Acute Care - Legislative Assembly of Ontario · for 9.5% of the population of the province of Ontario as a whole3. Champlain consists of Ottawa, Renfrew County, Prescott & Russell

Information ManagementA System We Can Count On

Acute CareUtilization Report

Champlain LHINHealth System Intelligence Project – March 2006

About HSIP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Section 1

Total Separations and Level of Care . . . . . . . . . . . . 1

1.1 Champlain Hospitals . . . . . . . . . . . . . . . . . . . . . . . . 2

1.2 Champlain Residents. . . . . . . . . . . . . . . . . . . . . . . . 3

Section 2

Acute Separations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2.1 Champlain Hospitals . . . . . . . . . . . . . . . . . . . . . . . 7

2.2 Champlain Residents . . . . . . . . . . . . . . . . . . . . . . . 8

Section 3

Mental Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

3.1 Champlain Hospitals . . . . . . . . . . . . . . . . . . . . . . . 9

3.2 Champlain Residents . . . . . . . . . . . . . . . . . . . . . . 10

Section 4

Alternate Level of Care (ALC) . . . . . . . . . . . . . . . . 11

4.1 Champlain Hospitals . . . . . . . . . . . . . . . . . . . . . . 11

4.2 Champlain Residents . . . . . . . . . . . . . . . . . . . . . . 13

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Page i

Table of Contents

The Health System Intelligence Project(HSIP)This report is produced by the Health System IntelligenceProject. HSIP consists of a team of health systemexperts retained by the Ministry of Health and Long-Term Care’s (MOHLTC) Health Results Team forInformation Management (HRT-IM) to provide the LocalHealth Integration Networks (LHINs) with:

• Sophisticated data analysis;

• Interpretation of results;

• Orientation of new staff to health system dataanalysis issues; and

• Training on new techniques and technologiespertaining to health system analysis.

HSIP was created as part of the Ontario government'sInformation Management Strategy. HSIP is designed tocomplement and augment the existing analytical capacitywithin the MOHLTC. The project team is working inconcert with MOHLTC analysts to ensure that the LHINsare provided with the analytical supports they need fortheir local health system planning activities.

Report Authors:Linda Baigent, HSIPStephanie Loomer, HSIPJennifer Sarkella, HSIP (Project Lead)Dave Zago, HSIP

Contributors:Carley Hay, HSIPPaul Lee, HSIPMarc Lefebvre, HSIP

For further information, please contact:[email protected]

Page ii

About HSIP

Identification and understanding of patterns of healthcare utilization are essential for health care planning.There are two aspects of utilization that should beconsidered for local planning. The first is the activity oflocal providers, which gives a measure of local capacity– what do local hospitals or agencies provide and towhom? The second aspect is utilization of provincialservices by local residents – where do residents go toobtain care? Although residents are generally served bylocal facilities, they can and are sometimes required toseek health care services outside their area of res-idence. Knowledge of both perspectives allows for thedevelopment of local strategies to meet the healthservice needs of area residents.

The examination of acute care hospital use is a keycomponent in the analysis of health care utilizationpatterns. Acute care refers to short-term, intensiveinpatient care for serious health problems involving a variety of medical and surgical services. Patterns ofacute inpatient utilization are influenced by a broadrange of factors including system capacity, the avail-ability of physicians and community services, and theage structure, health and socio-economic status of the

population. These factors should all be consideredwhen interpreting utilization patterns and planning forservices.

MethodsThis report describes key aspects of acute carehospitalization in fiscal year 2004/05 for both hospitalsand residents within the Champlain Local HealthIntegration Network (LHIN), hereafter referred to asChamplain. This information will be valuable for thoseinvolved in planning within the health care system, aswell as for those monitoring the health service needs ofthe population.

The analysis is divided into four sections:

1. Total separations and level of care (primary,secondary, tertiary/quaternary).

2. Acute care excluding mental health.

3. Acute mental health care.

4. Alternate level of care stays.

Introduction Page iii

Introduction

Highlights

• Champlain hospitals primarily served Champlain residents (90.4% of separations), and the majority ofseparations for Champlain residents were from Champlain hospitals (97.6%).

• The proportion of non-residents served by Champlain hospitals increased as complexity of care increased.Non-residents represented 7.2% of primary, 9.4% of secondary, and 18.2% of tertiary/quaternary separationsfrom Champlain hospitals.

• Relative to Ontario residents, Champlain residents had significantly lower age-standardized separation ratesfor primary and secondary levels of care, and acute care (excluding mental health).

• The average length of stay for acute mental health for Champlain residents was 2.4 days longer than that forOntario residents.

• The average length of stay in alternate level of care in Champlain hospitals was 3.2 days longer than suchstays in Ontario hospitals.

A separation is a completed case treated in a hospitalresulting in any of the following: discharge home,transfer to another facility, death, or patient sign out.Separations refer to the activity completed per facilityso patients transferred for further care to other acutefacilities will result in multiple separations. Days of staywithin acute care beds are classified as either acute oralternate level of care (ALC), the latter of which refersto patients who have completed the acute care phase oftheir treatment but remain in an acute care facilitywhile awaiting placement elsewhere1.

