3.0 Health System Characteristics

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3.0 Health System Characteristics

Health System

3.1 Coronary Artery Bypass Graft Surgery Rate

Definition
Age-standardized rate of coronary artery bypass graft (CABG) surgery performed on inpatients in acute care hospitals, per 100,000 population age 20 and older.

Method of Calculation
(Total number of discharges for CABG for inpatients age 20 and older / total mid-year population age 20 and older) x 100,000 (age adjusted)

CCP 1
48.1^

CCI xi
1.IJ.76^^

Interpretation
As with other types of surgical procedures, variation in CABG surgery rates can be attributed to numerous factors, including differences in population demographics, physician practice patterns and availability of services. In cases amenable to treatment with less-invasive procedures, percutaneous coronary intervention (PCI), an alternative intervention to improve blood flow to the heart muscle, may be used. Variations in the extent to which PCI is utilized may result in variations in the rate of bypass surgery.

Standards/Benchmarks
Benchmarks have not been identified for this indicator.

Data Sources
Discharge Abstract Database (DAD), CIHI
Fichier des hospitalisations MED-ÉCHO, ministère de la Santé et des Services sociaux du Québec

Reference Period
April 1, 2009, to March 31, 2010

Comprehensiveness
Available for all provinces and territories.

Comments
Rates are based on the total number of discharges for CABG in a given year. Therefore, a patient who received more than one CABG procedure during the same hospitalization was counted once.

CABG operations can only be performed in designated cardiac centres; therefore, procedures reported by facilities without on-site CABG services were excluded from the indicator calculation.

Bibliography
Cardiac Care Network of Ontario Consensus Panel on Target Setting. Final Report and Recommendations. Toronto, Ont.: CCN, 2004. Accessed from <http://www.ccn.on.ca/pdfs/Cons_Panel_Target_Setting_FRR.pdf>.

Conigliaro, J. et al. “Understanding Racial Variation in the Use of Coronary Revascularization Procedures: The Role of Clinical Factors.” Archives of Internal Medicine 160 (2000): pp. 1329–1335.

Faris, P. D. et al. “Diagnostic Cardiac Catheterization and Revascularization Rates for Coronary Heart Disease.” Canadian Journal of Cardiology 20 (2004): pp. 391–397.

Institute for Clinical Evaluative Sciences. Cardiovascular Health and Services in Ontario. Toronto, Ont.: ICES, 1999.

Yap, A. G. et al. “Coronary Artery Bypass Surgery on Small Patients.” Journal of Invasive Cardiology 12 (2000): pp. 242–246.

3.2 Percutaneous Coronary Intervention Rate

Definition
Age-standardized rate of percutaneous coronary interventions (PCIs) performed on patients in acute care hospitals, same-day surgery facilities or catheterization laboratories, per 100,000 population age 20 and older.

Method of Calculation
(Total number of discharges for PCI for patients age 20 and older / total mid-year population age 20 and older) x 100,000 (age adjusted)

CCP 2
48.02 or 48.03

CCI xii
1.IJ.50^^ or 1.IJ.57.GQ^^

Interpretation
In many cases, PCI serves as a non-surgical alternative to coronary artery bypass graft

(CABG) surgery and is undertaken for the purpose of opening obstructed coronary arteries.

While PCI encompasses several techniques, angioplasty is the procedure most frequently

provided. The choice of revascularization mode (PCI or CABG) depends on numerous

factors, including physician preferences, availability of services and referral patterns, as well as differences in population health and socio-economic status.

Standards/Benchmarks
Benchmarks have not been identified for this indicator.

Data Sources
Discharge Abstract Database (DAD), CIHI
National Ambulatory Care Reporting System (NACRS), CIHI
Alberta Ambulatory Care Database, Alberta Health and Wellness

Reference Period
April 1, 2009, to March 31, 2010

Comprehensiveness
Available for all provinces and territories, except Quebec. Rates for Quebec are not available

due to differences in data collection.

