Chapter 8: Musculoskeletal Conditions. Hawker GA, Badley EM, Jaglal S, Dunn S, Croxford R, Ko B, Degani N, Bierman AS. July 2010
POWER Study (Project for anOntario Women's Health Evidence-based Report) is producing a comprehensive Women's Health Report to serve as an evidence-based tool for policy makers, providers and consumers in their efforts to improve health and reduce health inequities among the women and men of Ontario. Musculoskeletal (MSK) Conditions limit physical function, impose significant pain and suffering and are the number one cause of disability in Ontario. As a result, the associated costs to our health care system and to society are staggering. This chapter examinescondition-specific prevalence, indicators of health and functional status, access and utilization of services and clinical care indicators for osteoarthritis, rheumatoid arthritis and osteoporosis. We examine performance on these indicators for women and men and assess differences by income, education, age and geography.
This atlas gives Ontario health service providers, policy makers, and the public new information on patterns of surgical care for Ontarians with cancer including regional distribution of services, types of providers and their scope of practice. This research was undertaken to support ongoing improvements in quality and accessibility of care for Ontarians being treated for cancer with a special focus on cancer related surgery. See Backgrounder, See Media Advisory
The first Canadian study of its kind, this ICES Atlas examines the role neighbourhoods play in the diabetes epidemic. In the three-year comprehensive study of 140 Torontoneighbourhoods, poverty and immigration were found to be key factors in developing type 2 diabetes. The atlas looks at the following factors related to diabetes prevention and control in Toronto: population density, service density and dispersion, immigration, socioeconomic status, ethnic composition, crime rates, car ownership, access to healthy and unhealthy food, opportunities for physical activity, and access to health care and its relationship to diabetes. Recommendations to address these factors are also presented.
Jaakkimainen L, Upshur R, Klein-Geltink J, Leong A, Maaten S, Schultz S, Wang L. November 2006 (Revised)
This report provides the most comprehensive picture, to date, on the state of primary care health services in Ontario between 1992/93 and 2002/03, prior to the introduction of new primary care reform initiatives in Ontario. Chapters 1-5 present current trends in primary care for women during pregnancy, labour and childbirth; care of children; care provided to adults; and, patterns in preventive health care. Chapters 6-10 describe how primary care services were provided to patients with congestive heart failure; cancer; respiratory diseases; mental health problems; and disadvantaged populations (for 2000/01). Chapters 11 and 12 examine the supply of physicians providing primary care, their practice locations, workloads, services provided, and patient characteristics, as well as the factors which influence preventive, chronic and acute disease management in primary care.
The current electronic version of the report (posted June 3, 2009) is correct.
The Canadian Cardiovascular Atlas, written by members of the Canadian Cardiovascular Outcomes Research Team (CCORT), is the largest and most advanced report of its kind to examine the influence of geography on the burden, risk factors, treatments, and outcomes of heart disease for the more than 1.2 million Canadians suffering from the condition. The 24 chapters of the Atlas were each originally published as articles in the Canadian Journal of Cardiology. Along with the findings, several recommendations are presented to help improve heart disease care in Canada and for future research.
Visit the CCORT website to downloadthe Atlas and related materials.
Tu JV, Pinfold SP, McColgan P, Laupacis A. May 2006
Athough wait times have not grown since 2003/04, there are still significant inequities in access to key services depending on where a person lives and depending on their income.
The 2nd edition of this Atlas focuses on changes in rates of service provision and wait times between 2003/04 and 2004/05. In addition, this year's report includes wait times by age and gender and socioeconomic status, as well as patient outcomes for joint replacement surgery, cardiac bypass surgery and cataract surgery.
Macpherson A, Schull M, Manuel D, Cernat G, Redelmeier D, Laupacis A. September 2005
Injuries, many of which are predictable and preventable, contribute substantially to the burden on Ontario's health care system. Between April 2002 and March 2003, there were more than 1.2 million injury-related emergency visits and over 62,000 injury-related hospitalizations.
This report provides a meaningful description of injuries across the province by age group, gender, geographic area and type of injury, highlighting the need for population-based prevention strategies that target specific at-risk groups.
Tu JV, Pinfold SP, McColgan P, Laupacis A. April 2005
This landmark report identifies the volumes and the associated wait times for key health services defined in the Ontario government’s Wait Times Strategy. Now, patients, providers, and policy-makers in Ontario know how long the wait time is in their local areas, and in other parts of the province for cancer, cataract and cardiac surgeries; and, hip and knee replacements. For CT/MRI scans, no data was available for assessing wait times for these diagnostic tests.
