Population, Performance, and Utilization Measures: Frontenac, Lennox & Addington OHT

1 Population Overview

Selected measures relating to population are presented in this section. For this analysis, population generally refers to the attributed population. Attribution is a process for determining the Ontario residents that an Ontario Health Team (OHT) will be clinically and fiscally accountable for. The attributed population for an OHT refers to the total patient population of Network or Networks that best align to the OHT.

The total Attributed Population in the table below has been revised (September 2021).

1.1 Characteristics of the OHT Population

Measure	OHT	ON
Attributed Population	221,796	14,626,516
Mean age	43.2	41.3
Median age	44	41
Number that are seniors (65+)	48,474	2,673,054
Percentage that are seniors (65+)	22.1	18.3
Number that are seniors (75+)	21,509	1,187,284
Percentage that are seniors (75+)	9.8	8.1
Number that are minors (<18)	38,325	2,796,538
Percentage that are minors (<18)	17.5	19.1
Percentage that are female	51.7	51

1.2 Population Characteristics of OHT Compared to Ontario

1.3 Age Distribution of the Attributed Population

Age Distribution of the Attributed Population

Age Group	Population	% of Total
0-4	10,119	4.6
5-9	10,640	4.9
10-14	11,174	5.1
15-19	10,981	5.0
20-24	13,874	6.3
25-29	15,148	6.9
30-34	14,309	6.5
35-39	13,185	6.0
40-44	12,362	5.6
45-49	12,447	5.7
50-54	13,776	6.3
55-59	16,878	7.7
60-64	15,977	7.3
65-69	14,390	6.6
70-74	12,575	5.7
75-79	8,885	4.1
80-84	5,878	2.7
85+	6,746	3.1

1.4 Attributed Population by Age Group in OHT Compared to Ontario

1.5 Attributed Population by Census Sub-Division (CSD)

This table lists the top 20 communities (2016 CSDs) in which the patients attributed to the OHT live, based on their postal code of residence. CSDs are in descending order by attributed population. The last column (% Attributed population in CSD) shows the percentage of the OHT’s attributed total population that lives in this CSD. The table also includes the remainder, which is the OHT’s total attributed population that is not assigned to one of the top 20 CSDs.

This table was revised (September 2021).

Attributed Population by Census Sub-Division (CSD)

CSDUID	CSD Name	CSD Type	Attributed Population in CSD	% Attributed Population in CSD
3510010	Kingston	CY	126,034	56.8
3510020	South Frontenac	TP	15,310	6.9
3511015	Greater Napanee	T	15,148	6.9
3511005	Loyalist	TP	12,543	5.7
3511030	Stone Mills	TP	6,955	3.1
3507021	Leeds and the Thousand Islands	TP	6,863	3.1
3507024	Gananoque	T	4,291	1.9
3512001	Tyendinaga	TP	3,474	1.6
3507040	Rideau Lakes	TP	3,346	1.5
3510035	Central Frontenac	TP	2,843	1.3
3506008	Ottawa	CV	2,337	1.1
3520005	Toronto	C	2,259	1.0
3511035	Addington Highlands	TP	2,021	0.9
3512005	Belleville	CY	1,951	0.9
3510005	Frontenac Islands	TP	1,734	0.8
3512015	Quinte West	CY	1,246	0.6
3512030	Tweed	MU	845	0.4
3510045	North Frontenac	TP	788	0.4
3512020	Stirling-Rawdon	TP	610	0.3
3513020	Prince Edward County	CY	579	0.3
NA	Remainder		10,619	4.8

1.6 Marginalization

The Ontario marginalization Index (ON-Marg) is an area-based index that measures various aspects of deprivation, using a range of demographic indicators to create four dimensions of marginalization - residential instability, material deprivation, ethnic concentration and dependency. The intent of the index is to show differences in marginalization between geographic areas, using measures of economic, ethno-racial, age-based and social marginalization, and to understand inequalities in various measures of health and social well-being.

For the analysis below, ON-Marg scores were calculated for each OHT, and the quintiles were determined based on the distribution of scores across the OHT areas in Ontario. They show the SES variation between areas (1 = least/low; 5 = most/high). Also shown is the distribution of the population within each area (across the quintiles) to illustrate the variation for index dimensions inside each OHT.

Weighted averages can disguise heterogeneity within large geographic areas. For example, when the weighted average method is used to determine the quintile for an OHT, for a dimension, the variation across the areas that make up that OHT are masked. Looking at the percent of the population in each quintile, by dimension, shows that there are pockets of low, moderate and high marginalization that are not shown when using the summary scores.

Quintile of OHT ON-Marg scores

Residential Instability	Material Deprivation	Dependency	Ethnic Concentration
4	2	4	3

Quintile of OHT ON-Marg Scores

Dimensions of Marginalization - Population in each Quintile

Quintile (% of Population)	Residential Instability	Material Deprivation	Dependency	Ethnic Concentration
Quintile 1	12.9	24.6	11.2	30.9
Quintile 2	25.3	24.6	13.6	30.8
Quintile 3	21.2	20.4	23.1	22.9
Quintile 4	17.6	14.2	24.4	13.4
Quintile 5	23.1	16.1	27.7	2.0
Note:
1 = least/low; 5 = most/high

Dimensions of Marginalization - Population in each Quintile

2 Population Health

This section provides a brief overview of measures relating to births and mortality. Births refer to those occurring in Ontario hospitals, based on analysis of the Discharge Abstract Database, and do not include home births or births in other non-hospital settings. This section provides the number of events as well as information on preterm and low birth weight births as a proportion of total live births.

Mortality statistics are based on those who died during 2019/20, according to the Registered Persons Databased (RPDB) and other administrative databases. Death counts may differ from those available in Vital Statistics data (Statistics Canada). Values include the number of deaths and the mortality rate per 100,000 attributed population.

Births and Mortality in OHT Compared to Ontario

Measure	OHT	Ontario
In-Hospital Births
Number of live births	1,816	134,943
Number of preterm births (<37 weeks)	159	11,136
Preterm birth rate (<37 weeks) per 100 live births	8.8	8.2
Number of low birth weight births (<2,500 grams)	116	9,616
Low birth weight rate (<2,500 grams) per 100 live births	6.4	7.1
Mortality
Number of deaths	2,255	108,060
Mortality rate per 100,000 attributed population	1028.1	738.8

Mortality Rate per 100,000 Attributed Population – OHT and Ontario

3 Performance Indicators

This section includes performance indicators for the OHT for 2019/20 by quarter and is separated into those that measure access and effectiveness. The volumes associated with the indicators are also shown; in some instances, the volume will be the numerator of the performance indicator such as the number of readmissions while for others, it will be the number of cases such as the number of residents placed for the median time to LTC placement indicators. Indicators are based on the attributed population except for patients in hallway beds, which is based on hospitals in the OHT’s Network(s).

3.1 Access

Performance Indicators

			Quarter
Performance Indicator	Location	Measure	Q1	Q2	Q3	Q4
Wait time for first home care service (from hospital)	OHT	90th percentile wait time in days	7.0	7.0	8.0	9.0
	ON		8.0	8.0	8.0	9.0
Wait time for first home care service (from community)	OHT	90th percentile wait time in days	22.0	23.0	24.0	30.0
	ON		26.0	28.0	27.0	28.0
Percentage of home care clients with complex needs who received their personal support visit within 5 days	OHT	Percentage within 5 days	92.5	74.5	77.2	83.3
	ON		86.0	84.8	85.5	86.4
Percentage of home care clients who received their nursing visit within 5 days	OHT	Percentage within 5 days	94.9	94.7	93.9	95.1
	ON		95.8	96.1	95.2	95.5
Emergency department wait time for inpatient bed	OHT	Average wait time (in hours) to an inpatient bed	7.0	9.5	9.8	8.7
	ON		9.4	9.2	9.4	9.4
Time to initial assessment in emergency department	OHT	Average wait time (in hours) to initial assessment	1.4	1.4	1.5	1.4
	ON		1.6	1.6	1.6	1.5
Emergency department visits for conditions best managed elsewhere	OHT	ED visit rate per 1,000 attributed population age 1-74	6.8	5.3	7.3	6.7
	ON		3.1	2.6	3.3	3.5
Acute care patients who had a follow up with a physician within 7 days of discharge	OHT	Percentage with physician visit within 7 days of discharge	41.7	41.8	38.4	36.5
	ON		46.7	47.1	44.7	42.9
Median time to long-term care placement - overall	OHT	Median time to placement (in days)-overall	150.0	177.0	187.5	175.5
	ON		144.0	137.5	147.0	148.0
Median time to long-term care placement - from community	OHT	Median time to placement (in days)-from community	147.0	180.0	165.0	175.5
	ON		159.0	151.0	162.0	161.0
Median time to long-term care placement - from hospital (acute)	OHT	Median time to placement (in days)-from hospital (acute)	161.0	151.0	314.0	199.0
	ON		84.0	93.0	84.0	99.0

