Impact of the COVID-19 Pandemic on Health System Use in Canada.

The Canadian Institute for Health Information has compiled health system data to investigate the impact of the COVID-19 pandemic on Canada's healthcare system. Information was aggregated from four distinct sectors of care: emergency department visits, in-patient hospital stays, physician care and home care. Across the sectors, there were two compelling themes: rapid transformation and change in human behaviour.

New Data on Access to Mental Health and Addictions Services and Home and Community Care.

As the population ages, more Canadians need home care to help manage their health conditions and live safely at home. For Canadians of all ages, timely access to mental health and addictions services is an area of growing concern. The impact of the COVID-19 pandemic and its strain on health system resources have further highlighted the need to improve services in these areas. The Canadian Institute for Health Information (CIHI) is working with governments across Canada to bridge data gaps, develop indicators and publicly report results as part of a collective effort to improve access in these two sectors. Results for three new indicators were released by CIHI in 2020.

Types of Opioid Harms in Canadian Hospitals: Comparing Canada and Australia.

Harms related to opioid use (whether prescribed or obtained illicitly) represent a growing cause of concern in developed countries, including Australia and Canada.This report examines the characteristics of opioid-related care visits to emergency departments (EDs) or hospital admissions and groups them into five distinct harm profiles. These profiles and their respective distributions illustrate how opioid-related harms differ across care settings in Canada. Opioid dependence and accidental poisoning were the more prominent types of harm seen in EDs, with a rate of 39.2 and 38.0 visits per 100,000 population, respectively. Within the in-patient population, rates of hospital stays were comparatively higher (26.8 per 100,000) for adverse drug reactions compared to other opioid-related harms. In addition to differing patterns in care settings, these harm groups differed on length of hospital stay, types of care received, other drugs involved and demographic variables such as age, gender and income.

Measuring the frequency and variation of unnecessary care across Canada.

BACKGROUND: Through the Choosing Wisely Canada (CWC) campaign, national medical specialty societies have released hundreds of recommendations against health care services that are unnecessary, i.e. present little to no benefit or cause avoidable harm. Despite growing interest in unnecessary care both within Canada and internationally, prior research has typically avoided taking a national or even multi-jurisdictional approach in measuring the extent of the issue. This study estimates use of three unnecessary services identified by CWC recommendations across multiple Canadian jurisdictions. METHODS: Two retrospective cohort studies were conducted using administrative health care data collected between fiscal years 2011/12 and 2012/13 to respectively quantify use of 1) diagnostic imaging (spinal X-ray, CT or MRI) among Albertan patients following a visit for lower back pain and 2) cardiac tests (electrocardiogram, chest X-ray, stress test, or transthoracic echocardiogram) prior to low-risk surgical procedures in Alberta, Saskatchewan, and Ontario. A cross-sectional study of the 2012 Canadian Community Health Survey was also conducted to estimate 3) the proportion of females aged 40-49 that reported having a routine mammogram in the past two years. RESULTS: Use of unnecessary care was relatively frequent across all three services and jurisdiction measured: 30.7% of Albertan patients had diagnostic imaging within six months of their initial visit for lower back pain; a cardiac test preceded 17.9 to 35.5% of low-risk surgical procedures across Alberta, Saskatchewan, and Ontario; and 22.2% of Canadian women aged 40-49 at average-risk for breast cancer reported having a routine screening mammogram in the past two years. CONCLUSIONS: The use of potentially unnecessary care appears to be common in Canada. This investigation provides methodology to facilitate future measurement efforts that may incorporate additional jurisdictions and/or unnecessary services.

Rehospitalizations, early revisions, infections, and hospital resource use in the first year after hip and knee arthroplasties.

We examined 3 negative outcomes for 58 351 hip and knee arthroplasty patients: rehospitalization, revision and infection, and their impact on resource use in the year after surgery. In the year before surgery, 12.9% of elective hip and 10.2% of knee patients were hospitalized. In the year after, 14.8% of elective hip and 15.5% of knee patients were hospitalized, representing a 15% and 52% increase, respectively. Twenty-eight percent of emergent hip patients were hospitalized at least once preoperatively; this did not change after surgery. Revision occurred in 2.0% of emergent hip, 1.7% of elective hip, and 0.9% of knee patients. Joint infection was diagnosed in 1.3% of patients. The increased hospitalization after the elective hip and knee procedures represents an incremental cost of 10% over the index hospital stay.

