Acute Care Utilization Report

Information Management A System We Can Count On Acute Care Utilization Report South East LHIN Health System Intelligence Project March 2006

Table of Contents About HSIP................................... ii Introduction................................. iii Section 1 Total Separations and Level of Care............ 1 1.1 South East Hospitals........................ 2 1.2 South East Residents....................... 3 Section 2 Acute Separations............................. 7 2.1 South East Hospitals....................... 7 2.2 South East Residents....................... 8 Section 3 Mental Health................................. 9 3.1 South East Hospitals....................... 9 3.2 South East Residents...................... 10 Section 4 Alternate Level of Care (ALC)................ 11 4.1 South East Hospitals...................... 11 4.2 South East Residents...................... 13 Glossary..................................... 16 References................................... 17 Page i

About HSIP The Health System Intelligence Project (HSIP) This report is produced by the Health System Intelligence Project. HSIP consists of a team of health system experts retained by the Ministry of Health and Long- Term Care s (MOHLTC) Health Results Team for Information Management (HRT-IM) to provide the Local Health Integration Networks (LHINs) with: Sophisticated data analysis; Interpretation of results; Orientation of new staff to health system data analysis issues; and Training on new techniques and technologies pertaining to health system analysis. Report Authors: Linda Baigent, HSIP Stephanie Loomer, HSIP Jennifer Sarkella, HSIP (Project Lead) Dave Zago, HSIP Contributors: Carley Hay, HSIP Paul Lee, HSIP Marc Lefebvre, HSIP For further information, please contact: hrtim@moh.gov.on.ca HSIP was created as part of the Ontario government's Information Management Strategy. HSIP is designed to complement and augment the existing analytical capacity within the MOHLTC. The project team is working in concert with MOHLTC analysts to ensure that the LHINs are provided with the analytical supports they need for their local health system planning activities. Page ii

Introduction Identification and understanding of patterns of health care utilization are essential for health care planning. There are two aspects of utilization that should be considered for local planning. The first is the activity of local providers, which gives a measure of local capacity what do local hospitals or agencies provide and to whom? The second aspect is utilization of provincial services by local residents where do residents go to obtain care? Although residents are generally served by local facilities, they can and are sometimes required to seek health care services outside their area of residence. Knowledge of both perspectives allows for the development of local strategies to meet the health service needs of area residents. The examination of acute care hospital use is a key component in the analysis of health care utilization patterns. Acute care refers to short-term, intensive inpatient care for serious health problems involving a variety of medical and surgical services. Patterns of acute inpatient utilization are influenced by a broad range of factors including system capacity, the availability of physicians and community services, and the age structure, health and socio-economic status of the population. These factors should all be considered when interpreting utilization patterns and planning for services. Methods This report describes key aspects of acute care hospitalization in fiscal year 2004/05 for both hospitals and residents within the South East Local Health Integration Network (LHIN), hereafter referred to as South East. This information will be valuable for those involved in planning within the health care system, as well as for those monitoring the health service needs of the population. The analysis is divided into four sections: 1. Total separations and level of care (primary, secondary, tertiary/quaternary). 2. Acute care excluding mental health. 3. Acute mental health care. 4. Alternate level of care stays. A separation is a completed case treated in a hospital resulting in any of the following: discharge home, transfer to another facility, death, or patient sign out. Separations refer to the activity completed per facility so patients transferred for further care to other acute facilities will result in multiple separations. Days of stay within acute care beds are classified as either acute or Highlights South East hospitals primarily served South East residents (93.9% of separations), and the majority of separations for South East residents were from South East hospitals (89.1%). The proportion of non-residents served by South East hospitals increased as complexity of care increased. Non-residents represented 3.8% of primary, 7.1% of secondary, and 11.2% of tertiary/quaternary separations from South East hospitals. Relative to Ontario residents, South East residents had significantly higher age-standardized separation rates for acute care (excluding mental health) and the tertiary/quaternary level of care category. The average length of stay in alternate level of care in South East hospitals was 8.5 days longer than such stays in Ontario hospitals. Introduction Page iii

alternate level of care (ALC), the latter of which refers to patients who have completed the acute care phase of their treatment but remain in an acute care facility while awaiting placement elsewhere 1. Each section in this report describes the activity in South East hospitals with comparisons to Ontario hospitals, followed by the hospital utilization of South East residents (regardless of where they were hospitalized within Ontario) with comparisons to that of Ontario residents. These data exclude newborns and stillborns, so as to avoid double counting of mothers and babies. Figures for Ontario residents include those with an unknown LHIN of residence, where assignment to a LHIN was not possible due to insufficient geographic information. Ontario numbers are included to provide context but should not necessarily be considered the ideal or target. report primarily reflect those provided by this database. It should be noted that some multi-site hospital corporations report their inpatient data by individual site while others report their data together. The South East LHIN South East is home to 481,092 people, which accounts for 3.9% of the population of the province of Ontario as a whole 3. South East consists of the Counties of Hastings, Prince Edward, Frontenac, and Lennox & Addington, as well as portions of Lanark County, Leeds & Grenville United Counties, and Northumberland County. Geographic names that appear in the tables refer only to the portions of the particular areas that are contained within the South East LHIN. At the end of the 2004/05 fiscal year, there were 913 acute care beds in operation in South East facilities; of these 70 were psychiatry beds 4. The data included in this report were obtained from the Inpatient Discharges section of the Ontario Ministry of Health and Long-Term Care s (MOHLTC) Provincial Health Planning Database 2. As this database only includes data for Ontario facilities, hospitalizations of South East residents that occurred in other provinces or countries are not included. Hospital names in this Page iv Introduction

