The purpose of the Technical Appendix and the Quality Monitor Indicator database is to provide access to details of the process that ICES and other organizations used to generate indicator results. This information will be useful to others interested in replicating the indicators presented in the 2011 report.  Further details on the process and methods used to select the indicators in the 2011 report can be obtained from the HQO.

This year, the HQO has created a database that houses the technical information for all the indicators found in the 2011 Quality Monitor report. This database, the Quality Monitor Indicator Database (QMID) that allows users to find technical information on all the indicators included in the 2011 annual report by theme, attribute or sector or keyword.  The QMID Microsoft Access database is available for download here , last updated August 9, 2010.
(Download the QMID User Guide here ).

An additional feature of the QMID is its ability to create pdf reports that are available by clicking on any of the attribute, theme or indicator links below.  There are eight pdf documents, one for each attribute of the HQO reporting framework (accessible, effective, safe, patient-centered, efficient, appropriately resourced, integrated, and focused on population health). Indicators that appear in the Equitable attribute also appear in other attributes, thus the information for calculation of the various equity lens for those indicators appears in their respective attribute.

Table of Contents

1.   Introduction

2.   Accessible  2.1    Wait times in emergency departments 2.1.1 Percentage of ED patient care completed within recommended timeframe 2.1.2 Percentage of pts who left without being seen 2.1.3 Median time to MD assessment by CTAS level 2.1.4 Median time from admission to transfer to bed 2.2    Access to primary care 2.2.1 Percentage of adults without a regular doctor 2.2.2 Percentage of adults without a regular doctor and actively seeking one 2.2.3 Percentage of adults able to see their doctor on the same or next day the last time they were sick or needed medical attention 2.2.4 Percentage of physicians who say most or all of their patients can see them the same or next day 2.2.5 Percentage of adults who thought they waited too long to see their doctor for an appointment 2.3    Treatment wait times and access to specialists 2.3.1 Percentage of cancer surgeries done within target 2.3.2 Percentage of patients where radiation therapy started within target ( from being ready to treat to getting treatment) 2.3.3 Percentage of patients completed within target for systemic treatment (chemotherapy): Referral to consult 2.3.4 Percentage of patients completed within target for systemic treatment (chemotherapy): Consult to treatment 2.3.5 Percentage of CT scans done within target 2.3.6 Percentage MRI scans done within target 2.3.7 Percentage of CABGs done within target 2.3.8 Percentage of angiographies (CATH) done within target 2.3.9 Percentage of PCIs done within target 2.3.10 Percentage of cases done within target: General surgery 2.3.11 Percentage of cases done within target: Cataract surgery 2.3.12 Percentage of cases done within target: Hip replacement surgery 2.3.13 Percentage of cases done within target: Knee replacement surgery 2.3.14 CT scans per 100,000 adults 2.3.15 MRI scans per 100,000 adults 2.3.16 Rates of hip and knee replacement surgeries per 100,000 adults 2.3.17 Rates of cataract surgeries per 100,000 adults 2.3.18 Rates of cardiac procedures per 100,000 adults 2.3.19 Rate of Telemedicine use for clinical patient consultations per 100,000 population 2.4    Access to long-term care and home care 2.4.1 Median number of days to long term care home placement: Overall 2.4.2 Median number of days to long term care home placement: For those placed from hospital 2.4.3 Median number of days to long term care home placement: for those placed from home 2.4.4 Percentage of residents placed into long-term care who got their first choice of home the first time around