Comments
Rates are based on the total number of discharges for PCI in a given year. Therefore, a patient who received more than one PCI procedure during the same hospitalization was counted once.

PCI can only be performed in designated cardiac centres; therefore, procedures reported by facilities without on-site PCI services were excluded from the indicator calculation.

Bibliography
Cardiac Care Network of Ontario Consensus Panel on Target Setting. Final Report and Recommendations. Toronto, Ont.: CCN, 2004. Accessed from <http://www.ccn.on.ca/pdfs/Cons_Panel_Target_Setting_FRR.pdf>.

Faris, P. D. et al. “Diagnostic Cardiac Catheterization and Revascularization Rates for Coronary Heart Disease.” Canadian Journal of Cardiology 20 (2004): pp. 391–397.

Institute for Clinical Evaluative Sciences. Cardiovascular Health and Services in Ontario. Toronto, Ont.: ICES, 1999.

King, S. B. 3rd et al. “2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.” Journal of the American College of Cardiology 51 (2008): pp. 172–209.

Smith, S. C. Jr. et al. “A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1993 Guidelines for Percutaneous Transluminal Coronary Angioplasty).” Journal of the American College of Cardiology 37 (2001): pp. 2215–2239.

3.3 Cardiac Revascularization Rate

Definition
Age-standardized rate of coronary artery bypass graft (CABG) surgery performed on inpatients in acute care hospitals or percutaneous coronary interventions (PCIs) performed on patients in acute care hospitals, same-day surgery facilities or catheterization laboratories, per 100,000 population age 20 and older.

Method of Calculation
(Total number of discharges for CABG or PCI for patients age 20 and older / total mid-year population age 20 and older) x 100,000 (age adjusted)

CCP 3
48.1^, 48.02 or 48.03

CCI xiii
1.IJ.76^^, 1.IJ.50^^ or 1.IJ.57.GQ^^

Interpretation
The choice of revascularization mode (PCI or CABG) depends on numerous factors, including physician preferences, availability of services and referral patterns, as well as differences in population health and socio-economic status. The combined cardiac revascularization rate represents total activity of cardiac revascularization in a jurisdiction.

Standards/Benchmarks
Benchmarks have not been identified for this indicator.

Data Sources
Discharge Abstract Database (DAD), CIHI
National Ambulatory Care Reporting System (NACRS), CIHI
Alberta Ambulatory Care Database, Alberta Health and Wellness

Reference Period
April 1, 2009, to March 31, 2010

Comprehensiveness
Available for all provinces and territories, except Quebec. Rates for Quebec are not available due to differences in data collection.

Comments
Rates are based on the total number of discharges for a cardiac revascularization procedure in a given year. Therefore, a patient who received more than one procedure (either CABG or PCI) during the same hospitalization was counted once.

Cardiac revascularization procedures can only be performed in designated cardiac centres;

therefore, procedures reported by facilities without on-site cardiac services were

excluded from the indicator calculation.

Bibliography
Cardiac Care Network of Ontario Consensus Panel on Target Setting. Final Report and Recommendations. Toronto, Ont.: CCN, 2004. Accessed from <http://www.ccn.on.ca/pdfs/Cons_Panel_Target_Setting_FRR.pdf>.

Faris, P. D. et al. “Diagnostic Cardiac Catheterization and Revascularization Rates for Coronary Heart Disease.” Canadian Journal of Cardiology 20 (2004): pp. 391–397.

Institute for Clinical Evaluative Sciences. Cardiovascular Health and Services in Ontario. Toronto, Ont.: ICES, 1999.

3.4 Hip Replacement Rate

Definition
Age-standardized rate of unilateral or bilateral hip replacement surgery performed on inpatients in acute care hospitals, per 100,000 population age 20 and older.