Each section in this report describes the activity inChamplain hospitals with comparisons to Ontariohospitals, followed by the hospital utilization ofChamplain residents (regardless of where they werehospitalized within Ontario) with comparisons to that ofOntario residents. These data exclude newborns andstillborns, so as to avoid double counting of mothersand babies. Figures for Ontario residents include thosewith an unknown LHIN of residence, where assignmentto a LHIN was not possible due to insufficientgeographic information. Ontario numbers are includedto provide context but should not necessarily beconsidered the ideal or target.

The data included in this report were obtained from theInpatient Discharges section of the Ontario Ministry ofHealth and Long-Term Care’s (MOHLTC) ProvincialHealth Planning Database2. As this database onlyincludes data for Ontario facilities, hospitalizations ofChamplain residents that occurred in other provinces orcountries are not included. Hospital names in thisreport primarily reflect those provided by this database.It should be noted that some multi-site hospitalcorporations report their inpatient data by individualsite while others report their data together.

The Champlain LHINChamplain is home to 1,176,579 people, which accountsfor 9.5% of the population of the province of Ontario as awhole3. Champlain consists of Ottawa, Renfrew County,Prescott & Russell United Counties, Stormont, Dundas &Glengarry United Counties, and portions of LanarkCounty and Leeds & Grenville United Counties.Geographic names that appear in the tables refer only tothe portions of the particular areas that are containedwithin the Champlain LHIN. At the end of the 2004/05fiscal year, there were 2,086 acute care beds inoperation in Champlain facilities; of these 192 werepsychiatry beds4.

Page iv Introduction

This section describes the total separations and daysfrom acute care facilities along with the complexityor level of care provided during these stays. Level ofcare is a method of categorizing acute inpatienthospital activity based on the degree of medical andtechnological specialization required.

Acute hospital separations can be grouped into Case Mix Groups (CMGTM), a methodology thataggregates hospital inpatients with similar diagnosesand treatment requirements5. Levels of care areaggregations of CMGs and CMG complexity agecategory combinations. Assignment of level of care in

this report is based on the Hay Level of CareMethodology 2002/03 version6, which has beenadopted by the Joint Policy and Planning Committee(JPPC) for use in the acute care portion of thehospital funding model. In the development of thismethodology, the Hay Group considered issuesincluding the number and distribution of cases,inflow/outflow patterns, the critical mass necessaryfor optimal outcomes, and the relative cost ofproviding care for each CMG and age category. The levels reflect differences in the acute averagelength of stay (ALOS) and the cost and complexity oftreatment5,7.

Section 1: Total Separations and Level of Care Page 1

Section 1

Total Separations and Level of Care

Table 1: Total Separations by Level of Care, Champlain & Ontario Hospitals, 2004/05

Hospitals Primary Secondary Tertiary/Quaternary Total

# % # % # % #

Lanark

Almonte General 683 62.3 348 31.8 65 5.9 1,096

Carleton Place & District Memorial 484 57.1 361 42.6 --† --† 848

Leeds & Grenville

Kemptville District 568 68.9 250 30.3 6 0.7 824

Ottawa

Children’s Hospital of Eastern Ontario 1,719 28.4 2,703 44.7 1,623 26.8 6,045

Montfort 4,035 46.4 4,341 49.9 321 3.7 8,697

Ottawa Hospital-Civic Site 6,819 37.2 8,378 45.7 3,130 17.1 18,327

Ottawa Hospital-General Site 7,996 38.0 11,147 52.9 1,922 9.1 21,065

Queensway-Carleton 5,211 52.1 4,445 44.4 355 3.5 10,011

University of Ottawa Heart Institute 599 9.9 1,296 21.4 4,168 68.7 6,063

Prescott & Russell

Hawkesbury & District General 1,071 53.5 826 41.2 106 5.3 2,003

Renfrew

Arnprior & District Memorial 782 59.7 515 39.3 12 0.9 1,309

Deep River & District 239 60.7 154 39.1 --† --† 394

Pembroke Regional 3,295 59.0 2,215 39.7 74 1.3 5,584

Renfrew Victoria 913 58.3 630 40.2 24 1.5 1,567

St. Francis Memorial 246 57.1 181 42.0 --† --† 431

Stormont Dundas & Glengarry

Cornwall Community-Second St. Site 1,250 52.0 1,079 44.9 75 3.1 2,404

Cornwall Community-McConnell Site 2,189 59.4 1,386 37.6 113 3.1 3,688

Glengarry Memorial Hospital 491 73.7 175 26.3 0 0.0 666

Winchester District Memorial 1,199 61.4 730 37.4 24 1.2 1,953

Total Champlain 39,789 42.8 41,160 44.3 12,026 12.9 92,975

Ontario 459,234 45.8 435,297 43.4 107,802 10.8 1,002,333

Source: Inpatient Discharges data, MOHLTC, Provincial Health Planning Database.

†Cell count suppressed due to small numbers (<5 separations).

There are three categories that define level of care7,8.Primary care can be provided in any hospital settingby general practitioners or specialists. Secondarycare includes surgical and other procedures providedby medical specialists, usually in larger communityhospitals. Tertiary and quaternary cases involvehighly specialized, costly care provided to seriouslyill patients, most often in larger regional referralcentres or teaching hospitals.

1.1 Champlain HospitalsThere were 92,975 total separations and 673,260 totalpatient days from acute hospitals in Champlain in2004/05. These numbers represented 9.3% of the totalseparations and 10.5% of the total days from acute carebeds within all Ontario hospitals.

