European Commission - Public Health: healthindicators.org

DOCUMENTATION SHEET FOR:

Indicator: 68. Hospital day-cases, selected diagnoses

SHORTLIST sub-division: D) Health interventions: health services

Status: implementation section

Date last modification documentation sheet: 23-08-2010

PDF version of documentation sheet

Operational indicators (Excel-file)

Definition

The number of hospital day-cases from all hospitals during the given calendar year, expressed per 100,000 population. Calculated and presented by the following 25 categories of the International Shortlist for Hospital Morbidity Tabulation (ISHMT).

Calculation

The indicator is calculated as the total number of hospital day-cases from all hospitals during a given calendar year, expressed per 100,000 inhabitants. The definition of hospitals (HP.1) follows the International Classification for Health Accounts– Providers of health care (ICHA-HP) of the System of Health Accounts. For definitions of day-cases see remarks.

Relevant dimensions and subgroups

• Calendar year
• Country
• Region (according to ISARE recommendations; see data availability)
• Age groups: 0-64 and 65+
• Age group exceptions:
• dementia: no disaggregation according to age (not relevant for population below 65)
• asthma: 0-14 and 15+ (similar to asthma incidence indicator: nr 26; hospital admissions for asthma in particular relevant in children)
• injury and poisoning & certain other consequences of external causes: 0-14, 15-24, 25-64, and 65+ (similar to injury incidence indicators: nr 29, 30 and 31; injuries are an important cause of burden of disease particularly in children and young adults).

Preferred data type and data source

Preferred data type

Registers (administrative data sources, national hospital discharge registers)

Preferred data source

Eurostat

Data availability

Annual national and regional data are provided in absolute numbers (total number). 24 EU countries, Norway and Switzerland are included in the Eurostat dataset. However, data availability varies by country and by year. Greece, Romania, Bulgaria were the only EU-27 countries not included. Regional data (NUTS II level) available for few countries and depending on year. The ISARE project on regional data has not collected data on numbers of hospital day-cases.

Data periodicity

Data are updated annually and available for the period 2000-2009.

Rationale

Indicators based on hospital day-cases for particular diseases provide information on the burden of these diseases on health services, complementing the information on hospital discharges. Besides, hospital daycases give information on the situation and evolution of these modes of production in health care sector. The indicator is also used in assessment of quality of care, costs and efficiency.

Remarks

• Hospital daycases is one of the indicators of the health and long-term care strand of the Open Method of Coordination on Social Inclusion and Social Protection. Data are under preparation.
• Data are not age-standardized by Eurostat. Therefore ECHIM uses breakdown in age groups (0-64, 65+). Data are available however by 5 year age groups, so age-standardized data could be computed.
• ECHIM does not require disaggregation of this indicator by sex, and only by two age groups (0-64 and 65+) to reduce the number of operationalisations. Data are provided by Eurostat for total population and for 5-year age groups. So the aggregated age groups need to be computed.
• Day-case: day care comprises medical and paramedical services (episode of care) delivered to patients who are formally admitted for diagnosis, treatment or other types of health care with the intention of discharging the patient on the same day. An episode of care for a patient who is admitted as a day-care patient and subsequently stays overnight is classified as an overnight stay or other in-patient case (source Eurostat metadata).
• In most Member States the administrative system does not allow to establish whether somebody was admitted as in-patient or day-case. In these instances in-patients dying on the day of admission may be counted as day-cases, inflating the figures for day-cases.
• Discharges by diagnosis refer to the principal diagnosis, i.e. the main condition diagnosed at the end of day treatment. The main condition is the one primarily responsible for the patient's need for treatment or investigation (source Eurostat metadata).
• Total hospital beds are all hospital beds which are regularly maintained and staffed and immediately available for the care of admitted patients. They include beds in all hospitals, including general hospitals (HP.1.1), mental health and substance abuse hospitals (HP.1.2), and other specialty hospitals (HP.1.3).
• Two different data sets for hospital discharges by diagnosis are available:
• For data from 2000 onwards: according to the International Classification for Hospital Morbidity Tabulation (ISHMT). This shortlist for statistical comparison of hospital activity analysis was adopted in 2005 by Eurostat, the OECD (Organisation for Economic Co-operation and Development) and the WHO-FIC (Family of International Classifications) Network.
• For data covering the period 1989-2002: according to a Eurostat shortlist of some 60 selective diseases based on ICD-10.
• The International Shortlist for Hospital Morbidity Tabulation (ISHMT) was developed by the Hospital Data Project (HDP).
• Data collection takes place in agreement with the World Health Organisation (WHO) and the Organization of Economic Co-operation and Development (OECD). Where applicable, common definitions and data specifications are used in the data collection. From 2010 data collection on health care non expenditure data is made jointly with the OECD and WHO-Europe for human and physical resources. This joint questionnaire might be extended to include procedures and hospital patients.

References

• Eurostat database: Hospital discharges by diagnosis (ISHMT), day cases, total number
• Eurostat database: Hospital discharges by diagnosis (ISHMT) and region, day cases, total number
• Eurostat metadata: Health care: resources and patients (non-expenditure data) Reference Metadata in Euro SDMX Metadata Structure (ESMS)
• Eurostat. Definitions and data collection specifications on health care statistics (non-expenditure data) Version 21 May 2008
• Eurostat/OECD/WHO international shortlist for hospital morbidity tabulation (ISHMT)
• Eurostat shortlist for hospital discharges (reference data 1989-2002)
• OECD Manual 'A system of Health Accounts' (2000)
• Hospital Data Project 2 (HDP2)
• Health Indicators in the European Regions (ISARE) project
• Eurostat OMC

Work to do

• Ask Eurostat to compute age-standardized rates. If these are available, ECHIM can consider skipping the breakdown by age group, as to limit the number of operationalizations.
• Only absolute numbers in Eurostat database. So rates need to be calculated, preferable using mid-year population as denominator (see documentation sheet for indicator 67. Hospital in-patient discharges, selected diagnoses). Ask Eurostat to provide rates.
• Definition provided by Eurostat for ‘day-case’ requires further explanation, in particular regarding the overlap with out-patients and regarding multiple (consecutive) admissions  Discuss this with Eurostat.
• Monitor developments Open Method of Coordination.