47
Integrated Health Services Plan 4 Presentation for the Bluewater Health Hospital Leaders and Board of Directors October 28, 2015 Ralph Ganter
Integrated Health Services Plan 4 Presentation for the Bluewater Health Hospital Leaders and
Board of Directors
October 28, 2015 Ralph Ganter
Purpose of IHSP 4
• How are we planning to improve health outcomes?
• How are we going to minimize adverse effects/results?
− Readmissions / revisits
− Admissions
− Alternate Level of Care (ALC)
− Conservable days
2
High Level Format of IHSP 4
• Aims / themes
• Objectives − (for the end of the IHSP 4 three-year period)
• Strategies to achieve objectives
• Strategies by county − (and/or Health Link planning region)
• Yearly goals by county
• Initiatives / actions to achieve the goals 3
Local Context Review
• Health Based Allocation Model (HBAM)
• Long stay individuals (acquired brain injury and
chronic ventilator cases)
• Heightened awareness of clients with multiple
comorbidities
• Inflationary / step increases / salary commitments
• Infrastructure deficits 4
What The Data Is Telling Us?
5
ESC LHIN Demographics
Population, Census 2011 Windsor
Essex
Chatham-Kent
County Lambton
Erie St Clair
Ontario
Total population 391,173 101,684 126,199 619,056 12,851,821
% rural area population 14% 31% 26% 19% 14%
% small population centre 7% 25% 11% 11% 9%
% medium population centre
8% 43% 63% 25% 7%
% large population centre 71% 0% 0% 45% 69%
% of Population 65 + 15% 18% 19% 16% 15%
6
Language, Immigration and Visible Minorities
Language, Census 2011; Immigration, Census 2006;Visible minorities and identity, Census 2006
Windsor Essex
Chatham-Kent
County Lambton
Erie St Clair
Ontario
% who include English as their mother tongue
75% 89% 91% 81% 70%
% who include French as their mother tongue
4% 3% 2% 3% 4%
% with no knowledge of English or French
2% 1% 0% 1% 2%
% who are immigrants 22% 10% 12% 18% 28%
% who arrived within 5 years 4% 1% 1% 3% 5%
% who are visible minorities 14% 4% 3% 10% 23%
7
Top 10 Leading Causes of Death
(Rates Per 100,000 Population)
ESC Ontario
Ischemic Heart Disease 125.3 97.5
Cancer of Lung and Bronchus 65.2 49.1
Dementia and Alzheimer Disease 53.9 52.9
Cerebrovascular Disease 49.6 37.1
Chronic Lower Respiratory Disease 40.6 28.6
Cancer of Colon, Rectum, Anus 28.5 24.2
Cancer of lymph, blood and related 24.3 19.7
Diabetes 22.0 21.6
Influenza and pneumonia 15.1 15.7
Cirrhosis and other Liver Disease 14.9 9.9
Top 5 Potential Years of Life Lost
(Rates Per 100,000, Age < 75)
ESC Ontario
Ischemic Heart Disease 587.9 395.0
Cancer of Lung and Bronchus 406.9 320.0
Intentional Self Harm 268.1 269.4
Accidental Poisoning 262.5 164.8
Cirrhosis and Liver Disease 215.1 131.2
Primary Care Physicians Per 10K Capita and
Unscheduled ED Visit Rate Per 1K Capita
Unscheduled emergency department (ED) visits (FY 2012)
Windsor-Essex
Chatham-Kent
Sarnia-Lambton
Erie St. Clair Ontario
Physicians per 10K capita 8.5 7.5 7.3 8.1 11.2
ED Visit Rate per 1,000 Population
395.6 617.1 713.4 494.8 427.2
10
Emergency Department Visits/1000 Population
Sarnia City
Centre
Sarnia
Central
Lambton
County/ Lake
Huron
Visits/1000 735.8 674.3 530.7
Primary Care
Physicians
68 15 9
Physicians/10,000 7.6 7.6 5.3
Total Acute Inpatient Hospital Days (Rates per 100,000)
ESC Ontario
Arthritis and Related Conditions 1748.1 1541.7
Cancer 4253.2 3592.2
Congestive Heart Failure (CHF) 1743.0 1635.6
Chronic Obstructive Pulmonary
Disease (COPD)
2032.4 1360.3
Diabetes 1095.9 892.2
