"Identifying Information: Name","High Users of Hospital Beds"
"Identifying Information: Short/Other Names","High Users of Inpatient Acute Care Services or Rate of High Users"
"Identifying Information: Description","The risk-adjusted rate of patients who had 3 or more inpatient acute care hospitalizations (episodes of care) with a cumulative length of stay (LOS) longer than 30 days (high users).For further details, please see the General Methodology Notes (PDF)."
"Background, Interpretation and Benchmarks: Rationale","Individuals with multiple admissions to acute care facilities are among high users of health care system services and resources. It is important to identify and monitor these high users. An Ontario study has shown that the top 5% of frequent users consumed about two-thirds of total health system spending and were mainly users of acute care and home care services.This indicator can be used to monitor the rate of high users of inpatient acute care services across jurisdictions over time. Variations in this indicator across jurisdictions may reflect differences in service delivery. Indicator results can help policy-makers and health care planners identify high-risk groups and design specific preventive strategies/programs that may prevent the need for frequent hospital admissions."
"Background, Interpretation and Benchmarks: Interpretation","A lower rate is more desirable."
"Background, Interpretation and Benchmarks: HSP Framework Dimension","Appropriate and effective"
"Background, Interpretation and Benchmarks: Areas of Need","Not applicable"
"Background, Interpretation and Benchmarks: Targets/Benchmarks","Not applicable"
"Available Data Years","2019
 to 2023"
"Available Data Years: Type of Year",Fiscal
"Availability of Results: Geographic Coverage","All provinces/territories"
"Reporting Level/Disaggregation",National
"Result Updates: Indicator Results","Web Tool:Your ºìÁì½í¹Ï±¨ System: In DepthPDF:Accessing Indicator Results on Your ºìÁì½í¹Ï±¨ System: In Depth (PDF)"
"Update Frequency","Every year"
"Result Updates: Latest Results Update Date","December 2024"
"Result Updates: Updates","Not applicable"
"Indicator Calculation: Description","The risk-adjusted rate of high users of inpatient acute care services is calculated by dividing the number of high users (patients with multiple episodes of care in a 1-year period and a cumulative length of stay greater than 30 days) in each region by the expected number of high users in the region and multiplying by the Canadian average high users rate.Unit of analysis: Patients"
"Indicator Calculation: Type of Measurement",Rate
"Indicator Calculation: Number or Rate","Rate per 100"
"Denominator: Description:","Patients age 18 and older discharged from an acute care facility within the fiscal year of reporting. The most recent episode of care (hospitalization) within the fiscal year of reporting is the index episode of care."
"Denominator: Inclusions:","Patients 18 years and older (at time of index episode of care)Sex recorded as male or femaleAdmission to an acute care institution (Facility Type Code = 1)The LOS of the index episode of care was shorter than 365 days"
"Denominator: Exclusions:","Abstracts with an invalid/missing health card number or invalid/missing province issuing health card numberRecords with admission category of cadaveric donor or stillbirth (Admission Category Code = R or S)Abstracts with a missing ageAbstracts with an invalid/missing admission dateAbstracts with an invalid/missing discharge dateRecords with a discharge status of dead on arrival (Discharge Disposition = 11, 71* for NACRS)2018–2019 data onward: Medical assistance in dying (MAID) (Discharge Disposition Code = 73)Note*2018–2019 data onward."
"Numerator: Description:","Patients within the denominator with 3 or more previous acute care episodes of care in a 1-year period and a cumulative LOS longer than 30 days."
"Numerator: Inclusions:","Patients with 3 or more previous acute care episodes of care in a 1-year period (365 days) from the admission date of the index episode of careANDA cumulative LOS greater than 30 days: cumulative LOS is calculated by summing the total episode LOS across the multiple episodes of care in a 1-year (365-day) period. It captures the length of time patients occupied acute care beds and may include alternate level of care (ALC) days, day surgery days and acute rehabilitation days."
"Numerator: Exclusions:","Same as in the denominatorFor further details, please see the High Users of Hospital Beds — Appendix (PDF)."
"Method of Adjustment","Logistic regression"
"Adjustment Applied: Covariates used in risk adjustment:","Age, sex, admission category (elective versus urgent) and patient clinical groups — palliative care, mental illness, obstetric, surgical and medical conditions (for a detailed description, please refer to the High Users of Hospital Beds — Appendix (PDF) and 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","Not applicable"
"Quality Statement: Comments","Not applicable"
References,"Doupe MB, Palatnick W, Day S, et al. Frequent users of emergency departments: developing standard definitions and defining prominent risk factors. Ann Emerg Med. July, 2012;60(1):24-32. PM:22305330.Kirby SE, Dennis SM, Jayasinghe UW, Harris MF. Patient related factors in frequent readmissions: the influence of condition, access to services and patient choice. BMC ºìÁì½í¹Ï±¨ Serv Res. 2010;10:216. PM:20663141.Lain SJ, Nassar N, Bowen JR, Roberts CL. Risk Factors and Costs of Hospital Admissions in First Year of Life: A Population-Based Study. J Pediatr. June 12, 2013; PM:23769505.Longman JM, Rolfe I, Passey MD, et al. Frequent hospital admission of older people with chronic disease: a cross-sectional survey with telephone follow-up and data linkage. BMC ºìÁì½í¹Ï±¨ Serv Res. 2012;12:373. PM:23110342.Rais S, Nazerian A, Ardal S, et al. High-cost users of Ontario's healthcare services. ºìÁì½í¹Ï±¨ Policy. August, 2013;9(1):44-51. PM:23968673."