The ministry collects patient outcome data for ST-segment elevation myocardial infarction (STEMI) and stroke patients as a measurement for land ambulance performance. The data below shows the survival rate for these patient cohorts, who are transported by ambulance to an emergency department.
ST-elevation myocardial infarction
ST-segment elevation myocardial infarction (STEMI) is a form of heart attack that can cause death if not treated quickly. footnote 1[1] A STEMI can be identified by a paramedic through evidence of myocardial damage visible on a 12-Lead ECG resulting in ST segment elevation. footnote 2[2]
STEMI Mortality Rate for Ambulance Patients for
Region Name
Number of Ambulance ED Visits
Risk-Adjusted 30-Day Mortality Ratio
%
Lower Confidence Limit
%
Upper Confidence Limit
%
Erie St. Clair
704
10.1%
7.9%
12.4%
South West
814
11.2%
9.1%
13.3%
Waterloo Wellington
320
12.9%
9.8%
16.0%
HNHB
1,307
8.2%
6.6%
9.8%
Central West
291
12.9%
9.4%
16.3%
Mississauga Halton
342
12.3%
9.4%
15.3%
Toronto Central
562
9.1%
6.6%
11.5%
Central
478
13.1%
10.7%
15.4%
Central East
711
12.5%
10.4%
14.6%
South East
495
9.3%
6.7%
11.9%
Champlain
627
9.3%
7.1%
11.5%
North Simcoe Muskoka
466
9.4%
6.6%
12.2%
North East
627
9.7%
7.3%
12.1%
North West
219
13.5%
9.5%
17.6%
Ontario
7,963
10.5%
9.8%
11.1%
Region Name
Number of Ambulance ED Visits
Risk-Adjusted 30-Day Mortality Ratio
%
Lower Confidence Limit
%
Upper Confidence Limit
%
Erie St. Clair
694
8.5%
6.1%
10.9%
South West
773
10.9%
8.7%
13.1%
Waterloo Wellington
338
14.2%
11.0%
17.4%
HNHB
1,301
8.4%
6.7%
10.0%
Central West
290
14.2%
10.6%
17.8%
Mississauga Halton
356
13.3%
10.3%
16.3%
Toronto Central
535
10.9%
8.4%
13.5%
Central
463
14.3%
11.9%
16.8%
Central East
709
13.4%
11.2%
15.6%
South East
511
10.7%
8.0%
13.3%
Champlain
614
10.4%
8.2%
12.7%
North Simcoe Muskoka
390
8.4%
5.3%
11.5%
North East
616
12.5%
9.9%
15.0%
North West
228
14.5%
10.3%
18.7%
Ontario
7,818
11.2%
10.5%
11.9%
Region Name
Number of Ambulance ED Visits
Risk-Adjusted 30-Day Mortality Ratio
%
Lower Confidence Limit
%
Upper Confidence Limit
%
Erie St. Clair
665
8.9%
7.4%
12.4%
South West
757
10.4%
8.8%
13.4%
Waterloo Wellington
307
16.6%
12.7%
19.4%
HNHB
1,292
9.4%
7.9%
11.3%
Central West
284
14.4%
11.4%
18.8%
Mississauga Halton
359
12.8%
8.4%
14.3%
Toronto Central
465
13.1%
9.6%
15.0%
Central
471
15.7%
10.7%
15.6%
Central East
682
13.5%
10.7%
15.2%
South East
516
13.2%
10.3%
15.6%
Champlain
597
11.2%
8.3%
13.0%
North Simcoe Muskoka
347
8.1%
5.2%
11.9%
North East
631
10.3%
8.8%
13.8%
North West
219
11.9%
8.5%
17.0%
Ontario
7,592
11.6%
10.9%
12.3%
Region Name
Number of Ambulance ED Visits
Risk-Adjusted 30-Day Mortality Ratio
%
Lower Confidence Limit
%
Upper Confidence Limit
%
Erie St. Clair
653
9.2%
6.7%
11.8%
South West
723
9.5%
7.3%
11.8%
Waterloo Wellington
319
17.2%
13.8%
20.6%
HNHB
1,379
9.4%
7.7%
11.0%
Central West
271
15.3%
11.6%
18.9%
Mississauga Halton
362
11.2%
8.3%
14.1%
Toronto Central
418
13.9%
11.2%
16.7%
Central
499
12.2%
9.7%
14.7%
Central East
646
12.9%
10.6%
15.2%
South East
508
12.9%
10.3%
15.5%
Champlain
591
11.8%
9.4%
14.1%
North Simcoe Muskoka
337
7.4%
4.0%
10.7%
North East
654
11.1%
8.6%
