FOOTNOTES AND LEGEND

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1 MLPA PERFORMANCE INDICATORS NOV, 2011 FOOTNOTES AND LEGEND NB Colour coding for 2010/11 has been updated to match the methodology being used for 2011/12, so may not match colour coding released previously * Indicator also has a provincial interim goal of 25 hours ** Indicator also has a provincial interim goal of 7 hours Notes (Refers to 14-Nov-11 data only) 1 Q2 2011/12 Data (Jul, Aug, Sep 2011 Data) 2 Q1 2011/12 Data (Apr, May, Jun 2011 Data) 3 Q4 2010/11 (Jan, Feb, Mar 2011 Data) Colour Legends Release dates: 13-May-11 DOING WELL: The result is less than or equal to its target MONITORING NEEDED:The result is 1) greater than its target AND 2) within 10% of its target AT RISK, ACTION REQUIRED: The result is greater than 10% above its target Release dates: 11-Feb-11, 12-Aug-11, 14-Nov-11 DOING WELL: The result is less than or equal to its target MONITORING NEEDED, IMPROVING: The result is 1) greater than its target AND 2) less than its baseline or less than a 10% corridor above its target (whichever is higher) AND 2) has improved since the last quarter MONITORING NEEDED, NOT IMPROVING: The result is 1) greater than its target AND 2) less than its baseline or less than a 10% corridor above its target (whichever is higher) AND 2) has not improved since the last quarter AT RISK, ACTION REQUIRED: The result is 1) greater than 10% above its target AND 2) greater than its baseline

2 Percentage of Alternate Level of Care (ALC) Days - By of Institution / /12 Erie St Clair 10.85% 9.00% 13.28% 14.51% 13.24% 12.00% 18.94% 11.27% South West 11.59% 8.80% 10.24% 10.32% 10.67% 8.80% 13.55% 11.90% Waterloo Wellington 17.64% 12.51% 18.56% 16.98% 16.88% 9.46% 18.11% 14.52% Hamilton Niagara Haldimand Brant 20.97% 11.00% 19.30% 17.82% 17.88% 11.00% 17.94% 12.94% Central West 10.13% 9.50% 9.26% 7.96% 9.55% 9.46% 9.89% 8.67% Mississauga Halton 9.21% 8.30% 10.03% 9.29% 9.73% 9.21% 12.23% 8.52% Toronto Central 11.20% 8.40% 10.08% 10.49% 10.78% 10.00% 11.01% 10.27% Central 15.43% 13.01% 16.53% 16.59% 16.10% 13.01% 15.04% 14.53% Central East 18.41% 12.20% 18.90% 21.29% 20.22% 14.80% 18.39% 16.95% South East 16.83% 10.10% 15.29% 14.99% 14.78% 9.46% 13.19% 10.35% Champlain 15.65% 12.80% 16.32% 18.33% 16.09% 13.50% 16.25% 14.37% North Simcoe Muskoka 19.82% 15.40% 19.77% 18.40% 19.40% 15.40% 18.51% 18.58% North East 27.99% 17.00% 34.11% 31.05% 33.22% 17.00% 40.76% 32.89% North West 17.86% 15.40% 21.54% 22.67% 21.76% 15.40% 21.31% 17.44% ONTARIO 15.90% 9.46% 16.40% 16.31% 16.70% 9.46% 17.50% 14.40%

3 90th Percentile ER Length of Stay for Admitted Patients* / /12 Low Erie St Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central Central Central East South East Champlain North Simcoe Muskoka North East North West ONTARIO hours hours

4 90th Percentile ER Length of Stay for Non-Admitted Complex (CTAS I-III) Patients** / /12 Low Erie St Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central Central Central East South East Champlain North Simcoe Muskoka North East North West ONTARIO hours hours

5 Low 90th Percentile ER Length of Stay for Non-Admitted Minor Uncomplicated (CTAS IV-V) Patients / /12 Erie St Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central Central Central East South East Champlain North Simcoe Muskoka North East North West ONTARIO hours hours

6 90th Percentile Wait Times for Diagnostic MRI Scan / /12 Erie St Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central Central Central East South East Champlain North Simcoe Muskoka North East North West ONTARIO days days 93 94

7 90th Percentile Wait Times for Diagnostic CT Scan / /12 Erie St Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central Central Central East South East Champlain North Simcoe Muskoka North East North West ONTARIO days days 33 35

