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					                                                                                                 Ministry of Health and Long-Term Care
                                                                             Health System Information Management & Investment Division
                                                                                                                 Health Analytics Branch



                            RIS INDICATOR NAME
                            Name of indicator using RIS         READMISSIONS FOR SELECTED CASE MIX GROUPS (CMGs)
                            naming conventions
    INDICATOR DESCRIPTION




                            RIS INDICATOR ID NUMBER
                                                                78



                            PROGRAM SPECIFIC INDICATOR
                            NAME(S)
                            How the indicator is named by
                                                                Readmissions within 30 days for selected CMGs
                            specific programs

                                                                The number of patients readmitted to any facility for non-elective
                                                                inpatient care. This is compared to the number of expected non-
                                                                elective readmissions using data from all Ontario acute hospitals.

                            INDICATOR DESCRIPTION               Readmission to any facility for selected Case Mix Groups (CMGs) =
                            Detailed description of indicator   Observed number of patients, discharged with specified CMGs within
                                                                calendar year, readmitted to any facility for any non-elective patient
                                                                care within the specified number days of discharge for index
                                                                admission
                                                                Calculate observed readmissions: The sum of readmissions for all
                                                                index cases in a calendar year.
                                                                    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:
                            CALCULATION                              - 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.
    NUMERATOR




                                                                Discharge Abstract Database (DAD), Canadian Institute for Health
                            DATA SOURCE
                                                                Information (CIHI)
                                                                Includes:
                                                                1. Acute inpatients in the specified CMGs (see Appendix A)
                                                                2. Age is cohort specific:
                                                                   a) ≥ 45 for stroke, chronic obstructive pulmonary
                                                                      disease (COPD), congestive heart failure (CHF),
                                                                   b) ≥ 40 for cardiac CMGs,
                            EXCLUSION/INCLUSION                    c) All ages for pneumonia, diabetes and gastrointestinal (GI)
                            CRITERIA                            3. 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) the DAD field “admission category” is urgent.




For more information about this indicator, please contact RIS@ontario.ca                                                      Page 1 of 4
                                                                                          Ministry of Health and Long-Term Care
                                                                      Health System Information Management & Investment Division
                                                                                                          Health Analytics Branch

                                                         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.

                                                         Identify index cases:
                                                             Select all discharges among the selected CMGs with discharge
                                                              dates for period in question and age restrictions as described in
                         CALCULATION                          Inclusions section. Include only typical and outlier cases (based
                                                              on DAD Resource Intensity Weights (RIW) Exclusion Indicator)
                                                              among the index cases.

                         DATA SOURCE                     DAD, CIHI

                                                         Includes:
    DENOMINATOR




                                                         1. Acute inpatients in the specified CMGs (see Appendix A)
                                                         2. Age is cohort specific:
                                                            a) ≥ 45 for stroke, chronic obstructive pulmonary
                                                               disease (COPD), congestive heart failure (CHF)
                                                            b) ≥ 40 for cardiac CMGs,
                                                            c) All ages for pneumonia, diabetes and
                                                               gastrointestinal (GI)
                                                         3. The readmission hospitalization is deemed non-elective or
                         EXCLUSION/INCLUSION
                         CRITERIA                           ‘unplanned’ if:
                                                             a) the admission date is within the specified number of
                                                                days of the index case discharge date, and
                                                             b) the DAD field “admission category” is urgent.

                                                         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
    GEOGRAPHY & TIMING




                         How often, and when, are data
                         being released
                                                         Data are available quarterly
                         E.g. Be as specific as
                         possible…..data are released
                         annually in mid-May

                         LEVELS OF COMPARABILITY         Data are available at the provincial, Local Health Integration
                         Levels of geography for         Network (LHIN) and hospital level
                         comparison

                         TRENDING                        Data are available since fiscal year 2008
                         Years available for trending




For more information about this indicator, please contact RIS@ontario.ca                                                Page 2 of 4
                                                                                                   Ministry of Health and Long-Term Care
                                                                               Health System Information Management & Investment Division
                                                                                                                   Health Analytics Branch


                                                                 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
                              LIMITATIONS                        analyzing performance results for interim quarterly reporting.
                              Specific limitations
                                                                 Indicator values may change substantially once complete data is
                                                                 analyzed (versus analysis based on interim potentially incomplete
                                                                 quarterly data).
     ADDITIONAL INFORMATION




                              COMMENTS
                                                                 N/A
                              Additional information regarding
                              the calculation, interpretation,
                              data source, etc.

                                                                      Phillips CO, Wright SM, Kern DE, Singa RM, Shepperd S , Rubin
                                                                       HR. Comprehensive discharge planning with postdischarge
                                                                       support for older patients with congestive heart failure: a meta-
                                                                       analysis. JAMA 2004; 291(11):1358-67.
                              REFERENCES
                              Provide URLs of any key
                              references E.g. Diabetes in             Puhan M, Scharplatz M, Troosters T, Walters EH, Steurer J.
                              Canada, HTTP://....                      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.
                                                                 1.

                              KEYWORDS                           2.

                                                                 3.


                                                                 2010-09-15
   INDICATOR




                              DATE CREATED (YYYY-MM-DD)
     DETAILS




                              DATE LAST REVIEWED (YYYY-          2010-12-16
                              MM-DD)




For more information about this indicator, please contact RIS@ontario.ca                                                        Page 3 of 4
                                                                                    Ministry of Health and Long-Term Care
                                                                Health System Information Management & Investment Division
                                                                                                    Health Analytics Branch




                    Appendix A: 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
        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
        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




For more information about this indicator, please contact RIS@ontario.ca                                         Page 4 of 4

				
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