Multidimensional and Longitudinal Indicators in Population Health

Within population health information systems, indicators are commonly presented as independent, cross-sectional measures, neglecting the multivariate, longitudinal nature of disease progression and health care use. We use administrative claims data for patients with a previous diagnosis of chronic obstructive pulmonary disease in Montreal, Canada to explore two approaches to facilitating the discovery and interpretation of patterns across indicators and over time. The first approach identifies regional clusters based on patterns across four health service indicators. Our second approach uses a hidden Markov model to analyze individuallevel trajectories based on the same four indicators. Both approaches offer additional insights, such as a dual interpretation of low use of general practitioner services. These approaches to the analysis and visualization of health indicators can provide a foundation for information displays that will help decision makers identify areas of concern, predict future disease burden, and implement appropriate policies.