Ministry of Health and Long-Term Care Orthopaedic …...Ministry of Health and Long-Term Care Orthopaedic Quality Scorecard Primary Hip Knee Replacement, Q2 2013/14 Key findings: The

Jan-14

Updates

Ministry of Health and Long-Term CareOrthopaedic Quality ScorecardPrimary Hip Knee Replacement, Q2 2013/14

Key findings:

The Q2 2013/14 Orthopedic Quality Scorecard (OQS) is a joint project by the Implementation Branch and Health Analytics Branch.

The analyses contained in this report are made to reflect the recommendations of the Orthopaedic Expert Panel at Health Quality Ontario regarding patient cohort selection. Patient cohorts were developed for the implementation of the Quality Based Procedures and as such are used in calculating the indicators in this report. Providers may use the information to track improvements against the implemenation of recommended best-practice in the care of these patients.

As legislated in Ontario’s Excellent Care for All Act, Health Quality Ontario’s mandate includes the provision of objective, evidence-informed advice about opportunities to improve quality and efficiency in the health care system. As part of its Quality-Based Funding initiative, Health Quality Ontario works with multidisciplinary expert panels (composed of leading clinicians, scientists, and administrators) to develop evidence-based practice recommendations and define episodes of care for selected disease areas or procedures. For more information on Health Quality Ontario’s Quality-Based Funding initiative, visit www.hqontario.ca.

This report has been updated from previous reports to present data for the hip replacement and knee replacement patient cohorts separately. The data presented in this way provides more detailed information for tracking improvements against each of these types of patients.

The main difference in the patient cohort as defined for this report compared to those previously reported from Cancer Care Ontario (CCO) is that bilateral replacements are now included . Patients undergoing bilateral surgeries comprised 1.5% of all primary hip knee replacements in FY 2011/12 and had average and median lengths of stay greater than their unilateral replacement counterparts (approximately 1 to 1.5 days longer on average).

As noted above, all indicators are presented on separate tabs for the hip and the knee patient cohorts.

Due to these changes the report does not include trending graphs or tables. Trending information will be presented as more data become available using the new cohorts.

Provincial LevelThe proportion of patients discharged 'Home' is 89% for hip and 92% for knee replacements.

The proportion of patients discharged home meeting the 4.4 day target length of stay is 88% for hip and 90% for knee replacements.

The 90th percentile for the target of 7 day length of stay is met for both hip and knee replacements, with 98% of patients in each group with hospital stay completed within 7 days.

Wait times for both hip and knee replacements are above the targeted 182 days, being 190 days for hip and 225 days for knee replacements.

Changes from reports by CancerCare Ontario

Jan-14


Regional LevelThere is variation across LHINs with respect to the percent of hip and knee replacement patients discharged home and the percent of these patients that meet the targets for length of stay in hospital.

0

20

40

60

80

100

Perc

ent

Percent of patients discharged home with stay completed within 4.4 days1 (Q2 2013/14)

Hip

Knee

0

20

40

60

80

100

Perc

ent

Percent of patients discharged home (Q2 2013/14)

Hip

Knee

0102030405060708090

100

Perc

ent

Percent of patients discharged home with hospital stay completed within 7 days (Q2 2013/14)

Hip

Knee

Target

1Target for hosptial stay

Jan-14


Contact:

Questions related to the analysis provided in this spreadsheet can be directed to:Health Analytics Branch [email protected]

Other questions can be directed to:Implementation Branch [email protected]

The Health Analytics Branch (HAB), in the Ministry of Health and Long-Term Care, provides high quality information, analyses and methodological support to enhance evidence-based decision making in the health system. As part of the Health System Information Management and Investment (HSIMI) Division, HAB manages health analytics requests, identifies methods, and creates reports and tools to meet ministry, LHIN and other client needs for accurate, timely and useful information.

mailto:[email protected]

mailto:[email protected]

Quality Dimensions Indicator Current Performance Target% Completed Within

Target

Average length of stay (days) - All patients 3.9 - -

Average length of stay (days) - Patients Discharged Home1 3.4 4.4 88.0

90th percentile for 7 day length of stay - Patients Discharged Home1 97.8 90% 97.8

Proportion of Patients Discharged Home 89.2 90% ±9% 89.2

Rate of Readmission within 30 days after primary joint replacement 3.4 - -

Rate of Revisions within 365 days after primary joint replacement 1.6 - -

Accessibility Replacement Wait Time (90th Percentile Days) 190 182 -

Quality Dimensions Indicator Current Performance Target% Completed Within

Target







AccessibilityReplacement Wait Time (90th Percentile Days) 225 182 -

Note:

1 Discharge destination Home includes Home Care, Senior's Care, Attendant Care (Discharge type = 04, 05)Please refer to indicator definitions worksheet for full description

PROVINCE

PROVINCE

Efficiency

Effectiveness/Safety

Provincial Orthopaedic Quality Scorecard - HIP Replacement SurgeryReporting Period - Q2 FY 13/14

Efficiency


Provincial Orthopaedic Quality Scorecard - KNEE Replacement SurgeryReporting Period - Q2 FY 13/14

Quality Dimensions IndicatorCurrent

Performance Target% Completed Within Target

















BACK TO TOP



















BACK TO TOP

Efficiency



SOUTH WEST LHIN

Efficiency



SOUTH WEST LHIN


Efficiency



Efficiency


ERIE ST. CLAIR LHIN

ERIE ST. CLAIR LHIN



















BACK TO TOP



















BACK TO TOP

Efficiency



HAMILTON NIAGARA HALDIMAND BRANT LHIN

Efficiency



WATERLOO WELLINGTON LHIN

Efficiency



HAMILTON NIAGARA HALDIMAND BRANT LHIN


WATERLOO WELLINGTON LHIN

Efficiency




















BACK TO TOP



















BACK TO TOP


MISSISSAUGA HALTON LHIN

Efficiency


Efficiency



MISSISSAUGA HALTON LHIN

Efficiency



CENTRAL WEST LHIN

Efficiency



CENTRAL WEST LHIN



















BACK TO TOP



















BACK TO TOP

Efficiency



CENTRAL LHIN

Efficiency



CENTRAL LHIN

Efficiency



TORONTO CENTRAL LHIN

Efficiency



TORONTO CENTRAL LHIN



















BACK TO TOP



















BACK TO TOP

Efficiency



SOUTH EAST LHIN

Efficiency



CENTRAL EAST LHIN

Efficiency



SOUTH EAST LHIN


CENTRAL EAST LHIN

Efficiency




















BACK TO TOP



















BACK TO TOP


NORTH SIMCOE MUSKOKA LHIN

Efficiency


Efficiency



NORTH SIMCOE MUSKOKA LHIN

Efficiency



CHAMPLAIN LHIN

Efficiency



CHAMPLAIN LHIN



















BACK TO TOP



















BACK TO TOP

Notes:

1 Discharge destination Home includes Home Care, Senior's Care, Attendant Care (Discharge type = 04, 05)

Please refer to indicator definitions worksheet for full description

Efficiency



NORTH WEST LHIN

Efficiency



NORTH WEST LHIN

Efficiency



NORTH EAST LHIN

Efficiency



NORTH EAST LHIN

Total VolumeLength of Stay

(Avg Days)Avg Length of Stay (days)

