BOARD MEETING AGENDA Champlain Local

Transcription

BOARD MEETING AGENDA
Champlain Local Health Integration Network
January 28, 2015 – 1:00 p.m.
Champlain LHIN Office, 1900 City Park Drive, Suite 500, Ottawa ON
(See link on page 2 for directions)
Item
Topic
1
Call to Order
2
One Minute of Reflection / Silence
Document
Action
Time
2 min
Welcome & Introductions
3
Declaration of Conflict of Interest
4
Approval of Agenda & Consent Agenda
5
Consent Agenda:

6
D
1 min
1 min
x
D
2 min
x
D
30 min
x
I
20 min
G
30 min
Approval of Minutes: November 26, 2014 and January 14, 2015
STRATEGIC PRIORITIES
6.1
Performance Scorecard: Second Quarter
-Brian Schnarch, Director, System Performance and Analysis, Champlain LHIN
6.2
Update on Champlain Strategy to Prevent Falls in Seniors
-Christine Gagné-Rodger, Senior Integration Specialist, Champlain LHIN
-Wanda MacDonald, Chief Executive Officer, Pinecrest-Queensway Community Health Centre
-Jacqueline Roy, Program Manager, Ottawa Public Health
6.3
Generative Discussion: Falls Prevention
-Chantale LeClerc, Chief Executive Officer
Meet your Board Members – An opportunity for members of the public
to interact with Champlain LHIN Board Members
6.4
Update on Community Support Services Sector Alignment Strategy*
-Cal Martell, Senior Director, Health System Integration, Champlain LHIN
-Valerie Bishop-De Young, Executive Director, VHA Health & Home Support
20 min
x
I
30 min
Item
Topic
7
REPORTS
Document
Action
Time
I
15 min
7.1
Update on Health System Funding Reform
7.2
Governance Committee Report (meeting of January 14, 2015)
x
I
10 min
7.3
Community Nominations Committee Report
x
I
2 min
7.4
Acting Chair’s Verbal Report
I
5 min
7.5
CEO’s Report
D
5 min
8
-Maureen Taylor-Greenly, Senior Director, Health System Performance, Champlain LHIN
- Randy Reid, Committee Chair
- Alexa Brewer, Committee Chair
IN-CAMERA SESSION
Motion to move into a closed session:
THAT members attending this meeting move into a Closed Session pursuant to the following
exceptions of LHINS set out in s.9(5) of the Local Health Integration Act, 2006:”
X
Personal or public interest
To address the following items:
 To approve confidential minutes (November 26, 2014)
 To receive confidential information from the CEO’s monthly report
 To receive confidential information from the Acting Chair’s monthly report
9
D
I
I
CONCLUSION & MEETING EVALUATION
Legend:
G = Generative, D = Decision, I = Information
Directions: Champlain LHIN Office, 1900 City Park Drive, Ottawa
Participants requiring accessibility supports or special accommodation may contact [email protected] prior to
the meeting.
Public documents and presentations distributed will be available on our website
2
Performance Report for the Champlain LHIN Board
January 2015
Table of Contents
Page Number(s)
Section A
Executive Summary
A1-A2
Section B
Summary of Performance by Domain
B1
Section C
Overview Status of All Indicators
C1
Section D
Ministry LHIN Performance Agreement (MLPA) Indicator Trends
D1
Section E
Detailed Indicator Performance Report*
E1-E21
Timely Access to the Care Needed
Right Care, Right Place
High Quality, Safe and Effective Care
Champlain LHIN Organizational Health
Performance Indicator Refresh Schedule
E1-E6
E7-E11
E12-E15
E16-E19
E20-E21
Section F
Methodology
F1-F2
Section G
Acronyms
G1
* Includes indicators with updated data this quarter
Section A – Executive Summary
Background
Welcome to the second issue of the new Champlain LHIN Board quarterly report. This report provides a broad
overview of the LHIN’s system level outcomes in six domains:
 Timely Access to the Care Needed
 Right Care, Right Place
 Positive Healthcare Experience (this domain is under development and does not currently have indicators)
 High Quality, Safe and Effective Care
 Champlain LHIN Organizational Health
 Health System Fiscal Management and Value
A high level overview of the status and trend of each domain is shown on page B1. For a set of priority indicators, the
report provides performance information, describes related activities, risks and opportunities for further action. This
provides a comprehensive picture of how the LHIN is performing. Only indicators with new data since the Q1 report
are shown in section E. Some of the new indicators are being monitored and evaluated to identify the need for
potential future activities.
A French version of the full report is also available for this quarter.
Indicator Highlights
Overall, the Champlain LHIN is showing good performance on most of its timely access indicators. The domain score
continues to be green. The exceptions to this performance are MRI wait times and cardiac wait times. Specifically:
 Wait times for hip and knee surgeries are exceeding targets for the past 2 quarters and are nearing
provincial targets. We believe now that appropriate processes are in place to sustain these improvements.
These improvements were achieved despite a 35% increase in referrals through the Central Intake.
 Wait times for CT scans have dramatically improved over the past few quarters and we are now exceeding
our target. This is due to the regional approach to distributing referrals and because the hospitals have been
providing extra hours of operations from their global budgets.
 We continue to be challenged in meeting MRI wait times for low priority scans. All hospitals are meeting
efficiency targets in terms of the number of scans performed per hours therefore it appears our region may
have inadequate supply of imagers to meet the demand. The introduction of a new imager in Pembroke next
fall will assist to improve the wait time. There is opportunity to better leverage the capacity available in
Cornwall as well.
 The percentage of people having their cardiac bypass completed within the target has decreased this
quarter as a result of tackling a large number of individuals on the wait list. We expect performance on this
indicator to improve by the end of fiscal year, once the wait list has been reduced.
Right Care, Right Place and High Quality, Safe and Effective Care
The domain score for High Quality, Safe and Effective Care has improved this quarter from red to orange. The
domain score for Right Care, Right Place is still green.
Champlain Health Systems Performance and Accomplishments: January 2015
A1
Seniors
The Champlain LHIN is doing well on most seniors-related indicators. Initiatives such as Home First are
positively impacting performance. There is continued progress on patients in acute hospitals beds needing
other care (% ALC days).
Performance on two falls prevention indicators has improved since last quarter including both seniors in the
community and in an institutional setting; however we have not yet achieved our targets on these indicators.
Primary Health Care Services and Community Care
Primary care services indicators and care in the community are generally showing average performance
compared to the other LHINs in the province. Performance on readmissions for selected case mix groups
has improved significantly this quarter for the best performance the LHIN has had on this indicator. There
have been a number of initiatives implemented to improve performance.
Mental Health Services:
Performance on repeat emergency visits for substance abuse conditions and on repeat emergency visits for
mental health conditions has weakened from last quarter.
Organizationally, the Champlain LHIN is generally achieving its targets. Key risks have generally been mitigated to
the extent possible, with one key risk moving from partially to fully-mitigated. Next quarter, a new indicator will be
available related to the quality of the workplace from the staff perspective.
Health System Fiscal Management and Value
Because of reporting timelines, there is no new data available for this section. Detailed data is therefore, not provided
in Section E. New information will be available next quarter.
A2
Section B - Summary of Performance by Domain
8 of 8 indicators *
0 indicators *
4 of 8 indicators *
10 of 11 indicators *
5 of 7 indicators *
11 of 13 indicators *
2.60 to 3.00
2.20
1.80
1.40
1.00
to
to
to
to
2.59
2.19
1.79
1.39
Average score for the Domain Based on average of
indicators with available scores (Green status = 3
points, yellow = 2, red = 1)
Red/Yellow/Green coding is based on approved
targets.
*identifies the number of indicators contributing to the domain score for the most recent period
B1
Section C - Overview Status of All Indicators (indicator page number in brackets)
High Quality, Safe and Effective Care
1.1 Time in ER (Admitted Patients) * (E1)
1.2 Time in ER (Complex patients, Not Admitted) * (E1)
1.3 Time in ER (Uncomplicated - Not Admitted) * (E2)
1.4 Cancer Surgery Wait Time * (E2)
1.5 Cardiac By-Pass Surgery Wait Time * (E3)
(E3)
1.6 Cataract Surgery Wait Time *
1.7 Hip Replacement Wait Time * (E4)
1.8 Knee Replacement Wait Tme * (E4)
1.9 MRI Scan Wait Time * (E5)
1.10 CT Scan Wait Time * (E5)
1.11 Wait for Home Care (Community Clients) * (E6)
1.12 Adults With a Primary Care Provider
1.13 Timely (Same / Next Day) Access to a Primary Care Provider
4.1
4.2
4.3
4.4
4.5
4.6 Hospitalization Due to Falls Among Long-Term Care Residents *
4.7 Fall-Related Emergency Department Visit Rate Among Seniors *
4.8 Fall-Related Hospitalization Rate Among Seniors * (E15)
Patients in Acute Hospital Beds Needing Other Care (%ALC) * (E7)
Repeat Mental Health ED visitors * (E7)
Repeat Substance Abuse ED visitors * (E8)
High Priority Clients Receiving CCAC Care at Home * (E8)
Long Term Care Placements for Highest Priority Clients * (E9)
Admission to LTC Homes from Community * (E9)
Patients Designated ALC Who Were Discharged to Long Term Care Homes *
(E10)
2.8 ALC days Attributable to Palliative Care Patients * (E10)
2.9 Hospitalization Rate for Ambulatory Care Sensitive Conditions * (E11)
2.10 ER Visits for Conditions That Could be Treated in a Primary Care Setting. *
(E11)
2.11 French Language Services
(E14)
(E15)
Right Care, Right Place
2.1
2.2
2.3
2.4
2.5
2.6
2.7
Readmissions for Certain Chronic Conditions * (E12)
Early Elective Low-Risk Repeat C-Sections * (E13)
(E13)
Complex Care Hospital Patients with New Pressure Ulcers *
Long Term Care Residents with New Pressure Ulcers * (E14)
Physician visit within 7 days of discharge for patients with select conditions
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
Status of LHIN Annual Business Plan Initiatives *
LHIN Enterprise Risk Assessment *
(E17)
LHIN Operational Budget Variance * (E18)
LHIN Staff Turnover
Twitter Followers * (E18)
Champlain LHIN YouTube Views * (E19)
LHIN Employee Satisfaction
Website Traffic
6.1
6.2
6.3
6.4
6.5
6.6
6.7
Hospital Cost Efficiency
CCAC Home Care Cost Efficiency
Total Margin - Hospitals
Total Margin - CCAC
Total Margin - CHC Agencies
Total Margin - CSS Agencies
Total Margin - Mental Health and Addictions Agencies
(E16)
Health System Fiscal Management and Value
Positive Healthcare Experience
Positive Healthcare Experience indicators under development
Indicator meets the LHIN target for the
current quarter
Indicator is above baseline, but below
LHIN target for the current quarter
Indicator is below target and below
baseline for the current quarter
Indicator does not have a LHIN target
Indicator is under development
Red/Yellow/Green coding is based on approved
targets
* Updated this quarter with new inform ation in
section E. See page E20-21 for indicator refresh
schedule.
C1
Section D – Ministry LHIN Performance Agreement (MLPA) Trends
2013/14
PI No.
Performance Indicator (PI)
1: Access to healthcare services
Objective: To enhance person-centred care.
1
90th percentile ER length of stay for admitted patients1
2
90th percentile ER length of stay for non-admitted complex (CTAS I-III) patients 1
3
90th percentile ER length of stay for non-admitted minor uncomplicated (CTAS IV-V) patients 1
LHIN Starting
Provincial Point or Baseline
(2013/14 to
target
2014/15)
90th Percentile Wait Time for CCAC In-Home Services - Application from Community Setting to first CCAC
Service (excluding case management)2
3: Quality and improved health outcomes
Objective: To implement evidence-based practice to drive quality and value and improve health outcomes.
13
Readmission within 30 Days for Selected CMGs3
Q2
Q3
Q4
Q1
Q2
Q3
12-Aug-13 12-Nov-13 10- Feb-14 12-May-14 12-Aug-14 12-Nov-14
Rank
8 hours*
8 hours**
27.7
8.2
25.8
8.0
23.8
7.9
23.9
8.0
26.2
7.8
29.6
8.1
26.7
7.7
26.2
7.8
6
14
4 hours
4.9
4.5
4.6
4.5
4.4
4.8
4.5
4.7
14
93.0%
91.3%
94.0%
70.0%
67.0%
21.0%
61.0%
90.0%
90.0%
90.0%
80.0%
80.0%
50.0%
75.0%
95.3%
93.0%
90.8%
80.5%
77.8%
45.9%
54.5%
89.9%
89.0%
90.2%
80.6%
81.1%
52.8%
41.0%
92.4%
88.0%
90.4%
73.7%
77.9%
47.7%
51.6%
94.9%
61.0%
90.9%
77.4%
83.2%
43.4%
59.7%
97.4%
58.0%
91.3%
79.4%
88.6%
41.0%
81.4%
97.4%
41.0%
89.9%
84.2%
85.8%
38.4%
85.1%
5
9
11
8
6
7
6
14.2%
13.5%
14.2%
12.7%
13.8%
12.8%
13.0%
10.6%
4
TBD
127
66
138.0
103.0
78.0
81.0
57.0
56.0
12
TBD
16.5%
14.5%
17.6%
16.9%
17.3%
17.4%
16.8%
15.9%
6
90.0%
4
Percent of priority IV cases completed within access target (84 days) for cancer surgery 1
1
5
90.0%
Percent of priority IV cases completed within access target (90 days) for cardiac by-pass surgery
1
6
90.0%
Percent of priority IV cases completed within access target (182 days) for cataract surgery
1
7
90.0%
Percent of priority IV cases completed within access target (182 days) for hip replacement
8
90.0%
Percent of priority IV cases completed within access target (182 days) for knee replacement 1
1
9
90.0%
Percent of priority IV cases completed within access target (28 days) for MRI scans
1
10
90.0%
Percent of priority IV cases completed within access target (28 days) for CT scans
2: Integration and coordination of care
Objective: To improve system integration and enhance coordination of care while ensuring better transitions to various care settings.
11
9.5%
Percentage of Alternate Level of Care (ALC) Days - By LHIN of Institution2
12
LHIN Target
(2013/14 to
2014/15)
2014/15
14
Repeat Unscheduled Emergency Visits within 30 Days for Mental Health Conditions ‡2
TBD
17.7%
17.7%
17.5%
17.4%
19.0%
18.2%
15.7%
18.1%
9
15
Repeat Unscheduled Emergency Visits within 30 Days for Substance Abuse Conditions ‡2
TBD
25.9%
24.8%
27.3%
27.2%
27.1%
21.8%
22.5%
26.4%
10
‡ The methodology for these indicators has been revised starting 2013/14. Results may not be comparable to the previous Agreement.
* Indicator also has a provincial internal goal of 25 hours.
** Indicator also has a provincial internal goal of 7 hours.
*** New indicator for 2013/14. The MOHLTC and LHINs will monitor performance in 2013/14 and work together to refine quality and consistency of data. Targets will be established starting 2014/15.
Note: The reporting for indicators #4 to #10 has been revised starting 2013/14 therefore there were no targets for previous quarters and colour coding cannot be determined.
Previous Agreements included the 90th percentile wait times for these surgical and diagnostic imaging services.
The methodology for indicator #12 for Q1 2013/14 was revised as follows to align with Health Quality Ontario: excludes first services that were respite (15); placement (14) or other (99). In addition the first service record must now be coded with
