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8 Pelvic Inflammatory Disease Morbidity

Description | Specific Indicators | Corresponding Outcomes from the OPHS | Corresponding Health Indicator from Stats Can/CIHI | Data Sources |  Alternative Data Sources | ICD Codes | OHIP Codes | Analysis Check List | Method of Calculation |  Basic Categories | Indicator Comments | Cross-References to Other Sections | Cited References | Other References | Acknowledgements | Changes Made  
  
 
Description

  • The inpatient discharges rate for pelvic inflammatory disease (PID) is the total number of inpatient discharges from PID per 100,000 population of females >=15 years in a given time frame.
  • The PID day procedure rate is the total number of PID day procedures per 100,000 population of females >= 15 years in a given time frame.
  • The PID emergency department visit rate is the total number of PID emergency department visits per 100,000 population of females >= 15 years in a given time frame.
  • The PID medical services rate is the total number of PID medical services per 100,000 population of females >= 15 years in a given time frame.
  • Age-specific hospitalization rates are the number of 1. inpatient discharges 2. day procedures or 3. emergency department visits from PID in a given age group per 100,000 population of females in that age group in a given time frame. 
  • Age-standardized hospitalization rates (SRATEs): the number of 1. inpatient discharges 2. day procedures or 3. emergency department visits from PID per 100,000 population that would occur if the population had the same age distribution as the 1991 Canadian population. 
  • Standardized morbidity ratio (SMRs): the ratio of observed 1. inpatient discharges 2. day procedures or 3. emergency department visits from PID to the number expected if the population had the same age-specific hospitalization rates as Ontario.
Specific Indicators
  • Pelvic inflammatory disease inpatient discharges
  • Pelivc inflammatory disease day procedures
  • Pelvic inflammatory disease emergency department visits rate
  • Pelvic inflammatory disease medical services rate

Corresponding Outcomes from the Ontario Public Health Standards (OPHS)

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.

Link to OPHS
http://www.ontario.ca/publichealthstandards

Outcomes Related to this Indicator:

  • Societal Outcome (Sexual Health, Sexually Transmitted Infections, and Blood-borne Infections (including HIV): There is reduced morbidity and mortality associated with sexually transmitted infections and blood-borne infections. 

  
Corresponding Health Indicator(s) from Statistics Canada and CIHI

  • None


Data Sources

Numerator: Inpatient Discharges 
Original source: Canadian Institute for Health Information (CIHI), Discharge Abstract Database (DAD)
Distributed by: Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO
Suggested citation (see Data Citation Notes):
Inpatient Discharges [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].
Note: Day Procedure information from Fiscal Year 1996-2002 was collected in the DAD.

Numerator: Ambulatory Visits
Original source: Canadian Institute for Health Information (CIHI), National Ambulatory Care Reporting System (NACRS)
Distributed by: Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO
Suggested citation (see Data Citation Notes):
Ambulatory Visits [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].
Note: Day Surgery and Outpatient Clinics have been collected in NACRS as of Fiscal Year 2003. Embergency Department visits have been collected since Fiscal Year 2001.

Numerator: Medical Services
Original source: Ontario Health Insurance Plan (OHIP) Approved Claims file
Distributed by: Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO
Suggested citation (see Data Citation Notes): 
Medical Services [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].

Denominator: Population Estimates
Original source: Statistics Canada
Distributed by: Provincial Health Planning Database (PHPDB), Ontario MOHLTC
Suggested citation (see Data Citation Notes): Population Estimates [years]*, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].
* Note: Use the total years of the estimates, including the most recent year, even if not all were used in the analysis. The years used in the analysis should be included in the report itself.
 
