Health by the Numbers

Using data to influence policy

Dr. Randy Fransoo doesn’t put cells under a microscope, nor does he assess the performance of blood vessels, but the research he does is essential in understanding how to improve the health of Manitobans.

“The social determinants of health are incredibly powerful.”

As an epidemiologist, he studies the patterns of diseases in a defined population. As a Senior Research Scientist at the Manitoba Centre for Health Policy, he has access to rich bodies of data that help him understand public health. The data go back to 1984.

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Dr. Fransoo, whose first degree was in engineering, recalls a time in his father’s life when he was dealing with heart disease and had a great deal of interaction with the health care system. It’s an experience that, in part, shaped his interest in data and epidemiology.

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“The really catastrophic event in my dad’s case was an acute myocardial infarction (heart attack) that happened while my parents were on their way home from a winter vacation in Arizona, visiting a friend in New Mexico. The friend was re-shingling his garage and my dad decided to help him out. He’s a 70-year-old cardiac patient throwing a bale of shingles on this shoulder and climbing up the ladder and couldn’t get to sleep that night,” recalls Dr. Fransoo. “My Mom finally got him to go to the hospital. They saw lots of blockages, and so they did emergency surgery – four vessels bypassed.”

After his father recovered, what fascinated Dr. Fransoo about his father’s care in the U.S. was the level of detail on the hospital’s bill – 18 pages long.

“I remember thinking how incredible it was, how detailed this bill was,” he says. “At Tuesday at 8:15, Nurse #17 brought you an aspirin, and then four minutes later Nurse #14 came and did this or that or the other thing. It was just incredible, and I thought, I’m a data guy, so I like having details and I like having information.”

Not surprisingly, Dr. Fransoo took an interest in cardiac epidemiology and what we can learn about prevention, diagnosis, and treatment. One specific area that made him curious was the differences in cardiac care and outcomes between men and women.

“Ten years ago, there was lots of media attention around women not getting the same amount or level of care as men,” says Dr. Fransoo. “I found that troublesome because in the early parts of my research, I didn’t see those kinds of results coming out. So I actually spent quite a bit more effort checking into that. We found that there actually is not any indication of a sex bias in care in Manitoba, and there isn’t actually much in Canada, either.”

What Dr. Fransoo learned by analyzing reams of data and exploring the subtleties is that there is indeed a sex difference in cardiac care, but not a sex bias. “The sex difference is really just secondary to the age difference. Females get their heart attacks about 10 years later than males on average.”

What that means, explains Dr. Fransoo, is that because women are typically older when they face heart disease for the first time, they are more likely to have other health conditions – like cancer or emphysema – that would alter the cardiac care they receive. You are more likely to perform a bypass operation on an otherwise-healthy 65-year-old than on a 75-year-old with other significant health concerns, whether male or female

Some of Dr. Fransoo’s current research looks at optimizing how cardiac care is organized in Manitoba. He is working on a project led by Dr. John Ducas and Dr. Lorraine Avery at St. Boniface Hospital, an initiative called the Acute Coronary Syndromes Network. The initiative focuses on patient management and transport. He is also working on a team led by Dr. Annette Schultz, studying heart health among First Nations residents of Manitoba.

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“After a heart attack, time is critical. If we can get somebody into the cardiac care centre really quickly, we can do things that you can’t do if it takes a couple of hours or more to get here,” he explains. “What we’re trying to do is work with people outside the Winnipeg region because lots of heart attacks happen among people who are actually within an hour-and-a-half or two hours of Winnipeg. Those are potentially candidates who could come straight to St. B and get more advanced care rather than being brought to a local hospital to get clot-buster drugs and then get transferred to St. B.”

Dr. Fransoo and his colleagues are finding efficiencies in the health care system, but their ultimate goal is to ensure that rural patients are getting the urgent care they need as quickly as possible. “All of these patients are going to end up at St. B anyways, so why don’t we do what we can to make sure we get them here as fast as we can? We can give them better care, and then get them back to their community hospital more quickly, as well, so that St. B can accept the next patient that needs to get in.”

For Dr. Fransoo, his work is all focused on influencing policy and practice where it needs to be changed. And you can’t make policy based on anecdotes or precedent. You need data. Objective data. It takes rigorous research and rich analysis to pursue continuous improvement and engage decision-makers.

And that pursuit, says Dr. Fransoo, must also consider what are known as the “social determinants of health,” such as education, employment, culture, social life, relationships, and more.

“All of those things are fabulously important for health status and for health care, and those are things we’re getting more and more data on all the time in Manitoba. We can make connections and see what the experiences are of people from lower and higher socioeconomic backgrounds. The differences are dramatic, really dramatic, far more than the differences that you would expect in other things,” says Dr. Fransoo.

For context, Dr. Fransoo notes that if all cancers were wiped out tomorrow, the average life expectancy of a Manitoban would increase by about three-and-a-half years. At the same time, the difference in life expectancy between Winnipeg’s wealthiest 20% and the city’s poorest 20% is about 20 years. The numbers suggest that addressing poverty would do far more to increase average lifespans that would eliminating cancer. That’s the story of a population, not an individual.

“The social determinants of health are incredibly powerful,” says Dr. Fransoo. And so is the population research being conducted by Dr. Fransoo and his colleagues.

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