Inputs, Outputs and Outcomes:
What Measures, What Matters
Glenda Yeates, President & CEO
Canadian Institute for Health Information
October 30, 2007
Overview
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CIHI: Taking Health Information Further
Health Inputs
Health Outputs
Health Outcomes
Moving to a Future Vision
Taking Health Information
Further
CIHI works to improve the health of
Canadians and the health care system by
providing quality health information.
Who we are
• A national, independent, non-profit agency
• Mandate:
– national coordination mechanism for health information
in Canada
– provide accurate and timely information for:
• sound health policy
• effective management of the health system
• public awareness of health determinants
What we do
Data Holdings
• Collect, process and maintain data for a
growing number of national and provincial
health databases and registries:
– Health Services
– Health Professionals
– Health Expenditures
What we do
Data Standards
• Coordinate/promote development and
maintenance of health information standards,
including:
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Financial and Managerial Standards
Minimum Data Sets
Grouping Methodologies
Disease/intervention Classifications
• ICD-10-CA/CCI
• International Classification of Functioning, Disability and
Health
What we do
Analytic Products
• Produce a variety of reports,
special studies and analytic
products to address questions
of interest to stakeholders
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Health Care in Canada
Health Indicators
Medical Imaging
Health Expenditures (NHEX)
Many others …
Inputs/Outputs/Outcomes
“Not everything that can be counted counts,
and not everything that counts can be
counted.”
– Albert Einstein
CIHI/STC Health Outcomes
Framework
Health Inputs-Outputs-Outcomes
INPUTS
OUTPUTS
Health Expenditures
Human Capital
Capital Equipment
Health Policy Decisions
Efficiency
Productivity
Value for Money
=
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OUTCOMES
Status of Population Health
Results of Interventions
(Changes in Morbidity and Mortality)
Health Inputs
“Inputs are productive resources: human time,
energy, and skills, the services of capital equipment
such as buildings and machinery, raw materials,
intermediate products which are themselves the
outputs of prior production processes, and
“knowhow” to combine all these.”
- Evans, 1984
Distribution of Health Spending in
Canada
Source: National Health Expenditure Database
(forecast 2006), CIHI.
Distribution of Health Human
Resources in Canada: Physicians
and Registered Nurses
Sources: Registered Nurses Database, CIHI; Scott’s Medical
Database, CIHI; 2005 population estimates, Statistics Canada.
What are the Gaps ?
• There are a number of gaps, for example:
– We have a better understanding of health inputs
for acute care than we are in other areas of
care
– We know more about physicians and nurses
than we do about other health professionals
Health Outputs
“The quantity of health care received by
patients, in terms of complete treatments,
adjusted to allow for the qualities of the
services provided.”
- Smith & Street, 2006
Health System Utilization
We know a lot about the types of health care
services being accessed by Canadians, for
example:
– Health Services Utilization
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Over 14 million ED visits annually
3.1 million hospitalizations in 2005-2006
Median length of stay 4 days
33,590 hip replacements and 25,124 hip replacements in
2004-2005
– Diagnostic Imaging
• 816,512 MRI scans and 2.8 million CT scans in 2004-2005
Trends in age-standardized
surgery rates
Sources: Discharge Abstract Database, CIHI; National
Ambulatory Care Reporting System, CIHI; special tabulations
provided by Alberta Health and Wellness and Manitoba Health.
What are the Gaps ?
There are a number of gaps, for example:
– Not all provinces and territories submit data to all
databases
– Community-based care
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Primary health care
Home care
Community mental health
– Private sector, Alternative payments for physicians
Health Outcomes
“A health outcome refers to the effect or result of
care or interventions on the health status of patients
or populations.” - Donabedian, 1988
“Changes in health status (mortality and morbidity)
which result from the provision of health (or other)
services.” - OECD, 1992
”Health outcomes are changes in health as a result
of the level of care received.”- ACHORD, 2003
Surgical Volumes and Outcomes
Based on our results, for every 10 additional procedures a
hospital performed, there was a lower risk-adjusted 30-day inhospital mortality rate for three procedures (angioplasty,
esophagectomy, and Whipple).
Source: Discharge Abstract Database, CIHI.
Regional Variations in Mortality
Following an AMI
Sources: Hospital Morbidity Database, CIHI;
Discharge Abstract Database, CIHI.
30 day Stroke & AMI in-hospital
Mortality Rates Over Time
Sources: Hospital Mortality Database, CIHI;
Discharge Abstract Database, CIHI.
Readmissions for Specific Medical
Conditions by LHIN
Sources: Discharge Abstract Database, CIHI;
National Ambulatory Care Reporting System, CIHI.
Unadjusted Short- and Long-Term
Survival in Patients on Dialysis With
and Without Diabetes
Source: Canadian Organ Replacement Register, CIHI.
Hospital Standardized Mortality
Ratio (HSMR)
Source: Health Indicators, CIHI.
Health Outcomes and Elective
Surgery: Cataracts (Charles Wright)
Results: 70% of patients indicated post-surgery improvements, but
27% reported worse or no change in outcomes
What are the Gaps?
There are a number of gaps, for example:
– Consensus
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No agreement on the important questions to ask
No agreement on the important outcomes to measure
How do we measure “success”?
– Data Collection
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Patient pre- and post-operative function
Patient satisfaction
– Functional Status of Patients
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Long-term tracking of patients after interventions
Moving to a Future Vision
“It is not the strongest of the species that
survives, nor the most intelligent, but the one
most responsive to change.”
— Charles Darwin
CIHI’s Vision for Better Measures
of Health Output and Outcomes …
• We will have robust dialogue and consensus around
which outcomes are the most important to measure
• We will have more and better quality data
– Pan Canadian
– Moving beyond acute care
• EHR and other sources: constructed and standardized in
a way to be able to address the questions that
physicians and others are asking
• As a country we would have better data to enable
discussion of outcomes for system-level planning
The Road Ahead . . .
To learn more,
visit the CIHI website:
www.cihi.ca