Method of Calculation
(Total number of discharges for hip replacement surgery for inpatients age 20 and older / total mid-year population age 20 and older) x 100,000 (age adjusted)

CCP 4
93.51, 93.52, 93.53 or 93.59

CCI xiv
1.VA.53.LA-PN^^ or 1.VA.53.PN-PN^^

Interpretation
Hip replacement surgery has the potential to improve functional status, reduce pain and contribute to other gains in health-related quality of life. Over the past two decades, rates of hip replacement surgery have increased substantially. Wide inter-regional variations in joint replacement rates may be attributable to numerous factors, including the availability of services, provider practice patterns and patient preferences.

Standards/Benchmarks
Benchmarks have not been established for this procedure.

Data Sources
Discharge Abstract Database (DAD), CIHI
Fichier des hospitalisations MED-ÉCHO, ministère de la Santé et des Services sociaux du Québec

Reference Period
April 1, 2009, to March 31, 2010

Comprehensiveness
Available for all provinces and territories.

Comments
Rates are based on the total number of discharges for hip replacement surgery in a given year. Therefore, a patient who received both a left and a right hip replacement in the same year but at separate admissions was counted twice.

Beginning with the 2005–2006 rate, this indicator is calculated for the population age 20 and older; therefore, it is not comparable with rates reported previously. Rates based on the new definition were calculated for the years prior to 2005–2006 to allow for comparisons over time.

Bibliography
Naylor, C. D. and D. P. DeBoer. “Variations in Selected Surgical Procedures and Medical Diagnoses by Year and Region. Total Hip and Knee Replacement.” In Goel, V. et al. (Eds.), Patterns of Health Care in Ontario, 2nd Ed. Ottawa, Ont.: Canadian Medical Association, 1996: p. 54.

University of Toronto and Ontario Hospital Association. The Hospital Report 98. A System-Wide Review of Ontario’s Hospitals. Toronto, Ont.: Ontario Hospital Association, 1998.

Wright, C. J. and Y. Robens-Paradise. Evaluation of Indications and Outcomes in Elective Surgery. Vancouver, B.C.: Centre for Clinical Epidemiology and Evaluation, Vancouver Hospital and Health Services Centre, May 2001.

3.5 Knee Replacement Rate

Definition
Age-standardized rate of unilateral or bilateral knee replacement surgery performed on patients in acute care hospitals or same-day surgery facilities, per 100,000 population age 20 and older.

Method of Calculation
(Total number of discharges for knee replacement surgery for patients age 20 and older / total mid-year population age 20 and older) x 100,000 (age adjusted)

CCP 5
93.40 or 93.41

CCI xv
1.VG.53^^

Interpretation
Knee replacement surgery has the potential to improve functional status, reduce pain and contribute to other gains in health-related quality of life. Over the past two decades, rates of knee replacement surgery have increased substantially. Wide inter-regional variation in joint replacement rates may be attributable to numerous factors, including the availability of services, provider practice patterns and patient preferences.

Standards/Benchmarks
Benchmarks have not been established for this procedure.

Data Sources
Discharge Abstract Database (DAD), CIHI
National Ambulatory Care Reporting System (NACRS), CIHI
Alberta Ambulatory Care Database, Alberta Health and Wellness
Fichier des hospitalisations MED-ÉCHO, ministère de la Santé et des Services sociaux du Québec

Reference Period
April 1, 2009, to March 31, 2010

Comprehensiveness
Available for all provinces and territories.

Comments
Rates are based on the total number of discharges for knee replacement surgery in a given year. Therefore, a patient who received both a left and a right knee replacement in the same year but at separate admissions was counted twice.

Beginning with the 2005–2006 rate, this indicator is calculated for the population age 20 and older and includes same-day surgery procedures; therefore, it is not comparable with rates reported previously. Rates based on the new definition were calculated for the years prior to 2005–2006 to allow for comparisons over time.