Section 1 Total Separations and Level of Care This section describes the total separations and days from acute care facilities along with the complexity or level of care provided during these stays. Level of care is a method of categorizing acute inpatient hospital activity based on the degree of medical and technological specialization required. Acute hospital separations can be grouped into Case Mix Groups (CMG TM ), a methodology that aggregates hospital inpatients with similar diagnoses and treatment requirements 5. Levels of care are aggregations of CMGs and CMG complexity age category combinations. Assignment of level of care in this report is based on the Hay Level of Care Methodology 2002/03 version 6, which has been adopted by the Joint Policy and Planning Committee (JPPC) for use in the acute care portion of the hospital funding model. In the development of this methodology, the Hay Group considered issues including the number and distribution of cases, inflow/outflow patterns, the critical mass necessary for optimal outcomes, and the relative cost of providing care for each CMG and age category. The levels reflect differences in the acute average length of stay (ALOS) and the cost and complexity of treatment 5,7. There are three categories that define level of care 7,8. Primary care can be provided in any hospital setting by general practitioners or specialists. Secondary care includes surgical and other procedures provided by medical specialists, usually in larger community hospitals. Tertiary and quaternary separations involve highly specialized, costly care provided to seriously ill patients, most often in larger regional referral centres or teaching hospitals. Table 1: Total Separations by Level of Care, South East & Ontario Hospitals, 2004/05 Hospitals Primary Secondary Tertiary/Quaternary Total # % # % # % # Frontenac Hotel Dieu 305 32.0 632 66.3 16 1.7 953 Kingston General 5,949 34.6 7,127 41.5 4,111 23.9 17,187 Hastings Quinte Healthcare (QHC)-Belleville General 4,404 49.7 4,115 46.4 342 3.9 8,861 QHC-North Hastings 228 66.1 116 33.6 -- -- 345 QHC-Trenton Memorial 1,089 58.9 742 40.1 18 1.0 1,849 Lanark Perth & Smiths Falls District-Perth Site 587 42.0 723 51.8 87 6.2 1,397 Perth & Smiths Falls District-Smiths Falls Site 1,156 63.2 657 35.9 17 0.9 1,830 Leeds & Grenville Brockville General 2,433 53.7 1,997 44.1 99 2.2 4,529 Lennox & Addington Lennox & Addington County General 830 65.5 421 33.2 16 1.3 1,267 Prince Edward QHC-Prince Edward County Memorial 1,075 72.5 401 27.0 7 0.5 1,483 Total South East 18,056 45.5 16,931 42.6 4,714 11.9 39,701 Ontario 459,234 45.8 435,297 43.4 107,802 10.8 1,002,333 Cell count suppressed due to small numbers (<5 separations). Section 1: Total Separations and Level of Care Page 1

1.1 South East Hospitals There were 39,701 total separations and 280,237 total patient days from acute hospitals in South East in 2004/05. These numbers represented 4.0% of the total separations and 4.4% of the total days from acute care beds within all Ontario hospitals. In South East hospitals, 45.5% of separations were primary, 42.6% were secondary, and 11.9% were tertiary/quaternary (see Table 1). On average, South East hospitals had a greater proportion of tertiary/ quaternary separations compared to Ontario hospitals (10.8%). Volumes from South East hospitals represented 3.9% of primary, 3.9% of secondary, and 4.4% of tertiary/ quaternary separations from Ontario hospitals. The vast majority of separations from South East hospitals (93.9%) were by South East residents. The next most common areas of patient origin for separations from South East hospitals were the Central East (2.9%) and Champlain (1.8%) LHINs. The proportion of nonresidents served by South East hospitals increased as complexity of care increased. Non-residents represented 3.8% of primary, 7.1% of secondary, and 11.2% of tertiary/ quaternary separations from South East hospitals. Following South East, the next most common areas of patient origin for tertiary/quaternary separations from South East hospitals were the Central East (7.5%) and Champlain (2.0%) LHINs. Program Cluster Categories (PCCs) consist of CMGs aggregated into 30 broad programs and provide a means to analyze groups of patients by the types of services received 9. Figure 1 shows the top ten PCCs (based on separations) in South East hospitals. Although obstetrics accounted for the largest proportion of separations (12.1%), it had the shortest ALOS (2.6 days) among the top ten categories in South East hospitals. This category also represented a smaller proportion of separations in South East hospitals compared to Ontario hospitals (15.6%). Psychiatry accounted for only 5.2% of separations yet had the longest ALOS (12.3 days) within the leading categories in South East hospitals. Figure 1: Leading Program Cluster Categories (PCCs) as a Proportion of Separations, South East & Ontario Hospitals, 2004/05 Obstetrics 12.1 15.6 Cardiology 10.6 12.1 Program Cluster Category Pulmonary Gastro/Hepatobiliary Orthopaedics General Surgery General Medicine Cardio/Thoracic 3.9 9.1 7.6 8.2 7.9 7.5 6.1 6.7 8.5 5.9 5.9 5.5 South East Hospitals Ontario Hospitals Trauma 5.4 4.7 Psychiatry 5.2 5.8 0 2 4 6 8 10 12 14 16 18 % of Separations Page 2 Section 1: Total Separations and Level of Care