8 90th Percentile Wait Times for Hip Replacement / /12 Erie St Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central Central Central East South East Champlain North Simcoe Muskoka North East North West ONTARIO

9 90th Percentile Wait Times for Knee Replacement / /12 Erie St Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central Central Central East South East Champlain North Simcoe Muskoka North East North West ONTARIO

10 90th Percentile Wait Times for Cancer Surgery / /12 Erie St Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central Central Central East South East Champlain North Simcoe Muskoka North East North West ONTARIO days days 56 59

11 90th Percentile Wait Times for Cardiac By-Pass Procedures / /12 South West Waterloo Wellington Hamilton Niagara Haldimand Brant Mississauga Halton Toronto Central Central South East Champlain North East ONTARIO days days 49 51

12 90th Percentile Wait Times for Cataract Surgery / /12 Erie St Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central Central Central East South East Champlain North Simcoe Muskoka North East North West ONTARIO days days

13 Readmission within 30 Days for Selected CMGs / /12 Erie St Clair 15.00% 12.80% 16.20% 14.77% 15.51% 12.80% 16.01% 15.02% South West 16.00% 14.20% 15.41% 16.28% 15.84% 14.00% 16.73% 13.19% Waterloo Wellington 14.40% 14.00% 13.64% 16.09% 14.81% 14.00% 13.37% 12.13% Hamilton Niagara Haldimand Brant 15.10% 14.00% 15.17% 15.03% 15.10% 14.00% 15.71% 15.18% Central West 15.20% 14.70% 15.44% 14.93% 15.19% 14.70% 14.80% 15.33% Mississauga Halton 13.10% 13.10% 12.60% 13.97% 13.34% 12.60% 12.87% 13.05% Toronto Central 16.20% 15.20% 18.70% 19.60% 19.17% 18.00% 19.07% 17.76% Central 15.20% 14.40% 14.74% 15.57% 15.19% 14.40% 15.23% 15.05% Central East 15.50% 15.30% 15.17% 14.21% 14.77% 14.50% 15.77% 15.17% South East 15.20% 14.30% 15.03% 15.56% 15.36% 14.30% 14.83% 16.57% Champlain 15.50% 14.00% 16.14% 16.38% 16.34% 14.50% 15.76% 15.73% North Simcoe Muskoka 15.50% 14.50% 14.13% 16.97% 15.53% 14.20% 15.34% 14.80% North East 16.60% 14.40% 16.30% 17.43% 16.99% 14.40% 16.22% 15.45% North West 15.80% 14.80% 16.10% 19.05% 17.58% 16.00% 18.04% 15.63% ONTARIO 15.3 TBD 15.53% 16.16% 15.83% TBD 15.88% 15.14%

14 Repeat Unscheduled Emergency Visits within 30 Days for Mental Health Conditions / /12 Erie St Clair 14.50% 12.50% 17.09% 15.75% 19.80% 18.80% 17.82% 17.70% South West 14.80% 12.50% 15.63% 13.98% 15.50% 14.70% 15.21% 14.80% Waterloo Wellington 13.70% 11.60% 13.16% 15.52% 14.80% 13.20% 15.41% 16.28% Hamilton Niagara Haldimand Brant 17.10% 15.40% 17.90% 15.98% 18.40% 18.40% 19.47% 20.01% Central West 14.20% 12.10% 15.86% 13.01% 15.30% 14.84% 15.54% 14.21% Mississauga Halton 14.90% 12.60% 14.59% 13.80% 15.50% 14.70% 12.46% 15.84% Toronto Central 25.80% 23.22% 26.32% 25.58% 25.80% 25.00% 23.43% 23.90% Central 16.10% 13.60% 19.12% 16.91% 17.90% 17.00% 17.98% 14.45% Central East 15.20% 13.00% 15.68% 17.72% 17.50% 16.60% 17.75% 18.68% South East 15.40% 13.10% 14.15% 15.53% 16.80% 16.00% 19.57% 20.85% Champlain 12.50% 12.50% 13.75% 13.91% 17.10% 17.10% 16.24% 17.27% North Simcoe Muskoka 14.10% 14.00% 11.55% 14.33% 13.60% 13.60% 14.47% 12.45% North East 16.00% 14.80% 17.51% 18.99% 19.10% 18.10% 19.70% 18.33% North West 16.50% 13.70% 15.33% 19.14% 19.30% 17.40% 21.15% 18.06% ONTARIO TBD 17.39% 17.48% 17.50% TBD 18.40% 18.15%

