HOSPITAL SERVICE ACCOUNTABILITY AGREEMENT: Indicator Technical Specifications

Transcription

1 HOSPITAL SERVICE ACCOUNTABILITY AGREEMENT: Indicator Technical Specifications January /15 H-SAA Technical Specifications Page 1

2 TABLE OF CONTENTS PATIENT EXPERIENCE ACCESS, EFFECTIVE, SAFE, PERSON-CENTERED... 4 PERFORMANCE th Percentile Emergency Room (ER) Length of Stay for Admitted Patients th Percentile ER Length of Stay for Non-Admitted Complex (CTAS I-III) Patients th Percentile ER Length of Stay for Non-Admitted Minor Uncomplicated (CTAS IV-V) Patients Percent of Priority IV cases completed within priority targets for cancer surgery (NEW) Percent of Priority IV cases completed within priority targets for Cardiac Bypass Surgery (NEW) Percent of Priority IV cases completed within priority targets for Cataract Surgery (NEW) Percent of Priority IV cases completed within priority targets for Joint Replacements (NEW) Percent of Priority IV cases completed within priority targets for MRI and CT scans (NEW) Rate of Ventilator-Associated Pneumonia Central Line Infection Rate Rate of Hospital Acquired Clostridium Difficile Infections Rate of Hospital Acquired Vancomycin Resistant Enterococcus Bacteremia Rate of Hospital Acquired Methicillin Resistant Staphylococcus Aureus Bacteremia EXPLANATORY Day Readmission of Patients with Stroke or Transient Ischemic Attack (TIA) to Acute Care for All Diagnoses 42 Percent of Stroke Patients Discharged to Inpatient Rehabilitation Following an Acute Stroke Hospitalization Percent of Stroke Patients Admitted to a Stroke Unit During Their Inpatient Stay Hospital Standardized Mortality Ratio (HSMR) Readmissions Within 30 Days for Selected Case Mix Groups (CMGs) ORGANIZATIONAL HEALTH - EFFICIENT, APPROPRIATELY RESOURCED, EMPLOYEE EXPERIENCE, GOVERNANCE PERFORMANCE Current Ratio (Consolidated all sector codes and fund types) Total Margin (Consolidated all sector codes and fund types) EXPLANATORY Total Margin (Hospital Sector Only) Adjusted Working Funds Adjusted Working Funds / Total Revenue % SYSTEM PERSPECTIVE INTEGRATION, COMMUNITY ENGAGEMENT, EHEALTH PERFORMANCE Percentage of Acute Alternate Level of Care (ALC) Days (closed cases) EXPLANATORY Repeat Unscheduled Emergency Visits Within 30 Days for Mental Health Conditions (methodology updated) /15 H-SAA Technical Specifications Page 2

3 Repeat Unscheduled Emergency Visits Within 30 Days for Substance Abuse Conditions (methodology updated) Alternate Level of Care (ALC) RATE (NEW) APPENDIX: SERVICE VOLUME METRICS GLOBAL VOLUMES (SCHEDULE C2) Complex Continuing Care Weighted Patient Days ED Weighted Cases (updated) Total Inpatient Acute Weighted Cases (updated) Day Surgery Weighted Visits Inpatient Mental Health Weighted Days Elderly Capital Assistance Program (ELDCAP) Inpatient Days Ambulatory Care Visits PROVINCIAL PROGRAMS OTHER VOLUME METRICS Emergency Department and Urgent Care Visits Inpatient Mental Health Days Inpatient Rehabilitation Days Rehabilitation Separations This document has been updated by the Health System Indicator Initiative. The Health System Indicator Initiative is a LHIN-led initiative that brings health system partners together to create awareness and alignment in our collective pursuit to establish a coordinated, system-based approach to indicator identification, development, maintenance, and reporting. Copyright 2012, Queens Printer, Ontario. All rights reserved. 2014/15 H-SAA Technical Specifications Page 3

4 NUMERATOR PATIENT EXPERIENCE Access, Effective, Safe, Person-Centered Performance INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION 90TH PERCENTILE EMERGENCY ROOM (ER) LENGTH OF STAY FOR ADMITTED PATIENTS The total emergency room (ER) length of stay (LOS) where 9 out of 10 admitted patients completed their visits. ER LOS is defined as the time from triage or registration, whichever comes first, to the time the patient leaves the ER. Performance Target: (i) For hospitals performing at the LHIN s MLPA target or better: Performance target= maintain or improve current performance PERFORMANCE STANDARD (ii) For hospitals performing above LHIN MLPA target: Performance target= MLPA target or better Corridor: (i) Upper corridor = performance target + 10% (ii) Upper corridor = performance target + 10% Step 1: Calculate ER LOS in hours for each patient. Step 2: Apply inclusion and exclusion criteria. Step 3: Sort the cases by ER LOS from shortest to highest. Step 4: The 90 th percentile is the case where 9 out of 10 admitted patients have completed their visits. National Ambulatory Care Administrative Database (NACRS) Includes: 1. Admitted patients Disposition Codes 06 and 07 Excludes: 1. ER visits where Registration Date/Time and Triage Date/Time are both missing. 2. ER visits where Left ER Date/Time and Disposition Date/Time are both missing. 3. ER visits where patients are over the age of 125 on earlier of triage or registration date. 4. Negative ER LOS (earlier of registration or triage after date/time patient 2014/15 H-SAA Technical Specifications Page 4

5 ADDITIONAL INFORMATION GEOGRAPHY & TIMING DENOMINATOR left ER) 5. Duplicate records within the same functional centre where all data elements have the same values, except Abstract ID number. All To identify duplicate records, screen all variables in the Level 1 NACRS file are used to identify those duplicates that are exact in all fields for abstract. So if two records are identical except for diagnosis 8, they differ on one variable other than abstract ID and both of these records would be kept 6. Non-Admitted Patients (Disposition Codes and 08 15). 7. Admitted Patients (Disposition Codes 06 and 07) with missing patient left ER Date/Time. TIMING/FREQUENCY OF RELEASE How often, and when, are data being released Data are released quarterly, at the end of month, in April, July, October and January LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. Data are available at Local Health Integration Network (LHIN) and hospital levels Data are available from April 2008 A small percentage of records are excluded from the analysis every month, due to missing/invalid values for the relevant wait time fields (such as Time patient left ER or Registration time etc.). Calculated indicator value is based on ER visits submitted by 126 sites participating in the ER National Ambulatory Care Reporting System Initiative (ERNI) reporting to the NACRS database. Approximately 90% of ER visits in Ontario are captured by hospital sites participating in ERNI (based on NACRS 08/09 data released June 2009). As of April 2009, a patient s stay in a designated Clinical Decision Unit (CDU) will be excluded in the total time spent in ER. Due to the introduction of newly designated CDUs in select hospitals, there may be a difference in the calculation methodology of the baseline and the 2014/15 H-SAA Technical Specifications Page 5

6 quarterly indicators. Access to Care (ATC) Informatics regularly informs the LHINs of the CDU impact on the overall time spent in the Emergency Department through the monthly ER reports. LHINs are provided with the list of hospitals with designated CDUs. The calculated 90th percentile ER LOS at the provincial level, for the latest month can be compared with the baseline of April 2008 in the Emergency Room Wait Times Government of Ontario website and in the ER Reports provided to LHIN s and hospitals every month (Provincial ER Highlights Report, ER LHIN Highlight Report and the LHIN ER Pay for Results Report). Historical trend data from April 2008 onwards for all ER facilities in Ontario is available on request to ATCDataRequest@cancercare.on.ca. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING Cancer Care Ontario DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 6

7 NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION 90TH PERCENTILE ER LENGTH OF STAY FOR NON-ADMITTED COMPLEX (CTAS I-III) PATIENTS The total emergency room (ER) length of stay (LOS) where 9 out of 10 nonadmitted complex (Canadian Triage and Acuity Scale (CTAS) levels I, II and III) patients completed their visits. ER LOS is defined as the time from triage or registration, whichever comes first, to the time the patient leaves ER. Performance Target: (i) For hospitals performing at the LHIN s MLPA target or better: Performance target= maintain or improve current performance PERFORMANCE STANDARD (ii) For hospitals performing above LHIN MLPA target: Performance target= MLPA target or better Corridor: (i) Upper corridor = performance target + 10% (ii) Upper corridor = performance target + 10% Step 1. Calculate ER LOS in hours for each patient. Step 2. Apply inclusion and exclusion criteria. Step 3. Sort the cases by ER LOS from shortest to highest. Step 4. The 90 th percentile is the case where 9 out of 10 non-admitted patients have completed their visits. National Ambulatory Care Administrative Database (NACRS), Canadian Institute for Health Information (CIHI) Includes: 1. Non-admitted patients (Disposition Codes 01, and with assigned CTAS I, II or III. Excludes: 1. ER visits where Registration Date/Time and Triage Date/Time are both missing 2. ER visits where Left ER Date/Time and Disposition Date/Time are both missing 3. ER visits where patients are over the age of 125 on earlier of triage or registration date 4. Negative ER LOS (earlier of registration or triage after date/time patient left ER) 5. Duplicate records within the same functional centre where all data elements have the same values, except Abstract ID number. All variables in the Level 1 NACRS file are used to identify duplicates. 2014/15 H-SAA Technical Specifications Page 7

8 ADDITIONAL INFORMATION GEOGRAPHY & TIMING DENOMINATOR 6. ER visits identified as the patient has left ER without being seen (Disposition Codes 02 and 03) 7. Admitted Patients (Disposition Codes 06 and 07) 8. Non-Admitted Patients (Disposition Codes 01, and 08 15) with assigned CTAS IV and V 9. Non-Admitted Patients (Disposition Codes 01, and 08 15) with missing CTAS 10. Transferred Patients (Disposition Codes 08 and 09) with missing patient left ER Date/Time TIMING/FREQUENCY OF RELEASE How often, and when, are data being released Data are released quarterly, at the end of month, in April, July, October and January LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. Data are available at the Local Health Integration Network (LHIN) and hospital levels Data are available from April 2008 A small percentage of records are excluded from the analysis every month due to missing/invalid values for the relevant wait time fields (such as Time patient left ER or Registration time etc.). Calculated indicator value is based on ER visits submitted by 126 sites participating in the ER NACRS Initiative (ERNI) database. Approximately 90% of ER visits in Ontario are captured by hospital sites participating in ERNI (based on NACRS 08/09 data released June 2009). As of April 2009, a patient s stay in a designated Clinical Decision Unit (CDU) will be excluded in the total time spent in ER. Due to the introduction of newly designated CDUs in select hospitals, there may be a difference in the calculation methodology of the baseline and the quarterly indicators. Access to Care (ATC) Informatics regularly informs the LHINs of the CDU impact on the overall time spent in the ER through the 2014/15 H-SAA Technical Specifications Page 8

9 monthly ER reports. LHINs are provided with the list of hospitals with designated CDUs. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) The calculated 90 th percentile ER LOS at the provincial level, for the latest month can be compared with the baseline of April 2008 in the Emergency Room Wait Times Government of Ontario website and in the ER Reports provided to LHIN s and hospitals every month (Provincial ER Highlights Report, ER LHIN Highlight Report and the LHIN ER Pay for Results Report). Historical trend data from April 2008 onwards for all ER facilities in Ontario is available on request to ATCDataRequest@cancercare.on.ca. Cancer Care Ontario /15 H-SAA Technical Specifications Page 9

10 NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION 90TH PERCENTILE ER LENGTH OF STAY FOR NON-ADMITTED MINOR UNCOMPLICATED (CTAS IV-V) PATIENTS The total emergency room (ER) length of stay (LOS) where 9 out of 10 nonadmitted minor/uncomplicated (Canadian Triage and Acuity Scale (CTAS) levels IV and V) patients completed their visits. ER LOS is defined as the time from triage or registration, whichever comes first, to the time the patient leaves the ER. Performance Target: (i) For hospitals performing at the LHIN s MLPA target or better: Performance target= maintain or improve current performance PERFORMANCE STANDARD (ii) For hospitals performing above LHIN MLPA target: Performance target= MLPA target or better Corridor: (i) Upper corridor = performance target + 10% (ii) Upper corridor = performance target + 10% Step 1: Calculate ER LOS in hours for each patient. Step 2: Apply inclusion and exclusion criteria. Step 3: Sort the cases by ER LOS from shortest to highest. Step 4: The 90 th percentile is the case where 9 out of 10 non-admitted patients have completed their visits. National Ambulatory Care Administrative Database (NACRS), Canadian Institute for Health Information (CIHI) Includes: 1. Non-Admitted Patients (Disposition Codes 01, and 08 15) with assigned CTAS IV and V. Excludes: 1. ER visits where Registration Date/Time and Triage Date/Time are both missing 2. ER visits where Left ER Date/Time and Disposition Date/Time are both missing 3. ER visits where patients are over the age of 125 on earlier of triage or registration date 4. Negative ER LOS (earlier of registration or triage after date/time patient left ER) 5. Duplicate records within the same functional centre where all data 2014/15 H-SAA Technical Specifications Page 10

