HOSPITAL SERVICE ACCOUNTABILITY AGREEMENT: Indicator Technical Specifications

2015-16 HOSPITAL SERVICE ACCOUNTABILITY AGREEMENT: Indicator Technical Specifications November 2014 2015/16 HSAA Technical Specifications Page 1

TABLE OF CONTENTS PATIENT EXPERIENCE ACCESS, EFFECTIVE, SAFE, PERSON-CENTERED... 4 PERFORMANCE... 4 90th Percentile Emergency Room (ER) Length of Stay for Admitted Patients... 4 90th Percentile ER Length of Stay for Non-Admitted Complex (CTAS I-III) Patients... 7 90th Percentile ER Length of Stay for Non-Admitted Minor Uncomplicated (CTAS IV-V) Patients... 10 Percent of Priority IV cases completed within priority targets for cancer surgery... 13 Percent of Priority IV cases completed within priority targets for Cardiac Bypass Surgery... 16 Percent of Priority IV cases completed within priority targets for Cataract Surgery... 19 Percent of Priority IV cases completed within priority targets for Joint Replacements... 22 Percent of Priority IV cases completed within priority targets for MRI and CT scans... 25 Rate of Hospital Acquired Clostridium Difficile Infections... 28 EXPLANATORY... 31 Percent of Stroke/TIA Patients Admitted to a Stroke Unit During Their Inpatient Stay... 31 Hospital Standardized Mortality Ratio (HSMR)... 33 Readmissions Within 30 Days for Selected Case Mix Groups (CMGs)... 37 Rate of Ventilator-Associated Pneumonia (Moved from Performance)... 41 Central Line Infection Rate (Moved from Performance)... 43 Rate of Hospital Acquired Vancomycin Resistant Enterococcus Bacteremia (Moved from Performance)... 45 Rate of Hospital Acquired Methicillin Resistant Staphylococcus Aureus Bacteremia (Moved from Performance)... 47 ORGANIZATIONAL HEALTH - EFFICIENT, APPROPRIATELY RESOURCED, EMPLOYEE EXPERIENCE, GOVERNANCE... 49 PERFORMANCE... 49 Current Ratio (Consolidated all sector codes and fund types)... 49 Total Margin (Consolidated all sector codes and fund types)... 52 EXPLANATORY... 55 Total Margin (Hospital Sector Only)... 55 Adjusted Working Funds / Total Revenue %... 58 SYSTEM PERSPECTIVE INTEGRATION, COMMUNITY ENGAGEMENT, EHEALTH... 61 PERFORMANCE... 61 Alternate Level of Care (ALC) Rate Acute (NEW)... 61 EXPLANATORY... 64 Repeat Unscheduled Emergency Visits Within 30 Days for Mental Health Conditions... 64 Repeat Unscheduled Emergency Visits Within 30 Days for Substance Abuse Conditions... 67 Percentage of Acute Alternate Level of Care (ALC) Days (closed cases) (Moved from Performance)... 70 2015/16 HSAA Technical Specifications Page 2

APPENDIX: SERVICE VOLUME METRICS... 72 GLOBAL VOLUMES (SCHEDULE C2 PART I)... 72 Ambulatory Care Visits... 72 Complex Continuing Care Weighted Patient Days... 75 Day Surgery Weighted Visits... 77 Elderly Capital Assistance Program (ELDCAP) Inpatient Days... 79 ED Weighted Cases... 81 Emergency Department and Urgent Care Visits... 83 Inpatient Mental Health Weighted Days... 85 Inpatient Mental Health Days... 87 Inpatient Rehabilitation Days... 89 Rehabilitation Separations... 91 Total Inpatient Acute Weighted Cases... 93 HOSPITAL SPECIALIZED SERVICES (SCHEDULE C2 PART II)... 95 Cochlear Implants (Cases)... 95 Sexual Assault/Domestic Violence Treatment Clinics (Patients)... 98 WAIT TIME VOLUMES (SCHEDULE C2 PART III)... 101 General Surgery (Base & incremental)... 101 Paediatric Surgery (Base & incremental)... 104 Hip & Knee Replacement - Revisions (Cases)... 111 Magnetic Resonance Imaging (MRI) Total Hours... 114 Ontario Breast Screening Program (OBSP) Magnetic Resonance Imaging (MRI) Total Hours... 116 Computed Tomography (CT) Total Hours... 119 PROVINCIAL PROGRAMS (SCHEDULE C2 PART IV)... 121 Automatic Inplantable Cardiac Defib's (# of New Implants)... 121 Bariatric Surgery (Procedures)... 124 QUALITY BASED PROCEDURES (SCHEDULE C2 PART V)... 128 Copyright 2014, Queens Printer, Ontario. All rights reserved. 2015/16 HSAA Technical Specifications Page 3

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 2015/16 HSAA Technical Specifications Page 4

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 01 05 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 2015/16 HSAA Technical Specifications Page 5

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, HTTP://... RESPONSIBILITY FOR REPORTING Cancer Care Ontario DATE CREATED (YYYY- MM-DD) 2009-09-17 DATE LAST REVIEWED (YYYY-MM-DD) 2013-01-13 2015/16 HSAA Technical Specifications Page 6

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, 04 05 and 08 15 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. 2015/16 HSAA Technical Specifications Page 7

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, 04 05 and 08 15) with assigned CTAS IV and V 9. Non-Admitted Patients (Disposition Codes 01, 04 05 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 2015/16 HSAA Technical Specifications Page 8

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, HTTP://... 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 2009-09-17 2013-01-13 2015/16 HSAA Technical Specifications Page 9

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, 04 05 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 2015/16 HSAA Technical Specifications Page 10

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, 04 05 and 08 15) with assigned CTAS I, II and III 9. Non-Admitted Patients (Disposition Codes 01, 04 05 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 2015/16 HSAA Technical Specifications Page 11

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, HTTP://... RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) Cancer Care Ontario 2009-09-17 2013-01-13 2015/16 HSAA Technical Specifications Page 12

NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION PERFORMANCE STANDARD PERCENT OF PRIORITY IV CASES COMPLETED WITHIN PRIORITY TARGETS FOR CANCER SURGERY 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. 2015/16 HSAA Technical Specifications Page 13

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. 2015/16 HSAA Technical Specifications Page 14

REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, HTTP://... 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) 2010-08-13 DATE LAST REVIEWED (YYYY-MM-DD) 2015/16 HSAA Technical Specifications Page 15

NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION PERCENT OF PRIORITY IV CASES COMPLETED WITHIN PRIORITY TARGETS FOR CARDIAC BYPASS SURGERY 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. 2015/16 HSAA Technical Specifications Page 16

REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, HTTP://... RESPONSBILITY FOR REPORTING Cardiac Care Network of Ontario DATE CREATED (YYYY- MM-DD) 2010-08-13 DATE LAST REVIEWED (YYYY-MM-DD) 2015/16 HSAA Technical Specifications Page 18

DENO MINA TOR NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION PERCENT OF PRIORITY IV CASES COMPLETED WITHIN PRIORITY TARGETS FOR CATARACT SURGERY 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. 2015/16 HSAA Technical Specifications Page 19

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, HTTP://... 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. 2015/16 HSAA Technical Specifications Page 20