These new criteritions had a minimal effect on the 90th percentile - 50% of the LHINs had no change, the other 50% had on average between 1 - 2 day difference. Overall an additional 0.3% of clients were excluded compared to the previous
methodology. The previous quarters have been updated with the most recent data and using the revised methodology for trending purposes.
Notes (Refers to 12-Nov-14 data only)
1 Q2 2014/15 Data (Jul, Aug, Sep 2014/15 Data)
2 Q1 2014/15 Data (Apr, May, Jun 2014/15 Data)
3 Q4 2014/15 (Jan, Feb, Mar 2013/14 Data)
The LHIN result has met its target
The LHIN does not meet the target for this indicator but has improved from
The LHIN does not meet the target for this indicator and has not improved from
Note: Color coding for previous quarters has been updated to match the methodology beng used as
of 2013/14, so may not match color coding released previously.
D1
(Indicators with updated data this quarter)
January 2015
TIMELY ACCESS TO THE CARE NEEDED
MLPA
1.1 T ime in ER (Admitted Patients)
Prov Target (8.0)
Lower Values are Better
30
LHIN Target
25.8
Hours
Q2 - 14-15
27.5
26.2
25
Baseline - 27.7
22.5
Prov Target - 8.0
Q3
12-13
Q4
12-13
Trend
Rank - 6
Q1
13-14
LHIN Target
Q2
13-14
Q3
13-14
Provincial Target
Q4
13-14
Q1
14-15
Baseline
LHIN
Q2
14-15
ONT
WW
ESC
SW
TC
NSM
CHP
SE
CE
C
NW
HNHB
NE
CW
MH
2 7 .4
1 2 .6
0
10
2 3 .3
2 3 .5
2 4 .3
2 5 .5
2 6 .2
2 7 .3
2 7 .6
2 8 .4
2 8 .9
3 0 .5
3 0 .7
3 2 .3
3 3 .6
20
30
Hours
Notes: 90th percentile: 90 out of 100 high urgency cases were completed in less time. Seasonal indicator, best performance expected in Q1 and
Q2.
Indicator Technical Description
Although performance has not quite achieved the LHIN target, performance improved slightly in the second quarter and is
better than baseline.
Hospitals continue to emphasize their successful strategies related to the "Pay-for-Results" program, ensuring that processes
are optimized to minimize waiting.
System level initiatives such as those that address the needs of high risk seniors, the timely repatriation of patients to their
'home' hospitals and institutions and strategies to ensure people are cared for in the most appropriate setting also continue.
Those initiatives are described in more detail under indicator 2.1.
MLPA
1.2 T ime in ER (Complex patients, Not Admitted)
Prov Target (8.0)
LHIN Target
8.0
8.2
Hours
Q2 - 14-15
8
Baseline - 8.2
7.8
Prov Target - 8.0
7.6
Rank - 14
7.8
Q2
12-13
Q3
12-13
Trend
Q4
12-13
LHIN Target
Q2
13-14
Q3
13-14
Provincial Target
Q4
13-14
Q1
14-15
Baseline
LHIN
Q2
14-15
ONT
NE
CE
MH
WW
NSM
SW
C
NW
ESC
SE
CW
HNHB
TC
CHP
6 .8
5 .7
0
6
6 .1
6 .2
6 .3
6 .3
6 .5
6 .7
6 .8
6 .8
7 .1
7 .2
7 .7
7 .8
5
7.5
2.5
Hours
Q2.
The Champlain LHIN continues to achieve the target and is better than the baseline in this quarter.
Hospitals continue to emphasize successful Pay-for-Results initiatives such as Rapid Assessment Zones and "LEAN" initiatives
to ensure that processes are efficient and optimized.
E1
MLPA
1.3 T ime in ER (Uncomplicated - Not Admitted)
Prov Target (4.0)
LHIN Target
4.5
4.8
Q2 - 14-15
Hours
4.7
4.6
Baseline - 4.9
4.4
Prov Target - 4.0
4.2
Q3
12-13
Q4
12-13
Trend
Rank - 14
Q1
13-14
LHIN Target
Q2
13-14
Q3
13-14
Provincial Target
Q4
13-14
Q1
14-15
Baseline
LHIN
Q2
14-15
ONT
C
CW
SW
MH
CE
NSM
WW
NW
NE
ESC
TC
HNHB
SE
CHP
4 .1
3 .5
3 .5
3 .6
3 .6
0
4
4 .1
4 .1
4 .1
4 .1
4 .1
4 .3
4 .4
4 .4
4 .7
4
2
Hours
Q2.
In this quarter the Champlain LHIN is better than the baseline but has not quite achieved the target.
Hospitals continue their efforts to maximize the impact of Fast Track Zones to decrease length of stay.
The LHIN continues to work with our counterparts in the Outaouis, the Ministry of Health, Provincial Physician Leads and
Champlain hospitals to address the significant volumes of patients from Quebec that are seen in Champlain emergency
rooms.
Other system level initiatives that impact this indicator include those that target emergency department visits for conditions
that could be treated in primary care and the Health Links strategy aimed at coordinating care for patients with high needs.
MLPA
1.4 Cancer Surgery Wait T ime
Prov Target (90.0)
Higher Values are Better
97.5
97.4
LHIN Target
90.0
Q2 - 14-15
%
95
Baseline - 93.0
Prov Target - 90.0
92.5
90
87.5
Rank - 5
Q3
12-13
Trend
Q4
12-13
Q1
13-14
LHIN Target
Q2
13-14
Q3
13-14
Provincial Target
Q4
13-14
Q1
14-15
Baseline
LHIN
Q2
14-15
ONT
C
SE
WW
ESC
CHP
NSM
CE
NW
MH
TC
CW
SW
HNHB
NE
0
25
50
9 4 .2
9 9 .3
9 8 .4
9 7 .8
9 7 .7
9 7 .4
9 7 .2
9 6 .4
9 5 .8
9 5 .6
9 4 .7
9 3 .9
8 9 .9
8 5 .4
7 9 .3
75
100
%
Notes: % cases completed within provincial access target (84 days)
The Champlain LHIN continues to meet and exceed the 90% provincial target for completing priority IV cancer surgery within
84 days.
We continue to monitor wait times and collaborate with Cancer Care Ontario and the Regional Cancer Program Care in local
planning and performance management. Together, we monitor the individual performance of our individual providers.
E2
MLPA
1.5 Cardiac By-Pass Surgery Wait T ime
Prov Target (90.0)
LHIN Target
90.0
ONT
80
92
HNHB
100
NE
100
SE
100
WW
100
SW
99
%
Q2 - 14-15
60
41
40
Baseline - 91.3
20
Prov Target - 90.0
Q3
12-13
Q4
12-13
Q1
13-14
Q2
13-14
Q3
13-14
Q4
13-14
Q1
14-15
Q2
14-15
TC
99
C
98
MH
85
CHP
Trend
Rank - 9
LHIN Target
Provincial Target
Baseline
41
LHIN
0
25
50
75
100
%
Notes: % cases completed within provincial access target (90 days). Only University of Ottawa Heart Institute performs this procedure , therefore
no hospital level data presented.
Cardiac care services are delivered locally through the University of Ottawa Heart Institute (UOHI). The UOHI reports that
their critical care work load (e.g. heart transplants), involving the patients with the most urgent needs, is impacting wait
times for elective surgery and access to cardiac intensive care unit (ICU) beds. Following meetings with the Champlain LHIN,
UOHI developed a plan to address the wait list for cardiac bypass, including additional surgical time on weekends, additional
surgical slots on weekdays for Coronary Artery Bypass Graft Surgery and additional ICU cardiac beds. Implementation of the
changes took place late in Q2 of this fiscal year and preliminary internal data show a positive impact on cardiac bypass wait
time. An improvement in cardiac bypass wait times is expected later this fiscal year as the effect of the changes have the
desired results.
MLPA
1.6 Cataract Surgery Wait T ime
Prov Target (90.0)
93
LHIN Target
90.0
92
%
Q2 - 14-15
91
Baseline - 94.0
90
Prov Target - 90.0
89
Rank - 11
89.9
Q3
12-13
Q4
12-13
Trend
Q1
13-14
LHIN Target
Q2
13-14
Q3
13-14
Provincial Target
Q4
13-14
Baseline
Q1
14-15
LHIN
Q2
14-15
ONT
C
ESC
CE
MH
NSM
WW
NW
SE
NE
TC
CHP
CW
SW
HNHB
0
25
50
93
9 9 .6
9 9 .1
98
9 7 .9
96
95
9 4 .8
9 3 .8
9 0 .6
8 9 .9
8 9 .9
8 9 .7
8 9 .2
8 7 .1
75
100
%
The performance indicator for cataract surgery just missed its target in Q2 of 2014-15, after being consistently been above
the 90% provincial target for completing priority IV cataract surgeries within 182 days over the past year. The Champlain
LHIN will follow-up with providers to ensure that performance is maintained.
E3
MLPA
1.7 Hip Replacement Wait T ime
Prov Target (90.0)
84.2
LHIN Target
80.0
Q2 - 14-15
%
80
75
Baseline - 70.0
70
Prov Target - 90.0
Q3
12-13
Q4
12-13
Trend
Rank - 8
Q1
13-14
LHIN Target
Q2
13-14
Q3
13-14
Provincial Target
Q4
13-14
Q1
14-15
Baseline
LHIN
Q2
14-15
ONT
CE
MH
C
TC
NSM
WW
ESC
CHP
HNHB
SW
NW
NE
CW
SE
8 6 .7
9 9 .1
9 8 .4
9 4 .9
9 3 .8
9 1 .5
8 5 .7
8 4 .8
8 4 .2
8 3 .1
7 9 .5
7 1 .9
7 1 .8
0
4 7 .2
4 0 .6
25
50
75
100
%
Wait times for hip replacement continue to improve in Champlain. The second quarter results exceed the 80% LHIN target.
All patients are now assessed through the central intake process and given the opportunity to choose the surgeon with the
shortest wait time.
This has resulted in more equal distribution of patients between surgeons and therefore more even wait times.
It is noteworthy that wait times continue to improve, despite a 35% increase in referrals to the Central Intake and
Assessment Centre.
MLPA
1.8 Knee Replacement Wait T me
Prov Target (90.0)
LHIN Target
80.0
85.8
Q2 - 14-15
%
80
70
Baseline - 67.0
Prov Target - 90.0
60
Rank - 6
Q3
12-13
Q4
12-13
Trend
Q1
13-14
LHIN Target
Q2
13-14
Q3
13-14
Provincial Target
Q4
13-14
Baseline
Q1
14-15
Q2
14-15
LHIN
ONT
CE
C
TC
NSM
SE
CHP
WW
SW
MH
HNHB
ESC
NE
NW
CW
8 4 .7
9 5 .5
9 5 .1
9 4 .6
9 0 .8
8 6 .6
8 5 .8
8 4 .9
8 4 .5
8 2 .3
7 8 .1
7 7 .7
7 0 .2
6 1 .3
0
3 9 .2
25
50
75
100
%
Wait times for knee replacement surgery continues to exceed the 80% LHIN target.
All patients are now assessed through the central intake process allowing more equal distribution between surgeons. Patients
are given the opportunity to choose the surgeon with the shortest wait time.
Of note is that wait time 2 (time from decision to treat to date of surgery) continues to improve, despite a 35% increase in
referrals to the Central Intake and Assessment Centre.
E4
MLPA
1.9 MRI Scan Wait T ime
LHIN Target
50.0
50
Q2 - 14-15
40
%
38.4
Baseline - 21.0
30
Prov Target - 90.0
20
Q3
12-13
Q4
12-13
Trend
Rank - 7
Q1
13-14
LHIN Target
Q2
13-14
Q3
13-14
Provincial Target
Q4
13-14
Baseline
Q1
14-15
Q2
14-15
LHIN
ONT
3 4 .9
SE
5 3 .4
NE
4 8 .8
TC
4 7 .7
NW
4 3 .6
HNHB
3 9 .2
CE
3 8 .5
CHP
3 8 .4
C
3 4 .4
WW
2 9 .9
ESC
2 9 .8
SW
2 7 .2
MH
2 3 .2
1 6 .1
CW
NSM 1 0 .5
0
20
40
%
In the second quarter of fiscal 2014-2015, a site shut down one of its two MRI machines while a higher resolution machine
was put in. As a result of the downtime, there was a limited in (delete ) this limited the number of patients that could be
taken from long wait time sites. Other shorter wait time sites continued to receive patients from long wait time sites, partially
mitigating the problem.
High demand continued be an issue throughout the summer. MRI throughput efficiency continues to be good relative to the
provincial averages. Some sites have increased their hours of operation using their own global funds to help alleviate the long
wait time in the LHIN.
Pembroke will have a new MRI machine available in the Fall of 2015. This will help serve patients in the Pembroke and Deep
River area and dramatically reduce the inconvenience of long trips into Ottawa to obtain service.
There may be an opportunity to increase referrals from other sites to Cornwall which became operational last year.
MLPA
1.10 CT Scan Wait T ime
Prov Target (90.0)
85.1
LHIN Target
75.0
80
Q2 - 14-15
%
60
Baseline - 61.0
40
Prov Target - 90.0
20
Rank - 6
Q3
12-13
Q4
12-13
Trend
Q1
13-14
LHIN Target
Q2
13-14
Q3
13-14
Provincial Target
Q4
13-14
Baseline
Q1
14-15
LHIN
Q2
14-15
ONT
SE
CE
ESC
C
CW
CHP
HNHB
SW
NE
WW
NW
NSM
TC
MH
7 9 .7
0
9 6 .1
9 5 .6
9 4 .8
92
9 0 .6
8 5 .1
79
7 8 .2
7 2 .1
6 5 .1
6 4 .5
5 7 .2
5 6 .1
5 1 .4
25
50
75
100
%
Performance on CT scan wait times continues to improve and exceeds the LHIN target. Implementation of a series of tactics
designed to improve wait time performance continues to be successful.
Strategies included: 1)a data reporting clean-up, 2) increased weekend shifts or weekday hours of service, 3)transferring
patients to sites with shorter CT wait times,
We will continue to monitor results as this work continues and will adjust strategies as necessary.
E5
MLPA
1.11 Wait for Home Care (Community Clients)
150
LHIN Target
66.0
Q2 - 14-15
Days
125
100
Baseline - 127.0
75
Prov Target - 90.0
50
56
Rank - 12
Q3
12-13
Trend
Q4
12-13
Q1
13-14
LHIN Target
Q2
13-14
Q3
13-14
Provincial Target
Q4
13-14
Q1
14-15
Baseline
LHIN
Q2
14-15
ONT
WW
CW
ESC
SE
CE
HNHB
SW
TC
C
MH
NW
CHP
NE
NSM
28
11
15
19
21
22
22
22
25
27
32
42
56
64
64
0
25
50
Hours
Notes: 90th percentile: 90 out of 100 clients received service within less time. CCAC data. No drill down to hospital level data.
This indicator has significantly improved over the last year. Targeted efforts have gone into increasing the efficiency of intake,
including scheduling follow up calls for non-urgent community referrals and triaging all incoming referrals. There is a high
demand for services and the Champlain LHIN is currently monitoring the wait list for services to mitigate the impact on this
indicator. Targeted funding to CCAC to support wait list reduction strategies is being implemented this fiscal year. For
additional information see indicator 2.4 High Priority Clients Receiving CCAC Care at Home.
E6
RIGHT CARE, RIGHT PLACE
MLPA
2.1 Patients in Acute Hospital Beds Needing Other Care (%ALC)
Prov Target (9.5)
14
LHIN Target
13.5
Q1 - 14-15
%
13
Baseline - 14.2
12
11
10.6
10
Prov Target - 9.5
Q2
12-13
Q3
12-13
Trend
Rank - 4
Q4
12-13
LHIN Target
Q1
13-14
Q2
13-14
Provincial Target
Q3
13-14
Q4
13-14
Baseline
LHIN
Q1
14-15
ONT
CW
SW
TC
CHP
MH
WW
SE
C
CE
ESC
HNHB
NW
NE
NSM
1 3 .6
7
8 .3
10
1 0 .6
11
12
1 2 .2
1 3 .8
1 4 .7
1 6 .6
1 7 .5
2 1 .3
2 1 .3
2 6 .1
0
10
20
%
Notes:
The Champlain LHIN has significantly improved its performance and has surpassed its LHIN target. During this quarter, the
LHIN met with hospitals and the Champlain CCAC to mitigate the challenge of high hospital bed occupancy. The Home First
initiative has effectively reduced the number of hospital days that patients spend in acute care beds waiting for other care, by
encouraging patients and staff to make home the first destination for patients after stays in hospitals. This quarter, the
Champlain CCAC helped by providing Enhanced Services to 251 clients with high needs after they left the hospital.
A Regional Steering Committee worked to optimize use of our recently expanded Convalescent Care program. Strategies were
identified to improve use of additional beds, resulting in higher than anticipated program occupancy this quarter. Additional
work is underway to address the needs of patients with the longest waits in acute care hospital beds (40 days or more) for
other services, including a program dedicated to meeting the needs of long-wait patients who have behavioural issues.
MLPA
2.2 Repeat Mental Health ED visitors
No Prov target
19
LHIN Target
17.7
Q1 - 14-15
18.1
%
18
17
Baseline - 17.7
16
Prov Target - None
15
Rank - 9
Q2
12-13
Q3
12-13
Trend
Q4
12-13
LHIN Target
Q1
13-14
Q2
13-14
Provincial Target
Q3
13-14
Baseline
Q4
13-14
LHIN
Q1
14-15
ONT
WW
MH
NSM
NW
NE
SW
ESC
C
CHP
CE
HNHB
CW
SE
TC
1 9 .4
1 3 .5
1 5 .1
1 5 .2
1 5 .5
1 6 .2
1 6 .4
17
1 7 .5
1 8 .1
1 8 .8
1 9 .3
0
2 4 .1
2 4 .5
2 6 .9
20
10
%
Notes: Results delayed as data from the subsequent quarter is needed to identify repeat visits up to 30 days later
The proportion of people making a second mental health related emergency department visit within 30 days of the first
increased (worsened) in the most recent quarter. During the first quarter of 2014-15, the number of visitors to the
emergency room for mental health conditions increased by 12% and the number of repeat visitors increased by 30%,
compared to the previous quarter. This is the highest number of repeat visitors in the last four reported quarters (525) and
the highest number of initial visits as well (3,193). The same trends are seen across the province. New services were
deployed during the reporting period to improve this indicator in the next reporting periods once they are at full capacity.
These are:
• New transitional case management and access coordination focused at the hospital point of care (270 clients)
