CIHI s Provisional Analytical Plan, 2016 to 2018 Overview of Indicator Development and New Reports
Production of this document is made possible by financial contributions from Health Canada and provincial and territorial governments. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government. All rights reserved. The contents of this publication may be reproduced unaltered, in whole or in part and by any means, solely for non-commercial purposes, provided that the Canadian Institute for Health Information is properly and fully acknowledged as the copyright owner. Any reproduction or use of this publication or its contents for any commercial purpose requires the prior written authorization of the Canadian Institute for Health Information. Reproduction or use that suggests endorsement by, or affiliation with, the Canadian Institute for Health Information is prohibited. For permission or information, please contact CIHI: Canadian Institute for Health Information 495 Richmond Road, Suite 600 Ottawa, Ontario K2A 4H6 Phone: 613-241-7860 Fax: 613-241-8120 www.cihi.ca copyright@cihi.ca ISBN 978-1-77109-438-2 (PDF) 2016 Canadian Institute for Health Information Cette publication est aussi disponible en français sous le titre Plan analytique provisoire de l ICIS de 2016 à 2018 : aperçu des projets d élaboration d indicateurs et des nouveaux rapports. ISBN 978-1-77109-439-9 (PDF)
Table of contents Introduction... 5 Priority population projects... 6 Children and youth... 6 Pediatric High Users of Hospital Beds... 6 Mental health and addictions... 6 Alcohol-Attributable Hospitalizations... 6 Hospitalizations and Emergency Department Visits Due to Opioid Poisoning... 6 Reporting Mental Health Performance Across Canadian Provinces... 6 Seniors and aging... 7 Dementia: Patients, Caregivers and the Health System... 7 Do Not Hospitalize and Do Not Resuscitate Reporting in Long-Term Care... 7 Examining Characteristics of High Users of Health Care for Persons With Chronic Obstructive Pulmonary Disease... 7 Promoting Independence: Improving Physical Functioning in Residential Care... 7 Seniors in Transition: Factors Associated With Placement in Home Care and Residential Care... 7 Health system performance projects... 8 Outcomes... 8 Patients With End-Stage Kidney Disease on Dialysis and Hospitalizations: Associated Risks, Outcomes and Costs... 8 Patient experience... 8 Access to Specialist Services in Canada: Wait 1 for Selected Priority Procedures... 8 Canadian Patient Experiences Survey Inpatient Care: A Focus on Pilot Results... 8 Wait Times for Priority Procedures A Summary, 2016 and 2017... 8 Quality and safety... 9 Ambulance Use in Time-Sensitive Conditions... 9 Appropriateness of Hysterectomy in Canada... 9 Cardiac Care Quality... 9 High Users of Hospital Beds... 9 Hospital Harm... 9 Hospitalized Surgical Site Infections...10 Mortality in Canadian Intensive Care Units...10 Primary Health Care in Canada: Selected Pan-Canadian Indicators...10 Rates of In-Hospital Specific Infections...10 Value for money... 10 Cost of a Standard Resident Day in Long-Term Care...10
Health Human Resources Expenditure in Canada...10 Improving Health System Efficiency in Canada: Perspectives of Decision-Makers...11 Indicator Variability: Cost of a Standard Hospital Stay...11 Measuring Efficiency of Inpatient Acute Care in Canada...11 Staff-to-Patient Ratio...11 Supporting Choosing Wisely Canada: Appropriateness of Tests, Treatments and Procedures in Canada...11 Use Pattern of High Users in Acute Care...12 International... 12 An International Study: Examining Canada s Relative Performance on Mortality Outcomes...12 How Canada Compares: Results From The Commonwealth Fund International Health Policy Survey, 2016 Focus on the General Population...12 International Comparisons: Benchmarking Canada s Health System, 2017...12 Annex... 13 4
Introduction The analytical products and indicators produced by the Canadian Institute for Health Information (CIHI) aim to inform the public, enlighten policy decisions and answer the most critical questions of health system managers, clinicians and other health stakeholders. The purpose of the corporate Analytical Plan is to provide a consolidated view of CIHI s analytical activities to ensure that they are Aligned with CIHI s strategic directions and priorities; Relevant to stakeholder needs; and Transparent for our partners, to help identify opportunities for collaboration and avoid duplication. The plan builds on consultations regarding the information needs of CIHI s priority audiences, including policy-makers and health system managers. It presents a rolling picture of CIHI s new analytical projects, including new indicators and analytical reports, over 2 years. Under the leadership of senior staff from across the organization, with expert external guidance from the Strategic Analytical Advisory Committee, CIHI s analytical planning process strives to identify relevant, appropriate and actionable analyses, while optimizing the efficient use of resources. This process has produced a number of collaborative projects, including partnerships with Statistics Canada, the Canadian Partnership Against Cancer, the Canadian Patient Safety Institute, Accreditation Canada, the Public Health Agency of Canada and provincial health quality