Volume

			Quarter
Performance Indicator	Location	Measure	Q1	Q2	Q3	Q4
Wait time for first home care service (from hospital)	OHT	Number of episodes	463	473	533	479
	ON		24,515	22,117	22,533	22,476
Wait time for first home care service (from community)	OHT	Number of episodes	715	733	700	704
	ON		35,790	36,405	35,529	33,045
Percentage of home care clients with complex needs who received their personal support visit within 5 days	OHT	Number of clients who received service within 5 days	49	35	44	50
	ON		4,066	3,695	3,881	3,974
Percentage of home care clients who received their nursing visit within 5 days	OHT	Number of clients who received service within 5 days	1,206	1,263	1,248	1,218
	ON		62,987	63,055	61,662	58,366
Emergency department wait time for inpatient bed	OHT	Total admitted visits, from ED	2,863	2,861	3,001	2,753
	ON		160,030	157,704	163,316	152,778
Time to initial assessment in emergency department	OHT	Total assessed ED visits	29,971	29,173	28,743	25,931
	ON		1,408,769	1,416,387	1,392,618	1,257,013
Emergency department visits for conditions best managed elsewhere	OHT	Total ED visits best managed elsewhere age 1-74	1,339	1,035	1,427	1,313
	ON		40,758	33,926	43,670	46,398
Acute care patients who had a follow up with a physician within 7 days of discharge	OHT	Patients with a physician visit within 7 days of discharge	371	350	336	296
	ON		21,648	19,837	20,498	19,530
Median time to long-term care placement - overall	OHT	Number of residents placed-overall	127	139	140	140
	ON		5,794	5,228	5,814	6,217
Median time to long-term care placement - from community	OHT	Number of residents placed-from community	101	111	118	104
	ON		4,454	4,061	4,370	4,395
Median time to long-term care placement - from hospital (acute)	OHT	Number of residents placed-from hospital (acute)	20	19	19	32
	ON		907	795	922	1,202

3.2 Effectiveness

Performance Indicators

			Quarter
Performance Indicator	Location	Measure	Q1	Q2	Q3	Q4
Alternate level of care (ALC) Days	OHT	Percentage ALC days of total days	24	19.8	18.3	26.0
	ON		16.8	16.9	18.3	19.9
30-day readmission rate for selected conditions	OHT	Crude readmission ratio (percent)	16.4	18.6	18.5	15.4
	ON		16.6	17	16.5	15.4
Repeat ED visits within 30 days for mental health and substance abuse conditions	OHT	Rate of repeat ED visits within 30 days (percent)	23.5	25.5	21.6	24.2
	ON		26.1	26.7	24.8	24.9
Hospital stay extended until home care services or supports are ready	OHT	Median ALC length of stay for discharges to home care	6	7	7	8.5
	ON		7	7	7	7.0
Frequent ED visits (4+/year) for mental health and addictions	OHT	Frequent ED visits, crude readmission rate (percent)	Fiscal Year Results Only			9.7
	ON		Fiscal Year Results Only			10.2
Hospitalizations for ambulatory care sensitive conditions (ACSC)	OHT	ACSC hospitalization rate per 100,000 attributed population age 0-74	121.3	121.3	122.3	132.4
	ON		84.3	75	82.5	82.1
Patients in hallway beds (ER stretchers and beds in unconventional spaces)^	OHT	Average number of hallway healthcare patients	19.4	23.4	26.6	29.2
	ON		968.2	902.1	1006.7	1,247.1
Note:
^Q4 data for this indicator includes the period from January 1 2020 to February 17 2020. Data in the daily Bed Census Summary after February 17 2020 are not directly comparable because of changes in the definition of hallway health care as of that date.

Volume

			Quarter
Performance Indicator	Location	Measure	Q1	Q2	Q3	Q4
Alternate level of care (ALC) Days	OHT	Total ALC days	7,955	6,047	6,066	9,150
	ON		295,781	282,510	326,439	367,489
30-day readmission rate for selected conditions	OHT	Readmissions	146	156	162	125
	ON		7,694	7,134	7,531	6,998
Repeat ED visits within 30 days for mental health and substance abuse conditions	OHT	Number of repeat ED visits within 30 days	308	338	277	313
	ON		19,391	19,236	17,873	17,262
Hospital stay extended until home care services or supports are ready	OHT	Hospital discharges to home care with ALC days	55	61	66	50
	ON		3,801	3,425	3,655	4,087
Frequent ED visits (4+/year) for mental health and addictions	OHT	Patients with 4+ ED visits for mental health and addictions	Fiscal Year Results Only			361
	ON		Fiscal Year Results Only			19543
Hospitalizations for ambulatory care sensitive conditions (ACSC)	OHT	Number of ACSC hospitalizations age 0-74	240	240	242	262
	ON		11,330	10,075	11,086	11,027
Patients in hallway beds (ER stretchers and beds in unconventional spaces)^	OHT	Number of hallway healthcare patients	1,761	2,156	2,444	1,402
	ON		88,108	82,989	92,619	59,863
Note:
^Q4 data for this indicator includes the period from January 1 2020 to February 17 2020. Data in the daily Bed Census Summary after February 17 2020 are not directly comparable because of changes in the definition of hallway health care as of that date.

4 Hospital Inpatient Care

Measures relating to inpatient hospital care, including acute care, inpatient rehabilitation, inpatient mental health, and complex continuing care, are summarized here. Data collection for acute care is based on the Discharge Abstract Database which provides information about ‘separations’ or discharges and lengths of stay. The National Rehabilitation Reporting System provides information about patients admitted to and discharged from adult inpatient rehabilitation units or hospitals in Ontario. The inpatient rehabilitation section summarizes the number of active cases, or cases that received one or more day of treatment within the fiscal year and the number of days of treatment received within the fiscal year.

The inpatient mental health section uses information from the Ontario Mental Health Reporting System and includes active cases in adult designated mental health units in Ontario hospitals and the associated days of treatment within the fiscal year. Complex Continuing Care (CCC) provides active cases and associated inpatient days within the fiscal year from the Continuing Care Reporting System RUG-weighted patient day dataset.

Acute Inpatient days (total, acute, ALC) refer to the inpatient days spent in hospital, as recorded at the time of the hospital separation. CCC, Rehabilitation and Mental Health days refer to the inpatient days spent in the respective units during 2019/20 only.

Hospital Inpatient Care Indicators in OHT Compared to Ontario

Measure	OHT	Ontario
Hospital Inpatient Days
Inpatient acute, total days excluding newborns and stillbirths	131,952	7,069,687
Inpatient rehabilitation, days in year	13,644	942,428
Inpatient adult mental health, days in year	54,968	1,647,094
Inpatient CCC, days in year	25,808	1,641,587
Total inpatient hospital days (acute, rehabilitation, mental health, CCC)	226,372	11,300,796
Acute Inpatient (excluding newborns and stillbirths)
Number of patients with at least 1 acute care overnight stay	13,196	764,045
Number of acute separations	17,938	1,041,327
Number of acute separations that were from hospitals in the OHT	15,305	NA
Percentage of acute separations that were from hospitals in the OHT	85.3	NA
Acute separation rate per 1,000 attributed population	81.8	71.2
Number of ALC separations	1,055	58,572
Acute days	102,734	5,797,446
ALC days	29,218	1,272,217
Total days	131,952	7,069,687
Number of total days that were from hospitals in the OHT	118,059	NA
Percentage of total days that were from hospitals in the OHT	89.5	NA
Total day rate per 1,000 attributed population	601.6	483.4
Average acute length of stay (days)	5.7	5.6
Average ALC length of stay (days)	27.7	21.7
Average total length of stay (days)	7.4	6.8
Inpatient Rehabilitation*
Number of patients with at least 1 rehabilitation overnight stay	396	33,007
Number of inpatient rehabilitation active cases	431	35,545
Inpatient rehab active case rate per 1,000 attributed population	2	2.4
Inpatient rehabilitation, days in year	13,644	942,428
Inpatient Mental Health
Number of patients with at least 1 mental health overnight stay	865	45,488
Number of inpatient mental health active cases	1,141	65,932
Inpatient mental health active case rate per 1,000 attributed population	5.2	4.5
Inpatient mental health, days in year	54,968	1,647,094
Inpatient Complex Continuing Care (CCC)
Number of patients with at least 1 CCC overnight stay	474	26,186
Inpatient CCC active cases	490	28,218
Inpatient CCC active case rate per 1,000 attributed population	2.2	1.9
Inpatient CCC, days in year	25,808	1,641,587
Note:
*Inpatient Rehabilitation also includes activity at Holland Bloorview Kids Rehabilitation Hospital
In this table, NA refers to Not Applicable

5 Hospital Ambulatory Care

The ambulatory care section summarizes information for emergency department, day surgery, ambulatory oncology and ambulatory dialysis as reported in the National Ambulatory Care Reporting System (NACRS).

The emergency department visits section includes the number of patients; number of patients by visit frequency within the fiscal year; total visits; ED visit rates; visits by Canadian Triage and Acuity Scale (triage) level; number of visits that arrived by ambulance; and number of visits that were admitted to inpatient care.

For the purposes of this analysis day surgery visits also include cardiac catheterization visits. Ambulatory oncology includes outpatient chemotherapy and radiation therapy visits to Ontario hospitals. Ambulatory dialysis includes hemodialysis and peritoneal dialysis treatment occurring in Ontario hospital and reported to NACRS. Reporting for day surgery, ambulatory oncology and dialysis includes the number of distinct patients who received treatments in the year, the total number of visits and the number of visits per 1,000 attributed population.

The Attributed Population in the table below has been revised (September 2021).