(Target 4.4 days)Median Length of Stay

(Days)

90th Percentile Length of Stay (days)

(Target 7 days)Percent completed

within 4.4 daysPercent completed

within 7 days

Proportion of Patients Discharged Home(Target 90% ±9%)

Ontario 2992 3.9 3.4 3 5 88.0 97.8 89.2Erie St.Clair 166 3.8 3.6 3 5 86.2 96.1 91.6

CHATAM KENT ALLIANCE 44 3.8 3.6 3 4 90.2 97.6 93.2HOTEL-DIEU GRACE HOSPITAL 68 3.9 3.7 3 6 80.0 95.0 88.2WINDSOR REGIONAL HOSPITAL 12 4.0 3.5 3 4 90.9 90.9 91.7BLUEWATER HEALTH 42 3.5 3.4 3 4 90.0 97.5 95.2

South West 270 3.1 2.7 3 4 94.5 97.9 87.4ST.JOSEPH'S HEALTH CARE,LONDON . . . . . . . .ST THOMAS-ELGIN GENERAL HOSPITAL 11 3.3 3.3 3 4 100.0 100.0 100.0STRATFORD GENERAL HOSPITAL 28 3.5 3.3 3 5 87.0 95.7 82.1STRATHROY MIDDLESEX GENERAL HOSPITAL 17 2.8 2.3 2 3 93.8 100.0 94.1WOODSTOCK GENERAL HOSPITAL 12 4.1 3.4 3 8 88.9 88.9 75.0LONDON HLTH SCIENCES CTR 153 2.9 2.4 2 4 95.6 97.8 88.9GREY BRUCE HEALTH SERVICES 49 3.1 3.2 3 4 95.1 100.0 83.7

Waterloo Wellington 175 3.7 3.5 3 5 88.4 97.0 93.7CAMBRIDGE MEMORIAL HOSPITAL 30 3.5 3.3 3 4 92.9 100.0 93.3GUELPH GENERAL HOSPITAL 43 3.7 3.6 3 5 80.5 92.7 95.3GRAND RIVER HOSPITAL CORP 102 3.7 3.5 3 4 90.5 97.9 93.1

Hamilton Niagara Haldimand Brant 400 4.8 3.9 3 6 80.1 97.2 88.0ST JOSEPH'S HEALTH CARE SYSTEM-HAMILTON 33 3.7 3.2 3 4 96.4 100.0 84.8JOSEPH BRANT MEMORIAL HOSPITAL 63 4.4 4.2 4 5 88.7 96.8 98.4HAMILTON HEALTH SCIENCES CORP 164 5.4 3.6 3 5 82.3 97.9 86.0NIAGARA HEALTH SYSTEM 106 4.9 4.4 4 7 62.5 94.3 83.0BRANT COMMUNITY HEALTHCARE SYSTEM 34 3.7 3.4 3 5 87.9 100.0 97.1

Central West 62 4.7 3.6 3 5 86.0 98.0 80.6WILLIAM OSLER HEALTH CENTRE 62 4.7 3.6 3 5 86.0 98.0 80.6

Mississauga Halton 145 3.9 3.7 3 5 86.7 97.8 93.1HALTON HEALTHCARE SERVICES CORP 56 4.2 3.9 4 5 82.7 98.1 92.9TRILLIUM HEALTH CENTRE 89 3.7 3.5 3 5 89.2 97.6 93.3

Patients Discharged HomeAll Patients

Quality Dimension - Efficiency

Orthopaedic Quality Scorecard - Hip Replacement SurgeryReporting Period - Q2 FY 13/14

Outside target

Below 80%




(Days)




within 7 days


Ontario 2992 3.9 3.4 3 5 88.0 97.8 89.2




Outside target

Below 80%

Toronto Central 532 3.6 3.3 3 4 93.1 99.1 86.7MOUNT SINAI HOSPITAL 51 3.4 2.8 2 5 89.2 97.3 72.5ST MICHAEL'S HOSPITAL 116 3.9 3.4 3 4 91.8 100.0 83.6TORONTO EAST GENERAL HOSPITAL (THE) 33 3.4 3.3 3 4 93.8 100.0 97.0ST JOSEPH'S HEALTH CENTRE 31 3.6 3.5 3 5 84.6 100.0 83.9UNIVERSITY HEALTH NETWORK 127 3.3 3.2 3 4 95.6 99.1 89.8SUNNYBROOK HEALTH SCIENCES CENTRE 174 3.8 3.3 3 4 94.2 98.7 89.1

Central 247 3.9 3.6 3 5 89.1 97.7 89.1NORTH YORK GENERAL HOSPITAL 97 3.6 3.4 3 4 90.8 98.9 89.7YORK CENTRAL HOSPITAL 29 4.7 4.6 4 7 74.1 92.6 93.1SOUTHLAKE REGIONAL HEALTH CENTRE 44 3.5 3.2 3 4 97.2 100.0 81.8MARKHAM STOUFFVILLE HOSPITAL 27 3.0 2.8 3 4 92.0 100.0 92.6HUMBER RIVER REGIONAL HOSP 50 4.8 4.0 3 5 86.7 95.6 90.0

Central East 199 3.9 3.6 4 5 84.7 99.4 88.4ROSS MEMORIAL HOSPITAL 27 2.8 2.6 2 4 92.3 100.0 96.3PETERBOROUGH REGIONAL HEALTH CENTRE 46 4.4 4.1 4 6 79.1 100.0 93.5LAKERIDGE HEALTH CORPORATION 49 3.8 3.5 3 5 88.6 100.0 89.8ROUGE VALLEY HEALTH SYSTEM 20 3.7 3.8 3 6 77.8 100.0 90.0SCARBOROUGH HOSPITAL (THE) 57 4.1 3.9 4 5 84.4 97.8 78.9

South East 161 3.5 3.2 3 4 92.0 96.7 93.2BROCKVILLE GENERAL HOSPITAL 23 4.6 3.8 3 5 85.0 90.0 87.0HOTEL DIEU HOSPITAL . . . . . . . .KINGSTON GENERAL HOSPITAL 49 3.8 3.2 3 4 90.2 97.6 83.7PERTH & SMITHS FALLS DIST 33 3.6 3.6 3 4 90.9 93.9 100.0QUINTE HEALTHCARE CORPORATION 56 2.7 2.7 3 3 96.4 100.0 100.0




(Days)




within 7 days


Ontario 2992 3.9 3.4 3 5 88.0 97.8 89.2




Outside target

Below 80%

Champlain 325 3.5 2.9 2 4 92.0 97.9 88.9KEMPTVILLE DISTRICT HOSPITAL 11 2.0 2.0 2 2 100.0 100.0 100.0HOPITAL MONTFORT 50 4.1 3.8 3 5 87.8 95.1 82.0QUEENSWAY-CARLETON HOSPITAL 136 2.7 2.5 2 4 95.9 99.2 90.4OTTAWA HOSPITAL 109 4.0 2.8 3 4 94.8 97.9 89.0CORNWALL COMMUNITY HOSP-GENERAL SITE 19 5.2 4.7 4 7 52.9 94.1 89.5

