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System Performance

Guide to Home Care Reporting

In Ontario, 14 Community Care Access Centres connect patients with the home care they need in the community. They either provide home care services directly or coordinate services with other organizations. More than 130 service providers deliver home care services across Ontario. Many provide multiple services and deliver them in more than one Community Care Access Centre.

About the home care quality indicators

Health Quality Ontario reports data on two categories of home care patients. Long-stay patients, who require care over a long period of time (more than 60 days), account for 46 percent of home care patients. Fifty-four percent of patients are considered short-stay and require short-term services when recovering from surgery or an injury. Some quality indicators pertain only to long-stay patients, while others include both short- and long-stay patients.

The Resident Assessment Instrument – Home Care (RAI-HC) is a standardized tool used to assess a long-stay patient’s health status. Quality indicators derived from the tool primarily measure changes in a patient’s health status (e.g. new pressure ulcers). Reassessment is recommended every six months, or earlier if there is significant clinical change, which makes it possible to measure changes in these patients’ health. Measuring this change in short-stay patients is generally not possible, as by definition, they only require short-term services.

Quality indicators that describe both short-stay and long-stay patients are derived from multiple data sources. For example, Health Quality Ontario calculates readmission indicators by linking information from multiple health care settings (e.g., home care, emergency departments and hospital stays). This data is available for information purposes only. All of our data comes from external data providers, which may occasionally make adjustments to the data published here. We ensure the information we report is of the highest quality, and protects privacy and confidentiality. We do not access any data that identifies personal information.

Data sources

Health Quality Ontario receives quality indicator results from several sources, including the Canadian Institute for Health Information, the Institute for Clinical Evaluative Sciences, the Ministry of Health and Long-Term Care, and the Ontario Association of Community Care Access Centres. Specific data sources that Health Quality Ontario uses to produce the indicators are:

Registered Persons Database (RPDB)
RPDB provides basic demographic information about anyone who has ever received an Ontario health card number. This database is maintained by the ministry and used and enriched by ICES with information from other data sets.

Discharge Abstract Database (DAD)
DAD is maintained by CIHI and houses information on patients treated in acute care hospitals. Every time an acute care hospital discharges a patient, the hospital submits an electronic record to CIHI that contains the patient’s demographic information as well as diagnostic and treatment data.

Home Care Database (HCD)
HCD is maintained by the OACCAC and is a clinical, client-centered database that captures all home care services provided or coordinated by CCACs.

Home Care Reporting System (HCRS)
HCRS is maintained by CIHI and contains demographic, clinical, functional and resource usage information on patients served by publicly funded home care programs in Ontario. Data in HCRS are collected using the Resident Assessment Instrument - Home Care (RAI-HC). The RAI-HC is a standardized, multi-dimensional assessment system for determining client needs. It includes client assessment protocols, outcome measurement scales and a case mix system. An international consortium of researchers called interRAI developed the tool and Ontario’s CCACs implemented it in 2004.

National Ambulatory Care Reporting System (NACRS)
NACRS is maintained by CIHI and contains data for hospital- and community-based emergency and ambulatory care (e.g., day surgery, outpatient clinics). CIHI receives data directly from participating facilities or from their respective regional health authorities or the ministry.

Risk adjustment

When interpreting and comparing the results of quality indicators in different populations, regions or over time, it is important to account for the underlying differences in the populations being compared. We call this “risk adjustment” and it allows us to make a fair comparison across groups and to distinguish variation that is due to differences in practice.

Results can be adjusted to account for differences in the age, sex, or other characteristics of people within a certain population. Characteristics such as age can significantly affect people’s health status and their need for health services. By accounting for differences in age, health status and other factors, data can be risk-adjusted so that quality indicators are comparable across the province and over time.

Risk-adjusted quality indicators allow fairer comparisons across Community Care Access Centres and over time as patient characteristics change. Risk adjustment helps Community Care Access Centres identify priority areas for quality improvement efforts and makes it easier for them to share information with each other. The data can also be useful for developing benchmarks and standards over time.

To learn more about home care in Ontario, visit:

If you have a question about home care sector performance, and other ways we report on Ontario’s health system, please email us at

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