Hospital Ambulatory Care Indicators in OHT Compared to Ontario

Measure	OHT	Ontario
Unscheduled Emergency Department (ED) Visits and Patients
Number of patients with at least one ED visit in the year	64,436	3,404,992
Patients with 1 ED visit during the year	37,757	2,127,401
Patients with 2-4 ED visits during the year	22,732	1,109,018
Patients with 5+ ED visits during the year	3,947	168,573
Attributed population	221,796	14,626,516
Percentage of attributed population with 1 ED visit	17.2	14.5
Percentage of attributed population with 2-4 ED visits	10.4	7.6
Percentage of attributed population with 5+ ED visits	1.8	1.1
Unscheduled Emergency Department Visits, Total and by CTAS Level
Number of ED visits	123,923	6,150,548
ED visit rate per 1,000 attributed population	565	420.5
Number of CTAS Level I & II ED visits	18,432	1,399,407
CTAS Level I & II visits as a percentage of all ED visits	14.9	22.8
Number of CTAS Level III ED visits	54,517	2,953,607
CTAS Level III visits as a percentage of all ED visits	44	48
Number of CTAS Level IV and V ED visits	50,703	1,774,290
CTAS Level IV & V visits as a percentage of all ED visits	40.9	28.9
Unscheduled Emergency Department Visit Characteristics
Number of ED visits that arrived by ambulance	20,079	1,018,062
Percentage of ED visits that arrived by ambulance	16.2	16.6
Number of ED visits that were admitted	11,478	633,828
Percentage of ED visits that were admitted	9.3	10.3
Day Surgery / Cardiac Catheterization Visits
Number of patients with at least one day surgery/cardiac catheterization visit in the year	17,420	1,024,610
Number of day surgery/cardiac catheterization visits	22,043	1,316,574
Day surgery/cardiac catheterization visit rate per 1,000 attributed population	100.5	90
Ambulatory Dialysis Visits
Number of patients with at least one ambulatory dialysis visit in the year	269	22,519
Number of ambulatory dialysis visits	26,946	1,315,311
Ambulatory dialysis visit rate per 1,000 attributed population	122.8	89.9
Ambulatory Oncology Visits
Number of patients with at least one ambulatory oncology visit in the year	1,568	93,506
Number of ambulatory oncology visits	18,662	1,130,560
Ambulatory oncology visit rate per 1,000 attributed population	85.1	77.3
Note:
CTAS (triage) levels: The Canadian Triage and Acuity Scale (CTAS) developed by the Canadian Association of Emergency Physicians (CAEP) is used by hospital emergency departments to prioritize patients’ care according to the type and severity of their presenting signs and symptoms. The levels are: CTAS I: Resuscitation, CTAS II: Emergent, CTAS III: Urgent, CTAS IV: Less Urgent, CTAS V: Non-urgent

6 Long Term Care (LTC) and Home Care

Measures relating to long-term care and home care are shown for the attributed population. Included is a count of residents in long-term care homes as of March 31, 2020, residents per 1,000 attributed population age 75 and older, the proportion of LTC residents in long-stay beds and the average age of LTC residents. Also shown is the number of individuals on the wait list for LTC on March 31, 2020. For home care, the number of clients receiving home care services in 2019/20 is shown as are service volumes by type. Also included is the number of home care admissions by referral source—community vs hospital.

LTC Indicators in OHT Compared to Ontario

Measure	OHT	Ontario
Number of LTC residents on March 31, 2020	1,488	75,635
LTC resident rate per 1,000 attributed population age 75+	69.2	63.7
Percentage of LTC residents that are long-stay	98	98
Mean age of LTC residents	83.6	83.5
Number of people on the LTC waitlist on March 31, 2020	693	37,838

Home Care Indicators in OHT Compared to Ontario

Measure	OHT	Ontario
Number of clients that received home care services	9,841	519,960
Number of admissions by referral source: community	2,725	144,887
Number of admissions by referral source: hospital	3,941	205,618
Home Care Service Volumes by Service Type
Number of nursing visits	157,889	7,476,417
Number of PT, OT, SLT visits*	33,053	1,227,656
Number of PSW & homemaking hours	505,812	33,264,181
Note:
* PT = Physical Therapy; OT = Occupational Therapy and SLT = Speech Language Therapy

7 Primary Care

An analysis of primary care for the attributed population is shown below. Primary care enrolment is based on the status recorded in the Client Agency Program Enrolment (CAPE) database as of March 31, 2020. Residents with fee-for-service (FFS) providers are those who were not enrolled to a PEM on March 31, 2020.

Also shown are primary care visits. These include visits for all individuals regardless of their enrolment status. Primary care visits are defined as those services (i.e., the fee schedule codes) that are covered by a PEM physician’s capitation payment (those services that the physicians do not get paid for individually). These visits include the most common services provided by primary care physicians such as: minor, intermediate, and general assessments, periodic health visits, well baby visits, some counselling/psychotherapy, basic procedures/tests involving skin lesions, the cardiovascular or pulmonary systems, allergies, immunizations, and diabetic management.

Also included are visits to providers outside the enrolling group; enrolled seniors who received house calls; emergency department visits and low acuity emergency department visits for enrolled patients; and the attributed population that is in a Family Health Team (FHT).

Primary Care Indicators in OHT Compared to Ontario

Measure	OHT	Ontario
Number of enrolled patients	175,868	11,055,231
Number with FFS providers (i.e., not enrolled to a PEM)	43,476	3,571,285
Number of primary care visits	681,832	49,613,810
Average number of primary care visits per person	3.1	3.4
Percentage of primary care visits made outside of enrolling group	10.9	21.3
Percentage of enrolled seniors who received house calls	1.3	2.1
Number of enrolled patients with any ED visit	51,010	2,526,131
Rate of CTAS IV/V ED visits per 1,000 enrolled patients	222.2	116.9
Number of attributed population in a Family Health Team (FHT)	96,056	3,404,197
Percentage of the attributed population in a FHT	43.8	23.3

8 Primary Care Patient Enrolment Models (PEMs)

The table below lists the Primary Care Patient Enrolment Models (PEMs) that the attributed population is attached to. The last column in the table flags PEMs where the attributed population is shared between this OHT, and at least one other, based on the alignment of physicians and rostered patients within the PEM.

This table was revised (September 2021) to add a PEM that was re-assigned from another OHT.

PEMs Associated with OHT

PEM Number	Type	Name	Address	Municipality	Family Health Team (FHT)	Some PEM patients are assigned to a different OHT
FXGC	FHG	MEADOWBROOK FHG	B-540 ARMSTRONG ROAD	KINGSTON		No
BADE	FHO	KINGSTON FHO	200-2437 PRINCESS STREET	KINGSTON	Kingston FHT	No
BADR	FHO	MAPLE FHO	D2-1036 PRINCESS ST	KINGSTON	Maple FHT	No
BADT	FHO	RICHMOND FHO	307 BRIDGE ST W	NAPANEE		No
BAJB	FHO	ISLANDVIEW FHO	J-6 SPEERS BLVD	AMHERSTVIEW		No
BAMB	FHO	AMHERSTVIEW FHO	101-200 SPEERS BLVD	AMHERSTVIEW	Loyalist FHT	No
BAE7	FHO	FRONTENAC ISLANDS FHO	102 ROAD 95	WOLFE ISLAND		No
BAHK	FHO	MIGHTY DOCS FHO	310 BRIDGE ST WEST	NAPANEE		No
BAYR	FHO	QUEEN’S FHO	220 BAGOT STREET	KINGSTON	Queen’s FHT	No
BHBC	CSA	LAKELANDS FHT-SALARIED PHYSICIANS	12357 HIGHWAY 41	NORTHBROOK		No
FAAF	FHG	CATARAQUI FHG	MEDICAL CENTRE	KINGSTON		No
B465	COE	DR MARIAN LUKA COE	175 PRINCESS STREET	KINGSTON		No
BAAL	FHO	RURAL KINGSTON PCN	6582 HWY 38	VERONA		No
FXAX	FHG	NEWTON FHG	201-190 WELLINGTON STREET	KINGSTON		No
FDAH	FHG	GREAT LAKES FHG	182 BAGOT ST	KINGSTON		No
FDAV	FHG	FRONTENAC MEDICAL ASSOCIATES FHG	791 PRINCESS ST	KINGSTON		No
BANU	FHO	THOUSAND ISLAND FHO	1-106 DRYNAN WAY	SEELEYS BAY	Upper Canada FHT	No
BAPT	FHO	GREENWOOD FHO	10-496 DISCOVERY AVE	KINGSTON		No
BAF1	FHO	PRIMUS HEALTH FHO	2-4048 PERTH ROAD	INVERARY		No

9 COVID-19 Indicators

This section includes COVID-19 cases, hospitalizations and fatalities for the OHT and Ontario as a whole. Data are from the Case and Contact Management System (CCM), which collects information on all COVID-19 cases in the province.

For this analysis, the attributed population is linked directly to CCM to identify cases and outcomes in the attributed population to March 31, 2021. Because the attributed population includes Ontario residents as of March 31, 2020, some COVID-19 cases will not be included in the provincial totals for new arrivals to the province; people that may have lived in the province but did not have health care eligibility; or newborns after that date.

COVID-19 Indicators in OHT Compared to Ontario

Measure	OHT	Ontario
Number of COVID-19 cases	799	354,428
COVID-19 case rate per 100,000 attributed population	364.3	2,401.1
Hospitalized COVID-19 cases	35	18,351
Hospitalized COVID-19 cases per 100,000 attributed population	16	124.3
Fatal cases	11	7,742
COVID-19 fatality rate per 100,000 attributed population	5	52.4

10 Health Conditions

This table presents measures relating to health conditions within the attributed population, based on the Canadian Institute for Health Information (CIHI) Population Grouper; it includes everyone who has been diagnosed with the indicated condition. Individuals can be counted under more than one condition. The Health Conditions shown are identified from inpatient (acute, adult mental health, CCC), emergency department, day surgery/cardiac catheterization, ambulatory oncology, ambulatory dialysis, LTC, home care, and physician claims administrative data. Because a patient might have more than one health condition the sum of conditions will be greater than the size of the attributed population.

The Health Conditions shown are best used to estimate the prevalence of conditions. In the CIHI methodology, Health Conditions can be used to assign each person to a single main Health Profile Group (HPG) that identifies the most complex and clinically relevant health condition present for the patient. Analysis of HPGs is not presented in this document.