In Champlain hospitals, 42.8% of separations wereprimary, 44.3% were secondary, and 12.9% were tertiary/quaternary (see Table 1). On average, Champlain

hospitals had a larger proportion of tertiary/quaternaryseparations compared to Ontario hospitals (10.8%).Volumes from Champlain hospitals represented 8.7% ofprimary, 9.5% of secondary, and 11.2% of tertiary/quaternary separations from Ontario hospitals.

Slightly more than 90% of separations from Champlainhospitals were by Champlain residents. The next mostcommon areas of patient origin for separations fromChamplain hospitals were out-of-province (5.5%) andthe South East LHIN (2.4%). The proportion of non-residents served by Champlain hospitals increased ascomplexity of care increased. Non-residentsrepresented 7.2% of primary, 9.4% of secondary, and18.2% of tertiary/quaternary separations fromChamplain hospitals. Following Champlain, the nextmost common areas of patient origin for tertiary/quaternary separations from Champlain hospitals wereout-of-province (8.5%), and the South East (5.0%) andNorth East (2.2%) LHINs.

Page 2 Section 1: Total Separations and Level of Care


3.9

4.7

5.9

6.1

5.8

7.9

8.5

7.6

10.6

15.6

5.2

5.3

5.6

5.7

6.1

6.9

7.7

7.9

9.3

16.4

0 2 4 6 8 10 12 14 16 18

Cardio/Thoracic

Trauma

General Medicine

Orthopaedics

Psychiatry

Gastro/Hepatobiliary

General Surgery

Pulmonary

Cardiology

Obstetrics

Pro

gram

Clu

ster

Cat

ego

ry

% of Separations

Ontario Hospitals

Champlain Hospitals

Figure 1: Leading Program Cluster Categories (PCCs) as a Proportion of Separations, Champlain

& Ontario Hospitals, 2004/05

Program Cluster Categories (PCCs) consist of CMGsaggregated into 30 broad programs and provide a meansto analyze groups of patients by the types of servicesreceived9. Figure 1 shows the top ten PCCs (based onseparations) in Champlain hospitals. Althoughobstetrics accounted for the largest proportion ofseparations (16.4%) from Champlain hospitals, it had theshortest ALOS among these categories at 2.5 days.Psychiatry accounted for only 6.1% of separations yethad the longest ALOS (14.6 days) of these categories inChamplain hospitals. Compared to Ontario hospitals,the proportion of cardiology separations was lower inChamplain hospitals, while the proportion ofcardio/thoracic separations was higher.

1.2 Champlain ResidentsChamplain residents had 86,104 total separations (fromall Ontario hospitals), which accounted for 622,740 totaldays. These figures represented 8.7% of total separ-ations and 9.8% of total days for Ontario residents.

For Champlain residents overall, 43.5% of separationswere primary, 44.6% were secondary, and 11.9% weretertiary/quaternary, as shown in Table 2. Compared toOntario residents, the proportion of primary separationswas lower, while the proportion of tertiary/quaternaryseparations was higher for Champlain residents.Champlain residents accounted for 8.2% of primary, 8.9%of secondary and 9.7% of tertiary/quaternary separationsfor Ontario residents.


Table 2: Total Separations by Level of Care, by Area of Residence, Champlain & Ontario Residents, 2004/05

Area of Residence Primary Secondary Tertiary/Quaternary Total

# % # % # % #

Lanark 1,426 46.5 1,280 41.7 362 11.8 3,068

Leeds & Grenville 683 50.5 548 40.5 121 8.9 1,352

Ottawa 21,814 41.9 23,677 45.4 6,609 12.7 52,100

Prescott & Russell 2,362 39.9 2,768 46.8 787 13.3 5,917

Renfrew 5,662 46.9 5,304 43.9 1,114 9.2 12,080

Stormont Dundas & Glengarry 5,516 47.6 4,827 41.7 1,244 10.7 11,587

Total Champlain 37,463 43.5 38,404 44.6 10,237 11.9 86,104

Ontario 455,262 45.9 430,779 43.4 105,910 10.7 991,951


1313

2

9

11

10

1

4

3

12

85

67

14

13

2

9

11

10

1

4

3

12

85

67

0 100 200 300

km

0 50 100 150

km

Local Health Integration Networks

1 Erie St. Clair2 South West3 Waterloo Wellington4 Hamilton Niagara Haldimand Brant5 Central West6 Mississauga Halton7 Toronto Central8 Central9 Central East10 South East11 Champlain12 North Simcoe Muskoka13 North East14 North West

Quebec

Manitoba

U.S.A.

U.S.A.

U.S.A.

Age- StandardizedTotal Acute Care SeparationRates per 1,000 Population

92.6 - 113.0

81.6 - 92.5

72.3 - 81.5

66.2 - 72.2

61.2 - 66.1

The distribution of age-standardized total separationrates by LHIN of residence is shown in Figure 2. Theoverall age-standardized rate for Champlain residentswas significantly lower than that for Ontario residentsas were the rates for primary and secondary level ofcare categories, see Table 3. The age-standardized ratefor tertiary/quaternary level of care for Champlainresidents was similar to that for Ontario residents.

Slightly less than 98% of Champlain residents’separations were from Champlain hospitals. Hospitalsin the South East LHIN served 0.9% of residents’separations, while those in the Toronto Central LHINserved 0.6%.


Figure 2: Age-Standardized Total Separation Rates by LHIN of Residence, Ontario, 2004/05


Statistics Canada 2001 Cartographic Boundary Files.