Ischemic Heart Disease (IHD) 2464.1 1863.4
Stroke 1929.7 1474.8
Chronic Conditions Prevalence Rates ESC Ontario
Arthritis 20.7 17.3
Asthma 8.5 7.5
Cancer 1.1 1.9
COPD 5.4 4.3
Diabetes 7.6 6.6
High Blood Pressure 19.4 18.3
Heart Disease 5.3 4.8
Suffer from Effects of Stroke 2.3 1.3
Have a Chronic Condition 41.5 37.3
Have Multiple Chronic
Conditions
18.7 15.0
Acute Mental Health Unit Utilization
% of Active Cases ESC Ontario
Schizophrenia and Psychotic
Disorders
33.1 28.4
Cognitive Disorders 3.9 4.7
Mood Disorders 33.4 30.2
Personality Disorders 1.7 2.1
Substance Related 2.6 4.4
Admissions per 100,000 524.6 483.2
Percentage of Patients Seeing A Primary Care
Physician Within 7 Days Of Acute Discharge
Discharge Type Discharges % Visit within 7 days
25 Top Case Mix Group
(CMG) Discharges
2689 35%
CHF 308 37.7%
COPD 435 34.3
Acute Admissions, Length of Stay and
Per Capita Rates
FY 2012 Windsor
Essex Chatham-
Kent Lambton
Erie St. Clair
Ontario
Average acute length of stay
(LOS) 5.7 5.1 5.4 5.6 5.4
Average total LOS 6.9 5.6 6.3 6.5 6.3
FY 2013 Windsor
Essex Chatham-
Kent Lambton
Erie St. Clair
Ontario
Acute Separations per 1,000
population 84 104 104 91 81
Acute LOS per 1,000 pop 430 517 546 468 418
ALC LOS per 1,000 pop 111 90 65 90 65
Total LOS per 1,000 pop 541 565 605 558 485
17
Chronic Disease Admission Rates
Separation Rates per 100,000 Population
Chronic Diseases Windsor
Essex
Chatham-Kent
County Lambton Erie St Clair Ontario
Arthritis 396 399.1 555.2 446.2 353
Asthma 25.1 17.6 61.2 33.1 36
Cancer 454.3 509.3 626.4 520.1 419.9
CHF 174.7 163.9 246.2 193.5 160.9
COPD 211.1 287.1 274.1 245.1 189.1
Diabetes 87.6 123.2 159.5 113.1 98.5
Hypertension 7.6 18.5 19.4 15.1 17.7
Ischemic Heart Disease 369.4 433.4 480.1 421.9 358.7
Stroke 130.2 176.9 195.1 157.4 131.5
18
30 Day Readmissions
30 Day Readmissions (MLPA Supplementary Reports up 2014Q2)
Rolling Year (2013Q3-2014Q2) Windsor
Essex
Chatham-Kent
County Lambton
Erie St Clair
Ontario
30 Day Readmission Rate (ALL) 17.0% 14.7% 15.7% 16.3% 16.6%
COPD 30 Day Readmission 22.3% 16.7% 21.8% 21.0% 19.8%
CHF 30 Day Readmission 21.4% 24.3% 18.1% 22.1% 23.1%
19
Mental Health Visits
20
Substance Abuse Visits
21
Definition of Social and Material Deprivation Index
• The Social Deprivation Index (SDI) is a measure of
inequality within a defined population, and is
calculated by combining a number of measures
22
• These include income levels, unemployment rates,
educational levels, number of immigrants, and
knowledge of French and English
23
Definition of Social and Material Deprivation Index
• The SDI is an important measure, as research has
demonstrated that persons living in areas with high
levels of social deprivation use healthcare services at a
higher rate than those living in areas of low social
deprivation
24
Definition of Social and Material Deprivation Index
Chatham-Kent Social and Material
Deprivation
25
Sarnia/Lambton Social and Material
Deprivation
26
HBAM All Hospital Total Expenses
Row Labels Sum of Actual Hospital Total
Expenses 2012/13
Sum of Expected Hospital Total
Expenses 2013/14
Sum of Expected Hospital Total Expenses with
Growth 2015/16
Sum of Actual
Hospital Total
Expenses 2012/13 2
Sum of Expected Hospital
Total Expenses 2013/14 2
Sum of Expected Hospital
Total Expenses
with Growth 2015/16_2
All Expenses Expected with
Growth (15/16) vs. Actual Expenses (2012/13)
Erie St. Clair $765,799,599.08 $773,702,944.7 $797,964,723.3 4.18% 4.08% 4.03% -3.58%
CHATHAM-Kent Health Alliance
