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System Performance

Measuring Home Care Performance in Ontario

Health Quality Ontario reports data on two categories of home care patients. Some quality indicators pertain only to long-stay patients, while other indicators apply to both short- and long-stay patients.

  • Long-stay patients require care over a long period of time (more than 60 days), and account for 46 percent of home care patients.
  • Short-stay patients require short-term services when recovering from surgery or an injury. They account for 54 percent of home care patients.

The Resident Assessment Instrument – Home Care 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.

Data Sources

Health Quality Ontario receives quality indicator results from several sources, including the Canadian Institute for Health Information (CIHI), the Institute for Clinical Evaluative Sciences (ICES), the Ministry of Health and Long-Term Care, and the Ontario Association of Community Care Access Centres.

Parts of these online indicators are based on data and information compiled and provided by CIHI. However, the analyses, conclusions, opinions and statements expressed herein are those of the author, and not necessarily those of CIHI.

Data included here is provided by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. The opinions, results and conclusions reported here are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred. These datasets were linked using unique encoded identifiers and analyzed at ICES.

Registered Persons Database

This database provides basic demographic information about anyone who has ever received an Ontario health card number. It is maintained by the Ministry of Health and Long-Term Care and used and enriched by the Institute of Clinical Evaluative Sciences with information from other data sets.

Discharge Abstract Database

The Discharge Abstract Database is maintained by the Canadian Institute for Health Information 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 the institute that contains the patient’s demographic information as well as diagnostic and treatment data.

Home Care Database

The Home Care Database is maintained by the Ontario Association of Community Care Access Centres and is a clinical, client-centered database that captures all home care services provided or coordinated by community care access centres.

Home Care Reporting System

This system is maintained by the Canadian Institute of Health Information and contains demographic, clinical, functional and resource usage information on patients served by publicly funded home care programs in Ontario. Data in the Home Care Reporting System are collected using the Resident Assessment Instrument - Home Care, 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 community care access centres implemented it in 2004.

National Ambulatory Care Reporting System

The National Ambulatory Care Reporting System is maintained by the Canadian Institute of Health Information and contains data for hospital- and community-based emergency and ambulatory care (e.g., day surgery, outpatient clinics). The institute receives data directly from participating facilities or from their respective regional health authorities or the Ministry of Health and Long-Term Care.

Risk Adjustments

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.

If you have a question about reporting on Ontario’s health system, please email us at systemperformance@hqontario.ca

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