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A Perspective on Canadian Initiatives in Health Care Quality

HL7 Clinical Quality Work Group

June 26, 2015

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Agenda

• Overview of health care in Canada

• Key players in Canada’s health system information and performance reporting landscape

• Overview of CIHI’s mandate and work

• Some of CIHI’s key initiatives

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Canada’s Health Care System

• Responsibilities

– Federal government

– Provincial/territorial governments

• Canada Health Act – conditions for receiving federal funds for delivery of health care services

– Publicly administered

– Comprehensive

– Universal

– Portable

– Accessible

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Health Status of Canadians

Sourceyourhealthsystem.cihi.ca/inbrief

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Health Status of Canadians

SourceVital Statistics, Statistics Canada as reported in yourhealthsystem.cihi.ca/inbrief

Avoidable Deaths per 100,000 2006-08 through 2009-11

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Canada’s per person spending is just more than half of what is spent on health care in the U.S. but higher than the OECD average

Turkey

Estonia

Hungary

Slovak Republic

Israel

Slovenia

New Zealand*

Iceland

Japan

Sweden

Belgium

CANADA

Germany

Netherlands*

Norway

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000 $10,000

$984$1,048

$1,447$1,540

$1,803$2,077$2,105

$2,291$2,304

$2,642$2,667

$2,998$3,172

$3,289$3,536$3,559$3,649

$3,997$4,106

$4,288$4,419

$4,578$4,602$4,698

$4,811$4,896

$5,219$6,080$6,140

$8,745

Average: US$3,590

Total Health Spending per Capita, US$, 30 Selected Countries, 2012

Per Capita Expenditure, US$ © Canadian Institute for Health Information.

Note* Data for 2011.SourceOECD Health Statistics 2014 (June edition), Organisation for Economic Co-operation and Development (OECD).

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The share of health spending funded by the public sector in Canada is less than the OECD average

United States

Korea

Hungary

Switzerland

Poland

CANADA

OECD Average

Finland

Austria

Turkey

Estonia

Sweden

New Zealand*

United Kingdom

Norway

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

47.6%50.6%

54.5%59.8%

62.6%65.0%65.8%

68.4%69.2%69.7%70.1%

71.5%73.3%73.0%

75.0%75.2%75.9%76.7%76.8%77.4%

78.7%80.5%81.3%82.1%82.7%83.5%84.0%84.0%85.0%85.8%

Average: 73.3%

© Canadian Institute for Health Information.Note* Data for 2011. SourceOECD Health Statistics 2014 (June edition), OECD.

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Canada’s Health System and Performance Improvement Landscape

• Federal departments and agencies

– Health Canada – regulatory role, delivers care to First Nations &Inuit

– Public Health Agency of Canada – health promotion & disease prevention, infectious diseases, public health emergencies

– Statistics Canada – Canada’s national statistical agency

• Source of information on population health status

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Canada’s Health System and Performance Improvement Landscape

• National organizations

– Includes CIHI

– Examples:

• Canadian Patient Safety Institute

• Canadian Partnership Against Cancer

• Canadian Foundation for Healthcare Improvement

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Canada’s Health System and Performance Improvement Landscape

• Provincial health quality councils

– Often mandated to report on provincial performance

– Often lead quality improvement within the jurisdiction

• Other data/information shops

– Institute for Clinical and Evaluative Sciences

– Manitoba Centre for Health Policy

– Newfoundland and Labrador Centre for Health Information

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CIHI’s mandate and role

Our VisionBetter data. Better decisions. Healthier Canadians.

Our MandateTo lead the development and maintenance of comprehensive and integrated health information that enables sound policy and effective health system management that improve health and health care.

Our ValuesRespect, Integrity, Collaboration, Excellence, Innovation

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CIHI’s Data Holdings

• Acute care – inpatient admissions, ED visits,

• Financial – macro and facility level

• Rehabilitation

• Acute mental health

• Health human resources

• Prescription drugs

• Home care and long-term care

• Registries – joint replacement, organ replacement, multiple sclerosis

• Wait times

• Patient experiences

• Gaps

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What we do with the data holdings

• Develop standards

• Collect data from stakeholders

• Manage data holdings

– Data quality assessments and reporting

• Disseminate

– Through standard annual reports

– E-tools

– Research requests

• Enrich

– Case Mix Grouper (CMG)

– Population Risk Adjustment Grouper (PRAG)

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CIHI’s Products – how we use our data holdings

• Public reporting of health system performance

– yourhealthsystem.cihi.ca – In Brief and In Depth

– Wait times

– International comparisons

• Analytical reports and indicator development, e.g.,

– Level and determinants of health system efficiency

– Weekend admissions and in-hospital mortality

– High users of health care

– Patient harm

– In-hospital infections

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Your Health System: In Depth

• 45 performance indicators covering:• Population health,

long-term care, acute care

• Focus on regional and facility results

• Benchmarking and visualization tools

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Health System Performance InitiativePhase 2

• Focus on benchmarking

• Focus on more and more powerful analytics