• Expanding peer and family support (1,250 clients)
• Expanding the Quick Response Treatment Program (Hawkesbury, 150 clients), and;
• Piloting single session walk-in counselling for individuals considering a visit to the emergency room (1,200 clients).
E7
MLPA
2.3 Repeat Substance Abuse ED visitors
No Prov target
LHIN Target
24.8
26.4
26
%
Q1 - 14-15
24
Baseline - 25.9
22
Prov Target - None
20
Q2
12-13
Q3
12-13
Trend
Rank - 10
Q4
12-13
LHIN Target
Q1
13-14
Q2
13-14
Provincial Target
Q3
13-14
Baseline
Q4
13-14
Q1
14-15
LHIN
ONT
SW
NSM
SE
CE
WW
MH
C
NE
ESC
CHP
CW
HNHB
NW
TC
3 0 .2
2 1 .6
2 1 .9
2 2 .6
2 3 .2
2 3 .7
24
2 4 .6
2 5 .7
2 5 .9
2 6 .4
2 6 .8
2 8 .5
3 4 .7
0
20
4 1 .1
40
%
Notes: Results delayed as data from the subsequent quarter is needed to identify repeat visits up to 30 days later
The proportion of people making a second substance abuse related emergency department visit within 30 days of the first
increased (worsened) in the most recent quarter.
During the first quarter of 2014-15,164 individuals visited our Emergency Departments more than once within thirty days for
a substance abuse issue. This represents a 30% increase in the number of repeat visitors over the previous reported period.
The total number of emergency room visitors with a substance abuse problem also increased by 14% to 964. The same
trends were seen across the province.
New community withdrawal management services have been deployed across Champlain during the reporting period that are
intended to have an impact on this indicator in the next reporting periods, once they are at full capacity.
SAA
2.4 High Priority Clients Receiving CCAC Care at Home
No Prov target
Higher values are Better
6,500
LHIN Target
5685.6
Q2 - 14-15
6,407
Clients
6,000
5,500
Baseline - 5677.0
5,000
Prov Target - None
4,500
Rank - N/A
Q3
12-13
Trend
Q4
12-13
Q1
13-14
LHIN Target
Q2
13-14
Q3
13-14
Provincial Target
Q4
13-14
Q1
14-15
Baseline
LHIN
Q2
14-15
CE
C
HNHB
CHP
SW
TC
MH
NE
WW
SE
NSM
ESC
CW
NW
8 ,8 1 6
8 ,6 7 6
6 ,7 1 1
6 ,4 0 7
5 ,6 8 4
5 ,2 1 8
3 ,9 1 9
3 ,5 6 1
3 ,0 2 1
2 ,9 3 3
2 ,6 5 2
2 ,5 7 0
2 ,4 6 5
1 ,3 8 9
0k
2.5k
5k
7.5k
Clients
Notes: No Rank. Result is a function of LHIN size. Ontario total not shown due to scale issues.
The Champlain CCAC continues to have one of the highest acuity levels in the province in 2013-14 with over 50% of the
clients categorized as high or very high needs. CCAC’s ability to increase services through programs such as home first and
stay at home has resulted in an increase in the acuity of clients cared for in the community.
E8
SAA
2.5 Long T erm Care Placements for Highest Priority Clients
No Prov target
Higher values are Better
LHIN Target
82.0
82
82
%
Q2 - 14-15
80
Baseline - 80.3
78
Prov Target - None
76
Q3
12-13
Q4
12-13
Trend
Rank - 6
Q1
13-14
LHIN Target
Q2
13-14
Q3
13-14
Provincial Target
Q4
13-14
Baseline
Q1
14-15
Q2
14-15
LHIN
ONT
SW
C
CE
WW
NE
CHP
MH
NSM
CW
ESC
TC
HNHB
NW
SE
83
0
25
50
91
88
86
86
84
82
82
82
80
80
80
79
79
77
75
%
Notes:
Champlain has improved from its baseline and is close to achieving its target of 84.6%. Champlain continues to place higher
acuity clients that have high to very high MAPLe scores to Long-term Care. Through the implementation of home first, more
clients have been able to remain in their homes for longer periods of time. As a result of this program, when clients are
placed in long-term care homes, they have higher needs (higher MAPLe score).
IHSP
2.6 Admission to LT C Homes from Community
80
LHIN Target
72.8
79
Q1 - 14-15
%
60
No comparison LHIN data to display
Baseline - 72.8
40
Prov Target - None
20
Rank - N/A
Q2
12-13
Q3
12-13
Trend
Q4
12-13
LHIN Target
Q1
13-14
Q2
13-14
Provincial Target
Q3
13-14
Baseline
Q4
13-14
Q1
14-15
LHIN
Notes:
It is preferable for people needing Long Term Care placement to access those services directly from the community rather
than through the hospital. This supports patients/clients and helps avoid potentially unnecessary or inappropriate time spent
in hospital waiting for alternate level of care. Strong performance on this indicator is, in large part, due to the strengthened
Home First philosophy in the region. The approach makes it possible for clients, their families and their caregivers to
thoughtfully assess the need for Long Term Care from comfort and familiarity of their home.
E9
IHSP
2.7 Patients Designated ALC Who Were Discharged to Long T erm Care Homes
17.5
LHIN Target
9.2
Q1 - 14-15
%
15
12.5
Baseline - 11.7
10.8
10
Prov Target - None
Q2
12-13
Q3
12-13
Trend
Rank - 8
Q4
12-13
LHIN Target
Q1
13-14
Q2
13-14
Provincial Target
Q3
13-14
Q4
13-14
Baseline
LHIN
Q1
14-15
No Prov target
ONT
1 0 .5
WW 0 .8
C 5 .3
TC
6 .9
CW
7 .5
ESC
7 .5
MH
9
HNHB
9 .2
CHP
1 0 .8
NSM
1 1 .1
NW
1 5 .2
NE
1 5 .4
SE
2 2 .1
2 3 .3
SW
2 4 .7
CE
0
10
20
%
Notes:
The proportion of patients designated ALC discharge to long-term care homes continues to improve as the Home First
approach is sustained throughout the Champlain region. The shift in philosophy persistently benefits patients and health
providers as this approach enables patients to remain independent in their own homes and communities, instead of relying
on admissions to long-term care as the primary option. In this quarter, Enhanced Services provided by Champlain CCAC to
patients with high acuity continuously allows them to be transitioned from acute hospitals to be cared for at home,
supporting the Home First philosophy. In this period, Champlain CCAC provided Enhanced Services to 241 clients leaving
Champlain’s hospitals.
IHSP
2.8 ALC days Attributable to Palliative Care Patients
4
LHIN Target
2.1
Q1 - 14-15
%
3
Baseline - 2.1
2
1.3
Prov Target - None
1
Rank - 3
Q2
12-13
Q3
12-13
Trend
Q4
12-13
LHIN Target
Q1
13-14
Q2
13-14
Provincial Target
Q3
13-14
Baseline
Q4
13-14
LHIN
Q1
14-15
No Prov target
ONT
3 .7
CW 0
SW 0 .7
CHP
1 .3
NE
2 .3
SE
2 .4
MH
2 .4
NW
2 .6
NSM
2 .8
CE
2 .8
C
4 .1
ESC
4 .9
HNHB
5
6 .2
TC
WW
0
2.5
5
8 .7
7.5
%
Notes:
Performance on this indicator continues to improve as the Champlain LHIN works with the regional program and our parters
to better coordinate palliative care services in the region.
An integrated Regional Palliative Consult Team was fully implemented in Q4 2013/14. This team supports primary care
physicians to provide palliative care to their own clients in the community and is expected to influence hospital usage for
patients who are palliative.
Lastly, the LHIN and Champlain Hospice Palliative Care Program continue to work with stakeholders across Champlain to
enhance community-based hospice palliative care services to support individuals and their families during an illness, death
and bereavement in their place of choice.
E10
IHSP
2.9 Hospitalization Rate for Ambulatory Care Sensitive Conditions
No Prov target
65
Q1 - 14-15
per 100,000
LHIN Target
60.0
Baseline - 60.0
60
59
55
50
Prov Target - None
Q2
12-13
Q3
12-13
Trend
Rank - 3 (tied)
Q4
12-13
LHIN Target
Q1
13-14
Q2
13-14
Provincial Target
Q3
13-14
Baseline
Q4
13-14
Q1
14-15
LHIN
ONT
C
MH
CE
CHP
TC
WW
NSM
CW
ESC
HNHB
SW
SE
NE
65
3 8 .7
46
59
59
5 9 .8
6 4 .7
6 7 .2
6 7 .3
7 4 .6
7 5 .7
8 1 .9
8 6 .9
0
1 2 1 .1
100
50
per 100,000
Notes: Age standardized rate per 100,000 population aged 74 years and younger. NW LHIN is excluded due to incomplete data. LHIN rank is out
of 13
The hospitalization rate for ambulatory care sensitive conditions (conditions that could be potentially treated in the
community by a primary care provider) is better than the provincial average. The LHIN is working with health service
providers, and patient and caregiver representatives, to establish ten Health Links in our region to enhance coordination of
care, and access to primary care and other services for patients with the highest complexity and service use. The LHIN has
just received Ministry approval for 2 Readiness Assessments and 4 Business Plans, and is awaiting approval of 2 additional
Readiness Assessments.
Other projects to lower hospitalization rates for clients with chronic disease include: Demonstration Projects for Medically
Complex Patients in Hawkesbury and central Ottawa; the Champlain Quality Care Practice Facilitation Program which
supports improvements in primary care; and investments to expand pulmonary rehabilitation and cardiac rehabilitation
services across the region.
IHSP
2.10 ER Visits for Conditions T hat Could be T reated in a Primary Care Setting.
No Prov target
LHIN Target
5.7
7
per 1000
Q1 - 14-15
6
Baseline - 5.7
5
Prov Target - None
4
Rank - 7
5
Q2
12-13
Q3
12-13
Trend
Q4
12-13
LHIN Target
Q1
13-14
Q2
13-14
Provincial Target
Q3
13-14
Baseline
Q4
13-14
LHIN
Q1
14-15
ONT
CW
C
MH
TC
WW
CE
CHP
HNHB
ESC
NSM
SE
SW
NE
5 .8
1 .3
1 .6
1 .6
1 .8
3
3 .3
5
6
6 .9
8 .9
1 0 .3
0
5
1 2 .4
1 3 .5
10
per 1,000
Notes: NW LHIN is not shown due to incomplete data.
The Champlain LHIN continues to monitor this indicator. As the Champlain Health Links continue to develop and begin to
identify their patients, improvements are expected as a result of improved coordination of care.
The Champlain LHIN also continues to support primary care initiatives such as working with the Primary Care Lead to support
regional Primary Care Networks, supporting Primary Care Outreach to frail seniors and improving access to primary care
supports through Community Health Centers.
E11
HIGH QUALITY, SAFE AND EFFECTIVE CARE
MLPA
4.1 Readmissions for Certain Chronic Conditions
No Prov target
17.5
LHIN Target
14.5
Q4 - 13-14
%
17
Baseline - 16.0
Prov Target - None
16.5
16
15.5
Rank - 6
15.9
Q1
12-13
Trend
Q2
12-13
Q3
12-13
LHIN Target
Q4
12-13
Q1
13-14
Provincial Target
Q2
13-14
Q3
13-14
Baseline
LHIN
Q4
13-14
ONT
NSM
NW
WW
CE
MH
CHP
C
HNHB
ESC
CW
SW
NE
SE
TC
0
5
1 6 .3
14
14
1 4 .3
1 4 .9
1 5 .3
1 5 .9
16
1 6 .1
1 6 .4
1 6 .6
1 6 .8
1 7 .3
1 7 .8
1 9 .6
10
15
20
%
Notes: Readmission within 30 days for stroke, chronic obstructive pulmonary disease, pneumonia, congestive heart failure, diabetes, selected
cardiac conditions, selected gastrointestinal conditions. Results delayed as data from the subsequent quarter is needed to calculate.
Readmissions within 30 days for selected case mix groups has improved and is the best result in a year and a half, but has
not quite achieved the target. The LHIN continues to work with hospitals, networks and partners to implement best practice
initiatives across the region. Related obligations were included in hospital service accountability agreements with the LHIN
including the programs related to congestive heart failure, smoking cessation, and a self-management program.
There has also been new investment across the region, including programs related to heart failure, diabetes, and COPD. There
are also plans to expand cardiac rehabilitation services and pulmonary rehabilitation services.
The LHIN is working with health service providers and patient and caregiver representatives, to establish ten Health Links in
our region with a focus on ensuring coordination of care, and quicker access to primary care and other services, for patients
with the highest complexity and service utilization. The LHIN has just received Ministry approval of 2 Readiness Assessments
and 4 Business Plans, and is awaiting approval of 2 additional Readiness Assessments.
Three demonstration projects are promising. One is designed to enhance access to HIV, endocrinology and chronic pain
clinics through the use of e-consultation. The other two projects focus on the transition of patients from the hospital to the
community.
E12
IHSP
4.2 Early Elective Low-Risk Repeat C-Sections
Prov Target (11.0)
3 7 .7
ONT
CHP
LHIN Target
20.0
30
1 5 .2
ESC
Q1 - 14-15
%
20
2 2 .1
NSM
3 6 .9
SW
3 8 .1
CW
3 8 .6
15.2
WW
10
Baseline - 15.3
0
Prov Target - 11.0
4 3 .1
HNHB
Q2
12-13
Q3
12-13
Trend
Rank - 1
Q4
12-13
LHIN Target
Q1
13-14
Q2
13-14
Provincial Target
Q3
13-14
Baseline
Q4
13-14
Q1
14-15
48
TC
4 9 .3
NW
50
NE
5 3 .7
C
LHIN
5 9 .8
0
20
40
60
%
Notes: No Ministry target, however, target of below 20% established as part of agreements with Champlain hospitals. BORN target is 11%.
Performance on this indicator in Q1 2014-15 is similar to the baseline and better than the LHIN target. In Q3 2013-14, the
Champlain LHIN was the only region in Ontario to ever reach a rate below 10%. Activities undertaken to improve performance
include: the Champlain Maternal Newborn Regional Program asked hospitals to identify physician and nurse champions to
lead improvement on this indicator. Hospitals were encouraged to use this indicator as a quality indicator and to add it to
their quality committee agendas. This key indicator is also addressed during the Regional Program’s annual visits to hospitals
and the Regional Program team is available to provide guidance or assistance. A target of below 20% has been included in
2014-15 accountability agreements between the LHIN and the hospitals. We expect Champlain's rate to remain among the
lowest in the province and to continue to decrease.
IHSP
4.3 Complex Care Hospital Patients with New Pressure Ulcers
Lower values are Better
LHIN Target
2.4
1.4
%
Q1 - 14-15
1.2
1.1
Baseline - 1.2
Prov Target - None
1
0.8
Rank - 1 (tied)
Q2
12-13
Q3
12-13
Trend
Q4
12-13
LHIN Target
Q1
13-14
Q2
13-14
Provincial Target
Q3
13-14
Q4
13-14
Baseline
LHIN
Q1
14-15
No Prov target
ONT
2
CW 1 .1
TC 1 .1
CHP 1 .1
CE
1 .9
MH
1 .9
WW
2 .2
NE
2 .4
HNHB
2 .6
ESC
2 .8
NW
2 .9
SW
3
C
4 .5
5 .7
SE
6 .7
NSM
0
2.5
5
per 100,000
Notes:
The Champlain LHIN continues to perform well on this indicator. Staff will continue to monitor and recommend strategies
appropriate to any performance change.
E13
IHSP
4.4 Long T erm Care Residents with New Pressure Ulcers
No Prov target
2.7
LHIN Target
2.7
2.65
Q1 - 14-15
%
2.6
2.55
Baseline - 2.7
2.5
2.5
2.45
Prov Target - None
Q2
12-13
Trend
Rank - 7 (tied)
Q3
12-13
Q4
12-13
LHIN Target
Q1
13-14
Q2
13-14
Provincial Target
Q3
13-14
Q4
13-14
Baseline
LHIN
Q1
14-15
ONT
C
TC
MH
CW
NSM
NW
CE
CHP
SE
HNHB
NE
ESC
SW
WW
0
1
2 .6
2 .1
2 .2
2 .3
2 .4
2 .4
2 .4
2 .5
2 .5
2 .6
2 .7
2 .7
2 .9
3 .1
3 .1
2
3
%
Notes: Not available at the Long-Term Care facility level.
The Champlain LHIN performance on this indicator remains slightly better than the average for the province. While there are
currently no initiatives focused on this indicator, staff will continue to monitor and recommend targeted interventions as
appropriate.
IHSP
4.6 Hospitalization Due to Falls Among Long-T erm Care Residents
No Prov target
719.2
LHIN Target
683.0
per 100,000
Q1 - 14-15
700
600
Baseline - 690.0
500
Prov Target - None
400
Rank - 3
Q2
12-13
Trend
Q3
12-13
Q4
12-13
LHIN Target
Q1
13-14
Q2
13-14
Provincial Target
Q3
13-14
Q4
13-14
Baseline
LHIN
Q1
14-15
ONT
SW
NE
CHP
TC
CE
NSM
SE
C
HNHB
MH
ESC
WW
CW
0
8 0 0 .4
6 1 9 .1
6 2 1 .1
7 1 9 .2
7 3 1 .3
7 6 4 .6
7 8 4 .9
7 9 3 .5
8 2 7 .4
8 6 6 .1
869
9 5 6 .6
1 ,1 5 7 .4
1 ,2 0 0 .8
500
1,000
per 100,000
Notes: NW LHIN is excluded due to incomplete data. LHIN rank is out of 13
The Champlain LHIN is implementing an integrated falls prevention program in the region to target people in the community.
For information on those initiatives see the indicator on "Fall-related hospitalization rate among seniors". This indicator is
linked to the rates of falls in long-term care homes to monitor the need for action in the coming fiscal year.