North Simcoe Muskoka 97 6.2 4.5 4 6 76.4 94.4 91.8ROYAL VICTORIA HOSPITAL 66 7.2 4.7 4 6 76.7 95.0 90.9COLLINGWOOD GENERAL AND MARINE HOSPITAL 16 4.0 4.0 3 5 80.0 93.3 93.8ORILLIA SOLDIERS' MEMORIAL HOSPITAL 15 4.5 4.1 3 7 71.4 92.9 93.3

North East 143 3.9 3.7 3 5 82.1 98.5 93.7TIMMINS & DISTRICT GENERAL HOSPITAL 10 4.0 4.2 4 6 60.0 100.0 50.0WEST PARRY SOUND HEALTH CENTRE 16 3.2 3.3 3 5 86.7 100.0 93.8HOPITAL REGIONAL DE SUDBURY 56 4.2 4.2 4 6 73.2 98.2 100.0SAULT AREA HOSPITAL 34 3.1 3.1 3 4 100.0 100.0 97.1NORTH BAY REGIONAL HEALTH CENTRE 27 4.5 3.8 3 5 80.0 96.0 92.6

North West 70 4.1 3.9 4 5 86.9 96.7 87.1DRYDEN REGIONAL HEALTH CENTRE 13 3.5 3.6 3 4 91.7 100.0 92.3LAKE-OF-THE-WOODS DISTRICT HOSPITAL . . . . . . . .RIVERSIDE HEALTH CARE FAC . . . . . . . .THUNDER BAY REGIONAL HLTH SCIENCES CTR 57 4.2 4.0 4 5 85.7 95.9 86.0


(Avg Days)

Avg Length of Stay (days)


(Days)




within 7 days


Ontario 5189 3.5 3.3 3 5 89.5 98.1 92.2Erie St.Clair 267 3.1 2.9 3 4 96.1 100.0 95.5

CHATAM KENT ALLIANCE 76 3.7 3.3 3 4 95.9 100.0 97.4HOTEL-DIEU GRACE HOSPITAL 70 2.7 2.6 3 4 100.0 100.0 92.9WINDSOR REGIONAL HOSPITAL 67 2.7 2.6 2 4 90.5 100.0 94.0BLUEWATER HEALTH 54 3.2 3.1 3 3 98.1 100.0 98.1

South West 498 3.0 2.9 3 4 93.7 98.3 95.0ST.JOSEPH'S HEALTH CARE,LONDON . . . . . . . .ST THOMAS-ELGIN GENERAL HOSPITAL 38 3.2 3.1 3 4 100.0 100.0 97.4STRATFORD GENERAL HOSPITAL 66 3.0 3.0 3 4 93.9 97.0 100.0STRATHROY MIDDLESEX GENERAL HOSPITAL 37 2.1 2.1 2 3 100.0 100.0 100.0WOODSTOCK GENERAL HOSPITAL 34 3.8 3.4 3 4 96.8 96.8 91.2LONDON HLTH SCIENCES CTR 225 2.9 2.9 2 5 89.0 97.6 92.9GREY BRUCE HEALTH SERVICES 98 3.1 3.1 3 3 97.8 100.0 94.9

Waterloo Wellington 296 3.7 3.6 3 5 84.2 97.5 95.9CAMBRIDGE MEMORIAL HOSPITAL 44 2.9 2.9 3 3 100.0 100.0 97.7GUELPH GENERAL HOSPITAL 78 3.5 3.5 3 5 81.8 97.4 98.7GRAND RIVER HOSPITAL CORP 174 3.9 3.8 3 5 81.1 97.0 94.3

Hamilton Niagara Haldimand Brant 633 3.9 3.7 3 5 80.3 97.4 96.2ST JOSEPH'S HEALTH CARE SYSTEM-HAMILTON 60 3.4 3.4 3 5 88.1 100.0 98.3JOSEPH BRANT MEMORIAL HOSPITAL 72 4.0 3.8 3 5 81.7 95.8 98.6HAMILTON HEALTH SCIENCES CORP 219 3.7 3.4 3 5 81.6 99.0 94.1NIAGARA HEALTH SYSTEM 177 4.5 4.5 4 6 68.4 94.7 96.6BRANT COMMUNITY HEALTHCARE SYSTEM 105 3.2 3.2 3 4 92.2 98.0 97.1

Central West 232 3.6 3.6 3 5 89.8 96.9 97.0WILLIAM OSLER HEALTH CENTRE 232 3.6 3.6 3 5 89.8 96.9 97.0

Mississauga Halton 313 3.8 3.7 3 5 85.4 96.4 98.4HALTON HEALTHCARE SERVICES CORP 74 4.5 3.8 3 5 81.7 95.8 95.9TRILLIUM HEALTH CENTRE 239 3.6 3.6 3 5 86.5 96.6 99.2

Toronto Central 712 3.6 3.4 3 4 91.9 98.8 81.3MOUNT SINAI HOSPITAL 51 2.9 2.6 2 4 94.7 100.0 74.5ST MICHAEL'S HOSPITAL 101 3.9 3.6 3 5 86.3 100.0 72.3TORONTO EAST GENERAL HOSPITAL (THE) 88 3.4 3.2 3 4 93.8 100.0 92.0ST JOSEPH'S HEALTH CENTRE 57 3.8 3.5 3 4 90.4 98.1 91.2

Patients Discharged Home

Orthopaedic Quality Scorecard - Knee Replacement SurgeryReporting Period - Q2 FY 13/14

Quality Dimension - EfficiencyAll Patients

Outside target

Below 80%


(Avg Days)



(Days)




within 7 days


Ontario 5189 3.5 3.3 3 5 89.5 98.1 92.2




Outside target

Below 80%

UNIVERSITY HEALTH NETWORK 142 3.5 3.3 3 4 92.9 98.2 78.9SUNNYBROOK HEALTH SCIENCES CENTRE 273 3.7 3.6 3 4 92.4 98.2 81.7

Central 559 3.7 3.5 3 4 90.7 97.1 85.0NORTH YORK GENERAL HOSPITAL 149 3.9 3.2 3 4 94.6 97.8 61.7YORK CENTRAL HOSPITAL 65 4.3 4.5 4 6 84.5 93.1 89.2SOUTHLAKE REGIONAL HEALTH CENTRE 98 3.6 3.5 3 5 89.0 98.9 92.9MARKHAM STOUFFVILLE HOSPITAL 72 2.7 2.4 2 4 98.5 100.0 91.7HUMBER RIVER REGIONAL HOSP 175 3.7 3.7 3 5 88.7 95.8 96.0

Central East 453 3.4 3.2 3 4 92.9 98.5 90.3ROSS MEMORIAL HOSPITAL 63 2.1 2.1 2 3 100.0 100.0 100.0PETERBOROUGH REGIONAL HEALTH CENTRE 107 3.9 3.7 4 5 89.2 99.0 95.3LAKERIDGE HEALTH CORPORATION 90 3.5 3.4 3 4 91.0 96.2 86.7ROUGE VALLEY HEALTH SYSTEM 61 3.7 3.6 3 4 92.9 98.2 91.8SCARBOROUGH HOSPITAL (THE) 132 3.4 3.1 3 4 93.6 99.1 83.3