  
ICD Codes

  • Pelvic Inflammatory Disease (ICD-9: 614-616.0); (ICD-10-CA: N70-N74)

OHIP Codes

  •  Pelvic Inflammatory Disease (614, 615) 
Analysis Check List
  • Suppress numbers <5 or rates and proportions based on counts less than 5, in accordance with the Ontario Provincial Health Planning Database (PHPDB) User Agreement.
  • PID will apply only to females thus the denominators are based on female population above 15 years.
  • For in-patient discharges in intelliHEALTH: use Inpatient Discharge Main Table data source from the ‘05 Inpatient Discharges' folder and # Dschg as Measure.
  • For day procedures/surgeries in intelliHEALTH: Prior to April 1, 2003, use Day Procedure Main Table F1996-2002 from '04 Ambulatory Visits' folder and # DP Cases as Measure. As of April 1, 2003, use Ambulatory All Visit Main Table '04 Ambulatory Visits' folder, filter on AM Case Type = DSU, and # AM Visits as Measure.
  • For emergency department visits in intelliHEALTH: use Ambulatory All Visit Main Table '04 Ambulatory Visits' folder, filter on AM Case Type = EMG, and # AM Visits as Measure.
  • For medical services in intelliHEALTH: use Medical Service 1 Yr table from '03 Medical Services' folder for most recent fiscal year's data or Medical Service table for previous year's data, and # Visits (D-HN) or # Pts (D-HN) as Measure.
  • ICD-10-CA has a greater level of specificity and different code titles than ICD-9. CIHI does not endorse forward conversions because of differences in the classification systems. Refer to Resources: ICD-10-CA for more information.


Method of Calculation
 

Total Hospitalization Rate:

total number of 1. hospital separations 2. day procedures/surgeries 3. emergency department visits OR 4. medical services for females aged 15+ by ICD code in a given time frame

    x 100,000

total number of females aged 15+

 
 
Age-Specific Hospitalization Rate:

total number of 1. hospital separations 2. day procedures/surgeries 3. emergency department visits OR 4. medical services for females aged 15+ by ICD code in an age group in a given time frame

    x 100,000

total number of females in that age group

  
 
SRATE (See Resources: Standardization of Rates):

Sum of (1.hospital separations 2. day procedures/surgeries 3. emergency department visits OR 4. medical services by ICD code in a given age group x 1991 Canadian population in that age group)

    x 100,000

Sum of 1991 Canadian population 

 
 
SIR (See Resources: Standardization of Rates):

Sum of 1.hospital separations 2. day procedures/surgeries 3. emergency department visits OR 4. medical services by ICD code in the population

    

Sum of (Ontario age-specific rate x population in that age group)


 
Basic Categories

  • 5 year age groups for age-specific rates for females only, starting at age 15.
  • Geographic areas: public health unit, census division, census sub-division.

  
Indicator Comments

  • Pelvic Inflammatory Disease (PID) is a bacterial infection caused by sexually transmitted diseases (usually gonnorhea or chlamydia) and represents a serious adverse outcome for women. Women at increased risk for developing PID are under 25 years of age, have had previous episodes of PID, have multiple sexual partners, and have an intrauterine device1.
  • Decreasing in-patient hospitalization rates may be due to altered hospital practices rather than a true decrease since cases of PID may be treated on an out-patient basis. Inclusion of day procedure/surgery, emergency department visit rates and medical services should provide a more complete picture.
  • As with all hospital separation data, the date is based on separation, not admission.
  • Geographic information for residence of patient for medical services must be interpreted with extreme caution. OHIP does not collect any geographic information on either the patient or the provider as part of the claim. The location of the patient in the PHPDB is based on the address of the person recorded in the Registered Persons Database. Many of these addresses have never been updated since they were first enetered in the early 1990's.
  • OHIP codes suggested for PID may under-estimate total number of medical services provided related to PID. Mecial services provided related to cervicitis are captured under code 616 however this code was excluded because it included a number of other services that would not be related to PID including vaginitis, cyst or abcess of Bartholin's gland, and vulvitis.
  • Multiple events may occur for any one person in a year. A special report/table in intelliHEALTH is currently under-development to combine all data sources to attempt to capture the distinct number of individuals with either a hospitalization, day procedure, emergency department visit or medical service provided in a given time frame.
  • 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) or ratios (SMRs, SIRs). The crude death (or disease) rate is the number of deaths (or disease cases) divided by the number of people in the population. This rate depicts the “true” picture of death /disease in a community although it is greatly influenced by the age structure of the population. An older population would likely have a higher crude death rate whereas a younger population may have a higher crude birth rate. Age-specific rates can best describe the “true” death /disease pattern of a community and allow comparison of 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. It is important to examine the data carefully before standardizing. In general, the SMR or SIR is used to compare an area (e.g., health unit) with one other area (e.g., Ontario). This indirect form of standardization requires a comparator that has a large population and stable age-specific rates. SRATEs, on the other hand, are generally used to compare a number of rates at the same time, e.g., health units across a region or rates over time. This direct form of standardization requires all comparators to have relatively stable age-specific rates. For more information about standardization, refer to the Resources section: Standardization of Rates.