The top ten PCCs for Champlain residents (based onseparations) are shown in Figure 3. Within thesecategories, obstetrics accounted for the largestproportion of separations (16.2%) but had the shortestALOS (2.5 days) for Champlain residents. Psychiatryaccounted for only 6.3% of Champlain residents’

separations yet had the longest ALOS (14.5 days) among the top ten categories. Cardiology represented a noticeably smaller proportion of separations forChamplain residents compared to Ontario residents(9.4% and 10.6%, respectively).


Table 3: Age-Standardized Total Separation Rates (95% Confidence Intervals) per 1,000 Population by Level of Care,

Champlain & Ontario Residents, 2004/05

Level of Care Champlain Residents Ontario Residents

Primary 31.8 (31.5-32.2)* 36.7 (36.6-36.8)

Secondary 30.3 (30.0-30.6)* 32.4 (32.3-32.5)

Tertiary/Quaternary 8.0 (7.8-8.1) 7.9 (7.8-7.9)

Total Separations 70.2 (69.7-70.6)* 77.0 (76.8-77.1)


*Significantly different from provincial average based on assessment of 95% confidence intervals.

Figure 3: Leading Program Cluster Categories (PCCs) as a Proportion of Separations, Champlain

& Ontario Residents, 2004/05


3.8

4.6

5.9

6.1

5.8

8.0

8.4

7.6

10.6

15.6

4.6

5.3

5.7

5.9

6.3

7.1

7.9

8.0

9.4

16.2

0 2 4 6 8 10 12 14 16 18

Cardio/Thoracic

Trauma

General Medicine

Orthopaedics

Psychiatry

Gastro/Hepatobiliary

General Surgery

Pulmonary

Cardiology

Obstetrics

Pro

gram

Clu

ster

Cat

ego

ry

% of Separations

Ontario Residents

Champlain Residents


This section focuses on the active treatment ofconditions involving medical and/or surgical servicesprovided during the acute care portion of the hospitalstay, thus ALC days are not included. Mental healthseparations (psychiatry PCC) have also been excludedand will be covered in the following section.

2.1 Champlain HospitalsIn 2004/05, there were 87,271 acute separations and531,982 acute days from hospitals in Champlain, asshown in Table 4. These figures accounted for 9.4% of

the acute separations and 10.2% of the acute days fromOntario hospitals. Overall, the acute ALOS in Champlainhospitals (6.1 days) was longer than the acute ALOS inOntario hospitals (5.5 days).

The majority of acute separations from hospitals inChamplain (90.2%) were by Champlain residents. Out-of-province (5.7%) and the South East LHIN (2.4%) werethe next most common areas of patient origin forseparations from Champlain hospitals.

Section 2: Acute Separations Page 7

Section 2

Acute Separations

Table 4: Acute Separations, Days, & Average Length of Stay (ALOS), Champlain & Ontario Hospitals, 2004/05

Hospitals Acute

Separations Days ALOS

Lanark

Almonte General 1,052 4,726 4.5

Carleton Place & District Memorial 797 4,660 5.8

Leeds & Grenville

Kemptville District 792 6,547 8.3

Ottawa

Children’s Hospital of Eastern Ontario 5,626 34,705 6.2

Montfort 7,918 40,602 5.1

Ottawa Hospital-Civic Site 17,106 103,893 6.1

Ottawa Hospital-General Site 20,090 130,047 6.5

Queensway-Carleton 9,462 51,697 5.5

University of Ottawa Heart Institute 6,063 37,741 6.2

Prescott & Russell

Hawkesbury & District General 1,872 13,825 7.4

Renfrew

Arnprior & District Memorial 1,255 7,224 5.8

Deep River & District 376 2,397 6.4

Pembroke Regional 4,941 29,110 5.9

Renfrew Victoria 1,494 8,787 5.9

St. Francis Memorial 387 2,987 7.7


Cornwall Community-Second St. Site 1,847 14,752 8.0

Cornwall Community-McConnell Site 3,658 22,444 6.1

Glengarry Memorial Hospital 630 4,149 6.6

Winchester District Memorial 1,905 11,689 6.1

Total Champlain 87,271 531,982 6.1

Ontario 944,650 5,200,536 5.5


As previously mentioned, acute hospital separations canbe grouped into CMGs. Each CMG is identified as eithersurgical or medical, based on the presence or absenceof a surgical procedure during the hospital stay5,10.Champlain hospitals had a smaller proportion ofmedical separations (63.7%) compared to Ontariohospitals (65.8%), and accordingly, a greater proportionof surgical separations (36.3% and 34.2%, respectively).Separations from Champlain hospitals represented 9.0%of the medical separations and 9.8% of the surgicalseparations from Ontario hospitals.

2.2 Champlain ResidentsIn 2004/05, there were 80,687 acute separations and487,594 acute days for Champlain residents (from allOntario hospitals), as shown in Table 5. These separ-ations accounted for 8.6% of the acute separations and9.5% of the acute days for Ontario residents. The acuteALOS for Champlain residents (6.0 days) was longerthan the acute ALOS for Ontario residents (5.5 days).

The age-standardized acute separation rate forChamplain residents was significantly lower than therate for Ontario residents, while the crude acute dayrate was similar, as shown in Table 6.

The majority of acute separations for residents ofChamplain (97.5%) were from Champlain hospitals. TheSouth East LHIN was the next most common locationfor residents’ hospitalizations (0.9%).

