Une approche intelligente pour le monitorage de l'information sur la santé de la population et le système de la santé

Transcription

1 Une approche intelligente pour le monitorage de l'information sur la santé de la population et le système de la santé David Buckeridge, MD PhD FRCPC Associate Professor, McGill University CIHR Chair, Applied Public Health Research Medical Consultant, Montreal Public Health surveillance.mcgill.ca

2 CADRE DE RÉFÉRENCE Enjeux : 1. Niveau Politique 2. Niveau Organisationnel 3. Niveau Financement 4. Niveau Gouvernance Clinique Intégration suffisante des besoins patients et des populations Insuffisance des données réelles Formation associée à l introduction du changement / de l innovation Pistes de solution: Dossier électroniques (patients mais aussi de façon systématique) Création de living labs Financer l introduction dans réseau (formation terrain / agents de transformation) Instauration de processus d évaluation en continu)

3 Lots of Relevant Data Weber GM, Mandl KD, Kohane IS. Finding the Missing Link for Big Biomedical Data. JAMA. 2014;311(24):

4 the United States lacks a coherent template for population health information to assess how well the nation s efforts and investments result in improved population health Institute of Medicine (2010). For the Public s Health: The Role of Measurement in Action and Accountability. IOM, Washington, DC.

5 Template for Population Health Social Environment Physical Environment Genetic Endowment Individual Response Behavior Biology Health and Function Disease Health Care Well-Being Prosperity Evans R, Stoddart G. Producing Health, Consuming Health Care. Canadian Institutes for Advanced Research. Program in Population Health. Working Paper No. 6, p 51. Toronto, April 1990.

6 Evidence-Based Population Health Best available research evidence Decision-making Environmental and organizational context Brownson, R. C., Fielding, J. E. & Maylahn, C. M. Evidence-based public health: a fundamental concept for public health practice. Annu Rev Public Health 30, (2009). Population characteristics, needs, values, and preferences Resources, including practitioner expertise

7 Defining a Population Health Record Representative information for a defined population Evidence about population health and health systems Explicit population health framework used to organize information and evidence Facilitates population health decision making Integrated data on determinants, outcomes, healthcare Alignment of information and evidence regarding population health and health system interventions Friedman DJ, Parrish RG. The population health record: concepts, definition, design, and implementation. JAMIA 2010;17:

8 Population Health Record Built Environment Marke ng Public Health Artificial Intelligence used to Organize and Interpret Information Neighbourhood Data Clinical Indicators Public Popula on Health Record Popula on Health Indicator Ontology Surveys Individual Data Buckeridge, D. L. et al. An infrastructure for real-time population health assessment and monitoring. IBM Journal of Research and Development 56, (2012). Real-Time Data Capacity Administra ve Data Admissions Billing Medica ons DSQ Clinical Data

9 Current PopHR Implementation 3.8 million people (2011) Data from 1998 to present 25% random sample 1 million people at any one time

10 Informal Model Indice de poten el piétonnier [INSPQ] Incidence [RAMQ] Stroke Incidence [RAMQ] Walkability Green Cover Physical Ac vity Myocardial Infarct Incidence [RAMQ] Niveau de verdure [INSPQ] Incidence, prevalence, mortality [RAMQ] Hypertension Amputa on # de restaurantsminute [INSPQ] BMI Diabetes Death Fast Food Density Dep Density Caloric Intake Incidence, prevalence, mortality [RAMQ] Renal Disease # de dépanneurs [INSPQ] Fruit Purchases So Drink Purchases Re nopathy Units of fruit purchased [Neilsen] Units of so drink purchased [Neilsen]

11 Formal Model A ribute PersonalCharacteris c applies to GeographicRegion HealthIndicator RateIndicator BMI has property is a Disposi on is a RiskOfDiabetes is realized in has effect on Popula on has member has property resides in Person Disease Diabetes has property IncidenceOfDiabetes takes account of results in takes account of Event DiseaseOnset OnsetOfDiabetes Shaban-Nejad, A. et al. PHIO: a knowledge base for interpretation and calculation of public health indicators. Stud Health Technol Inform 192, 1207 (2013).

12 Knowledge in PopHR System Type I Causal relationships between health indicators Type 2 Effectiveness of population health interventions Type 3 Adaptation and translation of effective interventions Types of Evidence Interpret indicators using existing knowledge Identify interventions suited to a population Document implemented interventions PopHR Function Display

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16 Applications of PopHR in Québec Population health planning for diabetes Primary care sensitive admissions for chronic disease

17 Contributors Applied Public Health Chair e-health interventions