11 ADDITIONAL INFORMATION GEOGRAPHY & TIMING DENOMINATOR elements have the same values, except Abstract ID number. All variables in the Level 1 NACRS file are used to identify duplicates. 6. ER visits identified as the patient has left ER without being seen (Disposition Codes 02 and 03) 7. Admitted Patients (Disposition Codes 06 and 07) 8. Non-Admitted Patients (Disposition Codes 01, and 08 15) with assigned CTAS I, II and III 9. Non-Admitted Patients (Disposition Codes 01, and 08 15) with missing CTAS 10. Transferred Patients (Disposition Codes 08 and 09) with missing patient left ER Date/Time TIMING/FREQUENCY OF RELEASE How often, and when, are data being released Data are released quarterly, at the end of month, in April, July, October and January LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. Provincial, LHIN, Hospital Data are available from April 2008 A small percentage of records are excluded from the analysis every month, due to missing/invalid values for the relevant wait time fields (such as Time patient left ER or Registration time etc.). Calculated indicator value is based on ER visits submitted participating sites in the ER National Ambulatory Care Reporting System Initiative (ERNI) reporting to the NACRS database. Approximately 90% of ER visits in Ontario are captured by hospital sites participating in ERNI As of April 2009, a patient s stay in a designated Clinical Decision Unit (CDU) will be excluded in the total time spent in ER. Due to the introduction of newly designated CDUs in select hospitals, there may be a difference in the calculation methodology of the baseline and the 2014/15 H-SAA Technical Specifications Page 11

12 quarterly indicators. Access to Care (ATC) Informatics regularly informs the LHINs of the CDU impact on the overall time spent in the Emergency Department through the monthly ER reports. LHINs are provided with the list of hospitals with designated CDUs. The calculated 90 th percentile ER LOS at the provincial level, for the latest month can be compared with the baseline of April 2008 in the Emergency Room Wait Times Government of Ontario website and in the ER Reports provided to LHIN s and hospitals every month (Provincial ER Highlights Report, ER LHIN Highlight Report and the LHIN ER Pay for Results Report). Historical trend data from April 2008 onwards for all ER facilities in Ontario is available on request to ATCDataRequest@cancercare.on.ca. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) Cancer Care Ontario /15 H-SAA Technical Specifications Page 12

13 NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION PERFORMANCE STANDARD PERCENT OF PRIORITY IV CASES COMPLETED WITHIN PRIORITY TARGETS FOR CANCER SURGERY (NEW) The calculated percent of cases completed within priority targets for cancer surgery. Performance Target: (i) For hospitals performing at the LHIN s MLPA target or better: Performance target = maintain or improve current performance (ii) For hospitals performing below LHIN MLPA target: Performance target = MLPA target or better Corridor: (i) Greater than or equal to the performance target to 100% 1. Count the total number cases that were completed for the reporting period (see inclusion/ exclusion criteria) 2. Of the total count in Step 1, count the number cases where wait times are less than or equal to the provincial priority target 3. Divide the count in Step 2 by the count in Step 1 and multiply by 100 to get the percentage WTIS, Cancer Care Ontario (Access to Care, 2008) Only procedures assigned as priority level 4 cases are included in the wait time calculation. Wait Time is calculated based on closed cases submitted by hospitals through the Wait Time Information System. All closed wait list entries with procedure dates within date range. Must be 18 and older on the day the procedure was completed. Procedures no longer required are excluded from wait time calculation. 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. Wait list entries identified by hospitals as data entry errors are also excluded. 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. 2014/15 H-SAA Technical Specifications Page 13

14 ADDITIONAL INFORMATION GEOGRAPHY & TIMING DENOMINATOR TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May Data are available monthly LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. Provincial, LHIN, Hospital The calculated percent of cases completed within priority target can be compared with the historical trend published in the Government of Ontario wait time s website. All inclusions/exclusions criteria used are similar. Also, historical wait times trend for low volume hospitals/lhins will show as NV (no or low volume) instead of a calculated percent of cases completed within priority target. Hospitals submitting wait time data voluntarily (not required to report) are included in wait time calculation. Calculated percent of cases completed within priority target is based only on the cases entered in the system. Logically, hospitals not reporting cases promptly are excluded at the time of data extraction. Volumes submitted by hospitals are checked monthly for completeness. Hospital volume is compared against the expected monthly average. Outliers are validated with hospitals if the wait days are accurate. 2014/15 H-SAA Technical Specifications Page 14

15 REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, Access to Care has developed a few comprehensive documentations to assess data quality under four key dimensions: timeliness, validity, reliability and usability. These documentations are available upon request to: ATCsupport@cancercare.on.ca. RESPONSBILITY FOR REPORTING Cancer Care Ontario DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) 2014/15 H-SAA Technical Specifications Page 15

16 NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION PERCENT OF PRIORITY IV CASES COMPLETED WITHIN PRIORITY TARGETS FOR CARDIAC BYPASS SURGERY (NEW) The calculated percent of cases completed within priority targets for cardiac bypass surgery. Performance Target: (i) For hospitals performing at the LHIN s MLPA target or better: Performance target = maintain or improve current performance PERFORMANCE STANDARD (ii) For hospitals performing below LHIN MLPA target: Performance target = MLPA target or better Corridor: (i) Greater than or equal to the performance target to 100% 1. Count the total number cases that were completed for the reporting period (see inclusion/ exclusion criteria) 2. Of the total count in Step 1, count the number cases where wait times are less than or equal to the provincial priority target 3. Divide the count in Step 2 by the count in Step 1 and multiply by 100 to get the percentage Cardiac Care Network cardiac registry in place since 1990 (Wait Times Information System, 2008). Waiting periods are counted from the date a patient was accepted for bypass surgery by the cardiac service. Waiting periods do not include time spent investigating heart disease before a patient is accepted for a procedure. Only procedures assigned as priority level 4 cases are included in the wait time calculation. Wait Time is calculated based on closed cases submitted by hospitals through the Wait Time Information System. All closed wait list entries with procedure dates within date range. Must be 18 and older on the day the procedure was completed. Procedures no longer required are excluded from wait time calculation. Wait list entries identified by hospitals as data entry errors are also excluded. 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. 2014/15 H-SAA Technical Specifications Page 16

17 ADDITIONAL INFORMATION GEOGRAPHY & TIMING DENOMINATOR TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May Data are available monthly LEVELS OF COMPARABILITY Levels of geography for comparison MOHLTC, CCN Member Hospitals TRENDING Years available for trending LIMITATIONS Specific limitations Cardiac Surgery wait times have been monitored since 1990 by Cardiac Care Network of Ontario and the data is available for historical trending. CCN performs numerous activities to ensure that there are minimal limitations to achieving its goal of acting as an oversight body for monitoring cardiac wait times. COMMENTS Additional information regarding the calculation, interpretation, data source, etc. 2014/15 H-SAA Technical Specifications Page 17

18 REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSBILITY FOR REPORTING Cardiac Care Network of Ontario DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) 2014/15 H-SAA Technical Specifications Page 18

19 DENO MINA TOR NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION PERCENT OF PRIORITY IV CASES COMPLETED WITHIN PRIORITY TARGETS FOR CATARACT SURGERY (NEW) The calculated percent of cases completed within priority targets for cataract surgery. Performance Target: (i) For hospitals performing at the LHIN s MLPA target or better: Performance target = maintain or improve current performance PERFORMANCE STANDARD (ii) For hospitals performing below LHIN MLPA target: Performance target = MLPA target or better Corridor: (i) Greater than or equal to the performance target to 100% 1. Count the total number cases that were completed for the reporting period (see inclusion/ exclusion criteria) 2. Of the total count in Step 1, count the number cases where wait times are less than or equal to the provincial priority target 3. Divide the count in Step 2 by the count in Step 1 and multiply by 100 to get the percentage WTIS, Access to Care (Access to Care, 2008) Only procedures assigned as priority level 4 cases are included in the wait time calculation. Wait Time is calculated based on closed cases submitted by hospitals through the Wait Time Information System. All closed Wait List Entries with procedure dates within date range. Must be 18 and older on the day the procedure was completed. Procedure No Longer Required are excluded from wait time calculation. Wait list entries identified by hospitals as data entry errors are also excluded. 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. 2014/15 H-SAA Technical Specifications Page 19

20 ADDITIONAL INFORMATION GEOGRAPHY & TIMING TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid-may Data are available monthly LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending Provincial, LHIN, Hospital The calculated percent of cases completed within priority target can be compared with the historical trend published in the Government of Ontario wait time s website. All inclusions/exclusions criteria used are similar. Also, historical wait times trend for low volume hospitals/lhins will show as NV (no or low volume) instead of a calculated percent of cases completed within priority target. LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, Hospitals submitting wait time data voluntarily (not required to report) are included in wait time calculation. Calculated percent of cases completed within priority target is based only on the cases entered in the system. Logically, hospitals not reporting cases promptly are excluded at the time of data extraction. Volumes submitted by hospitals are checked monthly for completeness. Hospital volume is compared against the expected monthly average. Outliers are validated with hospitals if the wait days are accurate. Access to Care has developed a few comprehensive documentations to assess data quality under four key dimensions: timeliness, validity, reliability and usability. These documentations are available upon request to: ATCsupport@cancercare.on.ca. 2014/15 H-SAA Technical Specifications Page 20

21 RESPONSBILITY FOR REPORTING Access to Care (Access to Care, 2008) DATE CREATED (YYYY-MM- DD) DATE LAST REVIEWED (YYYY-MM-DD) 2014/15 H-SAA Technical Specifications Page 21

22 DENO MINA TOR NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION PERCENT OF PRIORITY IV CASES COMPLETED WITHIN PRIORITY TARGETS FOR JOINT REPLACEMENTS (NEW) The calculated percent of cases completed within priority targets for joint replacements. Performance Target: (i) For hospitals performing at the LHIN s MLPA target or better: Performance target = maintain or improve current performance PERFORMANCE STANDARD (ii) For hospitals performing below LHIN MLPA target: Performance target = MLPA target or better Corridor: (i) Greater than or equal to the performance target to 100% 1. Count the total number cases that were completed for the reporting period (see inclusion/ exclusion criteria) 2. Of the total count in Step 1, count the number cases where wait times are less than or equal to the provincial priority target 3. Divide the count in Step 2 by the count in Step 1 and multiply by 100 to get the percentage Wait Time Information System (WTIS), Ontario Joint Replacement Registry/Access to Care (Access to Care, 2008) Only procedures assigned as priority level 4 cases are included in the wait time calculation. Wait Time is calculated based on closed cases submitted by hospitals through the Wait Time Information System. All closed wait list entries with procedure dates within date range. Must be 18 and older on the day the procedure was completed. Procedures no longer required are excluded from wait time calculation. Wait list entries identified by hospitals as data entry errors are also excluded. 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. 2014/15 H-SAA Technical Specifications Page 22

23 ADDITIONAL INFORMATION GEOGRAPHY & TIMING TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid-may Data are available monthly LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, Provincial, LHIN, Hospital The calculated percent of cases completed within priority target can be compared with the historical trend published in the Government of Ontario wait time s website. All inclusions/exclusions criteria used are similar. Also, historical wait times trend for low volume hospitals/lhins will show as NV (no or low volume) instead of a calculated percent of cases completed within priority target. Hospitals submitting wait time data voluntarily (not required to report) are included in wait time calculation. Calculated percent of cases completed within priority target is based only on the cases entered in the system. Logically, hospitals not reporting cases promptly are excluded at the time of data extraction. Volumes submitted by hospitals are checked monthly for completeness. Hospital volume is compared against the expected monthly average. Outliers are validated with hospitals if the wait days are accurate. Access to Care has developed a few comprehensive documentations to assess data quality under four key dimensions: timeliness, validity, reliability and usability. These documentations are available upon request to: ATCsupport@cancercare.on.ca. 2014/15 H-SAA Technical Specifications Page 23

24 RESPONSBILITY FOR REPORTING Ontario Joint Replacement Registry/Access to Care (Access to Care, 2008) DATE CREATED (YYYY-MM- DD) DATE LAST REVIEWED (YYYY-MM-DD) 2014/15 H-SAA Technical Specifications Page 24

25 NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION PERCENT OF PRIORITY IV CASES COMPLETED WITHIN PRIORITY TARGETS FOR MRI AND CT SCANS (NEW) The calculated percent of cases completed within priority targets for MRI and CT scans. Performance Target: (i) For hospitals performing at the LHIN s MLPA target or better: Performance target = maintain or improve current performance PERFORMANCE STANDARD (ii) For hospitals performing below LHIN MLPA target: Performance target = MLPA target or better Corridor: (i) Greater than or equal to the performance target to 100% 1. Count the total number cases that were completed for the reporting period (see inclusion/ exclusion criteria) 2. Of the total count in Step 1, count the number cases where wait times are less than or equal to the provincial priority target 3. Divide the count in Step 2 by the count in Step 1 and multiply by 100 to get the percentage Wait Time Information System (WTIS), Access to Care (Access to Care, 2008) Only procedures assigned as priority level 4 cases are included in the wait time calculation. Wait Time is calculated based on closed cases submitted by hospitals through the Wait Time Information System. All closed wait list entries with procedure dates within date range. Must be 18 and older on the day the procedure was completed. Procedures no longer required are excluded from wait time calculation. Wait list entries identified by hospitals as data entry errors are also excluded. 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. As of January 1, 2008, DI cases classified as specified date procedures (timed procedures) are excluded from wait time calculation. 2014/15 H-SAA Technical Specifications Page 25

26 ADDITIONAL INFORMATION GEOGRAPHY & TIMING DENOMINATOR TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid-may Data are available monthly LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Provincial, LHIN, Hospital The calculated percent of cases completed within priority target can be compared with the historical trend published in the Government of Ontario wait time s website. All inclusions/exclusions criteria used are similar. Also, historical wait times trend for low volume hospitals/lhins will show as NV (no or low volume) instead of a calculated percent of cases completed within priority target. Hospitals submitting wait time data voluntarily (not required to report) are included in wait time calculation. Calculated percent of cases completed within priority target is based only on the cases entered in the system. Logically, hospitals not reporting cases promptly are excluded at the time of data extraction. Volumes submitted by hospitals are checked monthly for completeness. Hospital volume is compared against the expected monthly average. Outliers are validated with hospitals if the wait days are accurate. Access to Care has developed a few comprehensive documentations to assess data quality under four key dimensions: timeliness, validity, reliability and usability. These documentations are available upon request to: ATCsupport@cancercare.on.ca. 2014/15 H-SAA Technical Specifications Page 26

27 Canada, RESPONSBILITY FOR REPORTING Access to Care (Access to Care, 2008) DATE CREATED (YYYY-MM- DD) DATE LAST REVIEWED (YYYY-MM-DD) 2014/15 H-SAA Technical Specifications Page 27

28 DENOMINATOR NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION RATE OF VENTILATOR-ASSOCIATED PNEUMONIA Pneumonia occurring in patients requiring mechanical ventilation, intermittently or continuously, through a tracheostomy or endotracheal tube for more than 48 hours Performance Target: 0 or hospital Quality Improvement Plan (QIP) target PERFORMANCE STANDARD Corridor: Upper corridor = 10% improvement on current rate or the submitted Health Quality Ontario QIP target, whichever is greater LHINs and hospitals should review current rates and identify achievable performance improvement or maintenance of current performance levels Total number of VAP cases age 18 and older that have required at least 48 hours of mechanical ventilation during the reporting period Critical Care Information System (CCIS), Ontario Ministry of Health and Long- Term Care (MOHLTC) Includes: 1. All publicly funded hospitals 2. ICU beds 3. Patients diagnosed with VAP and being treated with antibiotics for VAP Excludes: 1. Patients age 17 and younger Total number of ventilator days for Intensive Care Unit (ICU) patients age 18 and older during the reporting period Critical Care Information System (CCIS), Ontario Ministry of Health and Long- Term Care (MOHLTC) Includes: 1. All publicly funded hospitals 2. ICU beds 2014/15 H-SAA Technical Specifications Page 28

29 ADDITIONAL INFORMATION GEOGRAPHY & TIMING Excludes: 1. Patients age 17 and younger TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May Data are available each quarter for the previous quarter s data LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at provincial, LHIN and hospital levels TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, Data are available for the previous quarter as of April 2009 Data are self-reported by hospital. No individual patient data are available; therefore this indicator cannot be broken down by socio-demographic characteristics. Trending and comparisons are most valid by hospital type (e.g. small, large community, acute teaching, chronic care and rehab and mental health). This is in order to make limited adjustment for patient case mix. Patient Safety Website RESPONSBILITY FOR REPORTING Health Service Providers DATE CREATED (YYYY- MM-DD) /15 H-SAA Technical Specifications Page 29

30 DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 30

31 GEOGRAPHY & TIMING DENOMINATOR NUMERATOR INDICATOR NAME PROGRAM SPECIFIC INDICATOR NAME(S) How the indicator is named by specific programs Detailed description of indicator CENTRAL LINE INFECTION RATE Central Line-Associated Primary Bloodstream Infection (CLI) Rate Number of intensive care unit (ICU) patients with new central line bloodstream infection (BSI)(CLI) per 1,000 central line days INDICATOR CLASSIFICATION Performance Target: 0 or hospital Quality Improvement Plan (QIP) target PERFORMANCE STANDARD Corridor: Upper corridor = 10% improvement on current rate or the submitted Health Quality Ontario QIP target, whichever is greater LHINs and hospitals should review current rates and identify achievable performance improvement or maintenance of current performance levels Total number of laboratory confirmed BSI developing in patients age 18 and older in the ICU after 48 hours of placement of a central line TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are Critical Care Information System (CCIS), Ministry of Health and Long-Term Care (MOHLTC) Includes: 1. Patients in the ICU 2. Patients age 18 and older Total number of central line days for patients age 18 and older in the ICU with a central line in place CCIS, MOHLTC Includes: 1. Patients in the ICU 2. Patients age 18 and older Data are available quarterly 2014/15 H-SAA Technical Specifications Page 31

32 ADDITIONAL INFORMATION released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending Data are collected at hospital institution level; can be aggregated up to Local Health Integration Network (LHIN) and provincial levels. Initial reporting started April 30, 2009 and included cumulative data for the three-month period January 01 to March 31, LIMITATIONS Specific limitations Currently, no information has been provided COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING O Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep. Aug ; 51(RR-10): Pittet D, Tarara D, Wemze; RP, Nosocomial bloodstream infection in critically ill patient. Excess length of stay, extra cost, and attributable mortality. JAMA 1994; (20): 271: Health Service Providers DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 32

33 NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION RATE OF HOSPITAL ACQUIRED CLOSTRIDIUM DIFFICILE INFECTIONS The rate of hospital acquired Clostridium difficile infections (CDI) is a measure of the incidence of disease and is the number of CDI cases per 1,000 patient days. Performance Target: 0 or hospital Quality Improvement Plan (QIP) target PERFORMANCE STANDARD Corridor: Upper corridor = 10% improvement on current rate or the submitted Health Quality Ontario QIP target, whichever is greater LHINs and hospitals should review current rates and identify achievable performance improvement or maintenance of current performance levels The total number of new nosocomial (i.e. hospital acquired) CDI cases in the reporting period multiplied by 1,000 Self Reporting Initiative (SRI), Ontario Ministry of Health and Long-Term Care (MOHLTC) Includes: 1. All publicly funded hospitals 2. Inpatient beds 3. Laboratory-confirmed CDI cases (i.e. confirmation of a positive toxin assay (A/B) for Clostridium difficile together with diarrhea OR visualization of pseudomembranes on sigmoidoscopy or colonoscopy, or histological/pathological diagnosis of pseudomembranous colitis) 4. New nosocomial cases associated with the reporting facility is where the infection was not present on admission (i.e., onset of symptoms > 72 hours after admission) or the infection was present at the time of admission but was related to a previous admission to the same facility within the last 4 weeks and the case has not had CDI in the past 8 weeks. Excludes: 1. Patients less than 1 year of age 2. Long-term care beds 2014/15 H-SAA Technical Specifications Page 33

34 ADDITIONAL INFORMATION GEOGRAPHY & TIMING DENOMINATOR The total number of patient days spent in-hospital in a reporting period Self Reporting Initiative (SRI), Ontario Ministry of Health and Long-Term Care (MOHLTC) Includes: 1. All publicly funded hospitals 2. Inpatient beds Excludes: 1. Patients less than 1 year of age 2. Long-term care beds TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May Data are available each month for the previous month s data. Data may be aggregated across reporting periods to generate more stable rates. LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. Data are available at provincial, LHIN and hospital levels Data are available from September 2008 Data are self-reported by hospital No individual patient data are available, therefore indicator cannot be broken down by age, gender, income or education Baseline data should be generated on 1-years worth of data since CDI is expected to fluctuate seasonally Trending and comparisons are most valid by hospital type (e.g. small, large community, acute teaching, chronic care and rehab and mental health). This is in order to make limited adjustment for patient case mix. The CDI rate calculation allows the level of hospital activity to be taken into account because this will fluctuate over time and is different across hospitals. Hospital rates can also fluctuate significantly from one reporting 2014/15 H-SAA Technical Specifications Page 34

35 period to another for a variety of reasons. For example, a small hospital with relatively few patient days when compared to larger institutions could see its rates vary dramatically based on one or two cases in any given month. These types of fluctuations will level out over a longer period of time. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING Patient Safety Website Health Service Providers DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 35

36 DENO MINA TOR NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION RATE OF HOSPITAL ACQUIRED VANCOMYCIN RESISTANT ENTEROCOCCUS BACTEREMIA The rate of VRE bacteremia is a measure of the incidence of laboratory confirmed bloodstream VRE infection per 1,000 patient days Performance Target: 0 or hospital Quality Improvement Plan (QIP) target PERFORMANCE STANDARD Corridor: Upper corridor = 10% improvement on current rate or the submitted Health Quality Ontario QIP target, whichever is greater LHINs and hospitals should review current rates and identify achievable performance improvement or maintenance of current performance levels The total number of new nosocomial (i.e. hospital acquired) VRE bacteremia cases in the reporting period multiplied by 1,000 Self Reporting Initiative (SRI), Ontario Ministry of Health and Long-Term Care (MOHLTC) Includes: 1. All publicly funded hospitals 2. Inpatient beds 3. Laboratory-confirmed VRE bacteremia cases (i.e. confirmation through a single positive blood culture for VRE) 4. New nosocomial cases associated with the reporting facility is where the infection was not present on admission (i.e., onset of symptoms > 72 hours after admission) or the infection was present at the time of admission but was related to a previous admission to the same facility within the last 72 hrs. Excludes: 1. Long-term care beds The total number of patient days spent in-hospital in a reporting period 2014/15 H-SAA Technical Specifications Page 36

37 ADDITIONAL INFORMATION GEOGRAPHY & TIMING Self Reporting Initiative (SRI), Ontario Ministry of Health and Long-Term Care (MOHLTC) Includes: 1. All publicly funded hospitals 2. Inpatient beds Excludes: 1. Long-term care beds TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May Data are available each quarter for the previous quarter s data LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at provincial, LHIN and hospital levels TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, Data are available for the previous quarter as of December 2008 Data are self-reported by hospital. No individual patient data are available; therefore this indicator cannot be broken down by socio-demographic characteristics. Trending and comparisons are most valid by hospital type (such as small, large community, acute teaching, chronic care and rehab and mental health). This is in order to make limited adjustment for patient case mix. Patient Safety Website 2014/15 H-SAA Technical Specifications Page 37

