H-SAA MONITORING & ASSESSMENT PROCESS & OVERVIEW 2011/12 Q3

H-SAA MONITORING & ASSESSMENT PROCESS & OVERVIEW 2011/12 Q3

H SAA MONITORING & ASSESSMENT PROCESS & OVERVIEW The Hospital Service Accountability Agreement has been developed to enable users in how best to gauge & determine the current status of each public hospital within Central East LHIN in accordance with established priorities and strategies. This will facilitate individual Hospital reviews that will be conducted for each reporting period (fiscal quarters & Year End). The primary objectives are: 1. Assessment of performance (all domains/quadrants for designated performance requirement/obligations): a. Meeting negotiated targets/performance standards/corridors, b. Comparison of actuals vs budget and; c. Funding reconciliation; ***As defined per accountability agreements; 2. Identification of emerging issues/pressures/risks as well as status, both at the organization level and how this impacts at the system level (facilitating quick assessment of current status for further analysis if required). 3. Work collaboratively with each Hospital and other internal/external stakeholders in the development of innovative solutions to address and resolve identified issues where applicable. ***Dialogue and subsequent follow up where required and in accordance with the "Prioritization Framework" and principles contained within the H SAA (e.g. Performance Management and Improvement, Section 9.0). ***Development/Implementation of recommended solutions and outcome assessments going forward (analysis of impact). Alignment with CE LHIN priorities and strategies as well as provincially mandated priorities and strategies. The key mandate is to develop a better understanding of each Hospital's performance for each indicator in each quadrant as well as in relation to the pressures they are facing and how this is impacting at various levels. ***Supplementary reports will be developed and revised as needed/required to ensure flexibility and responsiveness to successfully meet current and future commitments (e.g. Peer Comparison Report). Note : The data displayed is primarily sourced from each Hospital s Hospital Annual Planning Submission (2008), Quarterly Reports via the Web Enabled Reporting System (WERS) & 2008 10 Hospital Signed Accountability Agreement (H SAA) Schedule D. Other data sources includes, Planning Decision Support Tool (PDST), Healthcare Indicator Tool (HIT), CIHI, etc. Page 2 of 12