Champlain residents had a smaller proportion ofmedical (64.2%) and accordingly, a larger proportion ofsurgical (35.8%) separations compared to Ontarioresidents (65.8% and 34.2%, respectively). Separationsfor Champlain residents represented 8.4% of the medicalseparations and 9.0% of the surgical separations forOntario residents.

Page 8 Section 2: Acute Separations

Table 5: Acute Separations, Days, & Average Length of Stay (ALOS), by Area of Residence, Champlain & Ontario

Residents, 2004/05

Area of Residence Acute


Lanark 2,890 16,366 5.7

Leeds & Grenville 1,296 8,348 6.4

Ottawa 48,898 290,094 5.9

Prescott & Russell 5,595 34,365 6.1

Renfrew 11,164 67,154 6.0

Stormont Dundas & Glengarry 10,844 71,267 6.6


Ontario 934,669 5,142,030 5.5


Table 6: Age-Standardized Acute Separation Rates (95% Confidence Intervals) per 1,000 Population & Crude Acute

Day Rates per 1,000 Population, Champlain & Ontario Residents, 2004/05

Champlain Residents Ontario Residents

Age-Standardized Acute Separation Rate 65.7 (65.3-66.2)* 72.5 (72.3-72.6)

Crude Acute Day Rate 414.4 414.9


*Significantly different from provincial average based on assessment of 95% confidence intervals.

Acute mental health separations are based on thepsychiatry PCC. Although there are acute beds insome facilities that are specifically for psychiatriccare, patients with such conditions can also be caredfor in other acute beds. As this report focuses onacute utilization, hospitalizations in specializedmental health facilities (the former provincialpsychiatric hospitals) are not included. This sectionwill provide information on both the acute and total(i.e. including ALC) hospital stay.

3.1 Champlain HospitalsAcute mental health separations represented 6.1% of allseparations from Champlain hospitals and 12.4% of totaldays, larger proportions compared to those for Ontariohospitals (5.8% and 10.9%, respectively). In 2004/05,there were 5,704 acute mental health separations and83,243 total mental health days from hospitals inChamplain, as shown in Table 7. These numbersaccounted for 9.9% of mental health separations and12.0% of mental health days from Ontario hospitals. InChamplain hospitals, the total ALOS was 1.8 days longer

Section 3: Mental Health Page 9

Section 3

Mental Health

Table 7: Acute Mental Health Separations, Days, & Average Length of Stay (ALOS), Champlain & Ontario Hospitals,

2004/05

Hospitals Separations Acute Total

Days ALOS Days ALOS

Lanark

Almonte General 44 389 8.8 504 11.5

Carleton Place & District Memorial 51 555 10.9 706 13.8

Leeds & Grenville

Kemptville District 32 516 16.1 814 25.4

Ottawa

Children’s Hospital of Eastern Ontario‡ 419 6,055 14.5 6,055 14.5

Montfort‡ 779 10,250 13.2 11,707 15.0

Ottawa Hospital-Civic Site‡ 1,221 14,999 12.3 16,929 13.9

Ottawa Hospital-General Site‡ 975 15,810 16.2 17,926 18.4

Queensway-Carleton‡ 549 7,470 13.6 8,517 15.5

Prescott & Russell

Hawkesbury & District General 131 1,355 10.3 1,519 11.6

Renfrew

Arnprior & District Memorial 54 375 6.9 430 8.0

Deep River & District 18 179 9.9 569 31.6

Pembroke Regional‡ 643 6,591 10.3 7,182 11.2

Renfrew Victoria 73 503 6.9 815 11.2

St. Francis Memorial 44 494 11.2 691 15.7


Cornwall Community-Second St. Site‡ 557 6,229 11.2 6,708 12.0

Cornwall Community-McConnell Site 30 516 17.2 810 27.0

Glengarry Memorial Hospital 36 263 7.3 332 9.2

Winchester District Memorial 48 506 10.5 1,029 21.4

Total Champlain 5,704 73,055 12.8 83,243 14.6

Ontario 57,683 621,495 10.8 696,049 12.1


‡Had acute psychiatry beds as at March 31, 20054.

than the acute ALOS, which reflects the impact of ALCstays. Overall, the total ALOS for mental health inChamplain hospitals (14.6 days) was 2.5 days longerthan the total ALOS in Ontario hospitals (12.1 days).

The vast majority of mental health separations fromhospitals in Champlain (94.0%) were by Champlainresidents. Out-of-province (2.9%) and the South EastLHIN (1.2%) were the next most common areas ofpatient origin for mental health separations fromChamplain hospitals.

3.2 Champlain ResidentsAcute mental health separations represented 6.3% of allseparations and 12.6% of total days for Champlainresidents, greater proportions compared to those forOntario residents (5.8% and 10.9%, respectively). In2004/05, there were 5,417 acute mental healthseparations and 78,548 total mental health days forChamplain residents (from all Ontario hospitals), as

shown in Table 8. Champlain residents accounted for9.5% of the mental health separations and 11.3% of thetotal mental health days for Ontario residents. ForChamplain residents, the total ALOS was 1.8 days longerthan the acute ALOS, which reflects the impact of ALCstays. Overall, the total ALOS for mental health forChamplain residents (14.5 days) was 2.4 days longerthan the total ALOS for Ontario residents (12.1 days).