RESPONSBILITY FOR REPORTING Access to Care (Access to Care, 2008) DATE CREATED (YYYY-MM- DD) 2010-08-13 DATE LAST REVIEWED (YYYY-MM-DD) 2015/16 HSAA Technical Specifications Page 21

DENO MINA TOR NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION PERCENT OF PRIORITY IV CASES COMPLETED WITHIN PRIORITY TARGETS FOR JOINT REPLACEMENTS 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. 2015/16 HSAA Technical Specifications Page 22

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, HTTP://... 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. 2015/16 HSAA Technical Specifications Page 23

RESPONSBILITY FOR REPORTING Ontario Joint Replacement Registry/Access to Care (Access to Care, 2008) DATE CREATED (YYYY-MM- DD) 2010-08-13 DATE LAST REVIEWED (YYYY-MM-DD) 2015/16 HSAA Technical Specifications Page 24

NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION PERCENT OF PRIORITY IV CASES COMPLETED WITHIN PRIORITY TARGETS FOR MRI AND CT SCANS 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. 2015/16 HSAA Technical Specifications Page 25

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. 2015/16 HSAA Technical Specifications Page 26

Canada, HTTP://... RESPONSBILITY FOR REPORTING Access to Care (Access to Care, 2008) DATE CREATED (YYYY-MM- DD) 2010-08-13 DATE LAST REVIEWED (YYYY-MM-DD) 2015/16 HSAA Technical Specifications Page 27

NUMERATOR INDICATOR NAME RATE OF HOSPITAL ACQUIRED CLOSTRIDIUM DIFFICILE INFECTIONS Detailed description of indicator INDICATOR CLASSIFICATION 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 2015/16 HSAA Technical Specifications Page 28

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 2015/16 HSAA Technical Specifications Page 29

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, HTTP://... RESPONSIBILITY FOR REPORTING Patient Safety Website Health Service Providers DATE CREATED (YYYY- MM-DD) 2009-10-13 DATE LAST REVIEWED (YYYY-MM-DD) 2013-01-13 2015/16 HSAA Technical Specifications Page 30

GEOGRAPHY & TIMING DENOMINATOR NUMERATOR Explanatory (Note: The technical specifications for the stroke indicator 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 PERCENT OF STROKE/TIA 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 INDICATOR CLASSIFICATION 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- 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 2015/16 HSAA Technical Specifications Page 31

ADDITIONAL INFORMATION May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending Data are available at the level of the facility LHIN 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, HTTP://... 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 http://www. ices.on.ca ICES DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) 2010-08-01 2013-01-13 2015/16 HSAA Technical Specifications Page 32

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 20. 95% confidence interval is calculated using Byar s approximation. A confidence interval that includes 100 suggests that the HSMR is not statistically different from the 2004 2005 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) 2015/16 HSAA Technical Specifications Page 33

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 (2004 2005). 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 2015/16 HSAA Technical Specifications Page 34

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, HTTP://... FY 2004-2005 till present Currently no information has been provided. The reference year for HSMR calculations is 2004 2005. 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, 2007. 2015/16 HSAA Technical Specifications Page 35

3. Jarman, B., A. Bottle and P. Aylin. Monitoring Changes in Hospital Standardised Mortality Ratios. BMJ 330 (2005): p. 329. 4. 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, 1987. 5. 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. 1130 1139. RESPONSIBILITY FOR REPORTING CIHI DATE CREATED (YYYY- MM-DD) 2010-12-15 DATE LAST REVIEWED (YYYY-MM-DD) 2011-02-03 2015/16 HSAA Technical Specifications Page 36

DENOMINATOR NUMERATOR INDICATOR DESCRIPTION INDICATOR NAME READMISSIONS WITHIN 30 DAYS FOR SELECTED CASE MIX GROUPS (CMGS) Detailed description of indicator 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, 2015/16 HSAA Technical Specifications Page 37

ADDITIONAL INFORMATION GEOGRAPHY & TIMING c) All ages for pneumonia, diabetes and 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. REFERENCES Provide URLs of any key 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. 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 2015/16 HSAA Technical Specifications Page 38

references E.g. Diabetes in Canada, HTTP://... 2004; 291(11):1358-67. 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.: CD005305. DOI: 10.1002/14651858.CD005305.pub2. RESPONSIBILITY FOR REPORTING Health Analytics Branch DATE CREATED (YYYY- MM-DD) 2010-09-15 DATE LAST REVIEWED (YYYY-MM-DD) 2011-04-08 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 2015/16 HSAA Technical Specifications Page 39

254 Gastrointestinal Hemorrhage 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 2015/16 HSAA Technical Specifications Page 40

GEOGRAPHY & TIMING DENOMINATOR NUMERATOR INDICATOR DESCRIPTION INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION RATE OF VENTILATOR-ASSOCIATED PNEUMONIA (MOVED FROM PERFORMANCE) Pneumonia occurring in patients requiring mechanical ventilation, intermittently or continuously, through a tracheostomy or endotracheal tube for more than 48 hours Explanatory 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 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- Data are available each quarter for the previous quarter s data 2015/16 HSAA Technical Specifications Page 41

ADDITIONAL INFORMATION May 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, HTTP://... 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) 2009-10-13 DATE LAST REVIEWED (YYYY-MM-DD) 2013-01-13 2015/16 HSAA Technical Specifications Page 42

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 (MOVED FROM PERFORMANCE) 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 Explanatory 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 released annually in mid- May LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending 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 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, 2009. 2015/16 HSAA Technical Specifications Page 43

ADDITIONAL INFORMATION 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, HTTP://... 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 9 2002; 51(RR-10): 1-29. www.cdc.gov/mmwr/pdf/rr/rr5110.pdf Pittet D, Tarara D, Wemze; RP, 1994. Nosocomial bloodstream infection in critically ill patient. Excess length of stay, extra cost, and attributable mortality. JAMA 1994; (20): 271: 1598-1601. Health Service Providers DATE CREATED (YYYY- MM-DD) 2010-12-15 DATE LAST REVIEWED (YYYY-MM-DD) 2013-01-13 2015/16 HSAA Technical Specifications Page 44

DENOMINATOR NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION RATE OF HOSPITAL ACQUIRED VANCOMYCIN RESISTANT ENTEROCOCCUS BACTEREMIA (MOVED FROM PERFORMANCE) The rate of VRE bacteremia is a measure of the incidence of laboratory confirmed bloodstream VRE infection per 1,000 patient days Explanatory 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 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 2015/16 HSAA Technical Specifications Page 45

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 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, HTTP://... 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 RESPONSIBILITY FOR REPORTING Health Service Providers DATE CREATED (YYYY- MM-DD) 2009-10-13 DATE LAST REVIEWED (YYYY-MM-DD) 2013-01-13 2015/16 HSAA Technical Specifications Page 46

DENOMINATOR NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION RATE OF HOSPITAL ACQUIRED METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS BACTEREMIA (MOVED FROM PERFORMANCE) The rate of MRSA bacteremia is a measure of the incidence of laboratory confirmed bloodstream MRSA infection per 1,000 patient days Explanatory 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 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 2015/16 HSAA Technical Specifications Page 47