13.6%
North West
219
11.8%
7.5%
16.0%
Ontario
7,579
11.4%
10.7%
12.0%
Region Name
Number of Ambulance ED Visits
Risk-Adjusted 30-Day Mortality Ratio
%
Lower Confidence Limit
%
Upper Confidence Limit
%
Erie St. Clair
613
10.1%
7.6%
12.6%
South West
714
9.6%
7.4%
11.7%
Waterloo Wellington
312
17.0%
13.6%
20.4%
HNHB
1,436
9.1%
7.5%
10.7%
Central West
234
14.0%
10.2%
17.8%
Mississauga Halton
337
10.3%
7.1%
13.4%
Toronto Central
437
13.9%
11.1%
16.6%
Central
517
11.1%
8.7%
13.5%
Central East
624
11.7%
9.5%
13.9%
South East
484
11.0%
8.3%
13.7%
Champlain
603
10.0%
7.6%
12.3%
North Simcoe Muskoka
332
8.8%
5.6%
12.1%
North East
627
10.7%
8.3%
13.2%
North West
183
11.7%
7.2%
16.3%
Ontario
7,453
10.8%
10.1%
11.5%
Region Name
Number of Ambulance ED Visits
Risk-Adjusted 30-Day Mortality Ratio
%
Lower Confidence Limit
%
Upper Confidence Limit
%
Erie St. Clair
553
8.5%
5.9%
11.0%
South West
670
9.2%
7.1%
11.4%
Waterloo Wellington
331
16.1%
12.9%
19.3%
HNHB
1,541
9.1%
7.6%
10.7%
Central West
233
14.3%
10.5%
18.1%
Mississauga Halton
327
12.4%
9.2%
15.5%
Toronto Central
481
13.7%
11.2%
16.3%
Central
550
11.0%
8.6%
13.4%
Central East
616
10.7%
8.5%
12.9%
South East
473
8.5%
5.7%
11.2%
Champlain
664
9.3%
7.1%
11.5%
North Simcoe Muskoka
301
8.5%
5.1%
11.9%
North East
575
10.4%
7.9%
12.9%
North West
170
10.5%
5.9%
15.1%
Ontario
7,485
10.4%
9.7%
11.1%
Region Name
Number of Ambulance ED Visits
Risk-Adjusted 30-Day Mortality Ratio
%
Lower Confidence Limit
%
Upper Confidence Limit
%
Erie St. Clair
508
9.5%
6.8%
12.2%
South West
656
9.7%
7.5%
11.9%
Waterloo Wellington
353
13.7%
10.8%
16.6%
HNHB
1,600
8.7%
7.2%
10.1%
Central West
236
11.9%
8.0%
15.8%
Mississauga Halton
305
9.2%
6.0%
12.5%
Toronto Central
511
14.4%
12.0%
16.8%
Central
569
12.2%
9.9%
14.5%
Central East
649
11.4%
9.3%
13.6%
South East
451
6.4%
3.6%
9.2%
Champlain
681
9.4%
7.3%
11.5%
North Simcoe Muskoka
281
10.2%
6.7%
13.8%
North East
536
10.5%
7.9%
13.1%
North West
162
6.6%
1.9%
11.3%
Ontario
7,498
10.2%
9.6%
10.9%
Stroke
A stroke occurs when blood stops flowing to any part of your brain, damaging brain cells. The effects of a stroke depend on the part of the brain that was damaged, and the amount of damage done.footnote 3[3]
Stroke Mortality Rate for
Region Name
Number of Ambulance ED Visits
Risk-Adjusted 30-Day Mortality Ratio
%
Lower Confidence Limit
%
Upper Confidence Limit
%
Erie St. Clair
3,518
13.6%
12.5%
14.7%
South West
5,189
12.3%
11.4%
13.1%
Waterloo Wellington
3,214
14.0%
12.9%
15.2%
HNHB
7,032
13.3%
12.5%
14.0%
Central West
1,862
12.3%
10.9%
13.6%
Mississauga Halton
4,807
12.7%
11.8%
13.6%
Toronto Central
5,944
11.1%
10.4%
11.9%
Central
5,059
13.1%
12.3%
13.9%
Central East
6,151
12.9%
12.1%
13.7%
South East
3,209
12.5%
11.4%
13.7%
Champlain
5,775
13.6%
12.8%
14.4%
North Simcoe Muskoka
2,980
13.6%
12.4%
14.8%
North East
3,048
15.9%
14.6%
17.1%
North West
1,147
15.0%
13.0%
17.1%
Ontario
58,935
13.0%
12.8%
13.3%
Region Name
Number of Ambulance ED Visits
Risk-Adjusted 30-Day Mortality Ratio
%
Lower Confidence Limit
%
Upper Confidence Limit
%
Erie St. Clair
3,634
13.5%
12.4%
14.6%
South West
5,133
12.7%
11.9%
13.6%
Waterloo Wellington
3,323
13.9%
12.9%
15.0%