x Total Margin 2008-12 Hospital Service Accountability Agreement 2011/12 Q3 LHIN - Financial/Volume/Surgical & DI Wait Times Current Ratio Total Weighted Cases (Inpatient & Day Surgery) OSMHS % Surplus/Deficit of LHIN Base Allocation OSMHS Current Ratio OSMHS Total Weighted Cases (Inpatient & Day Surgery) OSMHS OSMHS OSMHS Performance Comments [YE Total Margin] Performance Comments [Current Ratio] Performance Comments [Total Wtd Cases] All CE LHIN hospitals have reported in their forecast to balance at 2011/12 YE. 8 out of 9 CE LHIN hospitals have reported in their forecast to be above their lower H-SAA corridors except CMH which is lower by 0.04 (not material). All CE LHIN hospitals have reported in their forecast to be above their lower H-SAA corridors for Total Weighted Cases (Inpatient & Day surgery) at 2011/12 YE. Mental Health Patient Days [PD] CCC Weighted Patient Days & Rehab [PD] Ambulatory Care Visits [excl. ER] OSMHS Mental Health Patient Days [PD] OSMHS CCC Weighted Patient Days Rehab [PD] CCC Weighted Patient Days & Rehab [PD] OSMHS Ambulatory Care Visits [excl. ER] OSMHS CMH RMH CCC PRHC Weighted HHHS Patient Days NHH LH RVHS Rehab [PD] TSH OSMHS OSMHS Performance Commentary [MH PD] Performance Comments [Rehab, CCC Wtd PD] Performance Comments [Amb. Care Visits] All CE LHIN hospitals have reported in their forecast to be above their lower H-SAA corridors for Mental Health Patient Days at 2011/12 YE. All CE LHIN hospitals have reported in their forecast to be above their lower H-SAA corridors for CCC Weighted Patient Days & Rehab Patient Days at 2011/12 YE. All CE LHIN hospitals have reported in their forecast to be above their lower H-SAA corridors for Ambulatory Care Visits (exclude ER) at 2011/12 YE. 90th Percentile Wait Time Cancer Surgery 90th Percentile Wait Time Cataract Surgery 90th Percentile Wait Time Hip Relacement % Above/BelowPerformance Standard Cancer Surgery % Above/BelowPerformance Standard Cataract Surgery % Above/BelowPerformance Standard Hip Relacement Performance Comments [Cancer Surgery] Performance Comments [Cataract Surgery] Performance Comments [Hip & Knee Replacement Surgery] All CE LHIN hospitals are lower than their upper H-SAA corridors in Q3. 5 out of 6 CE LHIN hospitals are below their upper H-SAA corridors in Q3, with PRHC above its H-SAA upper corridor by 14 days, which is mainly due to two weeks operating room closure in December 2011. With the hiring of a new surgeon in November, PRHC expects to lower its cataract wait times and meet the H-SAA target by 2011/12 Q4. In addition, CE LHIN is funding 801 more procedures at TSH, which will help with wait times reduction in the CE LHIN. All CE LHIN hospitals are below their upper H-SAA corridors in Q3. 90th Percentile Wait Time Knee Relacement 90th Percentile Wait Time CT 90th Percentile Wait Time MRI 90th Percentile Wait Time Knee Relacement 90th Percentile Wait Time CT 90th Percentile Wait Time MRI Performance Comments [CT & MRI] 3 out of 5 CE LHIN hospitals are below their upper H-SAA corridors in Q3, with PRHC (above its H-SAA upper corridor by 6 days as surgeons are tapering off since PRHC is nearing its incremental funded volumes) and TSH by 12 days. In overall terms, we expect that the LHIN will meet the 179 days MLPA target in Q4. Performance Comments [Average Length of Stay] Performance Comments [% of Patients Discharged Home ] 4 out of 6 CE LHIN hospitals are below their upper H-SAA corridors in Q3, with NHH above its upper corridor by 8 days and LHC by 50 days due to increasing in referrals. All CE LHIN hospitals are below their upper H-SAA corridors in Q3. \ Initiatives that are improving wait time performance: Data quality improvement and in-house education; A replacement MRI machine at LH and two new MRI machines (in TSH and RVHS); $1.4 M in LHIN funding to purchase additional MRI volumes; $20k for each hospital to improve data quality; Plan for use of standard best practices at each of our hospitals; With these measures, even though the LHIN will not be able to achieve the Ministry set target of 63 days, improvements to the current performance of 96 days are expected in Q4. Page 3 of 12

