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Indicator Metadata

Name Hospital Stay Extended Until Home Care Services or Supports Ready
Short/Other Names

Hospital Stay Extended Until Home Care Services or Supports Ready

Description Median number of days patients remain in hospital when they no longer need that level of care, until home care services or supports are ready
Interpretation A low number is desirable for this indicator. It is also important to examine the number and percentage of cases with and without extended stays to support the interpretation of the indicator results.
HSP Framework Dimension

Health System Outputs: Access to comprehensive, high-quality health services

Areas of Need

Getting Better

Geographic Coverage

All provinces/territories except Quebec

Reporting Level/Disaggregation

National, Province/Territory

Indicator Results

https://yourhealthsystem.cihi.ca/hsp/inbrief?lang=en#!/indicators/079/hospital-stay-extended-until-home-care-services-or-supports-ready

Identifying Information
Name Hospital Stay Extended Until Home Care Services or Supports Ready
Short/Other Names

Hospital Stay Extended Until Home Care Services or Supports Ready

Indicator Description and Calculation
Description Median number of days patients remain in hospital when they no longer need that level of care, until home care services or supports are ready
Calculation: Description

Median (50th percentile) length of time, in days, a hospital stay is extended until home care services or supports are ready

Specifically, the indicator measures the median number of days patients spend in an inpatient acute care hospital bed when they don’t need acute care (also known as alternate level of care, or ALC) before they are discharged to home care.

Unit of analysis: Hospital discharge

Calculation: Geographic Assignment

Place of residence

Calculation: Type of Measurement

Number - Median, in days

Calculation: Adjustment Applied

None

Calculation: Method of Adjustment

Not applicable

Denominator

Description:
Not applicable

Numerator

Description:
Median length of time, in days, that patients spend in hospital as ALC before they are discharged to home care
Inclusions:
1. Records from acute care hospitals

2. Sex recorded as male or female

3. Records with a valid ALC length of stay greater than 0

4. Discharge disposition identified on the record as 04: Discharged to home or a home setting with support services

Exclusions:
1. Records with admission category of cadaveric donor or stillbirth (Admission Category Code = R or S)

2. Records with selected mental health diagnoses (i.e., most responsible diagnosis ICD-10-CA codes F10–F99). Selected jurisdictions submit mental health discharges to the Ontario Mental Health Reporting System (OMHRS) and are therefore not in the Discharge Abstract Database (DAD). In order to create a standard hospital population, discharges with mental health disorders (with the exception of organic — including symptomatic — mental health disorders, which includes dementia: ICD-10-CA codes F00–F09) were excluded from all provinces.

Background, Interpretation and Benchmarks
Rationale

Measuring the length of time a hospital stay is extended until home care services or supports are ready provides an indication of whether Canadians are getting timely access to home care when they no longer need inpatient acute care in a hospital.

A higher value may signal inadequate anticipation of needs, challenges in coordinating care, or lack of resources in the community to provide care at home. In some cases, it is possible that extended stays become longer when there are increased efforts to arrange home care services from hospital.

This indicator can also help to

  • Show where additional community and home supports could help to accelerate the discharge of patients and reduce the need for more expensive extended hospital services; and
  • Raise awareness of the importance of planning for the release of the patient as early as possible during the hospital stay to ensure that services are ready for patients at home.
Interpretation

A low number is desirable for this indicator. It is also important to examine the number and percentage of cases with and without extended stays to support the interpretation of the indicator results.

HSP Framework Dimension

Health System Outputs: Access to comprehensive, high-quality health services

Areas of Need

Getting Better

Targets/Benchmarks

Not applicable

References

1. Canadian Institute for Health Information. Inpatient Hospitalizations, Surgeries and Newborns Indicators, 2016–2017. Accessed July 23, 2018.

2. Canadian Institute for Health Information. Your Health System: In Depth — Technical Notes for Contextual Measures. Accessed October 5, 2018.

3. Canadian Institute for Health Information. Dementia in hospitals. Accessed October 5, 2018.

4. Canadian Institute for Health Information. Seniors in Transition: Exploring Pathway Across the Care Continuum. 2017.

5. Canadian Institute for Health Information. Your Health System: Insight. Accessed June 20, 2018.

6. Canadian Institute for Health Information. Seniors and Alternate Level of Care: Building on Our Knowledge. 2012.

7. Canadian Institute for Health Information. Alternate Level of Care in Canada. 2009.

8. Canadian Institute for Health Information. Patient Pathways: Transfers From Continuing Care to Acute Care. 2009.

9. Ontario Hospital Association. Managing Transitions: A Guidance Document. 2018.

10. Cancer Care Ontario. Alternate Level of Care (ALC): Reference Manual. 2017.

11. Ontario Hospital Association. Alternate Level of Care (ALC) Capacity Challenges and Long-Term Care Placement. 2012.

12. Health Canada. Home and community health care. Accessed September 14, 2018.

13. Statistics Canada. Formal Home Care Use in Canada. 2018.

Availability of Data Sources and Results
Data Sources

DAD

Available Data Years

Type of Year:
Fiscal
First Available Year:
2017
Last Available Year:
2017

Geographic Coverage

All provinces/territories except Quebec

Reporting Level/Disaggregation

National, Province/Territory

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
Your Health System: In Brief
URL: https://yourhealthsystem.cihi.ca/hsp/inbrief?lang=en#!/indicators/079/hospital-stay-extended-until-home-care-services-or-supports-ready

Updates

Not applicable

Quality Statement
Caveats and Limitations

This indicator is a starting point to measure access to home care after a hospital stay and can be further refined as data collection across sectors of care improves.

  • There may be differences among provinces and territories in how extended hospital stays are classified and recorded. CIHI introduced standards for ALC or extended stay designation in 2016; comparability of the indicator will improve as implementation of the CIHI standard continues to increase. It is also possible that health professionals will differ on when to designate someone as “on extended stay” given that it requires careful assessment of care needs.

  • Among regional challenges:
    ­– Quebec has no equivalent data, so results are not included.
    ­– Nova Scotia commonly describes patients as “waiting for nursing home,” which may contribute to some variation and under-reporting of patients discharged to home care.
    ­– In the territories and provinces with smaller populations, the number of admissions overall is small, and few extended stays are reported. For this reason, results should be interpreted with caution and may not be comparable.

  • This indicator does not show whether a patient actually received home care, only that he or she was discharged from hospital expecting to receive formal home care.

  • This indicator includes a broad scope of home care services that captures discharge to both
    short- and long-term home care as well as home care in private residence and supportive living. Data sources do not distinguish between different types of home care services provided.

  • In some cases, it may be that a patient discharged to home care was initially waiting for long-term care (or some other service). This scenario could increase the number of patients included in this indicator.

  • Hospital stays for mental health are not included because of variations in how provinces and territories collect this type of data. Where this data was available, it had little impact on the indicator results.

  • In some cases, it may be possible that there are an increased number of cases or longer extended stays when there are increased efforts to arrange home care services from hospital.
Trending Issues

Not applicable

Comments

This indicator belongs to the Shared Health Priorities portfolio measuring access to mental health and addictions services and to home and community care.

More information on this indicator is available in the companion report on the Shared Health Priorities page.