E14
IHSP
4.7 Fall-Related Emergency Department Visit Rate Among Seniors
No Prov target
LHIN Target
1648.5
1,700
per 100,000
Q1 - 14-15
1,655.9
1,650
Baseline - 1655.0
1,600
Prov Target - None
1,550
Q2
12-13
Trend
Rank - 12
Q3
12-13
Q4
12-13
LHIN Target
Q1
13-14
Q2
13-14
Provincial Target
Q3
13-14
Q4
13-14
Baseline
LHIN
Q1
14-15
ONT
CW
C
WW
ESC
MH
CE
TC
NSM
HNHB
NE
SW
CHP
SE
0
1 ,4 0 4 .7
1 ,1 2 8 .7
1 ,2 3 2 .4
1 ,2 4 0 .6
1 ,2 8 5 .2
1 ,2 8 5 .6
1 ,3 6 4 .6
1 ,3 7 4 .1
1 ,5 1 9 .4
1 ,5 2 0 .4
1 ,5 2 2 .5
1 ,6 0 8
1 ,6 5 5 .9
1 ,6 8 6 .7
500
1,000
1,500
per 100,000
Notes: Number of falls resulting in emergency department visits per 100,000 people aged 65 or older. Includes people living in the community
and in institutional settings. NW LHIN is excluded due to incomplete data. LHIN rank is out of 13
In 2012 the Champlain LHIN established the Champlain Regional Falls Prevention Steering Committee to support the
integration of falls prevention across the continuum of care and across the Champlain region. The committee has developed a
Champlain wide Falls Prevention Algorithm and adopted standardized screening and assessment tools.
Earlier this year a pilot of the algorithm and tools was completed. In Q2 strategies were developed to promote adoption of
algorithm by primary care and has initiated work with early adopters. Adoption by a limited number of sites should be
complete by end of fiscal 14/15. Impact of Algorithm will not be observed until adoption is completed across Champlain.
IHSP
4.8 Fall-Related Hospitalization Rate Among Seniors
No Prov target
LHIN Target
409.0
423.6
420
per 100,000
Q1 - 14-15
400
Baseline - 415.0
380
Prov Target - None
360
Rank - 13
Q2
12-13
Trend
Q3
12-13
Q4
12-13
LHIN Target
Q1
13-14
Q2
13-14
Provincial Target
Q3
13-14
Q4
13-14
Baseline
LHIN
Q1
14-15
ONT
CW
C
CE
ESC
MH
NSM
NE
WW
SW
TC
SE
HNHB
CHP
0
3 1 7 .8
2 2 3 .1
2 5 2 .4
267
2 7 3 .2
2 8 3 .6
3 1 0 .2
3 1 6 .9
3 1 7 .1
3 4 0 .1
3 4 5 .3
3 8 5 .6
4 1 0 .2
4 2 3 .6
200
400
per 100,000
Notes: NW LHIN is excluded due to incomplete data. LHIN rank is out of 13
As described in the previous indicator, in 2012 the Champlain LHIN established a regional steering committee which is
working to implement a regional strategy to reduce serious injuries requiring visits to emergency departments and
hospitalizations.
E15
CHAMPLAIN LHIN ORGANIZATIONAL HEALTH
OPS
5.1 Status of LHIN Annual Business Plan Initiatives
LHIN Target
85.0
95
% on track
Q2 - 14-15
92.5
Prov Target - None
90.1
90
Baseline - None
87.5
Rank - N/A
Q1
14-15
Q2
14-15
Trend
LHIN Target
Baseline
LHIN
Notes: The percentage of Annual Business Plan initiatives that are on track to meet milestones
Of the 55 interventions identified in the ABP, 50 are on track to achieve their planned milestones and the degree of progress
expected for the end of the fiscal year. Progress was made on the remaining five interventions; however the implementation
timelines for some projects (e.g. Health Links, introduction of Ontario Perception of Care tool) will require adjustments given
unanticipated delays in provincial funding. Due to limited funds, several planned investments (e.g. Assisted Living
expansion) identified in the draft ABP have been deferred and may be considered in the development of the 2015/16 ABP.
E16
OPS
5.2 LHIN Enterprise Risk Assessment
20
LHIN Target
None
#
15
Baseline - None
Prov Target - None
Rank - N/A
10
11
10
4
5
Q1
14-15
Q2
14-15
5
0
Unmitigated
Partially Mitigated
Fully Mitigated
Notes: Includes only the 15 risks/categories ranked as high or extreme risk by the Champlain LHIN Board in 2014. The status, after mitigation, is
based on quarterly assessment by the LHIN’s senior management team, ranking each risk as unmitigated (red), partially mitigated (yellow) or fully
mitigated (green).
The risk register was reviewed and several areas of risk have now been partially or fully mitigated as more information has
been received on the government's mandate and priorities. Some of the potential risks related to provincial policy direction
and the role of the LHIN within a provincial healthcare system have been clarified. There are no new risks that have been
identified this quarter. The new Minister of Health’s mandate letters have been released and there is a strong endorsement
for the role of the LHINs. The new Deputy Minister and his team are working closely with the CEOs.
E17
OPS
5.3 LHIN Operational Budget Variance
25
LHIN Target
From -10% to +10%
%
0
-25
Baseline - None
-50
Prov Target - None
Q3
12-13
Q4
12-13
Q1
13-14
Q2
13-14
Quarter Variance
Rank - N/A
Q3
13-14
Q4
13-14
Q1
14-15
Q2
14-15
Cumulative Variance
Notes: * Actual fiscal year spending does not include Amortization and any affect of Deferred Capital Contribution
The LHIN Operational Budget Variance chart illustrates the quarter-by-quarter variance between actual spending during the
quarter relative to the budget for that quarter.
Although the quarterly budget is allocated straight-line across quarters, the actual spending pattern is not. The LHIN spends
conservatively throughout the fiscal year with an increase in spending in the later quarters as we become more clear about
the amount of resources available.
As of Q1 2014-2015, the LHIN is tracking under budget by -7.3%
OPS
5.5 T witter Followers
850
844
LHIN Target
1000.0
800
#
Q2 - 14-15
750
Baseline - None
700
Prov Target - None
650
Rank - N/A
Q1
14-15
Q2
14-15
Trend
LHIN Target
Baseline
LHIN
Notes: Includes English plus French accounts. Counts as two if on both.
The Champlain LHIN is on track to gain a total of 1,000 Twitter followers by Q4 2014-15. The number of Twitter followers has
steadily increased due to consistent Tweeting, Re-Tweeting, and following other organizations and individuals.
E18
OPS
5.6 Champlain LHIN YouT ube Views
2,000
LHIN Target
None
#
1,500
1,000
Baseline - None
Prov Target - None
Rank - N/A
500
0
393
Q3
12-13
Q4
12-13
Q1
13-14
Trend
Q2
13-14
LHIN Target
Q3
13-14
Baseline
Q4
13-14
Q1
14-15
Q2
14-15
LHIN
Notes: Number of new videos fluctuates from quarter to quarter (may be none)
To maintain interest and activity in the YouTube channel, it is important to regularly add new content. The Champlain LHIN is
planning a new video in English and French to be completed by Q4 2014-15. The topic will be aligned with the Key Result
Area of ensuring more people with complex conditions are able to manage their conditions.
E19
Indicator
Domain
Indicator Display Name
1.1 Time in ER (Admitted Patients)
1.2 Time in ER (Complex patients, Not Admitted)
1.3 Time in ER (Uncomplicated - Not Admitted)
1.4 Cancer Surgery Wait Time
1.5 Cardiac By-Pass Surgery Wait Time
1.6 Cataract Surgery Wait Time
Timely
1.7 Hip Replacement Wait Time
Access to the
1.8 Knee Replacement Wait Tme
Care Needed
1.9 MRI Scan Wait Time
1.10 CT Scan Wait Time
1.11 Wait for Home Care (Community Clients)
1.12 Adults With a Primary Care Provider
1.13 Timely (Same / Next Day) Access to a
Primary Care Provider
2.1 Patients in Acute Hospital Beds Needing Other
Care (%ALC)
2.2 Repeat Mental Health ED visitors
2.3 Repeat Substance Abuse ED visitors
2.4 High Priority Clients Receiving CCAC Care at
Home
2.5 Long Term Care Placements for Highest
Priority Clients
2.6 Admission to LTC Homes from Community
Right Care,
2.7 Patients Designated ALC Who Were
Right Place
Discharged to Long Term Care Homes
2.8 ALC days Attributable to Palliative Care
Patients
2.9 Hospitalization Rate for Ambulatory Care
Sensitive Conditions
2.10 ER Visits for Conditions That Could be
Treated in a Primary Care Setting
Health Service Providers Who Meet French
Language Local Obligations
Available as of Q2 2014-15
Last 8 quarters to Q2 2014-15
2 periods to June 2014
New Data in Q2
Board Report
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Expected Update Date
Next quarter
Next quarter
Next quarter
Next quarter
Next quarter
Next quarter
Next quarter
Next quarter
Next quarter
Next quarter
Next quarter
TBD
2 periods to June 2014
No
TBD
Yes
Next quarter
Yes
Yes
Next quarter
Next quarter
Yes
Next quarter
Yes
Next quarter
Yes
Next quarter
Yes
Next quarter
Yes
Next quarter
Yes
Next quarter
Yes
Next quarter
One year to 2013-14
Yes
Next Year
E20
Indicator
Domain
Positive
Healthcare
Experience
Indicator Display Name
Indicators under development
4.1 Readmissions for Certain Chronic Conditions
Available as of Q2 2014-15
New Data in Q2
Board Report
Not available
No
TBD
Expected Update Date
Yes
Next quarter
4.2 Early Elective Low-Risk Repeat C-Sections
4.3 Complex Care Hospital Patients with New
Pressure Ulcers
High Quality, 4.4 Long Term Care Residents with New Pressure
Ulcers
Safe and
4.5 Physician Visit Within 7 days of Discharge
Effective
4.6 Hospitalization Due to Falls Among Long-Term
Care
Care Residents
4.7 Fall-Related Emergency Department Visit Rate
Among Seniors
4.8 Fall-Related Hospitalization Rate Among
Seniors
Yes
Next quarter
Yes
Next quarter
Yes
Next quarter
8 quarters to Q4 2012-13
No
Next year
Yes
Next quarter
Yes
Next quarter
Yes
Next quarter
5.1 Status of LHIN Annual Business Plan Initiatives
5.2 LHIN Enterprise Risk Assessment
Champlain 5.3 LHIN Operational Budget Variance
LHIN
5.4 LHIN Staff Turnover
Operational 5.5 Twitter Followers
Health
5.6 Champlain LHIN YouTube Views
5.7 LHIN Employee Satisfaction
5.8 Website Traffic
Yes
Next quarter
Last 4 fiscal years to 2013-14
Not available
Not available
Yes
Yes
No
Yes
No
No
No
Next quarter
Next quarter
Next year
Next quarter
Next quarter
Next quarter
Next quarter
6.1 Hospital Cost Efficiency
6.2 CCAC Home Care Cost Efficiency
Health
6.3 Total Margin - Hospital
System Fiscal 6.4 Total Margin - Community Care Access Centre
Managemen 6.5 Total Margin - Community Health Centres
t and Value 6.6 Total Margin - Community Support Services
6.7 Total Margin - Mental Health and Addictions
Agencies
Last fiscal year
Last 2 fiscal years
Last 2 fiscal years
Last 2 fiscal years
Last 2 fiscal years
Last 2 fiscal years
No
No
No
No
No
No
Next year
Next year
Next quarter
Next quarter
Next quarter
Next quarter
Last 2 fiscal years
No
Next quarter
E21
Section F—Methodology
The following describes the methodology for used to develop the scorecard.
Section B - Domain Scores
An overall composite score for each domain was derived by modifying each corresponding indicator
measurement scale into a standardized common scale. Indicators were scored based on their status for
the LHIN target.
 3 = Green status - performance is meeting or better than target and baseline
 2 = Yellow status - performance is better than baseline, but not yet achieving target
 1= Red status - performance has not achieved baseline and/or target.
 Grey status indicators are not included because they do not have a target.
The domain score is the average score of all the indicators in that domain that have targets.
The graphs show the trend of each domain’s composite score over the last available 4 periods of data.
Section E – Detailed Indicator Performance Report
Details on the methodology for calculating individual indicators are attached to the electronic version of
the Scorecard in the technical notes. Additional details and any exceptions to the methodology shown
below are also available in the technical notes.
Baseline
Baselines are the average performance from the previous year -usually fiscal year- where available.
Rank
Champlain’s rank is based on a numerical ordering of all the other LHINs with a rank of 1 being the top
performing LHIN in Ontario and 14, the worst. A tie with another LHIN will be given the same rank. For
example, if 2 LHlNs are tied for #7, both are given a rank of 7 and the next best LHIN will be given a rank
of 9.
Target Setting Approach
Provincial targets where applicable are set by the Ministry of Health and Long-Term Care.
LHIN targets were set based on the following approach:
1. Indicators contained in the Ministry LHIN Performance Agreement (MLPA) – 15
2013-14 targets were extended to 2014-15 by the Ministry of Health and Long Term
Care. These targets are set by the Ministry in collaboration with the LHIN.
F1
2. Indicators with sufficient data/information – 9:
If sufficient information is available, the target is set based on the previous year’s
baseline for all of the LHINs. If Champlain’s performance is among the top 7 ranked
LHINs, the target will be set to the 7th best LHIN’s performance for the previous year. If
performance is among the bottom 7 LHINs, the target will be set to improve performance. The
precise level of improvement required to meet the target was determined using a natural log
formula. The formula requires more improvement the farther performance is from optimal and
less improvement when close.
3. Indicators with partial data -10:
For indicators with partial data available, targets have been set based on industry best
practice and/or historical evidence. In some cases, LHIN targets were set based on
targets set for the region’s individual health care providers (e.g. indicator 4.2 Early
Elective Low-Risk Repeat C-Sections).
4. Indicators with insufficient data (10):
For indicators where there is no industry standard and insufficient historical evidence,
no target has been proposed. Once more data are available, a baseline and target will
be set.
F2
Section G –Acronyms
CCAC
Community Care Access Centre
HSAA
Hospital Services Accountability Agreement
HSFR
Health System Funding Reform
IHSP
Integrated Health Services Plan
LSAA
Long-Term Care Accountability Agreement
MSAA
Multi-Sectoral Accountability Agreement
MLPA
Ministry-LHIN Performance Agreement
OPS
Operations
SAA
Service Accountability Agreement
Q
Fiscal quarter
G1
Champlain Health System
Performance Highlights
Brian Schnarch, Director of System Performance and Analysis
Presented to Champlain LHIN Board of Directors
January 28, 2015
Outline
•
About our scorecard report
•
Performance results
• Overview
• Some successes in 2014
• Falls related indicators
•
Next steps
2
About the Scorecard Report
•
Focused squarely on health system
performance
•
Aligned with the LHIN vision, mission,
commitments & core business1
•
2nd quarterly issue. Most data: Q2 2014-15
•
Results & narratives for 44 indicators in 6
domains. 33 indicators updated this quarter.2
New French version, methodology section
and design improvements
•
“How is the
Health
System in
Champlain
doing?”
1 Indicators are aligned with: our Integrated Health Service Plan (IHSP), our Ministry LHIN Performance Agreement (MLPA), requirements in our Health
System Provider’s accountability agreements as well as our responsibility to manage our office resources effectively and efficiently office to deliver results.
2 For some indicators, data is not updated every quarter. Those indicators are included in the summary ‘all indicator’ and ‘’domain’ views. For detailed
information on those indicators, refer to the previous quarter’s report.
3
Performance Results: Overview
4
Performance Results: Overview
5
Some Successes in 2014
Six of the best and most improved
1.
2.
3.
4.
Hip replacement wait times
Knee replacement wait times
CT Scan Wait Time
Patients in Acute Hospital Beds
Needing Other Care (% ALC)
5. Alternate Level of Care Days
Attributable to Palliative Care Patients
6. Early Elective Low-Risk Repeat CSections
6
1. Hip Replacement Wait Time

