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For more than 30 years, the Manitoba Centre for Health Policy has been conducting research and evaluation to provide timely and critical evidence to answer real-world policy questions. Our experienced team of research scientists, analysts and other staff work extensively with policy-makers at the macro, meso and micro levels of government to support evidence-informed policy and program development in an effort to ensure that policy initiatives provide the greatest benefit possible to individuals and society as a whole. Using the widely recognized whole-population Manitoba Population Research Data Repository, which comprises approximately 100 different datasets from multiple sectors, we employ sophisticated and state-of-the-art research methods and data science technologies, and then translate the results into meaningful insights or recommendations for policy-makers.
Our long and productive history of working with policy-makers has taught us much about making our research relevant to policy-makers. In this article, we outline some examples of how research evidence has been used to influence policy in Manitoba, and the key lessons we have learned about what makes relationships between researchers and policy-makers work. In essence, policy-makers have supported the growth of the Repository over the last 30 years, because researchers have "closed the loop" by sharing valuable and policy-relevant research results with them. This ability to inform policies, programs and service delivery with scientific evidence continues to benefit individuals, communities and our society as a whole.

ObjectiveOlanzapine is an antipsychotic drug used in emergency departments to treat methamphetamine intoxication. Our study aim is to examine whether prehospital olanzapine administration by paramedics in Winnipeg, Canada, improves outcomes for individuals experiencing methamphetamine intoxication. However, the 'real-world' nature of the administrative data has presented several challenges.
ApproachFirst, we needed to determine whether individuals experiencing methamphetamine intoxication received or did not receive olanzapine. The paramedic records identify whether olanzapine was administered but not whether individuals were considered for olanzapine without receiving it. To address this, we manually reviewed the unstructured narratives from the paramedic assessments. 8000+ records were independently evaluated by two experienced paramedics to determine eligibility. Disagreements were resolved by a paramedic-educator.
Second, we discovered that ~40% of paramedic records for 2019 did not link correctly to other health data. We conducted a sensitivity analysis to assess the impact of excluding records with incorrect linkage, but the loss of records in the most critical year of assessment led us to reject this approach. Instead, we revisited the original data linkage to identify and correct the cause of the errors.
ResultsWe have constructed a cohort that allows us to compare treated (n=222) and untreated (n=205) individuals experiencing methamphetamine intoxication and provides enough statistical power to assess the impact of prehospital olanzapine treatment on hospital outcomes.
Conclusion & ImplicationsAdministrative data from the real world are powerful tools for research with potential to show important health impacts, but their use requires creative thinking to overcome unexpected data challenges.

For more than 30 years, the Manitoba Centre for Health Policy has been conducting research and evaluation to provide timely and critical evidence to answer real-world policy questions. Our experienced team of research scientists, analysts and other staff work extensively with policy-makers at the macro, meso and micro levels of government to support evidence-informed policy and program development in an effort to ensure that policy initiatives provide the greatest benefit possible to individuals and society as a whole. Using the widely recognized whole-population Manitoba Population Research Data Repository, which comprises approximately 100 different datasets from multiple sectors, we employ sophisticated and state-of-the-art research methods and data science technologies, and then translate the results into meaningful insights or recommendations for policy-makers. Our long and productive history of working with policy-makers has taught us much about making our research relevant to policy-makers. In this article, we outline some examples of how research evidence has been used to influence policy in Manitoba, and the key lessons we have learned about what makes relationships between researchers and policy-makers work. In essence, policy-makers have supported the growth of the Repository over the last 30 years, because researchers have "closed the loop" by sharing valuable and policy-relevant research results with them. This ability to inform policies, programs and service delivery with scientific evidence continues to benefit individuals, communities and our society as a whole.