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 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, HTTP://... 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 RESPONSIBILITY FOR REPORTING Health Service Providers DATE CREATED (YYYY- MM-DD) 2009-10-13 DATE LAST REVIEWED (YYYY-MM-DD) 2013-01-13 2015/16 HSAA Technical Specifications Page 48

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 (0.8-2.0): Performance corridor=10% (ii) If a negotiated target is outside of the accepted range (0.8-2.0): 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 2015/16 HSAA Technical Specifications Page 49

ITIO NAL INFO GEOGRAPHY & TIMING DENOMINATOR positive or negative. 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 2015/16 HSAA Technical Specifications Page 50

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, HTTP://... RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) Health Data Branch 2010-05-13 2011-12-14 2015/16 HSAA Technical Specifications Page 51

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) 2015/16 HSAA Technical Specifications Page 52

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 2015/16 HSAA Technical Specifications Page 53

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, HTTP://... 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 2010-05-13 2011-12-14 2015/16 HSAA Technical Specifications Page 54

DENO MINA TOR 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*) Total Corporate Revenues (excluding Interdepartmental Recoveries and 2015/16 HSAA Technical Specifications Page 55

GEOGRAPHY & TIMING 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) 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 Currently no information has been provided Currently no information has been provided 2015/16 HSAA Technical Specifications Page 56

ADDITIONAL INFORMATION Levels of geography for comparison TRENDING Years available for trending LIMITATIONS Specific limitations Currently no information has been provided 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, HTTP://... RESPONSIBILITY FOR REPORTING Health Data Branch DATE CREATED (YYYY- MM-DD) 2010-12-08 DATE LAST REVIEWED (YYYY-MM-DD) 2011-12-14 2015/16 HSAA Technical Specifications Page 57

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, & 1.6 1.19 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) 2015/16 HSAA Technical Specifications Page 58

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 Q4. 2015/16 HSAA Technical Specifications Page 59

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, HTTP://... 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) 2013-01-15 DATE LAST REVIEWED (YYYY-MM-DD) 2013-01-15 2015/16 HSAA Technical Specifications Page 60

NUMERATOR SYSTEM PERSPECTIVE Integration, Community Engagement, ehealth Performance INDICATOR NAME ALTERNATE LEVEL OF CARE (ALC) RATE ACUTE (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 reporting period, and therefore, will provide an accurate picture of ALC performance that can be trended over time. INDICATOR CLASSIFICATION Performance PERFORMANCE STANDARD Target: To be determined between hospitals and their respective LHINs. Historical performance should be reviewed prior to target setting. Corridor: Upper corridor = performance target + 10% The total number of ALC days contributed by ALC patients within the specific reporting period. 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 Wait Time Information System (WTIS) 2015/16 HSAA Technical Specifications Page 61

DENOMINATOR 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 The day of ALC designation is counted as an ALC day but the date of discharge or discontinuation is not counted as an ALC day. For cases with an ALC designation date on the last day of a reporting period and no discharge/discontinuation date, then ALC days = 1. The ALC Rate indicator methodology makes the assumption that the 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 period. 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) Bed Census Summary (BCS) [previously the Daily Census Summary (DCS)] from the Health Data Branch Web Portal maintained by MOHLTC 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. 2015/16 HSAA Technical Specifications Page 62

NUMERATOR Explanatory INDICATOR NAME Detailed description of indicator REPEAT UNSCHEDULED EMERGENCY VISITS WITHIN 30 DAYS FOR MENTAL HEALTH CONDITIONS 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) 2015/16 HSAA Technical Specifications Page 64

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 5. 2. 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 5. 2. 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. 2015/16 HSAA Technical Specifications Page 65

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, HTTP://... 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 2010-09-17 2011-12-14 2015/16 HSAA Technical Specifications Page 66

NUMERATOR INDICATOR NAME REPEAT UNSCHEDULED EMERGENCY VISITS WITHIN 30 DAYS FOR SUBSTANCE ABUSE CONDITIONS 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) 2015/16 HSAA Technical Specifications Page 67

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 2001 2015/16 HSAA Technical Specifications Page 68

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, HTTP://... 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 2010-09-17 2011-12-14 2015/16 HSAA Technical Specifications Page 69

GEOGRAPHY & TIMING DENOMINATOR NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION 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 PERCENTAGE OF ACUTE ALTERNATE LEVEL OF CARE (ALC) DAYS (CLOSED CASES) (MOVED FROM PERFORMANCE) 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. Explanatory 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 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 2015/16 HSAA Technical Specifications Page 70

ADDITIONAL INFORMATION 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, HTTP://... RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) 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. 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 2010-01-11 2011-12-12 2015/16 HSAA Technical Specifications Page 71

NUMERATOR APPENDIX: Service Volume Metrics Global Volumes (Schedule C2 Part I) 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% 30,001 100,000 80% 100,001 200,000 85% 200,001 300,000 90% 300,001 400,000 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: 7134055 (Endoscopy) and 71310* (Emergency) 3. OHRS secondary statistical account codes: 50*, 511*, 512*, 513*, 514*, 518*, 519*, 521* 2015/16 HSAA Technical Specifications Page 72

REPORTING RESPONSIBILITY Health Data Branch DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) 2010-05-13 2011-12-14 2015/16 HSAA Technical Specifications Page 74

ADDITIONAL INFORMATION GEOGRAPHY & TIMING DENOMINATOR NUMERATOR INDICATOR DESCRIPTION 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 LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. 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 1996-97 fiscal year Currently, no information has been provided 2015/16 HSAA Technical Specifications Page 75

REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, HTTP://... RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) Health Service Providers 2010-05-13 2012-06-13 2015/16 HSAA Technical Specifications Page 76

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 2002/2003 2015/16 HSAA Technical Specifications Page 77

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, HTTP://... 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) 2011-12-14 2012-06-13 2015/16 HSAA Technical Specifications Page 78

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, HTTP://... 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): http://www.health.gov.on.ca/english/public/ program/ltc/28_pr_glossary.html 2015/16 HSAA Technical Specifications Page 79

RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) Health Data Branch 2010-05-13 2011-12-14 2015/16 HSAA Technical Specifications Page 80

ADDITIO NAL INFORMA GEOGRAPHY & TIMING DENOMINATOR NUMERATOR INDICATOR DESCRIPTION INDICATOR NAME ED WEIGHTED CASES 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 2015/16 HSAA Technical Specifications Page 81

Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, HTTP://... REPORTING RESPONSIBILITY cases drives the calculation of weight Health Service Providers DATE CREATED (YYYY- MM-DD) 2011-12-14 DATE LAST REVIEWED (YYYY-MM-DD) 2012-06-13 2015/16 HSAA Technical Specifications Page 82

GEOGRAPHY & TIMING DENOMINATOR NU MER ATO R INDICATOR DESCRIPTION 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- May LEVELS OF COMPARABILITY Levels of geography for 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 levels 2015/16 HSAA Technical Specifications Page 83

ADDITIONAL INFORMATION 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, HTTP://... RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY-MM- DD) DATE LAST REVIEWED (YYYY-MM-DD) Data are available from the 1994/95 fiscal year Currently, no information has been provided Health Data Branch 2010-05-13 2011-12-14 2015/16 HSAA Technical Specifications Page 84