2008-11 Hospital Service Accountability Agreement 2011/12 Q3 LHIN - ED/ALC & Related Indicators 90th Percentile ER LOS for Admitted Patients 90th Percentile ER LOS for Non Admitted Patients Complex 90th Percentile ER LOS for Non Admitted Patients Minor 90th Percentile ER LOS for Admitted Patients 90th Percentile ER LOS for Non Admitted Patients Complex 90th Percentile ER LOS for Non Admitted Patients Minor Performance Comments [ER LOS - Admitted] Performance Comments [ER LOS - Non Admitted - Complex] Performance Comments [ER LOS - Non Admitted - Minor] Das Most hospitals are meeting their targets. The 2 worst performers, LHO and RVAP, while not meeting their targets, have improved over last year's baseline, LHO substantially. RVAP opened a 10-bed Short Stay Unit in January to increase capacity to manage Admitted patient pressures. The only hospital that has worsened is NHH which remains one of the best performing hospitals in the LHIN and in the Province when compared against standard rather than against their own previous performance. Most Central East LHIN hospitals are struggling with this measure. The Provincial standard for nonadmitted CTAS IV-V patients is 4 hours and only 3 hospitals, LHB, LHPP and RVAP, are consistently All but four hospitals are already meeting their targets. These 4 (LHO, NHH, PRHC, and RMH) have all increased their 90th percentile ED length of stay in this patient cohort over last year, and both LHO meeting this standard. The highest ED LOS in the LHIN for this patient cohort is LHO at 4.87 hours. and PRHC have performance longer than the provincial standard of 7 hours. P4R-designated hospitals P4R-designated hospitals are implementing initiatives to decrease time to Physician Initial Assessment are implementing various initiatives expected to improve performance in all patient cohorts. (PIA), the strongest contributor to length of stay for low acuity patients. Hospitals are expected to achieve or approach targets by March. ALC LTC Volume Repeat Unplanned Emergency Visits within 30 days MH Q4 2010 11 Repeat Unplanned Emergency Visits within 30 days SA Q4 2010 11 ALC LTC Volume Repeat Unplanned Emergency Visits within 30 days MH Repeat Unplanned Emergency Visits within 30 days SA Performance Comments [ALC - LTC Volume] Lakeridge Health Oshawa and PRCH have the largest number of ALC-LTC in Q3 2011-12 (Source CECCAC). WTIS data via iport makes much more meaningful and actionable information available to hospitals and to LHIN s. We are recommending selection of a different indicator that a) reflects open cases, b) focuses on beds rather than on days, and c) does not distinguish between acute and post-acute beds. Performance Comments [Repeat Unplanned Emergency Visits within 30 days - MH] Repeat unplanned Emergency visits within 30 days for Mental Health has increased from Q3 and from last year. It has been noted that there has been an increase in high acuity MH at Lakeridge Health Oshawa with no rationale noted. It is expected that the rate will be reduced in Q1 2011-12. \ Performance Comments [Repeat Unplanned Emergency Visits within 30 days - SA] Das hbo Although the rate for Repeat unplanned Emergency visits for Substance Abuse has increased, Central East LHIN performance is below the provincial rate. Strategies for providing Concurrent Disorder Services has been implemented across CE LHIN. Readmission within 30 days for Selected CMGs CMG 1 Q4 2010 11 Readmission within 30 days for Selected CMGs CMG 2 Q4 2010 11 Hospitals CMG 1 CMG 2 CMH CHF COPD Readmission within 30 days for Selected CMGs CMG 1 Readmission within 30 days for Selected CMGs CMG 2 Selected CMG by Hospital RMH PRHC NHH LHC CHF CHF COPD CHF Diabetes COPD Pneumonia COPD Performance Comments [CMG 1] Performance Comments [CMG 2] Each Hospital has identified two CMGs on which to focus their QI initiatives related to reducing 30 day Readmisisons. Hospitals have chosen CHF, COPD, Diabetes or Pneumonia. 30 day Readmit is relatively new MLPA indicator - thus only recently became a focus for hospitals. There were no specific readmisison initiatives in place in 2009/10 - during this timeframe the key focus of hospitals has been on work of the Flow Collaboratives and ED Process Improvement. RVHS TSH CHF CHF COPD COPD Page 4 of 12

x Total Margin 2008-12 Hospital Service Accountability Agreement 2011/12 Q3 LHIN - Financial/Volume Current Ratio Total Weighted Cases (Inpatient & Day Surgery) OSMHS OSMHS OSMHS % Surplus/Deficit of LHIN Base Allocation Current Ratio Total Weighted Cases (Inpatient & Day Surgery) OSMHS OSMHS OSMHS Performance Comments [YE Total Performance Comments [Current Performance Comments [Total Wtd Margin] Ratio] Cases] All CE LHIN hospitals have reported in their forecast to balance at 2011/12 YE. A hospital's Current Ratio is an indicator of the financial health of the organization. This measure indicates a Hospital's ability to currently and prospectively sustain their organization based on their "financial holdings or assets". 8 out of 9 CE LHIN hospitals have reported in their forecast to be within their H-SAA corridors except CMH which is lower by 0.04 (not material). Total weighted cases (Inpatient & Day Surgery) are OR Cases with weights applied (e.g. case-mix, resource utilization, etc.). All CE LHIN hospitals have reported in their forecast to be within their H-SAA corridors for Total Weighted Cases (Inpatient & Day surgery) at 2011/12 YE. Page 5 of 12