Bibliography
Naylor, C. D. and D. P. DeBoer. “Variations in Selected Surgical Procedures and Medical Diagnoses by Year and Region. Total Hip and Knee Replacement.” In Goel, V. et al. (Eds.), Patterns of Health Care in Ontario, 2nd Ed. Ottawa, Ont.: Canadian Medical Association, 1996: p. 54.

University of Toronto and Ontario Hospital Association. The Hospital Report 98. A System-Wide Review of Ontario’s Hospitals. Toronto, Ont.: Ontario Hospital Association, 1998.

Wright, C. J. and Y. Robens-Paradise. Evaluation of Indications and Outcomes in Elective Surgery. Vancouver, B.C.: Centre for Clinical Epidemiology and Evaluation, Vancouver Hospital and Health Services Centre, May 2001.

3.6 Hysterectomy Rate

Definition
Age-standardized rate of hysterectomy provided to patients in acute care hospitals or same-day surgery facilities, per 100,000 women age 20 and older.

Method of Calculation
(Total number of discharges for hysterectomy for women age 20 and older / total mid-year female population age 20 and older) x 100,000 (age adjusted)

CCP 6
80.2–80.6

CCI xvi
1.RM.89^^, 1.RM.91^^ or 1.RM.87.BA-GX, 1.RM.87.CA-GX, 1.RM.87.DA-GX or 1.RM.87.LA-GX with extent attribute coded as SU

Interpretation
As with other types of surgical procedures, variation in hysterectomy rates can be attributed to numerous factors, including differences in population demographics, physician practice patterns and availability of services. Utilization rates may reflect the level of uncertainty about the appropriate use of this surgical procedure. The right level of utilization is not known.

Standards/Benchmarks
Benchmarks have not been established for this procedure.

Data Sources
Discharge Abstract Database (DAD), CIHI
National Ambulatory Care Reporting System (NACRS), CIHI
Alberta Ambulatory Care Database, Alberta Health and Wellness
Fichier des hospitalisations MED-ÉCHO, ministère de la Santé et des Services sociaux du Québec

Reference Period
April 1, 2009, to March 31, 2010

Comprehensiveness
Available for all provinces and territories.

Comments
Beginning with the 2006–2007 rate, hysterectomy cases include both total and subtotal hysterectomies, similar to reporting prior to 2001–2002 data. Subtotal hysterectomy was not uniquely identified in the Canadian Classification of Health Interventions (CCI) versions 2001 and 2003; therefore, hysterectomy rates reported for 2001–2002 to 2005–2006 included only total hysterectomies. Identification of subtotal hysterectomies became possible again with version 2006 of CCI. For jurisdictions with higher volumes of subtotal hysterectomies, comparability with previous years might be affected.

Beginning with the 2005–2006 rate, this indicator includes same-day surgery procedures. However, due to small volumes of hysterectomy in same-day surgery settings, comparability with previous years should not be affected.

Bibliography
Cohen, M. M. and W. Young. “Hysterectomy.” In Goel, V. et al. (Eds.), Patterns of Health Care in Ontario, 2nd Ed. Ottawa, Ont.: Canadian Medical Association, 1996: p. 141.

Cumming, D. C. “Hysterectomy Revisited.” Journal of Obstetrics and Gynecology Canada 18 (1996): pp. 869–879.

Gimbel, H. “Total and Subtotal Hysterectomy for Benign Uterine Diseases? A Meta-Analysis.” Acta Obstetricia et Gynecologica 86 (2007): pp. 133–144.

Lefebvre, G. et al. “SOGC Clinical Practice Guidelines—Hysterectomy.” Journal of Obstetrics and Gynecology Canada 109 (2002).

Zekam, N. et al. “Total Versus Subtotal Hysterectomy: A Survey of Gynecologists.” Obstetrics and Gynecology 102 (2003): pp. 301–305.

3.7 Inflow/Outflow Ratio

Definition
A ratio of the number of separations (discharges and deaths) from acute care/same-day surgery facilities within a given region divided by the number of acute care/same-day surgery separations generated by residents of that region.

