Indicator Metadata

Not applicable

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.

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 and 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

Place of residence

Rate - per 100

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

Logistic regression

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 2017–2018 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.

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 2017–2018 Data Dictionary.

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.

Lower rates are desirable.

Health System Outputs: Person-centred

Living With Illness, Disability or Reduced Function

Not applicable

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

DAD, HMDB, NACRS, OMHRS

Type of Year:
Fiscal
First Available Year:
2015
Last Available Year:
2017

All provinces/territories

National, Province/Territory, Region

Every year

Web Tool:
Quick Stats
URL: https://www.cihi.ca/sites/default/files/document/hmhdb-qs-preformatted-2017-18-en.xlsx

Not applicable

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.

Not applicable

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.