Definitions

  • Separation – a separation from a health care facility occurs anytime a patient (or resident) leaves because of death, discharge or transfer. The number of separations is the most commonly used measure of the utilization of hospital services. Separations, rather than admissions, are used because hospital abstracts for inpatient care are based on information gathered at the time of discharge. The words 'separation', 'discharge', and 'stay' are used interchangeably.
  • Day Procedure – includes visits or treatment provided by hospitals to patients on an outpatient basis.


Cross-References to Other Sections


Cited References

  1. Public Health Research, Education and Development Program. Report on the Health Status of the Residents of Ontario, February 2000.


Other References

  • Goel V, Williams JI, Anderson GM, Blackstien-Hirsch P, Fooks C, Naylor CD (Eds). Appendix: A Summary of Studies on the Quality of Health Care Administrative Databases in Canada. In: Patterns of Health Care in Ontario. The ICES Practice Atlas, 2nd edition. Ottawa: Canadian Medical Association, 1996;339-345.
  • Coyte PC, Young W, Williams JI. Devolution of Hip and Knee Replacement Surgery? ICES Working Paper 1995;38;1-35.
  • Public Health Agency of Canada. 2004 Canadian Sexually Transmitted Infections Surveillance Report. CCDR 2007;33S1:1-69. Available at: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/07vol33/33s1/index_e.html

Acknowledgements

Lead Author(s)

Sherri Deamond

Contributing Author(s)

Core Indicators Infectious Disease Subgroup

CIWG Reviewers

Core Indicators Infectious Disease Subgroup

External Reviewers

Colin Lee, Simcoe Muskoka District Health Unit
Hong Ge, Durham Region Health Department
Effie Gournis, Toronto Public Health
Elizabeth Rae, Toronto Public Health
Rachel Savage, Ontario Agency for Health Protection and Promotion (now Public Health Ontario)
JoAnn Heale, Ontario Ministry of Health and Long-Term Care

 


Changes Made

Date

Type of Review(Formal or Adhoc)

Changes made by

Changes

Dec. 16, 2008

Formal

Infectious Disease subgroup

  • Added two new specific indicators
    • Pelivc inflammatory disease day procedures/surgeries rate
    • Pelvic inflammatory disease emergency department visits rate
  • Added outcomes from the draft Ontario Public Health Standards
  • Updated analysis checklist, indicator comments and references
Dec. 10, 2010Formal

Infectious Disease subgroup

  • Changed the "and" in method of calculation to "or" for clarification (e.g. total number of 1. hospital separations 2. day procedures/surgeries and or 3. emergency department visits for females aged 15+ by ICD code in a given time frame)
  • Change ICD-10-CA codes from N70-N77 to N70-N74(i.e. now excludes N75-N77) and ICD-9 codes from 614-616 to 614-616.0 (i.e. now excludes 616.1-616.9)
May 10, 2011Formal

Infectious Disease subgroup

  • Added Medical Services as additional indicator including OHIP codes 614 & 615. Updated indicator comments to reflect intelliHEALTH, include caveats regarding medical services data and note regarding current work to develop special report/table in intelliHEALTH to combine data sources for PID.
January 30, 2012Ad hocSherri Deamond on behalf of CIWG
  •  Added acknowledgements section

 

 
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