CIHI Health Conditions in OHT Compared to Ontario

CIHI Grouper Condition Code	Condition	OHT Count	OHT Rank	Ontario Count	Ontario Rank
A01	Congenital Malformation of the Nervous System (incl. Spina Bifida)	111	208	5,923	211
A02	Hereditary/Degenerative Condition of the Nervous System	567	153	19,050	183
A03	Muscular Dystrophy & Other Myopathy	242	193	9,197	199
A04	Parkinson’s Disease/Parkinsonism	784	140	37,296	151
A05	Multiple Sclerosis & Other Demyelinating Disease of CNS	520	159	27,348	167
A06	Cerebral Palsy	190	198	8,367	201
A07	Paralytic Syndrome/Spinal Cord Injury	442	167	28,227	166
A08	Disorder of the Peripheral Nervous System (incl. Carpal Tunnel, Bells Palsy)	2,151	87	122,606	99
A09	Epilepsy	1,398	111	75,110	114
A10	Other Cerebral and Spinal Disease/Disorder	590	150	45,213	139
A11	Other Disease of the Nervous System	818	139	58,846	127
A41	Stroke	1,136	120	64,632	122
A42	Cerebrovascular Disorder (excl. Stroke)	573	151	28,503	165
A43	Transient Ischemic Attack	1,031	127	61,264	126
A44	Intracranial Injury	572	152	46,080	138
A45	Skull Fracture	69	214	3,921	214
A46	Concussion	3,729	53	182,058	69
A47	Infection/Inflammation Nervous System	468	163	17,030	188
A48	Nerve Injury	166	200	6,698	206
A81	Coma Unspecified	36	219	1,935	221
A82	Seizure	328	178	17,131	187
A83	Migraine/Other Headache	4,240	45	247,121	53
A84	Neurological, Sensory, Cognitive Signs & Symptoms	2,919	71	177,406	72
B01	Cataract/Lens Disorder	4,418	43	296,681	44
B02	Retinopathy	4,017	50	164,100	77
B03	Strabismus	1,535	104	52,204	134
B04	Disorder of the Eyelids & Lacrimal System	4,784	39	352,959	35
B05	Vision Impairment (incl. Blindness)	882	135	40,450	145
B06	Glaucoma	7,714	27	325,592	38
B07	Other Eye Diseases & Disorders	3,083	68	135,048	92
B41	Retinal Break/Detachment	504	161	26,360	169
B42	Infection/Inflammation Eye	8,342	24	698,833	21
B43	Injury of Eye and Periocular Area	4,201	46	195,262	63
C01	Congenital/Acquired Malformation of Ear/Nose/Throat	277	186	17,886	185
C02	Disease of Oral Cavity, Salivary Gland, or Jaw	2,115	89	110,490	101
C03	Dental Caries/Gingivitis	3,350	62	187,711	66
C04	Chronic Upper Respiratory Condition (incl. Tonsillitis)	2,902	72	211,483	62
C05	Hearing Loss (incl. Deafness)	1,582	102	80,270	111
C06	Disorder of External Ear	6,157	33	391,851	32
C07	Other Disease Middle/Inner Ear & Mastoid	1,916	94	162,410	79
C08	Meniere’s/Dizziness/Vertigo	3,561	55	178,462	71
C41	Otitis Media	10,630	19	744,340	18
C42	Acute ENT Upper Respiratory Condition (incl. Benign Neoplasm Croup)	36,318	2	3,606,550	1
D01	Pleural Disease (incl. Pleural Effusion)	769	141	38,330	149
D02	Congenital Disorder of the Respiratory System	62	215	2,983	217
D03	Chronic Obstructive Pulmonary Disease	4,115	48	187,306	67
D04	Pulmonary Hypertension	178	199	6,341	208
D05	Other Chronic Lung Disease	748	143	36,631	152
D06	Asthma	4,338	44	312,456	43
D41	Respiratory Failure	460	164	24,791	170
D42	Pneumonia	8,935	23	498,515	25
D43	Acute Infectious/Parasitic Respiratory Disease (excl. Pneumonia)	249	191	24,216	175
D44	Acute and Other Respiratory Diseases & Disorders	12,708	14	1,090,960	9
D81	Signs Symptoms Respiratory System	13,432	12	1,048,230	10
E01	Heart Failure	3,190	66	163,710	78
E02	Malformation of the Cardiovascular System	243	192	30,037	161
E03	Cardiac Valve Disease	402	171	16,833	190
E04	Coronary Artery Disease	3,197	65	194,920	64
E05	Arrhythmia	6,387	32	329,560	37
E06	Other Heart Disease	4,679	40	244,150	54
E07	Peripheral Venous Disease/Phlebitis/Thrombophlebitis/DVT	1,499	106	87,729	110
E08	Uncomplicated Varicose Veins	566	154	61,797	124
E09	Other Vascular System Disease	2,170	85	159,671	80
E10	Hypertension	16,714	8	1,327,151	4
E11	Aortic Aneurysm	197	197	9,212	198
E12	Peripheral Artery Disease	446	166	24,304	174
E41	Acute Myocardial Infarction/Shock/Arrest	1,211	115	65,959	120
E43	Unstable Angina	359	176	29,952	162
E82	Signs Symptoms Cardiovascular System	14,425	11	1,091,943	8
F01	Congenital Malformation of the Digestive & Hepatobiliary System	93	212	5,652	212
F02	Gastroesophageal Reflux Disease	1,823	98	68,835	119
F03	Other Disease of the Esophagus	2,686	78	149,453	87
F04	Gastritis & Duodenitis	2,698	76	404,891	31
F05	Hernia	2,699	75	180,600	70
F06	Inflammatory Bowel (incl. Crohn’s Ulcerative Colitis)	1,910	95	102,570	103
F07	Vascular Disorder of Intestine (incl. Ischemic Bowel)	318	179	11,421	194
F08	Diverticulitis	2,452	82	176,448	73
F09	Hemorrhoids	1,671	100	124,328	98
F10	Benign Neoplasm/Polyp Colon Rectum Anus	5,846	35	267,619	50
F11	Other Rectal/Anal Disorder	2,076	91	154,039	83
F12	Other Disease/Disorder of the Digestive System	2,849	73	137,624	90
F41	Acute Gastrointestinal Infection	10,795	18	859,130	13
F42	Unspecified Gastrointestinal Hemorrhage	698	144	40,873	144
F43	Gastrointestinal Obstruction	1,088	125	56,622	131
F44	Peptic Ulcer	860	137	57,328	129
F45	Peritoneal Disease (incl. Peritonitis)	346	177	24,749	171
F46	Disease of Appendix	925	132	55,574	132
F81	Signs Symptoms Digestive & Hepatobiliary System	22,249	3	2,003,451	3
F82	Abdominal Pain	2,927	70	186,143	68
G01	Cirrhosis	650	145	30,552	159
G02	Chronic Liver Disease (incl. Hepatitis)	455	165	23,013	177
G03	Pancreatic Disease	529	158	31,453	158
G04	Acute Liver Disease & Other Hepatic Disorders	2,230	83	223,712	58
G05	Diseases of Gallbladder & Biliary Tract	1,823	99	100,045	106
H01	Rheumatoid & Other Inflammatory Arthropathy (excl. Gout)	2,611	80	124,623	97
H02	Osteoarthritis	8,141	25	496,496	26
H03	Crystal Arthropathy (incl. Gout)	2,142	88	152,885	85
H04	Osteoporosis	752	142	41,424	143
H05	Other Bone Disease	1,563	103	133,115	94
H06	Vertebral/Disk & Other Disease of Back	7,033	31	536,784	24
H07	Systemic Connective Tissue Disorder (incl. Lupus, Scleroderma)	880	136	50,370	136
H08	Musculoskeletal Malformation (excl. Spine)	3,682	54	215,797	61
H09	Myositis and Soft Tissue Disorder (incl. Muscle Inflammation)	7,365	29	439,058	29
H10	Other Musculoskeletal & Connective Tissue Condition	104	209	7,111	204
H41	Traumatic Amputation Arm/Hand/Leg/Foot	5	226	170	226
H42	Fracture/Dislocation Vertebrae, Pelvis	1,481	107	61,815	123
H43	Fracture Femur	960	129	49,688	137
H44	Other Fracture/Dislocation	11,659	16	762,351	17
H45	Benign/Unspecified Musculoskeletal Neoplasm	544	156	34,922	155
H46	Joint/Tendon Disorder and Injury (incl. Pain, Sprain, Strain)	45,946	1	3,338,788	2
H47	Musculoskeletal Infections	918	133	42,994	141
H81	Neuromuscular Signs & Symptoms	12,430	15	845,662	14
H82	Back Pain	2,671	79	134,534	93
I01	Autoimmune Skin Disorder	18	225	1,218	224
I02	Papulosquamous Disorder/Psoriasis	1,094	124	57,673	128
I03	Eczema/Dermatitis/Hives	9,192	21	717,242	20
I04	Acne/Rosacea	1,425	109	154,838	82
I05	Skin Ulcer (incl. Decubitus)	1,146	119	40,343	146
I06	Benign Skin Neoplasm	8,060	26	628,986	22
I07	Benign Disorder of Breast	3,921	52	347,417	36
I08	Disease of Hair/Nail/Sweat Glands	8,946	22	241,537	55
I09	Other Condition of Skin/Subcutaneous Tissue	11,053	17	827,423	16
I41	Serious Burn/Frostbite	38	218	2,135	219
I42	Skin Infection (incl. Cellulitis)	18,035	5	1,160,782	6
I43	Superficial Skin Injury/Contusion/Non-Serious Burn	15,256	9	737,029	19
I81	Signs Symptoms Skin	950	130	44,966	140
J01	Cystic Fibrosis	33	221	831	225
J02	Diabetes Mellitus	17,851	6	1,149,976	7
J03	Goitre	267	188	38,935	147
J04	Hyperthyroidism	366	175	36,581	153
J05	Hypothyroidism	2,182	84	224,930	57
J06	Adrenal Disorder	199	196	10,967	195
J07	Other Disease of the Endocrine System	1,150	118	113,884	100
J08	Malnutrition & Vitamin Deficiency	2,563	81	271,190	49
J09	Hypercholesterolaemia and other Dyslipidemia	1,394	112	291,743	45
J10	Obesity	4,497	42	322,225	41
J11	Disorder of Electrolyte Acid Base Balance	2,691	77	158,227	81
J12	Hypoglycemia	55	217	3,517	215
J13	Other Disorders of Metabolism	2,058	92	92,306	108
K01	Chronic Kidney Disease/Failure	2,088	90	152,978	84
K02	Benign/Unspecified Urinary Neoplasm	302	182	38,419	148
K03	Other Disease/Disorder Bladder & Urethra	15,023	10	1,034,368	11
K04	Other Disease of the Urinary System	293	184	18,041	184
K05	Prostate Disorder	2,166	86	165,685	74
K06	Other Disease of the Male Reproductive System	2,009	93	149,400	88
K07	Urinary Incontinence (Stress)	1,122	122	76,391	112
K41	Acute/Other Kidney Disease/Failure	3,527	58	239,266	56
K42	Urinary Tract Infection/Cystitis	13,424	13	844,497	15
K43	Urinary Obstruction & Retention	3,321	63	223,075	59
K81	Signs, Symptoms Urinary	1,199	116	132,476	95
L01	Female Infertility	937	131	102,119	105
L02	Menstruation Disorder (incl. Menopause)	4,121	47	388,679	33
L03	Congenital/Other Female Reproductive Condition	5,541	38	379,413	34
L04	Endometriosis/Pelvic Inflammatory Disease	646	146	42,791	142
L05	Other Uterine, Fallopian, Ovarian Condition (incl. Prolapse, Fistula)	1,841	96	136,601	91
M41	Antepartum Condition	1,255	113	102,150	104
M42	Unsuccessful/Ectopic Pregnancy	1,407	110	107,236	102
M43	Completed Pregnancy	3,482	60	256,371	51
N41	Extremely Low Birth Weight or Immaturity	19	224	1,466	222
N42	Serious Perinatal Condition	407	169	29,551	163
N43	Complicated Neonatal Condition	516	160	34,737	156
N44	Healthy Newborn	2,939	69	220,376	60
O01	Disease of White Blood Cells (incl. Neutropenia)	284	185	22,553	178
O02	Anemia Disorder (excl. Nutritional)	1,526	105	128,444	96
O03	Coagulation & Hemorrhagic Disorder	889	134	61,655	125
O04	Spleen Disorder	29	223	1,292	223
O05	Lymphatic System Disorder (excl. Spleen)	384	174	28,804	164
O06	Disorder of Immune Mechanism	103	210	6,668	207
O07	Other Disease of Blood & Blood Forming Organs	834	138	72,050	117
P01	Human Immunodeficiency Virus (HIV) Infection	134	204	16,913	189
P02	Tuberculosis Disease	161	201	38,190	150
P03	Sexually Transmitted Disease (excl. HIV)	3,228	64	280,170	47
P41	Sepsis	605	149	50,435	135
P42	Influenza	4,540	41	319,829	42
P43	Other Viral Infection	20,478	4	1,319,384	5
P44	Other Bacterial Infection	2,705	74	149,505	86
P45	Other & Unspecified Infection	4,055	49	322,994	40
Q01	Dementia (incl. Alzheimer’s)	3,428	61	189,599	65
Q02	Delusional Disorder (incl. Schizophrenia)	1,628	101	93,354	107
Q03	Mental Disorder Resulting from Brain Injury or Other Illness	77	213	6,097	210
Q04	Depression	5,906	34	323,485	39
Q05	Bipolar/Manic Mood Disorder	1,840	97	90,180	109
Q06	Personality Disorder	634	148	24,311	173
Q07	Drug/Alcohol Abuse/Dependence	5,694	36	278,561	48
Q08	Eating Disorder	115	205	6,169	209
Q09	Intellectual Disorder/Delay	395	173	8,537	200
Q10	Developmental Disorder (incl. Autism Spectrum)	1,124	121	75,479	113
Q11	Neurotic/Anxiety/Obsessive Compulsive Disorder	17,691	7	997,937	12
Q12	Adjustment Reaction/Stress	3,179	67	165,260	75
Q13	Emotional and Behavioural Disorder with Onset Generally in Childhood	3,524	59	148,690	89
Q14	Other/Unspecified Mental Disorder/Condition	299	183	22,140	179
Q81	Delirium	316	180	21,840	180
Q82	Mental Health Signs & Symptoms	7,508	28	454,161	28
R01A	Brain Cancer	100	211	8,304	202
R02C	Oral/Ear/Nose/Throat Cancer	403	170	21,186	181
R03D	Lung Cancer	472	162	24,404	172
R04F	Colorectal Cancer	555	155	30,417	160
R05F	Other Digestive & Hepatobiliary Cancer	251	190	20,054	182
R06H	Musculoskeletal Cancer	113	207	7,100	205
R07K	Renal Cancer	409	168	16,805	191
R08I	Breast Cancer	1,159	117	74,494	115
R09I	Skin Cancer	5,596	37	284,178	46
R10J	Thyroid Cancer	241	194	36,042	154
R11K	Prostate Cancer	1,227	114	74,344	116
R12K	Bladder Cancer	635	147	32,047	157
R13L	Ovarian Cancer	32	222	2,064	220
R14L	Uterine Cancer	158	202	10,459	196
R15L	Cervical Cancer	543	157	17,668	186
R16O	Leukemia/Lymphoma	1,035	126	57,166	130
R17	Other & Unspecified Primary Cancer	988	128	54,082	133
R18	Metastatic Cancer	1,099	123	64,815	121
S01	Palliative State	1,468	108	69,946	118
S02	Chromosomal/Other/Unspecified Congenital Syndrome/Disorder	303	181	26,531	168
S03	Transplant Recipient	138	203	7,942	203
S04	Presence of Ostomy	274	187	14,043	193
S41	Transplant Complication	57	216	2,330	218
S42	Orthopedic Complication	221	195	9,893	197
S43	Ostomy Complication	113	206	5,245	213
S44	Poisoning/Adverse Effects	7,351	30	459,252	27
S45	Other Trauma/Injury (Not Elsewhere Classified)	3,993	51	405,969	30
S46	Other Complication of Medical or Surgical Care	3,550	57	164,510	76
S47	Shock	33	220	2,992	216
S48	Open Wound	9,651	20	583,750	23
S49	Internal Trauma	398	172	23,910	176
S50	Reaction to Transfusion, Medication or Anaesthesia	260	189	14,458	192
S81	General Signs, Symptoms (Not Elsewhere Classified)	3,556	56	251,973	52