South East 248 3.0 2.9 3 4 94.7 99.6 98.4BROCKVILLE GENERAL HOSPITAL 55 3.0 3.0 3 3 94.4 100.0 98.2HOTEL DIEU HOSPITAL . . . . . . . .KINGSTON GENERAL HOSPITAL 62 3.4 3.3 3 5 88.3 98.3 96.8PERTH & SMITHS FALLS DIST 38 2.3 2.3 2 4 100.0 100.0 100.0QUINTE HEALTHCARE CORPORATION 93 2.9 2.9 3 3 96.7 100.0 98.9

Champlain 486 3.0 2.8 3 4 92.2 98.7 92.4KEMPTVILLE DISTRICT HOSPITAL 53 1.8 1.8 2 2 100.0 100.0 98.1HOPITAL MONTFORT 121 3.2 3.1 3 5 85.2 97.2 89.3QUEENSWAY-CARLETON HOSPITAL 178 2.7 2.6 2 4 93.5 98.8 94.9OTTAWA HOSPITAL 117 3.5 3.1 3 4 95.1 99.0 88.0CORNWALL COMMUNITY HOSP-GENERAL SITE 17 3.5 3.5 3 5 82.4 100.0 100.0

North Simcoe Muskoka 128 3.4 3.4 3 4 90.6 98.4 99.2ROYAL VICTORIA HOSPITAL 96 3.5 3.5 3 4 91.7 97.9 100.0COLLINGWOOD GENERAL AND MARINE HOSPITAL 23 3.2 3.1 3 5 86.4 100.0 95.7ORILLIA SOLDIERS' MEMORIAL HOSPITAL 9 3.4 3.4 3 6 88.9 100.0 100.0

North East 271 3.7 3.6 3 5 88.0 98.5 95.6TIMMINS & DISTRICT GENERAL HOSPITAL 13 4.2 4.3 3 7 62.5 100.0 61.5WEST PARRY SOUND HEALTH CENTRE 10 3.6 3.8 3 9 88.9 88.9 90.0


(Avg Days)



(Days)




within 7 days


Ontario 5189 3.5 3.3 3 5 89.5 98.1 92.2




Outside target

Below 80%

HOPITAL REGIONAL DE SUDBURY 109 3.8 3.7 3 5 87.9 98.1 98.2SAULT AREA HOSPITAL 68 3.3 3.2 3 4 95.5 100.0 97.1NORTH BAY REGIONAL HEALTH CENTRE 71 3.8 3.7 3 5 84.1 98.6 97.2

North West 93 3.9 3.9 4 5 81.1 98.9 96.8DRYDEN REGIONAL HEALTH CENTRE 8 3.4 3.4 3 4 100.0 100.0 100.0LAKE-OF-THE-WOODS DISTRICT HOSPITAL 9 3.9 3.9 3 9 88.9 88.9 100.0RIVERSIDE HEALTH CARE FAC 16 3.3 3.3 3 3 93.8 100.0 100.0THUNDER BAY REGIONAL HLTH SCIENCES CTR 60 4.1 4.1 4 5 73.7 100.0 95.0

90th Percentile wait time (days) Quarter (Q1 FY 13/14) 90th Percentile wait time (days) Month (Dec 2013)Ontario 190 208Erie St.Clair 228 202

CHATAM KENT ALLIANCE 352 365HOTEL-DIEU GRACE HOSPITAL 207 NVWINDSOR REGIONAL HOSPITAL 110 140BLUEWATER HEALTH 111 97

South West 181 202ST.JOSEPH'S HEALTH CARE,LONDON NV NVST THOMAS-ELGIN GENERAL HOSPITAL 96 NVSTRATFORD GENERAL HOSPITAL 208 NVSTRATHROY MIDDLESEX GENERAL HOSPITAL 169 NVWOODSTOCK GENERAL HOSPITAL 345 NVLONDON HLTH SCIENCES CTR 191 201GREY BRUCE HEALTH SERVICES 100 118

Waterloo Wellington 118 157CAMBRIDGE MEMORIAL HOSPITAL 306 319GUELPH GENERAL HOSPITAL 140 157GRAND RIVER HOSPITAL CORP 100 79

Hamilton Niagara Haldimand Brant 237 210ST JOSEPH'S HEALTH CARE SYSTEM-HAMILTON 174 236JOSEPH BRANT MEMORIAL HOSPITAL 307 100HAMILTON HEALTH SCIENCES CORP 226 210NIAGARA HEALTH SYSTEM 164 149BRANT COMMUNITY HEALTHCARE SYSTEM 407 NV

Central West 230 210WILLIAM OSLER HEALTH CENTRE 230 210

Mississauga Halton 115 133CREDIT VALLEY HOSPITAL 59 61TRILLIUM HEALTH CENTRE 114 133HALTON HEALTHCARE SERVICES CORP 155 174

Toronto Central 153 158


Quality Dimension - Accessibility

Outside target

90th Percentile wait time (days) Quarter (Q1 FY 13/14) 90th Percentile wait time (days) Month (Dec 2013)Ontario 190 208



Outside target

MOUNT SINAI HOSPITAL 131 157ST MICHAEL'S HOSPITAL 256 436TORONTO EAST GENERAL HOSPITAL (THE) 106 NVST JOSEPH'S HEALTH CENTRE 260 NVUNIVERSITY HEALTH NETWORK 137 111SUNNYBROOK HEALTH SCIENCES CENTRE 120 124

Central 127 172NORTH YORK GENERAL HOSPITAL 119 91YORK CENTRAL HOSPITAL 116 184SOUTHLAKE REGIONAL HEALTH CENTRE 145 185MARKHAM STOUFFVILLE HOSPITAL 180 NVHUMBER RIVER REGIONAL HOSP 153 125

Central East 186 195ROSS MEMORIAL HOSPITAL 192 NVPETERBOROUGH REGIONAL HEALTH CENTRE 148 NVLAKERIDGE HEALTH CORPORATION 243 NVROUGE VALLEY HEALTH SYSTEM 134 305SCARBOROUGH HOSPITAL (THE) 202 195

South East 161 223BROCKVILLE GENERAL HOSPITAL 118 NVHOTEL DIEU HOSPITAL 185 NVKINGSTON GENERAL HOSPITAL 176 252PERTH & SMITHS FALLS DIST 104 NVQUINTE HEALTHCARE CORPORATION 161 132

Champlain 328 326KEMPTVILLE DISTRICT HOSPITAL 357 NVHOPITAL MONTFORT 177 207QUEENSWAY-CARLETON HOSPITAL 143 105OTTAWA HOSPITAL 411 420CORNWALL COMMUNITY HOSP-GENERAL SITE 190 NV




Outside target

North Simcoe Muskoka 183 151ROYAL VICTORIA HOSPITAL 171 87COLLINGWOOD GENERAL AND MARINE HOSPITAL 507 NVORILLIA SOLDIERS' MEMORIAL HOSPITAL 140 NV

North East 240 241TIMMINS & DISTRICT GENERAL HOSPITAL NV NVWEST PARRY SOUND HEALTH CENTRE 130 NVHOPITAL REGIONAL DE SUDBURY 240 246SAULT AREA HOSPITAL 538 NVNORTH BAY REGIONAL HEALTH CENTRE 116 NV