IntroductionOut-of-school programs for grade K-12 students support healthy behaviours, boost academic achievement, and strengthen social networks. The Boys and Girls Clubs of Winnipeg (BGCW) have been active for 40+ years; however, little is known about how participating in their programs influences students' short- and long-term health, educational and social outcomes.
Objectives and ApproachWe are investigating the association between participation in BGCW out-of-school programs using the individual-level data held in the population-based Manitoba Population Research Data Repository at the Manitoba Centre for Health Policy (MCHP). Data on BGCW program participation for children born 1987-2010 was linked with administrative records from the healthcare system, education system, and social services. The comparison group of non-participants was matched on age, sex, 3-digit postal code and school division. Outcomes of interest include health services use, teen pregnancy, grade repetition, high school graduation, enrollment in post-secondary institutions, receipt of income assistance, and involvement with the justice system.
ResultsWe conducted analyses of children (K-8) attending the Community Schools Investigator (CSI) summer enrichment program, an academic and recreational program that aims to combat learning loss for children in low-income neighbourhoods. After one summer of CSI, participants (n=970) were significantly more likely to repeat a grade than the matched comparison group (n=783) (5.4% CSI students repeated a grade [95% CI 3.9, 6.8] vs 2.76% comparison students [95% CI 2.20, 3.32]). However, the likelihood of CSI students repeating a grade dropped to the level of the comparison group after two or more years of participation in CSI (2.91% CSI students repeated a grade [95% CI 1.26, 4.56]). Ongoing analyses are examining how participating in CSI and other BGCW programs is linked to health and social outcomes.
Conclusion/ImplicationsOur findings suggest that engagement in a BGCW out-of-school summer program contributes to better educational outcomes for low-income students. Using the information-rich Data Repository at MCHP, we can examine additional outcomes across multiple sectors to demonstrate how out-of-school programs help young people achieve their full developmental potential.

ObjectiveTo profile the Manitoba Centre for Health Policy (MCHP), a population health data centre located at the University of Manitoba in Winnipeg, Canada.
ApproachWe describe how MCHP was established and funded, and how it continues to operate based on a foundation of trust and respect between researchers at the University of Manitoba and stakeholders in the Manitoba Government's Department of Health. MCHP's research priorities are jointly determined by its scientists' own research interests and by questions put forward from Manitoba government ministries. Data governance, data privacy, data linkage processes and data access are discussed in detail. We also provide three illustrative examples of the MCHP Data Repository in action, demonstrating how studies using a variety of Repository datasets have had an impact on health and social policies and programs in Manitoba.
DiscussionMCHP has experienced tremendous growth over the last three decades. We discuss emerging research directions as the capacity for innovation at MCHP continues to expand, including a focus on natural language processing and other applications of artificial intelligence techniques, a leadership role in the new SPOR Canadian Data Platform, and a foray into social policy evaluation and analysis. With these and other exciting opportunities on the horizon, the future at MCHP looks exceptionally bright.

Children with special health needs (SHN) may be more likely to experience mental disorders compared to their peers without SHN. The aim of this study was to establish and contextualize the risk of mental disorders among children flagged as having SHN at school entry. We linked data from the Early Development Instrument (EDI), a teacher-completed questionnaire of children's developmental health in kindergarten, collected in Manitoba between 2006 and 2015, with provincial health administrative data up to 2019. Using binary logistic regressions, we examined the odds of receiving a diagnosis of any mental disorder, by categories of SHN: special needs, impairments in physical, vision/hearing, learning, speech, behaviour, and emotions, needing further assessment, and having 2+ SHN categories. Of the 36,462 children with EDI data linked to health administrative data, 5,882 (16.1%) were identified as having a SHN in kindergarten. The odds of developing a mental disorder varied by subtype of SHN. Children needing further assessment, with special needs, 2+ SHN categories, or with a learning, behavioural, or emotional impairment had between 1.35 and 3.27 times the odds of receiving a mental health diagnosis than their peers without these issues. Having a behavioural impairment increased a child's odds the most. Having a physical, visual, or hearing impairment was not associated with a mental disorder. Having a special needs designation and impairments in behaviour and emotions in kindergarten puts children at risk of a future mental disorder. These findings may help generate wider mental health supports in schools for children with SHN.

IntroductionThe quality of early education children receive influences their developmental trajectories, with long-term effects extending into adulthood. First Nations children face many structural barriers to academic success. Few studies have examined the impact of education programs on removing these barriers to support better outcomes amongst First Nations children.
Objectives and ApproachWe examined educational outcomes associated with full-day (FDK) versus half-day (HDK) kindergarten among First Nations children using data from the Manitoba Population Research Data Repository. We linked children's education records with the Manitoba Health Registry and the First Nations Registry to identify all First Nations children who attended kindergarten in a Winnipeg school division (1998-2011). Children enrolled FDK were age- and sex- matched to children enrolled in HDK. Propensity scores used to adjust for confounding. Outcomes included academic achievements in grades 3, 7, and 8 and high school graduation. We used generalized linear models to test for differences in education.
ResultsWe identified 324 First Nations children enrolled in FDK and 595 matches in HDK in the study period. Among these, 37% FDK and 31% HDK students met or approached numeracy expectations in grade 3; and 30% FDK and 33% HDK met or approached numeracy expectations in grade 7. For reading expectations, 37% FDK and 33% HDK met or approached grade 3 reading expectations; in grade 8, roughly half of each group met or approached expectations for reading and writing. High school graduation rate for First Nations children in both FDK and HDK children was 60%. We found no differences in education outcomes when we tested for differences between HDK and FDK children.
Conclusion/ImplicationsEducation outcomes did not differ between First Nations children enrolled in FDK vs. HDK programs. Kindergarten programs may be insufficient to overcome structural barriers to academic success that these children face. Culturally appropriate education strategies may be needed to support improved outcomes amongst this population.

