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Indicator Metadata

NameRepeat Hospital Stays for Mental Illness
Short/Other Names

Patients With Repeat Hospitalizations for Mental Illness

Description

Risk-adjusted percentage of individuals who had three or more episodes of care for a selected mental illness* among all those who had at least one episode of care for a selected mental illness in general hospitals within a given year.

An episode of care refers to all contiguous hospitalizations and same-day surgery visits in general hospitals.

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

Indicator Results

Accessing Indicator Results on Your Health System: In Depth

Identifying Information
NameRepeat Hospital Stays for Mental Illness
Short/Other Names

Patients With Repeat Hospitalizations for Mental Illness

Indicator Description and Calculation
Description

Risk-adjusted percentage of individuals who had three or more episodes of care for a selected mental illness* among all those who had at least one episode of care for a selected mental illness in general hospitals within a given year.

An episode of care refers to all contiguous hospitalizations and same-day surgery visits in general hospitals.

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

(Total number of individuals who had at least three episodes of care for a selected mental illness in a one-year period ÷ Total number of individuals who had at least one episode of care for a selected mental illness in a one-year period) × 100

The risk-adjusted percentage for each region was calculated by dividing the observed number of repeat hospitalizations in each region by the expected number of repeat hospitalizations in the region and multiplying by the Canadian average repeat hospitalizations percentage.

Calculation: Geographic Assignment

Place of residence

Calculation: Type of Measurement

Percentage or proportion

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 individuals who had at least one episode of care for a selected mental illness in a one-year period
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:
Total number of individuals who had at least three episodes of care for a selected mental illness in a one-year period. After the first episode of care, all individuals have one year of follow-up; the second and other subsequent episodes of care are identified within a year of discharge of the first episode of care. Therefore, two fiscal years are necessary to obtain the data for the numerator.

An episode of care for a mental illness is identified using the same inclusion and exclusion criteria as for the denominator.

Background, Interpretation and Benchmarks
Rationale

This indicator is considered an indirect measure of appropriateness of care, since the need for frequent admission to hospital depends on the person and the type of illness.

Challenges in getting appropriate care/support in the community and/or the appropriate medication often lead to frequent hospitalizations.

Variations in this indicator across jurisdictions may reflect differences in the services that help individuals with mental illness remain in the community for a longer period of time without the need for hospitalization.

This indicator may help to identify a population of frequent users; further investigation could provide a description of the characteristics of this group. Understanding this population can aid in developing/enhancing programs that may prevent the need for frequent rehospitalization.

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

Lin E, Durbin J, Zaslavska N, et al. Hospital Report 2007: Mental Health; Briefing Pages. 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:
2011
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:
Your Health System: In Depth
URL:
Accessing Indicator Results on Your Health System: In Depth

Updates

Not applicable

Quality Statement
Caveats and Limitations

Each individual has a 12-month follow-up after his or her first episode of care in a given year. Repeat hospitalizations over a 12-month period can occur at more than one facility.

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 repeat hospitalizations, 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

Indicator results are also available in

–The Health Indicators e-publication (http://yourhealthsystem.cihi.ca/epub/?language=en); data is updated annually starting from 2008–2009

–Your Health System: In Brief (http://yourhealthsystem.cihi.ca/inbrief/?lang=en#!/indicators/007/repeat-hospital-stays-for-mental-illness)