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Health system performance
Acceptability
Accessibility
Appropriateness
Effectiveness
Efficiency
Safety
Acceptability
Patient satisfaction (and quality rating of services received)
Definition:
Population aged 15 and over receiving health services in the past 12 months who rate their level of satisfaction with those services as either “very satisfied” or “somewhat satisfied”. Perceived rating of the quality of services received rated as “excellent” or “good” is another component of this indicator. ‘Health services’ are broken down as follows: Overall health care services; hospital care; physician care, community-based care; and telephone health line or tele-health services.
Sources:
Statistics Canada, Canadian Community Health Survey, 2003, 2000/01, health file
Accessibility
Influenza immunization
Definition:
Population aged 12 and over (aged 65 and over for data from the National
Population Health Survey) who reported when they had their last influenza
immunization (flu shot).
Sources:
Statistics Canada, Canadian Community Health Survey, 2003, 2000/01, health file;
Statistics Canada, National Population Health Survey, 1996/97, cross sectional
sample, health file
Screening mammography, women aged 50-69
Definition:
Women aged 50 to 69 who reported when they had their last mammogram for
routine screening or other reasons.
Screening mammography is an important strategy for early detection of breast cancer.
Sources:
Statistics Canada, Canadian Community Health Survey, 2003, 2000/01, health file;
Statistics Canada, National Population Health Survey, 1996/97, cross sectional
sample, health file
Pap smear, women aged 18-69
Definition:
Women aged 18 to 69 who reported when they had their last Pap smear test.
Pap tests detect pre-malignant lesions before cancer of the cervix develops.
Sources:
Statistics Canada, Canadian Community Health Survey, 2003, 2000/01, health file; Statistics Canada, National Population Health Survey, 1994/95, 1996/97 and 1998/99, cross sectional sample, health file and North component
Appropriateness
Caesarean sections
Definition:
Proportion of women delivering babies in acute care hospital by caesarean section.
Method of Calculation
(Number of Caesarean sections/Number of deliveries)*100
Delivery:
I. ICD-9 or ICD-9-CM
Any one diagnosis code of 640-676 and with a fifth digit of ‘1’ or ‘2’; 650 or V27
II. ICD-10-CA
Any one diagnosis code of O1, O2, O4, O6-O8, O30-O37, O90-O92, O95, O98, O99 with a sixth digit of ‘1’ or ‘2’; Z37
Deliveries in which an abortive procedure was provided are removed:
I. CCP
Any one procedure code of 78.52, 86.3, 86.4, 87.0, 87.1, or 87.2
II. ICD-9-CM
Any one procedure code of 66.62, 74.3, 74.91, 75.0, 69.51, or 69.0
III. CCI
Any one procedure code of 5.CA.88, 5.CA.89, 5.CA.90, or 5.CA.93
Code may be recorded in any position with cancelled, previous, out-of-hospital, and “abandoned after onset” cases excluded.
Caesarean section (Caesarean section is a subset of deliveries):
I. CCP
Any one procedure of 86.0-86.2, 86.8, or 86.9
II. ICD-9-CM
74.0, 74.1, 74.2, 74.4, or 74.99
III. CCI
5.MD.60
Code may be recorded in any position with cancelled, previous, out-of-hospital, and "abandoned after onset" cases excluded.
Source:
Canadian Institute for Health Information, Hospital Morbidity Database
Effectiveness
Pertussis
Definition:
Number of cases of pertussis reported in a given year.
Source:
Health Canada, Population and Public Health Branch, Notifiable Diseases
On-Line
Measles
Definition:
Number of cases of measles reported in a given year.
Source:
Health Canada, Population and Public Health Branch, Notifiable Diseases
On-Line
Tuberculosis
Definition:
Number of new cases of tuberculosis reported in a given year.
Source:
Health Canada, Population and Public Health Branch, Notifiable Diseases
On-Line
HIV
Definition:
Number of new positive HIV cases in a given year. Information is based
on those who have been tested for HIV.