3.    Effective  3.1    Receiving the right treatments in hospital 3.1.1 Percentage of elderly patients with AMI who, within 90 days of discharge, filled a prescription for the recommended drugs 3.1.2 Percentage of elderly patients with CHF who, within 90 days of discharge, filled a prescription for the recommended drugs 3.1.3 Percentage of acute stroke patients discharged on ASA or antithrombotic therapy 3.1.4 Percentage of ischemic stroke patients eligible for thrombolysis (clot-buster drug) who get it within one hour of arriving in the ED 3.2    Chronic disease management 3.2.1 Percentage of diabetic patients who, in the past 12 months, had an eye exam 3.2.2 Percentage of diabetic patients who, in the past 12 months, had a foot exam 3.2.3 Percentage of elderly diabetic patients (aged 66+) who, in the past year, regularly filled prescriptions for ACEI/ARB and/or statin 3.2.4 Number of emergency department visits or hospitalizations for too low or too high blood sugar per 100 newly diagnosed diabetes patient per year 3.2.5 Percentage of people with diabetes for more than a year who had a serious diabetes complication within a year 3.2.6 Adjusted mortality rate (chance of death) in the year after diagnosis of congestive heart failure 3.2.7 Adjusted rate of death per 100 heart attack patients between 30 days and one year after their first heart attack 3.2.8 Hospital admission rates per 100,000 population for all ambulatory care sensitive conditions 3.3    Potentially avoidable hospitalizations 3.3.1 Medical readmission rates: heart attack (AMI) 3.3.2 Medical readmission rates: asthma 3.3.3 Medical readmission rates: congestive heart failure (CHF) 3.3.4 Medical readmission rates: chronic obstructive pulmonary disease (COPD) 3.3.5 Medical readmission rates: diabetes 3.3.6 Medical readmission rates: stroke 3.3.7 Medical readmission rates: gastrointestinal bleed 3.3.8 Mental health readmission rates: depression 3.3.9 Mental health readmission rates: mental health and addictions 3.3.10 Surgical readmission rates: cholecystectomy 3.3.11 Surgical readmission rates: hysterectomy 3.3.12 Surgical readmission rates: prostatectomy 3.3.13 Readmission rates for labour and delivery 3.4    Keeping people healthy in long-term care 3.4.1 Percentage of residents with worsening† bladder control 3.4.2 Percentage of residents with increasing† difficulty carrying out normal everyday tasks (getting dressed, eating, personal hygiene) 3.4.3 Percentage of residents with pain that got worse recently 3.4.4 Percentage of residents with worsening† symptoms of depression or anxiety 3.4.5 Percentage of residents whose language, memory, and thinking abilities have recently† decreased 3.4.6 Percentage of residents with recent unintended weight loss 3.5    Keeping people healthy in home care 3.5.1 Percentage of CCC patients with less bladder control 3.5.2 Percentage of CCC patients who have improved their performance of normal everyday tasks (getting dressed, eating, personal hygiene) 3.5.3 Percentage of CCC patients with disruptive or severe pain 3.5.4 Percentage of CCC patients with increase in depression or anxiety 3.5.5 Percentage of CCC patients with communication decline 3.5.6 Percentage of CCC patients whose mobility - walking or in a wheel chair- has declined 3.6    Keeping people healthy in home care 3.6.1 Percentage of clients whose bladder function has recently decreased or did not improve compared to previous assessment 3.6.2 Percentage of clients with a new problem with normal everyday tasks (getting dressed, eating, personal hygiene) OR an old problem that is not getting better 3.6.3 Percentage of clients with pain that is not well controlled 3.6.4 Percentage of clients with serious signs of depression (e.g. profound sadness, withdrawal from normal activities) 3.6.5 Percentage of clients who recently developed a decline in their language, memory and thinking abilities 3.6.6 Percentage of clients with a new problem communicating or understanding others or an existing problem that did not improve over a period of time 3.6.7 Percentage of clients with recent unintended weight loss 3.7    Avoidable emergency department visits 3.7.1 Percentage of ED visits in major Ontario cities for conditions that could have been managed elsewhere 3.7.2 Number of non-urgent, avoidable ED visits per 100 LTC residents per year 3.7.3 Number of low acuity ED visits per 100 LTC residents per year