North West 261 186DRYDEN REGIONAL HEALTH CENTRE 84 NVLAKE-OF-THE-WOODS DISTRICT HOSPITAL NV NVRIVERSIDE HEALTH CARE FAC NV NVTHUNDER BAY REGIONAL HLTH SCIENCES CTR 282 193

90th Percentile wait time (days) Quarter (Q1 FY 13/14) 90th Percentile wait time (days) Month (Dec 2013)Ontario 225 219Erie St.Clair 348 215

CHATAM KENT ALLIANCE 407 459HOTEL-DIEU GRACE HOSPITAL 162 NVWINDSOR REGIONAL HOSPITAL 300 209BLUEWATER HEALTH 144 118

South West 238 226ST.JOSEPH'S HEALTH CARE,LONDON NV NVST THOMAS-ELGIN GENERAL HOSPITAL 92 130STRATFORD GENERAL HOSPITAL 202 291STRATHROY MIDDLESEX GENERAL HOSPITAL 143 172WOODSTOCK GENERAL HOSPITAL 401 NVLONDON HLTH SCIENCES CTR 242 247GREY BRUCE HEALTH SERVICES 104 88

Waterloo Wellington 145 414CAMBRIDGE MEMORIAL HOSPITAL 358 535GUELPH GENERAL HOSPITAL 155 174GRAND RIVER HOSPITAL CORP 112 89

Hamilton Niagara Haldimand Brant 244 218ST JOSEPH'S HEALTH CARE SYSTEM-HAMILTON 225 227JOSEPH BRANT MEMORIAL HOSPITAL 244 158HAMILTON HEALTH SCIENCES CORP 238 162NIAGARA HEALTH SYSTEM 192 208BRANT COMMUNITY HEALTHCARE SYSTEM 486 320

Central West 279 292WILLIAM OSLER HEALTH CENTRE 279 292

Mississauga Halton 171 146CREDIT VALLEY HOSPITAL 98 116TRILLIUM HEALTH CENTRE 265 160HALTON HEALTHCARE SERVICES CORP 212 146

Toronto Central 163 204



Outside target




Outside target

MOUNT SINAI HOSPITAL 129 NVST MICHAEL'S HOSPITAL 166 99TORONTO EAST GENERAL HOSPITAL (THE) 253 237ST JOSEPH'S HEALTH CENTRE 460 494UNIVERSITY HEALTH NETWORK 141 105SUNNYBROOK HEALTH SCIENCES CENTRE 132 162

Central 166 188NORTH YORK GENERAL HOSPITAL 133 132YORK CENTRAL HOSPITAL 180 263SOUTHLAKE REGIONAL HEALTH CENTRE 175 170MARKHAM STOUFFVILLE HOSPITAL 175 218HUMBER RIVER REGIONAL HOSP 156 213

Central East 177 164ROSS MEMORIAL HOSPITAL 175 NVPETERBOROUGH REGIONAL HEALTH CENTRE 95 NVLAKERIDGE HEALTH CORPORATION 176 98ROUGE VALLEY HEALTH SYSTEM 156 171SCARBOROUGH HOSPITAL (THE) 209 170

South East 154 124BROCKVILLE GENERAL HOSPITAL 104 95HOTEL DIEU HOSPITAL 101 NVKINGSTON GENERAL HOSPITAL 149 124PERTH & SMITHS FALLS DIST NV NVQUINTE HEALTHCARE CORPORATION 178 133

Champlain 246 283KEMPTVILLE DISTRICT HOSPITAL 230 307HOPITAL MONTFORT 246 201QUEENSWAY-CARLETON HOSPITAL 142 150OTTAWA HOSPITAL 309 361CORNWALL COMMUNITY HOSP-GENERAL SITE 321 433




Outside target

North Simcoe Muskoka 219 212ROYAL VICTORIA HOSPITAL 189 113COLLINGWOOD GENERAL AND MARINE HOSPITAL 615 NVORILLIA SOLDIERS' MEMORIAL HOSPITAL 125 NV

North East 278 247TIMMINS & DISTRICT GENERAL HOSPITAL 688 NVWEST PARRY SOUND HEALTH CENTRE 130 NVHOPITAL REGIONAL DE SUDBURY 274 271SAULT AREA HOSPITAL 425 625NORTH BAY REGIONAL HEALTH CENTRE 133 85

North West 237 252DRYDEN REGIONAL HEALTH CENTRE NV NVLAKE-OF-THE-WOODS DISTRICT HOSPITAL NV NVRIVERSIDE HEALTH CARE FAC 56 NVTHUNDER BAY REGIONAL HLTH SCIENCES CTR 272 254

Rate of Readmission within 30 days after primary joint replacement

Rate of Revision within 365 days after primary joint replacement

Ontario 3.4 1.6Erie St.Clair 3.5 2.7

CHATAM KENT ALLIANCE 2.4 2.0HOTEL-DIEU GRACE HOSPITAL 3.2 3.4WINDSOR REGIONAL HOSPITAL 0.0* 0.0BLUEWATER HEALTH 5.4 2.7

South West 3.0 1.9ST.JOSEPH'S HEALTH CARE,LONDON NV 5.3*ST THOMAS-ELGIN GENERAL HOSPITAL 0.0* 0.0STRATFORD GENERAL HOSPITAL 6.3 0.0STRATHROY MIDDLESEX GENERAL HOSPITAL 0.0* 2.2WOODSTOCK GENERAL HOSPITAL 0.0* 0.0LONDON HLTH SCIENCES CTR 3.6 3.1GREY BRUCE HEALTH SERVICES 2.0 1.4

Waterloo Wellington 4.1 0.9CAMBRIDGE MEMORIAL HOSPITAL 3.0 0.7GUELPH GENERAL HOSPITAL 7.3 0.6GRAND RIVER HOSPITAL CORP 3.2 1.2

Hamilton Niagara Haldimand Brant 3.6 1.5ST JOSEPH'S HEALTH CARE SYSTEM-HAMILTON 12.5 0.6JOSEPH BRANT MEMORIAL HOSPITAL 1.9 1.1HAMILTON HEALTH SCIENCES CORP 3.2 2.2NIAGARA HEALTH SYSTEM 0.0 1.5BRANT COMMUNITY HEALTHCARE SYSTEM 8.1 0.0

Central West 0.0 1.4WILLIAM OSLER HEALTH CENTRE 0.0 1.4

Mississauga Halton 5.8 1.6HALTON HEALTHCARE SERVICES CORP 8.5 0.8TRILLIUM HEALTH CENTRE 4.3 2.0

Toronto Central 2.7 0.9MOUNT SINAI HOSPITAL 2.0 1.6


Quality Dimension - Effectiveness/Safety

NV = No cases * = Low volume (<=25 cases)



Ontario 3.4 1.6




ST MICHAEL'S HOSPITAL 0.9 0.5TORONTO EAST GENERAL HOSPITAL (THE) 3.6 0.6ST JOSEPH'S HEALTH CENTRE 10.3 2.5UNIVERSITY HEALTH NETWORK 1.6 1.1SUNNYBROOK HEALTH SCIENCES CENTRE 3.1 0.8