Method of Calculation

Numerator:
Number of separations (discharges and deaths) from acute care/same-day surgery facilities within a given region (including non-residents)

Denominator:
Number of separations generated by residents of a given region, where region is as specified in the numerator

An overall ratio was calculated for discharges associated with any diagnosis or procedure for acute care discharges only and separately for coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), hip replacement, knee replacement and hysterectomy procedures.7

CABG (acute care discharges only):

CCP
48.1^

CCI
1.IJ.76^^

PCI (acute care and same-day surgery discharges):

CCP
48.02 or 48.03

CCI
1.IJ.50^^ or 1.IJ.57.GQ^^

Hip replacement (acute care discharges only):

CCP
93.51, 93.52, 93.53 or 93.59

CCI
1.VA.53.LA-PN^^ or 1.VA.53.PN-PN^^

Knee replacement (acute care and same-day surgery discharges):

CCP
93.40 or 93.41

CCI
1.VG.53^^

Hysterectomy (acute care and same-day surgery discharges):

CCP
80.2–80.6

CCI
1.RM.89^^, 1.RM.91^^ or 1.RM.87.BA-GX, 1.RM.87.CA-GX, 1.RM.87.DA-GX or 1.RM.87.LA-GX with extent attribute coded as SU

Interpretation
This indicator reflects the balance between the quantity of hospital stays provided to both residents and non-residents by all relevant facilities (acute care/same-day surgery) in a given region and the extent of utilization by residents of that region, whether they receive care within or outside of the region. A ratio of less than one indicates that health care utilization by residents of a region exceeded care provided within that region, suggesting an outflow effect. A ratio of greater than one indicates that care provided by a region exceeded the utilization by its residents, suggesting an inflow effect. A ratio of one indicates that care provided by a region is equivalent to the utilization by its residents, suggesting that inflow and outflow activity, if it exists at all, is balanced. A ratio of zero is an indication that none of the institutions in the region provided the service and residents received care outside of their region.

Standards/Benchmarks
Benchmarks are not available for this measure.

Data Sources
Discharge Abstract Database (DAD), CIHI
National Ambulatory Care Reporting System (NACRS), CIHI
Alberta Ambulatory Care Database, Alberta Health and Wellness
Fichier des hospitalisations MED-ÉCHO, ministère de la Santé et des Services sociaux du Québec

Reference Period
April 1, 2009, to March 31, 2010

Comprehensiveness
Available for all provinces and territories.

Comments
Beginning with the 2006–2007 rate, hysterectomy cases include both total and subtotal hysterectomies, similar to reporting prior to 2001–2002. Subtotal hysterectomy was not uniquely identified in the Canadian Classification of Health Interventions (CCI) versions 2001 and 2003; therefore, hysterectomy rates reported for 2001–2002 to 2005–2006 included only total hysterectomies. Identification of subtotal hysterectomies became possible again with version 2006 of CCI. For jurisdictions with higher volumes of subtotal hysterectomies, comparability with previous years might be affected.

Beginning with the 2005–2006 rate, hysterectomy and knee replacement totals include same-day surgery procedures. Due to small volumes of these procedures in same-day surgery settings, comparability with previous years should not be affected.

3.8 Mental Illness Hospitalization Rate

Definition
Age-standardized rate of separations from general hospitals8 through discharge or death following a hospitalization for a selected mental illness,9 per 100,000 population.