1.2 South East Residents South East residents had 41,847 total separations (from all Ontario hospitals) which accounted for 294,194 total days. These figures represented 4.2% of total separations and 4.6% of total days for Ontario residents. For South East residents, 44.4% of separations were primary, 42.8% were secondary, and 12.7% were tertiary/quaternary, as shown in Table 2. South East residents had a greater proportion of tertiary/quaternary separations compared to Ontario residents (10.7%). Table 2: Total Separations by Level of Care, by Area of Residence, South East & Ontario Residents, 2004/05 Area of Residence Primary Secondary Tertiary/Quaternary Total # % # % # % # Frontenac 4,471 41.5 4,650 43.1 1,659 15.4 10,780 Hastings 5,648 45.7 5,288 42.8 1,410 11.4 12,346 Lanark 1,359 43.2 1,391 44.3 393 12.5 3,143 Leeds & Grenville 3,754 45.9 3,481 42.6 940 11.5 8,175 Lennox & Addington 1,486 44.0 1,407 41.7 481 14.3 3,374 Northumberland 400 40.9 466 47.6 112 11.5 978 Prince Edward 1,475 48.3 1,236 40.5 340 11.1 3,051 Total South East 18,593 44.4 17,919 42.8 5,335 12.7 41,847 Ontario 455,262 45.9 430,779 43.4 105,910 10.7 991,951 Figure 2: Age-Standardized Total Separation Rates by LHIN of Residence, Ontario, 2004/05 Manitoba 14 Quebec Local Health Integration Networks 1 Erie St. Clair 2 South West 3 Waterloo Wellington 4 Hamilton Niagara Haldimand Brant 5 Central West 6 Mississauga Halton 7 Toronto Central 8 Central 9 Central East 10 South East 11 Champlain 12 North Simcoe Muskoka 13 North East 14 North West 13 13 Age- Standardized Total Acute Care Separation Rates per 1,000 Population 92.6-113.0 81.6-92.5 72.3-81.5 66.2-72.2 61.2-66.1 11 12 10 13 9 5 8 11 3 6 7 U.S.A. 2 12 9 5 8 3 7 6 4 10 U.S.A. 2 4 U.S.A. 1 1 0 100 200 300 0 50 100 150 km km Statistics Canada 2001 Cartographic Boundary Files. Section 1: Total Separations and Level of Care Page 3

South East residents accounted for 4.1% of primary, 4.2% of secondary and 5.0% of tertiary/quaternary separations for Ontario residents. The distribution of age-standardized total separation rates by LHIN of residence is shown in Figure 2. The overall age-standardized rate for South East residents was similar to that for Ontario residents, as were the rates for the primary and secondary level of care categories, see Table 3. However, the age-standardized rate for the tertiary/quaternary level of care category was significantly higher for South East residents compared to Ontario residents. Slightly more than 89% of South East residents separations were from South East hospitals. The next most common locations for South East residents separations were hospitals in the Champlain (5.2%) and Central East (2.2%) LHINs. As complexity of care increased, the proportion of South East residents separations that were provided in South East hospitals decreased. South East hospitals served 93.4% of South Table 3: Age-Standardized Total Separation Rates (95% Confidence Intervals) per 1,000 Population by Level of Care, South East & Ontario Residents, 2004/05 Level of Care South East Residents Ontario Residents Primary 36.8 (36.2-37.3) 36.7 (36.6-36.8) Secondary 31.8 (31.3-32.3) 32.4 (32.3-32.5) Tertiary/Quaternary 9.2 (8.9-9.4)* 7.9 (7.8-7.9) Total Separations 77.8 (77.0-78.5) 77.0 (76.8-77.1) *Significantly different from provincial average based on assessment of 95% confidence intervals. Page 4 Section 1: Total Separations and Level of Care

