Concept: Level of Care (LOC) - In Hospital

Introduction

Level of care is a classification for hospitalizations according to type of care received. In Manitoba, there are eight categories of level of care that are reported in the Hospital Abstracts data:


1. Acute Care (Adult and Child)
2. Day Surgery (Adult and Child)
3. Rehabilitative Care
4. Chronic Care (Riverview Health Centre and Deer Lodge Centre only),
5. Psychiatric Facilities
6. Acute Care, Paediatric (Winnipeg Children's Hospital only)
7. Day Surgery, Paediatric (Winnipeg Children's Hospital only)
8. Provincially Defined (includes Grace Hospital, Hospice Unit).

NOTE 1: Level of care is collected as the second digit in the "Institution Number", "Institution From" and "Institution To" variables (Canadian Institute for Health Information, 2004).

NOTE 2: Alternate Level of Care (ALC) hospitalizations do not have their own level of care, but typically fall under acute care (prior to April 1, 2010, ALC was restricted to acute care hospitalizations, but after that date ALC was been expanded to include chronic care, psychiatric care and rehabilitation levels of care in the Hospital Abstract data.)

Alternative Level of Care Codes ( ALC)

The coding of ALC hospitalizations in the Hospital Discharge Abstract Data is done according to guidelines from CIHI, except for some patients in Winnipeg10. To be coded as ALC, the patient needs to be identified as ALC by the attending physician or their delegate and have an ALC status code for more than one day. A specific Patient Service code (99) is to be used, along with a diagnosis code from a specified range of Z codes in the ICD-10-CA system. In Manitoba, a specific ALC Reason Code should also be provided from the list developed by Manitoba Health.

For more information on Z Codes please see Glossary Term: Z Codes in Fransoo et Al. (2013).

Limitations

Although this does not mean that all patients who were truly ALC were coded as such, it does confirm that when a patient was identified as ALC, the appropriate codes were recorded in the data system. The question about whether all ALC patients were properly identified, and our attempts to address this issue, is discussed at the end of this chapter.

Some ALC hospitalizations (17%) were identified with an ALC Reason Code on the day of admission (i.e., admissions for respite care), but the majority of patients identified as ALC were admitted to hospital for services pertaining to acute care.

 

Diagnosis codes : all hospital patients receive at least one (and up to 25) diagnostic codes to indicate the health conditions the patient was identified as having. Some of these codes are closely linked to ALC patients, so we analyzed this overlap and identified a number of diagnostic codes which were highly associated with ALC codes. We labeled as Possible ALC patients who had not been coded as ALC, but who had received an ALC-related Z code.