Description

The description provides the definition of the indicator.
Examples:

All Cause Hospitalization:

• The crude hospitalization rate is the total number of hospital separations (discharges, transfers and deaths) during a given year (fiscal or calendar) per total population (per 100,000).
• Age-standardized hospitalization rate (SRATE): the number of hospital separations per the population that would occur if the population had the same age distribution as the 1991 Canadian population (per 100,000).
• Standardized morbidity ratio (SMR): the ratio of observed hospital separations to the number expected if the population had the same age-specific hospitalization rates as Ontario.

Food insecurity:

• Proportion of the population who, because of lack of money, worried that there would not be enough to eat or didn't have enough food to eat or didn't eat the quality or variety of foods that they wanted to eat.

 Specific Indicators

List the names of the specific indicators within this grouping, if there are any. These should be the name that everyone uses for this indicator and should be simplified if possible.

Examples:

• AIDS death rate
• Tuberculosis death rate
• Pneumonia and influenza death rate

Ontario Public Health Standards (OPHS)

 This is a new section. Provide the name of the chapter in the OPHS or the name of the protocol for each excerpt. If there are no outcomes/requirements in the Program Standards chapters which are related to the indicator, excerpts from the Foundational Standards chapter can be listed or excerpts from the protocols can also be listed. Provide link to OPHS on Ministry website.

• The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.

Examples:

Outcomes Related to this Indicator 

• Societal Outcome (Chronic Disease Prevention): An increased proportion of the population lives, works, plays, and learns in healthy environments that contribute to chronic disease prevention.
• Societal Outcome (Chronic Disease Prevention): There is increased adoption of behaviours and skills associated with reducing the risk of chronic diseases of public health importance.
• Societal Outcome (Reproductive Health): An increased proportion of individuals in their reproductive years are physically, emotionally, and socially prepared for conception.
• Board of Health Outcome (Chronic Disease Prevention): Priority populations have food skills and adopt healthy eating behaviours.
• Board of Health Outcome (Reproductive Health): Individuals in their reproductive years, including pregnant women and their families, have the information, skills, and supports necessary to adopt health-promoting practices.

If there aren't any outcomes from the Program Standards chapters which are applicable, outcomes from the Foundational Standards chapter can be listed. For example:

• Societal Outcome (Foundational Standard): Population health needs are anticipated, identified, addressed, and evaluated.

Assessment and/or Surveillance Requirements Related to this Indicator

• The board of health shall conduct epidemiological analysis of surveillance data...in the area of healthy eating (Chronic Disease Prevention). 
• The board of health shall conduct epidemiological analysis of surveillance data...in the area of preconception health (Reproductive Health)

If there aren't any Assessment and/or Surveillance Requirements from the Program Standards chapters which are applicable, Assessment and/or Surveillance Requirements from the Foundational Standards chapter can be listed. For example:

• The board of health shall conduct surveillance, including the ongoing collection, collation, analysis, and periodic reporting of population health indicators, as required by the Health Protection and Promotion Act and in accordance with the Population Health Assessment and Surveillance Protocol, 2008 (or as current) (Foundational Standards).

If there aren't any outcomes or Assessment and/or Surveillance Requirements from the Program Standards chapters which are applicable, protocol requirements can be listed. For example:

 Corresponding Health Indicator(s) from Statistics Canada and CIHI

Name indicator and state any differences in definition or method of calculation. Put down "None" if there are no corresponding indicators. Provide link to general Health Indicators page with directions of how to find the indicator (see below). Do not provide a link right to the page because it changes with every update. Include the following text: 

The Internet publication Health Indicators, produced jointly by Statistics Canada and the Canadian Institute for Health Information, provides over 80 indicators measuring the health of the Canadian population and the effectiveness of the health care system. Designed to provide comparable information at the health region and provincial/territorial levels, these data are produced from a wide range of the most recently available sources.

Example:
Adult body mass index (BMI)
There have been changes in definitions for BMI over time. Past cycles of the CCHS may have derived variables that do not correspond to the current definition. Both the Core Indicator and the Health Indicator use the international standard for BMI.

http://www5.statcan.gc.ca/bsolc/olc-cel/olc-cel?catno=82-221-X&lang=eng
Click on "view" beside "Free", "Latest issue".
Click on "Data tables and maps" on the left side menu.
Click on the indicator "Adult body mass index (BMI)" under Health Status, Health Condition.

