Indicator Metadata

Name30-Day Stroke In-Hospital Mortality
Short/Other Names

Not applicable

Description

The risk-adjusted rate of all-cause in-hospital death occurring within 30 days of first discharge from an acute care hospital with a diagnosis of stroke

For further details, please see the General Methodology Notes.

Interpretation

Lower rates are desirable.

Inter-regional variations in stroke mortality rates may be due to jurisdictional and institutional differences in standards of care, as well as to other factors that are not included in the adjustment.

HSP Framework Dimension

Health System Outputs: Appropriate and effective

Areas of Need

Getting Better

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region

Indicator Results

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

Identifying Information
Name30-Day Stroke In-Hospital Mortality
Short/Other Names

Not applicable

Indicator Description and Calculation
Description

The risk-adjusted rate of all-cause in-hospital death occurring within 30 days of first discharge from an acute care hospital with a diagnosis of stroke

For further details, please see the General Methodology Notes.

Calculation: Description

The risk-adjusted mortality rate (RAMR) is calculated by dividing the observed number of in-hospital deaths by the expected number of in-hospital deaths and multiplying by the Canadian average in-hospital death rate.

Unit of Analysis for Denominator Cases: Single admission

Calculation: Geographic Assignment

Place of residence or service

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:
Total number of first stroke discharges in an 11-month period
Inclusions:
1. a. Stroke (per codes specified below) is coded as most responsible diagnosis (MRDx) but not also as a diagnosis type (2); or

b. Where another diagnosis is coded as MRDx and also a diagnosis type (2), and a diagnosis of stroke is coded as a type (1) [type (C) for Quebec data] or type (W), (X) or (Y) but not also as type (2); or

c. Where rehabilitation or convalescence (ICD-10-CA: Z50.1, Z50.5–Z50.9, Z54.8, Z54.9) is coded as MRDx and stroke as a type (1) [type (C) for Quebec data] or type (W), (X) or (Y) but not also as type (2)

Stroke diagnosis codes:

  • Subarachnoid haemorrhage (ICD-10-CA: I60)
  • Intracerebral haemorrhage (ICD-10-CA: I61, I62.9 [for data years prior to 2015–2016*])
  • Ischemic stroke (ICD-10-CA: I63.0-I63.5, I63.8, I63.9, H34.1)
  • Stroke, not specified as haemorrhage or infarction (ICD-10-CA: I64)
  • Venous sinus/cortical vein thrombosis (ICD-10-CA: I63.6, I67.6, G08)

*I62.9 was used for coding of hemorrhagic stroke not otherwise specified in fiscal years prior to 2015–2016. As of 2015–2016 data, this condition is coded to I61.9 (Intracerebral haemorrhage, unspecified).
Note: Transient ischemic attacks are not included in this indicator.

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

3. Age at admission 20 years and older

4. Sex recorded as male or female

5. Admission to an acute care institution (Facility Type Code = 1)

6. Admission category recorded as urgent/emergent (Admission Category Code = U)

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 admission category of cadaveric donor or stillbirth (Admission Category Code = R or S)

5. Previous stroke: Records with a stroke inpatient admission (stroke diagnosis codes as specified above) coded as diagnosis type (M), (1), (C) [for Quebec data only], (2), (W), (X) or (Y), and Facility Type Code = 1, within one year prior to the admission date of the index discharge

Numerator

Description:
Number of deaths from all causes occurring in hospital within 30 days of admission for stroke
Inclusions:
1. Discharge as death (Discharge Disposition Code = 07)

2. Admission to an acute care institution (Facility Type Code = 1)

3. (Discharge date on death record) − (Admission date on stroke record) less than or equal to 30 days

Exclusions:
1. Records with an invalid discharge date

Background, Interpretation and Benchmarks
Rationale

Stroke is a leading cause of death and long-term disability. Adjusted mortality rates following stroke may reflect the underlying effectiveness of treatment and quality of care.

Interpretation

Lower rates are desirable.

Inter-regional variations in stroke mortality rates may be due to jurisdictional and institutional differences in standards of care, as well as to other factors that are not included in the adjustment.

HSP Framework Dimension

Health System Outputs: Appropriate and effective

Areas of Need

Getting Better

Targets/Benchmarks

Not applicable

References

Hosmer DW, Lemeshow S. Confidence Interval Estimates of an Index of Quality Performance Based on Logistic Regression Models. Stat Med 1995(14): 2161-2172.

Mayo NE, Goldberg MS, Levy AR, et al. Changing Rates of Stroke in the Province of Quebec, Canada: 1981-1988. Stroke 1991;22(5): 590-595.

Mayo NE, Neville D, Kirkland S, et al. Hospitalization and Case-Fatality Rates for Stroke in Canada From 1982 Through 1991. The Canadian Collaborative Study Group of Stroke Hospitalizations. Stroke 1996(27): 1215-1220.

Weir N, Dennis MS. Towards a National System for Monitoring the Quality of Hospital-Based Stroke Services. Stroke 2001(32): 1415-1421.

Availability of Data Sources and Results
Data Sources

DAD, HMDB

Available Data Years

Type of Year:
Fiscal
First Available Year:
1998
Last Available Year:
2014

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region

Result Updates
Update Frequency

Every year

Indicator Results

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

Updates

Beginning with rates based on 2003–2004 to 2005–2006 data, case selection criteria for stroke were revised to include patients transferred to rehabilitation during their index admission. In this case, stroke may not be coded as the most responsible diagnosis; these cases were previously excluded from the indicator.

Quality Statement
Caveats and Limitations

Not applicable

Trending Issues

Beginning with 2004 rates, stroke case selection criteria were revised; therefore, comparison of rates from 2004 onward with those of previous years should be made with caution.

Comments

Indicator results by place of residence are based on three years of pooled data. The reference year reflects the mid-point of a three-year period.

The indicator excludes stroke cases coded with a most responsible diagnosis of palliative care (ICD-10-CA Z51.5). It is not possible to determine when during the admission it was decided to provide palliative care.

Indicator results by place of service, based on one year of data, are also available
– In the Data Preview for Indicators tool (https://www.cihi.ca/en/secure/health-system-performance/your-health-system-tools/data-preview-for-indicators)
– By request