"Identifying Information: Name","30-Day Readmission for Mental ºìÁì½í¹Ï±¨ and Substance Use"
"Identifying Information: Short/Other Names","Not applicable"
"Identifying Information: Description","This indicator measures the risk-adjusted rate of readmission following discharge for mental health and substance use (MHSU) disorders.NoteFor further details, please see the General Methodology Notes (PDF)"
"Background, Interpretation and Benchmarks: Rationale","Readmission to inpatient care may be an indicator of relapse or complications after an inpatient stay. Inpatient care for a person living with an MHSU disorder aims to stabilize acute symptoms. Once stabilized, the individual is discharged, and subsequent care and support are ideally provided through outpatient and community programs in order to prevent relapse or complications. High rates of 30-day readmission could be interpreted as a direct outcome of poor coordination of services and/or an indirect outcome of poor continuity of services after discharge."
"Background, Interpretation and Benchmarks: Interpretation","Lower rates are desirable."
"Background, Interpretation and Benchmarks: HSP Framework Dimension",Person-centred
"Background, Interpretation and Benchmarks: Areas of Need","Living With Illness, Disability or Reduced Function"
"Background, Interpretation and Benchmarks: Targets/Benchmarks","Not applicable"
"Available Data Years","2013
 to 2023"
"Available Data Years: Type of Year",Fiscal
"Availability of Results: Geographic Coverage","All provinces/territories"
"Reporting Level/Disaggregation",National
"Reporting Level/Disaggregation: Other reporting level/disaggregation","Age group Recorded sex or genderNeighbourhood income quintileUrban versus rural/remote Mental health categoryFor more information, please refer to CIHI’s Equity stratifiers web page."
"Update Frequency","Every year"
"Result Updates: Latest Results Update Date","December 2024"
"Result Updates: Updates","Not applicable"
"Indicator Calculation: Description","Risk-adjusted rate for each region = Observed number of readmissions in each region ÷ Expected number of readmissions in the region × Canadian average readmission rateUnit of Analysis: Episode of careAn episode of care refers to all contiguous inpatient hospitalizations in general and psychiatric hospitals and all day surgery visits regardless of diagnoses. To construct an episode of care, a transfer is assumed to have occurred if the following condition is met:Admission to a general/psychiatric hospital or day surgery facility occurs on the same day as discharge from another general/psychiatric hospital or day surgery facility"
"Indicator Calculation: Type of Measurement",Rate
"Indicator Calculation: Number or Rate","per 100"
"Denominator: Description:","Number of episodes of care for an MHSU disorder discharged between April 1 and March 1 of the fiscal year"
"Denominator: Inclusions:","An MHSU disorder is identified by DSM-IV/DSM-5 diagnostic category in Ontario Mental ºìÁì½í¹Ï±¨ Reporting System (OMHRS) data or by the most responsible diagnosis (MRDx) ICD-10-CA codes in Discharge Abstract Database (DAD)/Hospital Morbidity Database (HMDB) dataThe following MHSU disorders are included (see ºìÁì½í¹Ï±¨Mental ºìÁì½í¹Ï±¨ and Substance Use Diagnosis Code Groupings for Selected Indicators (XLSX)):  Substance-related and addictive disordersSchizophrenia and other psychotic disordersMood disordersAnxiety disordersSelected disorders of personality and behaviour: Other disorders Discharges between April 1 and March 1 of the following year (period of case selection ends on March 1 to allow for 30 days of follow-up)Recorded sex or gender coded as male or femaleAdmission to a general or psychiatric hospital"
"Denominator: Exclusions:","Records with an invalid health card numberRecords with an invalid code for province issuing health card numberRecords with a missing ageRecords with an invalid admission dateRecords with an invalid discharge dateEpisodes with discharge as death (DAD Discharge Disposition Code = 07, 72*, 73*, 74*; NACRS Visit Disposition Code = 10, 11, 71*, 72*, 73*, 74*; Discharge Reason Code = 2 or 3 for OMHRS)Cadaveric donor or stillbirth records (Admission Category Code = R or S)Note*2018–2019 data onward."
"Numerator: Description:","Cases within the denominator with a readmission for MHSU disorders within 30 days of discharge after the index episode of care"
"Numerator: Inclusions:","An episode of care is considered a readmission if the 2 following conditions are met:It has occurred within 30 days of discharge of an index episode; andAn MHSU disorder was identified the same way as for the denominator (see Denominator for criteria to select diagnosis)."
"Numerator: Exclusions:","2018–2019 data onward: Medical assistance in dying (MAID) (Discharge Disposition Code = 73)"
"Method of Adjustment","Logistic regression"
"Adjustment Applied: Covariates used in risk adjustment:","For a detailed list of covariates used in the model, please refer to the Model Specification (PDF) document."
"Indicator Calculation: Geographic Assignment","Place of residence"
"Data Sources",DAD
"Quality Statement: Caveats and Limitations","Not applicable"
"Quality Statement: Trending Issues","The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was implemented in the Ontario Mental ºìÁì½í¹Ï±¨ Reporting System as of 2016-2017. Prior to 2016-2017, the fourth edition (DSM-IV-TR) was used. Due to the fact that the DSM-IV-TR and DSM-5 diagnostic categories are not fully comparable, there may be some shift in the distribution of cases across categories. Therefore, trending of 2015-2016 and 2016-2017 rates for Ontario may potentially be affected."
"Quality Statement: Comments","A 30-day readmission can occur in the same facility as the index episode or in a different facility. A readmission can be a planned or unplanned admission. Planned versus unplanned admissions cannot be distinguished in all available data sources. For jurisdictions where comprehensive information was available, rates including both planned and unplanned readmissions and only unplanned readmissions were compared, and they were not statistically significantly different. Published work has shown that few planned readmissions for MHSU disorders within 30 days are scheduled by practitioners."
References,"Hermann R, Mattke S. Selecting Indicators for the Quality of Mental ºìÁì½í¹Ï±¨ Care at the ºìÁì½í¹Ï±¨ System Level in OECD Countries (PDF). 2004.Leslie DL, Rosenheck RA. Comparing Quality of Mental ºìÁì½í¹Ï±¨ Care for Public-Sector and Privately Insured Populations. Psychiatric Services. 2000.Lin E, Durbin J, Zaslavska M, et al. Hospital Report 2007: Mental ºìÁì½í¹Ï±¨. 2008."