East residents primary, 87.8% of secondary, and 78.5% of tertiary/quaternary separations. Hospitals in the Champlain LHIN provided care to 11.4% of South East residents tertiary/quaternary separations, while hospitals in the Toronto Central LHIN provided care to 7.0%. smaller proportion of separations for South East residents compared to Ontario residents (15.6%). Psychiatry accounted for only 5.1% of South East residents separations but had the longest ALOS (12.6 days) among the top ten categories. The top ten PCCs for South East residents (based on separations) are shown in Figure 3. Within these categories, obstetrics accounted for 12.0% of separations yet had the shortest ALOS (2.6 days) for South East residents. This category also represented a Figure 3: Leading Program Cluster Categories (PCCs) as a Proportion of Separations, South East & Ontario Residents, 2004/05 Obstetrics 12.0 15.6 Cardiology 10.6 11.9 Pulmonary 7.6 9.0 Program Cluster Category Gastro/Hepatobiliary General Surgery Orthopaedics General Medicine Cardio/Thoracic 3.8 6.1 5.9 5.9 5.6 8.1 8.0 7.4 8.4 7.3 South East Residents Ontario Residents Trauma 5.1 4.6 Psychiatry 5.1 5.8 0 2 4 6 8 10 12 14 16 18 % of Separations Section 1: Total Separations and Level of Care Page 5

Page 6 Section 1: Total Separations and Level of Care

Section 2 Acute Separations This section focuses on the active treatment of conditions involving medical and/or surgical services provided during the acute care portion of the hospital stay, thus ALC days are not included. Mental health separations (psychiatry PCC) have also been excluded and will be covered in the following section. 2.1 South East Hospitals In 2004/05, there were 37,651 acute separations and 218,610 acute days from hospitals in South East, as shown in Table 4. These figures accounted for 4.0% of the acute separations and 4.2% of the acute days from Ontario hospitals. Overall, the acute ALOS in South East hospitals (5.8 days) was slightly longer than the acute ALOS in Ontario hospitals (5.5 days). The majority of acute separations from hospitals in South East (93.8%) were by South East residents. The Central East LHIN (2.9%) and Champlain LHIN (1.9%) were the next most common areas of patient origin for separations from South East hospitals. As previously mentioned, acute hospital separations can be grouped into CMGs. Each CMG is identified as either surgical or medical, based on the presence or absence of a surgical procedure during the hospital stay 5,10. South East hospitals had a similar proportion of medical separations (65.9%) and surgical separations (34.1%) compared to Ontario hospitals (65.8% and 34.2%, respectively). Separations from South East hospitals represented 4.0% of the medical as well as 4.0% of the surgical separations from Ontario hospitals. Table 4: Acute Separations, Days, & Average Length of Stay (ALOS), South East & Ontario Hospitals, 2004/05 Hospitals Acute Separations Days ALOS Frontenac Hotel Dieu 9 118 13.1 Kingston General 17,079 112,731 6.6 Hastings Quinte Healthcare (QHC)-Belleville General 8,198 34,595 4.2 QHC-North Hastings 330 1,977 6.0 QHC-Trenton Memorial 1,791 8,752 4.9 Lanark Perth & Smiths Falls District-Perth Site 1,352 9,996 7.4 Perth & Smiths Falls District-Smiths Falls Site 1,779 11,714 6.6 Leeds & Grenville Brockville General 4,468 24,717 5.5 Lennox & Addington Lennox & Addington County General 1,226 8,087 6.6 Prince Edward QHC-Prince Edward County Memorial 1,419 5,923 4.2 Total South East 37,651 218,610 5.8 Ontario 944,650 5,200,536 5.5 Section 2: Acute Separations Page 7

2.2 South East Residents In 2004/05, there were 39,722 acute separations and 230,718 acute days for South East residents (from all Ontario hospitals), as shown in Table 5. These separations accounted for 4.2% of the acute separations and 4.5% of the acute days for Ontario residents. The acute ALOS for South East residents (5.8 days) was slightly longer than the acute ALOS for Ontario residents (5.5 days). The age-standardized acute separation rate for South East residents was significantly higher than the rate for Ontario residents, as shown in Table 6. In addition, the crude acute day rate was 15.6% higher than the rate for Ontario residents. The majority of acute separations for residents of South East (88.9%) were from South East hospitals. The Champlain LHIN was the next most common location for residents hospitalizations (5.3%), followed by the Toronto Central and Central East LHINs (both at 2.2%). South East residents had a smaller proportion of medical (64.9%) and accordingly, a greater proportion of surgical (35.1%) separations compared to Ontario residents (65.8% and 34.2%, respectively). Separations for South East residents represented 4.2% of the medical and 4.4% of the surgical separations for Ontario residents. Table 5: Acute Separations, Days, & Average Length of Stay (ALOS), by Area of Residence, South East & Ontario Residents, 2004/05 Area of Residence Acute Separations Days ALOS Frontenac 9,970 64,027 6.4 Hastings 11,691 58,265 5.0 Lanark 3,035 22,048 7.3 Leeds & Grenville 8,001 47,327 5.9 Lennox & Addington 3,197 20,265 6.3 Northumberland 927 5,253 5.7 Prince Edward 2,901 13,533 4.7 Total South East 39,722 230,718 5.8 Ontario 934,669 5,142,030 5.5 Table 6: Age-Standardized Acute Separation Rates (95% Confidence Intervals) per 1,000 Population & Crude Acute Day Rates per 1,000 Population, South East & Ontario Residents, 2004/05 South East Residents Ontario Residents Age-Standardized Acute Separation Rate 73.4 (72.7-74.1)* 72.5 (72.3-72.6) Crude Acute Day Rate 479.6 414.9 *Significantly different from provincial average based on assessment of 95% confidence intervals. Page 8 Section 2: Acute Separations