Method of Calculation

Total number of separations for a selected mental illness for patients age 15 and older

× 100,000 (age adjusted)

Total mid-year population age 15 and older

A selected mental illness is coded as most responsible diagnosis (MRDx). Diagnosis codes are:

    1. Substance-related disorders
      ICD-10-CA
      : F55, F10 to F19
      DSM-IV
      : 291.x (0, 1, 2, 3, 5, 81, 89, 9), 292.0, 292.11, 292.12, 292.81, 292.82, 292.83, 292.84, 292.89, 292.9, 303.xx (00, 90), 304.xx (00, 10, 20, 30, 40, 50, 60, 80, 90), 305.xx (00, 10 to 90 excluding 80)
    2. Schizophrenia, delusional and non-organic psychotic disorders
      ICD-10-CA
      :
      F20 (excluding F20.4), F22, F23, F24, F25, F28, F29, F53.1
      DSM-IV
      :
      295.xx (10, 20, 30, 40, 60, 70, 90), 297.1, 297.3, 298.8, 298.9
    3. Mood/affective disorders
      ICD-10-CA
      :
      F30, F31, F32, F33, F34, F38, F39, F53.0
      DSM-IV
      :
      296.0x, 296.2x, 296.3x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90, 300.4, 301.13
    4. Anxiety disorders
      ICD-10-CA
      :
      F40, F41, F42, F43, F48.8, F48.9, F93.8
      DSM-IV
      :
      300.xx (00, 01, 02, 21, 22, 23, 29), 300.3, 308.3, 309.x (0, 3, 4, 9), 309.24, 309.28, 309.81
    5. Selected disorders of adult personality and behaviour
      ICD-10-CA
      :
      F60, F61, F62, F68, F69, F21
      DSM-IV
      :
      300.16, 300.19, 301.0, 301.20, 301.22, 301.4, 301.50, 301.6, 301.7, 301.81, 301.82, 301.83, 301.9,

Interpretation
Hospitalization rate is a partial measure of general hospital utilization. It does not include inpatients who were using hospital services but had not yet been discharged within the fiscal year of interest. This indicator may reflect differences between jurisdictions, such as the health of the population, differing health service delivery models and variations in the availability and accessibility of specialized, residential and/or ambulatory and community-based services.

Monitoring hospital service use captures only the relatively small proportion of individuals who are acutely ill and require in-hospital treatment, compared to the much larger contingent that receives (or fails to receive) outpatient or community services. For these reasons, this indicator cannot be used to estimate the prevalence of mental disorders in the general population.

Standard/Benchmark
Benchmarks have not been identified for this indicator.

The following results were found in the literature. In 2005–2006, the age-standardized rate for general hospitals in Canada was 507.1 separations per 100,000 population.1 Over the last four years of reporting, results have been stable.

Data Sources
Discharge Abstract Database (DAD), CIHI
Ontario Mental Health Reporting System (OMHRS), CIHI
Fichier des hospitalisations MED-ÉCHO, ministère de la Santé et des Services sociaux du Québec

Reference Period
April 1, 2009, to March 31, 2010

Comprehensiveness
Available for all provinces and territories.

Comments
Individuals can be admitted to hospital more than once for the treatment of a mental illness, and they can have more than one condition at a given time. Separation data, therefore, does not represent either the number of mental illnesses that led to the separations or the number of people with mental illness who were separated from the hospital.

While this indicator does not include data from free-standing psychiatric facilities, it is acknowledged that in some jurisdictions (for example, Alberta) direct substitution between general and psychiatric facilities exists; the extent of this practice is unknown. As such, this indicator provides a partial view of hospital utilization for mental health issues in an acute setting.

Reference
1. Canadian Institute for Health Information, Hospital Mental Health Services in Canada 2005–2006 (Ottawa, Ont.: CIHI, 2008).

3.9 Mental Illness Patient Days Rate

Definition
Age-adjusted rate of total number of days in general hospitals10 for selected mental illness,11 per 10,000 population.