4.    Safe 4.1    Hospital Infections 4.1.1 Rate of hospital acquired C.difficile disease per 1000 bed days 4.1.2 Infections per 1000 bed days: Methicillin-resistant Staphylococcus aureus (MRSA) 4.1.3 Infections per 1000 bed days : Vancomycin-resistant Enterococci (VRE) 4.1.4 Cases per 1000 bed days in intensive care unit (ICU) of: Ventilator-associated pneumonia (VAP) 4.1.5 Cases per 1000 bed days in intensive care unit (ICU) of: Central line infection (CLI) 4.1.6 Percentage of hip and knee replacement surgeries where the right antibiotics were given at the right time to prevent surgical site infection (SSI) 4.1.7 Hand hygiene compliance among health care providers before patient contact 4.2    Adverse events in acute care hospitals 4.2.1 Adjusted rate of in-hospital pulmonary embolism and DVT per 100 surgical procedures 4.2.2 Nurse sensitive adverse events: medical 4.2.3 Nurse sensitive adverse events: surgical 4.2.4 Nurse sensitive adverse events: labour and delivery 4.3    Mortality in hospitals 4.3.1 Percentage of reportable hospitals whose hospital standardized mortality rates (HSMR) have decreased compared to the previous year 4.3.2 Adjusted in-hospital rate of death within 30 days per 100 patients admitted for stroke 4.3.3 Adjusted rate of death within 30 days per 100 patients admitted for heart attack 4.4    Drug safety in long-term care 4.4.1 Percentage of elderly long-term care residents prescribed a drug that should be avoided in the elderly (Beers list) 4.4.2 Percentage of elderly long-term care residents prescribed a drug that should never be given in the elderly (AHRQ list) 4.4.3 Percentage of elderly long-term care residents prescribed an antipsychotic drug without a psychotic condition 4.4.4 Percentage of elderly long-term care residents prescribed certain anti-anxiety or hypnotic drugs not supported by a specific diagnosis 4.4.5 Percentage of new long-term care home residents (age 65 and above) started on certain drugs where there was no clear reason to use them: anti-psychotics 4.4.6 Percentage of new long-term care home residents (age 65 and above) started on certain drugs where there was no clear reason to use them: Benzodiazepines 4.4.7 Percentage of complex continuing care (CCC) patients on anti-psychotic medication with no clear reason for using them 4.4.8 Percentage of physicians that routinely give their patients a written list of the medications they are currently taking 4.5    Avoiding harm in long-term care 4.5.1 Percentage of residents with a new pressure ulcer (stage 2 or higher) in LTC 4.5.2 Percentage of residents with a new pressure ulcer (stage 2 or higher) in CCC 4.5.3 Percentage of LTC residents whose behaviour has recently worsened 4.5.4 Percentage of LTC residents with a recent† bladder infection in LTC 4.5.5 Percentage of residents who were physically restrained in LTC 4.5.6 Percentage of residents who were physically restrained in CCC 4.5.7 Percentage of LTC residents who had a recent fall in last 30 days 4.5.8 Percentage of CCC residents who do not have a recent prior history of falling but fell in the last 90 days 4.5.9 Rate of falls per year among LTC residents seniors (aged 65+) resulting in an emergency department visit or inpatient hospitalization per 100 resident-years in long-term care homes 4.6    Avoiding harm in home care 4.6.1 Number of hospitalizations for falls per year per 100 seniors in the community 4.6.2 Percentage of home care clients who say they have fallen in the last 90 days 4.6.3 Percentage of clients with a new pressure ulcer (stage 2 to 4) 4.6.4 Percentage of home care clients with unexplained injuries, burns, or fractures 4.6.5 Percentage of home care clients showing signs of neglect or abuse