councils. Categorized by priority theme areas defined in CIHI s multi-year business plan, this document provides brief descriptions of projects envisaged for 2016 2017 and 2017 2018. This is a draft of CIHI s Analytical Plan as of March 9, 2016. Actual names, release dates and products may change during development. The plan is updated twice a year, and the latest version can be found on CIHI s website (www.cihi.ca). If you have any suggestions for CIHI s Analytical Plan or would like more information, please send an email to analyticalplan@cihi.ca. Icon legend Priority population themes Children and youth First Nations, Inuit and Métis Mental health and addictions Seniors and aging Health system performance themes Outcomes Patient experience Quality and safety Value for money New Indicator 5
Priority population projects Children and youth Pediatric High Users of Hospital Beds CIHI will develop an indicator to address the unique aspects of the pediatric population (patients younger than 18) who are high users of hospital beds. This project complements its adult counterpart of high users of hospital beds. Mental health and addictions Alcohol-Attributable Hospitalizations This indicator will measure the number of hospitalizations attributable to alcohol in a way that is comparable across Canada. Indicator results will be complemented with a summary and comparison of current alcohol control policies and programs across provinces. This project will inform discussions on the effectiveness of current alcohol policy and prevention strategies. Hospitalizations and Emergency Department Visits Due to Opioid Poisoning The number of opioid prescriptions has tripled in Canada over the past decade, but few studies have investigated the impact on health care resources. This report will identify the number of emergency department visits and hospitalizations due to opioid poisoning, including provincial/territorial trends and a description of patient demographics and clinical characteristics. Reporting Mental Health Performance Across Canadian Provinces Working with researchers and clinicians from 5 provinces and the Canadian Association for Mental Illness and Mental Health (CAMIMH), CIHI is participating in the development of a set of mental health indicators for comparative reporting on performance. 6
Seniors and aging Dementia: Patients, Caregivers and the Health System Canada is the only G8 country without a national dementia strategy in place. This study a first step in performance reporting for dementia care in Canada will provide baseline measures, profile patients with dementia and their caregivers, and explore the extent of support received from the health system. Do Not Hospitalize and Do Not Resuscitate Reporting in Long-Term Care Advance care planning has been associated with improved patient experiences and lower-cost medical care. This analysis will explore the extent to which do not hospitalize and do not resuscitate directives are in place within Canada s continuing care setting and whether they are being upheld. Examining Characteristics of High Users of Health Care for Persons With Chronic Obstructive Pulmonary Disease This study will describe the characteristics and health care utilization patterns of chronic obstructive pulmonary disease (COPD) patients in Alberta across sectors of care. A key objective is differentiating high users of acute care services from non-high users in order to inform strategies to reduce potentially avoidable acute care use. Promoting Independence: Improving Physical Functioning in Residential Care This project will explore CIHI s Continuing Care Reporting System to evaluate the factors associated with improving or maintaining physical functioning among seniors in residential care. The results of this analysis will lead to improvements in residents quality of life. Health system planners may target scarce resources to where they will have the biggest impact. Seniors in Transition: Factors Associated With Placement in Home Care and Residential Care There is international concern regarding the anticipated demand for health and social services from a growing senior population. This study provides a description of the trajectory of seniors as they move through the health system, with a focus on the factors that influence care paths. 7
Health system performance projects Outcomes Patients With End-Stage Kidney Disease on Dialysis and Hospitalizations: Associated Risks, Outcomes and Costs This study will use pan-canadian data to look at the risks of hospitalization for end-stage kidney disease patients on dialysis; the factors affecting these risks; the effect of these hospitalizations on outcomes for dialysis patients; and the associated costs to the health care system. Patient experience Access to Specialist Services in Canada: Wait 1 for Selected Priority Procedures Currently, CIHI measures wait times for priority procedures as the time between the decision for surgery and the surgery itself (termed wait 2 ). However, the wait time between the primary care physician s referral and the first specialist consultation (termed wait 1 ) also has important patient and health system implications. This project aims to fill this gap by examining wait 1 for priority surgical procedures using patient-level billing