Inflow/Outflow Ratio

This indicator is a ratio, calculated as the number of separations (discharges and deaths) from acute care/same-day surgery facilities within a given region divided by the number of acute care/same-day surgery separations generated by residents of that region.

A ratio of less than 1 indicates that health care utilization by residents of a region exceeded care provided within that region, suggesting an outflow effect. A ratio of greater than 1 indicates that care provided by a region exceeded the utilization by its residents, suggesting an inflow effect. A ratio of 1 indicates that care provided by a region was equivalent to the utilization by its residents, suggesting that inflow and outflow activity, if it existed at all, was balanced. A ratio of 0 is an indication that none of the institutions in the region provided the service and residents received care outside of their region.

Data updated:
Data availability: to (fiscal years)
Geographic coverage
All provinces/territories
Reporting level
Region
Calculation

The indicator is expressed as an overall ratio, calculated for discharges associated with any diagnosis or procedure (acute care discharges only) and separately for coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), hip replacement, knee replacement and hysterectomy procedures. There are six inflow/outflow ratios:

  1. Overall
  2. CABG
  3. PCI
  4. Hip replacement
  5. Knee replacement
  6. Hysterectomy

Ratio = Number in numerator ÷ Number in denominator

Unit of Analysis: Single admission

Denominator

Number of separations (discharges and deaths) from acute care/same-day surgery facilities generated by residents of the region for a given procedure

Numerator

Number of separations (discharges and deaths) from acute care/same-day surgery facilities within a given region (including non-residents) for all cases and for a given procedure

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Name

Inflow/Outflow Ratio

Short/Other Names

Not applicable

Description

This indicator is a ratio, calculated as the number of separations (discharges and deaths) from acute care/same-day surgery facilities within a given region divided by the number of acute care/same-day surgery separations generated by residents of that region.

For further details, please see the General Methodology Notes (PDF).

Rationale

This indicator reflects the balance between the quantity of hospital stays provided to both residents and non-residents by all relevant facilities (acute care/same-day surgery) in a given region and the extent of utilization by residents of that region, whether they received care within or outside of the region.

Interpretation

A ratio of less than 1 indicates that health care utilization by residents of a region exceeded care provided within that region, suggesting an outflow effect. A ratio of greater than 1 indicates that care provided by a region exceeded the utilization by its residents, suggesting an inflow effect. A ratio of 1 indicates that care provided by a region was equivalent to the utilization by its residents, suggesting that inflow and outflow activity, if it existed at all, was balanced. A ratio of 0 is an indication that none of the institutions in the region provided the service and residents received care outside of their region.

HSP Framework Dimension

Person-centred

Areas of Need

Getting Better

Targets/Benchmarks

Not applicable

Available Data Years

to

Geographic Coverage

  • All provinces/territories

Reporting Level/Disaggregation

  • Region

Indicator Results

Web Tool:
Health Indicators e-Publication

Update Frequency

Every year

Latest Results Update Date

Updates

Not applicable

Description

The indicator is expressed as an overall ratio, calculated for discharges associated with any diagnosis or procedure (acute care discharges only) and separately for coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), hip replacement, knee replacement and hysterectomy procedures. There are six inflow/outflow ratios:

  1. Overall
  2. CABG
  3. PCI
  4. Hip replacement
  5. Knee replacement
  6. Hysterectomy

Ratio = Number in numerator ÷ Number in denominator

Unit of Analysis: Single admission

Type of Measurement

Ratio

Denominator

Description:

Number of separations (discharges and deaths) from acute care/same-day surgery facilities generated by residents of the region for a given procedure

Inclusions:

CABG (acute care discharges only):
CCI: 1.IJ.76^^

PCI (acute care and same-day surgery discharges):
CCI: 1.IJ.50^, 1.IJ.57.GQ^^ (this code is used for 2017–2018 and earlier), 1.IJ.54.GQ-AZ (this code is used for 2006–2007 to 2008–2009 only), 1.IJ.57.GT (from 2018–2019), 1.IJ.57.GU (from 2018–2019)

Hip replacement (acute care and same-day surgery discharges):
CCI: 1.VA.53.^^ (excluding 1VA53LASLN and 1VA53LLSLN when intervention status attribute does not equal R), 1.SQ.53.^^

Knee replacement (acute care and same-day surgery discharges):
CCI: 1.VG.53.^^ (excluding 1VG53LASLN when intervention status attribute does not equal R), 1.VP.53.^^

Hysterectomy (acute care and same-day surgery discharges):
CCI: 1.RM.89^^, 1.RM.91^^, 1.RM.87.BA-GX, 1.RM.87.CA-GX, 1.RM.87.DA-GX, 1.RM.87.LA-GX with intervention extent attribute coded as SU

Note:
procedure codes may be recorded in any position.

Numerator

Description:

Number of separations (discharges and deaths) from acute care/same-day surgery facilities within a given region (including non-residents) for all cases and for a given procedure

Inclusions:

CABG (acute care discharges only):
CCI: 1.IJ.76^^

PCI (acute care and same-day surgery discharges):
CCI: 1.IJ.50^, 1.IJ.57.GQ^^ (this code is used for 2017–2018 and earlier), 1.IJ.54.GQ-AZ (this code is used for 2006–2007 to 2008–2009 only), 1.IJ.57.GT (from 2018–2019), 1.IJ.57.GU (from 2018–2019)

Hip replacement (acute care and same-day surgery discharges):
CCI: 1.VA.53.^^ (excluding 1VA53LASLN and 1VA53LLSLN when intervention status attribute does not equal R), 1.SQ.53.^^

Knee replacement (acute care and same-day surgery discharges):
CCI: 1.VG.53.^^ (excluding 1VG53LASLN when intervention status attribute does not equal R), 1.VP.53.^^

Hysterectomy (acute care and same-day surgery discharges):
CCI: 1.RM.89^^, 1.RM.91^^, 1.RM.87.CA-GX, 1.RM.87.DA-GX, 1.RM.87.LA-GX with intervention extent attribute coded as SU

Note that procedure codes may be recorded in any position.

Method of Adjustment

Not applicable

Adjustment Applied

None

Geographic Assignment

Place of residence or service

Data Sources

  • DAD
  • HMDB
  • NACRS

Caveats and Limitations

Not applicable

Trending Issues

Not applicable

Comments

Beginning with 2015-2016 data, cement spacers are excluded from hip and knee replacement cases when they are not revisions; comparability with previous years should not be affected.

References

Heart and Stroke Foundation of Canada. The Growing Burden of Heart Disease and Stroke in Canada 2003. Available at http://publications.gc.ca/collections/Collection/H1-10-2003E.pdf. Accessed March 01, 2014.

Johansen HL, et al. Incidence, Comorbidity, Case Fatality and Readmission of Hospitalized Stroke Patients in Canada. Can J Cardiol. 2006;22:65-71.

Truelsen T, Bonita R and Jamozik K. Suveillance of Stroke: A Global Perspective. Int J Epidemiol. 2001;30:S11-S16.

World Health Organization. WHO STEPS Stroke Manual: The WHO STEPwise Approach to Stroke Surveillance. Geneva, Switzerland: WHO, 2006.

How to cite:

Canadian Institute for Health Information. Inflow/Outflow Ratio. Accessed May 19, 2024.

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