Section 3 Mental Health Acute mental health separations are based on the psychiatry PCC. Although there are acute beds in some facilities that are specifically for psychiatric care, patients with such conditions can also be cared for in other acute beds. As this report focuses on acute utilization, hospitalizations in specialized mental health facilities (the former provincial psychiatric hospitals) are not included. This section will provide information on both the acute and total (i.e. including ALC) hospital stay. 3.1 South East Hospitals Acute mental health separations represented 5.2% of all separations from South East hospitals and 9.0% of total days, smaller proportions compared to those for Ontario hospitals (5.8% and 10.9%, respectively). In 2004/05, there were 2,050 acute mental health separations and 25,152 total mental health days from hospitals in South East, as shown in Table 7. These numbers accounted for 3.6% of mental health separations as well as 3.6% of mental health days from Ontario hospitals. In South East hospitals, the total Table 7: Acute Mental Health Separations, Days, & Average Length of Stay (ALOS), South East & Ontario Hospitals, 2004/05 Hospitals Separations Acute Total Days ALOS Days ALOS Frontenac Hotel Dieu 944 11,991 12.7 12,442 13.2 Kingston General 108 1,024 9.5 2,101 19.5 Hastings Quinte Healthcare (QHC)-Belleville General 663 5,865 8.8 6,529 9.8 QHC-North Hastings 15 85 5.7 90 6.0 QHC-Trenton Memorial 58 318 5.5 745 12.8 Lanark Perth & Smiths Falls District-Perth Site 45 352 7.8 466 10.4 Perth & Smiths Falls District-Smiths Falls Site 51 340 6.7 672 13.2 Leeds & Grenville Brockville General 61 693 11.4 1,207 19.8 Lennox & Addington Lennox & Addington County General 41 384 9.4 488 11.9 Prince Edward QHC-Prince Edward County Memorial 64 322 5.0 412 6.4 Total South East 2,050 21,374 10.4 25,152 12.3 Ontario 57,683 621,495 10.8 696,049 12.1 Had acute psychiatry beds as at March 31, 2005 4. Section 3: Mental Health Page 9

ALOS was 1.9 days longer than the acute ALOS, which reflects the impact of ALC stays. Overall, the total ALOS for mental health in South East hospitals (12.3 days) was similar to the total ALOS in Ontario hospitals (12.1 days). The majority of mental health separations from hospitals in South East (97.1%) were by South East residents. The Central East LHIN (1.3%) was the next most common area of patient origin for mental health separations from South East hospitals. 3.2 South East Residents Acute mental health separations represented 5.1% of all separations and 9.1% of total days for South East residents, smaller proportions compared to those for Ontario residents (5.8% and 10.9%, respectively). In 2004/05, there were 2,125 mental health separations and 26,726 total mental health days for South East residents (from all Ontario hospitals), as shown in Table 8. South East residents accounted for 3.7% of the mental health separations and 3.9% of the total mental health days for Ontario residents. For South East residents, the total ALOS was 1.9 days longer than the acute ALOS, which reflects the added impact of ALC stays. The total ALOS for mental health for South East residents was 12.6 days, slightly longer than the total ALOS for Ontario residents (12.1 days). The age-standardized acute mental health separation rate for South East residents was similar to the rate for Ontario residents, as was the crude total day rate, as shown in Table 9. The majority of mental health separations for residents of South East (93.6%) were from South East hospitals. The Champlain LHIN (3.3%) and the Central East LHIN (1.8%) were the next most common locations for residents hospitalizations. Table 8: Acute Mental Health Separations, Days, & Average Length of Stay (ALOS), by Area of Residence, South East & Ontario Residents, 2004/05 Area of Residence Separations Acute Total Days ALOS Days ALOS Frontenac 810 9,933 12.3 11,318 14.0 Hastings 655 6,054 9.2 7,236 11.0 Lanark 108 1,083 10.0 1,436 13.3 Leeds & Grenville 174 2,039 11.7 2,752 15.8 Lennox & Addington 177 2,166 12.2 2,416 13.6 Northumberland 51 302 5.9 412 8.1 Prince Edward 150 1,086 7.2 1,156 7.7 Total South East 2,125 22,663 10.7 26,726 12.6 Ontario 57,282 617,970 10.8 692,244 12.1 Table 9: Age-Standardized Acute Mental Health Separation Rates (95% Confidence Intervals) per 1,000 Population & Crude Total Mental Health Day Rates per 1,000 Population, South East & Ontario Residents, 2004/05 South East Residents Ontario Residents Age-Standardized Separation Rate 4.4 (4.2-4.6) 4.5 (4.4-4.5) Crude Total Day Rate 55.6 55.9 Page 10 Section 3: Mental Health

