CIHI is supporting the performance measurement commitments made by the health ministers in A Common Statement of Principles on Shared Health Priorities. We are working closely with federal, provincial and territorial (FPT) governments to develop a set of common indicators focused on measuring pan-Canadian access to mental health and addictions services and to home and community care.

Shared Health Priorities Phase 2 (July 2018 to 2027)

Shared Health Priorities Phase 1 (August 2017 to June 2018)

Indicator development and reporting

CIHI is moving forward with the development and public reporting of the indicators endorsed by the FPT health ministers to measure access to mental health and addictions services and to home and community care. Over the next 4 years, we will publicly report results for 3 new indicators each year, with the first public release scheduled for May 2019. The order in which we will report the indicators reflects jurisdictional readiness and data availability.

The indicators to be publicly released in May 2019 are

  • Hospitalization Rates for Problematic Substance Use  
  • Rates of Repeat Emergency Department and/or Urgent Care Centre Visits for a Mental Health or Addictions Issue 
  • Alternate Level of Care Length of Stay for Inpatients Discharged to Home Care Services 

A contextual report will track progress on the overall indicator development plan for the Shared Health Priorities work. It will also provide additional context for interpreting the 3 indicators being released in 2019.

CIHI will continue to work with FPT governments to define the methodology for indicator calculation and to identify new data sources to enable comparable reporting. This is a 10-year commitment to public reporting. To provide the best indicators possible, it will be necessary to evolve the work over time as new data sources are established, new methods become available or public needs evolve.

Shared Health Priorities Advisory Council

In September 2018, the Shared Health Priorities Advisory Council was established to provide strategic guidance on indicator development, to represent jurisdictional interests and to support public messaging and outreach.

The council consolidated the CIHI-FPT work groups from Phase 1 into a single body, with additional participation:

  • Council members include representatives from provinces/territories, Health Canada, CIHI and Statistics Canada.
  • Council observers include representatives from the Ministère de la Santé et des Services sociaux du Québec, the Canadian Home Care Association, the Mental Health Commission of Canada and the Canadian Centre on Substance Use and Addiction.

Shared Health Priorities background

All governments recognize the need to make home care more available and mental health care more accessible. In late 2017, the FPT governments reached a 10-year agreement that will lead to an $11 billion federal investment. This investment will go toward improving access to mental health and addictions services and to home and community care. By endorsing A Common Statement of Principles on Shared Health Priorities, FPT governments committed to working together to ensure that health care systems continue to respond to the evolving needs of Canadians.

CIHI was asked to work with the FPT governments to select and develop a set of pan-Canadian indicators that focus on measuring access to mental health and addictions services and to home and community care.

A Common Statement of Principles on Shared Health Priorities (PDF)

Public consultation

What do Canadians have to say about access to mental health and addictions services and to home and community care?

CIHI contracted Santis Health (in partnership with Nanos Research) to conduct public consultations to ensure that public priorities for access to mental health and addictions services and to home and community care were included in the indicator deliberations.

This research was independent of all other activities. It consisted of the following activities:

  • 10 focus groups in 5 cities, with a total 80 participants.
    The purpose of the qualitative research was to explore participants’ understanding of access to mental health and addictions services and to home and community care.  
  • Open Link survey.
    Over 650 participants self-selected to share their views. The results are not considered generalizable to the general Canadian population, to rural/remote communities or to Indigenous peoples.
  • Key informant interviews

View highlights from the public consultations

FPT health ministers endorse pan-Canadian indicators of access

In June 2018, the FPT health ministers* endorsed a set of indicators for measuring access to mental health and addictions services and to home and community care that had been recommended by CIHI, on behalf of the CIHI-FPT work groups. These recommended indicators were informed by the advice of sector stakeholders, measurement experts and the public, and by published literature on the subject.

The endorsement of these sets of common indicators of access to mental health and addictions services and to home and community care marks a significant step toward improving access to services and support in sectors that are clearly important to Canadians. Over the next 10 years, CIHI will work with FPT governments to report annually to the Canadian public on these indicators.

Important work remains to be done before CIHI can report reliable and comparable indicators on behalf of the provinces and territories. As we continue these efforts, the names of the endorsed indicators may change as the indicator definitions and methodologies are refined.

Recommended indicators for access to mental health and addictions services:

  • Wait Times for Community Mental Health Services, Referral/Self-Referral to Services (services provided outside of emergency departments, hospital inpatient programs and psychiatric hospitals)
  • Early Identification for Early Intervention in Youth Age 10 to 25 (to be defined)
  • Awareness and/or Successful Navigation of Mental Health and Addictions Services (self-reported, to be defined)
  • Rates of Repeat Emergency Department and/or Urgent Care Centre Visits for a Mental Health or Addiction Issue
  • Hospitalization Rates for Problematic Substance Use
  • Rates of Self-Injury, Including Suicide

Recommended indicators for access to home and community care:

  • Wait Times for Home Care Services, Referral to Services
  • Alternate Level of Care Length of Stay for Inpatients Discharged to Home Care Services
  • Home Care Services Helped the Recipient Stay at Home (self-reported)
  • Caregiver Distress
  • (In)appropriate Move to Long-Term Care
  • Death at Home/Not in Hospital (to be defined)

* The federal government has agreed to an asymmetrical arrangement with Quebec, distinct from the Common Statement of Principles. In addition, given the transition to a new government in Ontario, the province cannot officially endorse the recommendations.

FTP health ministers endorsed a set of indicators

CIHI’s role

CIHI has long-standing programs of work that measure the performance of health systems. Given CIHI’s experience, the organization is well-positioned to facilitate the selection and development of indicators to track progress on the FPT health ministers’ commitments. This work aligns with CIHI’s mandate to deliver meaningful, comparable information that will accelerate improvement in health care, the performance of health systems and the overall health of the population. The focus on mental health and addictions and on home and community care also aligns with CIHI’s strategic plan.

Read CIHI’s Performance Measurement Framework (PDF)

How is an indicator developed at CIHI?

CIHI’s strategic plan

CIHI-FPT work groups

2 CIHI-FPT work groups were established to consider and recommend to FPT health ministers 2 focused sets of common indicators of access: 1 for mental health and addictions services, and 1 for home and community care.

The CIHI-FPT work groups were made up of 1 representative appointed by each federal, provincial and territorial deputy minister of health and 1 representative each from CIHI. Quebec has observer status, to share information and best practices. Members received the advice of sector stakeholders, measurement experts and the public to support their decisions and recommendations.

Progress report

Selecting Pan-Canadian Indicators for Access to Mental Health and Addiction Services, and to Home and Community Care: Progress Report (March 2018) explains the indicator selection process, provides the status of the work completed to date and outlines the current state of performance measurement in these 2 sectors. In addition to identifying the state of information standards, infrastructure and measurement in mental health and addictions services and home and community care across Canada, the progress report also outlines how sector stakeholders, measurement experts and the public were engaged to provide advice on where to focus measurement. FPT government representatives will use this information as they work toward selecting meaningful indicators to measure pan-Canadian progress on improving access to mental health and addictions services, and to home and community care.

Read the progress report (PDF)

If you have any questions or would like more information on this program, please email sharedhealthpriorities@cihi.ca.