11 General Concepts

Rounding of Values

Decimal values are rounded to the nearest tenth (0.1). Percentages, rates, and ratios appearing as whole numbers are rounded from .0 to the nearest whole number.

Small Cell Suppression Appearing as “NA”

Small cell counts (<5) and calculations based on these counts are suppressed and are shown as “NA”. There are a few exceptions, in Section 1.5 Attributed Population by Census Sub-Division (CSD) and in Section 4 Hospital Inpatient Care, “NA” refers to Not Applicable.

Ontario Health Teams

Ontario Health Teams are groups of providers and organizations that are clinically and fiscally accountable for delivering a full and coordinated continuum of care to a defined population.

Network

Refers to virtual multispecialty physician networks comprised of primary care physicians and specialists and the hospital where most their patients are admitted to. Networks are designed around existing patterns of patient flow and not constrained geographically. The analysis to determine Networks was conducted by IC/ES using health administrative data.

Attributed Population

Attribution is a process for determining the population of Ontario residents an Ontario Health Team will be clinically and fiscally accountable for. The Attributed Population for an OHT refers to the total patient population of the Network or Networks that best align to the OHT. The method for assigning the attributed population is based on the methodology originally developed by IC/ES, and adapted by Health Sector Models Branch, MOH.

12 Performance Indicator Notes

Wait time for first home care service (from hospital)

Data Source

Homecare Database 2019/20 Q4; Discharge Abstract Database (DAD), 2019/20 Q4; Health Data Branch SAS Server, Ministry of Health, extracted June 2021.

Calculation Notes

This indicator is also known as 90th percentile wait time from hospital discharge to service initiation for home and community care.

Wait time = Number of days between Discharge Date and first service date

Service Date = April 1, 2019 - March 31, 2020

Home Care Program Types = In-Home (01)

Service Type is NOT EQUAL to Case Management (10); Placement Services (14); Other (99)

Referral source is hospital 1 (general hospital-outpatient), 2 (general hospital-inpatient), 3 (special hospital-outpatient), or 4 (special hospital-inpatient) and matching hospital discharge record is found

Service category is EQUAL to In-Home services (91-95)

Wait Time is between 0 and 365 Days

Calculations are aligned with the methodology in the Ministry-LHIN Accountability Agreement (MLAA) technical specifications.

Wait time for first home care service (from community)

Data source

Homecare Database (HCD), 2019/20 Q4; Health Data Branch SAS Server, Ministry of Health, extracted June 2021.

Calculation Notes

This indicator is also known as 90th percentile wait time from community for in-home services: Application from community setting to first service (excluding case management)

Wait time= Number of days between Application Date and first Service Date

Service Date = April 1, 2019 - March 31, 2020

Home Care Program Types = In-Home (01)

Service Type is NOT EQUAL to Case Management (10); Placement Services (14); Other (99)

Referral source is Community, i.e. NOT EQUAL to 1 (general hospital-outpatient), 2 (general hospital-inpatient), 3 (special hospital-outpatient), or 4 (special hospital-inpatient)

Service category is EQUAL to In-Home services (91-95)

Wait Time is between 0 and 365 Days

Calculations are aligned with the methodology in the MLAA technical specifications.

Percentage of home care clients with complex needs who received their personal support visit within 5 days

Data source

Homecare Database (HCD), 2019/20 Q4; Health Data Branch SAS Server, Ministry of Health, extracted June 2021.