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. 2015/16 HSAA Technical Specifications Page 85

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, HTTP://... 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 2011-12-14 2012-06-13 2015/16 HSAA Technical Specifications Page 86

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 < 5000 85% >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 7127650) S 4031520, 4031540 71310* 2015/16 HSAA Technical Specifications Page 87

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* 2015/16 HSAA Technical Specifications Page 89

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 2015/16 HSAA Technical Specifications Page 91

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, HTTP://... RESPONSIBILITY FOR REPORTING Currently, no information has been provided Health Data Branch DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) 2010-05-13 2011-03-02 2015/16 HSAA Technical Specifications Page 92

GEOGRAPHY & TIMING DENOMINATOR NUMERATOR INDICATOR INDICATOR NAME Detailed description of indicator TOTAL INPATIENT ACUTE WEIGHTED CASES 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. 2015/16 HSAA Technical Specifications Page 93

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, HTTP://... RESPONSIBILITY FOR REPORTING Health Service Providers DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) 2010-05-13 2012-06-13 2015/16 HSAA Technical Specifications Page 94

NUMERATOR Hospital Specialized Services (Schedule C2 Part II) INDICATOR NAME COCHLEAR IMPLANTS (CASES) Detailed description of indicator INDICATOR CLASSIFICATION The number of primary and revision cases of cochlear implants Performance (without corridor) PERFORMANCE STANDARD Target: # of procedures established through SAA negotiation process Corridor: No performance corridor exists for this indicator List of Canadian Classification of Health Intervention (CCI) Codes associated with Cochlear Implant Procedures within any intervention position Category Procedure CCI Code(s) Cochlear Implants Primary Revision 1.DM.53.^^ without status attribute assigned 1.DM.53.^^ with Status attribute = R National Ambulatory Care Reporting System (NACRS) and Discharge Abstract Database (DAD) Includes: Age: 18 years and over With Health Card Issued by Ontario: Province = ON Elective Procedure: Admission Category = L Excludes: 2015/16 HSAA Technical Specifications Page 95

ADDITIONAL INFORMATION GEOGRAPHY & TIMING DENOMINATOR Installation of bone anchored hearing aids (1.DL.53.^^) Installation of external appliance, ear NEC Including replacement of appliance or prosthesis, ear (1.DZ.37.^^ or 1.DL.53.^^) Status for Procedures not equal to A Out-of-Hospital for Procedures not equal to Y TIMING/FREQUENCY OF RELEASE How often, and when, are data being released Data is available quarterly, in September, December, March and June. LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at Local Health Integration Network (LHIN) and hospital levels TRENDING Years available for trending Data are available from April 2002 LIMITATIONS Specific limitations None COMMENTS Additional information regarding the calculation, interpretation, data source, etc. 2015/16 HSAA Technical Specifications Page 96

REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, HTTP://... RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) 2014-05-01 DATE LAST REVIEWED (YYYY-MM-DD) 2015/16 HSAA Technical Specifications Page 97

NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION SEXUAL ASSAULT/DOMESTIC VIOLENCE TREATMENT CLINICS (PATIENTS) The number of clinical patients identified in Emergency (self-referral, familyreferral, children's aid referral, or police accompanied) who require emergency medical care, forensic documentation and crisis support for sexual assault or domestic violence as defined under the criminal code. Performance (without corridor) PERFORMANCE STANDARD Target: # of procedures established through SAA negotiation process Corridor: No performance corridor exists for this indicator A distinct count of separate cases identified in the Emergency Department as identified below List of Canadian Classification of Health Intervention (CCI) Codes associated with Sexual Assault/Domestic Violence Treatment Interventions Category Procedure ICD10CA/CCI Code(s) Examination and observation following alleged rape and seduction Z04.4 Sexual Assault & Domestic Violence Injury due to alleged rape Counseling, for assault victimization Collection of Legal Evidence Alleged Rape = Y05 Z63.0 and 6.AA.10.AV 7.SJ.35.ZZ National Ambulatory Care Reporting System (NACRS) 2015/16 HSAA Technical Specifications Page 98

ONAL INFOR MATIO GEOGRAPHY & TIMING DENOMINATOR Includes: Age: all ages With Health Card Issued by Ontario: Province = ON Counseling for family or societal violence Counseling for physical, mental or sexual abuse Counseling for victim of bullying Photographic evidence gathering Photography done for forensic purposes Preparation, evidence kit (e.g. for abuse, rape or violent assault) Excludes: None TIMING/FREQUENCY OF RELEASE How often, and when, are data being released Data is available quarterly, at the end of month, in June, September, January and March LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at Local Health Integration Network (LHIN) and hospital levels TRENDING Years available for trending LIMITATIONS Specific limitations None 2015/16 HSAA Technical Specifications Page 99

COMMENTS Additional information regarding the calculation, interpretation, data source, etc. Includes OHRS secondary statistic codes: 916 88 40 Sexual Assault Adult Patients 916 88 60 Sexual Assault Paediatric Patients 916 89 40 Domestic Violence Adult Patients REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, HTTP://... RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) 2014-05-01 DATE LAST REVIEWED (YYYY-MM-DD) To Follow in Future Versions: Cleft Palate HIV Outpatient Clinics 2015/16 HSAA Technical Specifications Page 100

NUMERATOR Wait Time Volumes (Schedule C2 Part III) INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION GENERAL SURGERY (BASE & INCREMENTAL) Total number of base and one-time incremental General Surgery Cases, respectively. General Surgery cases are further categorized into: Anorectal Surgery Cholecystectomy Surgery Intestinal Surgery (non-oncologic) Groin (inguinal/femoral) Hernia repair Ventral Hernia repair Performance (without corridor) Target: PERFORMANCE STANDARD # of base volume procedures was established by Ministry in previous years. # of incremental procedures are reconciled based on actual incremental volumes performed during year Corridor: No performance corridor exists for this indicator List of Canadian Classification of Health Intervention (CCI) Codes associated with General Surgery Procedures General Surgery All 20 CCI Location for Category Codes (1) Procedure All 25 ICD-10 (2) First 5 Digits Diagnostic Codes Equal Not Equal Equal 1NT86^^ K60** 1NT72^^ Anorectal Surgery 1NT86^^ 1NT87^^ 1NQ87^^ K50**, K51** K64** Cholecystectomy 1OD89^^ K80*, K81* 1NK87^^ Intestinal Surgery (non-oncologic) Groin (inguinal/ femoral) hernia repair 1NM87^^ 1NM89^^ K50**, K51** K55**, K57**, K56**K63**, 1SY80^^ O K40**, K41* 2015/16 HSAA Technical Specifications Page 101