Arthritis is a leading cause of pain, physical disability and health care utilization in Ontario. By 2031, it is estimated that 738,000 Canadians in the 45–54 age group, along with 1.4 million in the 55–64 age group will be diagnosed with arthritis.
Arthritis and related (A&R) conditions stimulate a host of related costs. With more than four million Canadians living with A&R conditions, the attached annual cost is $17.8 billion, second only to costs associated with cardiovascular disease and more costly than cancer.
Following the 1998 ICES research atlas on A&R conditions, this 2nd edition paints a comprehensive picture of the impact of A&R conditions in Ontario from the 1990s to 2002 and proposes strategies to meet growing demand for care and treatment.
Colorectal cancer (CRC) is the leading cause of death from cancer in non-smoking Ontarians. Of the four most common types of cancer (including lung, prostate and female breast), CRC has the highest number of hospital bed days, representing a significant societal burden in terms of mortality, morbidity and health care costs.
Despite a rise in the number of large bowel tests used to screen for CRC, only 7% of screen-eligible Ontarians (individuals aged 50 to 74) received a test in 2001. This research atlas examines procedure practice patterns and associated resources to inform current discussions about the feasibility of implementing a population-based CRC screening program in Ontario.
Hux J, Booth G, Slaughter P, Laupacis A. June 2003
Diabetes is a leading cause of death in Canada and a growing health problem in Ontario. Over two million Canadians have diabetes, at an estimated cost of $9 billion annually. The expected future growth of this disease over the coming decades raises concerns about its impact on the health of Ontarians and the pressures it will place on our health care resources.
This research atlas is the most comprehensive resource on diabetes ever produced in North America and among the most extensive in the world. It provides population-based evidence to support policy development, resource planning and care for improved health outcomes.
Emergency departments (EDs) are a critical component of the health care system, interacting directly with many sectors of care. When resources are reduced in other parts of the system, the impact is frequently seen in the ED. Consequently, the effectiveness of EDs is a prime indicator of how well a community’s health care system is functioning.
This research atlas was developed to enhance the understanding of the province’s emergency services and to assist policymakers and planners in anticipating future trends. The report examines: changes to the organization and funding of EDs, including the impact of hospital restructuring; utilization of ED services by patients; and, the ED physician workforce in terms of supply, level of training, workload and demographics. [2,282 KB PDF]
In recent years, there has been increased focus on providing care in the community. While this change is not limited to the pediatric population, there are some important considerations when analyzing trends in health care utilization among children.
This research atlas highlights trends in inpatient health care service utilization from 1992 to 1998. The findings show no dramatic change in the types of childhood diseases requiring hospitalization, and an overall trend of fewer pediatric inpatient admissions, with no significant regional variation. Two exceptions were noted: infants with jaundice and dehydration, and teenagers with psychiatric disorders. [823 KB PDF]
With increasing emphasis on cost containment and a focus on meeting the needs of an aging population, the health care system must ensure that services meet the needs of all segments of the population. This research atlas describes trends in health service use by children under 20 years of age.
Despite an overall increase in the number of children in the province from 1991 to 1998, this report found that pediatric OHIP billing volumes declined in the same period by 10.6%. As well, the per capita expenditures dropped from $241 to $212, an 11.9% decrease, which accounted for a 5.7% reduction in expenditures since 1991. Close to 70% of the 1997/98 OHIP expenditures on children’s outpatient services were for physicians consultations or visits, including office, emergency room and home visits. [687 KB PDF]
The desire for the best possible health is common to all Ontarians. Improving health is not only about reducing death from disease, but is about maintaining a high health-related quality of life (HRQOL), especially for those living with chronic conditions.
This research atlas indicates that Ontarians as a whole are living longer and are in better health. Data shows that life expectancy in Ontario increased by one year (to 78.8 years) over the study period (1990 to 1996/97). However, health status varies considerably between district health council planning regions, and this disparity has grown since 1990.
Core mental health services include the assessment, diagnosis and treatment of emotional, mental or addiction problems, and are typically provided by a psychiatrist for persons with a psychiatric disorder, but may involve other health care professionals such as general practitioners/family physicians (GP/FP) for other types of conditions.
