Indicator Metadata
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Name |
Inflow/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 (PDF). |
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 |
Geographic Coverage |
All provinces/territories |
Reporting Level/Disaggregation |
Region |
Indicator Results |
Name |
Inflow/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 (PDF). |
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:
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: CCI: 1.IJ.76^^ PCI (acute care and same-day surgery discharges): CCI: 1.IJ.50^, 1.IJ.57.GQ^^ (this code is used for 2017–2018 and earlier), 1.IJ.54.GQ-AZ (this code is used for 2006–2007 to 2008–2009 only), 1.IJ.57.GT (from 2018–2019), 1.IJ.57.GU (from 2018–2019) Hip replacement (acute care and same-day surgery discharges): 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: CCI: 1.IJ.76^^ PCI (acute care and same-day surgery discharges): CCI: 1.IJ.50^, 1.IJ.57.GQ^^ (this code is used for 2017–2018 and earlier), 1.IJ.54.GQ-AZ (this code is used for 2006–2007 to 2008–2009 only), 1.IJ.57.GT (from 2018–2019), 1.IJ.57.GU (from 2018–2019) Hip replacement (acute care and same-day surgery discharges): 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. |
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 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. |
Data Sources |
DAD, HMDB, NACRS |
Available Data Years |
Type of Year: |
Geographic Coverage |
All provinces/territories |
Reporting Level/Disaggregation |
Region |
Update Frequency |
Every year |
Indicator Results |
Web Tool: |
Updates |
Not applicable |
Caveats and Limitations |
Not applicable |
Trending Issues |
Not applicable |
Comments |
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. |