GEOGRAPHY & TIMING DENOMINATOR Ventral hernia 1SY80^^ O K43** repair ^^ 6 th & 7 th digit of Procedure Codes not equal to BA Status for Procedures not equal to A Out-of-Hospital for Procedures not equal to Y (1) All CCI codes are included up to and including the first 20 CCI codes (2) All ICD codes are included up to and including the first 25 ICD codes National Ambulatory Care Reporting System (NACRS) or Discharge Abstract Database (DAD) Includes: Age: 18 years and over With Health Card Issued by Ontario: Province = ON Elective Procedure: Admission Category = L Acute Inpatient (for intestinal surgery and ventral hernia repair) and Outpatient (for all 5 categories- procedures are confined to the mandated Management Information System (MIS) Functional Centres 71260*, 71262*, 7134055*, 71360*, 71362*, 71369*) Collection of the Status and Location attribute Surgery includes both primary and revisions, therefore include revision status attribute R, as appropriate Excludes: Oncology Cases: Cases in which the Most Responsible = Diagnosis is equal and or between to C00-C97 or D00-D48 Groin Hernia repair specific excludes K42* & K44* (umbilical & diaphragmatic hernia) TIMING/FREQUENCY OF RELEASE How often, and when, are Data is available quarterly, in September, December, March and June. 2015/16 HSAA Technical Specifications Page 102

ADDITIONAL INFORMATION data being released LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at Local Health Integration Network (LHIN) and hospital levels TRENDING Years available for trending Data are available from 2002 LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. Base volume counts include a count of elective, non-elective, inpatient and outpatient volumes for all WTS surgical procedures. Only elective procedures are counted for incremental WTS surgical procedures. Incremental one-time cases are only calculated once the base volumes are completed by the hospital within the fiscal year. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, HTTP://... RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) 2014-05-01 2015/16 HSAA Technical Specifications Page 103

INDICATOR NAME PAEDIATRIC SURGERY (BASE & INCREMENTAL) Detailed description of indicator INDICATOR CLASSIFICATION Total number of base and one-time incremental Paediatric Surgery Cases, respectively. Paediatric Surgery cases are further categorized into: General Surgery o Hernia Repair o Gallbladder Excision o Hydrocele Repair Dental/Oral Surgery o Restoration o Extraction o All other dental procedures Otolaryngology Surgery o Tonsillectomy & Adenoidectomy o Myringotomy & Tube Placement Orthopaedic Surgery o Scoliosis Repair o ACL Repair (Anterior Cruciate Ligament) o Arthroscopy Urology Surgery o Ureter Implant o Orchiopexy o Circumcision o Pyeloplasty o Hypospadias Repair Ophthalmology Surgery o General Ophthalmology (all ophthalmology procedures excluding Strabismus o Strabismus Repair Plastic Surgery o Cleft Lip/Cleft Palate Repair o Craniosynostosis Repair o Maxiofacial Surgery o Treatment of Hemangiomas/Vascular Anomalies Performance (without corridor) Target: PERFORMANCE STANDARD # of base volume procedures was established by Ministry in previous years. # of incremental procedures are reconciled based on actual incremental volumes performed over and above base volumes during year Corridor: 2015/16 HSAA Technical Specifications Page 104

NUMERATOR No performance corridor exists for this indicator List of Canadian Classification of Health Intervention (CCI) Codes associated with Paediatric Surgery Procedures Paediatric Surgery Category Procedure Sub-Procedure CCI Code General Surgery Hernia Repair Gallbladder Excision Hydrocele Repair Restoration Extraction 1SY80 + Location Attribute cannot equal 0 1GX80 1OD89 1QH87, 1QP87 1FE29 1FE57 Pharmacotherapy 1FE35, 1FF35 External Appliance Internal Device Removal 1FE37, 1FE38 1FE53, 1FF53 1FE55, 1FF55, 1FF56 Dental/Oral Surgery All other dental procedures Release Fixation Repair 1FE72 1FE74 1FE80, 1FF80 Reattachment 1FE82 Transfer 1FE83 Excision 1FE87, 1FF87, 1FE89, 1FF89 Intervention NEC 1FE94 Destruction 1FF59 Otolaryngology Surgery Tonsillectomy & Adenoidectomy Myringotomy & Tube Placement 1FR87, 1FR89, 1FR59 1DF53JA-TS 2015/16 HSAA Technical Specifications Page 105

Orthopaedic Surgery Urology Surgery Ophthalmology Surgery Plastic Surgery Scoliosis Repair ACL Repair (Anterior Cruciate Ligament) Arthroscopy Ureter Implant Orchiopexy Circumcision Pyeloplasty Hypospadias Repair General Ophthalmology (all Ophthalmology procedures excluding Strabismus) Strabismus Repair Cleft Lip/Cleft Palate Repair Craniosynostosis Repair Maxiofacial Surgery 1SC74 and 1SC75 with diagnosis codes (Q67.5, Q76.3 or M41.0-M41.9) 1VL80,, 1VL78, 1VN78, 1VN80 2.VG.70.DA, 2.TB.70.DA, 2.WA.70.DA, 2.UB.70.DA, 2.TM.70.DA, 2.UL.70.DA, 2.WH.70.DA, 2.VA.70.DA, 2.TA.70.DA, 2.EL.70.DA 1PG80 1QM7,1QM80 1QD89 1PE80 or 1PG80 in combination with 1PE50 1QE80 CCI codes self-identified by Hospitals 1CQ59, 1CQ78, 1CQ83 1FB86, 1YE80 1EA72 with diagnosis code Q75.0 1.ED.80.LA-NW, 1.EE.80.LA- NW, 1.EE.79.LA-NW, 1.EE.78.LA-NW, 1.EF.80.LA- NW, 1.EM.80.LA-XX-A, 1.EN.80.LA-XX-A, 1.EE.58.LA- XX-A, 1.SQ.58.LA-XX-A, 1.FH.52.LA, 1.ES.80.LA-XX-E, 1.EE.74.LA-NW, 1.ED.74.LA- NW Plastic Surgery Treatment of Hemangiomas/ Vascular Anomalies via Pulse Dye Laser via Open 1(YA,YB,YC,YD,YE,YF,YG,YR,Y T,YU, YV,YW,YZ) ends in 59 JADN D18 inclusive as the Most Responsible Diagnosis in 2015/16 HSAA Technical Specifications Page 106

Excision combination with any of the following codes: 1EQ87LA, 1EQ87LAXXA, 1EQ87LAXXE, 1EQ87LAXXF, 1EQ87LAXXG, 1EQ87LAXXQ, 1SH87LA, 1SH87LAXXA, 1SH87LAXXE, 1SH87LAXXG,, 1SZ87LA, 1SZ87LAXXA, 1SZ87LAXXE, 1SZ87LAXXF, 1SZ87LAXXG, 1SZ87LAXXN, 1SZ87LAXXQ, 1TX87LA, 1TX87LAXXA, 1TX87LAXXE, 1TX87LAXXF, 1TX87LAXXQ, 1UY87LA, 1UY87LAXXA, 1UY87LAXXB, 1UY87LAXXE, 1UY87LAXXF, 1UY87LAXXQ, 1VX87LA, 1VX87LAXXA, 1VX87LAXXE, 1VX87LAXXF, 1VX87LAXXQ, 1WV87LA, 1WV87LAXXA, 1WV87LAXXE, 1WV87LAXXF, 1WV87LAXXQ, 1YC87LA, 1YC87LAAG, 1YC87LAAGA, 1YC87LAAGB, 1YC87LAAGE, 1YC87LAXXA, 1YC87LAXXB, 1YC87LAXXE, 1YD87LA, 1YD87LAAG, 1YD87LAAGA, 1YD87LAAGB, 1YD87LAAGE, 1YD87LAAY, 1YD87LAAYA, 1YD87LAAYB, 1YD87LAAYE, 1YD87LAXXA, 1YD87LAXXB, 1YD87LAXXE, 1YF87LA, 1YF87LAAG, 1YF87LAAGA, 1YF87LAAGB, 1YF87LAAGE, 1YF87LAAGF, 1YF87LAAY, 1YF87LAAYA, 1YF87LAAYB, 1YF87LAAYE, 1YF87LAAYF, 1YF87LAXXA, 1YF87LAXXB, 1YF87LAXXE, 1YF87LAXXF, 1YG87LA, 1YG87LAAG, 1YG87LAAGA, 1YG87LAAGB, 1YG87LAAGE, 1YG87LAAGF, 1YG87LAAY, 1YG87LAAYA, 1YG87LAAYB, 1YG87LAAYE, 1YG87LAAYF, 1YG87LAXXA, 1YG87LAXXB, 1YG87LAXXE, 1YG87LAXXF, 1YR87LA, 1YR87LAAG, 1YR87LAAGA, 1YR87LAAGB, 1YR87LAAGE, 2015/16 HSAA Technical Specifications Page 107

