Name | 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 |
Interpretation | Lower rates are desirable. |
HSP Framework Dimension |
Health System Outputs: Appropriate and effective |
Areas of Need |
Living With Illness, Disability or Reduced Function |
Geographic Coverage |
All provinces/territories |
Reporting Level/Disaggregation |
National, Province/Territory, Region |
Latest Result Update Date |
11/2013 |
Indicator Results |
http://ourhealthsystem.ca/#!/indicators/007/repeat-hospital-stays-for-mental-illness |
Identifying Information | |
Name | Patients With Repeat Hospitalizations for Mental Illness |
Short/Other Names |
Repeat Hospital Stays 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 |
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: |
Calculation: Method of Adjustment |
Logistic regression |
Denominator |
Description: 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, 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. Age at admission: 15 years or older 4. Sex recorded as male or female 5. Admission to a general hospital 6. Canadian resident 2. Records with an invalid date of birth 3. Records with an invalid admission date 4. Records with an invalid discharge date 5. Discharged as a death |
Numerator |
Description: 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: Appropriate and effective |
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, MED-ÉCHO, NACRS, OMHRS |
Available Data Years |
Type of Year: |
Geographic Coverage |
All provinces/territories |
Reporting Level/Disaggregation |
National, Province/Territory, Region |
Result Updates | |
Update Frequency |
Every year |
Latest Result Update Date |
11/2013 |
Indicator Results |
Web Tool: |
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 |
Not Applicable |