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Understanding the health of a population is not an easy task for policy-makers and health system planners. That's because it requires looking at the different health care needs of hundreds of thousands — or even millions — of people.
Let's take a closer look at one Canadian family and how they use the health care system.
George and Mary Peterson live in a rural community in Northern Canada and they've been married for 40 years.
George has uncontrolled diabetes and cardiovascular disease, and he has the onset of dementia. Mary has glaucoma but other than that is relatively healthy.
They both go to the same family doctor. George has been seeing her regularly about every 3 months, while Mary visits annually for a checkup. And she also sees her ophthalmologist twice a year.
The onset of George's dementia is creating some problems and he's visited the emergency department a couple of times in the last few months. Recently, he's been referred to a geriatrician.
The Peterson's 38-year-old son, Charlie, lives in the same community and hasn't had the need for any health care services in the last couple of years.
George's only brother, Douglas, has been in a long-term care facility for the past 3 years.
He has advanced Parkinson's disease and requires help from the home's staff for all of his daily activities such as eating and getting dressed.
The Peterson family can be viewed as an example of the variation of health care needs in a population.
If we multiply this by hundreds of thousands of people — all with different health profiles — what can a health system planner or policy-maker do to ensure health services are available according to population needs?
That is to say, how can they understand the health care needs of the whole population and develop the right policies and plans to get the needed resources to the required locations?
>> CIHI >> Population Grouping Methodology
In response to this challenge facing health system professionals, the Canadian Institute for Health Information, also known as CIHI, developed a Population Grouping Methodology — or POP Grouper. This POP Grouper is a made-in-Canada grouping methodology that is based on Canadian health care data and uses information from across the continuum of care, such as hospitals, physicians' offices and long-term care homes, to better understand the health conditions in a population and their associated costs.
The POP Grouper provides individual clinical and demographic profiles — such as those described for George, Mary, Charlie and Douglas — and uses these profiles to help determine the health needs of a population.
Let's break this down a little more. The POP Grouper looks at the clinical profile of each person in the population, as well as their demographic characteristics such as age, sex and socio-economic status.
With a focus on chronic conditions, identifying each person's clinical profile is a key component of the POP Grouper. In our example, we know that George has diabetes, cardiovascular disease and dementia; Mary has glaucoma; Charlie has no identified health conditions; and Douglas, who's living in long-term care, has Parkinson's disease.
From these clinical profiles, the POP Grouper assigns a health profile group to each person. This health profile group summarizes each person's health conditions into the main condition driving their health needs. It also considers the complexity of their health needs by recognizing that treating people with certain combinations of health conditions can be more complex and require more time and resources. For example, we know that George has 3 health conditions. The health profile group associated with George's clinical profile is Dementia with significant comorbidities. This means that based on George's current health needs and looking into the future, George's dementia is the health condition that will affect his future health the most and require the most clinical care.
Using the demographic and clinical profiles, the POP Grouper provides an estimate of the cost of providing health care for each person. The POP Grouper also predicts how often each person will visit a family physician and an emergency department. And for those people age 65 or older, like George and Mary, the POP Grouper also estimates the likelihood that they will enter a long-term care facility in the next year.
The methodology is applied to all persons within a defined subpopulation, such as a health region, to provide a clearer picture of the future health care needs of that population group.
Along with predicting costs, this methodology can be used to
- Monitor population health and the prevalence of certain health conditions;
- Understand variations in health across sub-populations;
- Explain variations in the use of health care resources;
- Identify high users of health care; and
- Provide a foundation for funding models.
CIHI clients across Canada have access to this methodology and can use it to make meaningful comparisons across health regions, provinces and territories and other lower levels of geography.
The POP Grouper methodology is another example of CIHI's commitment to putting case-mix tools into the hands of health system stakeholders so that they can make evidence-based decisions.
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The use of this and other CIHI grouping methodologies can support health system initiatives and innovation that ultimately improve the health of Canadians.