5.    Patient-centred 5.1    Patient experience in acute care hospitals and emergency departments 5.1.1 Would you recommend this hospital to your friends and family? 5.1.2 Percentage of patients who felt they were treated with respect and dignity 5.1.3 Percentage of hospital patients who usually waited less than 5 minutes before getting the help they needed 5.1.4 Percentage of ED patients who said they waited too long to see the doctor 5.1.5 Do you think that the staff did everything they could to help control your pain? 5.1.6 Did you get all the medical information that you need? 5.1.7 When you had important questions to ask a nurse, did you get answers you could understand? 5.1.8 When you had important questions to ask a doctor, did you get answers you could understand? 5.1.9 Did someone explain the results of the test in a way you could understand? 5.2    Patient experience in primary care

6.    Efficient 6.1    Cost of service delivery 7.1.1 Percentage of hospitals running a deficit 7.1.2 Current ratio (ability to pay bills without having to borrow) 7.1.3 Cost per weighted case in hospitals 6.2    Right service in right place 7.2.1 Percentage of acute care bed days which are designated as ALC 7.2.2 Percentage of hospitalizations which were ALC related in Ontario 7.2.3 Relationship between ALC bed days and LTC wait times 7.2.4 Percentage of clients placed into a long-term care home with MAPLe scores high or very high(i.e. appropriate) 6.3    Avoidable emergency department visits 7.3.1 Rate of pre-operative ECG testing per 100 cataract surgeries 7.3.2 Rate of pre-operative chest X-ray testing per 100 cataract surgeries 7.3.3 Percentage of elderly patients with uncomplicated hypertension treated with diuretic as first-line treatment 6.4    Avoiding unnecessary drugs and tests

7.    Appropriately Resourced 7.1    Overall spending and value for money 8.1.1 Total health care spending as a percentage of gross domestic product in Ontario and Canada 8.1.2 Total health care expenditures in province 8.1.3 Total health care expenditures per person 7.2    Information technology 8.2.1 Percentage of budget spent on information systems 8.2.2 Hospitals Electronic Medical Record Adoption Score EMRAM score† (from Stage 0 to 7) 8.2.3 Percentage of hospitals that use IT applications to send electronic referrals 8.2.4 Percentage of hospitals that use IT applications to store electronic patient records 8.2.5 Percentage of hospitals that use IT applications to do computerized practitioner order entry 8.2.6 Percentage of hospitals that use IT applications to store and retrieve digital images 8.2.7 Percentage of family physicians who use electronic medical records (EMRs) 8.2.8 Percentage of family physicians who receive a reminder for guideline based intervention and/or screening test 8.2.9 Percentage of family physicians who prescribe drugs electronically 8.2.10 Percentage of family physicians who use flags for possible drug errors 7.3    Healthy work environment 8.3.1 Lost time and non-lost time injury rates per 100 full-time equivalent workers in long-term care homes 8.3.2 Lost time and non-lost time injury rates per 100 full-time equivalent workers in hospitals 8.3.3 Lost time and non-lost time injury rates per 100 full-time equivalent workers in nursing services (home-care and other settings) 8.3.4 Lost time and non-lost time injury rates per 100 full-time equivalent workers in treatment clinics 8.3.5 Lost time and non-lost time injury rates per 100 full-time equivalent workers in professional offices and labs 8.3.6 Percentage of physicians satisfied with practicing medicine 7.4    Health human resources 8.4.1 Number of entry-level student positions for registered practical nurses 8.4.2 Number of entry-level student positions for registered nurses 8.4.3 Number of entry-level student positions for nurse practitioners 8.4.4 Number of entry-level student positions for undergrad medical students 8.4.5 Number of entry-level student positions for international medical grads 8.4.6 Number of entry-level student positions for pharmacists 8.4.7 Number of entry-level student positions for midwives 8.4.8 Supply per 100,000 people of family doctors 8.4.9 Supply per 100,000 people of specialists 8.4.10 Supply per 100,000 people of nurse practitioners (NPs) 8.4.11 Supply of French physicians per 100,000 people 8.4.12 Percentage of family doctors who routinely work with other health care providers in their practice