Mental Health Patient Days [PD] 2008-12 Hospital Service Accountability Agreement 2011/12 Q3 LHIN - Volume CCC Weighted Patient Days & Rehab [PD] Ambulatory Care Visits [excl. ER] OSMHS CCC Weighted Patient Days Rehab [PD] OSMHS Mental Health Patient Days [PD] CCC Weighted Patient Days & Rehab [PD] Ambulatory Care Visits [excl. ER] OSMHS CCC Weighted Patient Days Rehab [PD] OSMHS Performance Commentary [MH PD] Performance Comments [Rehab, CCC Wtd Performance Comments [Amb. Care Visits] PD] This indicator measures the MH Patient days within a given reporting period (regardless of bed designation). All CE LHIN hospitals have reported in their forecast to be within their H-SAA corridors for Mental Health Patient Days at 2011/12 YE. This indicators measures Rehab Patient Days & CCC Weighted Patient days. 5 Hospitals within CE LHIN currently provide CCC services (RMH, PRHC, NHH, LHC & RVHS). 6 Hospitals provide Rehab Services (RMH, PRHC, NHH, LHC, RVHS & TSH). All CE LHIN hospitals have reported in their forecast to be within their H-SAA corridors for CCC Weighted Patient Days & Rehab Patient Days at 2011/12 YE. Total Outpatient visits (excluding Day/Night Care Surgical Procedures OR/PARR & Endoscopy) within a given reporting period. All CE LHIN hospitals have reported in their forecast to be within their H-SAA corridors for Ambulatory Care Visits (exclude ER) at 2011/12 YE. Page 6 of 12

90th Percentile Wait Time Cancer Surgery 2008-12 Hospital Service Accountability Agreement 2011/12 Q3 LHIN - Surgical & DI Wait Times 90th Percentile Wait Time Cataract Surgery 90th Percentile Wait Time Hip Relacement Cancer Surgery Cataract Surgery Hip Relacement Performance Comments [Cancer] Performance Comments [Cataracts] Performance Comments [Hips] All CE LHIN hospitals are lower than their upper H-SAA corridors in Q3. 5 out of 6 CE LHIN hospitals are below their upper H-SAA corridors in Q3, with PRHC above its H-SAA upper corridor by 14 days, which is mainly due to two weeks operating room closure in December 2011. With the hiring of a new surgeon in November, PRHC expects to lower its cataract wait times and meet the H-SAA target by 2011/12 Q4. In addition, CE LHIN is funding 801 more procedures at TSH, which will help with wait times reduction in the CE LHIN. All CE LHIN hospitals are below their upper H-SAA corridors in Q3. Page 7 of 12

90th Percentile Wait Time Knee Relacement 2008-12 Hospital Service Accountability Agreement 2011/12 Q3 LHIN - Surgical & DI Wait Times 90th Percentile Wait Time CT 90th Percentile Wait Time MRI 90th Percentile Wait Time Knee Relacement 90th Percentile Wait Time CT 90th Percentile Wait Time MRI Dashboar Performance Comments [Knees] Performance Comments [CT] Performance Comments [MRI] d 4 out of 6 CE LHIN hospitals are below their upper H-SAA corridors in Q3, with NHH above its upper corridor by 8 days and LHC by 50 days due to increasing in referrals. 3 out of 5 CE LHIN hospitals are below their upper H-SAA corridors in Q3, with PRHC (above its H-SAA upper corridor by 6 days as surgeons are tapering off since PRHC is nearing its incremental funded volumes) and TSH by 12 days. In overall terms, we expect that the LHIN will meet the 179 days MLPA target in Q4. All CE LHIN hospitals are below their upper H-SAA corridors in Q3. Initiatives that are improving wait time performance: Data quality improvement and in-house education; A replacement MRI machine at LH and two new MRI machines (in TSH and RVHS); $1.4 M in LHIN funding to purchase additional MRI volumes; $20k for each hospital to improve data quality; Plan for use of standard best practices at each of our hospitals; With these measures, even though the LHIN will not be able to achieve the Ministry set target of 63 days, improvements to the current performance of 96 days are expected in Q4. Page 8 of 12