15 Repeat Unscheduled Emergency Visits within 30 Days for Substance Abuse Conditions / /12 Erie St Clair 19.00% 16.10% 20.03% 18.18% 19.20% 17.20% 19.29% 26.51% South West 22.70% 19.00% 31.42% 25.48% 26.30% 25.00% 26.21% 23.17% Waterloo Wellington 19.70% 16.80% 24.92% 21.36% 21.80% 18.75% 19.29% 16.91% Hamilton Niagara Haldimand Brant 19.00% 17.10% 22.59% 20.34% 21.40% 21.40% 20.66% 20.77% Central West 17.00% 14.50% 18.84% 20.39% 18.40% 17.90% 17.89% 17.67% Mississauga Halton 20.40% 17.40% 19.23% 20.06% 19.50% 18.50% 17.63% 19.81% Toronto Central 35.00% 32.00% 38.22% 39.49% 37.40% 35.00% 36.61% 37.31% Central 16.50% 16.50% 23.72% 22.17% 20.70% 19.70% 18.41% 16.50% Central East 20.60% 17.50% 17.28% 19.79% 19.60% 19.00% 20.59% 22.98% South East 14.30% 14.30% 25.13% 20.70% 20.90% 19.90% 12.47% 15.96% Champlain 20.90% 18.80% 26.75% 24.25% 25.90% 25.90% 19.93% 23.98% North Simcoe Muskoka 14.70% 14.70% 12.87% 12.64% 15.60% 14.00% 18.84% 16.57% North East 20.60% 19.00% 24.92% 29.20% 30.00% 27.00% 24.34% 26.24% North West 29.70% 22.20% 33.50% 29.47% 32.30% 29.10% 25.39% 31.72% ONTARIO TBD 28.06% 27.06% 27.60% TBD 25.20% 27.00%

16 90th Percentile Wait Time for CCAC In-Home Services - Application from Community Setting to first CCAC Service (excluding case management) / /12 Erie St Clair NA NA South West NA NA Waterloo Wellington NA NA Hamilton Niagara Haldimand Brant NA NA Central West NA NA Mississauga Halton NA NA Toronto Central NA NA Central NA NA Central East NA NA South East NA NA Champlain NA NA North Simcoe Muskoka NA NA North East NA NA North West NA NA ONTARIO 35 TBD TBD

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18 MLPA Final PI X s_(nov 14, 2011 Accountability Agreement Performance Indicator Notes Low This page provides detail for a performance indicator listed in Schedule 10 of the Performance Agreement. Notes below should align with descriptive sheets in the document: MOHLTC- Performance Agreement, Local Health System Performance Indicators Technical Information () Performance Indicator: Wait Times for Cancer Surgery Description: 90 th Percentile Wait Times for Cancer Surgery Indicator calculation: Step 1: Wait Days = Procedure Date Decision to Treat Date Patient Unavailable Days Step 2: Sort the records ascending. Patients with short wait days on top and patients with long wait days at the bottom. Step 3: Count the total number of cases and multiply by 0.90 (let s call this the 90 th obs ). If this value has a decimal digit greater than zero then roundup. The 90 th percentile wait time is the wait time of the 90 th obs patient. The 90 th percentile value is not interpolated. Numerator: N/A Denominator: N/A Inclusion and exclusion criteria: 1. Wait Time is calculated based on closed cases submitted by hospitals through the Wait Time Information System. 2. All closed wait list entries with procedure dates within date range 3. Must be 18 and older on the day the procedure was completed 4. Procedures No Longer Required are excluded from wait time calculation 5. Includes treatment cancer procedures only. Procedures classified as "NA" are currently included. Diagnostic, palliative and reconstructive cancer procedures are excluded. Procedures on skin - carcinoma, skin-melanoma, and lymphomas are also excluded. 6. Procedures assigned as priority level 1 are excluded from wait time calculation. 7. Wait list entries identified by hospitals as data entry errors are also excluded. 8. If unavailable days fall outside the decision to treat date up to procedure date, unavailable days are not deducted from patients wait days. These are considered data entry errors. Data Source: Cancer Care Ontario (Access to Care Informatics, 2011). MOHLTC\HSIMI\HA and HD Final