Corresponding Indicator(s) from Other Sources

This includes reference to other sources, including international organizations (WHO, CDC), national organizations other than the Statistics Canada/CIHI Health Indicators, provincial organizations, etc. Omit category if there are none listed.
Example:

Comparable health indicators: Select "View" under latest issue then "Data tables"
http://www5.statcan.gc.ca/bsolc/olc-cel/olc-cel?catno=82-401-x&lang=eng

• Incidence rate for invasive meningococcal disease
• Incidence rate for measles
• Incidence rate for Haemophilus influenza b (invasive) (Hib) disease

Data Sources

List the data sources for the numerator and denominator, with a link to the corresponding Data Source under APHEO Wiki - Resources. Note that we have removed HELPS as a data source (use only PHPDB Vital Statistics), except for Therapeutic Abortion Data.Currently there is a link to the list of Data Sources, ie. Data Sources (see Resources: Data Sources), but this link, and the part in brackets, can be deleted since the specific data source is listed; we don't need to take the user to the list of all data sources. 

Examples: 

Survey Questions

Survey questions apply only for survey data, specifically the CCHS and RRFSS. Omit this category if survey questions do not apply. 

< Introductory description. Can include details on whether core/optional/theme content, years not selected. For derived variables, details on how variable is derived (e.g. Food Insecurity).> Example:

Alternative Data Source(s)

An alternative data source may be listed and used by health units in cases where the primary data source is not sufficient for some reason. A prime example would be RRFSS - not all health units have RRFSS data, but some may choose to use it over CCHS because of a larger sample or the questions are more appropriate for their analysis, or some other reason. In the case of reproductive data where births can be counted many different ways by many sources, each source is a primary source and the health unit can choose which is most appropriate for their purposes. Omit category if there are none listed.

Example:

Rapid Risk Factor Surveillance System (RRFSS) contains a module called Alcohol- Drinking and Driving.  This module was core in 2001 and 2002. It has been optional since 2003.

ICD Code(s)

List the applicable ICD-9 and ICD-10 Codes, where appropriate. Omit category if there are none listed.

Examples:

• Unintentional Injury Deaths (ICD-9: E800-E929 excluding E870-E879); Accidents (ICD-10: V01-X59, Y85-Y86)
• Motor Vehicle Traffic Crashes (ICD-9: E810-E819); (ICD-10: V02-V04,V09.0,V09.2,V12-V14, V19.0-V19.2,V19.4-V19.6,V20-V79, V80.3-V80.5,V81.0-V81.1,V82.0-V82.1,V83-V86,V87.0-V87.8, V88.0-V88.8,V89.0,V89.2)
• Pedestrian (traffic-related) (ICD-9 Codes ending in .7 for E810-E819); (ICD-10: V02.1, V03.1, V04.1, V09.2, V09.3)

Analysis Check List

This is where analysis details and coding idiosyncrasies are noted. List indicator-specific points, as compared to generic analytical points related to a data source, earlier on in the check list for higher visibility.

The following is a list of generic check list points for some data sources. Check that each point is applicable prior to incorporating it into an indicator draft.

