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Indicator Metadata

NameInflow/Outflow Ratio
Short/Other Names

Not applicable

Description

This indicator is a ratio, calculated as the number of separations (discharges and deaths) from acute care/same-day surgery facilities within a given region divided by the number of acute care/same-day surgery separations generated by residents of that region.

For further details, please see the General Methodology Notes.

InterpretationA ratio of less than 1 indicates that health care utilization by residents of a region exceeded care provided within that region, suggesting an outflow effect. A ratio of greater than 1 indicates that care provided by a region exceeded the utilization by its residents, suggesting an inflow effect. A ratio of 1 indicates that care provided by a region was equivalent to the utilization by its residents, suggesting that inflow and outflow activity, if it existed at all, was balanced. A ratio of 0 is an indication that none of the institutions in the region provided the service and residents received care outside of their region.
HSP Framework Dimension

Health System Outputs: Person-centred

Areas of Need

Getting Better

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

Region

Indicator Results

http://yourhealthsystem.cihi.ca/epub/?language=en

Identifying Information
NameInflow/Outflow Ratio
Short/Other Names

Not applicable

Indicator Description and Calculation
Description

This indicator is a ratio, calculated as the number of separations (discharges and deaths) from acute care/same-day surgery facilities within a given region divided by the number of acute care/same-day surgery separations generated by residents of that region.

For further details, please see the General Methodology Notes.

Calculation: Description

The indicator is expressed as an overall ratio, calculated for discharges associated with any diagnosis or procedure (acute care discharges only) and separately for coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), hip replacement, knee replacement and hysterectomy procedures. There are six inflow/outflow ratios:

1. Overall

2. CABG

3. PCI

4. Hip replacement

5. Knee replacement

6. Hysterectomy

Ratio = Number in numerator ÷ Number in denominator

Unit of Analysis: Single admission

Calculation: Geographic Assignment

Place of residence or service

Calculation: Type of Measurement

Ratio

Calculation: Adjustment Applied

None

Calculation: Method of Adjustment

Not applicable

Denominator

Description:
Number of separations (discharges and deaths) from acute care/same-day surgery facilities generated by residents of the region for a given procedure
Inclusions:
CABG (acute care discharges only):

CCI: 1.IJ.76^^

PCI (acute care and same-day surgery discharges):

CCI: 1.IJ.50^^, 1.IJ.57.GQ^^, 1.IJ.54.GQ-AZ (this code is used for 2006–2007 to 2008–2009 data only)

Hip replacement (acute care discharges only):

CCI: 1.VA.53.^^ (excluding 1VA53LASLN and 1VA53LLSLN when intervention status attribute does not equal R), 1.SQ.53.^^

Knee replacement (acute care and same-day surgery discharges):

CCI: 1.VG.53.^^ (excluding 1VG53LASLN when intervention status attribute does not equal R), 1.VP.53.^^

Hysterectomy (acute care and same-day surgery discharges):

CCI: 1.RM.89^^, 1.RM.91^^, 1.RM.87.BA-GX, 1.RM.87.CA-GX, 1.RM.87.DA-GX, 1.RM.87.LA-GX with intervention extent attribute coded as SU

Note that procedure codes may be recorded in any position.

Numerator

Description:
Number of separations (discharges and deaths) from acute care/same-day surgery facilities within a given region (including non-residents) for all cases and for a given procedure
Inclusions:
CABG (acute care discharges only):

CCI: 1.IJ.76^^

PCI (acute care and same-day surgery discharges):

CCI: 1.IJ.50^^, 1.IJ.57.GQ^^, 1.IJ.54.GQ-AZ (this code is used for 2006–2007 to 2008–2009 data only)

Hip replacement (acute care discharges only):

CCI: 1.VA.53.^^ (excluding 1VA53LASLN and 1VA53LLSLN when intervention status attribute does not equal R), 1.SQ.53.^^

Knee replacement (acute care and same-day surgery discharges):

CCI: 1.VG.53.^^ (excluding 1VG53LASLN when intervention status attribute does not equal R), 1.VP.53.^^

Hysterectomy (acute care and same-day surgery discharges):

CCI: 1.RM.89^^, 1.RM.91^^, 1.RM.87.CA-GX, 1.RM.87.DA-GX, 1.RM.87.LA-GX with intervention extent attribute coded as SU

Note that procedure codes may be recorded in any position.

Background, Interpretation and Benchmarks
Rationale

This indicator reflects the balance between the quantity of hospital stays provided to both residents and non-residents by all relevant facilities (acute care/same-day surgery) in a given region and the extent of utilization by residents of that region, whether they received care within or outside of the region.

Interpretation

A ratio of less than 1 indicates that health care utilization by residents of a region exceeded care provided within that region, suggesting an outflow effect. A ratio of greater than 1 indicates that care provided by a region exceeded the utilization by its residents, suggesting an inflow effect. A ratio of 1 indicates that care provided by a region was equivalent to the utilization by its residents, suggesting that inflow and outflow activity, if it existed at all, was balanced. A ratio of 0 is an indication that none of the institutions in the region provided the service and residents received care outside of their region.

HSP Framework Dimension

Health System Outputs: Person-centred

Areas of Need

Getting Better

Targets/Benchmarks

Not applicable

References

Heart and Stroke Foundation of Canada. The Growing Burden of Heart Disease and Stroke in Canada 2003. Available at http://publications.gc.ca/collections/Collection/H1-10-2003E.pdf. Accessed March 01, 2014.

Johansen HL, et al. Incidence, Comorbidity, Case Fatality and Readmission of Hospitalized Stroke Patients in Canada. Can J Cardiol. 2006;22:65-71.

Truelsen T, Bonita R and Jamozik K. Suveillance of Stroke: A Global Perspective. Int J Epidemiol. 2001;30:S11-S16.

World Health Organization. WHO STEPS Stroke Manual: The WHO STEPwise Approach to Stroke Surveillance. Geneva, Switzerland: WHO, 2006.

Availability of Data Sources and Results
Data Sources

DAD, HMDB, NACRS

Available Data Years

Type of Year:
Fiscal
First Available Year:
2001
Last Available Year:
2015

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

Region

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
Health Indicators e-publication
URL: http://yourhealthsystem.cihi.ca/epub/?language=en

Updates

Not applicable

Quality Statement
Caveats and Limitations

Not applicable

Trending Issues

Not applicable

Comments

Beginning with the 2006–2007 rate, hysterectomy cases include both total and subtotal hysterectomies, similar to reporting prior to 2001–2002. Subtotal hysterectomy was not uniquely identified in the Canadian Classification of Health Interventions (CCI) versions 2001 and 2003; therefore, hysterectomy rates reported for 2001–2002 to 2005–2006 included only total hysterectomies. Identification of subtotal hysterectomies became possible again with version 2006 of CCI. For jurisdictions with higher volumes of subtotal hysterectomies, comparability with previous years might be affected.

Beginning with the 2005–2006 rate, hysterectomy and knee replacement totals include same-day surgery procedures. Due to small volumes of these procedures in same-day surgery settings, comparability with previous years should not be affected.

Beginning with 2015–2016 data, cement spacers are excluded from hip and knee replacement cases when they are not revisions; comparability with previous years should not be affected.