"Identifying Information: Name","Repeat Hospital Stays for Mental Health and Substance Use"
"Identifying Information: Short/Other Names","Patients With Repeat Hospitalizations for Mental Health and Substance Use"
"Identifying Information: Description","This indicator measures the risk-adjusted percentage of individuals who had 3 or more episodes of care for mental health and substance use (MHSU) disorders among all those who had at least one episode of care for MHSU disorders in general or psychiatric hospitals within a given year.NoteFor further details, please see the General Methodology Notes (PDF)"
"Background, Interpretation and Benchmarks: Rationale","This indicator is considered an indirect measure of appropriateness of care, since the need for repeat admissions to hospital depends on the person and the type of MHSU disorders.Challenges in getting appropriate care/support in the community and/or the appropriate medication often lead to repeat hospitalizations.Variations in this indicator across jurisdictions may reflect differences in the services that help individuals with MHSU disorders remain in the community for a longer period of time without the need for hospitalization.Understanding this population can aid in developing/enhancing programs that may prevent the need for repeat hospitalizations."
"Background, Interpretation and Benchmarks: Interpretation","Lower rates are desirable."
"Background, Interpretation and Benchmarks: HSP Framework Dimension",Person-centred
"Background, Interpretation and Benchmarks: Areas of Need","Living With Illness, Disability or Reduced Function"
"Background, Interpretation and Benchmarks: Targets/Benchmarks","Not applicable"
"Available Data Years","2013
 to 2022"
"Available Data Years: Type of Year",Fiscal
"Availability of Results: Geographic Coverage","All provinces/territories"
"Reporting Level/Disaggregation",National
"Reporting Level/Disaggregation: Other reporting level/disaggregation","Age groupRecorded sex or genderNeighbourhood income quintileUrban versus rural/remoteMental health category.For more information, please refer to AVÐÇÇò’s Equity stratifiers web page."
"Result Updates: Indicator Results","Web Tool:Your Health System: In DepthPDF:Accessing Indicator Results on Your Health System: In Depth (PDF)"
"Update Frequency","Every year"
"Result Updates: Latest Results Update Date","November 2023"
"Result Updates: Updates","Not applicable"
"Indicator Calculation: Description","(Total number of individuals who had at least 3 episodes of care for MHSU disorders [repeat hospitalizations] in a 1-year period ÷ Total number of individuals who had at least one episode of care for MHSU disorders in a 1-year period) × 100The risk-adjusted percentage for each region was calculated by dividing the observed number of individuals with repeat hospitalizations in each region by the expected number of individuals with repeat hospitalizations in the region and multiplying by the Canadian average percentage of individuals with repeat hospitalizations.Unit of Analysis : PatientsAn episode of care refers to all contiguous inpatient hospitalizations in general and psychiatric hospitals and all day surgery visits regardless of diagnoses. To construct an episode of care, a transfer is assumed to have occurred if the following condition is met: Admission to a general/psychiatric hospital or day surgery facility occurs on the same day as discharge from another general/psychiatric hospital or day surgery facility"
"Indicator Calculation: Type of Measurement","Percentage or proportion"
"Denominator: Description:","Total number of individuals who had at least one episode of care for MHSU disorders in a 1-year period. The most recent episode of care in a fiscal year is the index episode of care."
"Denominator: Inclusions:","A mental disorder is identified by DSM-IV/DSM-5 diagnostic category in Ontario Mental Health Reporting System (OMHRS) data or by the most responsible diagnosis (MRDx) ICD-10-CA codes in Discharge Abstract Database (DAD)/Hospital Morbidity Database (HMDB) dataThe following mental disorders are included (see AVÐÇÇò Mental Health and Substance Use Diagnosis Code Groupings for Selected Indicators (XLSX)): Substance-related and addictive disordersSchizophrenia and other psychotic disordersMood disordersAnxiety disordersSelected disorders of personality and behaviourOther disordersRecorded sex or gender coded as male or femaleAdmission to a general or psychiatric hospital "
"Denominator: Exclusions:","Records with an invalid health card numberRecords with an invalid code for province issuing health card numberRecords with a missing ageRecords with an invalid admission dateRecords with an invalid discharge dateCadaveric donor or stillbirth records (Admission Category Code = R or S)Records with a discharge status of dead on arrival (Discharge Disposition = 11, 71* for NACRS)2018–2019 data onward: Medical assistance in dying (MAID) (Discharge Disposition Code = 73)Note*2018–2019 data onward."
"Numerator: Description:","Total number of individuals in the denominator who had at least 3 episodes of care for MHSU disorders in a 1-year period. Each individual has a 12-month look-back period prior to their most recent episode of care in a given year. Therefore, data for 2 fiscal years is necessary to obtain the data for the numerator.An episode of care for an MHSU disorder is identified using the same inclusion and exclusion criteria as for the denominator."
"Method of Adjustment","Logistic regression"
"Adjustment Applied: Covariates used in risk adjustment:","For a detailed list of covariates used in the model, please refer to the Model Specification (PDF) document."
"Indicator Calculation: Geographic Assignment","Place of residence"
"Data Sources",DAD
"Quality Statement: Caveats and Limitations","Not applicable"
"Quality Statement: Trending Issues","The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was implemented in the Ontario Mental Health Reporting System as of 2016-2017. Prior to 2016-2017, the fourth edition (DSM-IV-TR) was used. Due to the fact that the DSM-IV-TR and DSM-5 diagnostic categories are not fully comparable, there may be some shift in the distribution of cases across categories. Therefore, trending of 2015-2016 and 2016-2017 rates for Ontario may potentially be affected."
"Quality Statement: Comments","Indicator results are also available inYour Health System: In Brief"
References,"Lin E, Durbin J, Zaslavska N, et al. Hospital Report 2007: Mental Health (PDF). 2008."