Section 4 Alternate Level of Care (ALC) ALC refers to cases where patients have completed the acute care phase of treatment but remain in acute care beds while awaiting placement elsewhere 1. The patient is classified as ALC when the attending physician or authorized designate indicates that acute care is no longer required and requests a transfer to another setting. Coding of ALC days began in 1989 in order to differentiate non-acute use of acute care beds from typical acute care 1. ALC days are considered an inefficient use of acute care resources and reflect problems with access to postacute services such as rehabilitation, long-term care homes, home care, etc. 11. This section includes individuals with at least one ALC day during their hospital stay, including those with mental health diagnoses. The ALC days and ALC ALOS refer to the length of the ALC stay only and exclude the acute care portion of the stay. 4.1 South East Hospitals ALC separations accounted for 4.4% of total separations while ALC days represented 14.4% of the total days in South East hospitals, larger proportions compared to those for Ontario hospitals (3.9% and 8.9%, respectively). There were 1,752 ALC separations and 40,252 ALC days from South East hospitals in 2004/05, as shown in Table 10. This represented 4.5% of the ALC separations and 7.1% of the ALC days from Ontario hospitals. Although there was variation among the hospitals, overall, the ALC ALOS in South East hospitals was 8.5 days longer than the ALC ALOS in Ontario hospitals (23.0 days and 14.5 days, respectively). Bed equivalents estimate the number of beds used based on ALC days at benchmark levels of occupancy (95% for these calculations). In 2004/05, there were approximately 116 acute care beds in South East hospitals filled by ALC patients who were more suited for service elsewhere. This represented 7.1% of the 1,637 ALC patient bed equivalents in Ontario hospitals. Table 10: Alternate Level of Care (ALC) Separations, Days, & Average Length of Stay (ALOS), South East & Ontario Hospitals, 2004/05 Hospitals ALC Separations Days ALOS Frontenac Hotel Dieu 5 451 90.2 Kingston General 544 23,322 42.9 Hastings Quinte Healthcare (QHC)-Belleville General 629 6,386 10.2 QHC-North Hastings 21 650 31.0 QHC-Trenton Memorial 243 2,605 10.7 Lanark Perth & Smiths Falls District-Perth Site 54 914 16.9 Perth & Smiths Falls District-Smiths Falls Site 58 1,331 22.9 Leeds & Grenville Brockville General 138 3,670 26.6 Lennox & Addington Lennox & Addington County General 31 582 18.8 Prince Edward QHC-Prince Edward County Memorial 29 341 11.8 Total South East 1,752 40,252 23.0 Ontario 39,052 567,548 14.5 Section 4: Alternate Level of Care Page 11

Approximately 98% of ALC separations from South East hospitals were by South East residents. The next most common area of patient origin for ALC separations from South East hospitals was the Central East LHIN (1.0%). The five PCCs associated with the largest proportion of ALC days for South East hospitals appear in Figure 4. Compared to Ontario hospitals, larger proportions of South East hospitals ALC days were associated with neurology, general surgery and trauma, while general medicine and psychiatry contributed a smaller proportion of ALC days. The transfer destinations associated with the largest number of ALC separations and days in South East hospitals were complex continuing care facilities, no transfer/unknown location (discharged home, death, etc.), and long-term care homes, as shown in Table 11. Figure 4: Leading Program Cluster Categories (PCCs) as a Proportion of Alternate Level of Care (ALC) Days, South East & Ontario Hospitals, 2004/05 Neurology 11.5 14.6 Program Cluster Category General Surgery Trauma General Medicine 8.6 11.6 11.1 10.0 10.8 South East Hospitals Ontario Hospitals 12.8 Psychiatry 9.4 13.1 0 2 4 6 8 10 12 14 16 % of ALC Days Page 12 Section 4: Alternate Level of Care

