Trends in hospital coding for people experiencing homelessness in Canada, 2015-2020: a descriptive study.

BACKGROUND: In 2018, hospitals were mandated to record homelessness using International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA code Z59.0). We sought to answer whether the coding mandate affected the volume of patients identified as experiencing homelessness in acute inpatient hospitalizations and if there was any geographic variation. METHODS: We conducted a serial cross-sectional study describing 6 fiscal years (2015/16 to 2020/21) of hospital administrative data from the Hospital Morbidity Database. We reported frequencies and percentages of hospitalizations with a Z59.0 diagnostic code and disaggregated by several types of Canadian geographies. Controlling for fiscal quarter (coded Q1 to Q4) and province or territory, adjusted logistic regression models quantified the odds of Z59.0 being coded during hospital stays. RESULTS: The frequency and percentage of people experiencing homelessness in hospitalization records across Canada increased from 6934 (0.12%) in 2015/16 to 21 529 (0.41%) in 2020/21. Trends varied by province and territory. Recording of the Z59.0 code increased following the mandate (adjusted odds ratio 2.29, 95% confidence interval 2.25-2.32), relative to the pre-mandate period. INTERPRETATION: The 2018 coding mandate coincided with an increase in the use of the Z59.0 code to document homelessness in health care administrative data; however, trends varied by jurisdiction. The ICD-10-CA code Z59.0 presents a promising opportunity for standardized and routinely collected data to identify people experiencing homelessness in hospital administrative data.

Health-adjusted potential years of life lost due to treatable causes of death and illness.

BACKGROUND: Summary measures based on potential years of life lost (PYLL) to death and to illness would complement population health measures such as health-adjusted life expectancy. These measures can be applied to deaths and to conditions that are considered amenable to treatment by the health care system. DATA AND METHODS: Life tables for 2007 to 2009 were used to calculate health-adjusted potential years of life lost (HAPYLL) for males and females from birth to age 75 for Canada and the provinces. Mortality rates for all causes were adjusted using the Health Utility Index 3 (HUI3) as a measure of the average value of a year in ill health. Average HUI3 was calculated for each age group for selected health conditions self-reported in the 2009/2010 Canadian Community Health Survey. HAPYLL was estimated by adding the average number of years lost due to treatable causes of death (treatable PYLL) to the average number of years lost because of ill health (HUI3 gap). RESULTS: More years of life are lost because of ill health than are lost because of premature death. During the 2007-to-2009 period, age-/sex-standardized PYLL due to treatable causes of death was 1,257 years per 100,000 person-years, while the age-/sex-standardized HUI3 gap was 6,477 years. Provincial rankings change when information on deaths is combined with information on ill health. INTERPRETATION: The impact of treatable conditions is greater in terms of quality of life lost than in life-years lost.

Strategic grouping in the spatial span memory task.

Spatial short-term memory performance was examined in relation to participants' strategies. A total of 20 adult participants viewed and reproduced sequences of locations that varied in length (five, six, seven, or eight locations) and spatial separability (a manipulation of the configurations). In trial-by-trial self-reports, participants described five types of strategies. Chunking the spatial sequences into groups of three or four locations was the sole strategy associated with increased accuracy. Participants demonstrated considerable variability in the strategies that they selected, suggesting that cognitive resources are allocated to strategy selection, execution, and monitoring in the spatial span task. Spatially separable sequences were more accurately recalled than nonseparable sequences, independent of strategic grouping, suggesting two levels of grouping in the spatial span task.