The New CIHI. What’s New? What’s Coming?

1. The New CIHI. What’s New? What’s Coming? Breakfast with the Chiefs November 27, 2007 Glenda Yeates & Graham Scott

2. 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

3. 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

4. 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

5. “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

6. What’s New? • Access & Wait Times • Patient Safety & Quality • Health Human Resources • Mental Health and Homelessness

7. Access & Wait Times

8. Trends in Age Standardized Surgery Rates Source: CIHI (2006).

9. Time in the ED After Decision to Admit Waiting time in hours based on 277 hospitals outside of Quebec Source: DAD, CIHI

10. Rate of Hospitalizations via the Emergency Department

11. Patient Safety& Quality

12. 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

13. % with Surgery on Same/Next Day Preliminary data – subject to validation

14. 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

15. 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.

16. Age-Sex Standardized Rates of Chronic Beers Use, Among Seniors on Public Drug Programs in Select Provinces*, 2000–2001 to 2005–2006 *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

17. Health Human Resources

18. 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

19. 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

20. Mental Health and Homelessness

21. 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

22. Top 5Reasons for ED Visits2005-06

23. Top 5 Reasons for Inpatient Hospitalization 2005-06

24. What’s Coming? Hospital Standardized Mortality Ratio (HSMR)

25. 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)

26. 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

27. 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.

28. To learn more, visit the CIHI website:  www.cihi.ca