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The New CIHI.
What’s New? What’s
Coming?
Breakfast with the Chiefs
November 27, 2007
Glenda Yeates & Graham Scott
CIHI
• Who: an independent, not-for-profit organization
providing essential data and analysis on Canada’s health
system and the health of Canadians
• What: comparable information, databases supported by
standards, pan-Canadian analyses
• When: opened its doors in 1994
• Where: Victoria, Edmonton, Toronto, Ottawa, Montreal
and St. John’s
• How: through partnerships with stakeholders
What Does Success Look
Like for CIHI?
• Decision-makers at all levels of the health sector
have high-quality, timely and comparable data
and information
• Data and information is used as a tool for
“change management” to
enhance the health system
and improve its service
and delivery
CIHI’s holdings and products
• Number of records CIHI stores: 500 million
• Number of CIHI databases: 27
– Number currently under development: 3
• Number of analytical and related products
published 2006-07: about 279
• Number of visits to website in 2006-07: over 2
million
“In times of change, learners
inherit the earth, while the
learned find themselves
beautifully equipped to deal
with a world that no longer
exists.”
— Eric Hoffer
What’s New?
•
•
•
•
Access & Wait Times
Patient Safety & Quality
Health Human Resources
Mental Health and Homelessness
Access & Wait Times
Trends in Age Standardized
Surgery Rates
Source: CIHI (2006).
Time in the ED After Decision to Admit
10%
50%
90%
Overall
0
1.7
15.1
Small Hospital
0
0.3
2.8
0.3
2.3
17.3
Teaching Hospital
Waiting time in hours based on 277 hospitals outside of Quebec
Source: DAD, CIHI
Rate of Hospitalizations via the
Emergency Department
Patient Safety
& Quality
Hip Fractures
• Hip fractures are relatively common
– > 28,200 admissions in 2005-2006
• More common for women and with increasing age
• Some improvement in recent years
• Wide variation in rates of hip fracture
– Some evidence re: effective strategies for prevention
% with Surgery on Same/Next Day
100
75
50
25
0
B.C Alta. Sask. Man. Ont. N.B
Preliminary data – subject to validation
N.S P.E.I N.L. Overall
Who is More Likely to Wait?
• Patient transferred from the admitting institution
– More common in SK/MB, less in NS, NL, NB
• Patients in large hospitals or hospitals with high
volumes of surgery
• Patients admitted in the afternoon/evening
• Patients admitted on weekdays
Preliminary data – subject to validation
Drug Claims by Seniors: Potentially
Inappropriate Medication Use, 2000-2006
• A study that examines public drug program
claims in Alberta, Saskatchewan, Manitoba and
New Brunswick.
• Focuses on medications on the Beers list:
– an internationally recognized list of medications
identified as “potentially inappropriate” for seniors due
to an elevated risk of adverse effects.
• CIHI’s first analytical release using the National
Prescription Drug Utilization Information System
(NPDUIS) database.
Age-Sex Standardized Rates of Chronic Beers Use,
Among Seniors on Public Drug Programs in Select
Provinces*, 2000–2001 to 2005–2006
(%)
30.0
25.0
20.0
Alt a.
Sask.
15.0
M an.
N.B.
10.0
5.0
0.0
2000/01
2001/02
2002/03
2003/04
2004/05
2005/06
*The four provinces submitting claims data to the NPDUIS database as of June 2007
Source: National Prescription Drug Utilization Information System (NPDUIS) Database, Canadian Institute
for Health Information 2007
Health Human
Resources
Number of physicians in Canada
and Ontario
• Nationally, the number of physicians has increased by
4.9% over five years, similar to the increase in the
population at large (4.0%)
• The average age of an Ontario physician increased from
48.5 years in 2002 to 50.1 years in 2006. Physicians in
Ontario are, on average, a year older than the national
average (50.1 vs. 49.2)
• More young women joining physician ranks
– Women represent 33% of the total Canadian physician workforce
and 49% of all medical doctors under the age of 40
Number of nurses in Canada and
Ontario
• Nationally, the number of nurses grew by 5% over four
years compared to 3% growth in the Canadian
population
• There is an increase in new graduates entering the
Canadian workforce
• The average age of nurses is up slightly - close to 45
years; in Ontario, the average of age of nurses is 45.5
years
• Nationally, the number of nurse practitioners is on the
rise
– from 725 to 1,300 between 2003 and 2006
Mental Health and
Homelessness
Mental Health and Homelessness
• Homelessness affects tens of thousands of Canadians
• Current research on the homeless population indicates a
tendency for compromised mental health including
maladaptive coping, low self-worth and low social
support, as well as mental illness, addictions and suicidal
behaviours
– In Toronto, 67% of 300 shelter users reported a lifetime diagnosis of
mental illness: 6% reported schizophrenia and 68% reported lifetime
substance abuse or dependence
• New analyses of CIHI data indicate that mental diseases
and disorders are the most common reason for
Emergency Department visits (36%) and inpatient
hospitalizations (52%) among the homeless
Top 5 Reasons for ED Visits
2005-06
Homeless
Mental and behavioural disorders
Symptoms, signs and abnormal clinical findings
Injury, poisoning and consequences of external causes
%
36.2
16.2
14.8
Contact with health services
Diseases of muskuloskeletal system and connective tissue
11.5
4.8
Others
Injury, poisoning and consequences of external causes
%
24.6
Symptoms, signs and abnormal clinical findings
19.3
Diseases of respiratory system
Contact with health services
Diseases of muskuloskeletal system and connective tissue
11.1
7.5
6.0
Top 5 Reasons for Inpatient
Hospitalization 2005-06
Homeless
Mental diseases and disorders
Significant Trauma
Respiratory Diseases
Digestive Diseases
Injuries Poisoning and Toxic Effect
Others
Pregnancy and Childbirth
Circulatory Diseases
Newborns and Other Neonates
Digestive Diseases
Respiratory Diseases
%
51.8
7.5
7.2
3.5
3.4
%
13.0
12.2
11.8
10.3
7.4
What’s Coming?
Hospital Standardized Mortality Ratio (HSMR)
What is HSMR?
• Hospital Standardized Mortality Ratios (HSMR)
track changes in hospital mortality rates in order
to improve quality of care
• Developed in the UK in mid-1990s by Sir Brian
Jarman of Imperial College
• Used in hospitals worldwide (i.e. UK, Sweden,
Holland and US)
What is HSMR? (2)
• Compares a hospital’s mortality rate with the
overall average rate
• Calculated as a ratio of the actual number of
deaths to the expected number of deaths among
patients in acute care hospitals
The Uses of HSMR
HSMR results are most helpful when used by individual hospitals
and health regions to track their progress over time.
• The HSMR is an important new measure, but no measure is ever
perfect.
• The HSMR calculation adjusts for many of the factors that influence
the risk of dying in hospital, but each hospital and community is
unique.
• It’s why the measure is most useful to compare results within a
facility over time, and not to compare results between facilities.
Results should be interpreted with caution.
To learn more,
visit the CIHI website:
www.cihi.ca