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.

Health System Outputs: Appropriate and effective

Living With Illness, Disability or Reduced Function

All provinces/territories

National, Province/Territory, Region

11/2013

http://ourhealthsystem.ca/#!/indicators/007/repeat-hospital-stays-for-mental-illness

Repeat Hospital Stays for Mental Illness

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.

(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.

Place of residence

Percentage or proportion

The following covariates are used in risk adjustment:
Age, sex, discharge against medical advice and type of mental illness (mood disorder, substance abuse–related disorder, schizophrenia, personality disorder)

Logistic regression

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, 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
Exclusions:
1. Records with an invalid health card number

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

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.

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.

Lower rates are desirable.

Health System Outputs: Appropriate and effective

Living With Illness, Disability or Reduced Function

Not Applicable

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.

DAD, MED-ÉCHO, NACRS, OMHRS

Type of Year:
Fiscal
First Available Year:
2008
Last Available Year:
Ongoing

All provinces/territories

National, Province/Territory, Region

Every year

11/2013

Web Tool:
ourhealthsystem.ca
URL: http://ourhealthsystem.ca/#!/indicators/007/repeat-hospital-stays-for-mental-illness

Not Applicable

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.

Not Applicable

Not Applicable