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Indicator Metadata

Name

Pan-Canadian Percentage of Total Days Stayed in General Hospitals for Mental Illness, by Province, Diagnosis Category, Sex and/or Age Group

Short/Other Names

Not applicable

Description

Percentage of total days stayed in hospital for mental illness/addiction out of all general hospital separations (discharges or deaths) by

  • Jurisdiction (province/territory)
  • Age group
  • Sex
  • Diagnosis category
Interpretation This indicator provides descriptive information about lengths of stay for mental illness inpatient separations in Canada stratified by diagnostic, geographic and demographic characteristics.
HSP Framework Dimension Health System Inputs and Characteristics: Health system resources
Areas of Need Not applicable
Geographic Coverage All provinces/territories
Reporting Level/Disaggregation National, Province/Territory
Indicator Results https://apps.cihi.ca/mstrapp/asp/Main.aspx?Server=apmstrextprd_i&project=Quick%20Stats&uid=pce_pub_en&pwd=&evt=2048001&visualizationMode=0&documentID=D901470C442A5B26D6CC89B28B21C75F
Identifying Information
Name Pan-Canadian Percentage of Total Days Stayed in General Hospitals for Mental Illness, by Province, Diagnosis Category, Sex and/or Age Group
Short/Other Names Not applicable
Indicator Description and Calculation
Description Percentage of total days stayed in hospital for mental illness/addiction out of all general hospital separations (discharges or deaths) by
  • Jurisdiction (province/territory)
  • Age group
  • Sex
  • Diagnosis category
  • Calculation: Description Percentage of Total Days Stayed in Hospital for Mental Illness/Addiction = Total days stayed in general hospital for mental illness/addiction divided by Total days stayed in general hospital for mental illness/addiction and non–mental illness/addiction diagnoses, by grouping (such as age, sex, province or diagnosis category) multiplied by 100
    Calculation: Geographic Assignment Place of service
    Calculation: Type of Measurement

    Percentage or proportion

    Calculation: Adjustment Applied

    None

    Calculation: Method of Adjustment

    None;

    Denominator

    Description:
    Total days stayed in hospital for inpatient separations from general hospitals involving mental illness/addiction and non–mental illness/addiction diagnoses
    Inclusions:

    1. Admission to a general hospital in Canada

    Exclusions:

    1. Newborns
    2. Psychiatric hospital separations
    Numerator

    Description:
    Total days stayed in hospital for inpatient separations from general hospitals involving mental illness/addiction as the primary diagnosis and/or diagnosis category (for data extracted from the Ontario Mental Health Reporting System [OMHRS])
    Inclusions:

    1. Admission to a general hospital in Canada
    2. Sex recorded as male or female for analyses with breakdown by sex
    3. Valid age recorded for analyses with breakdown by age
    4. Mental illness/addiction as the primary diagnosis and/or diagnosis category (for data extracted from OMHRS)


    The following codes were used for inpatient separations involving mental illness/addiction:

    For 2011–2012 through 2013–2014

    • DSM-IV-TR: 290–319, 607.84, 608.89, 625.0, 625.8 and 780.09
    • ICD-9-CM: 290–319 and 648.40–648.44
    • ICD-10-CA: F00–F99, G30, R41.0, R41.3 and O99.30


    For 2014–2015 through 2015–2016

    • DSM-IV-TR: 290–319, 607.84, 608.89, 625.0, 625.8 and 780.09
    • ICD-9-CM: 290–319 and 648.40–648.44
    • ICD-10-CA: F00–F99, G30 and O99.30


    As of 2016–2017

    • ICD-10-CA codes: F00–F99, G30 and O99.30
    • DSM-IV-TR codes: 290–319, 607.84, 608.89, 625.0, 625.8 and 780.09


    DSM-IV diagnostic category

    a = Disorders of childhood/adolescence
    b = Delirium, dementia and amnesic and other cognitive disorders
    c = Mental disorders due to general medical condition
    d = Substance-related disorders
    e = Schizophrenia and other psychotic disorders
    f = Mood disorders
    g = Anxiety disorders
    h = Somatoform disorders
    i = Factitious disorders
    j = Dissociative disorders
    k = Sexual and gender identity disorders
    l = Eating disorders
    m = Sleep disorders
    n = Impulse-control disorders not classified elsewhere
    o = Adjustment disorders
    p = Personality disorders

    DSM-5 diagnostic category

    a = Neurodevelopmental disorders
    b = Schizophrenia spectrum and other psychotic disorders
    c = Bipolar and related disorders
    d = Depressive disorders
    e = Anxiety disorders
    f = Obsessive–compulsive and related disorders
    g = Trauma- and stressor-related disorders
    h = Dissociative disorders
    i = Somatic symptoms and related disorders
    j = Feeding and eating disorders
    k = Elimination disorders
    l = Sleep–wake disorders
    m = Sexual dysfunctions
    n = Gender dysphoria
    o = Disruptive, impulse-control and conduct disorders
    p = Substance-related and addictive disorders
    q = Neurocognitive disorders
    r = Personality disorders
    s = Paraphilic disorders
    t = Other mental disorders

    For information on prior years, please contact the Mental Health and Addictions team at mentalhealth@cihi.ca.