Central 3.4 1.8NORTH YORK GENERAL HOSPITAL 3.0 1.7YORK CENTRAL HOSPITAL 4.3* 1.8SOUTHLAKE REGIONAL HEALTH CENTRE 7.7 1.8MARKHAM STOUFFVILLE HOSPITAL 0.0 0.0HUMBER RIVER REGIONAL HOSP 1.9 3.4

Central East 3.0 0.9ROSS MEMORIAL HOSPITAL 4.8* 0.0PETERBOROUGH REGIONAL HEALTH CENTRE 2.0 1.3LAKERIDGE HEALTH CORPORATION 4.0 0.0ROUGE VALLEY HEALTH SYSTEM 5.0* 2.0SCARBOROUGH HOSPITAL (THE) 1.6 0.7

South East 4.3 2.3BROCKVILLE GENERAL HOSPITAL 16.7* 2.4HOTEL DIEU HOSPITAL NV NVKINGSTON GENERAL HOSPITAL 1.9 2.0PERTH & SMITHS FALLS DIST 8.6 1.0QUINTE HEALTHCARE CORPORATION 0.0 3.1

Champlain 2.9 2.5KEMPTVILLE DISTRICT HOSPITAL 0.0* 0.0*HOPITAL MONTFORT 1.7 1.0QUEENSWAY-CARLETON HOSPITAL 3.2 3.8OTTAWA HOSPITAL 2.9 2.2CORNWALL COMMUNITY HOSP-GENERAL SITE 8.3* 0.0

North Simcoe Muskoka 2.9 1.4



Ontario 3.4 1.6




ROYAL VICTORIA HOSPITAL 4.5 1.4COLLINGWOOD GENERAL AND MARINE HOSPITAL 0.0* 1.8ORILLIA SOLDIERS' MEMORIAL HOSPITAL 0.0* 0.0

North East 5.0 0.7TIMMINS & DISTRICT GENERAL HOSPITAL 20.0* 0.0*WEST PARRY SOUND HEALTH CENTRE 7.7* 0.0HOPITAL REGIONAL DE SUDBURY 4.0 0.0SAULT AREA HOSPITAL 7.3 1.8NORTH BAY REGIONAL HEALTH CENTRE 0.0 1.8

North West 5.8 2.8DRYDEN REGIONAL HEALTH CENTRE 18.2* 2.8LAKE-OF-THE-WOODS DISTRICT HOSPITAL NV NVRIVERSIDE HEALTH CARE FAC NV NVTHUNDER BAY REGIONAL HLTH SCIENCES CTR 3.4 2.8



Ontario 3.2 1.1Erie St.Clair 3.4 1.5

CHATAM KENT ALLIANCE 3.3 0.3HOTEL-DIEU GRACE HOSPITAL 3.8 2.9WINDSOR REGIONAL HOSPITAL 1.6 0.8BLUEWATER HEALTH 4.5 1.6

South West 5.2 1.3ST.JOSEPH'S HEALTH CARE,LONDON NV 2.8ST THOMAS-ELGIN GENERAL HOSPITAL 11.4 0.8STRATFORD GENERAL HOSPITAL 3.3 0.7STRATHROY MIDDLESEX GENERAL HOSPITAL 5.4 0.0WOODSTOCK GENERAL HOSPITAL 8.1 1.4LONDON HLTH SCIENCES CTR 5.0 1.4GREY BRUCE HEALTH SERVICES 3.2 1.7

Waterloo Wellington 2.1 0.5CAMBRIDGE MEMORIAL HOSPITAL 5.1 0.6GUELPH GENERAL HOSPITAL 2.4 0.4GRAND RIVER HOSPITAL CORP 1.1 0.4

Hamilton Niagara Haldimand Brant 3.4 1.0ST JOSEPH'S HEALTH CARE SYSTEM-HAMILTON 5.0 1.4JOSEPH BRANT MEMORIAL HOSPITAL 2.4 0.3HAMILTON HEALTH SCIENCES CORP 3.8 1.3NIAGARA HEALTH SYSTEM 2.9 1.2BRANT COMMUNITY HEALTHCARE SYSTEM 2.9 0.6

Central West 3.0 0.2WILLIAM OSLER HEALTH CENTRE 3.0 0.2

Mississauga Halton 2.1 0.6HALTON HEALTHCARE SERVICES CORP 1.3 0.6TRILLIUM HEALTH CENTRE 2.4 0.6

Toronto Central 2.5 1.1MOUNT SINAI HOSPITAL 4.5 0.9






Ontario 3.2 1.1




ST MICHAEL'S HOSPITAL 7.0 0.7TORONTO EAST GENERAL HOSPITAL (THE) 3.5 1.2ST JOSEPH'S HEALTH CENTRE 1.6 1.4UNIVERSITY HEALTH NETWORK 2.1 1.2SUNNYBROOK HEALTH SCIENCES CENTRE 0.7 1.1

Central 2.9 1.4NORTH YORK GENERAL HOSPITAL 2.6 1.7YORK CENTRAL HOSPITAL 4.5 2.1SOUTHLAKE REGIONAL HEALTH CENTRE 2.9 1.2MARKHAM STOUFFVILLE HOSPITAL 1.4 0.8HUMBER RIVER REGIONAL HOSP 3.0 1.2

Central East 3.6 1.2ROSS MEMORIAL HOSPITAL 6.0 1.8PETERBOROUGH REGIONAL HEALTH CENTRE 4.6 0.8LAKERIDGE HEALTH CORPORATION 2.2 0.3ROUGE VALLEY HEALTH SYSTEM 1.3 1.1SCARBOROUGH HOSPITAL (THE) 4.0 1.6

South East 2.8 1.2BROCKVILLE GENERAL HOSPITAL 1.5 2.7HOTEL DIEU HOSPITAL NV NVKINGSTON GENERAL HOSPITAL 1.5 2.5PERTH & SMITHS FALLS DIST 0.0 0.5QUINTE HEALTHCARE CORPORATION 6.2 0.0

Champlain 3.2 1.4KEMPTVILLE DISTRICT HOSPITAL 3.6 1.5HOPITAL MONTFORT 3.5 0.8QUEENSWAY-CARLETON HOSPITAL 2.9 1.6OTTAWA HOSPITAL 3.8 1.1CORNWALL COMMUNITY HOSP-GENERAL SITE 0.0* 4.6

North Simcoe Muskoka 4.9 0.5



Ontario 3.2 1.1




ROYAL VICTORIA HOSPITAL 5.5 0.5COLLINGWOOD GENERAL AND MARINE HOSPITAL 0.0* 0.0ORILLIA SOLDIERS' MEMORIAL HOSPITAL 7.1* 1.6

North East 2.4 1.9TIMMINS & DISTRICT GENERAL HOSPITAL 0.0* 0.0WEST PARRY SOUND HEALTH CENTRE 0.0* 0.0HOPITAL REGIONAL DE SUDBURY 1.7 1.7SAULT AREA HOSPITAL 4.9 3.5NORTH BAY REGIONAL HEALTH CENTRE 2.2 2.1

North West 8.3 0.6DRYDEN REGIONAL HEALTH CENTRE 6.3* 2.6LAKE-OF-THE-WOODS DISTRICT HOSPITAL 0.0* 0.0*RIVERSIDE HEALTH CARE FAC 6.3* 0.0THUNDER BAY REGIONAL HLTH SCIENCES CTR 9.8 0.3

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1Data Source Frequency of Data Collection• CIHI DAD • QuarterlyRationale•Measure Description•Methods Notes

Inclusions:• Inpatient population reported based on Discharge Date for the reporting period• Elective patients – 'Admission Category' = "L"• Primary hip and knee replacement procedures • Patients 18 years and older on the day the procedure was completed•• CCI codes 1.VA.53.^^, 1.VG.53.^^

Exclusions:•• Intervention Status Attribute ' NE "R" to exclude revisions• Primary Cement Spacer procedure with CCI codes 1.VA.53.LA-SL-N and 1.VG.53.LA-SL-N attribute status = 0.

