ED-visits-first-point-contact-MHA-EN - Health Quality Ontario (HQO)

INDICATOR NAME

Name

Rates of Emergency Department Visits As First Point of Contact for Mental Health And Addictions–Related Care

Alternate Name

Rates of Emergency Department Visits As First Point of Contact for Mental Health And Addictions–Related Care

INDICATOR DESCRIPTION

Description

This indicator measures number of individuals for whom the emergency department was the first point of contact for mental health and addictions care per 100 population aged 0 to 105 years with an incident MHA-related ED visit.

HQO Reporting tool/product

Ontario Health Teams: Quality

Dimension

Timely

Type

Process

DEFINITION AND SOURCE INFORMATION

Unit of Measurement

Rate per 100 patients

Calculation Methods

Index ED visit includes individuals who left without being seen and those admitted to hospital.
Visits on the same day as the index are not considered prior contact.
Look-back can include scheduled ED visits.
Person-level indicator: one index visit per person.
Diagnostic categories represent the reason for the incident ED visit (i.e., the denominator).
Diagnoses-specific denominators do not add up to the overall denominator

Deliberate self-harm may be present as a secondary diagnosis in any of the other diagnostic types. Deliberate self-harm refers to residual deliberate self-harm, i.e., the presence of a self-harm diagnosis where the main reason for the ED visit is non-MHA-related.

Numerator (short description i.e. not inclusions/exclusions)

Number of individuals in Ontario without an MHA-related service contact in a 2-year look-back period; includes only those who did not have an MHA-related outpatient visit to a psychiatrist, primary care provider or pediatrician or an MHA-related ED visit (scheduled or unscheduled) or an MHA-related hospitalization in the 2 years preceding the index ED visit.

The numerator is a subset of denominator.

Index: Date of ED visit

Denominator (short description i.e. not inclusions/exclusions)

Number of unique Ontario residents aged 0–105 years with an incident (first in a calendar year) unscheduled mental health and addictions (MHA)–related emergency department (ED) visit in the reporting period.

Adjustment (risk, age/sex standardization)- generalized

None

Data Source

CHC (Community Health Centre), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS), Ontario Health Insurance Plan (OHIP) Claims History Database, Ontario Mental Health Reporting System (OMHRS), PCCF (Statistics Canada’s Postal Code Conversion File), Registered Persons Database (RPDB)

Data provided to HQO by

Institute for Clinical Evaluative Sciences (ICES)

Reported Levels of comparability /stratifications (defined)

Other

OTHER RELEVANT INFORMATION

Caveats and Limitations

• CHC data were not available for 2010/11 and after March 31, 2017, and only for reporting at organizational level. • Data did not capture most non-physician mental health and addictions services (i.e., psychologists, counsellors, and social workers). • General limitations of health administrative data include potential coding errors and lack of clinical detail.

Comments Summary

When access to timely community-based mental health assessment and treatment is insufficient, individuals who require services may use the emergency department (ED) as their first point of contact. Therefore, a high rate of use of the ED as a first point of contact for mental health and addictions (MHA) care may be a useful indicator of inadequate access to outpatient physician- and community-based care. This indicator is selected as a Collaborative Quality Improvement Plan indicator (cQIP) in 2022/23. Indicator is reported at OHT level with reporting period of April 2020 – March 2021