In South East hospitals, the ALC ALOS was shortest for patients who were transferred to home care (9.7 days). The longest ALC ALOS in South East hospitals was associated with transfers to psychiatric facilities (64.0 days, although the number of separations was small), and to long-term care homes (48.3 days). 4.2 South East Residents There were 1,804 ALC separations and 40,792 ALC days for South East residents (from all Ontario hospitals), as shown in Table 12. South East residents separations represented 4.6% of the ALC separations and 7.2% of the ALC days for all Ontario residents. The ALC ALOS varied by area of residence in the South East but Table 11: Alternate Level of Care (ALC) Separations, Days & Average Length of Stay (ALOS) for Specific Transfer Locations, South East & Ontario Hospitals, 2004/05 Transfer Locations South East Hospitals Ontario Hospitals ALC Separations Days ALOS Separations Days ALOS Complex Continuing Care 442 4,784 10.8 8,428 105,506 12.5 No Transfer/Unknown 428 8,575 20.0 8,722 124,164 14.2 Long-Term Care Home 410 19,799 48.3 8,579 197,545 23.0 Home Care 180 1,750 9.7 4,320 48,628 11.3 General Rehabilitation 159 1,868 11.7 6,358 57,179 9.0 Unclassified/Other Facility 73 2,500 34.2 582 9,741 16.7 Acute Care Facility 53 579 10.9 1,080 12,660 11.7 Psychiatric Facility 6 384 64.0 130 3,108 23.9 Ambulatory Care/Outpatient Dept. -- -- -- 28 424 15.1 Special Rehabilitation 0 0 0.0 825 8,593 10.4 Total 1,752 40,252 23.0 39,052 567,548 14.5 Cell count suppressed due to small numbers (<5 separations). Table 12: Alternate Level of Care (ALC) Separations, Days, & Average Length of Stay (ALOS) by Area of Residence, South East & Ontario Residents, 2004/05 Area of Residence ALC Separations Days ALOS Frontenac 413 18,179 44.0 Hastings 831 10,575 12.7 Lanark 99 1,963 19.8 Leeds & Grenville 241 6,823 28.3 Lennox & Addington 75 1,944 25.9 Northumberland 69 573 8.3 Prince Edward 76 735 9.7 Total South East 1,804 40,792 22.6 Ontario 38,912 565,640 14.5 Section 4: Alternate Level of Care Page 13

overall, was 8.1 days longer than the ALC ALOS for Ontario residents (22.6 days and 14.5 days, respectively). The longest ALC ALOS for South East residents was for those who were transferred to psychiatric facilities (56.9 days, although the number of separations was small), and to long-term care homes (48.3 days). This represented 7.2% of the approximately 1,631 acute care bed equivalents filled by Ontario resident ALC patients. The age-standardized ALC separation rate for South East residents was similar to the Ontario rate, but the crude day rate was 85.7% greater than the Ontario rate, as shown in Table 13. South East hospitals accounted for 95.3% of South East residents ALC separations. Hospitals in the Champlain LHIN provided care to 2.5% of South East residents ALC separations, while hospitals in the Toronto Central LHIN provided care to 1.2%. Figure 5 shows the PCCs associated with the largest proportion of ALC days for South East residents. Compared to Ontario residents, a larger proportion of South East residents ALC days were related to neurology, general surgery and trauma, while smaller proportions were related to general medicine and psychiatry. Table 13: Age-Standardized Alternate Level of Care (ALC) Separation Rates (95% Confidence Intervals) per 1,000 Population and Crude ALC Day Rates per 1,000 Population, South East & Ontario Residents, 2004/05 South East Residents Ontario Residents Age-Standardized ALC Separation Rate 2.5 (2.4-2.6) 2.6 (2.6-2.6) Crude ALC Day Rate 84.8 45.6 Figure 5: Leading Program Cluster Categories (PCCs) as a Proportion of Alternate Level of Care (ALC) Days, South East & Ontario Residents, 2004/05 Neurology 11.5 14.7 Program Cluster Category General Medicine General Surgery Trauma 8.6 11.1 12.8 10.7 10.6 10.0 South East Residents Psychiatry 10.0 Ontario Residents 13.1 0 2 4 6 8 10 12 14 16 % of ALC Days Page 14 Section 4: Alternate Level of Care

The transfer destinations associated with the largest number of ALC separations and days for South East residents were complex continuing care facilities, no transfer/unknown location (discharged home, death, etc.), and long-term care homes, as shown in Table 14. The ALC ALOS was shortest for South East residents who were transferred to home care (9.7 days). The longest ALC ALOS for South East residents was for those who were transferred to psychiatric facilities, (56.9 days, although the number of separations was small), and to long-term care homes (48.3 days). Compared to Ontario residents, the ALC ALOS was longer for South East residents for all transfer locations with the exception of complex continuing care and home care. Table 14: Alternate Level of Care (ALC) Separations, Days & Average Length of Stay (ALOS) for Specific Transfer Locations, South East & Ontario Residents, 2004/05 Transfer Locations South East Residents Ontario Residents ALC Separations Days ALOS Separations Days ALOS Complex Continuing Care 448 4,825 10.8 8,419 105,433 12.5 No Transfer/Unknown 437 8,526 19.5 8,671 123,350 14.2 Long-Term Care Home 414 19,989 48.3 8,574 197,266 23.0 General Rehabilitation 180 2,019 11.2 6,322 56,733 9.0 Home Care 177 1,718 9.7 4,316 48,583 11.3 Unclassified/Other Facility 72 2,479 34.4 569 9,645 17.0 Acute Care Facility 68 825 12.1 1,061 12,514 11.8 Psychiatric Facility 7 398 56.9 130 3,108 23.9 Ambulatory Care/Outpatient Dept. -- -- -- 27 423 15.7 Special Rehabilitation 0 0 0.0 823 8,585 10.4 Total 1,804 40,792 22.6 38,912 565,640 14.5 Cell count suppressed due to small numbers (<5 separations). Section 4: Alternate Level of Care Page 15

