Unplanned Hospital Visits After Surgery Methodology

Unplanned Hospital Visits after Breast Cancer Surgery
Short description of Indicator	Percentage of patients who had breast surgery for cancer and an unplanned emergency department (ED) visit or who were readmitted within 30 days after surgery.
Rationale for measurement	The intent of this indicator is to monitor the quality of breast surgeries by measuring the rate of ED visits and unplanned readmissions within 30 days of the original resection.
Evidence/references for rationale	The rate or ED visits and readmissions has been used for other disease sites as an indicator for the quality of surgery. Previously, a modified Delphi process, involving a systemic review and review with a multidisciplinary expert panel of physicians, was carried out to identify potential indicators of importance for lung cancer surgery. This indicator was identified as being an important indicator for the quality of surgery, and therefore has transitioned into other areas of care, such as breast, colorectal and prostate surgery.
Calculations for the indicator	(Number of QBP breast cancer surgeries followed by at least 1 ED visit (no readmission) within 30 days after cancer surgery /Total number of QBP breast cancer surgeries ) * 100 = Percentage of patients who had a breast cancer surgery and had an ED visit within 30 days of cancer surgery (Number of patients who had QBP breast cancer surgeries followed by readmission to hospital within 30 days after cancer surgery /Total number of QBP breast cancer surgeries ) * 100 = Percentage of patients who had a breast cancer surgery and were readmitted within 30 days of cancer surgery
Standardized Rate Calculation	N/A
Unit	Proportion
Data sources	Canadian Institute for Health Information (CIHI) - Discharge Abstracts Database (DAD) Canadian Institute for Health Information (CIHI) - National Ambulatory Care Reporting System (NACRS)
Time Frame	CY2014 - CY2017
Geographic Scale	By Province By Calendar Year
Denominator description	Total number of unique patients who had breast cancer surgical resection CY2014 - CY2017. Select cohort of in-scope cases based on QBP methodology for the discharge date range January 1, 2014 to December 31, 2017 - an in-scope case must satisfy both conditions below: Have an in-scope CCI procedure coded as the Primary Intervention on DAD/NACRS records. A list of procedure codes is shown in the Quality-Based Procedures Clinical Handbook for Cancer Surgery, Ministry of Health and Long-Term Care, August 2018. Have an in-scope ICD-10-CA diagnosis coded as the Main Diagnosis on DAD/NACRS records. A list of diagnosis codes is shown in the Quality-Based Procedures Clinical Handbook for Cancer Surgery, Ministry of Health and Long-Term Care, August 2018. Apply QBP exclusions. Assign resection date as a date when cancer surgery took place. QBP Exclusions: Cases with non-unique OHIP number (OHIP number in 1, 8, 9, 0) Cases younger than 18 years at the time of surgical intervention Records where the main intervention is missing Out-of-province records (non-Ontario health card numbers) Non-OHIP cases (responsibility of payment = 1) Interventions flagged as Cancelled, Abandoned and Out of Hospital Outpatient Records (NACRS) for colorectal and prostate disease sites. Inclusions: Small non QBP hospitals are included in the denominator
Numerator description	Number of QBP breast cancer surgeries followed within 30 days by at least 1 ED visit or 1 readmission to any Ontario facility; Subset of denominator: ED Visit is defined as a case in NACRS where * Visit functional centre is one of the following: Emergency, General Emergency, Observation, Trauma, Urgent Care, Emergency Mental Health Service, and, * Visit disposition was not transfer, or * Visit disposition was transfer but no record of hospital admission on a date of registration or on a day after registration was found in DAD Readmission is defined as * A case in NACRS where visit functional centre is one of the following: Emergency, General Emergency, Observation, Trauma, Urgent Care, Emergency Mental Health Service, visit disposition was transfer and a record of hospital admission on a date of registration or on a day after registration was found in DAD * A record of hospital admission in DAD not preceded by NACRS registration Restrictions when the initial resection was a QBP breast procedure: ER visits or readmissions where main intervention was a QBP breast resection are considered as scheduled repeated breast resections and are excluded from unplanned visits count
Considerations	Registration date range: January 1, 2014 to December 31, 2017. CCO’s QBP 18/19 Index Methodology. The case will be considered in-scope only if it has both an in-scope procedure and an in-scope diagnosis codes on the record. The in-scope procedure and diagnosis codes must be identified as Primary Intervention and Main Diagnosis, respectively. Type of unplanned visit is defined by the first visit (DAD or NACRS) that followed the initial resection. Unplanned visit reason is not considered. Certain exclusions have been applied for breast.
Data availability & limitations	Data is obtained from CIHI-DAD and CIHI-NACRS where the discharge date range was January 1, 2014 to December 31, 2017.