38 RESPONSIBILITY FOR REPORTING Health Service Providers DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 38

39 DENO MINA TOR NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION RATE OF HOSPITAL ACQUIRED METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS BACTEREMIA The rate of MRSA bacteremia is a measure of the incidence of laboratory confirmed bloodstream MRSA infection per 1,000 patient days Performance Target: 0 or hospital Quality Improvement Plan (QIP) target PERFORMANCE STANDARD Corridor: Upper corridor = 10% improvement on current rate or the submitted Health Quality Ontario QIP target, whichever is greater LHINs and hospitals should review current rates and identify achievable performance improvement or maintenance of current performance levels The total number of new nosocomial (i.e. hospital acquired) MRSA bacteremia cases in the reporting period multiplied by 1,000 Self Reporting Initiative (SRI), Ontario Ministry of Health and Long-Term Care (MOHLTC) Includes: 1. All publicly funded hospitals 2. Inpatient beds 3. Laboratory-confirmed MRSA bacteremia cases (i.e. confirmation through a single positive blood culture for MRSA) 4. New nosocomial cases associated with the reporting facility is where the infection was not present on admission (i.e., onset of symptoms > 72 hours after admission) or the infection was present at the time of admission but was related to a previous admission to the same facility within the last 72 hrs. Excludes: 1. Long-term care beds The total number of patient days spent in-hospital in a reporting period 2014/15 H-SAA Technical Specifications Page 39

40 ADDITIONAL INFORMATION GEOGRAPHY & TIMING Self Reporting Initiative (SRI), Ontario Ministry of Health and Long-Term Care (MOHLTC) Includes: 1. All publicly funded hospitals 2. Inpatient beds Excludes: 1. Long-term care beds TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May Data are available each quarter for the previous quarter s data LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at provincial, LHIN and hospital levels TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, Data are available for the previous quarter as of December 2008 Data are self-reported by hospital. No individual patient data are available; therefore indicator cannot be broken down by socio-demographic characteristics. Trending and comparisons are most valid by hospital type (e.g. small, large community, acute teaching, chronic care and rehab and mental health). This is in order to make limited adjustment for patient case mix. Patient Safety Website 2014/15 H-SAA Technical Specifications Page 40

41 RESPONSIBILITY FOR REPORTING Health Service Providers DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 41

42 GEOGRAPHY & TIMING DENOMINATOR NUMERATOR Explanatory (Note: The technical specifications for the stroke indicators will be updated in the next version to enhance understanding of their calculation the revisions will not affect the data presented in the ICES reports, which are the recommended data source for these explanatory indicators.) INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION 30-DAY READMISSION OF PATIENTS WITH STROKE OR TRANSIENT ISCHEMIC ATTACK (TIA) TO ACUTE CARE FOR ALL DIAGNOSES 30-day all-cause non-elective inpatient readmissions should be reduced if appropriate discharge planning and secondary prevention occur from the index stroke/tia ED visit or inpatient admission Explanatory Inpatient Readmission within 30 days of the first discharge in the fiscal year with the most responsible diagnosis in DAD and dx10code1 from NACRS-ED = I60, I61, I63, I64, G45; multiplied by 100 Discharge Abstract Database (DAD), Canadian Institute for Health Information (CIHI) Excludes: 1. Admission cat = L (elective) 2. If non-elective admission following the index stroke/tia discharge is within 24hrs. For each fiscal year take the first ED visit or hospitalization of a unique person s discharge Stroke/TIA Patients (Most Responsible Diagnosis (DAD) or dx10code1 for NACRS-ED) = G45 I60, I61, I63, I64) discharged alive DAD, CIHI National Ambulatory Care Reporting System (NACRS), CIHI Excludes: 1. Diagnostic code G Discharge disposition = died (code 07) TIMING/FREQUENCY OF RELEASE How often, and when, are data being released Data are available annually in December 2014/15 H-SAA Technical Specifications Page 42

43 ADDITIONAL INFORMATION LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending Data are available at the level of the hospital LHIN Data are available as of 2002 LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) There may be limitations as a result of the DAD being the only data source Indirect Standardization should be done to be able to compare across the LHINs. This indicator is based on only the first stroke discharge per year. If a subsequent discharge later in the year results in a readmission, it will not be counted, regardless of whether the index episode resulted in a readmission. This indicator will result in a slight under-representation of the true readmission rate. Ontario Stroke Evaluation Report 2010: Technical Report ices.on.ca ICES /15 H-SAA Technical Specifications Page 43

44 GEOGRAPHY & TIMING DENOMINATOR NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION PERCENT OF STROKE PATIENTS DISCHARGED TO INPATIENT REHABILITATION FOLLOWING AN ACUTE STROKE HOSPITALIZATION Appropriate stroke patients should be discharged from an acute stroke hospitalization to inpatient rehabilitation to ensure full recovery potential is achieved Explanatory Stroke Patients (Most Responsible Diagnosis = I60, I61, I63, I64) Discharge Disposition not equal to 07 (dead) in the DAD and linking them to the NRS. Admitted and classified RCG=1 in the same fiscal year as the DAD discharge NRS Includes: only RCG=1 For each fiscal year take the first stroke hospitalization discharge of a unique patient. Stroke Patients (Most Responsible Diagnosis = I60, I61, I63, I64) discharged disposition not equal 07 (died) DAD Excludes: 1. ICD-10-CA Diagnostic codes I 60.8, I Discharge disposition = died (07) TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending Data are released annually in December LHIN (using patient s postal code to assign to LHIN, i.e., LHIN performance is the proportion of patients that live in the LHIN that received inpatient rehab following an acute stroke inpatient stay) Data are available as of /15 H-SAA Technical Specifications Page 44

45 ADDITIONAL INFORMATION LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) Only looks at stroke patients admitted into the NRS in the same FY as the DAD discharge therefore the numerator does not capture those patients discharged at the end of the FY from the DAD database. Nor does it capture those patients that received inpatient rehab in facilities that do NOT report to the NRS * The OSN reports a LHINs performance using a patient-based analysis. Postal-code of patient is used to assign patient to their LHIN. *Multiply by 100 to present as a percentagepercentagepercentage Ontario Stroke Evaluation Report 2011: Technical Report (exhibit 3.4) ices.on.ca ICES DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 45

46 GEOGRAPHY & TIMING DENOMINATOR NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION PERCENT OF STROKE PATIENTS ADMITTED TO A STROKE UNIT DURING THEIR INPATIENT STAY All stroke/tia patients should be admitted to a stroke unit for acute stroke management for improved outcomes Explanatory Stroke/TIA Patients (Most Responsible Diagnosis = I60, I61, I63, I64, G45) admitted to a Stroke unit at any point during their inpatient stay, multiplied by 100 Registry of the Canadian Stroke Network- Ontario Stroke Audit (~20% random sample of Ontario stroke/tia patients) Hospitals participating in CIHI Special Project #340 via the Discharge Abstract Database (DAD), Canadian Institute for Health Information (CIHI) Excludes: 1. Diagnostic code G45.4 TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for Stroke/TIA Patients (Most Responsible Diagnosis = I60, I61, I63, I64, G45) admitted Registry of the Canadian Stroke Network- Ontario Stroke Audit (~20% random sample of Ontario stroke/tia patients) Hospitals participating in CIHI Special Project #340 via the DAD, CIHI Excludes: 1. Diagnostic code G45.4 Data are available biennially in December for data from Ontario Stroke Audit Data are available annually in December for hospitals participating in CIHI Special Project Data are available at the level of the facility LHIN 2014/15 H-SAA Technical Specifications Page 46

47 ADDITIONAL INFORMATION comparison TRENDING Years available for trending Data are available as of 2004 LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING There may be limitations as a result of the DAD being the only data source Currently no information has been provided Registry of the Canadian Stroke Network Report on the 2004/05 Ontario Stroke Audit ices.on.ca ICES DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 47

48 NUMERATOR INDICATOR NAME HOSPITAL STANDARDIZED MORTALITY RATIO (HSMR) The hospital standardized mortality ratio (HSMR) is a big-dot summary measure that is used to track a hospital s mortality over time. The HSMR is a tool that allows hospitals to measure and monitor their progress in quality of care. HSMR is a ratio of the actual number of in-hospital deaths in a region or hospital to the number that would have been expected based on the types of patients a region or hospital treats. It focuses on the diagnosis groups that account for the majority of in-hospital deaths. Observed deaths HSMR= x 100 Expected deaths Detailed description of indicator Using a logistic regression model, HSMR is adjusted for several factors that affect in-hospital mortality, including age, sex, length of stay, admission category, diagnosis group, co morbidity and transfer from another acute care institution. A ratio equal to 100 suggests that there is no difference between a local mortality rate and the average national experience, given the types of patients cared for. An HSMR greater or less than 100 suggests that a local mortality rate is higher or lower, respectively, than the national experience. The confidence intervals describe the precision of the HSMR estimate. HSMR values are estimated to be accurate within the upper and lower confidence interval, 19 times out of % confidence interval is calculated using Byar s approximation. A confidence interval that includes 100 suggests that the HSMR is not statistically different from the baseline of 100. HSMR results whose confidence interval does not include 100 are statistically different from the baseline. INDICATOR CLASSIFICATION Explanatory Observed deaths, or actual number of in-hospital deaths that occurred in a hospital or region (among patients who satisfy HSMR inclusion and exclusion criteria). Discharge Abstract Database (DAD), Canadian Institute of Health Information (CIHI) 2014/15 H-SAA Technical Specifications Page 48

49 DENOMINATOR Inclusion criteria: 1. Discharge between April 1 of a given year and March 31 of the following year 2. Admission to an acute care institution 3. Discharge with diagnosis group of interest (that is, one of the diagnosis groups that account for approximately 80% of in-hospital deaths) 4. Age at admission between 0 and 120 years 5. Sex recorded as male or female 6. Length of stay of up to 365 consecutive days 7. Admission category is elective or emergent/urgent 8. Canadian resident Exclusion criteria: 1. Cadavers 2. Stillborns 3. Sign-outs (that is, discharged against medical advice) 4. Patients who do not return from a pass 5. Neonates, with age at admission less than or equal to 28 days 6. Records with brain death as most responsible diagnosis code 7. Records with palliative care as most responsible diagnosis code Expected deaths, or number of deaths that would have occurred in a hospital or region had the mortality of these patients been the same as the mortality of similar patients across the country, based on the reference year ( ). The HSMR logistic regression model is fitted with age, sex, length-of-stay (LOS) group, admission category, diagnosis group, co morbidity group and transfers as independent variables and is based on data from all acute hospitals in Canada (excluding Quebec). Coefficients derived from a logistic regression model are used to calculate the probability of inhospital death. The expected number of deaths for a hospital, corporation or region is based on the sum of the probabilities of inhospital death for eligible discharges from that organization. DAD, CIHI Includes: 1. Discharge between April 1 of a given year and March 31 of the following year 2. Admission to an acute care institution 3. Discharge with diagnosis group of interest (that is, one of the diagnosis groups that account for approximately 80% of in-hospital deaths) 4. Age at admission between 0 and 120 years 5. Sex recorded as male or female 6. Length of stay of up to 365 consecutive days 7. Admission category is elective or emergent/urgent 8. Canadian resident 2014/15 H-SAA Technical Specifications Page 49

50 ADDITIONAL INFORMATION GEOGRAPHY & TIMING Excludes: 1. Cadavers 2. Stillborns 3. Sign-outs 4. Patients who did not return from a pass 5. Neonates, with age at admission less than or equal to 28 days 6. Records with brain death as most responsible diagnosis code 7. Records with palliative care as most responsible diagnosis TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May Results are available on a quarterly (Q1 and Q2 in February, Q3 in May and Q4 in September) and annual (in September, together with Q4 reports) basis. LEVELS OF COMPARABILITY Levels of geography for comparison Results are available for hospitals or hospital corporations (where applicable) and Local Health Integration Networks (LHINs). TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, FY till present Currently no information has been provided. The reference year for HSMR calculations is To allow for comparisons over time, the coefficients derived from the model using the reference year are used to determine expected deaths for all reported years. While HSMR adjusts for a number of factors affecting the risk of in-hospital mortality, it does not control for every factor. Therefore, HSMR results are most useful in tracking trends over time. More information about HSMR calculation can be found at the Methodology section of HSMR web-page. 1. HSMR web-page 2. Canadian Institute for Health Information. HSMR: A New Approach for Measuring Hospital Mortality Trends in Canada. Ottawa, Ont.: CIHI, /15 H-SAA Technical Specifications Page 50

51 3. Jarman, B., A. Bottle and P. Aylin. Monitoring Changes in Hospital Standardised Mortality Ratios. BMJ 330 (2005): p Breslow, N. E. and N. E. Day. Statistical Methods in Cancer Research: Volume II The Design and Analysis of Cohort Studies. Lyon, France: International Agency for Research on Cancer, Quan, H., V. Sundararajan, P. Halfon, A. Fong, B. Burnand, J. C. Luthi, L. D. Saunders, C. A. Beck, T. E. Feasby and W. A. Ghali. Coding Algorithms for Defining Comorbidities in ICD-9-CM and ICD-10 Administrative Data. Medical Care 43, 11 (2005): pp RESPONSIBILITY FOR REPORTING CIHI DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 51