CCHS  

• It is recommended that public health units use the Share File provided by the Ministry of Health and Long-Term Care rather than public use file (PUMF) provided by Statistics Canada. The Share File has a slightly smaller sample size because respondents must agree to share their information with the province to be included; however, the share file has more variables and fewer grouped categories within variables. The Share File is a cleaner dataset for Ontario analysis because all variables that were not common content, theme content or optional content for Ontario have been removed.
• There may be slight differences between results from the share file and data published on the Statistics Canada website for the Health Indicators because rates calculated for Health Indicators use the master CCHS data file.
• Not applicable respondents should be excluded; however, it is important to understand who these respondents are from the questionnaire skip patterns to be able to describe the relevant population.
• Users need to consider whether or not to exclude the ‘Refusal, 'Don't Know' and ‘Not Stated' response categories in the denominator. Rates published in most reports, including Statistics Canada's publication Health Reports generally exclude these response categories. In removing not stated responses from the denominator, the assumption is that the missing values are random, and this is not always the case.This is particularly important when the proportion in these response categories is high.
• Estimates must be appropriately weighted (generally the share weight for the CCHS) and rounded.
• Users of the CCHS Ontario Share File must adhere to Statistics Canada's release guidelines for the CCHS data when publishing or releasing data derived from the file in any form. Refer to the appropriate user guide for guidelines for tabulation, analysis and release of data from the CCHS. In general, when calculating the CV from the share file using the bootstrap weights, users should not use or release weighted estimates when the unweighted cell count is below 10. For ratios or proportions, this rule should be applied to the numerator of the ratio.  Statistics Canada uses this approach for the tabular data on their website. When using only the Approximate Sampling Variability (CV) lookup tables for the share file, data may not be released when the unweighted cell count is below 30. This rule should be applied to the numerator for ratios or proportions.  This provides a margin of safety in terms of data quality, given the CV being utilized is only approximate.
• Before releasing and/or publishing data, users should determine the CV of the rounded weighted estimate and follow the guidelines below:
• Acceptable (CV of 0.0 - 16.5%) Estimates can be considered for general unrestricted release. Requires no special notation.
• Marginal (CV of 16.6 - 33.3%) Estimates can be considered for general unrestricted release but should be accompanied by a warning cautioning subsequent users of the high sampling variability associated with the estimates. Such estimates should be identified by the letter E (or in some other similar fashion).
• Unacceptable (CV greater than 33.3%) Statistics Canada recommends not to release estimates of unacceptable quality. However, if the user chooses to do so then estimates should be flagged with the letter F (or in some other fashion) and the following warning should accompany the estimates: "The user is advised that...(specify the data)...do not meet Statistics Canada's quality standards for this statistical program. Conclusions based on these data will be unreliable and most likely invalid". These data and any consequent findings should not be published. If the user chooses to publish these data or findings, then this disclaimer must be published with the data.
• Caution should be taken when comparing the results from Cycle 1.1 (2000/01) to subsequent years of the survey, due to a change in the mode of data collection.  The sample in Cycle 1.1 had a higher proportion of respondents interviewed in person, which affected the comparability of some key health indicators.  Please refer to http://www.statcan.gc.ca/imdb-bmdi/document/3226_D16_T9_V1-eng.pdffor a full text copy of the Statistics Canada article entitled "Mode effects in the Canadian Community Health Survey: a Comparison of CAPI and CATI"
  

 

RRFSS

• Users should refer to the most recent RRFSS Manual of Operations for a complete list of RRFSS analysis guidelines.
• Denominator Data - cell size less than 30 not to be released (based on unweighted data).
• Numerator Data - cell size less than 5 not to be released (based on unweighted data).
• Coefficients of variation (CV) should be calculated for every estimate. The following categories determine the release of the data:
• CV between 0 and 16.5:  estimate can be released without qualification.
• CV between 16.6 and 33.3:  estimate can be released with qualification:  interpret with caution.  High variability.
• CV greater than 33.3:  estimate should not be released, regardless of the cell size.
• 95% confidence intervals should accompany all released estimates.  In general the simple computation of the C.I. for a proportion assuming SEp = sqrt(pq/n) and CI95% = p +/- 1.96*SEp is sufficient. However, if estimates are close to 0 or 100% and the simple computation confidence intervals include values less than zero or greater than 100 then the Fleiss 2^nd edition computation for skewed estimates should be employed.
• Weighting:
• General household weight will be applied for questions related to the individual. 
• Household weight is to be applied for questions about households when we wish to determine the population/number of people affected. 
• Household weight is not to be applied for child proxy questions (bicycle helmet use, car seat safety), dog and cat immunization modules, or other questions that relate to the household rather than the respondent. 
• Household weights are not required to be recalculated for sub-population based questions; for example mammography in women ages 35+ years and 50-74 years.
• If the weights supplied with the data set (health unit wave specific, health unit cumulative total, all health units combined wave specific, all health units combined cumulative total) are not appropriate for the required analysis, then a time-specific weight must be calculated.  For example, a new weight is required for all seasonal modules.
• If the cell size of ‘Don't Know' responses is 5% or greater, ‘Don't Know' responses should be included in the denominator of the analyses and reported separately.
• If the cell size of ‘Refusal' responses is 5% or greater, ‘Refusal' responses should be included in the denominator of the analyses and reported separately.
• When an indicator is being compared between groups (e.g. health units, time periods, gender), if any one group has ‘Don't Know' and/or ‘Refusal' responses that are 5% or greater, ‘Don't Know' and/or ‘Refusal' responses should be included in the denominator of the analyses and reported separately for all groups.
• A provincial sample is not available with the RRFSS.
• Refer to the RRFSS Data Dictionaries at http://www.rrfss.ca/ for more information about module questions and indicators.