IntroductionOut-of-school or after-school programs are designed to support healthy behaviours, boost academic achievement and strengthen social skills. The Boys and Girls Clubs of Winnipeg (BGCW) in Manitoba, Canada, have been offering out-of-school programs to children and adolescents in low-income neighbourhoods for more than 40 years. Many BGCW participants face considerable risk of poor health, social and educational outcomes due to challenges they experience at home, in school and in their communities.
ObjectiveWe examined whether BGCW participation among children and adolescents aged 5-18 is associated with improved school outcomes and lower risk of justice system encounters and adverse health outcomes.
MethodsWe linked de-identified data on BGCW participation for children and adolescents born 1987-2010 to administrative data from the healthcare system, education system, and social services in the Population Research Data Repository, Manitoba Centre for Health Policy. The exposure group (n = 8,990$) included children and adolescents who visited BGCW at least once from 2005—2016. The comparison group (n = 69,980) comprised children and adolescents matched on school year and neighbourhood who had never participated in BGCW.
ResultsParticipation in BGCW was significantly associated with better scores in grade 3 numeracy and grade 7 student engagement assessments. The risk of justice system encounters among adolescents (aged 12—17) dropped as the frequency of BGCW participation increased, as did justice system encounters among young adults (aged 18—24) who had participated in BGCW as adolescents. The likelihood of teen pregnancy among female adolescents (aged 13—19) and sexually transmitted infections among adolescents (aged 13—19) also declined as the frequency of participation in BGCW increased.
ConclusionsThe findings suggest that participation in BGCW is associated with positive outcomes for children and adolescents in multiple domains and despite socioeconomic and family challenges faced by many in this population.

ObjectiveWe examined healthcare use among people using methamphetamine who were connected to a Community Health Centre (CHC) in Winnipeg, Canada. CHCs are primary care clinics designed to provide person-centred, holistic care to people who may be impacted by discrimination and/or oppression.
ApproachFrom population-based administrative health data, we identified people with a record of a methamphetamine-related healthcare system encounter from 2013-2020 (cases) and created a comparison group matched on age, sex, and postal code but with no recorded history of using methamphetamine (controls). We narrowed this population to those who visited a CHC at least once. Then, using negative binomial regression models adjusted for sociodemographic characteristics, we produced rate ratios and 95% confidence intervals for primary care visits, CHC visits, emergency service contacts, emergency department (ED) visits, and hospitalizations in the 5 years after the first recorded methamphetamine use.
ResultsAdjusted rate ratios showed that healthcare use among CHC-connected people using methamphetamine was higher than among CHC-connected people not using methamphetamine: primary care 1.15 (95% CI 1.07-1.23); CHC 1.17 (95% CI 1.01-1.37); emergency services 6.19 (95% CI 5.46-7.02); ED 3.19 (95% CI 2.92-3.48); hospitalization 2.77 (95% CI 2.46-3.10).
Conclusion & ImplicationsBeing connected to a CHC may have facilitated access to other health and social services, but there is still unmet need for high quality, holistic care among people using methamphetamine. This research informs our team's ongoing efforts to address mental health and addictions concerns across sectors and to promote anti-discriminatory approaches to addictions care in the healthcare system.