Improved to better than Champlain target, closing in on provincial target

Central Intake optimized- patients can chose shortest wait (or preferred
surgeon, hospital, language…)

Surgeons with long waits took fewer new cases

More cases completed than in previous years
7
2. Knee Replacement Wait Time
 Same as hip replacement: hip and knee replacements are managed
through a common intake and assessment process.
8
3. CT Scan Wait Time





Improved to surpass Champlain target, closing in on provincial target
Increased service levels (weekend shifts, longer weekday hours)
Patients transferred to sites with shorter waits
Administrative/process improvements (e.g. data quality)
Active collaboration among hospitals and LHIN. LHIN priority focus.
9
4. Patients in Acute Hospital Beds Needing Other Care
(Percent Requiring Alternate Level of Care- % ALC)
 Improved to best level in years, surpassed Champlain target, closing in
on provincial target
 Home First program at hospitals. Enhanced CCAC home care for high
needs patients discharged from hospital
 45 new convalescent care beds in 2013-14
 Active collaboration of LHIN, hospitals and CCAC. High priority.
10
5. Alternate Level of Care Days Attributable to Palliative
Care Patients
 Improved to surpass Champlain target. Among the best LHINs.
 Regional Palliative Care Consult Team supporting other physicians to
care for their patients at home
 Implementation of central triage for palliative services in Ottawa
 Enhancement of community-based services
 Active collaboration of palliative care providers, LHIN, regional program
11
6. Early Elective Low-Risk Repeat C-Sections


Made a priority in 2010. Among the best performing LHINs ever since.
Indicator is:
 In hospital accountability agreements
 Monitored by Champlain Maternal Newborn regional program
 On the BORN Ontario Maternal Newborn Dashboard.