This research atlas examined fiscal changes to fee-for-service mental health services between 1992/93 and 1997/98 and found that costs increased as more Ontarians sought mental health care, however, underserved groups in 1992/93 were still underserved five years later. [414 KB PDF]
Distribution of resources according to need is an important component in the delivery of mental health care services. The measure of visit frequency provides information on cost and a rough measure of resource use. This research atlas examines changes from 1992/93 to 1997/98 in provider source (physicians who provide mental health care) and the visit frequency of mental health care users.
In the five-year period, usage patterns remained fairly constant, with 63% of mental health care users receiving care from a general practitioner or family physician, 22% seeing a psychiatrist and 12% seeing both. The most significant change is that services were delivered to a larger percentage of Ontario’s population through providers seeing more patients rather than an increase in the relative number of providers. [396 KB PDF]
A critical component to providing Ontarians with access to a comprehensive range of essential medical services is ensuring an adequate supply of physicians. This research atlas addresses the issue of physician supply and distribution within the province.
Key findings indicate that although the supply of active physicians rose steadily from 1991/92 to 1997/98, geographic maldistribution of doctors also increased. More doctors are practicing in urban centres while underserviced areas continue to lose physicians. The report also found that comprehensiveness of services declined as more general practitioners and family physicians shift their focus away from hospitals, nursing homes, and obstetrics, in favour of office practice. [988 KB PDF]
Heart disease remains the single largest cause of death for Canadians. The burden of heart disease generates massive health care costs, which will increase as the population ages. Developed with the support of the Heart and Stroke Foundation of Ontario, this research atlas represents a crucial step toward helping Ontario achieve improved cardiovascular health.
The research focuses primarily on coronary heart disease, with some chapters examining other cardiovascular conditions. Specifically, this research atlas provides population-based information to: encourage regional cardiac health promotion; accelerate primary and secondary prevention; create the impetus for improved patient care; encourage better data-gathering; and galvanize research to deepen the understanding of how factors such as ethnicity, gender, and socioeconomic status impact the incidence and management of heart disease.
Arthritis and related conditions comprise a large group of musculoskeletal disorders affecting the joints, ligaments, tendons, muscles, bones and connective tissues. Almost 20% of Canadians report having arthritis—by 2020, this will represent about three million people.While hospital, medical and drug costs for arthritis are significant, the true economic burden is apparent in the income lost due to arthritis disability, amounting to one-third of all chronic and one-fifth of all short-term income loss.
A collaborative effort with the Arthritis Society of Ontario and the Arthritis Community Research and Evaluation Unit (ACREU), this research atlas reviews patterns of health care for these conditions, presents findings on current and projected needs and services, and charts a course for changes in the health care system and future health services research.
Cancer surgery is dispersed throughout the province, offered in teaching and community hospitals, in both low-volume and high-volume institutions. Better coordination may lead to greater efficiencies and more importantly, better patient outcomes. The challenge surrounding the delivery of cancer surgery appears to be not in its availability, but in the assurance that geographical advantages are matched with appropriate local skill sets.
This research atlas provides important information for the regional integration and rationalization of cancer services. The data is invaluable in highlighting inter- and intra-regional discrepancies in access to cancer surgical services. It offers another set of guideposts to facilitate surgical oncology services what will balance quality, access and efficiency of care for Ontario’s cancer patients.
This research atlas is not available in pdf format, and is out of print.Reference copies may be available through a health science/medical library.
Goel V, Williams J, Anderson G, Blackstien-Hirsch P, Fooks C, Naylor D. May 1996
In the mid-1990s, Ontario’s health care system continued to undergo profound change with demands to restructure while maintaining or improving health outcomes. Funding constraints, combined with changing demographics, emerging technologies and prescription drugs resulted in reduced real dollars for health care.
As in the 1994 edition, this research atlas analyzes data about status, expenditure, and delivery of health care in Ontario. In addition to updating information in the last edition, this report covers additional topics such as physician billing patterns and impact of length of stay on hospital readmissions. As well, information is provided on utilization and expenditure trends in mental health and pediatric services.
In the early 1990s, Ontario’s health care system began to face an affordability crisis compounded by an information crisis. The central issue was to find a way to do as well, or better, with less. However, to develop proactive policies, providers, managers, planners and policymakers need information about both ideal and actual practices. Existing information systems were geared to services funding, hospital discharges, and insurance claims, rather than planning and management.
This inaugural research atlas marked the first attempt at comprehensive compilation of health indicators, processes of care, utilization patterns and resource consequences to enable improvements in health care delivery.
This research atlas is not available in pdf format, and is out of print. Reference copies may be available through a health science/medical library.
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