19 MLPA Final PI X s_(nov 14, 2011 Low Performance Indicator: Wait Times for Cardiac By-Pass Surgery Description: 90 th Percentile Wait Times for Cardiac By-Pass Surgery Waiting periods are counted from the date a patient was accepted for bypass surgery by the cardiac service or cardiac surgeon. Waiting periods do not include time spent investigating heart disease before a patient is accepted for a procedure. For example, the time it takes for a patient to have a heart catheterization procedure before being Indicator calculation: referred to a heart surgeon is not part of the waiting time shown for heart surgery (Access to Care Informatics, 2005). Waiting times for a catheterization done after a patient has been accepted for the surgery are included as acceptance does not equal medically ready. Numerator: N/A Denominator: N/A Inclusion and exclusion criteria: Inclusion Criteria: Only includes elective patients who are Ontario residents (Access to Care Informatics, 2008). Exclusion Criteria: None Data Source: Cardiac Care Network Provincial Patient Wait Times Registry in place since (Access to Care Informatics, 2011). MOHLTC\HSIMI\HA and HD Final

20 MLPA Final PI X s_(nov 14, 2011 Low Performance Indicator: Wait Times for Cataract Surgery Description: 90 th Percentile Wait Times for Cataract Surgery Indicator calculation: Step 1: Wait Days = Procedure Date Decision to Treat Date Patient Unavailable Days Step 2: Sort the records ascending. Patients with short wait days on top and patients with long wait days at the bottom. Step 3: Count the total number of cases and multiply by 0.90 (let s call this the 90thobs ). If this value has a decimal digit greater than zero then roundup. The 90th percentile wait time is the wait time of the 90thobs patient. The 90th percentile value is not interpolated. Numerator: N/A Denominator: N/A Inclusion and exclusion criteria: 1. Wait Time is calculated based on closed cases submitted by hospitals through the Wait Time Information System. 2. All closed wait list entries with procedure dates within date range 3. Must be 18 and older on the day the procedure was completed 4. Procedures no longer required are excluded from wait time calculation 5. Procedures assigned as priority level 1 are excluded from wait time calculation. 6. Wait list entries identified by hospitals as data entry errors are also excluded. 7. If unavailable days fall outside the decision to treat date up to procedure date, unavailable days are not deducted from patients wait days. These are considered data entry errors. Data Source: Cancer Care Ontario (Access to Care Informatics, 2011). MOHLTC\HSIMI\HA and HD Final

21 MLPA Final PI X s_(nov 14, 2011 Low Performance Indicator: Wait Times for Joint Replacement Description: 90 th Percentile Wait Times for Joint Replacement Indicator calculation: Step 1: Wait Days = Procedure Date Decision to Treat Date Patient Unavailable Days Step 2: Sort the records ascending. Patients with short wait days on top and patients with long wait days at the bottom. Step 3: Count the total number of cases and multiply by 0.90 (let s call this the 90thobs ). If this value has a decimal digit greater than zero then roundup. The 90th percentile wait time is the wait time of the 90thobs patient. The 90th percentile value is not interpolated. Numerator: N/A Denominator: N/A Inclusion and exclusion criteria: 1. Wait Time is calculated based on closed cases submitted by hospitals through the Wait Time Information System. 2. All closed wait list entries with procedure dates within date range 3. Must be 18 and older on the day the procedure was completed 4. Procedures no longer required are excluded from wait time calculation 5. Procedures assigned as priority level 1 are excluded from wait time calculation. 6. Wait list entries identified by hospitals as data entry errors are also excluded. 7. If unavailable days fall outside the decision to treat date up to procedure date, unavailable days are not deducted from patients wait days. These are considered data entry errors. Data Source: Cancer Care Ontario (Access to Care Informatics, 2011). MOHLTC\HSIMI\HA and HD Final