$121,921,812.06 $119,452,503.2 $122,753,341.4 0.67% 0.63% 0.62% -6.83%
Hotel-Dieu Grace Healthcare
$202,991,416.02 $143,864,960.5 $149,727,077.4 1.11% 0.76% 0.76% -31.74%
LEAMINGTON District Memorial
$33,087,654.20 $34,051,320.95 $35,310,585.82 0.18% 0.18% 0.18% -1.25%
SARNIA Bluewater Health $156,157,365.76 $149,966,305.3 $15,4262,856.3 0.85% 0.79% 0.78% -8.58%
WINDSOR Regional $251,641,351.03 $326,367,854.8 $335,910,862.3 1.37% 1.72% 1.70% 23.53%
27
Questions for Consideration
• What key conclusions are you drawing from the data?
• What trends are you perceiving?
• What worries you/requires immediate action?
• Is any data missing in order for you to set a strategic
direction?
28
IHSP 4 Aims (Next 1-3 Years)
• Improved patient flow across health care system
• More patient centered health care system
• Better management of care transition points
• Better management of patient behaviors
• Advance care paths based on best practices and care standardization
• More appropriate use of acute health care services
• Reduced wait times for specific health care services
• More of a focus on health promotion and illness prevention
• More support for people at home
• Increased patient/family satisfaction with the health care system
• Reduced prevalence rates for specific diseases in the ESC region
• More integrated approach to Health System IT development & deployment
29
Lambton County Community Engagement –
124 respondents
Over the next 3 to 5 years the health system needs to improve the most:
• Better access to health care services (availability, adequate supply and
addressing barriers to service)
• Better coordinated health care services
• More focus on health promotion and illness prevention
• More support for people at home
• More cost effective approaches to health care
30
Lambton County Community Engagement –
124 respondents
If you could change one thing in order to improve local health care services:
• Wait times and faster access (wait times in ED, family doctor, specialist and for
diagnostic tests)
• Walk In Clinics – especially after hours
• Better communication and coordination between hospital and community
• System navigation for patients accessing health care service
• Need for electronic medical records across health care continuum
31
Objective Setting
Leafs 2015-2016 32
IHSP 4 Objectives (Next 1-3 Years)
• 30 day readmission rate
• 30 day readmission rates for selected CMGs (COPD, CHF, Diabetes, Stroke, other?)
• Alternate Level of Care (ALC) rate
• Conservable days /1000
• ED visits /1000 (by Canadian Triage & Acuity Scale (CTAS))
• Repeat unplanned ED visits within 30 days for mental health
• Repeat unplanned ED visits within 30 days for substance use
• Potential years of life lost, mortality and life expectancy
(rates by age group) one table
• Prevalence rates for conditions for which ESC is significantly higher
• Acute care hospital utilization rate
33
Proposed Strategic Pillars as the Basis of Actions
• Chronic disease prevention and management/technology
• Addictions and mental health
• Hospice palliative care
• Restorative / rehabilitation care
• Performance targets / monitoring and performance
improvement / value for money: (ED and ALC)
• Special populations:
− Orthopedics
− Indigenous health care
− French language services
34
Questions for Consideration - Strategic Pillars
• Is the above list of strategic pillars a good
representation in order to establish health care system
focus and direction?
