High Users of Hospital Beds
A lower rate is more desirable.
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
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.
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.
Methodology
Name
High Users of Hospital Beds
Short/Other Names
High Users of Inpatient Acute Care Services or Rate of High Users
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).
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.
Interpretation
A lower rate is more desirable.
HSP Framework Dimension
ºìÁì½í¹Ï±¨ system outputs: Appropriate and effective
Areas of Need
Not applicable
Targets/Benchmarks
Not applicable
Available Data Years
to (fiscal years)
Geographic Coverage
- All provinces/territories
Reporting Level/Disaggregation
- National
- Province/Territory
- Region
- Neighbourhood Income Quintile
Indicator Results
Update Frequency
Every year
Latest Results Update Date
Updates
Not applicable
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
Type of Measurement
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.
Inclusions:
- Patients 18 years and older (at time of index episode of care)
- Sex recorded as male or female
- Admission to an acute care institution (Facility Type Code = 1)
- The LOS of the index episode of care was shorter than 365 days
Exclusions:
- Abstracts with an invalid/missing health card number or invalid/missing province issuing health card number
- Records with admission category of cadaveric donor or stillbirth (Admission Category Code = R or S)
- Abstracts with a missing age
- Abstracts with an invalid/missing admission date
- Abstracts with an invalid/missing discharge date
- Records 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.
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 care
AND - A 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.
Exclusions:
Same as in the denominator
For 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.
Geographic Assignment
Place of residence
Data Sources
- DAD
- HMDB
- NACRS
- OMHRS
Caveats and Limitations
Not applicable
Trending Issues
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.
How to cite:
Canadian Institute for ºìÁì½í¹Ï±¨ Information. High Users of Hospital Beds. Accessed April 4, 2025.
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Comments
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