1YR87LAAY, 1YR87LAAYA, 1YR87LAAYB, 1YR87LAAYE, 1YR87LAXXA, 1YR87LAXXB, 1YR87LAXXE, 1YS87LA, 1YS87LAAG, 1YS87LAAGA, 1YS87LAAGB, 1YS87LAAGE, 1YS87LAAGF, 1YS87LAAY, 1YS87LAAYA, 1YS87LAAYB, 1YS87LAAYE, 1YS87LAAYF, 1YS87LAXXA, 1YS87LAXXB, 1YS87LAXXE, 1YS87LAXXF, 1YT87LA, 1YT87LAAG, 1YT87LAAGA, 1YT87LAAGB, 1YT87LAAGE, 1YT87LAAGF, 1YT87LAAY, 1YT87LAAYA, 1YT87LAAYB, 1YT87LAAYE, 1YT87LAAYF, 1YT87LAXXA, 1YT87LAXXB, 1YT87LAXXE, 1YT87LAXXF, 1YV87LA, 1YV87LAAG, 1YV87LAAGA, 1YV87LAAGB, 1YV87LAAGE, 1YV87LAAGF, 1YV87LAAY, 1YV87LAAYA, 1YV87LAAYB, 1YV87LAAYE, 1YV87LAAYF, 1YV87LAXXA, 1YV87LAXXB, 1YV87LAXXE, 1YV87LAXXF National Ambulatory Care Reporting System (NACRS) or Discharge Abstract Database (DAD) Includes: A paediatric surgical procedure is a Hospital-based (inpatient or day surgery) case that is booked for a paediatric patient where a paediatric patient is defined as (1) any patient less than 18 years old ; or (2) any patient less than 23 years old, at the discretion of the treating surgeon, who is undergoing a procedure related to underlying congenital, developmental or genetic disorder such as craniofacial abnormality, muscular dystrophy, spina bifida, or cerebral palsy. The patient must be less than 18 years of age at the time the Decision to Treat was made. The actual surgery does not necessarily need to be 2015/16 HSAA Technical Specifications Page 108

GEOGRAPHY & TIMING DENOMINATOR performed prior to the patient s 18th birthday. For inpatient cases, the specific procedure in question should be counted on any position in the patient record. For outpatient procedures, the specific procedure in question should be counted on any position in the patient record with the ICD-10 diagnosis code listed as the Most Responsible Diagnosis. Additionally, the age restriction and Day Surgery are confined to the mandated MIS functional centres 71260*, 71262*, 71360*, 71362*, 71369*. Excludes: For the CCI codes listed, exclude the following cases: (i) abandoned or cancelled cases = A (ii) out-of-hospital indicator = Y (iii) out-of-province cases = Responsibility for Payment TIMING/FREQUENCY OF RELEASE How often, and when, are data being released Data is available quarterly, at the end of month, in June, September, December and March LEVELS OF COMPARABILITY Levels of geography for comparison TRENDING Years available for trending Data are available at Local Health Integration Network (LHIN) and hospital levels Data are available from 2002 Please note for NACRS to check the MIS functional centres as there have 2015/16 HSAA Technical Specifications Page 109

ADDITIONAL INFORMATION been changes over the years. LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. Base volume counts include a count of elective, non-elective, inpatient and outpatient volumes for all WTS surgical procedures. Only elective procedures are counted for incremental WTS surgical procedures. Incremental one-time cases are only calculated once the base volumes are completed by the hospital within the fiscal year. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, HTTP://... RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) 2014-05-01 2015/16 HSAA Technical Specifications Page 110

NUMERATOR INDICATOR NAME INDICATOR DESCRIPTION Detailed description of indicator INDICATOR CLASSIFICATION HIP & KNEE REPLACEMENT - REVISIONS (CASES) The number of joint replacement cases that are a revision of prosthesis Performance (without corridor) PERFORMANCE STANDARD Target: # of base volume procedures was established by Ministry in previous years. # of incremental procedures are reconciled based on actual incremental volumes performed during year Corridor: No performance corridor exists for this indicator Hip Inpatient (DAD) Any intervention beginning 1VA53*and case falls within HIG 320 Includes: Location attribute must equal either R or L Age of Patient 18 years or older Admission Category = L Cases with Status Attributes= R Excludes: Cases with Status Attributes = A Out of hospital indicator = Y MRDx does not begin with C**, D**, range S**to T** Intervention 1VA53LASLN (NACRS) Day Surgery Any intervention is 1VA53* Includes: Location attribute must equal either R or L Age of Patient 18 years or older Excludes: Main Problem does not begin with C**, D**, range S**to T** Knee Inpatient (DAD) Any intervention beginning with 1VG53* and case falls within HIG 321 Includes: Location attribute must equal R or L Age of patient 18 years or older Admission Category = L Cases with Status Attributes =R Excludes: Cases with Status Attributes = A 2015/16 HSAA Technical Specifications Page 111

GEOGRAPHY & TIMING DENOMINATOR Out of hospitals indicator = Y Intervention 1VG53LASLN MRDx does not begin with C**, D**, range S00* to T** NACRS (Day Surgery) Any intervention beginning with 1VG53* Includes: Location attribute must equal R or L Age of patient 18 years or older Admission Category = L Excludes: Cases with Status Attributes = R or A Out of hospitals indicator = Y Intervention 1VG53LASLN MRDx does not begin with C**, D**, range S00* to T** National Ambulatory Care Reporting System (NACRS) and Discharge Abstract Database (DAD) Includes: Age: 18 years and over With Health Card Issued by Ontario: Province = ON Elective Procedure: Admission Category = L Mandatory to report Status and Location Attribute Excludes: Excludes separations/discharges where Primary Condition for joint replacement is Cancer or Trauma. Cancer ICD10CA codes: C00 to D09 or Trauma S00-T32 TIMING/FREQUENCY OF RELEASE How often, and when, are data being released Data is available quarterly, in September, December, March and June. LEVELS OF COMPARABILITY Data are available at Local Health Integration Network (LHIN) and hospital levels Levels of geography for 2015/16 HSAA Technical Specifications Page 112