Improving measures of hip fracture wait times: a focus on ontario.

In 2009-2010, a "time of surgery" data element was added to CIHI's Discharge Abstract Database enabling a more precise calculation of patient wait times for hip fracture repair, measured in hours rather than days. Using an Ontario sample, we explored this more precise calculation for the first three quarters of 2009-2010 (April to December), and the impact of adding wait times in the emergency department (ED) to the total wait. When we linked emergency department and in-patient care wait times, the percent of patients meeting the benchmark of 48 hours dropped from 78% (when the start time was admission to an acute care bed) to 71%.

CIHI survey: Alternative level of care in Canada: a summary.

Canadian health system managers are increasingly concerned about the number of hospital in-patients who do not need acute care services (Ontario Association for Community Care Access Centres et al. 2006; Yassi et al. 2008). These patients are widely known as "ALC patients" because they are awaiting an alternative level of care in a more appropriate setting. ALC days in hospitals is a systems issue, reflecting challenges in different parts of the healthcare system, including hospitals, community care and long-term care (MacLeod et al. 2008; Ontario Association for Community Care Access Centres et al. 2006; Penney and Henry 2008). Planning and coordination across health sectors will be enhanced through a better understanding of the characteristics of ALC patients and what happens after they are discharged from hospital. This article summarizes more detailed findings presented in the recent report by the Canadian Institute for Health Information (CIHI 2009), Waiting in Hospital: Alternate Level of Care in Canada.

Bariatric surgery in Canada: obesity rates for Canadian adults are much higher today than in the past; however, rates of bariatric surgery, a treatment for high-risk severely obese individuals, have not risen in parallel.

Obesity rates for Canadian adults are much higher today than in the past, raising questions about how to achieve healthy weights and mitigate the associated health risks. While not a solution at the population level, bariatric surgery may be a treatment option for a relatively small proportion of obese individuals. In Canada, unlike in the United States, no consistent trend was evident in the use of this surgery between 1996-97 and 2003-04 across the five provinces for which comparable data were available. In 2003-04, bariatric surgeries were performed predominantly for women (87%); the average length of stay in hospital was 5 days; and 1.4% of patients were readmitted to hospital within 7 days of their discharge after surgery.

Cancer incidence in young adults in Canada: preliminary results of a cancer surveillance project.

Surveillance of cancer in young adults has been neglected, despite Sir Richard Doll's having emphasized its importance a decade ago. This report describes the patterns, time trends and regional variation in cancer incidence in Canada's young adults. In 1987 96, 97,469 cancers were diagnosed in Canadians aged 20 44, with almost two-thirds in females. Ten types of cancer accounted for 83% of diagnoses in women and 74% in men. The most common cancers in young women were breast, cervix, melanoma, thyroid and ovary, and in young men were testis, non- Hodgkin's lymphoma, melanoma, colorectal and lung. Although incidence rose only slightly for total cancer between 1969 and 1996, it increased dramatically for several specific types of cancer: lung (women), melanoma, testis, thyroid and non-Hodgkin's lymphoma. Incidence declined for a few cancers (colorectal, lung (men), cervix and ovary). Lung cancer incidence was significantly lower than the Canadian average in Prairie women and non-significantly high in Quebec (both sexes), while the rate of melanoma was significantly low in Quebec (both sexes) and high in women in the Pacific region.

Evaluation of a risk factor survey with three assessment methods.

This paper describes the evaluation of questions on a cancer risk factor survey using three different methods: dataset response patterns, qualitative feedback, and questionnaire appraisal. These methods addressed the survey data, procedures and questions. The three methods identified similar issues but also made unique contributions. Dataset response patterns showed missing and out-of-range data, an order effect, and mixed coding. Qualitative feedback revealed lack of clarity, sensitive topics, technical or undefined terms, failure to hear all response options, overlapping response options (as perceived by respondents), coding problems and recall difficulties. Questionnaire appraisal showed technical or undefined terms, complex syntax, hidden definitions, and ambiguous wording. The survey assessment methods described here can improve data quality, especially when limited time and resources preclude in-depth questionnaire development.