22 MLPA Final PI X s_(nov 14, 2011 Low Performance Indicator: Wait Times for MRI/CT Scans Description: 90 th Percentile Wait Times for MRI/CT Scans Indicator calculation: Step 1: Wait Days = Procedure Date Decision to Treat Date Patient Unavailable Days Step 2: Sort the records ascending. Patients with short wait days on top and patients with long wait days at the bottom. Step 3: Count the total number of cases and multiply by 0.90 (let s call this the 90 th obs ). If this value has a decimal digit greater than zero then roundup. The 90 th percentile wait time is the wait time of the 90 th obs patient. The 90 th percentile value is not interpolated. Numerator: N/A Denominator: N/A Inclusion and exclusion criteria: 1. Wait Time is calculated based on closed cases submitted by hospitals through the Wait Time Information System. 2. All closed wait list entries with procedure dates within date range 3. Must be 18 and older on the day the procedure was completed 4. Procedures no longer required are excluded from wait time calculation 5. Procedures assigned as priority level 1 are excluded from wait time calculation. 6. Wait list entries identified by hospitals as data entry errors are also excluded. 7. If unavailable days fall outside the decision to treat date up to procedure date, unavailable days are not deducted from patients wait days. These are considered data entry errors. 8. As of January 1, 2008, DI cases classified as specified date procedures (timed procedures) are excluded from wait time calculation. Data Source: Cancer Care Ontario (Access to Care Informatics, 2011). MOHLTC\HSIMI\HA and HD Final

23 MLPA Final PI X s_(nov 14, 2011 Percentage of Alternate Level of Care Days Low Description: Percentage of inpatient days where a physician (or designated other) has indicated that a patient occupying an acute care hospital bed has finished the acute care phase of his/her treatment. Data Source: CIHI Inpatient Discharge Abstract Database (DAD) Inclusion/Exclusion criteria: Inclusion: Data are retrieved from acute care hospitals. Exclusion: Newborns, stillborns, and records with missing or invalid Discharge Date are not included in this indicator. Methodology: Numerator = Total number of inpatient days designated as ALC in a given time period Denominator = Total number of inpatient days in a given time period Methodological Notes: All numbers used for calculations are as reported by the hospitals. The information is from each acute site of the hospital and the assignment to a is based on the postal code of the corporate head office site. Limitations: Data are collected continually so quarterly/annual tracking is possible. In-quarter data (as opposed to cumulative data) is presented. Q1 data is made available at the same time as Q2 data. Year end results may be issued in two waves: 1. preliminary results, 2. final results. The ALC days included are based on hospital discharge information and as such the measure does not include patients occupying ALC beds who have not been discharged. MOHLTC\HSIMI\HA and HD Final

24 MLPA Final PI X s_(nov 14, 2011 Low 90th Percentile ER Length of Stay Indicators EXCLUSION CRITERIA FOR NACRS FY 2011/12 [LEVEL 1] DATA Applicable to Ontario ER data from APRIL 2011 onwards Access to Care Informatics (ATCI), CCO will identify ER visits from NACRS (level 1) April 2011 data, for reporting purposes using the following criteria: Unscheduled ER visits captured under MIS functional centre codes 7*310* Cases are excluded from ED reports if they fall in ANY ONE of the following ER exclusion criteria: Cases where Patient Left ED Date/Time and Disposition Date/Time are both blank/unknown (9999) Cases where Registration Date/Time and Triage Date/Time are both blank/unknown (9999) Cases where patients over the age of 125 on the earlier of triage or registration date Duplicate cases within the same functional center where all ER data elements have the same values except for Abstract ID number Cases pertaining to Psychiatric assessment units reported in functional centre evaluated and approved by CCO's ED Information Program Cases where the Scheduled visit Indicator flag is = 'Y' If none of the Overall Exclusion Criteria applies to a record then Exclude_CD="0" Cases are excluded from specific performance metric calculations if they fall in ANY ONE of the following exclusion criteria: Key Performance Indicator Definition/Calculation Condition Exclusion Criteria - For ER Data Submission 1. Ambulance Offload time (AOT) Ambulance Transfer of Care date/time - For Ambulance Arrival ER Exclusion criteria Ambulance Arrival date/time Indicator A, G or C only Cases where Ambulance Arrival Date/Time is after the Ambulance Transfer of Care Date/Time 2. Time to Physician Initial Assess (PIA)* Physician Initial Assessment date/time - ED Triage/Registration Date/time (whichever is earlier / valid) 3. Time to Disposition Decision ED disposition date/time - ED Triage/Registration Date/time (whichever is earlier / valid) 4. Time to Admission (Admitted Patients Only; ED Disposition Codes 06 or 07) Date/time Patient Left ED - ED Disposition Date/time N/A Disposition code ED Disposition Code 06 or 07 Cases where Ambulance Arrival Date/Time and Ambulance Transfer of Care Date/Time is unknown (9999) or blank Cases where Ambulance arrival indicator is other than A, G or C AOT is greater than or equal to minutes (1666 hours) ER Exclusion criteria Cases where Physician Initial Assessment time is Unknown (9999) or blank Time to PIA is greater than or equal to minutes (1666 hours) ER Exclusion criteria Cases where Cases where Disposition Date/Time is unknown (9999) or blank Cases where patient has left without being seen by a physician during his/her visit (Disposition Code 02 & 03) Time to Disposition Decision is greater than or equal to minutes (1666 hours) ER Exclusion criteria Cases where Patient left ED date/time is 9999 (unknown) or blank Cases where ED Disposition codes are other than '06 and '07 Cases where Disposition date/time is 9999 (unknown) or blank Time to Admission is greater than or equal to minutes (1666 hours) MOHLTC\HSIMI\HA and HD Final