ADDITIONAL INFORMATION comparison TRENDING Years available for trending LIMITATIONS Specific limitations Data are available from 2006/07 None COMMENTS Additional information regarding the calculation, interpretation, data source, etc. Bilateral prosthesis would count as two prosthesis, where location attribute would equal B REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, HTTP://... RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) 2014-05-01 DATE LAST REVIEWED (YYYY-MM-DD) 2015/16 HSAA Technical Specifications Page 113

DENOMINAT OR NUMERATOR INDICATOR NAME Detailed description of indicator MAGNETIC RESONANCE IMAGING (MRI) TOTAL HOURS Total number of hours of operating time of the MRI machines including 3 rd Party machines performing work on behalf of the hospital INDICATOR CLASSIFICATION Performance (without corridor) PERFORMANCE STANDARD Target: # of base volume hours was established by Ministry in previous years. # of incremental hours are reconciled based on actual incremental hours performed during year Corridor: No performance corridor exists for this indicator Count of number of hours of operating time of MRI machines including 3 rd Party machines when performing work on behalf of the hospital Hospitals internal (clinical) database(s) Includes: Age: 18 years and over With Health Card Issued by Ontario: Province = ON OBSP hours Excludes: None 2015/16 HSAA Technical Specifications Page 114

ADDITIONAL INFORMATION GEOGRAPHY & TIMING TIMING/FREQUENCY OF RELEASE How often, and when, are data being released LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at hospital levels TRENDING Years available for trending LIMITATIONS Specific limitations None COMMENTS Additional information regarding the calculation, interpretation, data source, etc. Includes OHRS secondary statistic codes: 930 46 15 MRI Hours OHIP 930 46 90 MRI Hours Third Party REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, HTTP://... RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) 2014-05-01 DATE LAST REVIEWED (YYYY-MM-DD) 2015/16 HSAA Technical Specifications Page 115

NUMERATOR INDICATOR NAME Detailed description of indicator ONTARIO BREAST SCREENING PROGRAM (OBSP) MAGNETIC RESONANCE IMAGING (MRI) TOTAL HOURS Total number of hours of operating time of the MRI machines dedicated for breast screening for women at high risk (BSHR) through the Ontario Breast Screening Program (OBSP) including 3 rd Party machines performing work on behalf of the hospital INDICATOR CLASSIFICATION Performance (without corridor) PERFORMANCE STANDARD Target: # of base volume hours was established by Ministry in previous years. # of incremental hours are reconciled based on actual incremental hours performed during year Corridor: No performance corridor exists for this indicator Include MRI operating hours for BSHR OBSP interventions only. The definition a woman eligible for the high risk screening program is if they have no acute breast symptoms, are 30 to 69 years of age and meet one of the following risk criteria: Are known to be carriers of a deleterious gene mutation (e.g. BRCA1, BRCA2) Are the first degree relative of a mutation carrier (e.g. BRCA1, BRCA2) and have declined genetic testing Are determined to be at 25% lifetime risk of breast cancer -- must have been assessed using either the IBIS or BOADICEA risk assessment tools, preferably at a genetics clinic Have received chest radiation before age 30 and at least 8 years previously Hospitals internal (clinical) database(s) Includes: Age: 18 years and over With Health Card Issued by Ontario: Province = ON 2015/16 HSAA Technical Specifications Page 116

ADDITIONAL INFORMATION GEOGRAPHY & TIMING DENOMINATOR Excludes: None TIMING/FREQUENCY OF RELEASE How often, and when, are data being released LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at hospital levels TRENDING Years available for trending Data are available from 2006/07 LIMITATIONS Specific limitations None COMMENTS Additional information regarding the calculation, interpretation, data source, etc. Includes OHRS secondary statistic codes: 930 46 15 MRI Hours OHIP 930 46 90 MRI Hours Third Party Typical length of a breast screening MRI exam is 40 minutes 2015/16 HSAA Technical Specifications Page 117

To ensure high quality images, OBSP requires the following set of minimum standards for MRI-MSHR scans: Requirements: Injection contrast must be gadolinium (0.1-0.2 mmol/lkg) Minimum 1.5 Tesla Dedicated breast coil Bilateral imaging (unilateral only if mastectomy on one side) All MRI-BSHR imaging should be axial or sagittal imaging Pre-gadolinium T1 gradient echo (3D) fat sat T2 fat sat or IR Post-gadolinium T1 gradient echo (3D) fat sat At least three time points from the start of the injection o The first time point should be within 2 minutes o The last time point being after 5 minutes but no longer than 8 minutes post-injection Spatial Resolution Use largest imaging matrix within the acquisition window In-plane pixel size of 0.5mm x 0.5mm to 1mm x 1mm Through plane pixel size of 1mm - 3mm Recommended Protocol: Localizer protocol T2 fat sat/ir T1 fat sat (pre) T1 fat sat (post) (x3) Subtracted (computer generated processing stage) (x3) Sagittal reconstruction (post-contrast) REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, HTTP://... RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) 2014-05-01 DATE LAST REVIEWED (YYYY-MM-DD) 2015/16 HSAA Technical Specifications Page 118

DENOMINATOR NUMERATOR INDICATOR NAME Detailed description of indicator COMPUTED TOMOGRAPHY (CT) TOTAL HOURS Total number of hours of operating time of the CT machines including 3 rd Party machines performing work on behalf of the hospital INDICATOR CLASSIFICATION Performance (without corridor) PERFORMANCE STANDARD Target: # of base volume hours was established by Ministry in previous years. # of incremental hours are reconciled based on actual incremental hours performed during year Corridor: No performance corridor exists for this indicator Count of number of hours of operating time of CT machines including 3 rd Party machines when performing work on behalf of the hospital Hospitals internal (clinical) database(s) Includes: Age: 18 years and over With Health Card Issued by Ontario: Province = ON Excludes: None 2015/16 HSAA Technical Specifications Page 119

ADDITIONAL INFORMATION GEOGRAPHY & TIMING TIMING/FREQUENCY OF RELEASE How often, and when, are data being released LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at hospital levels TRENDING Years available for trending LIMITATIONS Specific limitations None COMMENTS Additional information regarding the calculation, interpretation, data source, etc. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, HTTP://... RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) 2014-05-01 DATE LAST REVIEWED (YYYY-MM-DD) 2015/16 HSAA Technical Specifications Page 120

NUMERATOR Provincial Programs (Schedule C2 Part IV) INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION AUTOMATIC INPLANTABLE CARDIAC DEFIB'S (# OF NEW IMPLANTS) Total number of base and one-time incremental Automatic Implantable Cardiac Defibrillators that are new implants: Performance (without corridor) Target: PERFORMANCE STANDARD # of base volume procedures was established by Ministry in previous years. # of incremental procedures are reconciled based on actual incremental volumes performed over and above base volumes during year Corridor: No performance corridor exists for this indicator List of Canadian Classification of Health Intervention (CCI) Codes associated with AICD Procedures New implants in any intervention position and mandatory to capture the Extent attribute Category Procedure CCI Code(s) Automatic Implantable Cardiac Defibrillator New Implants Percutaneous transluminal [transvenous] approach or approach NOS Percutaneous approach (to tunnel subcutaneously) Open [thoracotomy] approach 1.HZ.53.GR-FS 1.HZ.53.HA-FS 1.HZ.53.LA-FS Combined open (thoracotomy) approach and percutaneous transluminal (transvenous) approach 1.HZ.53.SY-FS 2015/16 HSAA Technical Specifications Page 121