Calculation Notes

Service Date = April 1, 2019 - March 31, 2020

Home Care Program Types = In-Home (01)

Service Type is Personal support work (11,12,13,15)

Client is designated as Complex =CCM=1

Service is delivered in in-home setting (Care Site NOT equal to 12,24,25)

Service category is EQUAL to In-Home services (91-95)

Age at Start Date of episode of care is greater than 18

Service Date is BETWEEN Episode of care Start Date and End Date (i.e. authorization/patient availability date)

On Hold dates do NOT fall between the start of episode and service date

Wait Time is between 0 and 365 Days.

Note: wait times are calculated from the Patient Availability Date (PAD) to the date of service. If the PAD is not completed, authorization date is used. Use of the PAD takes into consideration appropriate delays in the initiation of service, which may be due to clinical reasons or the client’s choice to wait. Appropriate delays are: the service is pre-planned; there is a clinical need for the service to begin on a specific date; patient is not yet available for service at their treatment address; patient has chosen to delay initiation of service.

Calculations are aligned with the methodology in the MLAA technical specifications.

Percentage of home care clients who received their nursing visit within 5 days

Data Source

Homecare Database (HCD), 2019/20 Q4; Health Data Branch SAS Server, Ministry of Health, extracted June 2021.

Calculation Notes

Service Date = April 1, 2019 - March 31, 2020

Home Care Program Types = In-Home (01)

Service Type is Nursing (1, 17, 18)-EXCLUDES shift nursing

Service is delivered in in-home setting (Care Site NOT equal to 12,24,25)

Service category is EQUAL to In-Home services (91-95)

Age at Start Date of episode of care is greater than 18

Service Date is BETWEEN Episode of care Start Date and End Date (i.e. authorization/patient availability date)

On Hold dates do NOT fall between the start of episode and service date

Wait Time is between 0 and 365 Days.

Note: wait times are calculated from the Patient Availability Date (PAD) to the date of service. If the PAD is not completed, authorization date is used. Use of the PAD takes into consideration appropriate delays in the initiation of service, which may be due to clinical reasons or the client’s choice to wait. Appropriate delays are: the service is pre-planned; there is a clinical need for the service to begin on a specific date; patient is not yet available for service at their treatment address; patient has chosen to delay initiation of service.

Calculations are aligned with the methodology in the MLAA technical specifications.

Emergency department wait time for inpatient bed

Data Source

National Ambulatory Care Reporting System (NACRS), 2019/20 Q4; Health Data Branch SAS Server, Ministry of Health, extracted May 2021.

Calculation Notes

This indicator measures average time elapsed (in hours) from the time of the decision to admit to the time the patient left the ED for patients admitted to inpatient care from the emergency department. Excludes cases where the time of disposition and/or the time the patient left the ED is missing.

Calculations are aligned with OH-Cancer Care Ontario (CCO) methodology.

Time to initial assessment in emergency department

Data Source

National Ambulatory Care Reporting System (NACRS), 2019/20 Q4; Health Data Branch SAS Server, Ministry of Health, extracted May 2021.

Calculation Notes

This indicator measures average time elapsed (in hours) from triage or registration (whichever is earlier) to initial assessment by a physician, nurse practitioner, physician assistant or dentist for all patients in the emergency department. Excludes cases where the time of registration and triage are missing and/or the time of physician and non-physician assessment is missing. Also excludes cases where the time of assessment occurs prior to the time of registration or triage.

Calculations are aligned with OH-Cancer Care Ontario (CCO) methodology.

Emergency department visits for conditions best managed elsewhere

Data Source

National Ambulatory Care Reporting System (NACRS), 2019/20 Q4; Health Data Branch SAS Server, Ministry of Health, extracted May 2021.

Calculation Notes

This indicator includes ED visits for those age 1-74, with Canadian Triage and Acuity Scale (CTAS) levels IV and V (less-urgent, non-urgent) for selected conditions that do not result in an inpatient admission. The conditions include conjunctivitis, otitis media, upper respiratory tract infections, and cystitis.

Calculations are aligned with the methodology in the MLAA technical specifications.

Acute care patients who had a follow up with a physician within 7 days of discharge

Data Source

Discharge Abstract Database (DAD), 2019/20 Q4 and Claims History Database; Health Data Branch SAS Server, Ministry of Health, extracted June 2021.

Calculation Notes

This indicator includes patients with an acute hospital stay for specified conditions who saw a physician (in office, home or long-term care) within 7 days of discharge. Conditions include acute myocardial infarction (age 45+), cardiac conditions other than heart attack (age 40+), congestive heart failure (age 45+), chronic obstructive pulmonary disease (age 45+), pneumonia, diabetes, stroke (age 45+), gastrointestinal disease.

Calculations are aligned with the methodology in the MLAA technical specifications.

Median time to long-term care placement - overall

Data Source

Client Profile database (CPRO), April 1, 2019 to March 31, 2020; Health Data Branch SAS Server, Ministry of Health, extracted May 2021.

Calculation Notes

Inclusion criteria:

1. Fiscal year 2019
2. Valid health card number

All placements or overall placements - All clients (includes all priority categories) placed from locations other than LTC Homes. Includes clients placed from hospitals (acute, rehab, CCC, etc.), assisted living residences, cluster care residences, group homes, private dwelling, retirement homes, supportive housing and other.

Median time to long-term care placement - from community

Data Source

Client Profile database (CPRO), April 1, 2019 to March 31, 2020; Health Data Branch SAS Server, Ministry of Health, extracted May 2021.

Calculation Notes

Inclusion criteria:

1. Fiscal year 2019
2. Valid health card number

Placed from Community - All clients (includes all priority categories) placed from assisted living residences, cluster care residences, group homes, private dwelling, retirement homes, and supportive housing.

Median time to long-term care placement - from hospital (acute)

Data Source

Client Profile database (CPRO), April 1, 2019 to March 31, 2020; Health Data Branch SAS Server, Ministry of Health, extracted May 2021.

Calculation Notes

Inclusion Criteria:

1. Fiscal year 2019
2. Valid health card number

Placed from Hospital (Acute) - All clients (includes all priority categories) placed from acute hospitals only. Does not include clients placed from rehab, CCC, etc.

Alternate level of care (ALC) Days

Data Source

Discharge Abstract Database (DAD), 2019/20 Q4; Health Data Branch SAS Server, Ministry of Health, extracted May 2021.

Calculation Notes

ALC days are those days where a physician (or designated other) has indicated that a patient occupying an acute care hospital bed does not require the intensity of resources/services provided in acute care. It includes discharges from acute care hospitals and excludes newborns and still births.

Calculations are aligned with the methodology in the MLAA technical specifications.

30-day readmission rate for selected conditions

Data Source

Discharge Abstract Database (DAD), 2019/20 Q4 and 2020/21 Q1; Health Data Branch SAS Server, Ministry of Health, extracted June 2021.

Calculation Notes

This indicator is also known as Readmissions within 30 days for selected HBAM Inpatient Grouper (HIG) conditions.

It includes readmissions for patients with an acute inpatient hospital stay for selected conditions who, after discharge, have a subsequent non-elective readmission within 30 days. Conditions include acute myocardial infarction (age 45+), cardiac conditions other than heart attack (age 40+), congestive heart failure (age 45+), chronic obstructive pulmonary disease (age 45+), pneumonia, diabetes, stroke (age 45+), gastrointestinal disease.

The crude readmission ratio is shown in the results.

Calculations are aligned with the methodology in the MLAA technical specifications.

Repeat ED visits within 30 days for mental health and substance abuse conditions

Data Source

National Ambulatory Care Reporting System (NACRS), 2019/20 Q4; Health Data Branch SAS Server, Ministry of Health, extracted May 2021.

Calculation Notes

Proportion of emergency department visits for mental health or substance abuse that are followed by another emergency department (also for mental health or substance abuse) within 30 days. The count of repeat visits considers visits that occur in the 30 days following the reporting period.

Calculations are aligned with the methodology in the MLAA technical specifications.

Hospital stay extended until home care services or supports are ready

Data Source

Discharge Abstract Database (DAD), 2019/20 Q4; Health Data Branch SAS Server, Ministry of Health, extracted May 2021.

Calculation Notes

Median ALC length of stay for discharges from acute care hospitals to home care services. Includes discharges from acute care hospitals (institution type=AT) that were discharged home with support services (discharge disposition=04) where there were ALC days associated with the stay. Excludes patients with mental health conditions (ICD-10-CA codes F10-F99) as the most responsible diagnosis. Values may include patients who received other community services (e.g. community support services) instead of home care.

Calculations are aligned with the Canadian Institute for Health Information (CIHI) methodology.

Frequent ED visits (4+/year) for mental health and addictions

Data Source

National Ambulatory Care Reporting System (NACRS), 2019/20 Q4; Health Data Branch SAS Server, Ministry of Health, extracted May 2021.

Calculation Notes

Proportion of patients with an ED visits with a mental health or addiction diagnosis (in any diagnosis field) who had 4+ ED visits (with mental health or addictions diagnoses) in the 365 days prior to the last visit in the reported fiscal year. Results are provided by fiscal year.

Calculations are aligned with the Canadian Institute for Health Information (CIHI) methodology.

Hospitalizations for ambulatory care sensitive conditions

Data Source

Discharge Abstract Database (DAD), 2019/20 Q4; Health Data Branch SAS Server, Ministry of Health, extracted May 2021.

Calculation Notes

Includes discharges for selected diagnoses with specific criteria from acute facilities for individuals aged 0 to 74. Excludes newborns, still births, and patients discharged as deceased. Conditions include a most responsible diagnosis of grand mal status and other epileptic convulsions, chronic obstructive pulmonary disease, asthma, congestive heart failure and pulmonary edema, hypertension, angina, diabetes, lower respiratory disorders.

Calculations are aligned with the methodology in the MLAA technical specifications.

