Indicator Metadata

Name30-Day Readmission for Mental Illness
Short/Other Names

Not applicable

Description

The indicator measures the risk-adjusted rate of readmission following discharge for a mental illness.*

Note
*The mental illnesses selected for this indicator are substance-related disorders; schizophrenia, delusional and non-organic psychotic disorders; mood/affective disorders; anxiety disorders; and selected disorders of adult personality and behaviour.

For further details, please see the General Methodology Notes.

InterpretationLower rates are desirable.
HSP Framework Dimension

Health System Outputs: Person-centred

Areas of Need

Living With Illness, Disability or Reduced Function

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region, Neighbourhood Income Quintile

Indicator Results

http://yourhealthsystem.cihi.ca/epub/?language=en

Identifying Information
Name30-Day Readmission for Mental Illness
Short/Other Names

Not applicable

Indicator Description and Calculation
Description

The indicator measures the risk-adjusted rate of readmission following discharge for a mental illness.*

Note
*The mental illnesses selected for this indicator are substance-related disorders; schizophrenia, delusional and non-organic psychotic disorders; mood/affective disorders; anxiety disorders; and selected disorders of adult personality and behaviour.

For further details, please see the General Methodology Notes.

Calculation: Description

Risk-adjusted rate for each region = Observed number of readmissions in each region ÷ Expected number of readmissions in the region × Canadian average readmission rate

Unit of Analysis: Episode of care

An episode of care refers to all contiguous inpatient hospitalizations in general hospitals (excluding free-standing psychiatric facilities) and all day surgery visits regardless of diagnoses. To construct an episode of care, a transfer is assumed to have occurred if the following condition is met:

– Admission to a general hospital/day surgery facility occurs on the same day as discharge from another general hospital

Calculation: Geographic Assignment

Place of residence

Calculation: Type of Measurement

Rate - per 100

Calculation: Adjustment Applied

The following covariates are used in risk adjustment:
For a detailed list of covariates used in the model, please refer to the Model Specification document.

Calculation: Method of Adjustment

Logistic regression

Denominator

Description:
Number of episodes of care for selected mental illness discharged between April 1 and March 1 of the fiscal year
Inclusions:
1. A selected mental illness is coded as the most responsible diagnosis (MRDx)

2. Diagnosis codes for selected mental illness:

a. Substance-related disorders: ICD-10-CA: F55, F10 to F19; DSM-IV: 291.x (0, 1, 2, 3, 5, 81, 89, 9), 292.0, 292.11, 292.12, 292.81, 292.82, 292.83, 292.84, 292.89, 292.9, 303.xx (00, 90), 304.xx (00, 10, 20, 30, 40, 50, 60, 80, 90), 305.xx (00, 10 to 90 excluding 80); Provisional diagnosis: (d) substance-related disorder; or

b. Schizophrenia, delusional and non-organic psychotic disorders: ICD-10-CA: F20 (excluding F20.4), F22, F23, F24, F25, F28, F29, F53.1; DSM-IV: 295.xx (10, 20, 30, 40, 60, 70, 80, 90), 297.1, 297.3, 298.8, 298.9; Provisional diagnosis: (e) schizophrenia disorder; or

c. Mood/affective disorders: ICD-10-CA: F30, F31, F32, F33, F34, F38, F39, F53.0; DSM-IV: 296.0x, 296.2x, 296.3x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90, 300.4, 301.13; Provisional diagnosis: (f) mood disorders; or

d. Anxiety disorders: ICD-10-CA: F40, F41, F42, F43, F48.8, F48.9, F93.8; DSM-IV: 300.xx (00, 01, 02, 21, 22, 23, 29), 300.3, 308.3, 309.x (0, 3, 4, 9), 309.24, 309.28, 309.81; Provisional diagnosis: (g) anxiety disorders or (o) adjustment disorders; or

e. Selected disorders of adult personality and behaviour: ICD-10-CA: F60, F61, F62, F68, F69, F21; DSM-IV: 301.0, 300.16, 300.19, 301.20, 301.22, 301.4, 301.50, 301.6, 301.7, 301.81, 301.82, 301.83, 301.9; Provisional diagnosis: (p) personality disorders.

