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Health Indicators
November 2003
Catalogue no. 82-221-XIE, Volume 2003, No. 2

Health system performance

Accessibility
Appropriateness
Effectiveness
Efficiency
Safety

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).

Source:
Statistics Canada, Canadian Community Health Survey, 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.

Sources:
Statistics Canada, Canadian Community Health Survey, 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.

Sources: Statistics Canada, Canadian Community Health Survey, 2000/01, health file; Statistics Canada, National Population Health Survey, 1994/95, 1996/97 and 1998/99, cross sectional sample, health file; Statistics Canada, National Population Health Survey, 1994/95 and 1996/97, cross sectional sample, North component

Appropriateness

Definition:
Proportion of women who have previously received a caesarean section who give birth via a vaginal delivery in an acute care hospital. (ICD-9 or ICD-9-CM diagnosis code of 654.2).

The Society of Obstetricians and Gynaecologists of Canada (SOGC) has issued guidelines with recommendations to promote vaginal birth after Caesarean where appropriate.

Source:
Canadian Institute for Health Information, Hospital Morbidity Database

Caesarean sections

Definition:
Proportion of women delivering babies in acute care hospital by caesarean section. Due to characteristics of the database, stillbirths are excluded from the denominator.

(CCP procedure code of 86.0-86.2, 86.8, or 86.9; ICD-9-CM procedure code of 74.0-74.2, 74.4 or 74.99).

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

Pneumonia and influenza hospitalizations

Definition:
Age-standardized acute care hospitalization rate for pneumonia and influenza per 100,000 population age 65 and older.

(Primary ICD-9 or ICD-9-CM diagnosis code of 480-487).

This indicator reflects the burden of illness due to pneumonia and influenza, a portion of which may be preventable through influenza and pneumococcal immunization programs. High rates of preventable pneumonia and influenza may suggest a problem with access to immunization.

Source:
Canadian Institute for Health Information, Hospital Morbidity Database

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 15 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.

(Based on a list developed by Alberta Health – primary ICD-9 or ICD-9-CM diagnosis code of 250, 291,292, 300, 303-305, 311, 401-405, or 493).

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. The "right" level of utilization is not known although a disproportionately high rate is presumed to reflect problems in obtaining access to primary care.

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).

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 are not available due to differences in coding of AMI (Newfoundland), Emergency Room admissions (BC), and the absence of a diagnosis type (Quebec).

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).

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 the absence of a diagnosis type (Quebec).

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.

(Primary ICD-9 or ICD-9-CM diagnosis code of 410).

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, Quebec and Manitoba are not available due to differences in coding of AMI admissions (Newfoundland) and data collection (Quebec and Manitoba).

Source:
Canadian Institute for Health Information, Discharge Abstract Database

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.

(Primary ICD-9 or ICD-9-CM diagnosis code of 493).

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.

Source:
Canadian Institute for Health Information, Discharge Abstract Database

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.

(CCP code of 80.2-80.6 or ICD-9-CM code of 68.3-68.7, 68.9).

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.

Source:
Canadian Institute for Health Information, Discharge Abstract Database

Pneumonia readmission rate

Definition: 
The risk adjusted rate of unplanned readmission following discharge for Pneumonia. 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.

(Primary ICD-9 or ICD-9-CM diagnosis code of 481, 482, 485 or 486).

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.

Source: 
Canadian Institute for Health Information, Discharge Abstract Database

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.

(CCP code of 72.1-72.3, 72.5 or ICD-9-CM code of 60.2-60.4, 60.6).

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.

Source:
Canadian Institute for Health Information, Discharge Abstract Database

Efficiency

May not require hospitalization

Definition:
Percentage of patients hospitalized in acute care facilities for conditions or procedures that experts say often allow outpatient treatment not requiring admission. These hospitalizations are classified as May Not Require Hospitalization (MNRH) and are derived from the Case Mix Group (CMG) methodology.

(May not require hospitalization CMGs: Lens insertion (055), other Ophthalmic procedures (057), other Ophthalmic diagnoses (063), Ethmoidectomy (088), Dental extraction/restoration (089), External & Middle ear procedures (090), Nasal procedures (091), Myringotomy (092), Tonsillectomy and Adenoidectomy procedures (093), Sinusitis (113), Sore throat (114), Miscellaneous ENT diagnosis (115), Croup (116), Atherosclerosis (229), Acquired valvular disorders (232), Hypertension (233), Congenital cardiac disorders (234), Anus & Stomal procedures (266), Unilateral hernia procedures (271), Soft tissue procedures (378), Other Musculoskeletal procedures (379),Other Lower extremity procedures (380), Hand & wrist procedures (381), Arthroscopy (382), Back Pain (409), Signs Symptoms & deformities (411), Joint Derangement (413), Sprains, Strains & minor injuries (414), Other Transurethral or biopsy procedures (512), Miscellaneous urinary tract procedures (514), Miscellaneous Urological diagnosis (534), Hematuria (535), Urinary Obstruction (536), Admission for dialysis (538), Miscellaneous male reproductive system procedures (554), Circumcision (555), Miscellaneous male reproductive system diagnosis (563), Gynecological Laparoscopy (585), Tubal Interruption (586), Miscellaneous Gynecological procedures (587), Miscellaneous Gynecological diagnoses (596), False labour LOS <3 days (619), Anxiety disorders (791), Adjustment disorders (792), Personality disorder with Axis III diagnosis (793), Personality disorder without Axis III diagnosis (794), Sexual dysfunction & Sexual disorders (795), Specific development disorders (796), Miscellaneous Psychiatric diagnosis (797), Procedure cancelled (852), Vein ligation & stripping (893), Unrelated O.R procedure (906), Obsolete psychiatric diagnosis (909)).

MNRH analyses may prompt review of inpatient cases to identify opportunities for providing such care in ambulatory settings. Case mix groups associated with MNRH do not suggest that a patient must be treated in an outpatient setting, as these patients may have a justifiable basis for inpatient admission.

Source:
Canadian Institute for Health Information, Discharge Abstract Database

Expected compared to actual stay

Definition:
The average number of actual days in acute care hospitals compared to expected length of stay.

Expected length of stay (ELOS) is derived from the Case Mix Group (CMG) methodology using calibration from a given year (i.e., 1999/00 data uses CMG 2000 methodology). ELOS is calculated on typical patients taking into account the reason for hospitalization, age, comorbidity, and complications. Typical cases exclude deaths, transfers, voluntary sign-outs, and cases where the actual length of stay is greater than the "trim point" established by Canadian Institute for Health Information. A positive value indicates actual days stay was longer than expected while a negative value suggests the average actual stay was shorter than expected.

Source:
Canadian Institute for Health Information, Discharge Abstract Database

Safety

Hip fracture hospitalization

Definition:
Age-standardized acute care hospitalization rate for fracture of the hip, per 100,000 population age 65 and older.

(Primary ICD-9 or ICD-9-CM diagnosis code of 820.0-820.3, 820.8, 820.9).

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