 

IntelliHEALTH data (Vital Statistics, Hospitalization, Emergency visits)

• The IntelliHEALTH licensing agreement does not require suppression of small cells, but caution should be used when reporting at a level that could identify individuals, (e.g., reporting at the postal code level by age and sex). Please note that privacy policies may vary by organization. Prior to releasing data, ensure adherence to the privacy policy of your organization.
• Aggregation (e.g. combining years, age groups, categories) should also be considered when small numbers result in unstable rates.

 

Method of Calculation

This provides the equation with numerator, denominator and multiplier. Note that full equation notation, including symbols, can be entered in the APHEO website using the editor. See the user guide for details.
Examples:

Crude Hospitalization Rate:

SRATE (See Resources: Direct Standardization (SRATES)):

SMR (See Resources: Indirect Standardization (SMRs, SIRs)):

Population Survey Data:
e.g., Specific Indicator - Proportion of the population that reported an injury

Basic Categories

Include the main groupings that would be used for this indicator, including pertinent age groups, and geography.
Examples:

• Age groups for age-specific crude rates: <1, 1-9, 10-19, 20-44, 45-64, 65-74, and 75+ (In the <1 age group healthy newborns make up a large proportion of all separations. Many organizations, including ICES and CIHI, exclude separations for healthy newborns from calculations of hospitalization rates for this age group).
• Suggested age groups, examples:
• Mortality, Hospitalization, Emergency Department Visits:
• <1-19 yr, 20-44, 45-64, 65-74, 75+. (IntelliHEALTH Chronic Disease age groups -Age Group (CD)) or
• <1, 1-4, then 5 yr groups to 90+. (IntelliHEALTH Infant + 5-yr age groups - (inf,5yr))
  *Note: Health units may choose to merge age categories due to small numbers, or change age categories depending on the specific analysis questions. Examples of other potential age categories include:
  • '<1, 1-4 could be changed to "0-4"
  • ‘Youth' could be analyzed as '15-24', a common category for analyzing self-harm data
  • ‘Seniors/Older adults' could be analyzed as ages "65+
• Canadian Community Health Survey Data:
• 12-19, 20-44, 45-64, 65+ [It may be necessary to aggregate data based on age groups to produce stable rates. (Refer to Document: Methods for Calculating Moving Averages)].
• Rapid Risk Factor Surveillance System Data:
• 18-24, 25-44, 45-64, 65+
• Sex: male, female and total.
• ICD Chapters
• Geographic areas of patient residence:
• Vital Statistics, Hospitalization (DAD), Ambulatory Visits (NACRS), Population Estimates data: Ontario, public health unit, municipality, and smaller areas of geography based on aggregated postal code.
• Census data: Ontario, public health unit, census division and census sub-division
• CCHS data: Ontario, public health unit
• RRFSS data: RRFSS-participating health units that chose the [module name] (Varies by wave. Check documentation.)
• BORN data: Ontario, public health unit
• CCASS data: Ontario, census division, census sub-division. Public health unit is not available in CCASS data but most PHUs correspond to a census division or groupings of census divisions. Refer to CCASS Data Source resource for further details.
• iPHIS, IRIS, Vaccine Distribution data: public health unit
• Ministry of Transportation Data: public health unit, census division, census sub-division
• Ontario Cancer Registry data: Ontario, public health unit

Indicator Comments

Include information that assists with the interpretation of the data, including background literature, key trends or findings.
Examples:

• The Collaborative Statement from the Dieticians of Canada, Canadian Paediatric Society, The College of Family Physicians of Canada, and Community Health Nurses Association of Canada recommends that the 2000 CDC growth charts be used for assessing and monitoring the growth of Canadian infants and children. This reference will be reassessed when the WHO releases a new international growth reference for children from birth to age five in 2005.1
• Causes are based on the most responsible diagnosis (diagnosis associated with the longest duration of treatment) during a given hospital stay.
• Hospitalizations in psychiatric hospitals are excluded.
• The CCHS is population based and therefore excludes homeless people among whom food insecurity is high.
• Because food insecurity is defined as lacking funds for food, this indicator may underestimate the percentage of seniors who are food insecure. Seniors may have other risk factors that can contribute to food insecurity: health problems, disabilities, and functional impairments that limit one's ability to purchase food or prepare meals.
• To best understand mortality or disease trends in a population, it is important to determine crude rates, age-specific rates and age-standardized rates (SRATES) and/or ratios (SMRs, SIRs). Although the crude death (or disease) rate depicts the "true" picture of death/disease in a community, it is greatly influenced by the age structure of the population: an older population would likely have a higher crude death rate. Age-specific rates can best describe the "true" death/disease pattern within particular age groups of a community, and allow for comparison of age groups across populations that have different age structures.
• Since many age-specific rates are cumbersome to present, age-standardized rates have the advantage of providing a single summary number that allows different populations to be compared; however, they present an "artificial" picture of the death/disease pattern in a community. For more information about standardization, refer to the Resources section: Standardization of Rates.