Physician and nurse champions led improvement in each hospital
Hospitals added indicator as a priority on their quality agendas
Regional program reviews during annual hospital visits, offers support
12
Falls Related Indicators
1. Hospitalizations Due to Falls Among
Long-Term Care Residents
2. Falls-Related Emergency Department
Visits Rate Among Seniors
3. Falls-Related Hospitalization Rate
Among Seniors
13
1. Hospitalizations Due to Falls Among Long-Term
Care Residents
14
2. Falls-Related Emergency Department Visits Rate
Among Seniors
15
3. Falls-Related Hospitalization Rate Among Seniors
16
Next Steps
• Quarterly updates. Next issue: April
• New indicators under development:
•
•
•
Patient experience
French language services
LHIN staff satisfaction
• Dissemination of results and engagement
• Prioritization, in-depth analysis,
performance improvement
17
Champlain Falls Prevention Strategy
= Community Health Agencies
= Primary Care Providers
Jan 2015
= Specialized or Tertiary Care Providers
All adults 65+ should be screened for falls on an annual basis in
community programs or with a Primary Care Practitioner.
Consider use of “Staying Independent Checklist’ *
Primary Care
Assessment/Intervention/Referral
Screen for fall(s) or near falls:
 Two or more falls or near falls in past 6 months
 Fall with injury
 Difficulty with walking or balance
 Score of 4 or more on Staying Independent Checklist
Yes to any one of the screening questions?
1. Obtain relevant medical history, history of falls,
physical examination, including cognitive and
functional assessment to identify root cause.
2. Determine multifactorial fall risk by assessing: (see
assessment checklist on reverse)
a. Postural hypotension
b. Medications: minimize meds contributing to falls
and consider pharmacy consult; optimize pain
management
c. Gait, balance and mobility and muscle strength (ie
TUG or other tests). Evaluate pain-related mobility:
consider referral for appropriate mobility aids
YES
 Obtain fall history
 Evaluate gait and use of aids if difficulty or
change in walking
Is recurrence of fall likely?
d.
e.
f.
g.
Visual acuity
Other neurological impairments and refer appropriately
Heart rate and rhythm
Bone health; assess calcium intake and fracture risk;
nutritional review. Supplement vitamin D and consider
calcium; if ongoing fall risk - consider bone density and
treat if OP or history of fragility fractures then treat
h. Feet and footwear;
i. Environmental hazards: consider home hazard
checklist at stopfalls.ca
j. Depression and Behavioural Risk Factors ie ETOH.
NO
Single fall in past 6
months or several
near falls?
NO
YES
Evaluate Gait:
Abnormalities
noted? Yes/No
YES
NO
Health Promotion Key Messages:
 Encourage regular periodic health visit; annual medication, alcohol
review and eye exam
 Complete a home safety checklist annually
 150 minutes of physical activity per week – consider Champlain
Exercise Programs: Champlainhealthline.ca
 Muscle and bone strengthening exercises to improve balance
 Eat 3 or more servings of calcium rich foods daily
 Take a daily vitamin D supplement
REFER
If appropriate refer to specialized programs and services
(see referral and resource list - includes referral forms)
stopfalls.ca
Algorithm based on AGS and BGS Geriatric algorithm: http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/prevention_of_falls_summary_of_recommendations/ *Staying Independent Checklist available
online at (www.stopfalls.ca). Health Canada http://hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php
Primary Care Multifactorial Risk Assessment for Falls
For Comprehensive Medical Assessment
See RGPEO Website: stopfalls.ca
CHECK ALL THAT APPLY
1. History of Falls:
 Complete history of frequency and circumstances of the fall(s)
Evaluation of Gait, Balance and
Strength
 Acute or fluctuating medical conditions (e.g. syncope, seizures, hypo/hyperglycemia, symptomatic postural hypotension, etc)
Recommended: TIMED UP and
GO (TUG):
 Chronic medical (e.g. osteoporosis, urinary incontinence, cardiovascular disease, etc)
 If memory or cognition issues observed - consider MMSE – results:
2.A. Medical History
 Prescription, over the counter, illicit, ETOH
 Polypharmacy (6+)
 Psychoactive medications (including sedative hypnotics, anxiolytics, antidepressants)
MoCA results:
 Alcohol intake
B. Postural Hypotension: obtain blood pressure readings: Pulse
Lying
Standing
Sitting
 Symptomatic
C. Gait, Balance, and Mobility Problems
 TUG results: > 14 secs (valid if no cognitive impairment)
 Unable to retrieve an item off the floor
 Reduced muscle strength/deconditioned
 Decreased lower extremity strength
 Decreased upper body strength
 Unable to rise independently from a chair without the use of arm rests or assistance
D. Impaired Vision: as reported by client and medical history
Risk factors:  Cataracts requiring surgery
 Bifocals or progressives
 Exam > 1 year ago
Time the individual as he rises from a
firm chair (can push off from arm
rests) walks 3 metres at normal pace
(with walking aid if normally used),
turns around and returns to chair.
>14 seconds correlates with high risk
for falls
>30 seconds correlates with more
dependence in ADLs, query need for
assistive devices
<20 secs correlates with
independence with ADLs
Chair Stand Test:
Graphics and descriptions of both
tests are available at:
stopfalls.ca
E.  Other Neurological Impairments: based on info gained from medical history, cognitive and physical evaluation
 Romberg Sign:
F.  Heart Rate and Rhythm Problems: pulse taken during Blood Pressure reading
G.  At higher risk for low BMD, future fractures and falls based on:  Prior fragility factures
 Parental hip fractures
 Rheumatoid arthritis
 Glucocorticoid use
 Current smoking
 High alcohol intake
H.  Foot
 Foot wear problems: examine feet and foot wear to determine need for interventions
I.
 Environmental hazards: review home situation and determine need for in home assessment
J.
 Assess for Depression and/or behaviour risks:
 Mood
 Psychomotor changes
 Sleep changes
 Psychosomatic complaints
 Decreased interest
 Appetite or weight loss
 Suicidal thoughts
Client’s perceived functional ability / Fear related to falling: contributing to deconditioning or curtailment of physical activities
Jan 2014: Developed by Geriatric Outreach Assessment Team, Regional Geriatric Program of Eastern Ontario: Based on 2010 AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons
Champlain Falls Prevention: a Strategy for Seniors
Scenario 1:
Mrs. Jones is an 81-year-old widow who lives in a condo she moved to two years ago after the
death of her husband. She is mostly quite well, but has an arthritic knee which causes her pain
and she occasionally uses her husband’s cane but is never sure which hand to use it in. She has
occasionally had some light headedness but thinks it is related to her age. She goes to see her
family doctor regularly as she is being treated for high blood pressure and is on medication for this.
Recently she stumbled in her condo, fell and broke her wrist. She was seen and casted in the
Emergency Department (ED), and received a follow-up phone call from the GEM nurse, but Mrs.
Jones did not feel she needed any other services, that her fall was a “one-time occurrence”, but
did agree that she would see her family doctor and follow up with physiotherapy treatment once
the cast was off. She saw her doctor several weeks later, explained to him that it was a simple trip,
he examined the cast and reviewed her medications and he again suggested she get a
physiotherapy follow up after the cast was removed. A referral was made to a private
physiotherapist.
Mrs. Jones became fearful of another fall and left her condo less and less, relying on her daughter
for more support. She began thinking that she would need to move to a retirement home as she
was concerned about being a burden to her daughter.
Scenario 2:
Mrs. Smith is an 81-year-old widow who lives in a condo she moved to two years ago after the
death of her husband. She is mostly quite well, but has an arthritic knee which causes her pain
and she occasionally uses her husband’s cane but is never sure which hand to use it in. She has
elevated blood pressure for which she takes medication. She has occasionally had some light
headedness but thinks it is related to her age. She went to a Public Health FLU Vaccination clinic
and while there was given a checklist to complete on the risk of falls. She was very surprised that
she scored 6 points and commented on this to the Public Health Nurse. The Public Health nurse
encouraged her to see her family doctor urgently and to take the checklist with her.
At her family doctor’s, the receptionist asked four questions of her (as she does with every patient
over 65) about whether she had had a fall or near falls and she asked if she had completed the
checklist. When the patient said that she had completed the checklist and had a number of
concerns - the receptionist alerted the team nurse who then asked more questions, asked her to
walk to demonstrate her gait and also took her blood pressure while lying and standing. She noted
Mrs. Smith’s sore knee and that she was walking with a bit of a limp and asked how she was
managing the pain. Mrs. Smith replied that it was just one of those things of old age. When Mrs.
Smith saw the doctor - he noted that her blood pressure was very low after lying down and asked
her about feeling dizzy. He also asked about her pain management. He reassured her that there
were a few things that would help. He started by looking at her blood pressure medication, and
reduced it. He prescribed regular Tylenol to deal with the pain and also suggested that Mrs. Smith
use a cane to support her sore knee. He arranged to see her again in a few weeks to follow up and
asked his nurse to provide her with a recommendation to attend the Better Strength, Better
Balance program, as she lived in the Ottawa area. She was able to begin attending the classes a
few weeks later. At the conclusion of the sessions she reported that she felt much stronger and it
was noted that she was using her cane appropriately. She really enjoyed the sessions and met
several women who lived near her and started seeing them for coffee after the sessions. She
hopes to either repeat the session or perhaps to attend a regular exercise program in the future.
Champlain Falls Prevention:
A Strategy
for Seniors
Champlain LHIN Board Presentation
January 28, 2015
On behalf of the Regional Geriatric Advisory Committee Champlain Falls
Prevention Working Group
1
Champlain LHIN
Integrated Health Service Plan
2013-16
for a Person-Centred Regional Health Care System
Vision:
Healthy people
and healthy
communities
supported by a
quality, accessible
health system
Mission:
Building a
coordinated,
integrated and
accountable health
system for people
where and when
they need it
Values:
Respect, Trust,
Openness,
Integrity,
Accountability
Mrs J: Before a Regional Falls Prevention Strategy
• 81 yr-old widow
• Few medical issues; seen
in Emergency Department
for fractured wrist after
fall.
• Feels fearful and is
becoming more isolated
• Worries about being a
burden; contemplating
retirement home – but
worries about the cost.
3
Why is Falls Prevention Important?
National Falls Statistics
1) 1 in 3 seniors fall annually
 Half of seniors who fall, do so repeatedly.
2) Falls are leading contributor to overall injury costs
 Account for $6.2 billion (31% of total costs of all injuries)
3) 1 in 4 falls result in injuries
 Lacerations, sprains, head injuries, death.
4) Falls cause 90+% of all hip fractures in the seniors
 20 per cent of seniors who suffer a hip fracture die within a year.
5) Falls are directly accountable for 40 % of all senior admissions to
long-term care homes.
4
Falls Rates Among Seniors
Champlain/Province
Fall-related emergency department
visit rate
Fall-related hospitalization rate
1,750
440
1,700
430
420
1,650
Ranked
12th
1,600
Ranked
13th
410
400
1,550
390
1,500
380
1,450
370
1,400
360
1,350
350
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
12-13 12-13 12-13 12-13 13-14 13-14 13-14 13-14 14-15
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
12-13 12-13 12-13 12-13 13-14 13-14 13-14 13-14 14-15
Solution: Champlain LHIN Regional Falls
Prevention Strategy
• Components from 2011 Provincial Falls Prevention Tool Kit
• Evidence-based practice approach
• Strategic framework for Champlain; built on knowledge and
capacity across all sectors.
• System change approach
•
Involving all sectors of health service provision
•
Identifying root causes of falls
•
Guiding intervention based on client needs.
6
RGAC Falls Prevention Working Group Vision
Effectively reduce falls and the impact of falls
on Champlain older adults through a
coordinated, evidence-informed approach to
falls prevention that builds on communitywide, inter-sectoral collaboration.
7
Champlain Falls Prevention Strategy for Seniors
Pillar 6
Advocacy
Falls Prevention Services along the Continuum of Care
Well Seniors
Seniors at Moderate to High Risk of Falls
Available across sectors
Community &
Public Health
Primary
Care
CCAC
Hospital
Tertiary
Care
Long-Term
Care
Homes
8
Consistent approach and messaging across Primary Care, all four Public
Health Units and community services
 Four Public Health Units agree with Regional Falls Prevention
messaging; using Public Health Agency of Canada document: You Can
Prevent Falls
 Coordinated dissemination of Staying Independent Checklist.
9
Evidence-based Algorithm for detection diagnosis and intervention refined and
implemented in a variety of primary care and community settings in the region.
Algorithm ready to be incorporated into electronic medical record and other
adaptations

Baseline established for number of primary care and community support
service settings where Falls Prevention tools are in place to support
decision processes.

Larger scale rollout of the algorithm across community, primary care and
other health care settings
10
Identified education and lesson plans for health care providers
Ensured all initiatives are evidence-based and standardized across
sectors and region
 Determine need for Falls Prevention training modules in different
modalities
 Education module for Personal Support Workers across Champlain to
support Falls Prevention in daily practice, including use of Staying
Independent Checklist
 Develop on-line accredited Continuing Medical Education module for
physicians and health care professionals
11
Developed a referral framework for referring to regional Falls
Prevention services
 More seniors will find, have access to and attend Falls Prevention,
exercise classes and services.
12
Developed tools, processes and structures to monitor project
performance
 Governance structures in place, including multi-sectoral committee
 Developed provincial and local Falls Prevention metrics and data
collection processes.
13
Present case to key stakeholders to advocate for standardized falls
prevention curricula and appropriate funding mechanisms
 Increased awareness and knowledge of need for standardized curricula
 Increased awareness and knowledge of need for appropriate funding
mechanisms.
14
Benefits of a Regional Strategy
Long-term
planning &
strategic
approach
Increased
knowledge &
capacity for
home care
workers
Excellent
multi-sectorial
working &
relationship
building, with
in-kind
investment
Enhanced
referrals &
smoother
navigation for
client
Improved
communication
&
understanding
across sectors
15
Anticipated Outcomes of a Regional Strategy
Per 100,000 seniors from the year prior:
• 10% decrease in rate of falls-related Emergency
Department visits
• Decrease in rate of repeat falls-related Emergency
Department visits
• Decrease in rate of falls-related admissions to hospital
• Decrease in rate of falls-related admissions for hip
fractures
16
Challenges and Opportunities
• Growing number of seniors:
o
In 2015 there will be 203703 seniors over 65 in Champlain
o
By 2020 there will be 243,939
o
In 2025 there will be 292,798
• With awareness comes demand
• Seniors with complex needs require timely access to resources
• Integration with other senior strategies.
17
Benefits of Investments
•
In 2013, there were 2765 admissions of seniors from Emergency
Department for falls in Champlain
•
Equivalent to 41475 bed days, costing $17.2 million
•
Average length of stay for a falls-related admission = 15 days
•
Cost per bed / day = $415 (50th percentile)
Potential health care dollar savings:
10% reduction in admissions of seniors with fallsrelated issues could save $1.72 million annually
18
Quality of Life Benefits
• Reduced fractures, pain, fear of falling
• Reduced use of health care services
• Increased confidence, independence and social participation
• Reduced caregiver stress.
19
Mrs Smith: In an integrated, prevention-oriented world
•
81 yr-old widow
Outcome:
•
Few medical issues
•
•
Occasionally uses a cane; has
some lightheadedness,
but not discussed with her
General Practitioner. Thought
she was well “for her age”
Ongoing review, evaluation
and intervention of Falls Risk
•
Improved strength and
balance leading to improved
confidence and independence
•
Improved social contact and
well-being
•
Attended Flu Clinic and
completed Staying Independent
Checklist
•
Checklist reviewed by team at
doctor’s office as per the
algorithm.
Over the next five years we plan to...
 Increase Falls Prevention awareness and engagement across seniors
and front line workers
 Work across the sectors to identify and improve the best practice falls
prevention programming capacity, that is important to a quality system
design, including specialist services, to meet the needs of seniors
including those identified as high risk
 Continue to ensure that health care providers across all sectors are
using current evidence informed practices in Falls Prevention service
delivery
 Gain commitment across all regional agencies to align themselves with
the strategy and identify processes to ensure smooth transitions for
seniors and caregivers across the continuum.
 Ensure our governance and evaluation structures are current, relevant
and valid
 Ensure synergy with other regional senior strategies
21
Questions & Comments
22
Champlain Community Support Services
Update on Strategic Initiatives
January 2015
Agenda
 Context of Community Support Services
(role, target population, services & resources, integrating functions)
 Strategic Plan 2014-2017
(client experience, strategic directions, service reference document, action plan, provincial
priorities)
2
Community Support Services
The sector supports people to live and
age well in their own homes and
communities in order to:
“Without your program I
would have to go to a nursing
home. Your services is very
special”
• achieve optimum levels of health and active
living
• avert preventable admissions to hospital and
long-term care facilities
• facilitate reintegration from hospital to home
3
Targeted Interventions: Patients with Chronic Conditions
15% - people with stable complex chronic conditions
Kaiser- Permanente Triangle
Organisational Structure
Champlain Community Support
Network
Community
Support
Coalition of
Renfrew
County and
Area
Ottawa
Community
Support
Coalition
Community
Support
Coalition of
Eastern
Counties
5
Scope of Sector Services in Champlain
•
CSS serves over
50,000 clients with
paid staff and over
8,500 volunteers
CSS Services
Assisted Living Services
Supportive Housing
Caregiver Support
Respite
Crisis Intervention and Support
Elder Abuse Prevention
Day Services
Foot Care Services
Homemaking
Home Maintenance
Social and Congregate Dining
Meals on Wheels
Friendly Visiting
Telephone Assurance
Attendant Care Outreach Services
Personal Support Services Training
General Geriatric Health Promotion
Psycho-Geriatric Health Promotion
Non Urgent Transportation
Service Arrangement/Coordination
Palliative Care Services
Residential Hospice
Social Recreational Activities
Health & Wellness Clinics
Deaf, Deafened & Hard of Hearing
Care
Vision Impaired Care Services
6
Community Support Services Funding: A Leveraged Investment
Total Expenditures $84 M
$31
+ 542,000 hours of
support provided by
8,500 volunteers =
$5.9M
Other
LHIN $
$53
7
Community Support Services Funding: ‘The Big 8’
Eight programs make up 81% of LHIN funding to CSS agencies in Champlain:
LHIN funding
% of total LHIN funding
Assisted Living Services for High-Risk Seniors*
Transportation *
Personal Support /Attendant Care*
Adult Day Services*
Respite
Meals Delivery
Homemaking
Service Arrangement
$17,100,000
$5,779,163
$5,552,859
$5,550,481
$3,480,134
$2,485,305
$1,680,000
$1,489,181
39.66%
13.40%
12.88%
12.87%
8.07%
5.76%
3.90%
3.45%
Total
$43,117,123
100%
* Region-wide centralized access
8
“Frameworks of Integrated Care for the Elderly”
“Your integration is my fragmentation.”
•
Umbrella organizational structures to guide integration of strategic,
managerial and service delivery levels and support effective
joint/collaborative working.
•
Multidisciplinary case management for effective evaluation and
planning of client needs, providing a single entry point into the health
care system.
•
Organized provider networks joined together by standardized
procedures, service agreements, joint training, shared information
systems and maintain quality
•
Financial incentives to promote prevention, rehabilitation and the
downward substitution of services, as well as to enable service
integration and efficiency (Source: MacAdam, Canadian Policy Research Network)
9
Key Initiatives
CSS
Service
Reference
Document
CSS
Action
Plan
2014-2017
CSS Strategic
Plan
2014-2017
There are 3 key planning
initiatives we have undertaken over
the past year
1. Strategic Plan: to articulate
strategic directions
2. Action Plan: to guide the
work of the sector
3. Service Reference
Document: to provide a
consistent baseline of data.
10
Strategic Plan 2014 - 2017
•
Focus: Client and Caregiver “Lived
Experience”
•
Value Stream Mapping
•
Stakeholder involvement:
Clients, Caregivers, Health Service
Providers, LHIN, CCAC
•
Completed June 2014
•
English and French
11
What Our Clients Told Us: Access & Navigation
The Community Support Coalition began the strategic planning process
earlier this year by listening to our clients in a value-stream mapping
process, funded by the LHIN. They said they want:
•
A standard referral process that is less confusing;
•
Services that are easier to find;
•
A sector where communication flows seamlessly;
•
Streamlined access to care where no door is the wrong door; and
•
Support to help navigate the larger health care system which can be
very complex and challenging.
12
What Our Clients Told Us: Planning & Coordination
•
Families and caregivers being consulted about the care of their loved
one;
•
Assessment processes that are coordinated and simple;
•
Consistent practices around the availability and sharing of client
information;
•
Community Support Services providers being included in the circle of
care;
•
Written care plans that are easily understood and shared with clients;
•
Fees and co-payments that make sense to those accessing the
services.
13
What Our Clients Told Us: Planning & Coordination
•
A strengthened Home and Community Support Services sector that
has the resources it requires to meet needs as the health care
landscape shifts to focus on care in the community;
•
Effectively deployed resources;
•
A less confusing sector structure; and
•
Strong quality improvement initiatives.
14
CSS Strategic Directions
Facilitate equitable access
to, and navigation within,
the CSS sector across
Champlain
Facilitate seamless
transitions and improved
care coordination for
clients within the CSS
Sector as well as between
CSS and Community
Partners
Building and maintaining
a strong and sustainable
system of seamless CSS
that meets the needs of
clients across Champlain
15
Source: Access to Care Report Jan 2014 - Wait Time Information System
Actions to Improve Access and Navigation
Client
Standard referral process
Action
Common referral and communication protocols for Community Support
Services, Community Health and Resource Centres and the Community Care
Access Centre
Activity:
CARESS E-Referral Project
Services that are easier to find /
Streamlined access
Centralized Intake and Common Assessments
Activities:
Coordinated access from Community Care Access Centre to Assisted
Living Services and Adult Day Programs
Coordinated Attendant Care Services waitlist
Champlain Community Transportation Collaborative with centralized
scheduling and sharing of vehicles
Common Assessment Form
Common client assessment tools within Community Support Services
(InterRAI CHA and Preliminary Screener)
Improved communication flow
Common Client Care Plans
Activity:
Define care coordination and the clients circle of care.
16
Activities to Improve Planning and Coordination
Client
Action
Coordinated assessment processes
Reduce duplication - share InterRAI assessments
Activity: Pilot underway between the CCAC and the
CHA designated agencies in Eastern Counties to facilitate
the sharing of assessments.
Consistent practices around the availability and sharing
of client information;
Coordinated and integrated services for the Client .
Activity:
-Coordinated training and refresh assessor training occurs
regionally for the interRAI CHA ‎within Champlain.
-Development of a Community Electronic Health
Record (CEHR) and Viewer
Community Support Services providers being included in
the circle of care;
All relevant client activity is shared amongst providers.
Families and caregivers being consulted about the care of
their loved one
Make this an embedded principle of care
Written care plans that are easily understood and shared
with clients;
Common Care Plan with guidelines
Fees and co-payments that make sense to those accessing
the services
Fee and co-payment review
Activity: Conduct analysis from data provided as part of
17
the SRD project
Activities to Improve System Capacity
Client
A strengthened Home and Community
Support Services sector
Actions
Development of coordinated Homemaking Services
Enhanced Caregiver Respite Services
Common IT platform and Shared Services Operations
Agency Leads developed for Transportation and Attendant
Care Services
Effectively deployed resources
PSS Wage Enhancement Strategy
Selected as a lead LHIN for Implementation of New Policy
Guidelines for Home & Community Care Coordination
A less confusing sector structure
CSS Leadership Structure and CCAC/CSS joint working
group.
Strong quality improvement initiatives
Excellent Care for All Act
18
Service Reference Document (SRD)
• Extensive data collection
and harmonization
• Detailed Current State
• Greater understanding of
the Sector
• Improved communication
and collaboration
19
Service Reference Document
•
The BIG 8 Services:
•
Adult Day Services
•
Assisted Living Services
•
Homemaking
•
Meals Delivery
•
Personal Support/Independence
Training
•
Respite
•
Service Arrangement/Coordination
•
Transportation
•
Initiated by the LHIN in July 2014 and is
due to be completed in February 2015.
•
Its objective is to collect and validate sector
data in order to articulate the current state of
CSS in Champlain with an emphasis on the
Big 8 services as they represent over 80%
of all funding to the sector.
•
Current state is based on OHRS 2013-14
Year End Reports from the MOHLTC
Health Data Branch.
•
The lack of consistent data was the
impetus behind this initiative.
•
This has been noted as a “one-of-a-kind
initiative across the province”.
20
The SRD Template
Overview of the sector
Detailed section by agency &
service
Definition of CSS, staff and
volunteers, sector organization
and leadership
Client journey, client access and
populations served
HSPs and functional centres
Funding
Assessment and referral tools
Lead Agencies
Business process and information
technology
21
Information Per Agency and Service
Functional Centre - Respite
OHRS DEFINITION
The provision of short or long-term significant others relief
within service maximums and available resources through a
Personal Support Worker. The service may include
homemaking, some personal care, light housekeeping,
attendant care, monitoring, supervision, and/or activation.
Includes

