000/01  9 additional administrative databases including registry, inpatient, ambulatory, home care, and provincial breast and cervical screening databases  Stratify all indicators first by sex and then by age group, socioeconomic status, and ethnicity  Use established definitions and methods

12. Value of the Process  Rigorous and collaborative  Stakeholders: providers and consumers  Experts in the field  Advantages of Delphi process:  Clarification of definitions  Operationalization of indicators  Introduction to new and unexplored databases Result: Set of comprehensive performance measurement and quality of care indicators for women’s health that spans the continuum of care

13. Challenges & Lessons Learned Challenge: Reconciling what is important with what is measurable Lesson: Contextualize quantitative content and include list of important but not currently measurable indicators Challenge: Presenting enough information to expert panel members to allow for informed responses Lesson: Develop reference manuals Challenge: Meeting timelines Lesson: This is a very time intensive phase of the project…allow enough lead time!

14. Thank You Acknowledgements  Arlene Bierman – Principal Investigator  Jocalyn Clark – Director of Knowledge Translation  Monika Krzyzanowska – Lead Investigator  Co-authors – Cynthia Damba, Mandana Vahabi Funded by the Ontario Ministry of Health & Long Term Care and Ontario Women’s Health Council

15. www.powerstudy.ca Contact: Asma Razzaq, MPH Institute for Clinical Evaluative Sciences G106 – 2075 Bayview Ave. Toronto, ON M4N 3M5 Tel: 416-480-4055 ext. 7460 Email: asma.razzaq@ices.on.ca