HNHB
7,092
13.0%
12.3%
13.8%
Central West
1,896
12.0%
10.6%
13.4%
Mississauga Halton
4,817
12.4%
11.5%
13.3%
Toronto Central
6,024
11.3%
10.6%
12.0%
Central
4,993
13.0%
12.2%
13.8%
Central East
6,067
12.5%
11.7%
13.3%
South East
3,119
11.9%
10.7%
13.1%
Champlain
5,835
13.4%
12.6%
14.3%
North Simcoe Muskoka
3,039
13.7%
12.6%
14.9%
North East
2,956
15.2%
13.9%
16.4%
North West
1,141
14.5%
12.5%
16.5%
Ontario
59,069
12.9%
12.6%
13.1%
Region Name
Number of Ambulance ED Visits
Risk-Adjusted 30-Day Mortality Ratio
%
Lower Confidence Limit
%
Upper Confidence Limit
%
Erie St. Clair
3,633
13.1%
12.3%
14.3%
South West
5,110
13.4%
12.9%
14.6%
Waterloo Wellington
3,378
14.7%
13.7%
15.9%
HNHB
7,101
13.6%
13.0%
14.4%
Central West
2,007
12.6%
10.9%
13.6%
Mississauga Halton
4,783
12.8%
11.5%
13.3%
Toronto Central
6,069
12.4%
10.1%
11.6%
Central
4,955
14.7%
12.1%
13.7%
Central East
6,053
12.6%
12.2%
13.8%
South East
3,017
11.3%
11.2%
13.6%
Champlain
5,892
12.5%
12.1%
13.8%
North Simcoe Muskoka
2,969
12.5%
12.6%
15.0%
North East
2,949
13.0%
13.7%
16.1%
North West
1,098
13.8%
13.5%
17.5%
Ontario
59,014
13.1%
12.8%
13.3%
Region Name
Number of Ambulance ED Visits
Risk-Adjusted 30-Day Mortality Ratio
%
Lower Confidence Limit
%
Upper Confidence Limit
%
Erie St. Clair
3,643
12.6%
11.6%
13.7%
South West
5,039
14.0%
13.1%
14.9%
Waterloo Wellington
3,451
14.8%
13.7%
15.9%
HNHB
7,142
13.7%
13.0%
14.4%
Central West
2,100
12.7%
11.3%
14.0%
Mississauga Halton
4,546
12.3%
11.4%
13.2%
Toronto Central
6,062
10.5%
9.8%
11.3%
Central
4,971
12.5%
11.7%
13.3%
Central East
6,068
13.2%
12.4%
14.0%
South East
2,904
12.7%
11.5%
13.9%
Champlain
5,948
12.7%
11.9%
13.5%
North Simcoe Muskoka
2,891
14.7%
13.5%
15.9%
North East
2,924
14.2%
13.0%
15.5%
North West
1,125
16.5%
14.5%
18.4%
Ontario
58,814
13.0%
12.8%
13.3%
Region Name
Number of Ambulance ED Visits
Risk-Adjusted 30-Day Mortality Ratio
%
Lower Confidence Limit
%
Upper Confidence Limit
%
Erie St. Clair
3,577
13.1%
12.1%
14.2%
South West
4,982
14.9%
14.0%
15.8%
Waterloo Wellington
3,419
15.2%
14.1%
16.3%
HNHB
7,063
14.2%
13.5%
15.0%
Central West
2,089
12.1%
10.8%
13.5%
Mississauga Halton
4,397
12.6%
11.7%
13.5%
Toronto Central
6,009
10.9%
10.2%
11.6%
Central
4,930
12.6%
11.8%
13.5%
Central East
6,033
13.8%
13.0%
14.6%
South East
2,805
14.4%
13.2%
15.6%
Champlain
5,779
12.7%
11.8%
13.5%
North Simcoe Muskoka
2,804
14.0%
12.8%
15.3%
North East
2,947
15.8%
14.6%
17.0%
North West
1,101
17.0%
15.0%
19.0%
Ontario
57,935
13.4%
13.2%
13.7%
Region Name
Number of Ambulance ED Visits
Risk-Adjusted 30-Day Mortality Ratio
%
Lower Confidence Limit
%
Upper Confidence Limit
%
Erie St. Clair
3,618
13.4%
12.3%
14.4%
South West
4,735
14.8%
13.9%
15.7%
Waterloo Wellington
3,337
15.9%
14.8%
17.0%
HNHB
6,958
13.8%
13.0%
14.5%
Central West
2,043
12.2%
10.8%
13.6%
Mississauga Halton
4,168
12.5%
11.6%
13.5%
Toronto Central
5,986
11.5%
10.8%
12.3%
Central
4,922
12.5%
11.6%
13.3%
Central East
5,959
13.7%
12.9%
14.5%
South East
2,742
14.9%
13.7%
16.2%
Champlain
5,600
13.0%
12.2%
13.9%
North Simcoe Muskoka
2,738
14.9%
13.6%
16.1%
North East
2,959
15.6%
14.4%
16.8%
North West
1,095
15.8%
13.7%
17.8%
Ontario
56,860
13.5%
13.3%
13.8%