3. Discharges between April 1 and March 1 of the following year (period of case selection ends on March 1 to allow for 30 days of follow-up)

4. Age at admission is 15 years or older

5. Sex recorded as male or female

6. Admission to a general hospital (Facility Type Code = 1)

Exclusions:
1. Records with an invalid health card number

2. Records with an invalid code for province issuing health card number

3. Records with an invalid admission date

4. Records with an invalid discharge date

5. Discharges as deaths (Discharge Disposition Code = 07 for DAD/NACRS records; Discharge Reason Code = 2 or 3 for OMHRS)

6. Cadaveric donor or stillbirth records (Admission Category Code = R or S)

7. Records that are dead on arrival (Discharge Disposition = 11 for NACRS)

Numerator

Description:
Cases within the denominator with a readmission for specific mental illness within 30 days of discharge after the index episode of care
Inclusions:
1. An episode of care is considered a readmission if the two following conditions are met:

a. It has occurred within 30 days of discharge of an index episode; and

b. A diagnosis of mental illness was recorded as the most responsible diagnosis (see Denominator for criteria to select diagnosis).

Background, Interpretation and Benchmarks
Rationale

Readmission to inpatient care may be an indicator of relapse or complications after an inpatient stay. Inpatient care for a person living with a mental illness aims to stabilize acute symptoms. Once stabilized, the individual is discharged, and subsequent care and support are ideally provided through outpatient and community programs in order to prevent relapse or complications. High rates of 30-day readmission could be interpreted as a direct outcome of poor coordination of services and/or an indirect outcome of poor continuity of services after discharge.

Interpretation

Lower rates are desirable.

HSP Framework Dimension

Health System Outputs: Person-centred

Areas of Need

Living With Illness, Disability or Reduced Function

Targets/Benchmarks

Not applicable

References

Canadian Institute for Health Information. Hospital Mental Health Services in Canada 2005-2006. Ottawa, ON: CIHI; 2008.

Hermann R, Mattke S. Selecting Indicators for the Quality of Mental Health Care at the Health System Level in OECD Countries (Paris, France: Organisation for Economic Co-operation and Development, 2004).

Leslie DL, Rosenheck RA. Comparing Quality of Mental Health Care for Public-Sector and Privately Insured Populations. Psych Serv 2000;(5):650-655.

Lin E, Durbin J, Zaslavska M, et al. Hospital Report 2007: Mental Health. Joint Initiative of the Ontario Hospital Association and the Government of Ontario. Toronto ON: HSPRN; 2008. <http://www.oha.com/KnowledgeCentre/Library/HospitalReports/Documents/Hospital%20Reports%202007/Mental%20Health.pdf>.

Availability of Data Sources and Results
Data Sources

DAD, HMDB, NACRS, OMHRS

Available Data Years

Type of Year:
Fiscal
First Available Year:
2009
Last Available Year:
2015

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region, Neighbourhood Income Quintile

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
Health Indicators E-publication
URL: http://yourhealthsystem.cihi.ca/epub/?language=en

Updates

Not applicable

Quality Statement
Caveats and Limitations

When building episodes of care, the exclusion of psychiatric hospitals might introduce a bias. It is possible that the wrong discharge date might be used to track readmissions, or that two hospitalizations that belong to the same episode might be erroneously attributed to two different episodes. Further analyses demonstrated that this bias is minimal and does not affect the indicator results.

Trending Issues

Not applicable

Comments

A 30-day readmission can occur in the same facility as the index episode or in a different facility. A readmission can be a planned or unplanned admission. Planned versus unplanned admissions cannot be distinguished in all available data sources. For jurisdictions where comprehensive information was available, rates including both planned and unplanned readmissions and only unplanned readmissions were compared, and they were not statistically significantly different. Published work has shown that few planned readmissions for mental illness within 30 days are scheduled by practitioners.