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
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
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
Objectives
To illustrate the project, using the
cancer chapter as an example
Value of the process
Challenges & lessons learned
Process for Indicator Selection
Literature review of published articles and grey literature
Working Groups
• Identify key issues to be
addressed in each chapter
• Shortlist indicators
according to importance and
feasibility
Expert Panels
• Review and finalize indicators using selection criteria
• Modified Delphi Process (online survey & face-to-face
meeting).
Data Analysis
• Administrative and survey data
• Stratify by sex, age, SES, and regional
level
Stakeholder
Consultations
• Identify and
discuss priority
issues in each
chapter
• Perspectives of
providers and
consumers
Example - Cancer
General indicators
 Incidence
 5 year survival
 Wait time for surgery
Sex-specific cancers




Breast
Cervical
Ovarian
Uterine
Non sex-specific cancers
 Colorectal
 Lung
End of Life care
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
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
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
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
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
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
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!
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
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