Christchurch EarthquakeThe impact on PHO Enrolment in the         Canterbury DHB  Nikolai Minko, Danny Wu, Andrew Mackenzi...
Agenda•   Terminology overview•   The event•   Population movement/migration•   How to register migration•   Data collecti...
Terminology• Earthquake - shaking and vibration at the  surface of the earth resulting from  underground movement along a ...
22 February 2011
5 March 2011
19 April 2011• Chief Executive Officer of Canterbury DHB  sent a letter to the Interim Chief Executive  of Canterbury Eart...
Population movement/Human Migration• Migration is the movement of people from  one place to another• The reasons for migra...
Principal sources of data on internalmigration• Censuses• Population registers• Sample surveys
PHO data collection• Started in 2002• Updated quarterly• Contains all NZ population enrolled with  PHOs including:  •   Pa...
Canterbury DHB population enrolled with PHOs                                  Canterbury DHB population enrolled in PHOs  ...
Stock and flow modelStockq 1   Stockq    Inflowq 1 - Outflowq
Stock and flows in subsequent quarters    Quarter 1                            Quarter 2   Practice A                     ...
Quarterly patients’ flows                                             Patients flows in CDHB                   16000      ...
Canterbury DHB external flows          DHB             2010         2010        2010       2011        2011       2011    ...
Earthquake impact on the enrolmentEarthqua Internal   Internal   External   Externalke       inflow     Outflow    Inflow ...
Spatial distribution of the impacted GP
Comparing Shaking Distributions                                  In Christchurch,                                  acceler...
Conclusions• PHO enrolment database is a valuable source of  information on the population movement in New  Zealand• Cante...
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Christchurch Earthquake 22 February and Its Impact on PHO Enrolment in the Canterbury DHB

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Nikolai Minko
Ministry of Health
(Friday, 2.30, Science 2)

Describes the changes in patients enrolled with Primary Healthcare Organisations (PHOs) in Canterbury District Health Board (CDHB) over eight quarters starting July 2010 and ending June 2011, including one quarter after the devastating earthquake 22 February 2011. The main findings are as follow:
• The enrolment in CDHB dropped by about 1% after the earthquake
• There was a small reduction in patients who joined CDHB, and a significant increase in the number of patients who left CDHB after the earthquake
• There are 80 practices located in the Canterbury region where quarterly patients inflow or outflow exceeded average values by two standard deviations.
These findings show that the earthquake caused patient movement that was higher then average in the two years prior to the earthquake.

Published in: Health & Medicine
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Christchurch Earthquake 22 February and Its Impact on PHO Enrolment in the Canterbury DHB

  1. 1. Christchurch EarthquakeThe impact on PHO Enrolment in the Canterbury DHB Nikolai Minko, Danny Wu, Andrew Mackenzie and Edward Griffin Ministry of Health 25th November 2011
  2. 2. Agenda• Terminology overview• The event• Population movement/migration• How to register migration• Data collection• Data Analysis• Findings• Discussion• Conclusion
  3. 3. Terminology• Earthquake - shaking and vibration at the surface of the earth resulting from underground movement along a fault plane of from volcanic activity• GP – General Practitioner• PHO – Primary Healthcare Organisation• PHO enrolment – population enrolled with PHO• DHB - District Health Board
  4. 4. 22 February 2011
  5. 5. 5 March 2011
  6. 6. 19 April 2011• Chief Executive Officer of Canterbury DHB sent a letter to the Interim Chief Executive of Canterbury Earthquake Recovery Authority with a suggestion• “…it will be important to monitor the ongoing movement of population after the earthquake with as many different methods as possible.” including “…re-enrolment in general practice…”
  7. 7. Population movement/Human Migration• Migration is the movement of people from one place to another• The reasons for migration can be economic, social, political or environmental• There are usually push factors and pull factors driving migration• Migration impacts on both the place left behind, and on the place where migrants settle
  8. 8. Principal sources of data on internalmigration• Censuses• Population registers• Sample surveys
  9. 9. PHO data collection• Started in 2002• Updated quarterly• Contains all NZ population enrolled with PHOs including: • Patient unique identification • General patient demographic information • Practice, PHO and DHB of enrolment • Enrolment date • Latest visit date
  10. 10. Canterbury DHB population enrolled with PHOs Canterbury DHB population enrolled in PHOs 495,000 490,000 485,000 Enrolled population 480,000 475,000 470,000 465,000 460,000 455,000 450,000 2007Q1 2007Q3 2008Q1 2008Q3 2009Q1 2009Q3 2010Q1 2010Q3 2011Q1 2011Q3 Calendar quarter
  11. 11. Stock and flow modelStockq 1 Stockq Inflowq 1 - Outflowq
  12. 12. Stock and flows in subsequent quarters Quarter 1 Quarter 2 Practice A Practice A Practice B Stayers within “B” Practice B Outside world Outside World
  13. 13. Quarterly patients’ flows Patients flows in CDHB 16000 15000 14000 Headcount 13000 12000 11000 10000 9000 8000 7000 6000 2009Q4 2010Q1 2010Q2 2010Q3 2010Q4 2011Q1 2011Q2 2011Q3 Calendar Quarter Ext_In Ext_Out Int_In/Out
  14. 14. Canterbury DHB external flows DHB 2010 2010 2010 2011 2011 2011 Inflow Outflow to Netflow Inflow Outflow Netflow from from to Unknown DHB 7300 5179 2121 5977 6205 -228 Auckland DHB 175 276 -101 287 1097 -810 Bay of Plenty DHB 85 116 -31 92 242 -150 Capital Coast DHB 226 329 -103 212 538 -326 Counties Manukau DHB 183 154 29 46 711 -665 Hawkes Bay DHB 85 65 20 75 193 -118 Hutt DHB 63 76 -13 53 157 -104 Lakes DHB 60 44 16 41 150 -109 Mid Central DHB 109 110 -1 87 265 -178 Nelson Marlborough 396 359 37 355 1049 -694 DHB Northland DHB 97 89 8 57 206 -149 Otago DHB 608 573 35 609 1257 -648 South Canterbury DHB 273 197 76 256 507 -251 Tairawhiti DHB 29 23 6 14 39 -25 Taranaki DHB 46 59 -13 52 90 -38 Waikato DHB 184 178 6 153 424 -271 Wairarapa DHB 32 26 6 29 49 -20 Waitemata DHB 125 138 -13 86 202 -116 West Coast DHB 205 187 18 188 321 -133 Whanganui DHB 38 28 10 40 61 -21 Total: 10319 8206 2113 8709 13763 -5054
  15. 15. Earthquake impact on the enrolmentEarthqua Internal Internal External Externalke inflow Outflow Inflow OutflowimpactlevelLow 68 48 14 98Medium 27 19 2 62High 0 0 0 0
  16. 16. Spatial distribution of the impacted GP
  17. 17. Comparing Shaking Distributions In Christchurch, accelerations were much higher during the 02/21 event - up to x6 the accelerations of the Darfield earthquake.
  18. 18. Conclusions• PHO enrolment database is a valuable source of information on the population movement in New Zealand• Canterbury DHB enrolment dropped by 1.06% in May 2011 and by another 0.6% in August 2011.• Eighty out of one hundred thirty practices had higher patients outflow after the earthquake compare to the average outflow in two years prior the earthquake.• Further monitoring of population movement is recommended

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