52 DENOMINATOR NUMERATOR INDICATOR DESCRIPTION INDICATOR NAME Detailed description of indicator READMISSIONS WITHIN 30 DAYS FOR SELECTED CASE MIX GROUPS (CMGS) Measures the percentage of acute hospital inpatients discharged with selected CMGs (see Note 1 below for included CMGs) that are readmitted to any acute inpatient hospital for non-elective patient care within 30 days of the discharge for index admission. INDICATOR CLASSIFICATION Explanatory Calculate observed readmissions: The sum of readmissions for all index cases in the reporting period. For each index case, identify whether there is a non-elective readmission to any facility within the specified number 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. Discharge Abstract Database (DAD), Canadian Institute for Health Information (CIHI) Includes: 1. The readmission hospitalization is deemed non-elective or unplanned if: a) the admission date is within the specified number of days of the index case discharge date, and b) DAD field admission category is urgent. Excludes: 1. Records with missing valid data on discharge/admission date, health number, age and gender. Identify index cases: 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 Resource Intensity Weights (RIW) Exclusion Indicator) among the index cases. DAD, CIHI Includes: 1. Acute inpatients in the specified CMGs (see Note 1 below) 2. Age is cohort specific: a) 45 for stroke, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) b) 40 for cardiac CMGs, c) All ages for pneumonia, diabetes and 2014/15 H-SAA Technical Specifications Page 52

53 ADDITIONAL INFORMATION GEOGRAPHY & TIMING gastrointestinal (GI) Excludes: 1. Deaths, transfers, patient sign-outs against medical advice; 2. Records with missing valid data on discharge/admission date, health number, age and gender. TIMING/FREQUENCY OF RELEASE How often, and when, are data being released Data are available quarterly LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at the provincial, Local Health Integration Network (LHIN) and hospital level TRENDING Years available for trending LIMITATIONS Specific limitations Data are available since fiscal year 2005 There are data quality issues with interim quarterly reporting. Data quality for interim quarterly reporting (based on submitted interim quarterly data) should be accounted for when interpreting and analyzing performance results for interim quarterly reporting. Indicator values may change substantially once complete data is analyzed (versus analysis based on interim potentially incomplete quarterly data). Performance is monitored by comparing the actual readmission ratio to the expected readmissions ratio. COMMENTS Additional information regarding the calculation, interpretation, data source, etc. Expected Readmissions: To calculate the predicted probability of non-elective readmission to any Ontario acute care hospital for patients discharged with the specified CMGs, a logistic regression model is fitted with CMG, age, gender, prior hospitalizations (within 1, 2 and 3 months), quarterly seasonality and the Charlson co morbidity adjustment index score as independent variables. Coefficients derived from the logistic model are used to calculate the probability of readmission for each patient. The expected number of readmissions for a hospital/lhin is the sum of the patient probabilities for all the index admissions in that hospital/lhin. REFERENCES Provide URLs of any key references E.g. Diabetes Phillips CO, Wright SM, Kern DE, Singa RM, Shepperd S, Rubin HR. Comprehensive discharge planning with post discharge support for older patients with congestive heart failure: a meta-analysis. JAMA 2004; 291(11): /15 H-SAA Technical Specifications Page 53

54 in Canada, Puhan M, Scharplatz M, Troosters T, Walters EH, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD DOI: / CD pub2. RESPONSIBILITY FOR REPORTING Health Analytics Branch DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) Note 1: List of Eligible Conditions (CMGs) CMG+ CMG+ description Stroke (Age 45) 25 Hemorrhagic Event of Central Nervous System 26 Ischemic Event of Central Nervous System 28 Unspecified Stroke COPD (Age 45) 139 Chronic Obstructive Pulmonary Disease Pneumonia (All ages) 136 Bacterial Pneumonia 138 Viral/Unspecified Pneumonia 143 Disease of Pleura Congestive Heart Failure (Age 45) 196 Heart Failure without Cardiac Catheter Diabetes (All ages) 437 Diabetes Cardiac CMGs (Age 40) 202 Arrhythmia without Cardiac Catheter 204 Unstable Angina/Atherosclerotic Heart Disease without Cardiac Cath 208 Angina (except Unstable)/Chest Pain without Cardiac Catheter Gastrointestinal CMGs (All ages) 231 Minor Upper Gastrointestinal Intervention 248 Severe Enteritis 251 Complicated Ulcer 253 Inflammatory Bowel Disease 254 Gastrointestinal Hemorrhage 2014/15 H-SAA Technical Specifications Page 54

55 255 Gastrointestinal Obstruction 256 Esophagitis/Gastritis/Miscellaneous Digestive Disease 257 Symptom/Sign of Digestive System 258 Other Gastrointestinal Disorder 285 Cirrhosis/Alcoholic Hepatitis 286 Liver Disease except Cirrhosis/Malignancy 287 Disorder of Pancreas except Malignancy 288 Disorder of Biliary Tract 2014/15 H-SAA Technical Specifications Page 55

56 NUMERATOR ORGANIZATIONAL HEALTH - Efficient, Appropriately Resourced, Employee Experience, Governance Performance INDICATOR NAME CURRENT RATIO (CONSOLIDATED ALL SECTOR CODES AND FUND TYPES) Detailed description of indicator INDICATOR CLASSIFICATION Number of times a hospital s short-term obligations can be paid using the hospital s short-term assets Performance PERFORMANCE STANDARD Target: Performance target: A balanced position with respect to Current Ratio is understood between 0.8 and 2.0. Hospitals are encouraged to set targets within this range Corridor: (i) If a negotiated target is within the accepted range ( ): Performance corridor=10% (ii) If a negotiated target is outside of the accepted range ( ): Performance corridor=5% Current assets - Credits in current asset accounts (excluding bad debts) + Debits in current liabilities Ontario Healthcare Financial and Statistical Database (OHFS) Includes: 1. Current Assets: Provincial Sector Code Primary Accounts SC Type Secondary Accounts All sectors All sectors Debit balance in 1* + Credit Balance in 1*355 + Debit Balance in 4* F *Balances in Bad Debt accounts (655*) are kept in the numerator whether positive or negative. 2014/15 H-SAA Technical Specifications Page 56

57 ITIO NAL INFO GEOGRAPHY & TIMING DENOMINATOR Current Liabilities, excluding deferred contributions Debits in current liability accounts + Credits in current asset accounts OHRS, MIS Includes: 1. Current Liabilities: Provincial Sector Code All sectors Primary Accounts Credit balances in 4* (excluding 4*8*) + Credit balance in 1* (excluding bad debts 1*355) Secondary Account Type F Secondary Accounts TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May The OHRS is populated by the Ontario Healthcare Financial and Statistical database (OHFS) which are available in Quarter (Q) 2, Q3 and year-end (YE). Data are also available in the Hospital Annual Planning Submission (HAPS) for Q2, Q3 and YE. LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at the hospital level TRENDING Years available for trending Specific RMALIMITATIONS limitations Data are available from the 1994/95 fiscal year Currently, no information has been provided 2014/15 H-SAA Technical Specifications Page 57

58 Note 1: This performance indicator should be calculated using consolidated corporate balance sheet (all fund types and all sector codes). Note 2: Treatment of credits in current assets and debits in current liabilities is applied at the HAPS account rollup level and not the detailed OHRS Management Information System (MIS) account level, although they should be consistent. Note 3: Credits in current assets are really liabilities and should be moved to the denominator; debits in current liability accounts are actually assets and should be moved to the numerator. COMMENTS Additional information regarding the calculation, interpretation, data source, etc. Note 4: Deferred contributions not considered part of current liabilities as they are usually related to capital Note 5: Current Ratio is HAPS calculated using information reported in Balance Sheet Form (roll ups of OHRS Balance Sheet accounts) Note 6: This is one of the 2 formulae for current ratio in HAPS. This calculation of the Current Ratio in HAPS is done at the account roll-up level provided in the HAPS Balance Sheet form. Specific treatments in the calculation of the indicator (such as the moving of current asset credit balances to the numerator and current liability debit balances to the numerator) would need to be applied at the HAPS roll-up level. As such, direct calculation of the indicator for the hospital s MIS trial balance should be applied at the HAPS rollup level based on the MIS account(s) that map to each row in the HAPS form. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) Health Data Branch /15 H-SAA Technical Specifications Page 58

59 DENO MINA TOR NUMERATOR INDICATOR NAME TOTAL MARGIN (CONSOLIDATED ALL SECTOR CODES AND FUND TYPES) Detailed description of indicator INDICATOR CLASSIFICATION Percent by which total corporate (consolidated) revenues exceed or fall short of total corporate (consolidated) expenses, excluding the impact of facility amortization and interest on long-term liabilities, in a given year Performance Target: = 0% PERFORMANCE STANDARD (An approved waiver may impact the target) Corridor: No negative variance from the negotiated target Total Corporate Revenue (excluding Interdepartmental Recoveries and Facility Related Deferred Revenue) minus Total Corporate Expenses (excluding Interdepartmental Expenses and Facility Related Amortization Expenses and interest on long-term liabilities) Ontario Healthcare Financial and Statistical Database (OHFS) Includes: 1. Provincial Sector Code Primary Accounts All 7*, 8* F Secondary Account Type Secondary Accounts 1* to 9* (Excluding 12171, 12195, 12196, 12197, 122*, 13002, 13102, 14102, 15102, 15103, 45100, 62800, 62,900, 69571, 69700, 72000, 950*, 955*) 2. Balances in Bad Debt accounts (665*) are kept in the numerator whether positive or negative. Total Corporate Revenue (excluding Interdepartmental Recoveries and Facility Related Deferred Revenues) 2014/15 H-SAA Technical Specifications Page 59

60 IONAL INFOR MATI GEOGRAPHY & TIMING Ontario Healthcare Financial and Statistical Database (OHFS) Includes: Provincial Sector Code Primary Accounts All 7*, 8* F Secondary Account Type Secondary Accounts 1* (Excluding 12171, 12195, 12196, 12197, 122*, 13002, 13102, 14102, 15102, 15103) TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending The OHRS is populated by the Ontario Healthcare Financial and Statistical database (OHFS) which are available in Quarter (Q) 2, Q3 and year-end (YE). Data are available at the hospital level Data are available from the 1994/1995 fiscal year LIMITATIONS Specific limitations Currently, no information has been provided 2014/15 H-SAA Technical Specifications Page 60

61 Note 1: Total Margin is calculated before facility-related amortized expenses and revenues. Facility amortization has been excluded from the calculation because of Ministry policy stating that buildings ought to be funded via other revenue streams such as grants or capital campaigns. Inter-departmental recoveries and expenses are also excluded. COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) Note 2: The Total Margin Performance Indicator should be calculated using consolidated corporate income statements (all fund types and all sector codes). Note 3: Total Margin in Hospital Annual Planning Submission (HAPS) calculated using the information reported in Expense/Revenues Form (should be based on OHRS accounts). Note 4: The calculation of the Total Margin in HAPS/Web Enabled Reporting System (WERS) is done at the account roll-up level detailed in the Revenues and Expenses form. Direct calculation of the indicator from the hospital s MIS trial balance should provide identical results to calculations based on the HAPS roll-up levels (which represent groupings of OHRS Management Information System (MIS) expense and revenues accounts). It is important for hospitals to populate the HAPS forms using the account numbers provided to ensure this is the case. Health Data Branch /15 H-SAA Technical Specifications Page 61

62 NUMERATOR Explanatory INDICATOR NAME INDICATOR CLASSIFICATION TOTAL MARGIN (HOSPITAL SECTOR ONLY) Explanatory Detailed description of indicator Total Margin measures the relative financial health of an organization and represents the percentage by which total revenues exceed total expenses (before building depreciation net of amortization of deferred grants) in a given year. This is the prime indicator of financial viability as it measures the extent to which hospitals are operating within their financial means. A negative Total Margin (a deficit) is not normally acceptable. Significant deficits forecasted over two or more years indicate an unsustainable system and require corrective measures. This indicator includes only sector code 1 revenues and expenses. Total Corporate Revenues (excluding interdepartmental recoveries and Facility Related Deferred Revenues) minus Total Corporate Expenses (excluding Interdepartmental Expenses and Facility Related Amortization Expenses and interest on long-term liabilities) for provincial Sector Code 1 (PSC 1*), multiplied by 100 Ontario Healthcare Financial and Statistical Database (OHFS) Includes: Provincial Sector Code Primary Accounts Secondary Account Type Secondary Accounts 1* 7*, 8* F 1* to 9*(excluding 12171, 12195, 12196, 12197, 122*, 13002, 13102, 14102, 15102, 15103, 45100, 62800, 62900, 69571, 69700, 72000, 950*, 955*) 2014/15 H-SAA Technical Specifications Page 62

