It is gratifying to see that national indicators are being developed with the support of provincial and federal governments. We hope that the information will be used to identify areas for improvement and define targets for the future. In addition it is important to continue to improve where Alberta is already performing better than other provinces.

From the perspective of seniors' health care, there are still major gaps in the availability of comparable indicators including quality of life, home care, primary care, health promotion and continuing care. Only Alberta data and national averages are presented which provides a limited picture of how Alberta compares to other provinces and territories. Furthermore health indicators are not yet linked to corresponding expenditures, although this appears to be a recommendation of the Romanow Report. We recommend that future reports address these gaps so that the information can be used to improve performance in our health services that serve seniors.

Specific comments are provided according to the major headings in the report:

1. Health Status
   • Disability free life expectancy is lower in Alberta than in Canada primarily because females have a significantly lower disability free life expectancy than males. This is an example of an area where other data needs to be presented to explain why this is the case.
   • For self reported health, it would be helpful to see trends especially for seniors.
     
     
2. Public Health
   • Seniors' data on smoking should be presented including trends.
   • Physical activity data is presented for seniors but not trends. It is interesting to note that males become more active as they age but females steadily less so. Perhaps this is linked to self-reported health but this indicator lumps males and females together so it is not possible to tell.
   • Immunization for influenza among seniors is a good indicator but performance needs to improve, especially in Alberta.
     
     
3. Quality of Service
   • Wait times and waitlists are included for surgery and radiation therapy but not for publicly funded continuing care facilities and home care. These are areas of significant concern for seniors and their families.
   • Access to first contact immediate care (24/7 health services) is significantly lower in Alberta than the national average. This appears to be linked to a lower percentage of the population with a regular family doctor. Again, this is information that should lead to action so we can see an improvement in the future.
   • The report fails to provide comparable home care indicators due to the lack of common definitions. (Note: Capital Health is involved in a CIHI pilot project with this objective and we commend this initiative.) We encourage Alberta Health & Wellness to adopt standard national definitions. The indicator of home care clients per 1000 population does not differentiate between the type of home care (for example palliative vs. post-acute), age groups or intensity of service.
   • Patient satisfaction with community based services by age group and gender is not included in the report because of the "high variability of the estimates". This should be explained. Since many seniors rely on services in the community, their viewpoints should be highlighted.

We commend Alberta Health and Wellness for developing these indicators to improve health system performance and hope that our suggestions will be useful in further improving our measurement efforts, particularly as they pertain to services used most frequently by seniors.

Submitted March, 2003