Patients in hallway beds (ER stretchers and beds in unconventional spaces)

Data Source

Daily Bed Census Summary (dBCS), April 1, 2019-February 17, 2020; Health Data Branch SAS Server, Ministry of Health, extracted May 2021.

Calculation Notes

Hallway beds includes emergency room stretchers and beds in unconventional spaces. Note that 2019/20 Q4 includes data for January 1, 2020-February 17, 2020. This is because of changes to the Daily Bed Census Summary and to the hallway bed definition that came into effect on February 18, 2020. As of February 18, 2020, the hallway definition changed to: admitted patients in emergency beds, patients in ER stretchers, and patients in unconventional spaces.

The number of patients in these beds are for the hospitals in the networks associated with the OHT, as identified by IC/ES. Averages are provided by fiscal quarter, with the denominator being the number of days sites reported to the dBCS.

Data includes all institution types for the sites identified by IC/ES within each Network.

13 Utilization Analysis Notes

13.1 Population Overview

Age

Data Source

Registered Persons Database (RPDB), extracted March 2021.

Calculation Notes

Age as of March 31, 2020. For those who died during 2019/20, their ages are as of their date of death.

Census Sub Division (CSD)/attributed population analysis

Data Source

Postal Code Conversion File (PCCF), November 2020 postal codes. Statistics Canada.

Calculation Notes

The attributed population within each OHT was assigned to a 2016 Census Subdivision by linking postal codes of each individual to the PCCF, which includes census geography for each unique postal code.

Ontario Marginalization Index

Data Source

Matheson FI, van Ingen T. 2016 Ontario marginalization index. Toronto, ON: St. Michael’s Hospital; 2018. Joint publication with Public Health Ontario.

The data used in the creation of the 2016 index is from Statistics Canada as extracted by Ontario Agency for Health Protection and Promotion (Public Health Ontario). 2016 census of population – dissemination area: Census profile - age and sex for Canada, provinces, territories, census divisions, census subdivisions and dissemination areas, 2016 census [Internet]. Ottawa, ON: Statistics Canada; 2017 November 29 [extracted 2018 April 24].

Calculation Notes

ON-Marg is an Ontario-specific version of the Canadian Marginalization Index, in use since 2006, and created collaboratively by Public Health Ontario, and the Centre for Urban Health Solutions at St. Michael’s Hospital. Using data from the 2016 Canadian Census, 18 indicators are grouped across four dimensions of marginalization – residential instability, material deprivation, dependency and ethnic concentration.

Residential instability refers to area-level concentrations of people who experience high rates of family or housing instability. Indicators for this dimension include measures on the type/density of accommodations, as well as family structure characteristics. Material deprivation includes indicators that measure income, quality of housing, educational attainment and family structure characteristics. Dependency refers to area-level concentrations of people who do not have income from employment. Ethnic concentration refers to high area-level concentrations of people who are recent immigrants, and/or people belonging to ‘visible minority’ groups.

The 18 Census indicators are grouped across the four dimensions of marginalization - Factor scores are constructed from the principal component factor analysis and represent a standardized scale with a mean of zero and a standard deviation of one.

For each of the four dimensions, quintiles have been created by sorting the marginalization data into five groups. For this analysis, the quintile of each area, for each of dimensions, is presented.

Further documentation, including a complete list of the 18 indicators included in the dimensions, can be found at: https://www.publichealthontario.ca/-/media/documents/o/2017/on-marg-userguide.pdf?la=en

Dissemination Area (DA) analysis

Data Source

Postal Code Conversion File (PCCF), November 2020 postal codes. Statistics Canada.

Calculation Notes

Includes the count of the attributed population by 2016 Census DA. The attributed population within each OHT was assigned by linking postal codes of each individual to the PCCF, which includes census geography for each unique postal code. Analysis excludes 73,455 records (0.5%) where the postal code was not found in the PCCF or where the linked DAUID in the PCCF = ‘00000000’. This DAUID indicates postal codes that Statistics Canada cannot assign to a DA.

13.2 Population Health

Births

Data Source

Discharge Abstract Database (DAD), 2019/20 Q4; Health Data Branch SAS server, Ministry of Health, extracted May 2021.

Calculation Notes

Includes live births (entry code=N (newborn)) occurring in acute hospitals, that were discharged in 2019/20. Preterm birth is defined as gestation weeks at delivery <37 weeks, preterm birth rate is expressed per 100 live births; Low birth weight is defined as birth weight < 2500 grams, low birth weight rate is expressed per 100 live births.

Mortality

Data Source

Deaths that occurred during 2019/20. Death dates were obtained from an internal file that includes death dates that were identified in the MOH’s administrative databases, extracted April 2021.

Calculation Notes

Includes those whose died during 2019/20.

Death deaths were obtained from the MOH’s administrative databases (Discharge Abstract Database [DAD], National Ambulatory Care Reporting System [NACRS], Continuing Care Reporting System [CCRS-CCC], National Rehabilitation Reporting System [NRS], Continuing Care Reporting System-LTC [CCRS-LTC], Ontario Mental Health Reporting System [OMHRS], Claims History Database [CHDB], Registered Persons Database [RPDB]). An algorithm is used to define the hierarchy of death dates when there is more than one death date per individual. Death counts may differ from those available in Vital Statistics data (Statistics Canada).

13.3 Hospital Inpatient Care

Acute care utilization

Data Source

Discharge Abstract Database (DAD), 2019/20 Q4; Health Data Branch SAS server, Ministry of Health, extracted May 2021.

Calculation Notes

Includes activity in acute care hospitals (institution type=AT), excluding newborns and stillbirths (entry code ≠N or S). Includes patients (a unique count of people) who had at least one acute overnight stay in 2019/20 and acute separations in 2019/20.

A separation refers to a discharge, death, transfer or sign out from an acute hospital.

The days (total, acute, ALC) refer to the inpatient days spent in hospital, as recorded at the time of the hospital separation.

ALC analysis: ALC days are those days where a physician (or designated other) has indicated that a patient occupying an acute care hospital bed does not require the intensity of resources/services provided in acute care.

The total attributed population is used as the denominator for the rate calculations.

Rehabilitation utilization

Data Source

Adult rehabilitation records: National Rehabilitation Reporting System (NRS), 2019/20 Q4; Health Data Branch SAS Server, Ministry of Health, extracted May 2021. Children’s records from Holland Bloorview Kids Rehabilitation Hospital: Discharge Abstract Database (DAD), 2019/20 Q4; Health Data Branch SAS server, Ministry of Health, extracted May 2021.

Calculation Notes

Includes activity associated with discharges from children’s rehabilitation at Holland Bloorview Kids Rehabilitation Hospital (facility number=939) as reported to DAD and active cases in adult inpatient rehabilitation units as reported to NRS. Includes patients (unique count of people) and active cases who had at least one overnight stay in rehabilitation units in 2019/20.

An active case for 2019/20 is one where the admission date was on or before March 31, 2020 and where the discharge date was between April 1, 2019 and March 31, 2020 or where the discharge date was missing.

The days in year refer to the inpatient days spent in the rehabilitation units during 2019/20.

Where possible, corrections were made to records to account for missing discharge dates (i.e., cases that were still appearing ‘active’ but should have been closed). This involved assigning discharge dates to: records from rehabilitation units that were no longer open, records for deceased patients, records that had discharge lengths of stay but no discharge date, and to short-stay records that were missing a discharge date.

The total attributed population is used as the denominator for the rate calculations.

Mental Health utilization

Data Source

Ontario Mental Health Reporting System (OMHRS), 2019/20 Q4; Health Data Branch SAS Server, extracted May 2021.

Calculation Notes

Includes activity for active cases in adult designated mental health units. Includes patients (unique count of people) and active cases who had at least one overnight stay in adult mental health units in 2019/20.

An active case for 2019/20 is one where the admission date was on or before March 31, 2020 and where the discharge date was between April 1, 2019 and March 31, 2020 or the discharge date was missing.

Cases were also limited to those who had assessments during the last two fiscal years.

The days in year refer to the inpatient days spent in the adult mental health units during 2019/20.

The total attributed population is used as the denominator for the rate calculations.

Complex Continuing Care (CCC) utilization

Data Source

Continuing Care Reporting System (CCRS-CCC), RUG Weighted Patient Days (RWPD), 2019/20 Q3 (RWPD_CCC_2011_2020 Q3); Health Data Branch SAS Server, extracted May 2021.

Calculation Notes

Includes activity for active cases in complex continuing care (CCC) units from the RUG weighted patient days dataset. Includes patients (unique count of people) and active cases who had at least one overnight stay in complex continuing care (CCC) in 2019/20.

An active case for 2019/20 is one where the admission date was on or before March 31, 2020 and where the discharge date was between April 1, 2019 and March 31, 2020 or where the discharge date was missing.

The days in year refer to the inpatient days spent in CCC units during 2019/20.

13.4 Hospital Ambulatory Care

Emergency department (ED) utilization

Data Source

National Ambulatory Care Reporting System (NACRS), 2019/20 Q4; Health Data Branch SAS server, Ministry of Health, extracted May 2021.

Calculation Notes

Includes unscheduled ED visits (ED visit indicator = “1” and patient category=”ER”) to hospital emergency departments and hospital-based urgent care centres (UCCs). Includes patients (a unique count of people) who had at least one ED visit in 2019/20 and all ED visits in 2019/20. Arrival by ambulance includes records that arrived by air ambulance, ground ambulance, or a combination of air and ground ambulance.

Admitted visits includes records where the visit disposition = “06” (Admitted to critical care unit or operating room in the reporting facility) or “07” (Admitted as an inpatient to another unit of the reporting facility).