IntroductionUsing data in research often requires that the data first be de-identified, particularly in the case of health data, which often include Personal Identifiable Information (PII) and/or Personal Health Identifying Information (PHII). There are established procedures for de-identifying structured data, but de-identifying clinical notes, electronic health records, and other records that include free text data is more complex. Several different ways to achieve this are documented in the literature. This scoping review identifies categories of de-identification methods that can be used for free text data.
MethodsWe adopted an established scoping review methodology to examine review articles published up to May 9, 2022, in Ovid MEDLINE; Ovid Embase; Scopus; the ACM Digital Library; IEEE Explore; and Compendex. Our research question was: What methods are used to de-identify free text data? Two independent reviewers conducted title and abstract screening and full-text article screening using the online review management tool Covidence.
ResultsThe initial literature search retrieved 3,312 articles, most of which focused primarily on structured data. Eighteen publications describing methods of de-identification of free text data met the inclusion criteria for our review. The majority of the included articles focused on removing categories of personal health information identified by the Health Insurance Portability and Accountability Act (HIPAA). The de-identification methods they described combined rule-based methods or machine learning with other strategies such as deep learning.
ConclusionOur review identifies and categorises de-identification methods for free text data as rule-based methods, machine learning, deep learning and a combination of these and other approaches. Most of the articles we found in our search refer to de-identification methods that target some or all categories of PHII. Our review also highlights how de-identification systems for free text data have evolved over time and points to hybrid approaches as the most promising approach for the future.

ObjectivesLack of consistent and relevant Indigenous identifiers in Canadian data sources leads to misclassification and under-recognition of the health and social issues impacting Indigenous Peoples, further perpetuating the harms of colonization. We are evaluating and optimizing our approach for identifying First Nations (FN) individuals in administrative data in Manitoba.
MethodsIn partnership between the First Nations Health and Social Secretariat of Manitoba and the Manitoba Centre for Health Policy, we sought to evaluate to what extent four distinct Manitoba datasets derived from surveillance and social programs were able to identify FN individuals among a cohort of children in low-income Winnipeg neighbourhoods between 2005-2016. In choosing data sources to identify FNs, the population and research question were considered.
We then compared the number of FNs identified in each dataset to the First Nations population research file, considered gold standard, but cognizant of its roots in colonial systems of registration.
ResultsThe total cohort comprised N=78,864; among these, n=27,347 children were identified as FN in either the FN registry or at least one of the datasets. The FN registry was the most sensitive dataset and identified 85.7% of these individuals. The two program datasets identified 58.2% and 46.2%, and the surveillance-based datasets each identified less than 10%.
The First Nations Registry is critical to accurately identify FN individuals. Our analyses demonstrated that without it we would miss 23.5% of those identified as FN in at least one other dataset. However, using it alone could potentially cause us to miss 15% of FN individuals identified in other datasets.
The proportions of FN individuals that would be missed by excluding any of the other datasets were smaller (<6%).
ConclusionWe found inconsistent FN identification across the datasets evaluated. Among the issues is that some datasets rely on self-identification. In Manitoba, no single administrative dataset can reliably and comprehensively identify FN individuals, and linking multiple datasets together is currently our best approach.

ObjectiveA multi-disciplinary E2A group was established as part of a linked administrative data study examining methamphetamine use in Manitoba. In this presentation we will share our experiences of establishing an E2A, embedding stakeholders in the research process, and outline an iterative engagement plan for the remaining study years.
ApproachThe E2A group is led by two researchers with expertise in patient and public engagement and guided by Pal's (2014) work on policy analysis and activation. Pal emphasizes a multidisciplinary and iterative process as the basis of a more inclusive approach to policy development for complex problems, such as the prevalence of methamphetamine use in Manitoba. Our goal in engaging public rightsholders, service providers and knowledge users in the research is to ensure that their first-hand knowledge and perspectives are reflected in the interpretations of the findings and that analyses address identified complexities in a culturally sensitive and equity-focused way.
ResultsIn the fall of 2020 E2A members were recruited, including persons with lived experience using methamphetamines and their families/care-givers, academics, clinicians, government, and non-government stakeholders. Training was provided on the topics of trauma-informed care, public engagement, effects of colonial and racist institutions, and cultural safety. The first E2A meetings co-developed guiding principles, a vision and mission, as well as provided capacity building around administrative data research. This work was done as a foundation for the next two years, wherein the group will make decisions about key variables (ie: between methamphetamine use and mental health), interpretation of results, knowledge mobilization, and policy development using an iterative self-evaluation process. To date challenges addressed included public health restrictions related to Covid-19 and adapting the research flow to centre lived-experience decision making.
ConclusionThe E2A group is a key component of this study and could serve as a model for other administrative data studies. The group prioritizes stakeholder knowledge, interprets results, flags potential biases in the data research process, and ensures the findings are relevant to the people they are meant to support.