data. Canadian Patient Experiences Survey Inpatient Care: A Focus on Pilot Results Using an evidence-based approach and extensive national consultation, this first-ever pan- Canadian patient experience survey will allow for comparable measurement of patient experiences in hospital settings to inform care improvements. This journal article will summarize the rigorous approach in developing the Canadian Patient Experiences Survey Inpatient Care and highlight pilot test results. Wait Times for Priority Procedures A Summary, 2016 and 2017 and 2017 2018 This report will provide a snapshot of how long patients wait for a priority procedure and the proportion of patients who receive care within benchmarks for hip/knee replacements, hip fracture repair, cataract surgery, coronary artery bypass graft, radiation therapy, MRI scans and CT scans. The 2017 report will include new wait time measures for intravenous chemotherapy. 8
Quality and safety Ambulance Use in Time-Sensitive Conditions Patients with signs of stroke or acute myocardial infarction (AMI) should call an ambulance immediately. This allows paramedics to begin early treatment and inform the hospital so staff can prepare for immediate care. This analysis aims to illustrate the proportion of individuals with AMI and stroke symptoms who don t use an ambulance to get to the hospital, as well as predictors of ambulance use. Appropriateness of Hysterectomy in Canada Canada has one of the highest rates of hysterectomy among developed countries. This study will provide an updated and more detailed look at hysterectomy rates, consider factors associated with jurisdictional variation, and look at the frequency and efficiency of minimally invasive versus open techniques. Adherence to best practices will be assessed where possible. Cardiac Care Quality This suite of indicators will measure complication and mortality following selected cardiac procedures/interventions in cardiac centres. The indicators are designed to monitor quality of cardiac care over time and to improve care by learning from the best. High Users of Hospital Beds This indicator provides a pan-canadian perspective of high users of acute care services from both an effectiveness (repeat hospitalizations) and efficiency (cumulative length of stay) lens. Understanding this patient population will help with the design of initiatives and programs aimed at reducing high use of hospital services. Hospital Harm This patient safety indicator will include inpatient harmful events that can be potentially prevented by implementing known best practices. As a first deliverable, a report (fall 2016) will provide an overview of the status of these patient safety events in Canada; other deliverables planned for later releases include a facility-level patient safety indicator to help monitor variations over time and an Improvement Resource online tool (led by the Canadian Patient Safety Institute) to provide evidence-informed resources to support patient safety improvement efforts. 9
Hospitalized Surgical Site Infections This patient safety indicator will measure surgical site infection (SSI) rates among hospitalized patients at the facility level. SSIs can often be prevented by following pre- and post-operative wound care treatment best practices. Mortality in Canadian Intensive Care Units Early intensive care unit (ICU) readmission, which is used as a measure of intensive care quality in many countries, is associated with poorer patient outcomes, such as longer lengths of stay in the ICU and higher mortality risk. This study will analyze the prevalence of and factors related to ICU readmissions across Canada. Utilization rates and variations in ICU measures at facility, regional and provincial levels will be included where appropriate. Primary Health Care in Canada: Selected Pan-Canadian Indicators Based on the 2012 Pan-Canadian Primary Health Care Indicator Update Report, this chartbook profiles a selected group of PHC indicators using a range of data sources. It aims to provide an integrated view of PHC information in Canada. Rates of In-Hospital Specific Infections New indicators will measure the rate of challenging infections caused by 3 major pathogens: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and Clostridium difficile (C. difficile). These infections are often associated with longer patient lengths of stay, higher mortality rates and increasing health care costs. Value for money Cost of a Standard Resident Day in Long-Term Care This indicator will use CIHI s financial and clinical data to measure the cost of a standard resident day in long-term care (LTC). It will support more effective budgeting and planning for LTC. Health Human Resources Expenditure in Canada This study will provide a 10-year retrospective analysis estimating expenditures on health human resources (HHR) in Canada. It will compare workforce composition and spending trends of registered nurses and physicians in hospital and long-term care sectors. 10