Source:
Health Canada, Population and Public Health Branch, HIV and AIDS in Canada:
Surveillance Report to June 30, 2000
Chlamydia
Definition:
Number of new cases of chlamydia reported in a given year.
Source:
Health Canada, Population and Public Health Branch, Notifiable Diseases
On-Line
Deaths due to medically treatable diseases: Bacterial
infections
Definition:
Age-standardized rate of deaths due to bacterial infections (ICD-9 001-005,
020-041, 320, 382, 383, 390-392, 680-686, 711, 730) for persons aged 5
to 64.
For the specified age groups, the majority of people with such infections
should respond adequately to antibiotics if treated promptly and correctly.
Sources:
Statistics Canada, Vital Statistics, Death Database, and Demography Division
(population estimates)
Deaths due to medically treatable diseases: Cervical
cancer
Definition:
Age-standardized rate of deaths due to cervical cancer (ICD-9 180) for
women aged 15 to 64.
The early detection and treatment of cervical cancer appears to be effective
in reducing mortality from this disease.
Sources:
Statistics Canada, Vital Statistics, Death Database, and Demography Division
(population estimates)
Deaths due to medically treatable diseases: Hypertensive
disease
Definition:
Age-standardized rate of deaths due to hypertensive disease (ICD-9 401-405)
for persons aged 35 to 64.
Intervention on people with hypertensive disease has been shown to decrease
morbidity and mortality.
Sources:
Statistics Canada, Vital Statistics, Death Database, and Demography Division
(population estimates)
Deaths due to medically treatable diseases: Pneumonia
and unspecified bronchitis
Definition:
Age-standardized rate of deaths due to pneumonia and unspecified bronchitis
(ICD-9 481-486, 490) for persons aged 5 to 49.
Most pneumonia should respond adequately to antibiotics. With appropriate
care, the survival rate should be high for the specified age groups.
Sources:
Statistics Canada, Vital Statistics, Death Database, and Demography Division
(population estimates)
Ambulatory care sensitive conditions
Definition:
Age-standardized acute care hospitalization rate for conditions where appropriate ambulatory care prevents or reduces the need for admission to hospital, per 100,000 population under age 75 years.
This definition of ACSC is based on the work of Billings et al (see Billings J, Zeital L, Lukomnik J, Carey TS, Blank AE, Newman L. Impact of socio-economic status on hospital use in New York City. Health Affairs 1993; Spring:162-173; Billings J, Anderson GM, Newman LS. Recent findings on preventable hospitalizations. Health Affairs 1996; 15(3):239-249.)
Most responsible diagnosis code of:
I. ICD-9 /CCP
• Grand mal status and other epileptic convulsions [345]
• Chronic obstructive pulmonary disease [491, 492, 493.2, 494, 496, 466.0] (include acute bronchitis [466.0] only when a secondary diagnosis* of 491, 492, 494, or 496 is also present). Pneumonia [480, 481, 482, 483, 484, 485, 486] only when a secondary diagnosis* of COPD [491, 492, 494, or 496] is also present
• Asthma [493.0, 493.1, 493.8, 493.9]
• Congestive heart failure [428.0, 402.9, 518.4] (exclude cases with the following surgical procedures (CCP): 48.1, 49.5, 48.02, 48.03, 49.71, 49.72, 49.73, 49.82, 49.86)
• Hypertension [401.0, 401.9, 402.0, 402.1, 402.9] (exclude cases with the following surgical procedures (CCP): 48.1, 49.5, 48.02, 48.03, 49.71, 49.72, 49.73, 49.82, 49.86)