The age-standardized acute mental health separationrate for Champlain residents was similar to the rate forOntario residents, as shown in Table 9. However, thecrude total mental health day rate was 19.5% higherthan the rate for Ontario residents.

The majority of mental health separations for residentsof Champlain (98.9%) were from Champlain hospitals.Hospitals in the South East and the Toronto CentralLHINs each served 0.2% of Champlain residents’ mentalhealth separations.

Page 10 Section 3: Mental Health

Table 8: Acute Mental Health Separations, Days, & Average Length of Stay (ALOS), by Area of Residence, Champlain

& Ontario Residents, 2004/05

Area of Residence Separations Acute Total

Days ALOS Days ALOS

Lanark 178 1,848 10.4 2,209 12.4

Leeds & Grenville 56 752 13.4 1,105 19.7

Ottawa 3,202 43,585 13.6 49,802 15.6

Prescott & Russell 322 4,038 12.5 4,445 13.8

Renfrew 916 9,509 10.4 10,918 11.9

Stormont Dundas & Glengarry 743 8,889 12.0 10,069 13.6

Total Champlain 5,417 68,621 12.7 78,548 14.5

Ontario 57,282 617,970 10.8 692,244 12.1


Table 9: Age-Standardized Acute Mental Health Separation Rates (95% Confidence Intervals) per 1,000 Population

& Crude Total Mental Health Day Rates per 1,000 Population, Champlain & Ontario Residents, 2004/05


Age-Standardized Separation Rate 4.4 (4.3-4.5) 4.5 (4.4-4.5)

Crude Total Day Rate 66.8 55.9


ALC refers to cases where patients have completedthe acute care phase of treatment but remain in acutecare beds while awaiting placement elsewhere1. The patient is classified as ALC when the attendingphysician or authorized designate indicates thatacute care is no longer required and requests atransfer to another setting. Coding of ALC days beganin 1989 in order to differentiate non-acute use ofacute care beds from typical acute care1. ALC daysare considered an inefficient use of acute careresources and reflect problems with access to post-acute services such as rehabilitation, long-term carehomes, home care, etc.11.

This section includes individuals with at least oneALC day during their hospital stay, including thosewith mental health diagnoses. The ALC days and ALCALOS refer to the length of the ALC stay only andexclude the acute care portion of the stay.

4.1 Champlain HospitalsALC separations accounted for 4.1% of the totalseparations in Champlain hospitals, a similar proportioncompared to Ontario hospitals (3.9%); however, ALCdays represented a greater proportion of the total daysin Champlain hospitals (10.1%) compared to Ontario

Section 4: Alternate Level of Care Page 11

Section 4

Alternate Level of Care (ALC)

Table 10: Alternate Level of Care (ALC) Separations, Days, & Average Length of Stay (ALOS), Champlain & Ontario

Hospitals, 2004/05

Hospitals ALC


Lanark

Almonte General 8 169 21.1

Carleton Place & District Memorial 26 380 14.6

Leeds & Grenville

Kemptville District 37 1,485 40.1

Ottawa

Montfort 290 5,230 18.0

Ottawa Hospital-Civic Site 1,258 18,679 14.8

Ottawa Hospital-General Site 917 14,032 15.3

Queensway-Carleton 449 8,612 19.2

University of Ottawa Heart Institute 40 278 7.0

Prescott & Russell

Hawkesbury & District General 31 534 17.2

Renfrew

Arnprior & District Memorial 98 907 9.3

Deep River & District 21 1,164 55.4

Pembroke Regional 78 3,635 46.6

Renfrew Victoria 124 3,295 26.6

St. Francis Memorial 9 385 42.8


Cornwall Community-Second St. Site 153 2,004 13.1

Cornwall Community-McConnell Site 125 3,065 24.5

Glengarry Memorial 68 983 14.5

Winchester District Memorial 115 3,313 28.8


Ontario 39,052 567,548 14.5


hospitals (8.9%). There were 3,847 ALC separations and68,150 ALC days from Champlain hospitals in 2004/05,as shown in Table 10. This represented 9.9% of the ALCseparations and 12.0% of the ALC days from Ontariohospitals. Although there was variation by hospital, onaverage, the ALC ALOS in Champlain hospitals (17.7days) was 3.2 days longer than the ALC ALOS in Ontariohospitals (14.5 days).

Bed equivalents estimate the number of beds usedbased on ALC days at benchmark levels of occupancy(95% for these calculations). In 2004/05, there wereapproximately 197 acute care beds in Champlainhospitals filled by ALC patients who were more suitedfor service elsewhere. This represented 12.0% of the1,637 ALC patient bed equivalents in Ontario hospitals.

Approximately 96% of ALC separations from Champlainhospitals were by residents of Champlain. The nextlargest proportion (1.9%) were from out-of-province.

The five PCCs associated with the largest proportion ofALC days for Champlain hospitals appear in Figure 4.Compared to Ontario hospitals, larger proportions ofChamplain hospitals’ ALC days were associated withpsychiatry and trauma, while general medicine andneurology contributed a smaller proportion of ALC days.

The transfer destinations associated with the largestnumber of ALC separations and days from Champlainhospitals were long-term care homes, general rehab-ilitation, and no transfer/unknown location (dischargedhome, death, etc.), as shown in Table 11. The ALC ALOSin Champlain hospitals was shortest for those who weretransferred to acute care facilities (9.6 days) and longestfor transfers to psychiatric facilities (43.6 days),although the number of separations was small for thelatter. Compared to transfers in Ontario hospitals, theALC ALOS for Champlain hospitals was longer for alltransfer destinations with the exception of acute carefacilities and unclassified/other facilities.