Method of Calculation

Total number of days in hospital for selected mental illness for patients age 15 and older

× 10,000 (age adjusted)

Total mid-year population age 15 and older

A selected mental illness is coded as most responsible diagnosis (MRDx). Diagnosis codes are:

    1. Substance-related disorders
      ICD-10-CA
      :
      F55, F10 to F19
      DSM-IV
      :
      291.x (0, 1, 2, 3, 5, 81, 89, 9), 292.0, 292.11, 292.12, 292.81, 292.82, 292.83, 292.84, 292.89, 292.9, 303.xx (00, 90), 304.xx (00, 10, 20, 30, 40, 50, 60, 80, 90), 305.xx (00, 10 to 90 excluding 80)
    2. Schizophrenia, delusional and non-organic psychotic disorders
      ICD-10-CA
      :
      F20 (excluding F20.4), F22, F23, F24, F25, F28, F29, F53.1
      DSM-IV
      :
      295.xx (10, 20, 30, 40, 60, 70, 90), 297.1, 297.3, 298.8, 298.9
    3. Mood/affective disorders
      ICD-10-CA
      :
      F30, F31, F32, F33, F34, F38, F39, F53.0
      DSM-IV
      :
      296.0x, 296.2x, 296.3x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90, 300.4, 301.13
    4. Anxiety disorders
      ICD-10-CA
      :
      F40, F41, F42, F43, F48.8, F48.9, F93.8
      DSM-IV
      :
      300.xx (00, 01, 02, 21, 22, 23, 29), 300.3, 308.3, 309.x (0, 3, 4, 9), 309.24, 309.28, 309.81
    5. Selected disorders of adult personality and behaviour
      ICD-10-CA
      :
      F60, F61, F62, F68, F69, F21
      DSM-IV
      :
      300.16, 300.19, 301.0, 301.20, 301.22, 301.4, 301.50, 301.6, 301.7, 301.81, 301.82, 301.83, 301.9

Interpretation
The patient days rate is a partial measure of general hospital utilization. It does not include patients who were admitted to hospital but had not yet been discharged within the fiscal year of interest. Patient-days are influenced by the number of hospitalizations and the length of stay. For the same number of hospitalizations, the rate of patient days will increase as length of stay increases. This indicator may reflect differences between jurisdictions, such as the health of the population, differing health service delivery models and variations in the availability of and accessibility to specialized, residential and/or ambulatory and community-based health services.

Standard/Benchmark
Benchmarks have not been identified for this indicator.

Data Sources
Discharge Abstract Database (DAD), CIHI
Ontario Mental Health Reporting System (OMHRS), CIHI
Fichier des hospitalisations MED-ÉCHO, ministère de la Santé et des Services sociaux du Québec

Reference Period
April 1, 2009, to March 31, 2010

Comprehensiveness
Available for all provinces and territories.

Comments
While this indicator does not include data from free-standing psychiatric facilities, it is acknowledged that in some jurisdictions (for example, Alberta) direct substitution between general and psychiatric facilities exists; the extent of this practice is unknown. As such, this indicator provides a partial view of hospital utilization for mental health issues in an acute setting.

Resources

3.10 General/Family Physicians and Specialist Physicians

Definition
General practitioners or family physicians (family medicine and emergency family medicine specialists) on December 31 of the reference year, per 100,000 population. Specialist physicians (medical, surgical and laboratory specialists) on December 31 of the reference year, per 100,000 population.

The data includes active physicians in clinical practice and those not working in clinical practice. Active physicians are defined as physicians that have an MD degree, are registered with a provincial/territorial medical college and have a valid address (mail sent to the physician by Scott’s Directories is not returned). The data excludes residents and non-licensed physicians who requested that their information not be published in the Canadian Medical Directory as of December 31 of the reference year.

Method of Calculation
(Total number of general and family practitioners / total mid-year population) x 100,000

(Total number of specialists / total mid-year population) x 100,000

Physicians are geo-coded to a region based on the postal code of correspondence submitted to Scott’s Medical Database. Records with invalid, missing or partial postal codes are excluded from the regional totals.