Employee compensation for providing direct services
– homemaking and respite workers

Coordination costs - direct staff compensation

Transportation costs (e.g. fuel, public transit costs,
gas, and mileage)
Excludes

Volunteer compensation
NUMBER OF HSPS
LEAD HSP(S)
SERVICES
CLIENTS SERVED
DELIVERED
LHIN FUNDING
PROPORTION OF
LHIN FUNDING TO
CSS SECTOR
%
$
Functional Centre D
15%
22
Supply and Demand Maps
A very important component of the
Service Reference Document relates
to the supply and demand maps.
The demand part is currently in
development thanks to the help of
Bruce Libman, Epidemiologist at the
Champlain LHIN.
The supply part requires postal code
data from each of the HSPs
providing one or more of the BIG 8.
Action Plan 2014-2017
Access &
Navigation
• In Champlain there is a common process for referral.(2016). Ereferral 2017
• Clients have appropriate and personalized care plans in which
they and their caregivers are engaged and informed.(2016)
Planning &
Coordination
• Clear and consistent data is available to facilitate service planning
and resource allocation. (2015)
• Harmonization of fees for services (2017)
• Develop common protocol regarding client transitions between
health service providers, including CCAC (2016)
Capacity
• Implementation of the Excellent Care for All Act (per MOHLTC)
• Culturally sensitive services for a variety of populations.(2016)
24
Emerging Provincial Initiatives
New Regulations: The government enacted new regulations that came in effect July 1, 2014 that allow LHINs
to fund designated Community Support Service organizations to deliver personal support services (PSS), and
improve coordination between CCACs and CSS.
Our work with the Champlain LHIN has been recognized in our selection as an early adopter for the first phase of
these changes.
Home and Community Care Expert Group: A Home and Community Care Review Expert Group was
created earlier this year. This expert group solicited input from across the province, including clients and
caregivers, and are now developing recommendations to address the home and community care sector.
25
Motion
That the Champlain LHIN Board of Directors endorses the
strategic plan for the Champlain Community Services Network
2014-17 as distributed.
26
Questions
27
Champlain Community Support Services
STRATEGIC PLAN
2014 – 2017
Building a strong, responsive and seamless system of community health services.
Contents
Message from Champlain Community Support Network Chair ________________________ 1
Community Support Services _________________________________________________ 2
The Context _______________________________________________________________ 6
The Journey_______________________________________________________________ 8
The Plan _________________________________________________________________ 9
In Conclusion _____________________________________________________________ 13
Dear Friend;
Over this past year, the most significant task of the Champlain Community Support Network (CCSN) was
guiding the development of Champlain’s Strategic Plan for Community Support Services for seniors and
adults with physical disabilities. On behalf of the CCSN and of the 58 member agencies, I am pleased to
introduce this three year strategic plan - a document that builds on the sector’s achievements and serves
as the roadmap for the future of Community Support Services throughout the Champlain LHIN.
This Strategic Plan is the result of a process that brought together audiences from across the Champlain
LHIN. The lens of lived experience – applied from the perspective of clients and caregivers as well as from
service provider agencies – brought communities together in the spirit of collaboration for the betterment of
health care services in our communities.
Achieving such a level of consultation was no small feat and we applaud the work of the members of the
Project Team and LHIN Senior Leadership who moved this work forward. Working with some urgency, their
considerable effort put to practice our commitment to meaningful conversation and thoughtful deliberation.
Thank you to all community participants for your constructive comments. Thanks also to my colleagues at
CCSN for your considerable commitment to advancing Community Support Services.
The strategies outlined in this plan build on the work to date of remarkable, resilient Community Support
Service health providers and their volunteer leaders. Implementing the strategies through a consistent effort
of collective planning, decision-making and management will be important to ensuring the continued
responsiveness of Community Support Services to the growing needs of clients and community.
This strategic plan speaks to our galvanized commitment to strong, connected, resourced Community
Support Services – our vision for the future.
Regards,
Valerie Bishop de Young,
Chair, Champlain Community Support Network
1
The Community Support Services sector serves more than 50,000 clients per year1 in the Champlain region.
The sector is comprised of 58 agencies funded by the LHIN to provide Community Support Services.
Supported by 8,578 dedicated volunteers providing over 542,258 hours of service annually, the sector offers
home support and personal care as well as care coordination to seniors and adults with disabilities, their
family members and caregivers2. Community Support Services:
 support people to live and age well in their own homes and communities;
 avert preventable admissions to hospital and long-term care facilities;
 facilitate reintegration from hospital to home;
 assist people to achieve optimum levels of health and active living.
Community Support Services not only enhance quality of life by providing the direct services and caregiver
support that make it possible for people to remain in their homes, but also play an important role in alleviating
the demands on emergency departments, long term care facilities and hospital beds.
The sector plans and delivers culturally sensitive services for a variety of populations including, but not
limited to francophone, Aboriginal, immigrant and GLBTTQ communities.
1
2
OHRS FY 2012-13.
For the purposes of this document, the term caregiver is inclusive of family members.
“Ever since the accident, Community Support Services has been finding volunteer drivers for the
endless number of medical appointments which I seem to have. As well as getting me there, the
volunteers have been so good about making sure I get to the right place when the appointment is
in one of the big hospitals. In short, I would have found the last two months very difficult without
the help we have had from Community Support Services. Thank you all so much!”
2
The Community Support Services listed below respond to a wide range
of client and caregiver needs:
Assisted
Living
Services for
High Risk
Seniors







Deaf, Deafened and Hard of Hearing
Care


Footcare
Services
Caregiver
Support
Caregiver
Support
Respite
Hearing
Day Services
Adult Day
Program
Alzheimer
Day Program
Acquired
Brain Injury

Homemaking


Crisis
Support
Crisis
Intervention
and Support
Emergency
Response
Support
Services









Home Help
Home
Maintenance
Health
Promotion

Personal
Support
Services
Personal
Support
Services
Training
Attendant
Care
Supportive Housing
Meals
Meals on
Wheels
Social and
Congregate
Dining

General
Geriatric Health
Promotion
Psycho-Geriatric
Health
Promotion
Personal
Support

Transportation
Non-urgent Transportation Services
Palliative Care
Volunteer Hospice Visiting
Health Promotion
Residential Hospice
Palliative Day Programs
Service Arrangement
Service Coordination
Information and Referral



Vision Care
Vision Impaired
Care Services
Visiting
Friendly
Visiting
Telephone
Assurance
3
For this diverse and dynamic Community Support Services sector to
continue to excel in the current climate of escalating demands on
services, partner agencies must function increasingly as a unified sector.
At the local level, Coalitions are established to support further
collaboration among service providers. Within Champlain there are
three Coalitions: Community Support Coalition-Renfrew County and
Area, Ottawa Community Support Coalition and Community Support
“Just a little note to tell you how
grateful I am. I thank you for
everything that you do for me. I also
Coalition - Eastern Counties. The three Coalitions are reflective of the
unique geography, demographics (including cultural and linguistic
make-up) and service needs of their respective regions.
want you to know that I appreciate
your kindness, not to mention the
kindness of your drivers.”
“It's been almost 3 years since I
joined the group and it has turned
out to be one of my favourite days of
the week. The seniors are all so
The Champlain Community Support Network, comprised of
interesting and willing to share their
representatives from all three coalitions, is the regional voice of the
stories and knowledge that I learn
Community Support Services sector in Champlain. It is the
something new every week.”
mechanism that promotes and facilitates a consistent and efficient
system for the delivery of community support services across
Champlain by:

communicating with the Champlain LHIN and other partners
on behalf of the three Coalitions;

advocating on issues faced by community support service
providers throughout Champlain; and

supporting integration initiatives among all service providers.
4
As an integral partner in home and community care, the Community Support Services sector commits to
formalizing collaborative mechanisms with funders, health planners and other partners. The following
initiatives demonstrate improved coordinated access and continuity of care through integration of services
within and across sectors:
 common client assessment tools within Community Support Services
(InterRAI CHA and Preliminary Screener);
 Champlain Community Transportation Collaborative with centralized
scheduling and sharing of vehicles;
 common referral and communication protocols for Community Support
Services, Community Health and Resource Centres and the
Community Care Access Centre;
 coordinated access from Community Care Access Centre to Assisted
Living Services and Adult Day Programs;
 coordinated Attendant Care Services waitlist;
 development of coordinated Homemaking Services;
 enhanced Caregiver Respite Services; and
 IT upgrades and Shared Services Operations, including deployment
of a regional collaboration system and development of a common
Client Information System.
5
The Context
KEY DRIVERS
Champlain Community Support Services operate within an evolving system of health services. A scan of
key population trends, policy directions and priorities underpin this plan. The key strategic drivers are:
Provincial Funding Priorities


Increased investment in program based
funding for home and community care
services.
No planned stabilization increases to
agency base budgets.
Population Health Pressures


The number of Ontarians who are
elderly and living with age-related
chronic conditions is rising.
Increasingly, clients are presenting
with multiple, complex conditions.
Ontario’s Action Plan for Health Care


