Transcript
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Hospitals in Canada provide people with many services and treat all types of conditions. Yet hospitals are not all the same in terms of what they provide Canadians.
Large teaching hospitals tend to treat more complex medical and surgical cases than community hospitals do. However, there may still be overlap in the conditions that each of them treats.
So how can we measure a hospital’s performance, compare it with others or provide it with equitable funding when the complexity of the cases differs from one hospital to another?
One solution is to use case-mix methodologies.
Case-mix methodologies provide a consistent way of classifying or sorting patients into groups that are similar in their clinical characteristics and the resources required for their care.
And it’s by looking at combinations of patient groups that we can make meaningful comparisons.
Let’s look at some examples of how case mix is used in our health care system.
Susan Clark is the CEO of Eastern Memorial, a large teaching hospital. She wants to make sure that the hospital is providing optimal care for its patients given the available resources.
Her team tells her that the types of patients they’re treating have changed over the last 3 years.
Examining the hospital’s case mix reveals that Eastern Memorial is treating patients with more complex needs, such as organ transplants, cardiac procedures and highly premature births. These treatments require more intensive hospital resources.
Susan and her team can use case-mix information and other data to realign budgets and to adjust staffing allocations.
Marc Morin is CEO of Greenwood Community Hospital, located a few kilometres away from Eastern Memorial.
He wants to understand how his hospital is performing compared with other hospitals in the area in terms of patient lengths of stay for similar conditions and procedures.
Marc knows that it’s best to compare Greenwood with other hospitals that provide similar services and that have a similar mix of patients.
Although Eastern Memorial is geographically close to Greenwood, the case-mix information shows that Marc’s hospital is treating less-complex patients who require less-intensive resources.
Marc identifies several hospitals that treat similar types of patients to Greenwood. He uses case-mix reports to understand whether patients with similar care needs are staying longer at his hospital than at other hospitals.
Marc decides to set up a community of practice with these peer hospitals so that they can share their experiences and best practices around providing good and efficient care.
Jin Lee works for the Ministry of Health as the director of the department responsible for making funding allocations.
She wants to ensure that the health care organizations in her jurisdiction are receiving funding according to the needs of the patients they provide care to.
Jin knows that the case-mix information she receives from the Canadian Institute for Health Information — also known as CIHI — can help with her funding decisions.
CIHI is considered a world leader in case-mix systems that provide a picture of the differences among hospital patient mixes and their associated costs.
Thanks to CIHI, hospitals, regions and ministries of health have case-mix information at their fingertips.
So how does this work?
Behind the scenes, the hospitals collect and submit their data to CIHI using its robust pan-Canadian standards.
CIHI then applies its case-mix methodologies.
<Slide about 2 of CIHI’s hospital grouping methodologies>
2 of CIHI’s hospitals grouping methodologies are
- The Comprehensive Ambulatory Classification System — or CACS — that’s used for outpatient cases, including those seen in emergency departments, day surgeries and clinics; and
- The Case Mix Group Plus — or CMG+ — methodology that’s used for inpatient cases.
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These methodologies use patient information such as health conditions and medical or surgical procedures to assign each case to a case-mix group.
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CIHI then makes this information available in its decision-support tools, allowing Susan, Marc and Jin
- To effectively plan, monitor and manage the services they provide;
- To support resource allocation; and
- To facilitate peer, provincial and national comparisons.
<www.cihi.ca/casemix>
For more information about case mix, visit www.cihi.ca/casemix.
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