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8. Health System Indicators (Canadian Institute for Health Information - CIHI)

CIHI’s Privacy and Confidentiality policy does not permit the publication of data that might reasonably identify an individual, whether a patient or care provider, without consent. As a result, measures were taken to protect against residual disclosure from the dissemination of the regional rates including the suppression of small cell sizes. In addition, reporting data based on the region of the patient’s residence (not hospitalization) reduces opportunities for identifying individual care providers.

8.1 Hospitalization data and rates (CIHI)

• Data are reported based on the region of the patient’s residence, not region of hospitalization. Consequently, these figures reflect the hospitalization experience of residents of the region wherever they are treated, as opposed to the comprehensive activity of the region’s hospitals (who will also treat people from outside of the region).

• Regional rates for British Columbia were derived from the reported postal codes and a translation file developed by BC STATS, BC Ministry of Finance and Corporate Relations. Health region level data for the other provinces and territories were produced through a geo-coding process using correspondence files developed with input from each provincial and territorial health ministry and Alberta Treasury. The link between dissemination areas and health regions was first created to provide the best resolution to census geography, and a census subdivision link to health regions was derived from this file. Boundaries are those that were in effect as of June 2005 with the exception of Ontario regions, which are current as of August 2005. Records with invalid, missing, or partial postal codes are not included in the regional rates. The absence of complete postal codes from Quebec may affect rates for the Champlain LHIN (Ottawa area) and other border regions.

• Where possible, an all-Canada rate is provided for comparison purposes.

• At the Canada level and provincial levels, rates for health data that are based on a fiscal year (April to March) use October 1st population estimates. Unless otherwise specified, Canadian and provincial hospitalization rates are standardized using the same methodology as regional rates. Standardized rates are age-adjusted using a direct method of standardization based on the July 1st, 1991 Canadian population. See section 2.2.2 for details.

• Hospitalizations include discharges and deaths for inpatients in acute care hospitals for the reference period. Same day surgery (outpatient) cases and patients admitted to non-acute care hospitals (e.g. chronic care, psychiatric or rehabilitation facilities) are not included in the totals unless otherwise specified. For procedure-derived indicators (e.g., hip and knee replacement, percutaneous coronary intervention, coronary artery bypass), rates are based on the total number of discharges rather than the total number of interventions. For example, a bilateral knee replacement provided at the same admission is counted as one event.

• Indicators based on the Discharge Abstract Database (DAD) include only jurisdictions that submit comprehensively to the database. As of April 1, 2004, all provinces and territories with the exception of Quebec submit to the DAD.

• ICD-10-CA and the Canadian Classification of Health Interventions (CCI) systems of coding diagnoses and procedures came into effect in 2001 and by April 1, 2004 had been adopted by all provinces and territories with the exception of Quebec. Indicator cases that were originally coded in ICD-10-CA or CCI were extracted on the relevant codes and not the ICD-9 or CCP translations. New and revised coding standards introduced with the ICD-10-CA/CCI classification systems may affect the comparability of rates with those appearing in previous releases for some of the indicators.

• Bypass Surgery: Variations in the use of this procedure may be related to utilization rates of percutaneous coronary intervention, an alternative method for improving blood flow to the heart.

• 30-day acute myocardial infarction (AMI) and stroke in-hospital mortality indicators: Rates for British Columbia were calculated by applying the risk-adjusted coefficients from a model utilizing data from PEI, Nova Scotia, New Brunswick, Ontario, Manitoba, Saskatchewan, Alberta, the Yukon and Northwest Territories.

• The methodology for calculating the acute myocardial infarction (AMI) readmission indicator has been revised. These revisions may affect the comparability of rates with those appearing in previous releases. See the AMI Readmission Technical Note for further information .

• As of 2003-2004, knee replacement rates include revisions for all provinces/territories. Previously, rates for Quebec may have been underestimated due to data issues, which did not permit the identification of knee replacement revisions. Note that in 2003-2004, 6.5% of knee replacements provided in Quebec were revisions.

• In 2004-2005, hospitalization data for Region 6 in New Brunswick were incomplete and several indicators including hip and knee replacement, hip fracture, injury, ACSC, caesarean section, and hysterectomy, could not be calculated for this region. For these indicators, New Brunswick provincial rates exclude Region 6 cases and therefore the comparability of the provincial rates with those appearing in previous releases will be affected. Quebec data for 2004-2005 were unavailable and residents from other provinces and territories hospitalized in Quebec in 2004-2005 will not be included in the provincial/territorial rates of their residency.

• The 30-day in-hospital mortality, in-hospital hip fracture, and readmission indicator rates are based on a three-year average. Due to differences in the way data are collected, these indicators are not available for all provinces and territories. Therefore, the average (Canada) rate does not include all provinces/territories.technical notes and model specifications are available for AMI and Stroke 30-day mortality, in-hospital hip fracture, as well as the readmission indicators ( AMI, asthma, hysterectomy, and prostatectomy).

• Where information is available, cancelled, previous, out-of-hospital, and “abandoned after onset” procedures are excluded from the calculations. For ACSC rates, out-of-hospital procedures are not excluded. For Quebec data, cancelled procedures are not reported.

8.2 Physician data (CIHI)

• Physician counts include all active general practitioners, family practitioners, and specialist physicians as of December 31 of the reference year. The data include physicians in clinical and non-clinical practice and exclude residents and physicians who are not licensed to provide clinical practice and have requested that their information not be published in the Canadian Medical Directory.

• For all jurisdictions and data years specialist physicians include certificants of the Royal College of Physicians and Surgeons of Canada (RCPSC) and/or the College des médecins du Québec (CMQ). As of 2004, Saskatchewan and Newfoundland and Labrador specialists also include physicians who are licensed as specialists but who are not certified by the RCPSC or the CMQ (i.e., non-certified specialists). For all other jurisdictions, and for Saskatchewan and Newfoundland and Labrador prior to 2004, non-certified specialists are counted as family practitioners. With the exception of the criteria just noted all other physicians are counted as family practitioners, including certificants of the College of Family Physicians of Canada (CCFP and CCFP-Emergency Medicine). For further information on physician count methodologies please see CIHI’s reports on the “Supply, Distribution and Migration of Canadian Physicians” and “Certified and Non-Certified Specialists: Understanding the Numbers” (www.cihi.ca).

• It is recognized that physician specialty classification as noted above does not necessarily reflect the services provided by individual physicians. The range of services provided by a physician is subject to provincial licensure rules, medical service plan payment arrangements, and individual practice choices. Therefore, CIHI physician-to-population rates may differ from those published by other sources.

• Physician-to-population ratios are used to support health human resource planning. While physician density ratios are useful indicators of changes in physician numbers relative to the population, inference from total numbers or ratios as to the adequacy of provider resources should not be made.

Note: Scott’s Medical Database (SMDB) information may undercount physicians due to Provincial/Territorial licensing authority data supply interruptions. SMDB data does not reflect licensing authority updates for the following jurisdictions and years: British Columbia 2004; Québec 2003; Ontario 2002; Alberta and the Yukon 2000.

Source: CIHI, Scott’s Medical Database.

8.3 National Health Expenditure Database (CIHI)

• Expenditure figures include spending by both the public and private sectors. For further information, see National Health Expenditure Trends, 1975-2004.

• Provincial per capita figures are affected by numerous factors that will affect inter-provincial comparisons including, but not limited to, differing provincial inflation rates that are related to provincial differences in arbitration agreements between provincial governments and, for example, medical associations; different population distributions; geography; and differences in provincial purchasing power.