Seniors’ Strategy for
Ontario Living Longer,
Living Well
The right care, at the right time, in the right place
Patient centered, and evidence based planning
Champlain LHIN Integrated
Health Services Plan
2013-2016


Build a strong foundation of integrated
primary, home and community care.
Improve coordination and transitions
of care.
“The Ministry of Health and LongTerm Care should support the LHINs,
their Community Care Access
Centres and Community Support
Services agencies to formalize a
Standardized Collaborative Care
Model that can allow acuity-based
wait-list and care coordination
assignments between Community
Care Access Centres and select
Community
Support
Services
agencies, thus allowing both sectors
to provide publicly funded personal
support services in each LHIN.”
- Dr. Samir Sinha
“My first experience with the (agency)
was several years ago, providing support to
understanding and dealing with a very difficult family
situation. This support has been ongoing and greatly appreciated.”
6
STRATEGIC ALIGNMENT
The Community Support Services strategic directions align with both the Champlain LHIN Integrated Health
Service Plan and the Champlain LHIN Community Sector Alignment Project, a recently completed
environmental scan.
Champlain LHIN
Integrated Health
Services Plan 2013-16
Key Result Area 1:
More people involved in
planning their health
services
Key Result Area 4:
More seniors are cared for
in their communities
Key Result Area 5:
More people with complex
health conditions are able
to manage their conditions
Key Result Area 6:
More people at end-of-life,
families and caregivers
receive palliative care
supports in their setting of
choice
Champlain
Community Support
Services Strategic
Directions
Champlain LHIN
Community Sector
Alignment Project
Recommendations
Planning and
Coordination
Facilitate seamless
transitions and improved
care coordination for clients
within the Community
Support Services sector as
well as between Community
Support Services and
community partners.
Develop a Comprehensive
Plan to Strengthen the
Sector
Access and Navigation
Facilitate equitable access
to and navigation within the
Community Support
Services sector across
Champlain.
Improve Referrals and
Service Coordination
System Capacity
Build and maintain a strong
and sustainable system of
seamless services that
meets the needs of clients
across Champlain.
Enhance Sector Governance
and Management
Ensure Universality and
Standardization of Services
Further Align with Community
Support Services Business
Process and IT Support
Implement Lead Agencies to
Promote Coordinated Access
7
The Journey
The strategic directions and associated activities evolved from the following consultation process between
clients and providers:
Value Stream
Mapping
Lived
Experience
Engagement
Service
Provider
Consultations
Champlain
Community
Support
Services
Strategic Plan
1. A Regional Value Stream Mapping Exercise
Over 120 participants representing clients, caregivers and
health service providers came together from across the
Champlain region to review the current state of Community
Support Services through a Value Stream Mapping process.
Outcomes achieved included:
 an understanding of the current state of the client and
caregiver journey through system transitions;
 opportunities for improvement in the current system
and;
 actions that would achieve those improvements in the short and medium term.
A person-centered approach ensured the voice of clients and family members remained central throughout
this planning process.
2. An Engagement Session with People with Lived Experience
The voices of people with lived experiences are compelling. Clients and caregivers participated in a
Champlain-wide engagement session via Ontario Telemedicine Network. The participants confirmed that
the activities identified during the Value Stream Mapping Exercise would enhance their healthcare
experience.
3.
Service Provider Consultations
Health service providers and stakeholders were consulted
extensively throughout the planning process via local
Coalition meetings and monthly regional network meetings.
8
The Plan
The Community Support Services sector goal and seven guiding principles provide a framework to guide
decision-making throughout the implementation of the strategic directions described in this plan.
SECTOR GOAL
The Champlain Community Support Services Sector is committed to working with our community and healthcare
partners to ensure personalized care and support to clients and caregivers where and when they need it, by
creating and sustaining a strong, responsive and seamless system of community health services.
GUIDING PRINCIPLES
1. Provide responsive and responsible care: prioritize the needs of clients and their caregivers. The intent
is to expedite getting the right person to the right service at the right time.
2. Accommodate client preference whenever feasible: consider client choice to the greatest extent possible
with respect to access to and provision of services in such a way as to foster dignity and respect of individual
needs.
3. Facilitate direct and indirect communication and information sharing: continually strive to ensure that
information flows seamlessly with clients, their caregivers, within Community Support Services and with
partner service providers.
4. Practice mutual trust and respect: foster an environment of trust and respect that enables diverse
agencies to work together in a positive and productive fashion.
5. Recognize the diversity of agencies within their unique communities: build on strengths of agencies
when planning and implementing service (including size, mandate, and geography, primary language of
service and nature of services provided).
6. Promote efficiency and effectiveness: work individually and collaboratively to make the most efficient
and effective use of resources. Wherever possible, leverage existing expertise, practice, tools and
infrastructure.
7. Uphold excellence in service and organizational administration: ensure alignment with current service
standards and best practice by creating a culture of quality improvement and evaluation and by promoting
evidence-based decision-making.
CHAMPLAIN COMMUNITY SUPPORT SERVICES STRATEGIC DIRECTIONS
ACCESS AND
NAVIGATION
PLANNING AND
COORDINATION
Facilitate equitable access to
and navigation within the
sector across Champlain.
Facilitate seamless transitions and
improved care coordination for
clients within the Community
Support Services sector as well as
between Community Support
Services and community partners.
SYSTEM CAPACITY
Build and maintain a
strong and sustainable
system of seamless
services that meet the
needs of clients across
Champlain.
9
1. ACCESS AND NAVIGATION
When asked about the opportunities within the system, those with lived experience, their caregivers and
service providers expressed hope that the activities outlined in the strategic plan would address access and
navigation and result in:
 a standard referral process that is less confusing;
 a sector that is branded and easily recognized;
 a sector where communication flows seamlessly;
 streamlined access to care where no door is the wrong door; and
 support to help navigate the larger health care system which can be very complex and
challenging.
In response to the input received over the course of the strategic planning process, the Community Support
Services sector commits to the following:
ACCESS AND NAVIGATION:
Facilitate equitable access to, and navigation within, the CSS sector across Champlain.
STRATEGIC ACTIVITIES
S1.1.
Improve access and standardize intake to Community Support Services.3
S1.2.
Standardize4 the case management/case coordination functions within Community Support
Services.
S1.3.
Implement a Communication Capacity Building Plan and Strategy.
STRATEGIC RESULTS
 Referral processes leave clients and their caregivers feeling engaged and informed.
 Clients find it easier to access care in a timely fashion.
 Clients, their families and health care partners are more informed about services and programs
available to them.
 Clients and their caregivers have easy access to information and support on navigating the
Community Support Services system.
______________________________
Standardized /centralized intake processes do not eliminate intake at an agency or program level. They create an additional,
more centralized option for access, such as a one number to call.
3
4 Throughout
this document standardized is used interchangeably with the term consistent.
10
2. PLANNING AND COORDINATION
During the consultation process, those with lived experience, their caregivers and service providers
expressed hope that the activities outlined in this plan would address the planning and coordination of
services and result in:
 assessment processes that are coordinated and as simple as possible for clients;
 consistent practices around the availability and sharing of client information;
 Community Support Services providers being included in the circle of care;
 families and caregivers being consulted about the care of their loved one;
 written care plans that are easily understood and shared with clients;
 fees and co-payments that make sense to those accessing the services.
In response to the input received over the course of the strategic planning process, the Community Support
Services sector commits to the following:
PLANNING AND COORDINATION:
Facilitate seamless transitions and improved care coordination for clients within the CSS
Sector as well as between CSS and community partners.
S2.1.
Address information gaps for sector planning and accountability that continue to exist due to
an inconsistent and sometimes unreliable Ontario Healthcare Reporting Standards data
and/or a lack of centrally integrated data that precisely describes who the Community Support
Services agencies serve (demographically), where, and how (which services).
S2.2.
Continue to work with the Common Assessment and Referral for Enhanced Support Services
project (CARESS) and Shared Services Operations (SSO) on alignment of shared business
processes and IT support.
S2.3.
Align Community Support Services with Community Care Access as well as other key
healthcare and community service partners to better serve clients where there are shared
services or where clients are transitioning between services.
STRATEGIC RESULTS
 Clear and consistent data is available to facilitate service planning and resource allocation.
 Appropriate sharing of client data is facilitating the referral process.
 Clients are transitioning seamlessly between services.
 There is enhanced equity through the application of consistent subsidy processes.
11
3. SYSTEM CAPACITY
During the consultation process, those with lived experience, their caregivers and service providers
expressed hope that the activities outlined in this plan will address system capacity and result in:
 a strengthened Community Support Services sector that has the resources it requires to meet
needs as the health care landscape shifts to focus on care in the community;
 effectively deployed resources;
 a less confusing sector structure; and
 strong quality improvement initiatives.
In response to the input received over the course of the strategic planning process, the sector commits to
the following:
SYSTEM CAPACITY:
Building and maintaining a strong and sustainable system of seamless CSS that meets the
needs of clients across Champlain.
S3.1.
Identify and implement adjustments necessary to ensure that the current roles and
organization of the various Community Support Services resources create an aligned and
unified sector.
S3.2.
Clarify resources availability and projected investment across the sector.
S3.3.
Develop a Champlain Quality Improvement Framework and Decision Support Plan.
S3.4.
Work with the LHIN, Le Réseau and Community Support Service agencies to build capacity
within the sector so as to ensure effective services in French for Francophones.
S3.5.
Work with the LHIN, Aboriginal Health Circle Forum (AHCF), and CSS providers of Aboriginal
Services to ensure effective services for Aboriginal peoples.
S3.6.
Develop a plan for linking with Community Support Service programs and agencies that are
not currently Coalition members.
STRATEGIC RESULTS
 Community Support Services agencies in Champlain are perceived as strong, sustainable and
crucial partners in the health care system.
 There is a map of sector resources and a plan is being implemented to address gaps and
inconsistencies.
 Quality improvement and decision support functions are adequately resourced and optimized for
positive impact.
 Francophones and Aboriginals across Champlain have equitable access to services and an
improved experience with health care.
 All LHIN funded Community Support Services agencies are represented by the Champlain
12
Community Support Network.
In Conclusion
The Champlain Community Support Services Strategic Plan
brings together the lived experience of clients and caregivers
with the knowledge and expertise of program partners. This
plan will serve as a compass for the sector over the next
three years as it continues to work towards improved client
experiences
in
health,
increased
service
capacity,
integration among health care partners and quality
improvement. The sector will collaborate with the
community and healthcare partners to build a strong,
responsive and seamless system of services which
support seniors and adults with disabilities to live and age
well in their own homes and communities.
“The variety of activities are exceptional, as are the
meals! I know, at least, that she eats well two days
a week.”
“Without your program I would have to go to
a nursing home. Your service is something very
special.”
13
Update on
Health System Funding Reform
Champlain LHIN Board of Directors
January 2015
OVERVIEW
Purpose
To provide the Champlain LHIN Board of Directors an
update on HSFR implementation and initiatives since the
Board Education Session
AGENDA
• Review key principles of HSFR from Board Education
Session
• Review Champlain LHIN/HSP HSFR engagement
opportunities
• Summarize lessons learned
• Board opportunities
KEY PRINCIPLES - HSFR
The goal of MOHLTC is to make Ontario the healthiest
place in North America to grow up and grow old
HEALTHY
CHANGE
•
Keeping Ontarians Healthy
•
Faster access and a stronger link
to family health care
•
Right care, right time, right place
A historical approach where health service
providers received lump sum funding
• Hospitals, on average, received 75-90% of
their funding from global budgets
• Majority of the funding is in the form of:
• Base annualized funding
• New incremental funding
• Remaining funding acquired from other
sources (i.e. preferred accommodation,
alternative revenue etc.)
An evidence-based approach with incentives
to deliver high quality care based on:
• Best available evidence & best practices
• Needs of the population served
• Services delivered
• Number of patients
• Patient focused funding systems
reimburse providers at an
established rate, based upon quality
care for standard patient groups
• Ontario is one of the last leading
jurisdictions to move down this path
Receiving
Less
ReceivingLess
Less$ $$
Receiving
Receiving More $
*
Note *: 1415 post-mitigation vs 1314 post mitigation,
includes HBAM & LHIN/CCO QBPs
CCAC – Home Module Performance by LHIN
HSFR FUTURE DIRECTIONS
1. Increasing number of QBPs
2. Introduction of “bundled payments”
• Funding care across sectors
CHAMPLAIN LHIN LOCAL
PARTNERSHIP
The Champlain Local Health Partnership has been established to
support the successful implementation of the HSFR by encouraging
a supportive change management environment locally and across
Ontario. Each LHIN has established a group.
• The Local Partnership acts as an advisory group, facilitating
clinical, financial and decision support advice to and from the
LHINs and the Ministry.
• The group meets quarterly and is co-chaired by the LHIN and a
Hospital Representative
ENGAGEMENT
Engagement Sessions
Sept 29
Oct 2
Oct 3
Oct 6
Oct 7
Oct 15
Nov 12
Nov 28
December
Jan 12
Jan 30
Meeting with LP Co-Chair & CEO Forum Update
Provincial Webcast (Hospitals)
Local CFO Meeting
Champlain LHIN Local Partnership
Provincial Webcast (CCACs)
Champlain LHIN Board Education Session
Provincial Webcast (small hospitals)
Local MOHLTC/Champlain LHIN HSFR Session
Call for proposals to HSFR organizations for HSFR
implementation projects (7 submissions received, 7 funded)
Local Partnership Meeting – QBP Volume Management
Framework
Guest speaker – Champlain LHIN CFO Meeting (Gary
Mitchell, Lakeridge Healthcare)
In addition…..
Provincial
• Ensuring representation on key provincial
committees (HSFR Governance)
• Participation in pan-LHIN Local Partnership
survey
• Participation and collaboration with MOHLTC in
the HSFR engagement session
16
TAKE AWAYS
• Due to the significant negative impact in our region it was important for us to
understand the main contributing factors.
• The LHIN and each HSFR hospital has examined the contributing factors related to
significant financial impacts. In our region:
o Long stay ALC clients at the time of carve-out has proven to be a consistent
theme and certainly more significant then average provincial impacts
o The analysis also focused on:
 Treatment of non-LHIN / Non- Ministry Funded Activity (inpatient)
o This includes a specific focus on the ED service component (currently
underway)
 How PCOP and new program funding should be accounted for during rampup periods
 Impact of regional program funding (eg Regional Maternal Newborn) to
hospitals who manage the funds for these programs (that have no additional
activity)
BOARD OPPORTUNITIES
Board meetings, strategic planning events:
• How has the hospital organized itself to deploy QBPs and
accompanying handbooks?
• How is this work integrated into the Board’s Quality
Committee?
• What are the effects of HSFR on your hospital’s funding,
strategic objectives ? Have you engaged with the LHIN in
these discussions?
• How is your hospital partnering with others to improve
quality of care and service?
Questions

BOARD MEETING AGENDA Champlain Local

Transcription

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