Region Name
Number of Ambulance ED Visits
Risk-Adjusted 30-Day Mortality Ratio
%
Lower Confidence Limit
%
Upper Confidence Limit
%
Erie St. Clair
3,601
13.7%
12.6%
14.8%
South West
4,534
14.6%
13.6%
15.5%
Waterloo Wellington
3,129
14.7%
13.6%
15.9%
HNHB
6,761
13.4%
12.6%
14.2%
Central West
1,929
12.5%
11.1%
13.9%
Mississauga Halton
4,076
12.4%
11.5%
13.4%
Toronto Central
5,907
11.2%
10.4%
11.9%
Central
4,691
12.6%
11.7%
13.4%
Central East
5,686
14.0%
13.2%
14.9%
South East
2,698
16.0%
14.8%
17.3%
Champlain
5,262
12.7%
11.9%
13.6%
North Simcoe Muskoka
2,675
13.2%
12.0%
14.4%
North East
2,905
15.4%
14.1%
16.6%
North West
1,061
14.0%
12.0%
16.1%
Ontario
54,915
13.3%
13.1%
13.6%
Mortality rate
The mortality rate is created by linking STEMI and stroke cohort data to Health Analytics Branch’s internal death file. The death file uses several administrative databases (Discharge Abstract Database, National Ambulatory Care Reporting System, Ontario Mental Health Reporting System, Continuing Care Reporting System, OHIP Claims, and Registered Person Database) to determine Ontario residents’ date of death.
The 30-day mortality rate includes STEMI and stroke patients who died within 30 days from the ED registration date. STEMI and stroke mortality rate for ambulance patients by region is reported on a 3-fiscal year combined basis ending March 31st of the previous year.
Risk adjustment factors
When comparing outcomes across regions or over time, it is important to account for differences in patient characteristics. Risk adjustment is a method used to control for patient characteristics that may affect health care outcomes and improves comparability after the pre-existing influence of patient population is removed. Therefore, risk adjustment allows for fair comparison of performance between the populations in different regions. The selected risk factors for STEMI and stroke were identified based on a literature review, clinical evidence and expert group consultations using the principles of appropriateness, viability (for example, enough events) and data availability.
The risk adjustments for the STEMI 30-day mortality rate control for:
fiscal year
quarter
age
sex
Charlson Comorbidity Index
previous inpatient admissions
shock
diabetes with complications
congestive heart failure
cancer
cerebrovascular disease
renal failure
arrival by ambulance
The risk adjustments for the stroke 30-day mortality rate control for:
fiscal year
quarter
age
sex
Charlson Comorbidity Index
stroke type
previous inpatient admissions
atrial fibrillation
previous stroke/TIA
history of coronary artery disease
diabetes
peripheral vascular disease
hypertension and hyperlipidemia following an Emergency Department Visit for Stroke
Confidence limit
A confidence interval (CI) reflects the uncertainty surrounding the risk-adjusted mortality ratio. The narrower a CI, the more one can be confident in the value of the risk-adjusted mortality ratio. The data presented here shows a 95% confidence interval of the risk-adjusted mortality ratio.
Reporting period
Is based on three years of pooled data. The data is updated annually to show the previous 3 fiscal years.