Unplanned Hospital Visits after Colorectal Cancer Surgery
Short description of Indicator	Percentage of patients who had colorectal surgery for cancer and an unplanned emergency department (ED) visit or who were readmitted within 30 days after surgery.
Rationale for measurement	The intent of this indicator is to monitor the quality of colorectal surgeries by measuring the rate of ED visits and unplanned readmissions within 30 days of the original resection.
Evidence/references for rationale	The rate or ED visits and readmissions has been used for other disease sites as an indicator for the quality of surgery. Previously, a modified Delphi process, involving a systemic review and review with a multidisciplinary expert panel of physicians, was carried out to identify potential indicators of importance for lung cancer surgery. This indicator was identified as being an important indicator for the quality of surgery, and therefore has transitioned into other areas of care, such as breast, colorectal and prostate surgery.
Calculations for the indicator	(Number of QBP colorectal cancer surgeries followed by at least 1 ED visit (no readmission) within 30 days after cancer surgery /Total number of QBP cancer surgeries ) * 100 = Percentage of patients who had a cancer surgery and had an ED visit within 30 days of cancer surgery (Number of patients who had QBP colorectal cancer surgeries followed by readmission to hospital within 30 days after cancer surgery /Total number of QBP cancer surgeries ) * 100 = Percentage of patients who had a cancer surgery and were readmitted within 30 days of cancer surgery
Standardized Rate Calculation	N/A
Unit	Proportion
Data sources	Canadian Institute for Health Information (CIHI) - Discharge Abstracts Database (DAD) Canadian Institute for Health Information (CIHI) - National Ambulatory Care Reporting System (NACRS)
Time Frame	CY2014 - CY2017
Geographic Scale	By Province By Calendar Year
Denominator description	Total number of unique patients who had colorectal cancer surgical resection CY2014 - CY2017. Select cohort of in-scope cases based on QBP methodology for the discharge date range January 1, 2014 to December 31, 2017 - an in-scope case must satisfy both conditions below: Have an in-scope CCI procedure coded as the Primary Intervention on DAD/NACRS records. A list of procedure codes is shown in the Quality-Based Procedures Clinical Handbook for Cancer Surgery, Ministry of Health and Long-Term Care, August 2018. b. Have an in-scope ICD-10-CA diagnosis coded as the Main Diagnosis on DAD/NACRS records. A list of diagnosis codes is shown in the Quality-Based Procedures Clinical Handbook for Cancer Surgery, Ministry of Health and Long-Term Care, August 2018. Apply QBP exclusions. Assign resection date as a date when cancer surgery took place. QBP Exclusions: Cases with non-unique OHIP number (OHIP number in 1, 8, 9, 0) Cases younger than 18 years at the time of surgical intervention Records where the main intervention is missing Out-of-province records (non-Ontario health card numbers) Non-OHIP cases (responsibility of payment = 1) Interventions flagged as Cancelled, Abandoned and Out of Hospital Outpatient Records (NACRS) for colorectal and prostate disease sites. Inclusions: Small non QBP hospitals are included in the denominator
Numerator description	Number of QBP colorectal cancer surgeries followed within 30 days by at least 1 ED visit or 1 readmission to any Ontario facility; Subset of denominator: ED Visit is defined as a case in NACRS where * Visit functional centre is one of the following: Emergency, General Emergency, Observation, Trauma, Urgent Care, Emergency Mental Health Service, and, * Visit disposition was not transfer, or * Visit disposition was transfer but no record of hospital admission on a date of registration or on a day after registration was found in DAD Readmission is defined as * A case in NACRS where visit functional centre is one of the following: Emergency, General Emergency, Observation, Trauma, Urgent Care, Emergency Mental Health Service, visit disposition was transfer and a record of hospital admission on a date of registration or on a day after registration was found in DAD * A record of hospital admission in DAD not preceded by NACRS registration Restrictions when the initial resection was a QBP breast procedure: ER visits or readmissions where main intervention was a QBP breast resection are considered as scheduled repeated breast resections and are excluded from unplanned visits count
Considerations	Registration date range: January 1, 2014 to December 31, 2017. CCO’s QBP 18/19 Index Methodology. The case will be considered in-scope only if it has both an in-scope procedure and an in-scope diagnosis codes on the record. The in-scope procedure and diagnosis codes must be identified as Primary Intervention and Main Diagnosis, respectively. Type of unplanned visit is defined by the first visit (DAD or NACRS) that followed the initial resection. Unplanned visit reason is not considered. Certain exclusions have been applied for breast.
Data availability & limitations	Data is obtained from CIHI-DAD and CIHI-NACRS where the discharge date range was January 1, 2014 to December 31, 2017.

