Health System Performance Information for Health Care Improvement: A pan-canadian Initiative OECD Workshop on Health Data Governance May 20, 2015 1
HSP Agenda Phase 1: the Why, the What and the How Why What How Confusion about performance measurement Large number of organizations reporting at various levels and in an uncoordinated fashion A need to strengthen public reporting on system performance Three-year plan (2012 to 2015) to strengthen pan- Canadian health system performance (HSP) reporting Provide structured and coordinated pan-canadian performance reporting - Information tailored to the needs of different audiences Develop analytical products and tools that support jurisdictional priorities for health care improvement 2
The approach: align with strategy and use parsimony to put indicators to use 3
Five Deliverable Packages Over 2012-2015 Package Objectives Deliverables HSP measurement framework Interactive HSP public accessible reporting Integrated analytical environment Research and analysis activities Capacity building activities Strengthen evidence base, improve alignment and make it actionable Deliver cascading sets of HSP reports over 3 years Analytical capacity to better understand health system performance drivers Further align CIHI research and analytical agenda with priorities of P/T; strengthen collaboration Support capacity building in use of data Redeveloped HSP framework Related facility-level frameworks Interactive web tool for the public (In Brief) Interactive facility/regional web tool (In Depth) Long-term care facility-level reporting Indicator library Hospital private ereporting product (Insight) CEHQ mobile app New indicator development Patient experience survey/reporting Consensus conference 2014 Analytical plan aligned with HSP 3 HSP schools (Atlantic, MB, ON) Conferences and workshops 4
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Your Health System: Timeline Our Health System (Your Health System: In Brief) Nov 2013 15 indicators covering 5 aspects of health system performance Meant for a general audience Your Health System: In Depth Sept 2014 37 regional, acute care facility indicators Meant for Ministry decision-makers and regional/facility executives Your Health System: In Depth Integrating Long Term Care (LTC) sector results June 10, 2015 Facility-level results for 9 additional longterm care indicators 6
YourHealthSystem.ca 1 2 In Brief In Depth Audience: General public Audience: Ministry, facility, regional decision-makers (available publicly) 7
Your Health System Data Sources YHS Data Source Canadian Community Health Survey (CCHS) Continuing Care Reporting System (CCRS) Canadian MIS Database (CMDB) Discharge Abstract Database (DAD) The Early Development Instrument (EDI) Offord Centre for Child Studies Description The CCHS is a cross-sectional survey that collects information related to health status, health care utilization and health determinants for the community-dwelling Canadian population on an ongoing basis. The Continuing Care Reporting System (CCRS) captures residentlevel clinical and administrative data from residential care homes using the RAI MDS 2.0, an internationally recognized standard assessment tool. The Canadian MIS Database (CMDB) contains financial and statistical operations information on public hospitals and regional health authorities across Canada. The Discharge Abstract Database (DAD) captures patient demographic, administrative, clinical and service-specific data on hospital discharges (including deaths, sign-outs and transfers) from acute inpatient facilities and selected day surgery, chronic, rehabilitation and psychiatric facilities. The EDI is a measure of children's readiness to learn at school in five domains: physical health and well-being; social knowledge and competence; emotional health/maturity; language and cognitive development; and general knowledge and communication skills. 8
Your Health System Data Sources YHS Data Source The Hospital Morbidity Database (HMDB) National Ambulatory Care Reporting System (NACRS) Description The Hospital Morbidity Database (HMDB) contains pan- Canadian patient demographic, administrative, clinical and service specific data on inpatient separations from acute care hospitals. The HMDB also contains day surgery data from Quebec. The National Ambulatory Care Reporting System (NACRS) contains patient demographic, administrative, clinical and service-specific data about hospital and community-based emergency department and ambulatory care visits, including visits to day surgery and outpatient clinics. National Prescription Drug Utilization Information System (NPDUIS) Vital Statistics - Death Database The National Prescription Drug Utilization Information System (NPDUIS) Database contains prescription claimslevel data collected from publicly financed drug benefit programs in Canada. The vital statistics database is an administrative survey that collects demographic and medical (cause of death) information annually from all provincial and territorial vital statistics registries on all deaths in Canada. 9
Your Health System: Insight -- Key Features Timely monthly updates using open-year data Increased flexibility to understand performance drivers Pan-Canadian comparisons Support of result reconciliation with facilities own local data (access to chart level data) Over time, adding content, evolving and adapting to better meet client needs 10
Product Navigation Summary Dashboard Customize your organizational preferences Summary results, comparisons and trends, aligns with In Depth website Choose indicators to focus on Trends and Comparisons Dashboard View your results over time, select comparators Presentation-ready reports Indicator Exploration Visually explore your results Uncover potential performance drivers Customize to suit your needs Custom Breakdowns Use prompts to create custom reports Drill into your results, right down to the chart number Chart Export Export your results, right down to the chart number Integrate your results with your own system 11