CTAS (triage) levels: The Canadian Triage and Acuity Scale (CTAS) developed by the Canadian Association of Emergency Physicians (CAEP) is used by hospital emergency departments to prioritize patients’ care according to the type and severity of their presenting signs and symptoms. The levels are: CTAS I: Resuscitation, CTAS II: Emergent, CTAS III: Urgent, CTAS IV: Less Urgent, CTAS V: Non-urgent. A small number of ED visits have a missing triage level. As a result, the percentage of visits by CTAS level will not add up to 100%.

Day surgery/cardiac catheterization, ambulatory dialysis, ambulatory oncology utilization

Data Source

National Ambulatory Care Reporting System (NACRS), 2019/20 Q4; Health Data Branch SAS server, Ministry of Health, extracted May 2021.

Calculation Notes

Patient category = “DS” or “Cath_lab” was used to identify day surgery and cardiac catheterization visits; patient category = “Dialysis” was used to identify ambulatory dialysis visits; patient category “Oncology” was used to identify ambulatory oncology visits.

Includes patients (a unique count of people) who had at least one ambulatory visit in 2019/20 for day surgery/cardiac catheterization, or dialysis, or oncology.

13.5 LTC and Home Care

Home care utilization

Data Source

Home Care Database (HCD), 2019/20 Q4; Health Data Branch SAS Server, Ministry of Health, extracted May 2021.

Calculation Notes

Includes in-home service clients: Requested Program Group=In-Home

Service Date = April 1, 2019-March 31, 2020.

Referral source is Community, i.e. NOT EQUAL to 1 (general hospital-outpatient), 2 (general hospital-inpatient), 3 (special hospital-outpatient), or 4 (special hospital-inpatient).

Clients that received home care services: clients who have received one or more days of service within a fiscal year. The number of active clients is an important indicator of the current system load.

Admissions: the number of client intakes receiving services. This is not the equivalent of the number of individuals receiving services. Should an individual be discharged from home care services and be readmitted later on, this individual will be considered as two distinct intakes or admissions.

Long-Term Care Home utilization

Data Source

Continuing Care Reporting System (CCRS-LTC), 2019/20 Q4; Health Data Branch SAS server, Ministry of Health, extracted May 2021.

Calculation Notes

Includes all LTC home residents active on the last day of reporting period.

Selection criteria: entry date <= March 31, 2020, discharge date > March 31, 2020 or discharge date is missing.

Long-stay residents are defined by the licensed long-stay bed in a LTC home (for people who require the availability of 24-hour nursing care, daily assistance with activities of daily living or frequent supervision to ensure safety or well-being for an indefinite period of time).

Residents’ age is as of first day of the reporting period. Rate is expressed per 1000 attributed population age 75+.

Long-Term Care Home waitlist

Data Source

Client Profile database (CPRO), April 1, 2019 to March 31, 2020; Health Data Branch SAS Server, Ministry of Health, extracted May 2021.

Calculation Notes

Includes all people waiting for long-stay beds as of March 31, 2020; long term care home residents waiting for transfer are excluded.

Selection criteria: LTC choice close date is missing (is an open case); old CPRO flag=0; old waitlist flag=yes, waitlist as of date=March 31, 2020; admit type=long stay; previous residence type not equal to long term care homes.

13.6 Primary Care

Enrolled patients

Data Source

Client Agency Program Enrolment (CAPE); Health Data Branch SAS server, Ministry of Health, extracted May 2021.

Calculation Notes

Includes all individuals who were enrolled to a patient enrolment model on March 31, 2020.

Residents with fee-for-service (FFS) providers

Data Source

Client Agency Program Enrolment (CAPE); Health Data Branch SAS server, Ministry of Health, extracted May 2021.

Calculation Notes

Includes all individuals who were NOT enrolled to a patient enrolment model on March 31, 2020. Individuals who are ‘virtually rostered’ based on their visit pattern have been included as those with a fee-for-service provider.

Primary care visits/Average primary care visits per person

Data Source

Claims History Database (CHDB), 2019/20; Health Data Branch SAS server, Ministry of Health, extracted May 2021.

Calculation Notes

Includes visits for all individuals regardless of their enrolment status. Primary care visits are defined as those covered by the Patient Enrolment Model (PEM) capitation ‘baskets’ (i.e., the fee schedule codes that are covered by a PEM physician’s capitation payment and that do not get paid for individually). It includes the most common services provided by a primary care physician such as: minor, intermediate, and general assessments, periodic health visits, well baby visits, some counselling/psychotherapy, basic procedures/tests involving skin lesions, the cardiovascular or pulmonary systems, allergies, immunizations, and diabetic management.

Percentage of primary care visits made outside of enrolling group

Data Source

Claims History Database (CHDB), 2019/20; Health Data Branch SAS server, Ministry of Health, extracted May 2021; Client Agency Program Enrolment (CAPE), 2019/20; Health Data Branch SAS server, Ministry of Health, extracted May 2021.

Calculation Notes

Includes primary care visits for individuals who were enrolled to a Patient Enrolment Model during the fiscal year. Outside visits are defined as those that were not made to the enrolling physician or to another physician in the enrolling group, and that were not made to a focused practice physician.

Percentage of enrolled seniors who received house calls

Data Source

Claims History Database (CHDB), 2019/20; Health Data Branch SAS server, Ministry of Health, extracted May 2021; Client Agency Program Enrolment (CAPE); Health Data Branch SAS server, Ministry of Health, extracted May 2021.

Calculation Notes

Includes seniors (aged 65 and older) who were enrolled to a Patient Enrolment Model (based on enrolment status on March 31, 2018) and who had received a house call (defined as fee schedule codes: ‘A900A’, ‘A901A’, ‘A902A’, ‘B990A’, ‘B992A’, ‘B993A’, ‘B994A’, ‘B996A’, ‘B960A’, ‘B961A’, ‘B962A’, ‘B963A’, ‘B964A’, ‘B997A’, ‘B998A’, ‘B966A’).

Percentage of enrolled patients with any ED visit

Data Source

National Ambulatory Care Reporting System (NACRS), 2019/20 Q4; Health Data Branch SAS server, Ministry of Health, extracted May 2021; Client Agency Program Enrolment (CAPE); Health Data Branch SAS server, Ministry of Health, extracted May 2021.

Calculation Notes

Includes all individuals who were enrolled to a Patient Enrolment Model (based on enrolment status on March 31, 2020) and who had an unscheduled emergency department visit (defined as ED visit indicator=“1” and patient indicator =“ER”).

Rate of CTAS IV/V ED visits per 1,000 enrolled patients

Data Source

National Ambulatory Care Reporting System (NACRS), 2019/20 Q4; Health Data Branch SAS server, Ministry of Health, extracted May 2021; Client Agency Program Enrolment (CAPE); Health Data Branch SAS server, Ministry of Health, extracted May 2021.

Calculation Notes

Includes all individuals who were enrolled to a Patient Enrolment Model (based on enrolment status on March 31, 2020) and who had an unscheduled emergency department visit (defined as ED visit indicator=“1” and patient indicator =“ER”) with a Canadian Triage and Acuity Scale (CTAS) level of IV (less urgent) or V (non-urgent).

Attributed population in a Family Health Team (FHT)

Data Source

FHT List, September 2020. Health Analytics and Insights Branch, MOH; Health Data Branch SAS server, Ministry of Health, extracted June 2021.

Calculation Notes

This analysis links the primary care group number of the individual to a standardized Family Health Team crosswalk. This crosswalk is based on Generic Alternate Payment Program (GAPP) and is current to September 2020.

13.7 COVID-19 analysis

COVID-19 counts and rates per 100,000 attributed population for cases, hospitalizations, and fatalities

Data Source

CCM Case File; Health Data Branch SAS Server, Ministry of Health, extracted June 2021.

Calculation Notes

This analysis links to the record-level CCM Case File on encrypted HCN to identify COVID-19 cases in the OHT’s attributed population. Counts and rates are based on cumulative COVID-19 cases from January 23 2020 to March 31, 2021. Hospitalizations and fatalities are as recorded in CCM.

It is important to note that the FY 2019/20 attributed population is used for this analysis. As a result, the Ontario totals shown here do not include any cases after March 31, 2020 who are in the attributed population HCN file, and will be smaller than provincial totals published elsewhere. Cases that would not be captured in this analysis include, among others, new immigrants, migrants from other provinces, or newborns. This analysis also excludes COVID-19 cases in CCM without a health card number, which account for 10.7% of cases to March 31, 2021.

13.8 PEMs

Family Health Teams (FHT) assigned to PEMs

Data Source

FHT List, September 2020. Health Analytics and Insights Branch, MOH; Health Data Branch SAS server, Ministry of Health, extracted June 2021.

Calculation Notes

This analysis links the primary care group number of the individual to a standardized Family Health Team crosswalk. This crosswalk is based on Generic Alternate Payment Program (GAPP) and is current to September 2020. Primary care group numbers were assigned by HSMB using standard 2019 PEM and physician reference files (February 2021).

13.9 Health Conditions

Health conditions using the Grouper

Data Source

Canadian Institute for Health Information (CIHI) Population Grouper.

Calculation Notes

The attributed 2019/20 population with the indicated conditions, as recorded in one of the MOH’s administrative databases (Discharge Abstract Database [DAD], Claims History Database [CHDB], National Ambulatory Care Reporting System [NACRS], Ontario Mental Health Reporting System [OMHRS], Continuing Care Reporting System [CCRS-CCC, CCRS-LTC], Homecare database [HCD]) during 2018/19 or 2019/20. There are 226 health conditions that are assigned based on health care events (including physician visits) in the previous two years. Note that patients can have more than one health condition and because of this, the sum of conditions will be greater than the size of the attributed population.

The Health Conditions shown in this report are best used to estimate the prevalence of conditions. In the CIHI methodology, Health Conditions can be used to assign each person to a single main Health Profile Group (HPG) that identifies the most complex and clinically relevant health condition present for the patient, however, an analysis of HPGs is not presented in this report.

Produced on: 04 July 2021, Data from April 1 2019-March 31 2020