8.    Integrated 8.1    Discharge/transitions from hospital and primary care 9.1.1 Percentage of patients who have all the information they need after discharge 9.1.2 Percentage who know danger signals to watch for after going home 9.1.3 Percentage who had someone explain to them the purpose of medicines 9.1.4 Percentage who had someone explain to them how to take new medications 9.1.5 Percentage who had someone tell them about medication side effects to watch for 9.1.6 Percentage who were told when to resume usual activities 9.1.7 Percentage who knew who to call if they needed help or had more questions after leaving hospital 9.1.8 Percentage of family physicians reporting prompt receipt of information from hospital after discharge 9.1.9 Percentage of family physicians reporting prompt receipt of information from specialists 9.1.10 Percentage of stroke patients discharged from acute care to inpatient rehabilitation

9.    Focused on Population Health 9.1    Unhealthy behavior 10.1.1 Percentage of the population who smoke daily 10.1.2 Percentage of the population who are heavy drinkers 10.1.3 Percentage of the population who are obese 10.1.4 Percentage of the population who are physically inactive 10.1.5 Percentage of the population with inadequate fruit and vegetable intake 9.2    Maternal and infant health 10.2.1 Infant mortality rate (per 1000 infants) 10.2.2 Percentage of babies with low birth weight 10.2.3 Percentage of mothers breastfeeding right after birth 10.2.4 Percentage of mothers breastfeeding exclusively for six months 9.3    Sexual health 10.3.1 Sexually transmitted Chlamydia rates per 100,000 people 10.3.2 HIV incidence per 100,000 people 10.3.3 Teen pregnancy rate per 1,000 teen girls 9.4    Preventive measures 10.4.1 Percentage of people (aged 65 and over) who reported having a flu shot in the year prior to the survey 10.4.2 Percentage of people who had the H1N1 shot 10.4.3 Percentage of Ontario women 50-69 years of age who reported having a mammogram in the 2 years prior to the survey 10.4.4 Percentage of Ontario women 20-69 years of age who reported having a Pap smear test in the 3 years prior to the survey 10.4.5 Percentage of people (aged 50-74) who reported having a fecal occult blood test in the 2 years prior to the survey 10.4.6 Percentage of women aged 65 who had a bone mineral densitometry test since turning 55 years of age 10.4.7 Rates of immunization being up to date for school-aged children for MMR, DPT & Polio 10.4.8 Rates of immunization being up to date for school-aged children for Haemophilus B (Hib) 9.5    Deaths and harm that could be avoided by prevention 10.5.1 Lung cancer incidence per 100,000 10.5.2 Breast cancer mortality rate per 100,000 10.5.3 AMI incidence per 100,000 10.5.4 Rate of suicides per 100,000 in Canada 10.5.5 Rate of ED visits for intentional self-harm per 100,000 10.5.6 Rate of injury-related ED visits 10.5.7 Rate of injury-related hospitalizations

10.    Equitable 10.1    Primary care — access and effectiveness 6.1.1 Percentage of adults without a regular doctor 6.1.2 Percentage of patients with diabetes who, in the past 12 months, had eye and foot exams 10.2    Unhealthy behaviour 6.2.1 Percentage of women (aged 50-69) who reported having a mammogram in the last two years 6.2.2 Percentage of women (aged 25-69) who reported having a Pap test in the last three years 6.2.3 Percentage of people (aged 50-74) who reported having a fecal occult blood test 10.3    Preventative measures 6.3.1 AMI incidence per 100,000 6.3.2 Rate of ED visits for intentional self-harm per 100,000 6.3.3 Rate of injury-related ED visits per capita 6.3.4 Rate of injury-related hospitalizations per capita 10.4    Diseases that could be avoided with a population health focus 6.4.1 Percentage of the population who smoke daily 6.4.2 Percentage of the population who are obese 6.4.3 Percentage of the population who are physically inactive 6.4.4 Percentage of the population with inadequate fruit & vegetable intake 6.4.5 Percentage of the population who are heavy drinkers