• Angina [411, 413] (exclude cases with a surgical procedure (any one CCP code of 01.01-01.39, 07.24, 14.01-14.83, 14.88-16.82, 16.89-21.82, 21.89-29.7, 29.82-34.81, 34.89-41.81, 41.83-43.82, 43.84-45.84, 45.88-46.88, 46.90-48.91, 48.99-50.79, 50.91-50.93, 50.96-52.81, 52.89-63.95, 63.97-64.96, 64.98-66.83, 66.89-67.84, 67.89-69.82, 69.89-71.96, 71.98-72.95, 72.97-75.81, 75.89-80.83, 80.89-88.81, 88.89-92.69, 92.80-97.82, or 97.89-98.99)
• Diabetes [250.0, 250.1, 250.2, 250.9]
II. ICD-9-CM
• Grand mal status and other epileptic convulsions [345]
• Chronic obstructive pulmonary disease [491, 492, 493.2, 494, 496, 466.0] (include acute bronchitis [466.0] only when a secondary diagnosis* of 491, 492, 494 or 496 is also present). Pneumonia [480, 481, 482, 483, 484, 485, 486] only when a secondary diagnosis* of COPD [491, 492, 494 or 496] is also present
• Asthma [493.0, 493.1, 493.8, 493.9]
• Congestive heart failure [428.0, 402.01, 402.11, 402.91, 518.4] (exclude cases with the following surgical procedures (ICD-9-CM): 36.01, 36.02, 36.05, 36.1, 37.5, 37.7
• Hypertension [401.0, 401.9, 402.00, 402.10, 402.90] (exclude cases with the following surgical procedures (ICD-9-CM): 36.01, 36.02, 36.05, 36.1, 37.5, 37.7
• Angina [411.1, 411.8, 413] (exclude cases with a surgical procedure (any one ICD-9-CM code of 01-86.99)
• Diabetes [250.0, 250.1, 250.2, 250.3, 250.8, 250.9]
III. ICD-10-CA/CCI
• Grand mal status and other epileptic convulsions [G40, G41]
• Chronic obstructive pulmonary disease [J41, J42, J43, J44, J47, J20] (acute bronchitis [J20] only when a secondary diagnosis* of COPD [J41, J42, J43, J44, J47] is also present). Pneumonia [J12, J13, J14, J15, J16, J18] only when a secondary diagnosis* of COPD [J41, J42, J43, J44 or J47] is also present
• Asthma [J45]
• Congestive heart failure [I50, J81] (exclude cases with the following surgical procedures (CCI): 1.IJ.50, 1.HZ.85, 1.IJ.76, 1.HB.53, 1.HD.53, 1.HZ.53, 1.HB.55, 1.HD.55, 1.HZ.55, 1.HB.54, 1.HD.54)
• Hypertension [I10.0, I10.1, I11] (exclude cases with the following surgical procedures (CCI): 1.IJ.50, 1.HZ.85, 1.IJ.76, 1.HB.53, 1.HD.53, 1.HZ.53, 1.HB.55, 1.HD.55, 1.HZ.55, 1.HB.54, 1.HD.54)
• Angina [I20, I23.82, I24.0, I24.8, I24.9] (exclude cases with a surgical procedure: any one CCI procedure of 1*, 2*, 5*)
• Diabetes [E10.1, E10.6, E10.7, E10.9, E11.0, E11.1, E11.6, E11.7, E11.9, E13.0, E13.1, E13.6, E13.7, E13.9, E14.0, E14.1, E14.6, E14.7, E14.9]
* “Secondary diagnosis” refers to a diagnosis other than most responsible
Patients who died before discharge are excluded.
A measure of access to appropriate medical care. While not all admissions for ambulatory care sensitive conditions are avoidable, it is assumed that appropriate prior ambulatory care could prevent the onset of this type of illness or condition, control an acute episodic illness or condition, or manage a chronic disease or condition. A disproportionately high rate is presumed to reflect problems in obtaining access to primary care.
Rates are not comparable to those published by CIHI prior to June 2005 due to a change in the definition. See
Definitions, Data Sources and Rationale from June 2004 for information on how this indicator was previously defined.
Source:
Canadian Institute for Health Information, Hospital Morbidity Database
30-day Acute Myocardial Infarction (AMI) in-hospital
mortality rate
Definition:
The risk-adjusted rate of all-cause in-hospital death occurring within
30 days of first admission to an acute care hospital with a diagnosis
of AMI.