25 MLPA Final PI X s_(nov 14, 2011 Low 5. ED LOS - All Disposition ED Visits without designated CDU: Date/time Patient Left ED - ED Triage/Registration (whichever is earlier and valid) Date/time Note: If Patient Left ED Date/Time is unknown (9999) or blank, use Disposition 6. ED Admits at Midnight Number of patients with an ED Disposition code of 06 or 07 in the ED at midnight (daily average) 7. Total ED Visits Number of ED Visits 8. CDU Length of stay** CDU Date/Time Out or Patient Left ED Date/Time - CDU Date/Time In Note: If CDU Date/Time Out is unknown (9999) or blank, Patient Left ED Date/Time will be used, if available 9. ED LOS-Admitted Patients Date/time Patient Left ED - ED Triage/Registration Date/time ((whichever is earlier / valid) N/A ED disposition Code 06 or 07; ER Exclusion criteria Cases where Patient left ED date/time is unknown or blank and the Disposition Code is 06-09, 12, 14 (admitted and transferred patients) ED LOS is greater than or equal to minutes (1666 hours) Cases where patient has left without being seen by a physician during his/her visit (Disposition Code 02 & 03) Cases where Date/Time patient left ED is unknown (9999) or blank at midnight Cases where Disposition Date/Time is unknown (9999) Count based on Registration/Triage date ED Disposition Code 06 or ED LOS-Discharged Patients Date/time Patient Left ED - ED ED Disposition Code 01 or Triage/Registration Date/time (whichever is 15 earlier / valid) If Date/Time patient left ED 11. ED LOS-Left without being seen Date/time Patient Left ED - ED ED Disposition Code 02 or 03 Triage/Registration Date/time ((whichever 12. ED LOS-Left without treatment Date/time Patient Left ED - ED Triage/Registration Date/time ((whichever is earlier / valid) ER Exclusion criteria Cases where Date/Time Patient left ED is unknown (9999) or blank and the Disposition Code is 06-09, 12, 14 (admitted patients and transferred patients) Cases where patient has left without being seen by a physician during his/her visit (Disposition Code 02 & 03) ER Exclusion criteria Cases from hospitals with non-designated CDUs Cases where CDU Date/Time In is before Triage / Registration Date/Time (whichever is earlier and valid) Cases where CDU admission Date/Time is after Date/Time Patient Left ED or CDU Date/Time out Cases where Patient Left ED AND CDU Date/Time Out is unknown (9999) or blank for CDU cases Cases where CDU Date/Time In is unknown (9999) or blank Cases where CDU Date/Time In is unknown (9999) or blank Cases where patient has left without being seen by a physician during his/her visit (Disposition Code 02 & 03) CDU LOS is greater than or equal to minutes (1666 hours) ER Exclusion criteria Cases where Date/Time Patient left ED is unknown (9999) or blank ED LOS (for Admitted Patients) is greater than or equal to minutes (1666 hours) ER Exclusion criteria ED LOS is greater than or equal to minutes (1666 hours) ER Exclusion criteria ED LOS is greater than or equal to minutes (1666 hours) ER Exclusion criteria ED Disposition Code 04 ED LOS is greater than or equal to minutes (1666 hours) * If PIA is less than or equal to 24 hours prior to registration/triage time i.e. when 'Time to PIA' is negative, the Time to PIA or PIA LOS will be set to 'zero'. ** CDU Length of Stay: ED facilities who have NOT informed CCO about their designated CDU status will be excluded, even if CDU Flag is 'Y' and/or other CDU fields are completed MOHLTC\HSIMI\HA and HD Final