Page 12 Section 4: Alternate Level of Care

7.5

11.5

12.8

10.0

13.1

7.8

9.7

11.7

12.9

14.9

0 2 4 6 8 10 12 14 16

Pulmonary

Neurology

General Medicine

Trauma

Psychiatry

Pro

gram

Clu

ster

Cat

ego

ry

% of ALC Days

Ontario Hospitals

Champlain Hospitals

Figure 4: Leading Program Cluster Categories (PCCs) as a Proportion of Alternate Level of Care

(ALC) Days, Champlain & Ontario Hospitals, 2004/05


4.2 Champlain ResidentsThere were 3,721 ALC separations and 66,453 ALC daysfor Champlain residents (from all Ontario hospitals), asshown in Table 12. Champlain residents’ separationsrepresented 9.6% of the ALC separations and 11.7% ofthe ALC days for all Ontario residents. Overall, the ALCALOS for Champlain residents (17.9 days) was 3.4 days

longer than the ALC ALOS for Ontario residents (14.5days). Champlain residents’ ALC days were equivalentto approximately 192 beds, based on 95% occupancy, aspreviously described. This represented 11.7% of theapproximately 1,631 acute care bed equivalents filled byOntario resident ALC patients.


Table 11: Alternate Level of Care (ALC) Separations, Days & Average Length of Stay (ALOS) for Specific Transfer

Locations, Champlain & Ontario Hospitals, 2004/05

Transfer Locations Champlain Hospitals Ontario Hospitals

ALC

Separations Days ALOS Separations Days ALOS

Long-Term Care Home 1,063 29,268 27.5 8,579 197,545 23.0

General Rehabilitation 835 9,426 11.3 6,358 57,179 9.0

No Transfer/Unknown 827 12,565 15.2 8,722 124,164 14.2

Home Care 381 5,700 15.0 4,320 48,628 11.3

Complex Continuing Care 341 6,317 18.5 8,428 105,506 12.5

Acute Care Facility 199 1,902 9.6 1,080 12,660 11.7

Unclassified/Other Facility 190 2,492 13.1 582 9,741 16.7

Psychiatric Facility 11 480 43.6 130 3,108 23.9

Special Rehabilitation 0 0 0.0 825 8,593 10.4

Ambulatory Care/Outpatient Dept. 0 0 0.0 28 424 15.1

Total 3,847 68,150 17.7 39,052 567,548 14.5


Table 12: Alternate Level of Care (ALC) Separations, Days, & Average Length of Stay (ALOS) by Area of Residence,

Champlain & Ontario Residents, 2004/05

Area of Residence ALC


Lanark 72 976 13.6

Leeds & Grenville 43 1,442 33.5

Ottawa 2,546 42,817 16.8

Prescott & Russell 159 2,151 13.5

Renfrew 381 9,578 25.1

Stormont Dundas & Glengarry 520 9,489 18.2


Ontario 38,912 565,640 14.5


The age-standardized ALC separation rate forChamplain residents was similar to the Ontario rate;however, the crude day rate was 23.7% higher than theOntario rate, as shown in Table 13.

Champlain hospitals accounted for 99.2% of ALC separ-ations for Champlain residents. The Toronto CentralLHIN served 0.2% of Champlain residents’ ALCseparations.

Figure 5 shows the top five PCCs associated with thelargest proportion of ALC days for Champlain residents.Compared to Ontario residents, a larger proportion ofChamplain residents’ ALC days were related topsychiatry and trauma, while smaller proportions wererelated to general medicine and neurology.

Page 14 Section 4: Alternate Level of Care

7.5

11.5

12.8

10.0

13.1

7.8

9.7

11.6

12.7

14.9

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0

Pulmonary

Neurology

General Medicine

Trauma

Psychiatry

Pro

gram

Clu

ster

Cat

ego

ry

% of ALC Days

Ontario Residents

Champlain Residents

Figure 5: Leading Program Cluster Categories (PCCs) as a Proportion of Alternate Level of Care

(ALC) Days, Champlain & Ontario Residents, 2004/05


Table 13: Age-Standardized Alternate Level of Care (ALC) Separation Rates (95% Confidence Intervals) per 1,000

Population and Crude ALC Day Rates per 1,000 Population, Champlain & Ontario Residents, 2004/05


Age-Standardized ALC Separation Rate 2.6 (2.5-2.7) 2.6 (2.6-2.6)

Crude ALC Day Rate 56.5 45.6


The transfer destinations associated with the largestnumber of ALC separations and days for Champlainresidents were long-term care homes, generalrehabilitation, and no transfer/unknown location(discharged home, death, etc.), as shown in Table 14.The ALC ALOS was shortest for Champlain residentswho were transferred to acute care facilities (10.3 days)

and longest for those who were transferred topsychiatric facilities (42.5 days), although the number of separations was small for the latter. Compared toOntario residents, the ALC ALOS for Champlainresidents was longer for all transfer destinations withthe exception of unclassified/other facilities and acutecare facilities.


