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 2005, 2003, 2000/01, health file

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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 2005, 2003, 2000/01, health file; Statistics Canada, National Population Health Survey, 1996/97, cross sectional sample, health file

Screening mammography, women aged 50 to 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 2005, 2003, 2000/01, health file; Statistics Canada, National Population Health Survey, 1996/97, cross sectional sample, health file

Pap smear, women aged 18 to 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 2005, 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

Regular medical doctor

Definition:
Population aged 12 and over were asked to report whether they had a regular medical doctor. Those who did not were asked to report why not.

Respondents were considered not to have looked for a regular medical doctor if their responses included "Have not tried to contact one" or "Other reasons". All other respondents without a regular medical doctor were considered to have been unable to find one. Their responses included various combinations of the following: "No medical doctors available in the area", "Medical doctors in the area are not taking new patients" and "Had a medical doctor who left or retired".

Establishing an ongoing relationship with a regular medical doctor is believed to be important in maintaining health and ensuring appropriate access to health services.

Source:
Statistics Canada, Canadian Community Health Survey 2005, health file

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Appropriateness

Caesarean section

Definition:
Proportion of women delivering babies in acute care hospitals by caesarean section.

Method of Calculation

(Number of Caesarean sections/Number of deliveries (live births and stillbirths) )*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’; or 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.

Sources:
Canadian Institute for Health Information, Hospital Morbidity Database, Discharge Abstract Database; Ministère de la Santé et des Services sociaux du Québec

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

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Effectiveness

Deaths due to medically treatable diseases: Bacterial infections

Definition:
Age-standardized rate of deaths due to bacterial infections (ICD9 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.)

Inclusion criteria:

• Any one most responsible diagnosis code of:
• Grand mal status and other epileptic convulsions
• Chronic obstructive pulmonary disease
• Acute bronchitis, only when a secondary diagnosis* of COPD is also present
• Pneumonia, only when a secondary diagnosis* of COPD is also present
• Asthma
• Congestive heart failure**
• Hypertension**
• Angina**
• Diabetes

(See technical notes for codes used).

*“Secondary diagnosis” refers to a diagnosis other than most responsible
** Excluding cases with a specific procedure recorded (refer to technical notes for details)

Ambulatory Care Sensitive Conditions have been considered to be 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.

Sources:
Canadian Institute for Health Information, Hospital Morbidity Database, Discharge Abstract 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 notes 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 and Labrador and Quebec regions are not available due to differences in coding of AMI (Newfoundland and Labrador) and diagnosis type (Quebec). Rate for Nunavut is not available due to incomplete data submission.

Sources:
Canadian Institute for Health Information, Hospital Morbidity Database, Discharge Abstract 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 diagnosis code of 430-432, 434, 436, or ICD-9-CM 430, 431, 432, 434.01, 434.11, 434.91, 436 or ICD-10 I60-I62, I63.3-I63.5, I63.8, I63.9, I64. A technical notes 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 Quebec are not available due to differences in coding of diagnosis type. Rate for Nunavut is not available due to incomplete data submission.

Sources:
Canadian Institute for Health Information, Hospital Morbidity Database, Discharge Abstract 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 notes 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 and Labrador 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 notes 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 notes 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 notes 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

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Efficiency

- nothing new to report

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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, Discharge Abstract 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 notes 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