(Primary ICD-9 or ICD-9-CM diagnosis code of 410 or ICD-10-CA I21, I22. A technical note for this indicator is available)
To enable comparison across regions, a statistical model was used to
adjust for differences in age, sex and co-morbidities. Inter-regional
variation in 30-day in-hospital mortality rates may be due to jurisdictional
and institutional differences in standards of care, as well as other factors
that were not included in the adjustment. These rates should be interpreted
with caution due to potential differences in the coding of comorbid conditions
across provinces and territories.
Rates for Newfoundland, British Columbia and Quebec regions are not available
due to differences in coding of AMI (Newfoundland), Emergency Room admissions
(BC), and diagnosis type (Quebec). Rate for Nunavut is not available due to incomplete data submission.
Source:
Canadian Institute for Health Information, Hospital Morbidity Database
30-day Stroke in-hospital mortality rate
Definition:
The risk-adjusted rate of all-cause in-hospital death occurring within
30 days of first admission to an acute care hospital with a diagnosis
of stroke.
(Primary ICD-9 or ICD -9-CM diagnosis code of 430-432, 434, 436 or ICD-10 I60-I62, I63.3-I63.5, I63.8, I63.9, I64. A technical note for this indicator is available).
To enable comparison across regions, a statistical model was used to
adjust for differences in age, sex and co-morbidities. Adjusted mortality
rates following stroke may reflect, for example, the underlying effectiveness
of treatment and quality of care. Inter-regional variations in rates may
be due to jurisdictional and institutional differences in standards of
care, as well as other factors that are not included in the adjustment.
These rates should be interpreted with caution due to potential differences
in the coding of comorbid conditions across provinces and territories.
Rates for British Columbia and Quebec are not available due to
differences in coding of Emergency Room admissions (BC) and diagnosis type (Quebec). Rate for Nunavut is not available due to incomplete data submission.
Source:
Canadian Institute for Health Information, Hospital Morbidity Database
Acute Myocardial Infarction (AMI) readmission rate
Definition:
The risk-adjusted rate of unplanned readmission following discharge for
Acute Myocardial Infarction (AMI). A case is counted as a readmission
if it is for a relevant diagnosis and occurs within 28 days after the
index AMI episode of care. An episode of care refers to all contiguous
in-patient hospitalizations and same-day surgery visits.
(See technical note for codes used).
To enable comparison across regions, a statistical model was used to adjust for differences in age, sex and co-morbidities. The risk of readmission following an AMI may be related to the type of drugs prescribed at discharge, patient compliance with post-discharge therapy, the quality of follow-up care in the community, or the availability of appropriate diagnostic or therapeutic technologies during the initial hospital stay. Although readmission for medical conditions can involve factors outside the direct control of the hospital, high rates of readmission act as a signal to hospitals to look more carefully at their practices, including the risk of discharging patients too early and the relationship with community physicians and community-based care. These rates should be interpreted with caution due to potential differences in the coding of comorbid conditions across provinces and territories.
Rates for Newfoundland are not available due to differences in coding of AMI admissions. Rates for Quebec and Manitoba are not available due to differences in data collection. Rate for Nunavut is not available due to incomplete data submission.
Source:
Canadian Institute for Health Information, Discharge Abstract Database, National Ambulatory Care Reporting System
Asthma readmission rate
Definition:
The risk-adjusted rate of unplanned readmission following discharge for Asthma. A case is counted as a readmission if it is for a relevant diagnosis and occurs within 28 days after the index episode of care. An episode of care refers to all contiguous in-patient hospitalizations and same-day surgery visits.
(See technical note for codes used).
To enable comparison across regions, a statistical model was used to adjust for differences in age, sex and co-morbidities. Although readmission for medical conditions may involve factors outside the direct control of the hospital, high rates of readmission act as a signal to hospitals to look more carefully at their practices, including the risk of discharging patients too early and the relationship with community physicians and community-based care. These rates should be interpreted with caution due to potential differences in the coding of comorbid conditions across provinces and territories.
