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Health System Performance Information for Health Care
Improvement: A pan-Canadian Initiative
OECD Workshop on Health Data Governance
May 20, 2015
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HSP Agenda Phase 1: the Why, the What and the How
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Why
• Confusion about performance measurement • Large number of organizations reporting at various
levels and in an uncoordinated fashion • A need to strengthen public reporting on system
performance
What • Three-year plan (2012 to 2015) to strengthen pan-Canadian health system performance (HSP) reporting
How • Provide structured and coordinated pan-Canadian performance reporting
- Information tailored to the needs of different audiences
• Develop analytical products and tools that support jurisdictional priorities for health care improvement
The approach: align with strategy and use parsimony to put indicators to use
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Five Deliverable Packages Over 2012-2015
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Package Objectives Deliverables
HSP measurement
framework
Strengthen evidence base,
improve alignment and make it
actionable
Redeveloped HSP framework
Related facility-level frameworks
Interactive HSP public
accessible reporting
Deliver cascading sets of HSP
reports over 3 years
Interactive web tool for the public (In Brief)
Interactive facility/regional web tool (In Depth)
Long-term care facility-level reporting
Indicator library
Integrated analytical
environment
Analytical capacity to better
understand health system
performance drivers
Hospital private eReporting product (Insight)
CEHQ mobile app
Research and analysis
activities
Further align CIHI research and
analytical agenda with priorities
of P/T; strengthen collaboration
New indicator development
Patient experience survey/reporting
Consensus conference 2014
Analytical plan aligned with HSP
Capacity building activities Support capacity building in use
of data
3 HSP schools (Atlantic, MB, ON)
Conferences and workshops
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Your Health System: Timeline
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Our Health System
(Your Health System: In Brief)
• Nov 2013 • 15 indicators covering 5 aspects of
health system performance
• Meant for a general audience
Your Health System:
In Depth
• Sept 2014 • 37 regional, acute care
facility indicators
• Meant for Ministry decision-makers and regional/facility executives
Your Health System: In Depth
Integrating Long Term Care (LTC) sector results
• June 10, 2015 • Facility-level
results for 9 additional long-term care indicators
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YourHealthSystem.ca
1 2
• Audience: General public
• Audience: Ministry, facility, regional
decision-makers (available publicly)
In Brief In Depth
Your Health System Data Sources
YHS Data Source Description
Canadian Community Health Survey (CCHS)
The CCHS is a cross-sectional survey that collects information related to health status, health care utilization and health determinants for the community-dwelling Canadian population on an ongoing basis.
Continuing Care Reporting System (CCRS) The Continuing Care Reporting System (CCRS) captures resident-level clinical and administrative data from residential care homes using the RAI MDS 2.0©, an internationally recognized standard assessment tool.
Canadian MIS Database (CMDB) The Canadian MIS Database (CMDB) contains financial and statistical operations information on public hospitals and regional health authorities across Canada.
Discharge Abstract Database (DAD) The Discharge Abstract Database (DAD) captures patient demographic, administrative, clinical and service-specific data on hospital discharges (including deaths, sign-outs and transfers) from acute inpatient facilities and selected day surgery, chronic, rehabilitation and psychiatric facilities.
The Early Development Instrument (EDI) – Offord Centre for Child Studies
The EDI is a measure of children's readiness to learn at school in five domains: physical health and well-being; social knowledge and competence; emotional health/maturity; language and cognitive development; and general knowledge and communication skills.
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Your Health System Data Sources
YHS Data Source Description
The Hospital Morbidity Database
(HMDB)
The Hospital Morbidity Database (HMDB) contains pan-
Canadian patient demographic, administrative, clinical and
service specific data on inpatient separations from acute
care hospitals. The HMDB also contains day surgery data
from Quebec.
National Ambulatory Care Reporting
System (NACRS)
The National Ambulatory Care Reporting System (NACRS)
contains patient demographic, administrative, clinical and
service-specific data about hospital and community-based
emergency department and ambulatory care visits,
including visits to day surgery and outpatient clinics.
National Prescription Drug
Utilization Information System
(NPDUIS)
The National Prescription Drug Utilization Information
System (NPDUIS) Database contains prescription claims-
level data collected from publicly financed drug benefit
programs in Canada.
Vital Statistics - Death Database The vital statistics database is an administrative survey
that collects demographic and medical (cause of death)
information annually from all provincial and territorial vital
statistics registries on all deaths in Canada.
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Your Health System: Insight -- Key Features
• Timely monthly updates using open-year data
• Increased flexibility to understand performance drivers
• Pan-Canadian comparisons
• Support of result reconciliation with facilities’ own local data (access to chart level data)
• Over time, adding content, evolving and adapting to better meet client needs
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Product Navigation
Summary Dashboard
•Customize your organizational preferences
•Summary results, comparisons and trends, aligns with In Depth website
•Choose indicators to focus on
Trends and Comparisons Dashboard
•View your results over time, select comparators
•Presentation-ready reports
Indicator Exploration
•Visually explore your results
•Uncover potential performance drivers
•Customize to suit your needs
Custom Breakdowns
•Use prompts to create custom reports
•Drill into your results, right down to the chart number
Chart Export
•Export your results, right down to the chart number
•Integrate your results with your own system
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Next steps work on health system performance (2015-2020) through renewed partnerships
• Enhanced public reporting on system performance: progress on horizontal and vertical reporting
• Indicator development
– Outcomes
– Integration and continuity of care
– Community care including mental health
– Value for money
– Upstream investments in population health
• Connect performance measurement to best practices and innovation for quality improvement
• Expanded health analytics agenda
• Refocused research agenda on performance improvement priorities
• Capacity building, peer to peer learning activities and knowledge exchange
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Website Functionality
Your Health System: In Depth
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How do I access my results?