Table 14: Alternate Level of Care (ALC) Separations, Days & Average Length of Stay (ALOS) for Specific Transfer

Locations, Champlain & Ontario Residents, 2004/05

Transfer Locations Champlain Residents Ontario Residents

ALC

Separations Days ALOS Separations Days ALOS

Long-Term Care Home 1,053 28,841 27.4 8,574 197,266 23.0

General Rehabilitation 802 8,972 11.2 6,322 56,733 9.0

No Transfer/Unknown 794 12,083 15.2 8,671 123,350 14.2

Home Care 374 5,653 15.1 4,316 48,583 11.3

Complex Continuing Care 340 6,318 18.6 8,419 105,433 12.5

Unclassified/Other Facility 182 2,426 13.3 569 9,645 17.0

Acute Care Facility 164 1,690 10.3 1,061 12,514 11.8

Psychiatric Facility 11 467 42.5 130 3,108 23.9

Special Rehabilitation --† --† --† 823 8,585 10.4

Ambulatory Care/Outpatient Dept. 0 0 0.0 27 423 15.7

Total 3,721 66,453 17.9 38,912 565,640 14.5


†Cell count suppressed due to small numbers (<5 separations).

Age-Standardized Rate: A summary rate whichadjusts for variations in population age distributionsover time and place. Hospitalization rates have beenadjusted using the direct method and the 1991 Canadianpopulation as the standard.

Alternate Level of Care (ALC): When a patient whohas completed the acute care phase of treatmentoccupies an acute care bed while awaiting placementelsewhere (long-term care home, rehabilitation,complex continuing care, home care, etc.).

Average Length of Stay: The number of patient daysdivided by the number of separations, reported in days.

Bed Equivalents: The approximate number of bedsused annually based on patient days (ALC or othertypes) at benchmark occupancy rates (95% for thesecalculations). Bed Equivalents = days/(occupancy * days/year)

Case Mix Group (CMGTM): A methodology designedto aggregate hospital inpatients with similar diagnosesand treatment requirements. CMG is a registeredtrademark of the Canadian Institute for HealthInformation.

Case Mix Group Complexity Age Category:Categories refer to broad age groupings (<17 years, 18-69 years, 70+ years) that are associated with differinglevels of treatment complexity and lengths of stay forspecific CMGs.

Confidence Interval: The interval with a givenprobability (here 95%) that the true value of a rate iscontained within the interval.

Crude Rate: The number of events occurring in aspecific time period, expressed per population. A cruderate is not adjusted for differences in populationstructure.

Primary Level of Care: Procedures or treatments thatcan be provided in any hospital setting by generalpractitioners or specialists.

Program Cluster Category (PCC): Consists of CaseMix Groups (CMGs) aggregated into broad programsand reflects the main types of services received.

Secondary Level of Care: Surgical and otherprocedures provided by medical specialists, usually inlarger community hospitals.

Separation: A completed case treated in a hospitalresulting in any of the following: discharge home,transfer to another facility, death or sign out.

Statistical Significance: The probability that a resultis not likely to have occurred due to chance alone.

Tertiary/Quaternary Level of Care: Procedures ortreatments provided to seriously ill patients that involvehighly specialized, costly care most often provided inlarger regional referral centres or teaching hospitals.

Total Days of Stay: Includes the acute and ALCportions of a hospital stay.

Page 16 Glossary

Glossary

1. Canadian Institute for Health Information. DADabstracting manual 2004-2005 Edition, 10-1-10-3.Ottawa, ON; 2004.

2. Ontario Ministry of Health and Long-Term Care.Provincial Health Planning Database, InpatientDischarges. Version 16.03; December 2005.

3. Ontario Ministry of Health and Long-Term Care.Provincial Health Planning Database, PopulationEstimates [2004]. Version 16.03; December 2005.

4. Ontario Ministry of Health and Long-Term Care,Finance and Information Management Branch. Dailycensus summary, acute beds staffed and in operation2004/05 (March). Retrieved November 16, 2005, fromhttp://fimdata.com/dcs/ab_mth.asp?pYR=2004%2F2005&pMTH=March

5. Campbell L. CIHI case mix tools. In: Johnson L,Richards J, Pink G, & Campbell L (Eds.). Case mixtools for decision making in health care. Ottawa,ON: Canadian Institute for Health Information; 1998.p.1-10.

6. Hay Health Care Consulting Group. Hay level ofcare methodology: 02/03 version using AARVweights. 2004. Retrieved September 1, 2005, fromhttp://www.jppc.org/library/funding/hay_2004.pdf

7. Hay Health Care Consulting Group and JPPC. TheHay Group level of care methodology: CMG 1999.2001. Retrieved September 1, 2005, fromhttp://www.jppc.org/library/funding/rd10_1.pdf

8. Baigent L, Shaw R, & Chalmers F. Health systemmonitoring report 2004/05. Windsor, ON: Essex KentLambton District Health Council; 2005.

9. Joint Committee of the Ministry of Health and theOntario Hospital Association. Rural and NorthernHealth: Parameters and Benchmarks; 1998.

10. Canadian Institute for Health Information.CMGTM/PLXTM Directory ICD-10-CA/CCI. Ottawa,ON; 2002.

11. Damba C, Vahabi M, & Zon L. First annual Toronto’shealth system report card November 1999. Toronto,ON: Toronto District Health Council; 1999.

References

References Page 17

Notes

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Documents

Acute Care - Legislative Assembly of Ontario · for 9.5% of the population of the province of Ontario as a whole3. Champlain consists of Ottawa, Renfrew County, Prescott & Russell