90th Percentile ER LOS for Admitted Patients 2008-11 Hospital Service Accountability Agreement 2011/12 Q3 LHIN - ED LOS 90th Percentile ER LOS for Non Admitted Patients Complex 90th Percentile ER LOS for Non Admitted Patients Minor 90th Percentile ER LOS for Admitted Patients 90th Percentile ER LOS for Non Admitted Patients Complex 90th Percentile ER LOS for Non Admitted Patients Minor Performance Comments [ER LOS- Admitted] Performance Comments [ER LOS-Non- Performance Comments [ER LOS-Non- Admitted-Complex] Admitted-Minor] Most hospitals are meeting their targets. The 2 worst performers, LHO and RVAP, while not meeting their targets, have improved over last year's baseline, LHO substantially. RVAP opened a 10-bed Short Stay Unit in January to increase capacity to manage Admitted patient pressures. The only hospital that has worsened is NHH which remains one of the best performing hospitals in the LHIN and in the Province when compared against standard rather than against their own previous performance. All but four hospitals are already meeting their targets. These 4 (LHO, NHH, PRHC, and RMH) have all increased their 90th percentile ED length of stay in this patient cohort over last year, and both LHO and PRHC have performance longer than the provincial standard of 7 hours. P4R-designated hospitals are implementing various initiatives expected to improve performance in all patient cohorts. Most Central East LHIN hospitals are struggling with this measure. The Provincial standard for non-admitted CTAS IV-V patients is 4 hours and only 3 hospitals, LHB, LHPP and RVAP, are consistently meeting this standard. The highest ED LOS in the LHIN for this patient cohort is LHO at 4.87 hours. P4R-designated hospitals are implementing initiatives to decrease time to Physician Initial Assessment (PIA), the strongest contributor to length of stay for low acuity patients. Hospitals are expected to achieve or approach targets by March. Page 9 of 12

ALC LTC Volume 2008-11 Hospital Service Accountability Agreement 2011/12 Q3 LHIN - ALC, Mental Health & Substance Abuse Repeat Unplanned Emergency Visits within 30 days MH Repeat Unplanned Emergency Visits within 30 days SA ALC LTC Volume Repeat Unplanned Emergency Visits within 30 days MH Repeat Unplanned Emergency Visits within 30 days SA Performance Comments Performance Comments Performance Comments Lakeridge Health Oshawa and PRCH have the largest number of ALC-LTC in Q3 2011-12 (Source CECCAC). WTIS data via iport makes much more meaningful and actionable information available to hospitals and to LHIN s. We are recommending selection of a different indicator that a) reflects open cases, b) focuses on beds rather than on days, and c) does not distinguish between acute and post-acute beds. Repeat unplanned Emergency visits within 30 days for Mental Health has increased from Q3 and from last year. It has been noted that there has been an increase in high acuity MH at Lakeridge Health Oshawa with no rationale noted. It is expected that the rate will be reduced in Q1 2011-12. Although the rate for Repeat unplanned Emergency visits for Substance Abuse has increased, Central East LHIN performance is below the provincial rate. Strategies for providing Concurrent Disorder Services has been implemented across CE LHIN. Page 10 of 12

2008-11 Hospital Service Accountability Agreement 2011/12 Q3 LHIN - Selected CMG Readmission within 30 days for Selected CMGs CMG 1 Readmission within 30 days for Selected CMGs CMG 2 Hospitals CMG 1 CMG 2 CMH CHF COPD RMH CHF Diabetes Readmission within 30 days for Selected CMGs CMG 1 Readmission within 30 days for Selected CMGs CMG 2 Selected CMG by Hospital PRHC CHF COPD NHH COPD Pneumonia LHC CHF COPD RVHS CHF COPD TSH CHF COPD Performance Comments Performance Comments Each Hospital has identified two CMGs on which to focus their QI initiatives related to reducing 30 day Readmisisons. Hospitals have chosen CHF, COPD, Diabetes or Pneumonia. 30 day Readmit is relatively new MLPA indicator - thus only recently became a focus for hospitals. There were no specific readmisison initiatives in place in 2009/10 - during this timeframe the key focus of hospitals has been on work of the Flow Collaboratives and ED Process Improvement. Page 11 of 12