63 DENOMINATOR Total Corporate Revenues (excluding Interdepartmental Recoveries and Facility Related Deferred Revenues) OHRS, MIS Includes: Provincial Sector Code Primary Accounts Secondary Account Type Secondary Account 1* 7*, 8* F 1*(excluding 12171, 12195, 12196, 12197, 122*, 13002, 13102, 14102, 15102, 15103) 2014/15 H-SAA Technical Specifications Page 63

64 ADDITIONAL INFORMATION GEOGRAPHY & TIMING TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending Currently no information has been provided Currently no information has been provided Currently no information has been provided LIMITATIONS Specific limitations Currently no information has been provided COMMENTS Additional information regarding the calculation, interpretation, data source, etc. The Total Margin Explanatory indicator reflects revenues and expenses associated with sector code 1 only. It is calculated before facility related amortized expenses and revenues. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING Health Data Branch DATE CREATED (YYYY- MM-DD) /15 H-SAA Technical Specifications Page 64

65 DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 65

66 NUMERATOR INDICATOR NAME ADJUSTED WORKING FUNDS Detailed description of indicator Adjusted Current Assets minus Adjusted Current Liabilities based on the methodology used by the ministry under the Hospital Working Funds Initiative and communicated to the Hospital. Where Adjusted Current Assets = current assets adjusted for certain items reported as non-current assets that are available for working funds or certain items reported as current assets not available for working funds; and Adjusted Current Liabilities = current liabilities adjusted for local share debt for capital projects and for certain items that are not expected to require cash outlay in the next twelve months. INDICATOR CLASSIFICATION Explanatory Adjusted current assets minus adjusted current liabilities 1.1 Current Assets 1.1 Plus Unrestricted or internally restricted long-term investments 1.2 Plus Portion of externally restricted long-term investments that is NOT restricted (e.g. Interest) 1.3 Minus Externally restricted cash and cash equivalents reported in current assets 1.4 Minus externally restricted investments reported in current assets 1.5 Minus externally restricted receivables reported in current assets 1.6 Plus trust or research funds not included in current assets that are available to operations 1.7 Plus other non-current assets not externally restricted available for working funds 1.8 Plus other adjustments to working funds not previously reported above 1.9 Equals Adjusted Current Assets 1.10 Current Liabilities 1.11 Minus total vacation accrual 1.12 Plus cash payouts for terminations and retirements (6% assumption) 1.13 Minus Vested sick leave accruals in current liabilities 1.14 Plus average annual payout from vested sick bank 1.15 Minus callable debt and short-term debt that is deemed to be longterm in nature 1.16 Plus current portion of long-term debt not already in current liabilities 1.17 Minus any current liability associated with items 1.4, 1.5, & Plus other adjustments to working funds not previously reported above 1.19 Equals Adjusted Current Liabilities Adjusted Working Funds equals the following: 1.10 minus /15 H-SAA Technical Specifications Page 66

67 GEOGRAPHY & TIMING DENOMINATOR Self Reporting Initiative (SRI), Ontario Ministry of Health and Long- Term Care (MOHLTC) None TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending Data are available quarterly Data are available at the hospital level None currently available. Reporting starts 2013/14 HAPS Budget and 2012/13 Q /15 H-SAA Technical Specifications Page 67

68 ADDITIONAL INFORMATION LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING Data are self-reported by hospital. Currently, no information has been provided Adjustments being made to the traditional accounting definition of working funds of current assets minus current liabilities should result in a more accurate picture of working funds since liabilities not expected to be settled within the next twelve months are excluded, non-current assets (internally restricted assets) available for working funds are included and current assets not available for working funds (externally restricted current assets) are excluded. None Health Data Branch DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 68

69 NUMERATOR INDICATOR NAME ADJUSTED WORKING FUNDS / TOTAL REVENUE % Detailed description of indicator (Adjusted Working Funds divided by Total Revenue) multiplied by 100. INDICATOR CLASSIFICATION Explanatory 1.1 Current Assets 1.2 Plus Unrestricted or internally restricted long-term investments 1.3 Plus Portion of externally restricted long-term investments that is NOT restricted (e.g. Interest) 1.4 Minus Externally restricted cash and cash equivalents reported in current assets 1.5 Minus externally restricted investments reported in current assets 1.6 Minus externally restricted receivables reported in current assets 1.7 Plus trust or research funds not included in current assets that are available to operations 1.8 Plus other non-current assets not externally restricted available for working funds 1.9 Plus other adjustments to working funds not previously reported above 1.10 Equals Adjusted Current Assets 1.11 Current Liabilities 1.12 Minus total vacation accrual 1.13 Plus cash payouts for terminations and retirements (6% assumption) 1.14 Minus Vested sick leave accruals in current liabilities 1.15 Plus average annual payout from vested sick bank 1.16 Minus callable debt and short-term debt that is deemed to be longterm in nature 1.17 Plus current portion of long-term debt not already in current liabilities 1.18 Minus any current liability associated with items 1.4, 1.5, & Plus other adjustments to working funds not previously reported above 1.20 Equals Adjusted Current Liabilities Adjusted Working Funds equals the following: 1.10 minus 1.20 Self Reporting Initiative (SRI), Ontario Ministry of Health and Long-Term Care (MOHLTC) 2014/15 H-SAA Technical Specifications Page 69

70 GEOGRAPHY & TIMING DENOMINATOR None Total Revenue Self Reporting Initiative (SRI), Ontario Ministry of Health and Long-Term Care (MOHLTC) None TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending Data are available quarterly Data are available at the hospital level None currently available. Reporting starts 2013/14 HAPS Budget and 2012/13 Q /15 H-SAA Technical Specifications Page 70

71 ADDITIONAL INFORMATION LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING Data are self-reported by hospital. Currently, no information has been provided None None Health Data Branch DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 71

72 NUMERATOR SYSTEM PERSPECTIVE Integration, Community Engagement, ehealth Performance INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION PERCENTAGE OF ACUTE ALTERNATE LEVEL OF CARE (ALC) DAYS (CLOSED CASES) 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. Performance Target: (i) For hospitals performing lower than the LHIN s MLPA target but above provincial target (9.46%): Performance target = provincial target of 9.46% PERFORMANCE STANDARD (ii) For hospitals currently performing lower than the provincial target (9.46%): Performance target= maintain or improve on performance (iii) For hospitals performing above the LHIN MLPA target: Performance target = LHIN MLPA target Corridor: (i) Upper corridor = LHIN MLPA target (ii) Upper corridor = performance target + 10% (iii) Upper corridor = performance target + 10% Total number of inpatient days designated as ALC for patients in acute beds discharged in a given time period Discharge Abstract Database (DAD), Canadian Institute for Health Information (CIHI) Includes: 1. Data from acute care hospitals 2. Individuals designated as ALC Excludes: 1. Newborns and stillborns 2. Records with missing or invalid Discharge Date 2014/15 H-SAA Technical Specifications Page 72

73 ADDITIONAL INFORMATION GEOGRAPHY & TIMING DENOMINATOR TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending LIMITATIONS Specific limitations Total number of acute inpatient days in a given time period DAD, CIHI Includes: 1. Data from acute care hospitals Excludes: 1. Newborns and stillborns 2. Records with missing or invalid Discharge Date Final data by fiscal year are available annually (usually by September); interim data are updated quarterly Data are available at the LHIN and hospital levels Data are available as of 1996/97 fiscal year This indicator is based on discharge. Successes resulting in a higher rate of discharges in ALC clients will result in an initial spike in the results. Discharges of long-stay ALC clients will attribute all days to the time period of discharge, also potentially skewing the results. Point-in-time results must be analyzed with caution, and trending of this indicator is preferred. COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING In 2006/07, reporting of activity from adult designated mental health units moved from the DAD to the Ontario Mental Health Reporting System (OMHRS). This means that moving a patient from an acute bed to a bed in a designated mental health bed is now coded as a transfer. This would account for the substantial increase in ALC separations and days transferred to acute or psychiatric facilities over the period. Health Analytics Branch 2014/15 H-SAA Technical Specifications Page 73

74 DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 74

75 NUMERATOR Explanatory INDICATOR NAME Detailed description of indicator REPEAT UNSCHEDULED EMERGENCY VISITS WITHIN 30 DAYS FOR MENTAL HEALTH CONDITIONS (METHODOLOGY UPDATED) Percentage unscheduled repeat emergency visits following an emergency visit for a mental health condition. A visit is counted as an index visit (first visit) if it is followed by another visit that occurs in any Ontario hospital within 30 days. The index visit must be for a mental health condition however, the repeat visit can be for any diagnosis within ICD-10-CA Chapter 5 (i.e. either a mental health OR substance abuse condition). INDICATOR CLASSIFICATION Explanatory Number of unscheduled visits for mental health conditions followed within 30 days by a repeat visit. Steps: 1. Identify all mental health and substance abuse emergency visits: select unscheduled emergency visits with Main Problem Diagnosis (MPDx) in ICD10-CA Chapter 5 in a given fiscal year/quarter plus the first 30 days of the following fiscal year/quarter. 2. Determine index visits: sort emergency visits identified in Step 1 by encrypted health card number and visit date/time, calculate the time difference between two consecutive visits, and then identify the visits that are followed within 30 days by another visit as index visits. 3. Categorize index visit to Mental Health or Substance Abuse category based on its MPDx: substance abuse has MPDx F10-F19, all others are mental health. 4. The number of mental health index visits is the numerator for this indicator. National Ambulatory Care Reporting System (NACRS), Canadian Institute for Health Information (CIHI) 2014/15 H-SAA Technical Specifications Page 75

76 ONAL INFOR MATIO GEOGRAPHY & TIMING DENOMINATOR Includes: 1. Information on unscheduled emergency visits to Ontario hospitals for mental health or substance abuse conditions, defined by the main problem diagnosis in ICD-10-CA Chapter The diagnostic categories refer to the main problem diagnosis for the index visit. 3. All ICD-10-CA codes beginning with F, excluding Substance Abuse (F10-F19). Excludes: 1. Visits for those without a valid health card number. 2. Visits for those without a valid registration date. Total number of index cases NACRS, CIHI Includes: 1. Information on unscheduled emergency visits to Ontario hospitals for mental health conditions, defined by the main problem diagnosis in ICD-10-CA Chapter The diagnostic categories refer to the visits main problem. 3. All ICD-10-CA codes beginning with F, excluding Substance Abuse (F10-F19). Excludes: 1. Visits for those without a valid health card number. 2. Visits for those without a valid registration date. TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May Data are available quarterly LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at the LHIN and hospital levels TRENDING Years available for trending Data are available from fiscal year 2001 LIMITATIONS Specific limitations Calculations based on interim data are subject to change when the final NACRS data are available. 2014/15 H-SAA Technical Specifications Page 76

77 COMMENTS Additional information regarding the calculation, interpretation, data source, etc. This explanatory indicator is defined to be similar to an Performance indicator for the Ministry-LHIN Performance Agreement (MLPA). Calculation is done at the LHIN level by the LHIN of patient residence and at the hospital level by the LHIN where the index visit occurred. This indicator measure is intended to measure the community integration of care, such as measure as measure as an indicator of availability and access to community mental health services by local LHIN residents. A visit is counted as an index visit (first visit) if it is followed by another visit that occurs in any Ontario hospital within 30 days, for any diagnosis within ICD-10-CA Chapter 5. The index visit is for mental health condition; however, the repeat visit could be for either a mental health or substance abuse diagnosis. The diagnostic category and LHINs refer to the index visit. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, REPORTING RESPONSIBILITY DATE CREATED (YYYY-MM- DD) DATE LAST REVIEWED (YYYY-MM-DD) For each quarter the data period is extended to include 30 days after the last day of the reporting quarter to avoid under-counting of qualified repeat visit pairs that have the index visit in the reporting quarter and a repeat visit in the next quarter. Health Analytics Branch /15 H-SAA Technical Specifications Page 77

