frequent-ED-visits - Health Quality Ontario (HQO)

INDICATOR NAME

Name

Frequent Emergency Department Visits for Mental Health and/or Addictions Reasons

Alternate Name

Percentage of people with four or more visits over the previous 12 months, among people who visited the emergency department for a mental illness or addiction

INDICATOR DESCRIPTION

Description

This indicator measures the percentage of people with four or more visits over the previous 12 months, among people who visited the emergency department for a mental illness or addiction

Indicator Status

Active

HQO Reporting tool/product

Public Reports (annual report, bulletins and theme reports)

Dimension

Effective

Type

Outcome

DEFINITION AND SOURCE INFORMATION

Unit of Measurement

Percentage

Calculation Methods

Numerator divided by the denominator times 100

Numerator including inclusion/exclusion

Total number of individuals who had at least one emergency visit for mental health and/or addictions (MHA) in a fiscal year. The most recent visit in a fiscal year is the index visit.
Inclusions:

Sex coded as male or female (Sex = M, F)
Records with valid age on the index visit
Records with either/or

MHA as defined by ICD-10-CA codes in the main problem or other problem fields:

Substance-related and addictive disorders: ICD-10-CA: F10–F19, F55, F63.0
Schizophrenia and other psychotic disorders: ICD-10-CA: F20, F21, F22, F23, F24, F25, F28, F29
Mood disorders: ICD-10-CA: F30, F31, F32, F33, F34, F38, F39, F53.0, F53.1
Anxiety disorders: ICD-10-CA: F40, F41, F93.0, F93.1, F93.2, F94.0
Selected disorders of personality and behaviour: ICD-10-CA: F60, F61, F62, F68 (excluding F68.1), F69
Other disorders: ICD-10-CA: F42, F43, F44, F45, F48.0, F48.1, F48.8, F48.9, F50, F51, F52, F53.8, F53.9, F54, F59, F63 (excluding F63.0), F64, F65, F66, F68.1, F70–F73, F78, F79, F80–F84, F88, F89, F90, F91, F92, F93.3, F93.8, F93.9, F94.1, F94.2, F94.8, F94.9, F95, F98.0, F98.1, F98.2, F98.3, F98.4, F98.5, F98.8, F98.9, F99, O99.3

An ED Discharge Diagnosis code as defined by the Canadian Emergency Department Diagnosis Shortlist (CED-DxS) version 2015, mental and behaviour disorders:

Substance-related and addictive disorders: ICD-10-CA: F10.0, F10.3, F11.9, F13.9, F14.9, F15.9, F16.9, F18.9, F19.9
Schizophrenia and other psychotic disorders: ICD-10-CA: F20.9, F23.9
Mood disorders: ICD-10-CA: F31.9, F32.9
Anxiety disorders: ICD-10-CA: F41.9
Selected disorders of personality and behaviour: ICD-10-CA: F60.9
Other disorders: ICD-10-CA: F48.9, F50.9, F99

Exclusions:

Records with invalid health card number
Records that are dead on arrival (Visit Disposition Code = 11, 71*)
Scheduled ED visits (ED_visit_indicator = 0)
Transfer to and from ED (Transfer from OR Transfer to Type = E)
2018–2019 data onward: Medical assistance in dying (MAID) (Visit Disposition Code = 73)

Denominator including inclusion/exclusion

Total number of individuals in the denominator who had at least four emergency department visits for mental health and/or addiction in a 365-day period. Each individual has a 12-month look-back period prior to his or her most recent visit in a given year. Therefore, data for two fiscal years is necessary to obtain the data for the numerator.

Data Source

National Ambulatory Care Reporting System (NACRS), Registered Persons Database (RPDB)

Data provided to HQO by

Ministry of Health and Long-Term Care (MOHLTC)

OTHER RELEVANT INFORMATION

Caveats and Limitations

Complete diagnoses in EDs are not always possible and tend to reflect symptoms or problems instead, which may lead to an under-estimate of conditions included in the indicator. Addiction- and substance-related visits may be underestimated, as poisonings are not included in the indicator.