Alternate-level-care-rate - Health Quality Ontario (HQO)

INDICATOR NAME

Name

Alternate Level of Care (ALC) rate

Alternate Name

Percentage of inpatients days that beds were occupied by patients who could have been receiving care elsewhere

INDICATOR DESCRIPTION

Description

This indicator measures the total number of alternate level of care (ALC) days contributed by ALC patients within the specific reporting month/quarter using near-real time acute and post-acute ALC information and monthly bed census data. Alternate level of care (ALC) refers to those cases where a physician (or designated other) has indicated that a patient occupying an acute care hospital bed has finished the acute care phase of their treatment. A lower rate is better.

Indicator Status

Active

HQO Reporting tool/product

Public reporting, Quality Improvement Plans (QIPs)

Dimension

Efficient

Type

Process

DEFINITION AND SOURCE INFORMATION

Unit of Measurement

Rate per 100 inpatient days

Calculation Methods

This indicator is calculated as the numerator divided by the denominator times 100

Note that only those facilities (acute & post-acute) submitting both alternate level of care (ALC) data (to the Wait Time Information System (WTIS)) and Bed Census Summary (BCS) data (through the Health Database Web Portal) are included in the ALC rate calculation. Any master number that does not have inpatient days reported to the BCS for a given month/quarter will be excluded from reporting for that month/quarter.

Numerator including inclusion/exclusion

The total number of inpatient days designated as alternate level of care (ALC) in a given time period (i.e., monthly, quarterly, yearly). Inpatient service type is identified in the Wait Time Information System (WTIS).

Calculation:

Acute ALC days equals the total number of ALC days contributed by ALC patients waiting in non-surgical, surgical and intensive/critical care beds
Post-acute ALC days equals ALC days for Inpatient Services in complex continuing care, rehabilitation and mental health beds

Exclusions:

ALC cases discontinued due to ‘Data Entry Error’.
ALC cases having Inpatient Service = Discharge Destination for Post-Acute Care (*exception: Bloorview Rehab, complex continuing care to complex continuing care).
ALC cases identified by the facility for exclusion.

Notes:

The day of ALC designation is counted as an ALC day but the date of discharge or discontinuation is not counted as an ALC day
For cases with an ALC designation date on the last day of a reporting period and no discharge/discontinuation date, then ALC days are equal to 1
The ALC Rate indicator methodology makes the assumption that the Inpatient Service data element (as defined in the WTIS) is comparable to the Bed Type data element (as defined in the Bed Census Summary (BCS))

Denominator including inclusion/exclusion

The total number of inpatient days in a given time period (i.e., monthly, quarterly, yearly).

Calculation:

Acute Patient days = the total number of patient days occupying Acute with Mental Health Children/Adolescent (AT) beds
Post-Acute Patient days = the total number of patient days occupying Complex Continuing Care (CR) + General Rehabilitation (GR) + Special Rehabilitation (SR) + Mental Health - Adult (MH) Beds
CCC Patient days = the total number of patient days occupying Complex Continuing Care (CR) Beds
Rehab Patient days = the total number of patient days occupying in General Rehabilitation (GR) + Special Rehabilitation (SR) Beds
Mental Health Patient days = the total number of patient days occupying Mental Health - Adult (MH) Beds

Note: Bed Census Summary (BCS) data has been updated according to the new Daily Census Summary (DCS) format as of June 2017. The methodology for the calculation of the denominator has been updated beginning with June 2017 data.

Adjustment (risk, age/sex standardization)- detailed

None

Data Source

Bed Census Summary (BCS), Wait Time Information System (WTIS)

Data provided to HQO by

Cancer Care Ontario (CCO)

Reported Levels of comparability /stratifications (defined)

Region, Time

OTHER RELEVANT INFORMATION

Caveats and Limitations

The alternate level of care (ALC) rate indicator excludes facilities that are currently not reporting ALC data to the Wait Time Information System (WTIS). WTIS-ALC data are only available beginning in July 2011. The Bed Census Summary (BCS) has a three month reporting lag. Validation is required to ensure that specific bed types (in the BCS) correspond to those in WTIS. The information for both the numerator (WTIS) and denominator (BCS) are based on data that are available at a specific point in time. Therefore, rates calculated using these data are subject to change depending on when the calculations are made.

Comments Detailed

This indicator looks at "inpatient days" – a count of the days individual hospital beds were occupied by patients – to measure the percentage of days hospital beds were occupied by patients identified as requiring an alternate level of care (ALC). meaning they did not require the type of care for which the bed was designated. Patients designated ALC are usually waiting for a place elsewhere in the health system that provides the type of care they need, such as a long-term care home or home care. This is a Quality Improvem9ent Plan (QIP) priority indicator for 2020/21. QIP current performance: Reporting period July 2019 - September 2019. For more information about this indicator, visit the Ministry of Health and Long-Term Care’s (MOHLTC) Resource for Indicator Standards website. To access your organization’s data for the reporting period, refer to Health Quality Ontario’s (HQO) QIP Navigator. Alternatively, hospitals can access ALC reports via Access to Care Site at https://share.cancercare.on.ca. Those not registered can contact Access To Care at ATC@cancercare.on.ca.