78 NUMERATOR INDICATOR NAME REPEAT UNSCHEDULED EMERGENCY VISITS WITHIN 30 DAYS FOR SUBSTANCE ABUSE CONDITIONS (METHODOLOGY UPDATED) Percentage of repeat unscheduled emergency visits following an emergency visit for a substance abuse condition. Detailed description of indicator INDICATOR CLASSIFICATION A visit is counted as an index visit (first visit) if it is followed by another visit that occurs in any Ontario hospital within 30 days. The index visit must be for a substance abuse condition however, the repeat visit can be for any diagnosis within ICD-10-CA Chapter 5 (i.e. either a mental health OR substance abuse condition). Explanatory Number of unscheduled visits for substance abuse condition followed by a repeat visit within 30 days. Steps: 1. Identify all mental health and substance abuse emergency visits: select unscheduled emergency visits with Main Problem Diagnosis (MPDx) in ICD10-CA Chapter 5 occurring within the fiscal year/quarter or within the first 30 days of the following fiscal year/quarter. 2. Determine index visits: sort visits identified in Step 1 by encrypted health card number and visit date/time, calculate the time difference between two consecutive visits, and then identify visits that are followed within 30 days by another visit as index visits. 3. Categorize index visit to Mental Health or Substance Abuse category based on its MPDx: substance abuse has MPDx = F10-F19, all others are mental health. 4. The number of substance abuse index visits is the numerator for this indicator. National Ambulatory Care Reporting System (NACRS), Canadian Institute for Health Information (CIHI) 2014/15 H-SAA Technical Specifications Page 78

79 GEOGRAPHY & TIMING DENOMINATOR Includes: 1. Information on unscheduled (ambulatory case type=emg)emergency visits to Ontario hospitals for mental health or substance abuse conditions, (MPDX=ICD-10-CA Chapter 5). 2. The diagnostic categories refer to the index cases main problem diagnosis. 3. ICD-10-CA codes beginning with F10 - F19. Excludes: 1. Visits for those without a valid health card number. 2. Visits for those without a valid registration date. Total number of index cases NACRS, CIHI Includes: 1. Information on unscheduled emergency department visits to Ontario hospitals for substance abuse conditions, defined by the main problem diagnosis in ICD-10-CA Chapter 5, in the fiscal year/quarter. 2. The diagnostic categories refer to the visits main problem diagnosis. 3. ICD-10-CA codes beginning with F10 - F19. TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid-may LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending Excludes: 1. Visits for those without a valid health card number. 2. Visits for those without a valid registration date. Data are available quarterly Data are available at the LHIN and hospital levels Data are available from fiscal year /15 H-SAA Technical Specifications Page 79

80 ADDITIONAL INFORMATION LIMITATIONS Specific limitations Calculations based on interim data may be subject to change when the final NACRS data are available. This explanatory indicator is defined to be similar to the Performance indicator for the Ministry-LHIN Performance Agreement (MLPA). Calculation is done at the LHIN level by the LHIN of patient residence and at the hospital level by the LHIN where the index visit occurred. This indicator is intended to measure the community integration of care, such as availability and access to community mental health services by local LHIN residents. COMMENTS Additional information regarding the calculation, interpretation, data source, etc. A visit is counted as an index visit (first visit) if it is followed by another visit that occurs in any Ontario hospital within 30 days, for any diagnosis within ICD-10-CA Chapter 5. The index visit is for substance abuse for this indicator; however the repeat visit could be for either a mental health or substance abuse diagnosis. The diagnostic category (substance abuse) and LHINs refer to the index visit. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY-MM- DD) DATE LAST REVIEWED (YYYY-MM-DD) For each quarter the data period is extended to include 30 days after the last day of the reporting quarter to avoid under-counting of qualified repeat visit pairs that have the index visit in the reporting quarter and a repeat visit in the next quarter. Health Analytics Branch /15 H-SAA Technical Specifications Page 80

81 NUMERATOR INDICATOR NAME ALTERNATE LEVEL OF CARE (ALC) RATE (NEW) Detailed description of indicator The ALC Rate indicator represents an accurate count of total ALC days and total patient days for both open and closed cases in a given month, and therefore, will provide an accurate picture of ALC performance that can be trended over time. INDICATOR CLASSIFICATION Explanatory The total number of ALC days contributed by ALC patients within the specific reporting month/quarter. Inpatient service type is identified in the WTIS. Acute ALC days = the total number of ALC days contributed by ALC patients waiting in non-surgical (NS), surgical (SU), and intensive/critical care (IC) beds Post-Acute ALC days = the total number of ALC days contributed by ALC patients waiting in complex continuing care (CC), rehabilitation (RB), and mental health (MH) beds CCC ALC days = the total number of ALC days contributed by ALC patients waiting in complex continuing care (CC) beds Rehab ALC days = the total number of ALC days contributed by ALC patients waiting in rehabilitation (RB) beds Mental Health ALC days = the total number of ALC days contributed by ALC patients waiting in mental health (MH) beds Wait Time Information System (WTIS) and the monthly Bed Census Summary (BCS) data provided to the Ministry of Health and Long-Term Care (ministry) by all Ontario hospitals. Exclusions 1. ALC cases discontinued due to Data Entry Error. 2. ALC cases having Inpatient Service = Discharge Destination for Post-Acute Care (*Exception: Bloorview Rehab, CCC to CCC). 3. ALC cases identified by the facility for exclusion. Methodology Notes discharge or discontinuation is not counted as an ALC day. ay of a reporting period and no discharge/discontinuation date, then ALC days = /15 H-SAA Technical Specifications Page 81

82 DENOMINATOR Inpatient Service data element (as defined in the WTIS) is comparable to the Bed Type data element (as defined in the BCS). Note that only those facilities (Acute & Post-Acute) submitting both ALC data (to the WTIS) and BCS data (through the HDB Web Portal) are included in ALC Rate calculation. Any master number that does not have inpatient days reported to the BCS for a given month/quarter will be excluded from reporting for that month/quarter. Please refer to Appendix A and the BCS DQ Notes tab for more details. The total patient days represents the total number of patient days contributed by inpatients within the specific reporting month/quarter. Bed type is identified in the BCS data submission. Acute Patient days = the total number of patient days contributed by inpatients in Medical (MED) + Surgical (SURG) + Combined Medical & Surgical (CMS) + Intensive Care and Coronary Care (ICU) + Obstetrics (OBS) + Paediatric (PAE) + Child/Adolescent Mental Health (Children MH) + Acute Addiction (Addiction) + Pediatrics in Nursery (Paed Days in Nursery) + Newborns (Level 1 - General + Level 2 - Intermediate + Level 3 - ICU Neonatal + Not in Regular) Post-Acute Patient days = the total number of patient days contributed by inpatients in Chronic (Chronic) + General Rehabilitation (Gen. Rehab) + Special Rehabilitation (Spec. Rehab) + Acute Psych (Acute Psy) + Addiction (Addiction) + Forensic (Forensic) + Psychiatric Crisis Unit (Crisis Unit) + Longer Term Psychiatric (Long Term) CCC Patient days = the total number of patient days contributed by inpatients in complex continuing care (Chronic) beds Rehab Patient days = the total number of patient days contributed by inpatients in General Rehabilitation (Gen. Rehab) + Special Rehabilitation (Spec. Rehab) Mental Health Patient days = the total number of patient days contributed by inpatients in Acute Psych (Acute Psy) + Addiction (Addiction) + Forensic (Forensic) + Psychiatric Crisis Unit (Crisis Unit) + Longer Term Psychiatric (Long Term) Bed Census Summary (BCS) [previously the Daily Census Summary (DCS)] 2014/15 H-SAA Technical Specifications Page 82

83 ADDITIONAL INFORMATION GEOGRAPHY & TIMING Exclusions 1. Patient days contributed by inpatients in the emergency department (Bed Type = Emergency (Emerg + PARR, Emergency + PARR)). Note that only those facilities (Acute & Post-Acute) submitting both ALC data (to the WTIS) and BCS data (through the HDB Web Portal) are included in ALC Rate calculation. Any master number that does not have inpatient days reported to the BCS for a given month/quarter will be excluded from reporting for that month/quarter. Please refer to Appendix A and the BCS DQ Notes tab for more details. TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May The data source used to calculate the total ALC days in the ALC Rate Report is the WTIS for ALC. The data cut takes place on the 6th business day following the reporting month. LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at the LHIN and hospital levels TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. The ALC Rate indicator developed and produced by ATC is not the same indicator as the % ALC indicator developed by the Canadian Institute for Health Information (CIHI) and produced by the ministry s Health Analytics Branch that is currently part of the Quarterly Stocktake Report. Please note that these two indicators are not meant to be compared and answer different questions. 2014/15 H-SAA Technical Specifications Page 83

84 REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, REPORTING RESPONSIBILITY DATE CREATED (YYYY-MM- DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 84

85 GEOGRAPHY & TIMING DENOMINATOR NUMERATOR INDICATOR DESCRIPTION APPENDIX: Service Volume Metrics Global Volumes (Schedule C2) INDICATOR NAME COMPLEX CONTINUING CARE WEIGHTED PATIENT DAYS Detailed description of indicator This indicator is based on Continuing Care Reporting System (CCRS) Resource Utilization Group (RUG-III) weighted patient days Number of days associated with a RUG-III group multiplied by the groupspecific Case Mix Index (CMI) value Continuing Care Reporting System (CCRS), Canadian Institute for Health Information (CIHI) TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending Data are updated annually with all admission records up to approximately June of the previous fiscal year Data are available at the hospital level. Data are available as of fiscal year 2014/15 H-SAA Technical Specifications Page 85

86 ADDITIONAL INFORMATION LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) Currently, no information has been provided Health Service Providers /15 H-SAA Technical Specifications Page 86

87 ADDITIO NAL INFORMA GEOGRAPHY & TIMING DENOMINATOR NUMERATOR INDICATOR DESCRIPTION INDICATOR NAME ED WEIGHTED CASES (UPDATED) Detailed description of indicator Total emergency visits adjusted for resource intensity using the Comprehensive Ambulatory Care Classification System (CACS), the methodology that is applied to ambulatory care data. Sum of Emergency Visits multiplied by the associated CACS weights. National Ambulatory Care Reporting System (NACRS), CIHI Includes: 1. All scheduled and non-scheduled ED visits. n/a n/a n/a TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending Data using the CACS grouping methodology are released annually (broken down by quarter) based on the May 31 Performance cut of the NACRS database. Interim data are available quarterly. Data are available at the hospital level Data are available from the 1994/1995 fiscal year Specific limitations TION LIMITATIONS COMMENTS Result may not be a good indicator of the number of patients, as severity of 2014/15 H-SAA Technical Specifications Page 87

88 Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, REPORTING RESPONSIBILITY cases drives the calculation of weight Health Service Providers DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 88

89 GEOGRAPHY & TIMING DENOMINATOR NUMERATOR INDICATOR INDICATOR NAME Detailed description of indicator TOTAL INPATIENT ACUTE WEIGHTED CASES (UPDATED) Total acute inpatient discharges adjusted for resource intensity. Sum of inpatient discharges multiplied by the resource intensity weight for their associated Case Mix Group CIHI, Discharge Abstract Database (DAD) Includes: 1. Acute Inpatient volumes TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May Data grouped using the CMG+ methodology are released annually (broken down by quarter) based on the May 31 accountability cut of the DAD database. Interim data are available quarterly. LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at the hospital level TRENDING Data from DAD are available as of 2003/04 fiscal year for this indicator. 2014/15 H-SAA Technical Specifications Page 89

90 ADDITIONAL INFORMATION Years available for trending LIMITATIONS Specific limitations DAD: The data source is discharge-based, so the indicator will not capture those who are still hospitalized. COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING Health Service Providers DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 90

91 GEOGRAPHY & TIMING DENOMINATOR NUMERATOR INDICATOR DESCRIPTION INDICATOR NAME DAY SURGERY WEIGHTED VISITS Detailed description of indicator Total day surgery visits adjusted for resource intensity using the Comprehensive Ambulatory Care Classification System (CACS), the methodology that is applied to ambulatory care data. Sum of included visits multiplied by the associated CACS weights Canadian Institute for Health Information (CIHI) National Ambulatory Care Reporting System (NACRS) Includes: 1. Day surgery visits 2. Endoscopy 3. Cardiac Cath Excludes: 1. Emergency and 2. Clinic visits. TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending Data using the CACS grouping methodology are released annually (broken down by quarter) based on the May 31 accountability cut of the NACRS database. Interim data are available quarterly. Data are available at the hospital level Data are available from the 2002/ /15 H-SAA Technical Specifications Page 91