GEOGRAPHY & TIMING DENOMINATOR National Ambulatory Care Reporting System (NACRS) or Discharge Abstract Database (DAD) Includes: With Health Card issued by Ontario: Province = ON Applicable to any age patient Excludes: For the CCI codes listed, exclude the following cases: (iv) out-of-province indicator = Y (v) Status attribute values not equal to A (exclude abandoned cases) or R (exclude revisions) (vi) Out-of-Hospital indicator not equal to Y TIMING/FREQUENCY OF RELEASE How often, and when, are data being released Data is available quarterly, in September, December, March and June. LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at Local Health Integration Network (LHIN) and hospital levels 2015/16 HSAA Technical Specifications Page 122

ADDITIONAL INFORMATION TRENDING Years available for trending Data are available from 2002 LIMITATIONS Specific limitations COMMENTS Additional information regarding the calculation, interpretation, data source, etc. AICDs are devices implanted under the skin which will deliver an electrical charge to the heart in the event of sudden cardiac arrest (terminates heart rates that are too fast and cause sudden cardiac death). Incremental one-time cases are only calculated once the base volumes are completed by the hospital within the fiscal year. REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, HTTP://... RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) DATE LAST REVIEWED (YYYY-MM-DD) 2014-05-01 2015/16 HSAA Technical Specifications Page 123

NUMERATOR INDICATOR NAME Detailed description of indicator INDICATOR CLASSIFICATION BARIATRIC SURGERY (PROCEDURES) The number of base and one-time incremental bariatric surgery procedures that include the CCI codes below Performance (without corridor) Target: PERFORMANCE STANDARD # of base volume procedures was established by Ministry in previous years. # of incremental procedures are reconciled based on actual incremental volumes performed over and above base volumes during year Corridor: No performance corridor exists for this indicator List of Canadian Classification of Health Intervention (CCI) Codes associated with Bariatric Surgery Procedures Category Procedure CCI Code(s) Vertical banded gastroplasty Adjustable banded gastroplasty Roux-en-Y Gastric Bypass Gastric Sleeve Biliopancreatic 1.NF.78.XP 1.NF.78.XO 1.NF.78.EJ 1.NF.78.SH 1.NF.78.DQ 1.NF.78.WJ 1NF.78.GB 1.NF.78.SJ 1.NF.78.DO 2015/16 HSAA Technical Specifications Page 124

DENOMINATOR Duodenal Switch Circular stapling or suturing Reversal of previous vertical banded gastroplasty Revision of Reversal of previous vertical banded gastroplasty 1.NF.78.SI 1.NF.78.DI 1.NF.78.BN 1.NF.82.^^ Same as above but includes Status Attribute = R ICD-10-CA Code MDRx Obesity (Primary Surgery) E66.0, E66.1, E66.2, E66.8, E66.9 National Ambulatory Care Reporting System (NACRS) or Discharge Abstract Database (DAD) Includes: Age: 18 years and over With Health Card Issued by Ontario: Province = ON Elective Procedure: Admission Category = L Excludes: For the CCI codes listed, exclude the following cases: out-of-province cases abandoned or cancelled cases (Status attribute value A ) out of hospital indicator = Y most revisions, except those specifically included 2015/16 HSAA Technical Specifications Page 125

ADDITIONAL INFORMATION GEOGRAPHY & TIMING TIMING/FREQUENCY OF RELEASE How often, and when, are data being released Data is available quarterly, at the end of month in June, September, December and March. LEVELS OF COMPARABILITY Levels of geography for comparison Data are available at Local Health Integration Network (LHIN) and hospital levels TRENDING Years available for trending LIMITATIONS Specific limitations None For Fiscal 2015 there are 3 new CCI codes for Bariatric surgery that must be included in chart: COMMENTS Additional information regarding the calculation, interpretation, data source, etc. 1.NF.78.DW Repair by decreasing size, stomach endoscopic [laparoscopic] approach using circular stapling or suturing [plication] technique 1.NF.78.EI Repair by decreasing size, stomach endoscopic [laparoscopic] approach using combined techniques [e.g. adjustable banding technique and plication] 1.NF.78.VT Repair by decreasing size, stomach open approach using circular stapling or suturing [plication] technique REFERENCES Provide URLs of any key references E.g. Diabetes in Canada, HTTP://... RESPONSIBILITY FOR REPORTING DATE CREATED (YYYY- MM-DD) 2014-05-01 2015/16 HSAA Technical Specifications Page 126

DATE LAST REVIEWED (YYYY-MM-DD) To Follow in Future Versions: Cardiac Surgery Cardiac Services - Catheterization Cardiac Services- Interventional Cardiology Cardiac Services- Permanent Pacemakers Automatic Inplantable Cardiac Defib's - Replacements Automatic Implantable Cardiac Defib's - Replacements done at Supplier's Request Automatic Implantable Cardiac Defib's - Manufacturer Requested ICD Replacement Procedures Organ Transplantation Neurosciences Regional Trauma Number of Forensic Beds - General Number of Forensic Beds - Secure Number of Forensic Beds Assessment Medical and Behaviour Treatment 2015/16 HSAA Technical Specifications Page 127

Quality Based Procedures (Schedule C2 Part V) To Follow in Future Versions: Cognitive: Stroke Hemorrhage Cognitive: Stroke- Ischemic or Unspecified Cognitive: Stroke- Transient Ischemic Attack (TIA) Orthopaedics: Acute Primary Unilateral Hip Replacement Orthopaedics: Elective Hips Inpatient Rehab for Primary Hip Orthopaedics: Elective Hips Outpatient Rehab for Primary Hip Orthopaedics: Elective Hips Acute Primary Unilateral Knee Replacement Orthopaedics: Elective Hips Inpatient Rehab for Primary Knee Orthopaedics: Elective Hips Outpatient Rehab for Primary Knee Orthopaedics: Bilateral Hip/Knee Replacement Orthopaedics: Hip Fracture Orthopaedics: Knee Arthroscopy Gastrointestinal: Endoscopy Cardiac: Congestive Heart Failure Cardiac: Aortic Valve Replacement Cardiac: Coronary Artery Disease Respiratory: Chronic Obstructive Pulmonary Disease Respiratory: Pneumonia Cancer: Chemotherapy Systemic Treatment Cancer: Cancer Surgery Cancer: Colposcopy Non-Cardiac Vascular: Aortic Aneurysm (AA) Non-Cardiac Vascular: Lower Extremity Occlusive Disease (LEOD) Paediatric: Neonatal Jaundice (Hyperbilirubinemia) Paediatric: Tonsillectomy Vision Care: Cataracts- Unilateral Vision Care: Cataracts- Bilateral Vision Care: Retinal Disease CKD: Chronic Kidney Disease HomeCare: Short-Stay Post-hospital Discharge Homecare: Medical Discharge HomeCare: Short-Stay Post-hospital Discharge Homecare: Surgical Discharge 2015/16 HSAA Technical Specifications Page 128

2015/16 HSAA Technical Specifications Page 129