Notes:•Data Quality & Limitations• Quarterly CIHI DAD is available two months after the end of the reporting quarter•

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Data Source Frequency of Data Collection• CIHI DAD • QuarterlyRationale• The purpose of this indicator is to report on the mean (average) LOS for patients discharged home• Length of stay is an indicator of quality of care.• The established current provincial target is 4.4 daysMeasure Description•Methods Notes

Numerator = [Sum of individual length of stays over the specified period of time for valid patients]Denominator = [Count of valid cases over the specified period of time]

Inclusions:• Inpatient population reported based on "Discharge Date" for the reporting period• Elective patients – 'Admission Category' = "L"• Primary hip and knee replacement procedures • Patients 18 years and older on the day the procedure was completed•• Only patients discharged to home - Discharge Type = 04 and 05• CCI codes 1.VA.53.^^, 1.VG.53.^^


Notes:• The average length of stay will be presented as days to one decimal place •

Data Quality & Limitations• Quarterly CIHI DAD is available two months after the end of the reporting quarter•

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Data Source Frequency of Data Collection• CIHI DAD • QuarterlyRationale••

Measure Description

Primary Hip and Knee Replacement Surgery Orthopaedic Quality Scorecard - Indicators Dictionary

IndicatorsLength of Stay - All Patients (Average Days)Length of Stay - Patients Discharged Home (Average Days)Length of Stay - Patients Discharged Home (Median Days)Length of Stay - Patients Discharged Home (90th Percentile Days)

Average length of stay for all hip and knee joint replacement patients

The purpose of this indicator is to report the length of stay for all patients who have hip or knee joint replacement, regardless of

The Average length of stay in acute care for all primary unilateral hip of knee joint replacement patients regardless of discharge

Numerator = [Sum of all lengths of stay over the specified period of time for valid patients]Denominator = [Count of all valid patient over the specified period of time]Average length of stay = [Sum of all lengths of stay over the specified period of time for valid patients] / [Count of all valid patients

Proportion of Patients Discharged HomeRate of Readmissionwithin 30 days after primary joint replacementRate of Revision within 365 days after primary joint replacementPrimary Hip and Knee Replacement Wait Time (90th Percentile days)Percent completed within 4.4 days (LOS indicator)Percent completed within 7 days (LOS indicator)

Mean length of stay = [Sum of individual length of stays over the specified period of time for valid patients] / [Count of valid cases

Valid patient = the patient who has a valid record for a specific data element and corresponds to the inclusion and exclusion criteria.

Patients where primary (most responsible) condition for joint replacement is Cancer (ICD-10 Chapter code= 'C' and 'D') or Trauma

Length of stay is the time period from the date and time of admission to acute care to the date and time of discharge from acute

Quarterly data undergoes data quality processes prior to year end and results after year end closes will be the most accurate

Median length of stay for patients discharged directly home after primary hip or knee joint replacement surgery





Average length of stay for patients discharged directly home after primary hip or knee joint replacement surgery

The mean length of stay in acute care for primary hip or knee joint replacement patients who are discharged from acute care

The purpose of this indicator is to report the length of stay at which point 50 % of patients have been dischargedThe median is less sensitive to extreme scores than the mean, which makes the median a better measure for highly skewed

•Methods Notes



Notes:•


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Data Source Frequency of Data Collection• CIHI DAD • QuarterlyRationale• The purpose of this indicator is to report the 90th percentile LOS for patients discharged home• Length of stay is an indicator of quality of care.• The established current provincial target is 7 daysMeasure Description•Methods Notes



Notes:• The 90th percentile length of stay in days to one decimal place •


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Data Source Frequency of Data Collection• CIHI DAD • QuarterlyRationale••• The LHIN level target has been set for 90 % of patients discharged home.• LHINs can negotiate hospital performance within a corridor of +/- 9% (81% to 99%)

Measure Description• The percentage of hip or knee joint replacement patients discharged from acute care directly home.Methods Notes

Numerator = [Count of all valid patients discharged directly home over a specified period of time]Denominator = [Count of all valid patients over the specified period of time]Proportion of Patients Discharged Directly Home from Acute Care =

Inclusions:• Inpatient population reported based on Discharge Date for the reporting period• Elective patients – 'Admission Category' = "L"• Primary hip and knee replacement procedures • Patients 18 years and older on the day the procedure was completed• Patients who were discharged directly home from acute care for numerator only• All valid patients for the denominator regardless of discharge destination•• CCI codes 1.VA.53.^^, 1.VG.53.^^


Notes:• The percentage of patients discharged directly home to one decimal point.



90th percentile length of stay for patients discharged directly home after primary hip or knee joint replacement surgery

90th percentile is the length of stay for the 9 out of 10 patients if ordered from shortest to longest length of stay.

90th percentile is the length of stay for the 9 out of 10 patients if ordered from shortest to longest length of stay.


The median is the number of days within which half of the patients in the specified time period were discharged home

Median length of stay is the value for LOS for a patient positioned in the middle of the list ordered from the lower to the highest



([Count of all valid patients discharged directly home over a specified period of time] / [Count of all valid patients over the specified






Proportion of patients discharged to home after primary hip and knee joint replacement surgery

To report the proportion (percentage) of patients discharged home of all patients who have hip or knee joint replacement.Evidence identifies that after hip or knee joint replacement most patients can be discharged directly to home.


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Data Source Frequency of Data Collection• CIHI DAD • QuarterlyRationale•• No target has been set at this time for the readmission indicator.Measure Description•Methods Notes

Proportion of patients readmitted within 30 days = Numerator/Denominator * 100

Inclusions for Denominator:• Inpatient population reported based on Discharge Date for the reporting period• Elective patients – 'Admission Category' = "L"• Primary hip and knee replacement procedures • Patients 18 years and older on the day the procedure was completed• Primary joint procedure – 'Attribute status' NE "R" for primary (included in denominator)• For patients with multiple primaries, only the most recent primary intervention is included•• CCI codes 1.VA.53.^^, 1.VG.53.^^

Exclusions for Denominator•• Primary Cement Spacer procedure with CCI codes 1.VA.53.LA-SL-N and 1.VG.53.LA-SL-N attribute status = 0.