    Exclusions:

    1. Newborns
    2. Psychiatric hospital separations
    Background, Interpretation and Benchmarks
    Rationale Average and total days stayed provide measures of hospital utilization and may reflect differences in the health of the population and mental health service delivery models as well as variations in the availability and accessibility of specialized, residential and/or ambulatory and community-based health services.
    Interpretation This indicator provides descriptive information about lengths of stay for mental illness inpatient separations in Canada stratified by diagnostic, geographic and demographic characteristics.
    HSP Framework Dimension Health System Inputs and Characteristics: Health system resources
    Areas of Need Not applicable
    Targets/Benchmarks Not applicable
    References Not applicable
    Availability of Data Sources and Results
    Data Sources DAD, HMDB, HMHDB, OMHRS
    Available Data Years Type of Year:
    Fiscal
    First Available Year:
    2003
    Last Available Year:
    2018
    Geographic Coverage All provinces/territories
    Reporting Level/Disaggregation National, Province/Territory
    Result Updates
    Update Frequency Every year
    Indicator Results Web Tool:
    Quick Stats
    URL: https://apps.cihi.ca/mstrapp/asp/Main.aspx?Server=apmstrextprd_i&project=Quick%20Stats&uid=pce_pub_en&pwd=&evt=2048001&visualizationMode=0&documentID=D901470C442A5B26D6CC89B28B21C75F
    Updates 2016–2017: For records from the Ontario Mental Health Reporting System (OMHRS) — one of the data sources that populates the Hospital Mental Health Database (HMHDB) — broad mental health category in the HMHDB was assigned based on the DSM-5 diagnosis category instead of the specific diagnosis code.

    The assignment of diagnosis codes to diagnosis categories was modified. Several ICD-10-CA and DSM-IV-TR diagnosis codes were regrouped into HMHDB broad mental health categories. These changes decreased the volume of separations in the Anxiety Disorders broad mental health category and increased the volume of separations in the Other Disorders category.

    Quality Statement
    Caveats and Limitations

    As this indicator excludes psychiatric hospitals, it should not be construed to represent all mental health and addiction hospital separations in Canada.

    Certain cells were suppressed for confidentiality reasons in accordance with CIHI's privacy policy. Totals exclude suppressed values.

    Many factors contribute to the observed variations in the analysis of indicators at the provincial/territorial and regional levels. These include, but are not limited to, geography, population health, provincial and regional health service resources, and health services administration. It is important to consider these factors and the effect they may have on indicator results when conducting comparative analyses. The variation in results between provinces/territories or between health regions suggests systematic differences in

    • Provincial/territorial or regional health policies, practices and resources
    • Geography and urban/rural population distribution
    • Environmental and socio-economic characteristics
    • Types of patients served and acuity of illness
    • The range of health services available beyond general and specialty psychiatric hospitals (such as community mental health services)
    • Accessibility and awareness of alternative points of entry to the health system


    The above list suggests a few of the factors that should be considered when making provincial/territorial and/or regional comparisons.

    Trending Issues

    2011–2012: Additional ICD-10-CA diagnosis codes were added to the extraction criteria for the DAD-HMDB, one of the data sources that populates the HMHDB. This increased the volume of separations and consequently had an impact on the total days stayed.

    2014–2015: Two ICD-10-CA diagnosis codes were removed from the extraction criteria for the DAD-HMDB, one of the data sources that populates the HMHDB. This decreased the volume of separations and consequently had an impact on the total days stayed.

    2016–2017: For records from the Ontario Mental Health Reporting System (OMHRS) — one of the data sources that populates the Hospital Mental Health Database (HMHDB) — broad mental health category in the HMHDB was assigned based on the DSM-5 diagnosis category instead of the specific diagnosis code.

    The assignment of diagnosis codes to diagnosis categories was modified. Several ICD-10-CA and DSM-IV-TR diagnosis codes were regrouped into HMHDB broad mental health categories. These changes decreased the volume of separations in the Anxiety Disorders broad mental health category and increased the volume of separations in the Other Disorders category.

    Comments

    Separations by year are based on the date of discharge, not the date of admission. As such, records with invalid discharge dates are not included.

    The HMHDB is an event-based rather than a person-based database; individuals may be represented multiple times in the data.

    Length of stay includes days stayed that occurred prior to the fiscal year of separation.

    • If Admission Date is missing or invalid, then Length of Stay (LOS) is not calculated and is set to missing.
    • If Discharge Date is missing or invalid, then LOS is not calculated and is set to missing.
    • Records with a missing LOS are excluded from LOS analyses.
    • Length of Stay = Discharge Date minus Admission Date.
    • Where Discharge Date = Admission Date, the LOS is set to 1. –Service interruptions and alternate level of care (ALC) days are included if they occurred during the stay.
    • Days stayed is equivalent to LOS.