Next steps work on health system performance (2015-2020) through renewed partnerships Enhanced public reporting on system performance: progress on horizontal and vertical reporting Indicator development Outcomes Integration and continuity of care Community care including mental health Value for money Upstream investments in population health Connect performance measurement to best practices and innovation for quality improvement Expanded health analytics agenda Refocused research agenda on performance improvement priorities Capacity building, peer to peer learning activities and knowledge exchange 12
Thank You! If you have any question or comment: jveillard@cihi.ca 13
Your Health System: In Depth Website Functionality 14
How do I access my results? Enter a province, territory, city, region or the name of a hospital to reach Indicator results. Enter a facility, city or region to see Overall Results 15
How do I Compare Across all Measures? Ability to export, share and print Contextual (profile) data for region or facility selected. Data displayed by Theme. The user can also select an indicator from this page to view individual indicator results. 16
Where are all of our relevant indicators? 17
What are my Overall Results? Provides a snapshot of results for a hospital or health region compared to the national or peer group average and the trend over time. 18
What are my overall results? 19
What are my overall results? 20
How do I Compare to Others? Ability to export, share and print 21
What is the Trend Over Time for my Results? Ability to export, share and print Ability to add new comparator organizations 22
How do I Compare within my region or province? Ability to export, share and print 23
Who can I Learn from? 24
Enhanced Interactive Map Drill down from provincial level data to regional and facility level data 25
Exporting Capability Ability to export and create Reports: Visuals into PPT, PDF, Excel Data into excel formal 26
Your Health System: In Depth List of indicators 27
Interactive Facility/Regional Website Indicators Indicator Name Total time spent in Emergency Room (admitted patients) Emergency wait time for physician assessment Hip fracture surgery wait times Obstetric trauma (with instrument) (revised) In-hospital sepsis (new) Hospital deaths (HSMR) Hospital deaths following major surgery (revised) (Previously 5-day In-Hospital Mortality Following Major Surgery ) All patients readmitted to hospital Medical patients readmitted to hospital Surgical patients readmitted to hospital Obstetric patients readmitted to hospital Patients 19 and younger readmitted to hospital Low-risk Caesarean sections (revised) (Previously C-Section rate: excluding pre-term births and multiple gestations ) Cost of a standard hospital stay Have a regular doctor Repeat hospital stays for mental illness Potentially inappropriate medication in long-term care Potentially inappropriate medication prescribed to seniors (new) Repeat hospital stay for mental illness Level of Reporting 28
Interactive Facility/Regional Website Indicators (continued) Indicator Name Restraint use in long-term care Patient flow for hip replacement Breastfeeding initiation Influenza Immunization for Seniors Ambulatory care sensitive conditions Life expectancy at birth Life expectancy at age 65 Avoidable deaths Avoidable deaths from preventable causes Avoidable deaths from treatable causes Perceived Health Hospitalized heart attacks Hospitalized strokes Self-injury hospitalizations Healthy child development Obesity Smoking Physical Activity During Leisure Time Heavy drinking Level of Reporting 29
Facility/Regional Contextual Measures Contextual Measure Total population Rural area population Seniors aged 65 and over Family medicine physicians per 100,000 population Patient days in alternate level of care (percentage) Unemployment rate Immigration population Post-secondary educational attainment Children living in low-income families Household food insecurity Prevalence of diabetes Prevalence of chronic obstructive pulmonary disease (COPD) Prevalence of high blood pressure Prevalence of mood disorders Type of hospital Level of Reporting 30
Facility/Regional Contextual Measures (continued) Contextual Measure Level of Reporting Number of inpatients Number of beds Number of emergency department visits Average resource use intensity Total resource use intensity Average length of a hospital stay Hospital occupancy rate Percentage of patients admitted through the emergency department Patient days in alternate level of care Type of hospital 31
Long Term Care Indicators 2015 release Indicator Name Percentage of residents with "0" score on the Index of Social Engagement Percentage of residents in daily physical restraints Percentage of residents on antipsychotics without a diagnosis of psychosis Percentage of residents who fell in the last 30 days Percentage of residents who had worsened pressure ulcer at stage 2-4 Percentage of residents whose mood symptoms of depression worsened Percentage of residents with improved mid-loss activities of daily living Percentage of residents with worsened mid-loss activities of daily living Percentage of residents with worsened pain Percentage of residents with pain Level of Reporting 32
Long Term Care Contextual Measures Note: Contextual measures are subject to change prior to release Contextual Measure Level of Reporting Urban or rural Number of beds (large, medium, small) Percentage of female residents Percentage of residents under 65 years of age Percentage of residents over 85 years of age Percentage of residents with dementia Percentage of residents with heart failure Average length of stay 33