Inclusions for Numerator:••

Exclusions for Numerator:•• All Elective readmissions (Admission Category = L)•

Notes:• The readmission rate for a hospital is attributed to the hospital where the primary surgery took place.• The readmission rate for a LHIN is attributed to the LHIN where the primary surgery took place.•

Example: Reporting Quarter is Q2 FY 10/11 - July 1, 2010 to Sept 30, 2010


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Data Source Frequency of Data Collection• CIHI DAD • QuarterlyRationale•• No target has been set at this time for the revision indicator.Measure Description•• The rate of revision is measured from discharge date (primary surgery) to admission date (revision surgery)• The rate of the revisions on a monthly or quarterly basis are very lowMethods Notes

Revision rate = Numerator/Denominator * 100

Inclusions for Denominator:• Inpatient population reported with primary hip and knee surgery• Elective patients – 'Admission Category' = "L"• Patients 18 years and older on the day the primary procedure was completed•••• CCI codes 1.VA.53.^^, 1.VG.53.^^

Inclusions for Numerator:••• CCI codes 1.VA.53.^^, 1.SQ.53.^^, 1.VG.53.^^ (only revision codes for 1.SQ.53 are included) • Both elective and urgent revisions are included

Exclusions for Denominator•• Patients with multiple primaries. It is difficult to link the revision to a particular primary intervention.• Primary Cement Spacer procedure with CCI codes 1.VA.53.LA-SL-N and 1.VG.53.LA-SL-N attribute status = 0.

Notes:• The revision rate for a hospital is attributed to the hospital where the primary surgery took place.• The revision rate for a LHIN is attributed to the LHIN where the primary surgery took place.



The purpose of this indicator is to report the percentage of patients readmitted to acute care within 30 days of discharge from

For patients with multiple readmissions, only the earliest readmission is used to calculate the difference between discharge date and

Patients readmitted for another primary total hip and knee within 30 days of discharge from primary total hip and knee

Duplicates identified as transfers within an episode of care

Denominator specified time period is the month prior to the reporting quarter plus the first two months of the reporting quarter.

Denominator specified time period for rate of readmission is from June 1, 2010 to August 31, 2010 (3 months).There is no time period for the numerator as long as the readmission occurred within 30 days after discharge from

The percentage of hip or knee joint replacement patients admitted to acute care within 30 days after discharge from acute care.

Numerator = [Count of primary hip and knee joint replacement patients who were readmitted for any reasons within 30 days from Denominator = [Count of all patients discharged after primary hip or knee joint replacement from acute care for the specified time



Subset of selected patients from the denominator group who were readmitted in acute care within 30 days from discharge

Primary hip or knee replacement procedure – 'Attribute status' NE "R" for primary (included in denominator)Patients who were discharged from hospital after primary surgical intervention within 365 days before the end of the reporting Valid patient = the patient who has a valid record for a specific data element and corresponds to the inclusion and exclusion criteria.

Subset of selected patients from the denominator group who received Revision Joint Replacement (Attribute Status = "R") within For patients with multiple revisions, only the earliest revision is used to calculate the difference between discharge date (primary)



Rate of Revision within 365 days after primary hip or knee joint replacement

The purpose of this indicator is to report the rate (percentage) of patients who underwent a revision joint surgery within 365 days

The percentage of hip and knee joint replacement who received a revision within 365 days of discharge from hospital after primary

Numerator = [Count of primary hip and knee joint replacement patients who had revisions within 365 days from discharge]Denominator = [Count of all patients discharged after primary hip or knee joint replacement from acute care for the specified time

•

Example: Reporting Quarter is Q2 FY 10/11 - July 1, 2010 to Sept 30, 2010

Data Quality & Limitations••

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Data Source Frequency of Data Collection• Wait Time Information System • QuarterlyRationale•• The established provincial target is 182 daysMeasure Description•

Methods NotesWait time = "treatment" date minus "decision to treat" date less patient unavailable days

Inclusions:• Primary total hip and knee replacements with procedure dates within the specified reporting period. • Patients 18 years and older on the day the procedure was completed• Wait List Entries assigned Priority Levels 2,3 and 4 (Elective Cases)

Exclusions:• Procedures no longer required. • Wait list entries identified by hospitals as data entry errors.• Cases with very long waits (if confirmed by hospital). • Priority 1 emergency cases

Notes:

These are considered data entry errors. Data Quality & Limitations••

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Data Source Frequency of Data Collection• CIHI DAD • QuarterlyRationale•Measure Description• The percent of patients discharged home withing the indicator target of 4.4 days.Methods Notes

Numerator = [Count of all valid patients discharged home within 4.4 days over the specified time period]Denominator = [Count of all valid patient discharged home over the specified period of time]Percent discharged within 4.4 days = Numerator/Denominator * 100

Inclusions:• Inpatient population reported based on Discharge Date for the reporting period• Elective patients – 'Admission Category' = "L"• Primary hip and knee replacement procedures • Patients 18 years and older on the day the procedure was completed• Primary joint procedure – 'Attribute status' NE "R" for primary •• Patients with a discharge destination of home; code 04 or 05.

Exclusions:•

Notes:•


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Data Source Frequency of Data Collection• CIHI DAD • QuarterlyRationale•Measure Description• The percent of patients discharged home withing the indicator target of 7 days.Methods Notes

Numerator = [Count of all valid patients discharged home within 7 days over the specified time period]Denominator = [Count of all valid patient discharged home over the specified period of time]Percent discharged within7days = Numerator/Denominator * 100

Inclusions:• Inpatient population reported based on Discharge Date for the reporting period• Elective patients – 'Admission Category' = "L"• Primary hip and knee replacement procedures • Patients 18 years and older on the day the procedure was completed• Primary joint procedure – 'Attribute status' NE "R" for primary •• Patients with a discharge destination of home; code 04 or 05.

The purpose of this indicator is to report on the wait time of hip and knee patients from Decision to Treat Date to Surgical Procedure

90th percentile is the length of stay for the 9 out of 10 patients if ordered from shortest to longest length of stay. For example, if a 58 days, this means that 9 out of 10 of the patients waited less than 58 days, and the other 10 per cent waited more than 58 days.

If patient unavailable dates fall outside the Decision to Treat Date up to Procedure Date, the patient unavailable dates are not

Data is based on the monthly extract of the Wait Time Information System taken 7-8 days after the end of the month.Data Quality validation/verification with hospitals are done twice a month for accuracy and validity of reported wait time

Denominator specified time period is 4 quarters prior to most recent 4 quarters. The most recent quarter is the reporting quarter.

Denominator specified time period for rate of revision is from October 1, 2008 to September 30, 2009 (1 year data)There is no time period for the numerator as long as the revision occurred within 365 days after discharge to the

Quarterly CIHI DAD is available two months after the end of the reporting quarterQuarterly data undergoes data quality processes prior to year end and results after year end closes will be the most accurate

90th Percentile Wait Time for primary hip or knee joint replacement surgery

Percent completed within 7 days (LOS indicator)

The purpose of this indicator is to report the percent of patients who have hip or knee joint replacementwho and are discharged


Percent completed within 4.4 days (LOS indicator)

The purpose of this indicator is to report the percent of patients who have hip or knee joint replacement who are discharged home





Exclusions:•

Notes:•


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Patients where primary (most responsible) condition for joint replacement is Cancer or Trauma – please see ROW 500 below for the



Documents

Ministry of Health and Long-Term Care Orthopaedic …...Ministry of Health and Long-Term Care Orthopaedic Quality Scorecard Primary Hip Knee Replacement, Q2 2013/14 Key findings: The