26 MLPA Final PI X s_(nov 14, 2011 Low Repeat Unscheduled Emergency Visit Within 30 days for Mental Health & Substance Abuse Conditions Note: The methodology for this indicator has been revised for 2011/12. The revisions include: 1. Beginning April 2011 the visit type data element was retired from NACRS data collection. This data element was used in prior reporting periods to identify "unplanned" visits. Consistent with this change in NACRS data collection this performance indicator now includes all emergency visits (both planned and unplanned). 2. To more precisely measure the time interval between two ER visits the method has been revised to measure the time interval between the disposition date of the index visit and the registration date of the next visit. Previously the method measure the time interval between the registration dates of the index and the repeat visit. A repeat ER visit has occurred if the interval is less than or equal to 30 days. For the detailed methodology change and its impact to the indicator, please refer to the "MOHLTC Performance Agreement Local Health System Performance Indicators Technical Information" (August 12, 2011) or contact Domenic Della Ventura (Domenic.Dellaventura@ontario.ca). Data Source: Ontario Ministry of Health and Long-Term Care, NACRS, IntelliHealth, 2010/11 Inclusion/Exclusion criteria: Includes information on unscheduled emergency department visits to Ontario hospitals for Mental Health and Substance Abuse conditions, defined by the main problem diagnosis in ICD-10-CA Chapter 5. The diagnostic categories refer to the main problem diagnosis (the problem deemed to be the most clinically significant reason for the visit) and are based on ICD-10-CA diagnoses. Mental Health: All ICD-10-CA codes beginning with 'F', excluding Substance Abuse. Substance Abuse: ICD-10-CA codes beginning with 'F10' - 'F19'. The analysis excludes visits for those without a valid health card number. The patient assignment is consistent with the IntelliHealth assignment. Methodology: For each quarter the data period is extended to include 30 days after the last day of the reporting quarter to avoid undercounting of qualified repeat visit pairs that have the 'index' visit in the reporting quarter and a 'repeat' visit in the next quarter. Note that this 30 day period is based on 2010/11 Q1 interim data which may be subject to change. A visit is counted as an 'index' visit if it is followed by another visit that occurs in any Ontario hospital within 30 days, for any diagnosis within the ICD-10-CA Chapter 5. The 'repeat' visit can be for either a mental health or substance abuse condition. The diagnostic category and groups refer to the diagnosis reported for the 'index' visit. Numerator = Total # of emergency visits in the reporting quarter that followed by another visit within 30 days for mental health (or substance abuse) conditions, by of patient residence. Denominator = Total # of emergency visits in the reporting quarter for mental health (or substance abuse) conditions, by of patient residence. Limitations: The 2010/11 Q1 and Q3 calculations are based on interim data, which are subject to change. The method for this indicator has been revised, therefore the magnitude of values for 2010/11 Q3 may differ from those for previous MLPA reporting periods. It is recommended that comparisons of performance across quarters should be based on the results using the same methodology. MOHLTC\HSIMI\HA and HD Final