Improving Health System Efficiency in Canada: Perspectives of Decision-Makers This project will examine in greater depth the populations, system characteristics and mechanisms that help to explain why some regions in Canada have achieved a higher level of efficiency relative to others. This case study research focuses on 2 provinces British Columbia and Nova Scotia and uses qualitative methods. Indicator Variability: Cost of a Standard Hospital Stay This analysis will look to explain the observed variation in the Cost of a Standard Hospital Stay (CSHS) indicator, including between Canadian hospitals and across years within hospitals. It will analyze the impact of various factors, including size, teaching status and location. Key drivers of CSHS within a hospital s control will be identified. Measuring Efficiency of Inpatient Acute Care in Canada The purpose of this project is to measure how efficiency of inpatient acute care at the hospital level accounts for quality of care as a component of efficiency, and to examine factors associated with efficiency. Staff-to-Patient Ratio The aim of this project is to develop Canada s first comparable measure of staff-to-patient ratios (i.e., the number of patients cared for by staff). This indicator can be used to inform staffing decisions and to examine relationships with patient outcomes, safety, quality of care and the health of staff. Supporting Choosing Wisely Canada: Appropriateness of Tests, Treatments and Procedures in Canada The purpose of the Choosing Wisely campaign is to start a conversation about potentially unnecessary tests, treatments and procedures. CIHI is partnering with Choosing Wisely Canada to provide information about a shortlist of 5 to 10 tests and treatments identified as having low value for patients when used in certain situations. 11
Use Pattern of High Users in Acute Care Building on CIHI s High Users of Hospital Beds indicator, this project examines trends of high users of hospital beds over several years. It is suspected that persistent high users (high users for several years) are different from episodic high users (one-time high users) in their diagnosis, age, rurality and emergency department use, among other factors. Understanding these differences will help prioritize initiatives to address high users needs. International An International Study: Examining Canada s Relative Performance on Mortality Outcomes Over the last several decades, Canada has fallen on Organisation for Economic Co-operation and Development (OECD) rankings of population-level mortality outcomes. This analysis will unpack what Canada s fall through the ranks really means for the measure of potential years of life lost. The report will determine whether Canada s performance on this measure is actually getting worse and what s at the heart of Canada s relative performance in terms of burden of disease. How Canada Compares: Results From The Commonwealth Fund International Health Policy Survey, 2016 Focus on the General Population The Commonwealth Fund 2016 International Health Policy Survey will focus on the health care experiences of the general adult population (age 18 and older) in 11 countries, including Canada. This companion report will offer a closer look at the Canadian story, including provincial breakdowns and changes over time where possible, and show how Canadian experiences with health care compare internationally. International Comparisons: Benchmarking Canada s Health System, 2017 This report will examine how Canada and the provinces compare with other countries in the OECD on health status, non-medical determinants of health, and quality of and access to care. 12
Annex Annual reports, indicators and data releases In addition to the new projects listed in this plan, CIHI also publicly releases updates of the following reports and indicators on a yearly or other regular basis: Types of care Breast Cancer Mastectomy Rates and Prostate Cancer Prostatectomy Rates Quick Stats Canadian Organ Replacement Register (CORR): Treatment of End-Stage Organ Failure in Canada Annual report and Quick Stats Cardiac Rate Book Quick Stats Continuing Care Reporting System (CCRS) Quick Stats Dental Caries in Children Quick Stats Emergency Department Visits in Canada Quick Stats Hip and Knee Replacements in Canada: Canadian Joint Replacement Registry (CJRR) Annual report and Quick Stats Home Care Reporting System (HCRS) Quick Stats Hospital Mental Health Database (HMHDB) Quick Stats Hospitalization and Childbirth in Canada Quick Stats Induced Abortions Reported in Canada Quick Stats Injury and Trauma Hospitalization and Emergency Department Visits Quick Stats National Rehabilitation Reporting System (NRS) Quick Stats Health system performance Health Indicators e-publication International Comparisons: Benchmarking Canada s Health System, 2017 etool Organisation for Economic Co-operation and Development (OECD) Health Data Wait Times for Priority Procedures in Canada Interactive web tool Your Health System: In Brief Interactive web tool for the general public Your Health System: In Depth Interactive web tool for health regions and acute care and long-term care facilities 13
Health workforce and spending Health Human Resources in Canada Data tables Hospital Financial and Statistical Information (Canadian MIS Database) Quick Stats National Health Expenditure Trends Annual report and Quick Stats Prescribed Drug Spending in Canada Annual report Physicians in Canada Annual report and Quick Stats Regulated Nurses in Canada Annual report and Quick Stats 14
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