H SAA Indicator Name Financial Year End Total Margin Current Ratio Volumes Total Wtd Cases (Inpatient & Day Surgery) Mental Health Patient Days Rehab Patient Days CCC Weighted Patient Days Ambulatory Visits [excl. ER] Wait Time Services 90th Percentile Wait Times Cancer Surgeries Cataract Surgeries Total Hip & Knee Replacements Computed Tomography (CT) Magnetic Resonance Imaging (MRI) ER & ALC ER Length of Stay for Admitted Patients ER Length of Stay for Non Admitted Complex ER Length of Stay for Non admitted Minor ALC LTC Volume H SAA Indicator Definition Corporate revenues that are over/under corporate expenses (certain exclusions apply to both such as Interdepartmental recoveries/expenses, etc to either numerator/denominator). Measure of liquidity that denotes an organization's capacity to meet their short term obligations Total weighted cases (Inpatient & Day Surgery Services) are Operating Room (OR) Cases with weights applied (e.g. case mix groups, resource utilization, etc.) Number of Mental Health patient days reported within a given reporting period (number of days a patient is admitted and occupying a Mental Health bed within a designated unit before discharge from the organization). Number of Rehabilitation patient days reported within a given reporting period (number of days a patient is admitted and occupying a Rehabilitation bed within a designated unit before discharge from the organization). Number of Complex Continuing Care patient days reported within a given reporting period (number of days a patient is admitted and occupying a CCC bed within a designated unit before discharge from the organization). Number of visits (scheduled, non scheduled) that are reported within an organization's clinics & non surgical Day/Night Care units/functional centres (excluding Emergency Room Department visits) in a given reporting period. The time between a patient s and surgeon s decision to proceed with surgery, and the time the procedure is conducted. The 90th percentile is the point at which 90% of the patients received their treatment while the other 10% waited longer. The time between a patient s and surgeon s decision to proceed with surgery, and the time the procedure is conducted. The 90th percentile is the point at which 90% of the patients received their treatment while the other 10% waited longer. The time between a patient s and surgeon s decision to proceed with surgery, and the time the procedure is conducted. The 90th percentile is the point at which 90% of the patients received their treatment while the other 10% waited longer. This indicator measures the wait time from when a diagnostic scan is ordered, until the time the actual exam is conducted. This interval is typically referred to as intent to treat. This indicator measures the wait time from when a diagnostic scan is ordered, until the time the actual exam is conducted. This interval is typically referred to as intent to treat. 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. The total emergency room (ER) length of stay (LOS) where 9 out of 10 non admitted 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. The total emergency room (ER) length of stay (LOS) where 9 out of 10 non admitted 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. Patients occupying an inpatient hospital bed for whom a physician (or designated other) has indicated that the acute care phase of treatment has ended, and the patient has been designated by the CCAC as ALC for Long Term Care (ALC LTC). Hospitals are being measured on the total volume of patients designated ALC LTC (by hospital corporation). Repeat Unplanned Emergency Visits within 30 days Repeat Unplanned Emergency Visits Within 30 Days for Mental Health Conditions Repeat Unplanned Emergency Visits Within 30 Days for Substance Abuse Conditions Percent of unplanned and unscheduled repeat emergency visits following an emergency visit for a mental health or 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 condition or substance abuse condition). Percent of unplanned and unscheduled repeat emergency visits following an emergency visit for a substance abuse 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 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). Repeat Unplanned Emergency Visits within 30 days Readmission Within 30 Days For Selected CMGs Cardiovascular: Stroke Age greater than or equal to age 45: 1. Hemorrhagic Event of Central Nervous System; 2. Unspecified Stroke COPD: 1. Chronic Obstructive Pulmonary Disease (greater than or equal to age 45) Pneumonia (All Ages): 1. Bacterial Pneumonia; 2. Viral/Unspecified Pneumonia; 3. Disease or Pleura Diabetes (All Ages): 1. Diabetes; Congestive Heart Failure (ages greater than or equal to 45); 1. Heart Failure without Cardiac Catheter; Cardiac CMGs (Ages greater than or equal to 40): 1. Arrhythmia without Cardiac Catheter; 2. Unstable Angina/Atherosclerotic Heart Disease without Cardiac Catheter; 3. Angina (except Unstable/Chest Pain without Cardiac Catheter Gastrointestinal CMGs (All Ages): 1. Minor Upper Gastrointestinal Intervention; 2. Severe Enteritis; 3. Complicated Ulcer; 4. Inflammatory Bowel Disease; 5. Gastrointestinal Haemorrhage; 6. Gastrointestinal Obstruction; 7. Esophagitis/Gastritis/Miscellaneous Digestive Disease; 8. Symptoms. Signs of Digestive System; 9. Other Gastrointestinal Disorder; 10. Cirrhosis/Alcoholic Hepatitis; 11. Liver Disease except Cirrhosis/Malignancy; 12. Disorder of Pancreas except Malignancy; 13. Disorder of Biliary Track Page 12 of 12