Glossary Age-Standardized Rate: A summary rate which adjusts for variations in population age distributions over time and place. Hospitalization rates have been adjusted using the direct method and the 1991 Canadian population as the standard. Alternate Level of Care (ALC): When a patient who has completed the acute care phase of treatment occupies an acute care bed while awaiting placement elsewhere (long-term care home, rehabilitation, complex continuing care, home care, etc.). Average Length of Stay: The number of patient days divided by the number of separations, reported in days. Bed Equivalents: The approximate number of beds used annually based on patient days (ALC or other types) at benchmark occupancy rates (95% for these calculations). Bed Equivalents = days/(occupancy * days/year) Case Mix Group (CMG TM ): A methodology designed to aggregate hospital inpatients with similar diagnoses and treatment requirements. CMG is a registered trademark of the Canadian Institute for Health Information. Case Mix Group Complexity Age Category: Categories refer to broad age groupings (<17 years, 18-69 years, 70+ years) that are associated with differing levels of treatment complexity and lengths of stay for specific CMGs. Crude Rate: The number of events occurring in a specific time period, expressed per population. A crude rate is not adjusted for differences in population structure. Primary Level of Care: Procedures or treatments that can be provided in any hospital setting by general practitioners or specialists. Program Cluster Category (PCC): Consists of Case Mix Groups (CMGs) aggregated into broad programs and reflects the main types of services received. Secondary Level of Care: Surgical and other procedures provided by medical specialists, usually in larger community hospitals. Separation: A completed case treated in a hospital resulting in any of the following: discharge home, transfer to another facility, death or sign out. Statistical Significance: The probability that a result is not likely to have occurred due to chance alone. Tertiary/Quaternary Level of Care: Procedures or treatments provided to seriously ill patients that involve highly specialized, costly care most often provided in larger regional referral centres or teaching hospitals. Total Days of Stay: Includes the acute and ALC portions of a hospital stay. Confidence Interval: The interval with a given probability (here 95%) that the true value of a rate is contained within the interval. Page 16 Glossary

References 1. Canadian Institute for Health Information. DAD abstracting manual 2004-2005 Edition, 10-1-10-3. Ottawa, ON; 2004. 2. Ontario Ministry of Health and Long-Term Care. Provincial Health Planning Database, Inpatient Discharges. Version 16.03; December 2005. 3. Ontario Ministry of Health and Long-Term Care. Provincial Health Planning Database, Population Estimates [2004]. Version 16.03; December 2005. 4. Ontario Ministry of Health and Long-Term Care, Finance and Information Management Branch. Daily census summary, acute beds staffed and in operation 2004/05 (March). Retrieved November 16, 2005, from http://fimdata.com/dcs/ab_mth.asp?pyr=2004%2f20 05&pMTH=March 5. Campbell L. CIHI case mix tools. In: Johnson L, Richards J, Pink G, & Campbell L (Eds.). Case mix tools for decision making in health care. Ottawa, ON: Canadian Institute for Health Information; 1998. p.1-10. 7. Hay Health Care Consulting Group and JPPC. The Hay Group level of care methodology: CMG 1999. 2001. Retrieved September 1, 2005, from http://www.jppc.org/library/funding/rd10_1.pdf 8. Baigent L, Shaw R, & Chalmers F. Health system monitoring report 2004/05. Windsor, ON: Essex Kent Lambton District Health Council; 2005. 9. Joint Committee of the Ministry of Health and the Ontario Hospital Association. Rural and Northern Health: Parameters and Benchmarks; 1998. 10. Canadian Institute for Health Information. CMG TM /PLX TM Directory ICD-10-CA/CCI. Ottawa, ON; 2002. 11. Damba C, Vahabi M, & Zon L. First annual Toronto s health system report card November 1999. Toronto, ON: Toronto District Health Council; 1999. 6. Hay Health Care Consulting Group. Hay level of care methodology: 02/03 version using AARV weights. 2004. Retrieved September 1, 2005, from http://www.jppc.org/library/funding/hay_2004.pdf References Page 17

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