27 MLPA Final PI X s_(nov 14, 2011 Low 90th Percentile Wait Time In Days for CCAC In-Home Services Application from Community Setting to first CCAC service (excluding case management) Data Source: Inclusion Criteria Stratifications: Home Care Database (HCD), SAS EG Server, Ontario Ministry of Health and Long-Term Care - FY2011/12 Q1 Service Date = April 1, 2011 to June 30, 2011 Home Care Program Types = In-Home (01); Adult Day Care (05); Supportive Housing (06) Assessment Outcome = Eligible Clients Only 12; 15; 16 Service Type is NOT EQUAL to Case Management (10) Wait Time is between 0 and 365 Days Fiscal Year: based on the first Service Date Fiscal Quarter: is based on the first Service Date : CCAC recorded on the Application Form Referral Source: Defined by variable Referral Source. Hospital referrals are first identified as Referral Source equal to 1 (general hospital-outpatient), 2 (general hospital-inpatient), 3(special hospital-outpatient), or 4 (special hospital-inpatient). All non-hosptial referrals are identified as community referrals. The methodology to identify community referrals has been revised for 2011/12. The revision includes: Notes: To be more precisely define community referrals and consistent with MSAA, the methodology has been revised to use Referral Source to define referring settings. First the hospital referrals are identified using the Referral Source 1 (general hospital-outpatient), 2 (general hospital-inpatient), 3 (special hospital-outpatient), and 4 (speical hospital-inpatient). Then all the remaining non-hospital referrals are identified as community referrals. Previously the variable Prior Site Code were used to identify the referring settings. For detailed methodology change and its impact to the indicator, please refer to the"mohltc Performance Agreement Local Health System Performance Indicators Technical Information" (August 12, 2011) or contact Domenic Della Ventura (Domenic.Dellaventura@ontario.ca). MOHLTC\HSIMI\HA and HD Final

28 MLPA Final PI X s_(nov 14, 2011 Low Readmissions within 30 days for Selected CMGs Description: The number of patients readmitted to any facility for non-elective inpatient care. This is compared to the number of expected non-elective readmissions using data from all Ontario acute hospitals. Data Source: Discharge Abstract Database (DAD), CIHI. Inclusion/Exclusion criteria: Acute inpatients in the specified CMGs (see the table below), age restrictions are cohort specific: 45 for stroke, COPD, CHF, 40 for cardiac CMGs, all ages for pneumonia, diabetes and GI. The readmission hospitalization is deemed nonelective or unplanned if: a) the admission date is within 30 days of the index case discharge date; b) the DAD field admission category is urgent. Exclude deaths, transfers, patient sign-outs against medical advice; records with missing valid data on discharge/admission date, health number, age and sex. Methodology: Readmission to any facility for selected CMGs = Observed number of patients, discharged with specified CMGs within calendar year, readmitted to any facility for any nonelective patient care within 30 days of discharge for index admission Indicator Calculation: Step 1: Identify index cases (Denominator): Select all discharges among the selected CMGs with discharge dates for period in question and age restrictions as described in Inclusions section. Include only typical and outlier cases (based on DAD RIW Exclusion Indicator) among the index cases. Step 2: Calculate observed readmission (Numerator): The sum of readmissions for all index cases in a calendar years: For each index case, identify whether there is a non-elective readmission to any facility within 30 days of discharge. The readmission hospitalization is a non-elective readmission event if: - The admission date is within 30 days of the index case discharge date; - The DAD field admission category is urgent; and - Patient admission is not coded as an acute transfer by receiving hospital, keep as readmission if admitted to own hospital. Potential for Historical Trends: Data are collected quarterly so quarterly/annual tracking is possible. Limitations: Note that the interim data may be subject to change. MOHLTC\HSIMI\HA and HD Final

29 MLPA Final PI X s_(nov 14, 2011 Low CMG List of Eligible Conditions (CMGs) CMG+ description Stroke (Age 45) Hemorrhagic Event of Central Nervous System Ischemic Event of Central Nervous System Unspecified Stroke COPD (Age 45) Chronic Obstructive Pulmonary Disease Pneumonia (All ages) Bacterial Pneumonia Viral/Unspecified Pneumonia Disease of Pleura Congestive Heart Failure (Age 45) Heart Failure without Cardiac Catheter Diabetes (All ages) Diabetes Cardiac CMGs (Age 40) Arrhythmia without Cardiac Catheter Unstable Angina/Atherosclerotic Heart Disease without Cardiac Cath Angina (except Unstable)/Chest Pain without Cardiac Catheter Gastrointestinal CMGs (All ages) Minor Upper Gastrointestinal Intervention Severe Enteritis Complicated Ulcer Inflammatory Bowel Disease Gastrointestinal Hemorrhage Gastrointestinal Obstruction Esophagitis/Gastritis/Miscellaneous Digestive Disease Symptom/Sign of Digestive System Other Gastrointestinal Disorder Cirrhosis/Alcoholic Hepatitis Liver Disease except Cirrhosis/Malignancy Disorder of Pancreas except Malignancy Disorder of Biliary Tract MOHLTC\HSIMI\HA and HD Final