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Enter a facility,
city or region to
see Overall
Results
Enter a province, territory, city,
region or the name of a
hospital to reach Indicator
results.
How do I Compare Across all Measures?
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Contextual (profile) data for
region or facility selected.
Data displayed by Theme. The
user can also select an
indicator from this page to view
individual indicator results.
Ability to export,
share and print
Where are all of our relevant indicators?
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What are my Overall Results?
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Provides a
snapshot of results
for a hospital or
health region
compared to the
national or peer
group average and
the trend over time.
What are my overall results?
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What are my overall results?
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How do I Compare to Others?
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Ability to
export, share
and print
What is the Trend Over Time for my Results?
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Ability to add
new comparator
organizations
Ability to export,
share and print
How do I Compare within my region or
province?
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Ability to export,
share and print
Who can I Learn from?
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Enhanced Interactive Map
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Drill down from
provincial level
data to regional
and facility level
data
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• Ability to export and create Reports:
– Visuals into PPT, PDF, Excel
– Data into excel formal
Exporting Capability
List of indicators
Your Health System: In Depth
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Interactive Facility/Regional Website Indicators
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Indicator Name Level of Reporting
Total time spent in Emergency Room (admitted patients) · Facility, region
Emergency wait time for physician assessment · Facility, region
Hip fracture surgery wait times · Facility, region
Obstetric trauma (with instrument) (revised) · Facility, region
In-hospital sepsis (new) · Facility, region
Hospital deaths (HSMR) · Facility, region
Hospital deaths following major surgery (revised) (Previously “5-day In-Hospital
Mortality Following Major Surgery”) · Facility, region
All patients readmitted to hospital · Facility, region
Medical patients readmitted to hospital · Facility, region
Surgical patients readmitted to hospital · Facility, region
Obstetric patients readmitted to hospital · Facility, region
Patients 19 and younger readmitted to hospital · Facility, region
Low-risk Caesarean sections (revised) (Previously “C-Section rate: excluding pre-term
births and multiple gestations”) · Facility, region
Cost of a standard hospital stay · Facility, region
Have a regular doctor · Region
Repeat hospital stays for mental illness · Region
Potentially inappropriate medication in long-term care · Region
Potentially inappropriate medication prescribed to seniors (new) · Region
Repeat hospital stay for mental illness · Region
Interactive Facility/Regional Website Indicators (continued)
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Indicator Name Level of Reporting
Restraint use in long-term care · Region
Patient flow for hip replacement · Region
Breastfeeding initiation · Region
Influenza Immunization for Seniors · Region
Ambulatory care sensitive conditions · Region
Life expectancy at birth · Region
Life expectancy at age 65 · Region
Avoidable deaths · Region
Avoidable deaths from preventable causes · Region
Avoidable deaths from treatable causes · Region
Perceived Health · Region
Hospitalized heart attacks · Region
Hospitalized strokes · Region
Self-injury hospitalizations · Region
Healthy child development · Region
Obesity · Region
Smoking · Region
Physical Activity During Leisure Time · Region
Heavy drinking · Region
Facility/Regional Contextual Measures
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Contextual Measure Level of Reporting
Total population · Region
Rural area population · Region
Seniors aged 65 and over · Region
Family medicine physicians per 100,000 population · Region
Patient days in alternate level of care (percentage) · Region
Unemployment rate · Region
Immigration population · Region
Post-secondary educational attainment · Region
Children living in low-income families · Region
Household food insecurity · Region
Prevalence of diabetes · Region
Prevalence of chronic obstructive pulmonary disease (COPD) · Region
Prevalence of high blood pressure · Region
Prevalence of mood disorders · Region
Type of hospital · Facility
Facility/Regional Contextual Measures (continued)
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Contextual Measure Level of Reporting
Number of inpatients · Facility
Number of beds · Facility
Number of emergency department visits · Facility
Average resource use intensity · Facility
Total resource use intensity · Facility
Average length of a hospital stay · Facility
Hospital occupancy rate · Facility
Percentage of patients admitted through the emergency department · Facility
Patient days in alternate level of care · Facility
Type of hospital · Facility
Long Term Care Indicators 2015 release
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Indicator Name Level of Reporting
Percentage of residents with "0" score on the Index of Social Engagement · Facility, region
Percentage of residents in daily physical restraints · Facility, region
Percentage of residents on antipsychotics without a diagnosis of psychosis · Facility, region
Percentage of residents who fell in the last 30 days · Facility, region
Percentage of residents who had worsened pressure ulcer at stage 2-4 · Facility, region
Percentage of residents whose mood symptoms of depression worsened · Facility, region
Percentage of residents with improved mid-loss activities of daily living · Facility, region
Percentage of residents with worsened mid-loss activities of daily living · Facility, region
Percentage of residents with worsened pain · Facility, region
Percentage of residents with pain · Facility, region
Long Term Care Contextual Measures Note: Contextual measures are subject to change prior to release
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Contextual Measure Level of Reporting
Urban or rural · Facility
Number of beds (large, medium, small) · Facility
Percentage of female residents · Facility
Percentage of residents under 65 years of age · Facility
Percentage of residents over 85 years of age · Facility
Percentage of residents with dementia · Facility
Percentage of residents with heart failure · Facility
Average length of stay · Facility