Rates for Quebec and Manitoba are not available due to differences in data collection. Rate for Nunavut is not available due to incomplete data submission.
Source:
Canadian Institute for Health Information, Discharge Abstract Database, National Ambulatory Care Reporting System
Hysterectomy readmission rate
Definition:
The risk-adjusted rate of unplanned readmission following discharge for
Hysterectomy. A case is counted as a readmission if it is for a relevant
diagnosis and occurs within 7 or 28 days after the index episode of care.
An episode of care refers to all contiguous in-patient hospitalizations
and same-day surgery visits.
(See technical note for codes used).
To enable comparison across regions, a statistical model was used to
adjust for differences in age and co-morbidities. Although readmission
for surgery may involve factors outside the direct control of the hospital,
high rates of readmission act as a signal to hospitals to look more carefully
at their practices, including the risk of discharging patients too early
and the relationship with community physicians and community-based care.
These rates should be interpreted with caution due to potential differences
in the coding of comorbid conditions across provinces and territories.
Rates for Quebec and Manitoba are not available due to differences in data collection. Rate for Nunavut is not available due to incomplete data submission.
Source:
Canadian Institute for Health Information, Discharge Abstract Database, National Ambulatory Care Reporting System
Prostatectomy readmission rate
Definition:
The risk-adjusted rate of unplanned readmission following discharge for
Prostatectomy. A case is counted as a readmission if it is for a relevant
diagnosis or procedure and occurs within 28 days after the index episode
of care. An episode of care refers to all contiguous in-patient hospitalizations
and same-day surgery visits.
(See technical note for codes used).
To enable comparison across regions, a statistical model was used to
adjust for differences in age and co-morbidities. Although readmission
for surgery may involve factors outside the direct control of the hospital,
high rates of readmission act as a signal to hospitals to look more carefully
at their practices, including the risk of discharging patients too early
and the relationship with community physicians and community-based care.
These rates should be interpreted with caution due to potential differences
in the coding of comorbid conditions across provinces and territories.
Rates for Quebec and Manitoba are not available due to differences in data collection. Rate for Nunavut is not available due to incomplete data submission.
Source:
Canadian Institute for Health Information, Discharge Abstract Database, National Ambulatory Care Reporting System
Efficiency
Safety
Hip fracture hospitalization
Definition:
Age-standardized acute care hospitalization rate for fracture of the hip, per 100,000 population age 65 and over.
(Most responsible diagnosis code of: ICD-9 or ICD-9-CM 820.0-820.3, 820.8, 820.9 or ICD-10-CA S72.0, S72.1, S72.2).
Hip fractures occur for various reasons including environmental hazards,
the prescription of potentially inappropriate psychotropic medications
to the ambulatory elderly, and safety issues in long-term care facilities.
As well as causing disability or death, hip fractures can have a major
impact on independence and quality of life. This measure is based on
the
number of cases admitted to hospital.
Some cases may represent readmissions for additional treatments or transfers
from one medical setting to another. Thus, the hospitalization rate may
over-estimate the incidence of hip fractures.
Source:
Canadian Institute for Health Information, Hospital Morbidity Database
In-hospital hip fracture
Definition:
Risk-adjusted rate of in-hospital hip fracture among acute care inpatients age 65 years and over, per 1,000 discharges.
(See technical note for codes used).
Proposed by the Agency for Healthcare Research and Quality (AHRQ) and based on the Complications Screening Program, this indicator represents a potentially preventable complication resulting from an inpatient stay in an acute care facility. Variation in the rates may be attributed to numerous factors, including hospital processes, environmental safety, and availability of nursing care. High rates may prompt investigation of potential quality of care deficiencies.
Rates for Quebec and Manitoba are not available due to differences in data collection. Rate for Nunavut is not available due to incomplete data submission.
Source:
Canadian Institute for Health Information, Discharge Abstract Database
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