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Description
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This indicator measures the age-standardized rate of coronary artery bypass graft (CABG) surgery performed on inpatients in acute care hospitals or percutaneous coronary interventions (PCIs) performed on patients in acute care hospitals, same-day surgery facilities or catheterization laboratories, per 100,000 population age 18 and older.

For further details, please see the General Methodology Notes.

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Calculation: Description
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(Total number of discharges for CABG or PCI for patients age 18 and older ÷ total mid-year population age 18 and older) × 100,000 (age adjusted)

Unit of Analysis: Single admission

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Calculation: Geographic Assignment
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Place of residence

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Calculation: Type of Measurement
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Rate - Per 100,000

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Calculation: Adjustment Applied
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Age-adjusted

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Calculation: Method of Adjustment
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Direct Standardization
Standard Population:
Canada 2011

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Denominator
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Description:
Total mid-year population age 18 and older

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Numerator
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Description:
Total number of discharges for CABG or PCI for patients age 18 and older

Inclusions:
1. Cardiac revascularization is identified as the following procedure code recorded in any position of the procedure code fields:

CCP: 48.1^, 48.02 or 48.03

CCI: IJ.76^, 1.IJ.50^ or 1.IJ.57.GQ^^. 1.IJ.54.GQ-AZ (this code is used for 2006–2007 to 2008–2009 only)

2. Age at admission 18 years and older

3. Sex recorded as male or female

4. Admission to an acute care institution or same-day surgery facility (instype Facility Type Code = 1 or A)

5. Canadian resident (Canadian postal code)
Exclusions:
1. Newborn, stillbirth or cadaveric donor records (Admission Category = N, R or S)

2. PCI/CABG can be performed in designated cardiac centres only; therefore, procedures reported by facilities without on-site PCI/CABG services were excluded from the indicator calculation.

3. Procedures coded as out of hospital and abandoned after onset (Intervention Status Attribute = A or OOH Indicator Flag = Y)

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Rationale
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The choice of revascularization mode (PCI or CABG) depends on numerous factors, including physician preferences, availability of services and referral patterns, as well as differences in population health and socio-economic status. The combined cardiac revascularization rate represents total cardiac revascularization activity in a jurisdiction.

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Interpretation
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Does not apply to this measure (i.e., there is no predefined preference for the measure score)

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HSP Framework Dimension
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Health System Inputs and Characteristics: Health system resources

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Areas of Need
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Not applicable

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Targets/Benchmarks
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Benchmarks have not been identified for this indicator.

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References
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Cardiac Care Network of Ontario Consensus Panel on Target Setting. Final Report and Recommendations. Toronto, Ont.: CCN, 2004. Accessed from <http://www.ccn.on.ca/ccn_public/UploadFiles/files/Cons_Panel_Target_Setting_FRR.pdf>.

Faris, P. D. et al. "Diagnostic Cardiac Catheterization and Revascularization Rates for Coronary Heart Disease." Canadian Journal of Cardiology 20 (2004): pp. 391-397.

Institute for Clinical Evaluative Sciences. Cardiovascular Health and Services in Ontario. Toronto, Ont.: ICES, 1999.

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Data Sources
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DAD, NACRS

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Available Data Years
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Type of Year:
Fiscal
First Available Year:
2006 2010
Last Available Year:
2014 2016

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Geographic Coverage
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All provinces/territories except Quebec

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Reporting Level/Disaggregation
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National, Province/Territory, Region

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Caveats and Limitations
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Some of the Rates for Quebec are not available due to differences in data collection.

Some residents in New Brunswick's Brunswick’s Zone 4 and Zone 5 receive CABG cardiac procedures in Quebec (there is under a referral agreement between Quebec and New Brunswick)the 2 provinces. Due to differences in data collection in MED-ECHO data, with or without Quebec data, we can not assign these patients to the regionsQuebec, data for New Brunswick residents undergoing PCI in Quebec is not available; thus the CABG rates for these 2 regions will be suppressed until they stop referring their patients to Quebecare suppressed.

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Trending Issues
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This data was not produced for fiscal year 2012–2013.Not applicable

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Comments
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Cardiac revascularization procedures can be performed in designated cardiac centres only; therefore, procedures reported by facilities without on-site cardiac services were excluded from the indicator calculation.

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