92 ADDITIONAL INFORMATION LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING Historical data would have to be regrouped using the same grouping methodology for comparative analysis. Health Service Providers DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 92

93 GEOGRAPHY & TIMING DENOMINATOR NUMERATOR INDICATOR DESCRIPTION INDICATOR NAME Detailed description of indicator INPATIENT MENTAL HEALTH WEIGHTED DAYS This indicator is a weighted total of days reported in adult mental health beds based on the System for Classification of Inpatient Psychiatry (SCIPP) weighted patient days (SWPD) methodology. The SWPD methodology is an accounting process that combines the SCIPP weighting groups, SCIPP Funding CMI values and administrative information about the patient to produce counts of the number of patient days and weighted patient days. Each day that a person is an inpatient is referred to as a patient day, and each patient day is weighted using the SCIPP Funding CMI associated with the appropriate SCIPP group for that period of time. The SWPD reports available from CIHI s Ontario Mental Health Reporting System (OMHRS) sums the weighted patients days for a given period of time according to the following rules: 1. The information from an assessment covers all patient days until the next assessment. 2. Information from the OMHRS admission assessment applies from the date of admission until the date of the admission assessment. The patient s SWPD events are set up based on the OMHRS assessments submitted within the reporting period. Information from these assessments is transformed into corresponding SWPD events by subdividing each episode into segments. The start date of each segment is the entry date, the assessment reference date or the discharge date. Patient days for each event are calculated as the event end date minus the event start date. The entry date is counted as one patient day, whereas the discharge date is not. While the discharge date is not counted as a patient day, we create a discharge event to acknowledge that discharge occurred. Ontario Mental Health Reporting System (OMHRS) TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as Information collected for OMHRS is used to produce SWPD reports. CIHI produces SWPD reports quarterly to summarize clinical and resource characteristics of individuals and facilities. Each fiscal year, Q1, Q2 and Q3 SWPD reports are generated based on data cuts made following the OMHRS submission deadline (two months after the end of the quarter). The yearend SWPD report is produced based on the June 1 data cut. These reports are produced for use by the MOHLTC. 2014/15 H-SAA Technical Specifications Page 93

94 ADDITIONAL INFORMATION possible..data are released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) The SWPD reports summarize these measures of resource intensity at the episode, patient and facility levels for each facility that submits data to OMHRS within a given reporting period. SWPD region-level reports are also available. These reports summarize information from the other two reports for each local health integration network (LHIN) in Ontario. All reports can be accessed through OMHRS Operational Reports (formerly known as eomhrs). Data are available from the 2006/07 fiscal year Historical data would have to be regrouped using the same grouping methodology for comparative analysis. Health Service Providers /15 H-SAA Technical Specifications Page 94

95 ADDITIONAL INFORMATION GEOGRAPHY & TIMING DENOMINATOR NUMERATOR INDICATOR DESCRIPTION INDICATOR NAME INPATIENT REHABILITATION WEIGHTED CASES Detailed description of indicator The total Number of inpatient rehabilitation cases, adjusted for resource intensity using Rehabilitation Patient Group (RPG) weights Sum of RPG weights across included cases Canadian Institute for Health Information (CIHI) National Rehabilitation Reporting System (NRS) TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data Data are updated annually. Data are available at the hospital level Data are available from the 2003/04 fiscal year Historical data should be regrouped using the same grouping methodology for comparative analysis. 2014/15 H-SAA Technical Specifications Page 95

96 source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) Health Service Providers /15 H-SAA Technical Specifications Page 96

97 ADDITIONAL INFORMATION NUMERATOR INDICATOR NAME Detailed description of indicator PERFORMANCE STANDARD ELDERLY CAPITAL ASSISTANCE PROGRAM (ELDCAP) INPATIENT DAYS The total number of inpatient days in designated ELDCAP beds Target: To be determined based on negotiations with hospitals Corridor: For all hospitals, the corridor is between 98% and 102%. The total number of inpatient days in designated ELDCAP beds Ontario Healthcare Financial and Statistical Database (OHFS) Includes: Reported in the OHFS as ELDCAP inpatient days: Provincial Sector Code Primary Accounts Secondary Account Type Secondary Accounts 1* 712* S 40317* LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, Data are available at the hospital level Data are available from the 1994/1995 fiscal year Currently, no information has been provided The methodology updates for this indicator is based on the Healthcare Indicator Tool (HIT). Elderly Capital Assistance Program (ELDCAP): program/ltc/28_pr_glossary.html 2014/15 H-SAA Technical Specifications Page 97

98 RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) Health Data Branch /15 H-SAA Technical Specifications Page 98

99 NUMERATOR INDICATOR NAME Detailed description of indicator AMBULATORY CARE VISITS This indicator is based on total ambulatory visits, which includes day/ night care but excludes endoscopy and emergency visits. Target: To be determined based on negotiations with hospitals PERFORMANCE STANDARD Corridor: Hospital Ambulatory Visits (excluding Emergency) Corridor floor <=30,000 75% 30, ,000 80% 100, ,000 85% 200, ,000 90% 300, ,000 92% >400,000 94% Total ambulatory visits (including day/ night care) minus emergency visits and endoscopy visits Ontario Healthcare Reporting System (OHRS), Management Information System (MIS) Includes: 1. OHRS primary account codes: 7134*, 712*, 7135*, 715* 2a. From 2002 and on, OHRS secondary statistical account codes: 447*, 450*, 5* 2b. Prior to 2002, OHRS secondary statistical account codes: S416* and S418* Excludes: 1. Emergency visits (all scheduled, non-scheduled, inpatient and outpatient clinic visits, and visits in surgical day/night functional centres) 2. OHRS primary account code: (Endoscopy) and 71310* (Emergency) 3. OHRS secondary statistical account codes: 50*, 511*, 512*, 513*, 514*, 518*, 519*, 521* 2014/15 H-SAA Technical Specifications Page 99

100 ADDITIONAL INFORMATION GEOGRAPHY & TIMING DENOMINATOR TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, The OHRS is populated by the Ontario Healthcare Financial and Statistical database (OHFS) which are available in Quarter (Q)2, Q3 and year-end (YE). Data are available at the hospital level Data are available from the 1994/1995 fiscal year Visits such as telephone, patients not uniquely identified, number of individuals in group are not included because the information is not consistently reported from hospitals. 2014/15 H-SAA Technical Specifications Page 100

101 REPORTING RESPONSIBILITY Health Data Branch DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) Provincial Programs Cardiac Surgery Services included in this line are: o Coronary Artery Bypasses o Other Open Heart o Valve o Valve/CABG Surgeries Cardiac Services Catheterization Services included in this line are: o Cardiac Services - Interventional Cardiology Services included in this line are: o Angioplasty (PTCA) o Coronary Stent Non-Drug Eluting o Coronary Stent Drug Eluting o Valvuloplasty o Septal Defect closed with device o Electrophysiological Studies o Ablations o Ablations with Advanced Mapping Cardiac Services - Permanent Pacemakers Organ Transplant Services included in this line are: o Living Donors o Deceased Donors Neurosciences 2014/15 H-SAA Technical Specifications Page 101

102 Services included in this line are: o Deep Brain Stimulation o Sacral Nerve Stimulation o Spinal Cord Stimulation o Coil Embolization o Intrathecal Baclofen 2014/15 H-SAA Technical Specifications Page 102

103 GEOGRAPHY & TIMING DENOMINATOR NU MER ATO R INDICATOR DESCRIPTION Other Volume Metrics INDICATOR NAME Detailed description of indicator EMERGENCY DEPARTMENT AND URGENT CARE VISITS This indicator is based on visits to emergency rooms (ERs) and urgent care centers (UCC) reported to the Ministry of Health and Long-term Care (MOHLTC) and Local Health Integration Networks (LHINs) using the Ontario Healthcare Reporting Standards (OHRS) The total number of visits to ERs and UCCs Ontario Healthcare Financial and Statistical Database (OHFS) Includes: Data reported in the OHFS as Emergency visits (including all scheduled, nonscheduled, inpatient and outpatient visits in emergency functional centers): Provincial Sector Code Primary Accounts Secondary Account Type Secondary Accounts 1* 71310* S 450* + 5* (Excluding 50*, 511*, 512*, 513*, 514*, 518*, 519*, 521*) TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- The OHRS is populated by the Ontario Healthcare Financial and Statistical database (OHFS) which are available in Quarter (Q) 2, Q3 and year-end (YE) 2014/15 H-SAA Technical Specifications Page 103

104 ADDITIONAL INFORMATION May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY-MM- DD) DATE LAST REVIEWED (YYYY-MM-DD) Data are available at the hospital levels Data are available from the 1994/95 fiscal year Currently, no information has been provided Health Data Branch /15 H-SAA Technical Specifications Page 104

105 DENOMINATOR NUMERATOR INDICATOR NAME Detailed description of indicator INPATIENT MENTAL HEALTH DAYS Number of mental health inpatient days in adult mental health beds Target: To be determined based on negotiations with hospitals PERFORMANCE STANDARD Corridor: Mental Health Inpatient Days Corridor Floor < % >5,001 <10,000 90% >10,000 94% Note: An upper limit should also be established. Total number of inpatient days for designated mental health beds Ontario Healthcare Financial and Statistical Database (OHFS) Includes: 1.reported in the OHFS as Mental health Inpatient days: Provincial Sector Code Primary Account codes 712* Secondary Account Type Secondary Account Codes 1* (Excluding ) S , * 2014/15 H-SAA Technical Specifications Page 105

106 ADDITIONAL INFORMATION GEOGRAPHY & TIMING TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING The OHRS is populated by the Ontario Healthcare Financial and Statistical database (OHFS) which are available in Quarter (Q) 2, Q3 and year-end (YE). Data are available at the hospital level Data are available from the 1994/95 fiscal year Currently, no information has been provided The methodology updates for this indicator is based on the Healthcare Indicator Tool (HIT). Health Data Branch DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 106

107 DENOMINATOR NUMERATOR INDICATOR NAME INPATIENT REHABILITATION DAYS Detailed description of indicator Number of inpatient days in designated rehabilitation beds PERFORMANCE STANDARD Target: To be determined based on negotiations with hospitals Corridor: Hospital Rehabilitation Inpatient Days Corridor floor <10,000 85% 10,001 20,000 90% >20,000 94% The total number of inpatient days in designated rehabilitation beds Ontario Healthcare Financial and Statistical Database (OHFS) Includes: Reported in the OHFS as rehabilitation inpatient days: Provincial Sector Code Primary Accounts Secondary Account Type Secondary Accounts 1* 712* S 40312* 2014/15 H-SAA Technical Specifications Page 107

108 ADDITIONAL INFORMATION GEOGRAPHY & TIMING TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING The OHRS is populated by the Ontario Healthcare Financial and Statistical database (OHFS) which are available in Quarter (Q) 2, Q3 and year-end (YE). Data are available at the hospital level Data are available from the 1994/1995 fiscal year Currently, no information has been provided OHFS DATE CREATED (YYYY-MM- DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 108

109 GEOGRAPHY & TIMING DENOMINATOR NUMERATOR INDICATOR DESCRIPTION INDICATOR NAME REHABILITATION SEPARATIONS Detailed description of indicator Number of inpatient days in designated rehabilitation beds The total number of rehab separations in designated rehabilitation beds Ontario Healthcare Financial and Statistical Database (OHFS) Includes: Reported in the OHFS as Rehabilitation Inpatient Discharges (including deaths): Provincial Sector Code Primary Accounts Secondary Account Type Secondary Accounts 1* 712* S 41012*, 41112* TIMING/FREQUENCY OF RELEASE How often, and when, are data being released E.g. Be as specific as possible..data are released annually in mid- May The OHRS is populated by the Ontario Healthcare Financial and Statistical database (OHFS) which are available in Quarter (Q) 2, Q3 and year-end (YE). LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at the hospital level 2014/15 H-SAA Technical Specifications Page 109

110 ADDITIONAL INFORMATION TRENDING Years available for trending Data are available from the 1994/1995 fiscal year LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, RESPONSIBILITY FOR REPORTING Currently, no information has been provided Health Data Branch DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) /15 H-SAA Technical Specifications Page 110

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