Definitions

Use this category if there are key definitions that are relevant to this indicator that are important to highlight. Provide citation.
Examples:

• Separation - "a separation refers to a discharge, death, sign out or transfer. If a patient is transferred to another hospital, multiple separations will occur. Separations, rather than admissions, are used because hospital abstracts for inpatient and day procedure care are based on information gathered at the time of discharge. The terms ‘separation,' ‘discharge,' ‘hospitalization,' and ‘stay' are often used interchangeably." Health System Intelligence Project. The Health Analyst's Toolkit. Ministry of Health and Long Term Care, Government of Ontario, 2006.
• Day Procedure - These are also referred to as "day surgeries." Health System Intelligence Project. The Health Analyst's Toolkit. Ministry of Health and Long Term Care, Government of Ontario, 2006.
• Food security - "Food security exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food which meets their dietary needs and food preferences for an active and healthy life. Household food security is the application of this concept to the family level, with individuals within households as the focus of concern." The Food and Agriculture Organization of the United Nations. Trade Reforms and Food Security- Conceptualizing the Linkages, 2003. Available online at: http://www.fao.org/docrep/005/Y4671E/y4671e00.HTM#Contents(Accessed July 31, 2008).
• Food insecurity- "Food insecurity exists when people do not have adequate physical, social or economic access to food as defined above." The Food and Agriculture Organization of the United Nations. Trade Reforms and Food Security- Conceptualizing the Linkages, 2003. Available online at: http://www.fao.org/docrep/005/Y4671E/y4671e00.HTM#Contents (Accessed July 31, 2008).

Cross-References to Other Indicators

This section provides links to other related indicators.
Examples (for hospitalization indicators):

• Chronic Disease Hospitalization (Section 4A: Chronic Diseases)
• Cancer Hospitalization (Section 4B: Cancer Incidence and Early Detection of Cancer)
• Injury Hospitalization (Section 4C: Injury Prevention and Substance Abuse Prevention)
• Child Hospitalization (Section 6C: Child and Adolescent Health)
• Attempted Suicide Hospitalization (Section 7: Mental Health)
• Pelvic Inflammatory Disease Hospitalization (Section 8: Infectious Diseases)
• Enteric Diseases Hospitalization (Section 8: Infectious Diseases)

Cited Reference(s)

The references are numbered and refer to superscripted numbers in the text of the indicator. Provide references using Vancouver Citation Method, as used by the Canadian Public Health Association Canadian Journal of Public Health style guidelines (see "Manusript Preparation - References").
Examples:

1. Single E, Rehm J, Robson L, Van Truong M. The relative risk and etiologic fractions of different cause of death and disease attributable to alcohol, tobacco and illicit drug use in Canada. CMAJ 2000;162(12):1669-1675.
2. Appendix:  A Summary of Studies on the Quality of Health Care Administrative Databases in Canada. In: Goel V, Williams JI, Anderson GM, Blackstien-Hirsch P, Fooks C, Naylor CD, editors. Patterns of Health Care in Ontario. The ICES Practice Atlas, 2nd edition. Ottawa:  Canadian Medical Association; 1996. p. 339-45.

Other Reference(s)

The references are bulleted and are general references for this indicator. Provide references using CPHA style guidelines (see Data Citation under Core Indicators Resources).
Examples:

• Canadian Institute for Health Information. Abstracting Manual. Ottawa, ON: Canadian Institute for Health Information, 1995.
• Ontario Ministry of Health. Tobacco and your health: Report of the Chief Medical Officer of Health, 1991.
• Appendix:  A Summary of Studies on the Quality of Health Care Administrative Databases in Canada. In: Goel V, Williams JI, Anderson GM, Blackstien-Hirsch P, Fooks C, Naylor CD, editors. Patterns of Health Care in Ontario. The ICES Practice Atlas, 2nd edition. Ottawa:  Canadian Medical Association; 1996. p. 339-45. 

Changes made

The Changes Made section lists the changes that have been made to the indicator over time (minor changes such as fixing a broken link or a spelling error do not need to be recorded). Record who made the change (the name of a subgroup or person) and whether the change was made as part of a formal review or ad hoc. A "Changes Made" section should also be included in Core Indicator Resources.

Example: