• The My Patients table now includes 3 additional patient-level variables. These variables are No Health Card Number, No Postal Code, and Discharged to Long-Term Care. These are presented as percentages in the My Patients table.
• The My Patients table now includes 2 additional neighborhood-level variables. These variables are Percentage Visible Minority and After Tax Income. Neighborhood-level variables are from Statistics Canada’s 2016 census, linked to hospitalizations at the level of dissemination area. Each patient is assigned a value based on their dissemination area, and median (25th - 75th) are presented in the My Patients table.
• The Advanced Imaging indicator now considers two imaging measurements from the same imaging order as a single imaging test. This is a small update to correct for duplicate measurements, which only affects a minority of hospitals.
• The 7-Day Readmission and 30-Day Readmission indicator definitions have been updated to further align with CIHI’s definition. See FAQ section Why did the readmission rate from my previous report change? for more details.

This report was optimized for 1080p screens on modern browsers such as Google Chrome, Microsoft Edge, and Mozilla Firefox in full screen mode. The report will read well on higher resolutions and will default to a mobile “scrollable” layout for resolutions less than 768p. For resolutions between 768p and 1080p, the report may be uncomfortable to read. In this situation, experimenting with the “zoom” feature on your browser may improve readability.

Patients who meet the following criteria are included:

• Discharged between February 28, 2019 to February 29, 2020 (inclusive)
• Total length of stay was less than or equal to 14 days. Patients with long length of stay are excluded because it may not be reasonable to attribute their care to a single physician for typical practice patterns
• Admitted to or discharged from general medicine or hospitalist service

General medicine involves frequent handovers of patients between physicians, making it challenging to attribute patient care to a single physician. To enable fair reporting of practice and outcomes for individual physicians, patients were attributed to a single physician as follows:

The data for this report were collected by GEMINI. GEMINI is one of Canada’s largest hospital patient data repositories for research. Established in 2015 as a hospital research collaborative based out of Unity Health Toronto with seven hospitals, GEMINI currently holds data on >1.8 million admissions from over 30 Ontario hospitals. GEMINI collects data for all medical (including general medicine, cardiology, oncology, etc.) and intensive care hospitalizations, covering >60% of all inpatients across the province.

GEMINI contains administrative and clinical data extracted from hospital information systems and administrative databases. Administrative data include variables standardized for reporting to the Canadian Institute for Health Information (e.g., patient demographics, admission and discharge dates, diagnosis codes). Clinical data include rich and granular variables from the patient’s electronic health record (e.g. patient vital signs, laboratory test results, medication orders). GEMINI receives hospital data every 3 months and has established analytical processes to handle the large volume and broad range of data.

The GEMINI team has undertaken extensive efforts to validate the data that were collected. These include checking data quality by testing for missing data, consistency over time, and implausible values. We have developed workflows for preparing research-ready data that include deidentification, quality control, standardization and validation. Our methodology for assessing data quality has been rigorously validated (98%-100% accuracy), as described in this article. In addition, a data validator at each hospital manually compared the extracted data from GEMINI with the data in the hospital’s electronic health records.

Below is a list of the hospitals participating in GeMQIN to date.

• Brampton Civic Hospital - William Osler Health System
• Cortelluci Vaughan Hospital - Mackenzie Health
• Credit Valley Hospital - Trillium Health Partners
• Etobicoke General Hospital - William Osler Health System
• Grand River Hospital
• Greater Niagara General Site - Niagara Health
• Hamilton General Hospital - Hamilton Health Sciences
• Humber River Hospital
• Juravinski Hospital - Hamilton Health Sciences
• Kingston General Hospital - Kingston Health Sciences Centre
• Mackenzie Richmond Hill Hospital - Mackenzie Health
• Markham Stouffville Hospital - Oak Valley Health
• Michael Garron Hospital - Toronto East Health Network
• Mississauga Hospital - Trillium Health Partners
• Mount Sinai Hospital - Sinai Health System
• North York General Hospital
• Oakville Trafalgar Memorial Hospital - Halton Healthcare Services
• Sault Area Hospital - Sault Area Hospital
• St. Catharines Site - Niagara Health
• St. Joseph's Health Centre - Unity Health Toronto
• St. Mary's General Hospital
• St. Michael's Hospital - Unity Health Toronto
• Sunnybrook Health Sciences Centre
• Thunder Bay Regional Health Sciences Centre
• Toronto General Hospital - University Health Network
• Toronto Western Hospital - University Health Network
• University Hospital - London Health Science Centre
• Victoria Hospital - London Health Science Centre
• Welland Hospital Site - Niagara Health

The indicators in this report were selected by the GeMQIN Report Development Committee, which includes the program’s provincial clinical leads, physicians and interdisciplinary health professionals, hospital administrators, quality improvement experts, and researchers. Part of GeMQIN’s ongoing work over the coming years will be to further develop quality indicators that are relevant to hospital medicine, and we welcome feedback and participation in that process. If you have any feedback about these reports, please contact us at GeMQIN@ontariohealth.ca.

Definitions can be found on the bottom-left of each indicator tab by expanding the Definition and Indicator details headings. Table 1 below provides a summary of definitions. Please see the MyPractice Background and Indicator Details document for additional information.

The 30-day timeframe to measure readmission is what is most commonly used to report hospital readmissions. However, recent research (Graham et al, 2018) suggests that earlier readmissions (e.g., within 7 days) are more likely to be preventable and amenable to hospital-based interventions, while later readmissions (e.g., within 30 days) are more likely to be preventable and improved upon by home and community-based interventions.

Readmission indicators exclude episodes of care with at least one record for mental health as the most responsible discharge diagnoses, and do not consider readmissions for mental health as readmissions. This is to align with CIHI’s reporting, and because we do not comprehensively capture all mental health hospitalizations. Mental health hospitalizations may go to non-medical services, and if included, may bias the reported data.

There are several reasons why data may not be shown in the report, including the absence of data, identified data quality issues, or the suppression of data. Data on fewer than 6 admissions are suppressed to reduce the privacy risk that could lead to re-identification of individuals and residual disclosure of information.

For each hospitalization, the most responsible inpatient discharge diagnosis is coded using ICD-10 codes in hospital administrative data. We use the Clinical Classifications Software Refined (CCSR) to group ICD-10 codes into clinically meaningful diagnosis groups. This approach allows us to aggregate >70,000 unique ICD-10 diagnosis codes into 540 mutually exclusive categories across 22 body systems. When a proxy most responsible discharge diagnosis is present, that code is used in place of the most responsible discharge diagnosis.

These data are intended to be used to help front-line healthcare providers understand the quality of general medicine care and inform quality improvement efforts. There are sometimes large differences in practice and outcomes between physicians within a hospital. In general, these differences are not explained by differences in case-mix or patient characteristics between physicians, because general medicine physicians take care of whichever patients are admitted when they are on service, resulting in a “quasi-randomization” of patients. However, there may be subtle differences in practice patterns, which require knowledge of local context to interpret (e.g., some physicians work for 4-week blocks and others work for 2-week blocks; or some physicians attend more on hospitalist vs. clinical teaching unit teams). Thus, we encourage these data to be interpreted by physicians and care teams with local context in mind.

The summary statistics in this report are based on multiple years. There have been changes to clinical practice patterns over time (for example, use of routine bloodwork has generally reduced in more recent years). Clinicians who only practiced in more recent time periods may appear different from their colleagues. Please consider this when interpreting your own data.

Calculations in this report include the time that a general medicine patient spends in CTU/ICU.

Physicians will only see indicators from their previous report if they had received a Version 3 report from the same site. The indicators from the Version 3 reports have been recalculated and updated using updated methodology and the most recent data available. There may be small variations between values in this report and the previous report.

Your 7-day and 30-day readmission rates in last year’s report may be slightly different than the My Previous Report values on the Overview page. This is because we have updated our definition of readmission to further align with CIHI’s definition. These updates are as follows:

• Now episodes of care with the last record as self sign-out are excluded from the denominator.
• Now episodes of care where any encounter (including transfers) involves mental heath, palliative care, or chemotherapy are excluded from the numerator. Elective admissions are excluded from the numerator only if the initial encounter in the readmission is coded as elective.
• Now episodes of care that involve obstetric delivery are excluded from the numerator.

These updates result in slightly lower readmission rates for all physicians compared to previous reports. Please see the MyPractice Background and Indicator Details document for additional information.

GEMINI data are used to create the MyPractice: General Medicine Report, which is available to physicians who practice in participating GeMQIN hospitals. Through continuously evolving quality improvement tools, resources, and activities, GeMQIN supports participating general medicine physicians across Ontario to:

• Use their data to identify opportunities for quality improvement
• Get ideas and strategies to improve care
• Be quality improvement leaders in their hospitals
• Be connected with other general internal medicine physicians and hospital teams

The Charlson comorbidity index score was used to assess comorbidity at admission. This score is based on administrative diagnosis codes and is one of the most common comorbidity scores used in health services research. We used an updated version of the original score (Quan et al., 2011).