IntroductionThe Boys & Girls Clubs of Winnipeg (BGCW) provide out-of-school programs to children and youth living in low-income neighbourhoods in Winnipeg, Canada. These programs aim to set participants on a path to success by supporting healthy behaviours, academic achievement and social skills. First Nation children and youth make up a substantial proportion of BGCW participants, but there are few empirical data available on how the programs influence health, social and education outcomes in this population.
Objectives and ApproachWe linked BGCW attendance records for all Manitoba children born 1987-2010 to the individual-level administrative health, social and education data in the population-based Data Repository at the Manitoba Centre for Health Policy in Winnipeg. The comparison group of non-participants was matched on age and neighbourhood of residence. We narrowed the cohort to First Nation participants by linking to datasets containing First Nation identifiers. Education outcomes were examined using a generalized additive model, and health and justice system outcomes with a time-to-event model, adjusted for socioeconomic status, mother's mental health and age at first birth, and involvement in the child welfare system.
Results3,754 First Nation children and youth participated in BGCW from 2005-2016. The comparison group comprised 23,593 First Nation children and youth. Greater BGCW participation was associated with higher likelihood of performing well in grade 3 numeracy, but not other education outcomes (grade 3 reading, grade 7 student engagement or mathematics, grade 7/8 reading/writing, or graduating high school). Greater BGCW participation was also associated with lower risk of becoming involved with the justice system among youth aged 12-17 (i.e., lower risk of being charged with a crime) and with lower risk of teen pregnancy.
Conclusion / ImplicationsParticipation in BGCW programs may contribute to improved health, justice and education outcomes for First Nation children and youth in Winnipeg.

Over the last 30 years, public investments in Canada and many other countries have created clinical and administrative health data repositories to support research on health and social services, population health and health policy. However, there is limited capacity to share and use data across jurisdictional boundaries, in part because of inefficient and cumbersome procedures to access these data and gain approval for their use in research. A lack of harmonization among variables and indicators makes it difficult to compare research among jurisdictions. These challenges affect the quality, scope, and impact of work that could be done. The purpose of this paper is to compare and contrast the data access procedures in three Canadian jurisdictions (Manitoba, Alberta and British Columbia), and to describe how we addressed the challenges presented by differences in data governance and architecture in a Canadian cross-jurisdictional research study. We characterize common stages in gaining access to administrative data among jurisdictions, including obtaining ethics approval, applying for data access from data custodians, and ensuring the extracted data is released to accredited individuals in secure data environments. We identify advantages of Manitoba's flexible 'stewardship' model over the more restrictive 'custodianship' model in British Columbia, and highlight the importance of communication between analysts in each jurisdiction to compensate for differences in coding variables and poor quality data. Researchers and system planners must have access to and be able to make effective use of administrative health data to ensure that Canadians continue to have access to high-quality health care and benefit from effective health policies. The considerable benefits of collaborative population-based research that spans jurisdictional borders have been recognized by the Canadian Institutes for Health Research in their recent call for the creation of a National Data Platform to resolve many of the issues in harmonization and validation of administrative data elements.

IntroductionThe province-wide Families First Home Visiting Program (FFHV) provides home visiting to families with children living in conditions of risk. It remains unknown if First Nations families are benefiting from the program. Using existing administrative and population-wide data is an innovative practice to evaluate programs that have been scaled up.
Objectives and ApproachThe objective is to determine FFHV's effectiveness at improving outcomes for First Nations children and parents. The partnership with First Nations Health and Social Secretariat of Manitoba facilitated access to First Nations identifiers and provided guidance in conducting the study. Program data from 4,010 First Nations children and parents were linked at an individual-level to administrative data housed at the Manitoba Centre for Health Policy. We compared the predictive probability of outcomes of program and non-program families. Inverse probability of treatment weights were used to adjust for confounders related to both entry into FFHV and the outcomes under study.
ResultsThe cohort of First Nations children and parents was successfully linked through an individual scrambled health identifier. FFHV was associated with higher rates of child immunization at age one (71% versus 66%) and age two (47% versus 41%) and parental involvement in community support groups (21% versus 17%). It was also associated with lower rates of being in care of child welfare at age one (10% versus 14%) and age two (15% versus 19%); maltreatment-related hospitalizations at age three (0.4% versus 1.0%); and child victimization as measured by justice system records (1.7% versus 3.0%). However, there were no differences in being "not ready for school" between the two groups of children, nor between the groups of mothers in physician visits for mental health reasons.
Conclusion/ImplicationsHome visiting services can play a role in supporting healthy development of First Nations children by providing support to parents and connecting children to health and social services, however, there also remains an urgent need for long term strategies to address structural inequality and the ongoing effects of colonization.