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Indicator Metadata

Name30-Day Readmission for Mood Disorders
Short/Other Names

Not applicable

Description

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

Note
*The mental illnesses selected for this indicator are substance-related disorders, schizophrenic and psychotic disorders, mood disorders, anxiety disorders, personality disorders and other disorders.

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

https://www.cihi.ca/sites/default/files/document/hmhdb-qs-preformatted-201617-en.xlsx

Identifying Information
Name30-Day Readmission for Mood Disorders
Short/Other Names

Not applicable

Indicator Description and Calculation
Description

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

Note
*The mental illnesses selected for this indicator are substance-related disorders, schizophrenic and psychotic disorders, mood disorders, anxiety disorders, personality disorders and other disorders.

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 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 or psychiatric hospital or day surgery facility occurs on the same day as discharge from another general or psychiatric 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:
Sex, age, multiple previous admissions for a selected mental illness (2 and more) during the past 12 months, discharged against medical advice and hospital type

Calculation: Method of Adjustment

Logistic regression

Denominator

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

– For diagnosis codes for mood disorders, please refer to the Diagnosis codes tab in the HMHDB 2016–2017 Data Dictionary.

2. Discharge is 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)

3. Sex is recorded as male or female

4. Admission is to a general or psychiatric hospital (Facility Type Code = 1, 5)

Note
HMHDB: Hospital Mental Health Database.

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 or 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)

Notes
DAD: Discharge Abstract Database.
NACRS: National Ambulatory Care Reporting System.
OMHRS: Ontario Mental Health Reporting System.

Numerator

Description:
Cases within the denominator with a readmission for a selected 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 2 following conditions are met:

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

b. A diagnosis of a selected mental illness was recorded as the most responsible diagnosis. Selected mental illnesses are substance-related disorders, schizophrenic and psychotic disorders, mood disorders, anxiety disorders, personality disorders and other disorders. For inclusion criteria and diagnosis codes for the 6 selected mental illnesses, please refer to the Diagnosis codes tab in the HMHDB 2016–2017 Data Dictionary.

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 mood disorder 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. Discharge planning, continuity of services after discharge and availability of community services and supports are factors that are expected to influence readmission rates.

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

Agency for Healthcare Research and Quality. Hospital Readmissions Involving Psychiatric Disorders, 2012. May 2015.

Hermann R, Mattke S. Selecting Indicators for the Quality of Mental Health Care at the Health System Level in OECD Countries. 2004.

Leslie DL, Rosenheck RA. Comparing quality of mental health care for public-sector and privately insured populations. Psychiatric Services. 2000.

Lin E, Durbin J, Zaslavska M, et al. Hospital Report 2007: Mental Health. 2008

Availability of Data Sources and Results
Data Sources

DAD, HMDB, NACRS, OMHRS

Available Data Years

Type of Year:
Fiscal
First Available Year:
2015
Last Available Year:
2016

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
Quick Stats
URL: https://www.cihi.ca/sites/default/files/document/hmhdb-qs-preformatted-201617-en.xlsx

Updates

Not applicable

Quality Statement
Caveats and Limitations

A patient may have had additional inpatient hospitalizations in psychiatric hospitals that are excluded from the methodology. Potentially, these could be contiguous with hospitalizations in general hospitals that are included in the methodology. Episode building was based only on episodes in general hospitals.

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.