Unplanned Hospital Visits after Lung Cancer Surgery
Short description of Indicator	Percentage of patients who had lung surgery for cancer and an unplanned emergency department (ED) visit or who were readmitted within 30 days after surgery.
Rationale for measurement	The intent of this indicator is to monitor the quality of lung surgeries by measuring the rate of ED visits and unplanned readmissions within 30 days of the original resection.
Evidence/references for rationale	The rate or ED visits and readmissions has been used for other disease sites as an indicator for the quality of surgery. Previously, a modified Delphi process, involving a systemic review and review with a multidisciplinary Expert Panel of physicians, was carried out to identify potential indicators of importance for lung cancer surgery. This indicator was identified as being an important indicator for the quality of surgery, and therefore has transitioned into other areas of care, such as breast, colorectal and prostate surgery.
Calculations for the indicator	(Number of QBP lung cancer surgeries followed by at least 1 ED visit (no readmission) within 30 days after cancer surgery /Total number of QBP cancer surgeries ) * 100 = Percentage of patients who had a cancer surgery and had an ED visit within 30 days of cancer surgery (Number of patients who had QBP lung cancer surgeries followed by readmission to hospital within 30 days after cancer surgery /Total number of QBP cancer surgeries ) * 100 = Percentage of patients who had a cancer surgery and were readmitted within 30 days of cancer surgery
Standardized Rate Calculation	N/A
Unit	Proportion
Data sources	Canadian Institute for Health Information (CIHI) - Discharge Abstracts Database (DAD) Canadian Institute for Health Information (CIHI) - National Ambulatory Care Reporting System (NACRS)
Time Frame	CY2014 - CY2017
Geographic Scale	By Province By Calendar Year
Denominator description	Total number of unique patients who had lung cancer surgical resection CY2014 - CY2017. Select cohort of in-scope cases based on QBP methodology for the discharge date range January 1, 2014 to December 31, 2017 - an in-scope case must satisfy both conditions below: Have an in-scope CCI procedure coded as the Primary Intervention on DAD/NACRS records. A list of procedure codes is shown in the Quality-Based Procedures Clinical Handbook for Cancer Surgery, Ministry of Health and Long-Term Care, August 2018. Have an in-scope ICD-10-CA diagnosis coded as the Main Diagnosis on DAD/NACRS records. A list of diagnosis codes is shown in the Quality-Based Procedures Clinical Handbook for Cancer Surgery, Ministry of Health and Long-Term Care, August 2018. Apply QBP exclusions. Assign resection date as a date when cancer surgery took place. QBP Exclusions: Cases with non-unique OHIP number (OHIP number in 1, 8, 9, 0) Cases younger than 18 years at the time of surgical intervention Records where the main intervention is missing Out of province records (non-Ontario health card numbers) Non-OHIP cases (responsibility of payment = 1) Interventions flagged as Cancelled, Abandoned and Out of Hospital Outpatient Records (NACRS) for Colorectal and Prostate disease sites. Inclusions: Small non QBP hospitals are included in the denominator
Numerator description	Number of QBP lung cancer surgeries followed within 30 days by at least 1 ED visit or 1 readmission to any Ontario facility; Subset of denominator: ED Visit is defined as a case in NACRS where * Visit functional centre is one of the following: Emergency, General Emergency, Observation, Trauma, Urgent Care, Emergency Mental Health Service, and, * Visit disposition was not transfer, or * Visit disposition was transfer but no record of hospital admission on a date of registration or on a day after registration was found in DAD Readmission is defined as * A case in NACRS where visit functional centre is one of the following: Emergency, General Emergency, Observation, Trauma, Urgent Care, Emergency Mental Health Service, visit disposition was transfer and a record of hospital admission on a date of registration or on a day after registration was found in DAD * A record of hospital admission in DAD not preceded by NACRS registration Restrictions when the initial resection was a QBP breast procedure: ER visits or readmissions where main intervention was a QBP breast resection are considered as scheduled repeated breast resections and are excluded from unplanned visits count
Considerations	Registration date range: January 1, 2014 to December 31, 2017. CCO’s QBP 18/19 Index Methodology. The case will be considered in-scope only if it has both an in-scope procedure and an in-scope diagnosis codes on the record. The in-scope procedure and diagnosis codes must be identified as Primary Intervention and Main Diagnosis, respectively. Type of unplanned visit is defined by the first visit (DAD or NACRS) that followed the initial resection. Unplanned visit reason is not considered. Certain exclusions have been applied for breast.
Data availability & limitations	Data is obtained from CIHI-DAD and CIHI-NACRS where the discharge date range was January 1, 2014 to December 31, 2017.