Interpretation
Physician-to-population ratios are used to support health human resources planning. While physician density ratios are useful indicators of changes in physician numbers relative to the population, inference from total numbers or ratios as to the adequacy of provider resources should not be made. Various factors influence whether the supply of physicians is appropriate, such as distribution and location of physicians within a region or province; physician type (family medicine physicians versus specialists); level of service provided (full time versus part time); physician age and gender; population access to hospitals, health care facilities, technology and other types of health care providers; population needs (demographic characteristics and health problems); and society’s perceptions and expectations.

In some regions, health facilities and personnel provide services to a larger community than the residents of the immediate region. In others, residents may seek care from physicians and specialists outside the region where they live. The physician-to-population ratio reflects the number of doctors in a region and has not been adjusted to take these movements into account. The extent to which this affects individual regions is likely to vary.

Standards/Benchmarks
Benchmarks are not available for this measure.

Data Source
Scott’s Medical Database (SMDB), CIHI

Reference Period
January 1, 2009 to December 31, 2009

Comprehensiveness
Available for all provinces and territories.

Comments
While the postal code of correspondence may not necessarily reconcile with a physician’s place of practice, approximately 90% of postal codes submitted refer to the physician’s office, in-home office or hospital address.

Specialist physicians include certificants of the Royal College of Physicians and Surgeons of Canada (RCPSC) and/or the Collège des médecins du Québec (CMQ), unless noted otherwise. Specialists in Saskatchewan and Newfoundland and Labrador (as of 2004), Nova Scotia, New Brunswick and the Yukon (as of 2007) and Prince Edward Island and Quebec (as of 2009) also include physicians who are licensed as specialists but who are not certified by the RCPSC or the CMQ (non-certified specialists). For all other jurisdictions, and for above noted provinces prior to the change, non-certified specialists are counted as family practitioners. With the exception of the criteria just noted all other physicians are counted as family practitioners, including certificants of the College of Family Physicians of Canada (CCFP and CCFP—Emergency Medicine). For further information on physician count methodologies please see CIHI’s report Supply, Distribution and Migration of Canadian Physicians (www.cihi.ca).

It is recognized that physician specialty classification as noted above does not necessarily reflect the services provided by individual physicians. The range of services provided by a physician is subject to provincial licensure rules, medical service plan payment arrangements and individual practice choices. Due to differences in data collection, processing and reporting methodology, these indicators may differ from provincial and territorial data.

Note: Scott’s Medical Database (SMDB) information may undercount physicians due to provincial/territorial licensing authority data supply interruptions. SMDB data does not reflect licensing authority updates for the following jurisdictions and years: British Columbia, 2004; Quebec, 2003; Ontario, 2002; and Alberta and the Yukon, 2000.

1 . Code may be recorded in any position. Procedures coded as cancelled, previous, out of hospital and abandoned after onset are excluded.

2 . Code may be recorded in any position. Procedures coded as cancelled, previous, out of hospital and abandoned after onset are excluded.

3 . Code may be recorded in any position. Procedures coded as cancelled, previous, out of hospital and abandoned after onset are excluded.

4 . Code may be recorded in any position. Procedures coded as cancelled, previous, out of hospital and abandoned after onset are excluded.

5 . Code may be recorded in any position. Procedures coded as cancelled, previous, out of hospital and abandoned after onset are excluded.

6 . Code may be recorded in any position. Procedures coded as cancelled, previous, out of hospital and abandoned after onset are excluded.

7 . Code may be recorded in any position. Procedures coded as cancelled, previous, out of hospital and abandoned after onset are excluded.

8 Refer to the General Methodology Notes section for more information.

9 . The mental illnesses selected for this indicator are substance-related disorders; schizophrenia, delusional and non-organic psychotic disorders; mood/affective disorders; anxiety disorders; and selected disorders of adult personality and behaviour.

10 Refer to the General Methodology Notes section for more information.

11 . The mental illnesses selected for this indicator are substance-related disorders; schizophrenia, delusional and non-organic psychotic disorders; mood/affective disorders; anxiety disorders; and selected disorders of adult personality and behavior.

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