Unplanned Hospital Visits after Prostate Cancer Surgery
Short description of Indicator	Percentage of patients who had prostate surgery for cancer and an unplanned emergency department (ED) visit or who were readmitted within 30 days after surgery.
Rationale for measurement	The intent of this indicator is to monitor the quality of prostate surgeries by measuring the rate of ED visits and unplanned readmissions within 30 days of the original resection.
Evidence/references for rationale	The rate or ED visits and readmissions has been used for other disease sites as an indicator for the quality of surgery. Previously, a modified Delphi process, involving a systemic review and review with a multidisciplinary expert panel of physicians, was carried out to identify potential indicators of importance for lung cancer surgery. This indicator was identified as being an important indicator for the quality of surgery, and therefore has transitioned into other areas of care, such as breast, colorectal and prostate surgery.
Calculations for the indicator	(Number of QBP prostate cancer surgeries followed by at least 1 ED visit (no readmission) within 30 days after cancer surgery /Total number of QBP prostate cancer surgeries ) * 100 = Percentage of patients who had a prostate cancer surgery and had an ED visit within 30 days of cancer surgery (Number of patients who had QBP prostate cancer surgeries followed by readmission to hospital within 30 days after cancer surgery /Total number of QBP prostate cancer surgeries ) * 100 = Percentage of patients who had a prostate cancer surgery and were readmitted within 30 days of cancer surgery
Standardized Rate Calculation	N/A
Unit	Proportion
Data sources	Canadian Institute for Health Information (CIHI) - Discharge Abstracts Database (DAD) Canadian Institute for Health Information (CIHI) - National Ambulatory Care Reporting System (NACRS)
Time Frame	CY2014- CY2017
Geographic Scale	By Province By Calendar Year
Denominator description	Total number of unique patients who had prostate cancer surgical resection CY2014 - CY2017. Select cohort of in-scope cases based on QBP methodology for the discharge date range January 1, 2014 to December 31, 2017 - an in-scope case must satisfy both conditions below: Have an in-scope CCI procedure coded as the Primary Intervention on DAD/NACRS records. A list of procedure codes is shown in the Quality-Based Procedures Clinical Handbook for Cancer Surgery, Ministry of Health and Long-Term Care, August 2018. Have an in-scope ICD-10-CA diagnosis coded as the Main Diagnosis on DAD/NACRS records. A list of diagnosis codes is shown in the Quality-Based Procedures Clinical Handbook for Cancer Surgery, Ministry of Health and Long-Term Care, August 2018. Apply QBP exclusions. Assign resection date as a date when cancer surgery took place. QBP Exclusions: Cases with non-unique OHIP number (OHIP number in 1, 8, 9, 0) Cases younger than 18 years at the time of surgical intervention Records where the main intervention is missing Out of province records (non-Ontario health card numbers) Non-OHIP cases (responsibility of payment = 1) Interventions flagged as Cancelled, Abandoned and Out of Hospital Outpatient Records (NACRS) for colorectal and prostate disease sites. Inclusions: Small non QBP hospitals are included in the denominator
Numerator description	Number of QBP prostate cancer surgeries followed within 30 days by at least 1 ED visit or 1 readmission to any Ontario facility; Subset of denominator: ED Visit is defined as a case in NACRS where * Visit functional centre is one of the following: Emergency, General Emergency, Observation, Trauma, Urgent Care, Emergency Mental Health Service, and, * Visit disposition was not transfer, or * Visit disposition was transfer but no record of hospital admission on a date of registration or on a day after registration was found in DAD Readmission is defined as * A case in NACRS where visit functional centre is one of the following: Emergency, General Emergency, Observation, Trauma, Urgent Care, Emergency Mental Health Service, visit disposition was transfer and a record of hospital admission on a date of registration or on a day after registration was found in DAD * A record of hospital admission in DAD not preceded by NACRS registration Restrictions when the initial resection was a QBP breast procedure: ER visits or readmissions where main intervention was a QBP breast resection are considered as scheduled repeated breast resections and are excluded from unplanned visits count
Considerations	Registration date range: January 1, 2014 to December 31, 2017. CCO’s QBP 18/19 Index Methodology. The case will be considered in-scope only if it has both an in-scope procedure and an in-scope diagnosis codes on the record. The in-scope procedure and diagnosis codes must be identified as Primary Intervention and Main Diagnosis, respectively. Type of unplanned visit is defined by the first visit (DAD or NACRS) that followed the initial resection. Unplanned visit reason is not considered.
Data availability & limitations	Data is obtained from CIHI-DAD and CIHI-NACRS where the discharge date range was January 1, 2014 to December 31, 2017.