• Is there a key strategic pillar missing?
• In your view what is the most important area to start
with in the next year to get improvement results?
35
Focus of Attention….
• Clinical value compass measures (see next slide)
• Readmissions / revisits
0-7 days (hospital processes)
8-21 days (community services processes)
22+ days (self-management processes)
36
High Level Tactics
Improve (clinical value compass model)…
• Capacity
• Capability
− (including multidisciplinary approaches)
• Competencies
− (knowledge, skills, abilities and attitudes)
• Coordination and transitions
37
Evaluative Attributes
Does the initiative enhance…
• Accessibility
• Effectiveness
• Efficiency
• Safety
• Coordination / integration
• Equity
• Patient experience
• Sustainability / appropriately resourced 38
IHSP4 Improvement Targets - Community
• For COPD, CHF, Stroke and Diabetes
− focus on hospital discharge rates, length of stay and 30 day readmissions
• For Addictions and Mental Health
− focus on ED visits and repeat visits
• For Hospice Palliative Care
− focus on ED visits, wait time to palliative care, access to bereavement services
• For Rehabilitation
− focus on reduced acute care length of stay and reduced unplanned ED visits
• For special populations
− focus on increasing access to primary care, cultural sensitivity training, reduced
ED visits and hospital admissions
39
IHSP4 Improvement Targets – Acute/ALC/ED
40
Where we are Where we want to go
ESC LHIN
Total
Volumes
ESC LHIN Rate
per 1,000 Pop'n
OR % Total
Proposed ESC LHIN
Rate per 1,000 Pop'n
OR % Total Impact on ESC LHIN
Change required to
meet target
Acute Care
Acute separations 51,695 80.3 71.6 5,612 fewer acute separations -11%
Total Days 329,745 512.5 470.7 26,846 fewer total days -8%
Acute Days 287,416 446.7 391.7 35,398 fewer acute days -12%
ALC
%ALC Discharges to Long-term Care 2,543 14.9% 9.2% (HNHB LHIN) 145 fewer discharges to LTC -38%
%ALC Discharges to home with support 2,543 17.5% 25.4% (HNHB LHIN) 201 more discharges home with support +45%
%ALC Discharges to Chronic Care 2,543 28.1% 19.5% (MH LHIN) 219 fewer discharges to Chronic Care -31%
%ALC Discharges to Rehabilitation 2,543 17.0% 28.3% (MH LHIN) 287 more discharges to Rehabilitation +66%
ED
ED Visits Crude Rate 310,573 482.7 415.5 43,220 Fewer visits -14%
CTAS Level I & II 52,361 81.4 65.0 10,516 fewer visits -20%
CTAS Level III 119,583 185.8 171.6 9,146 fewer visits -8%
CTAS Level IV & V 138,091 214.6 177.1 24,116 fewer visits -17%
Emergency visit rate (age standardized 1-74)
that could be treated in an alternative
primary care setting 18,909 34.8 23.3 6,215 fewer visits -33%
IHSP4 Improvement Targets – Bed Types/Capacity
Bed Type Current Future Percentage
Change
Acute
(medical/surgical) 678 603 -11%
Sub-acute (rehab and
CCC) 421 496 +18%
Assisted living 150 225 +50%
LTC 4,341 4,470 +3%
Convalescent care 20 107 +434%
41
Questions for Consideration - Improvement Targets:
1) Are the performance measures / targets identified for the
community, acute care, ALC, and ED reasonable? Would
you change anything?
2) Are the proposed bed types and future bedded capacity
projections reasonable? Would you change anything?
3) Are there any key improvement targets missing that you
would like to add to the list?
42
IHSP4 Other Suggestions for Consideration
Please list any other suggestions you may have to
improve the IHSP4:
-
-
-
-
43
IHSP 4 Next Steps
• Ensure that the IHSP 4 is aligned with Ministry of Health and
Long-Term Care priorities and ESC LHIN Board priorities
• Advance a community / stakeholder engagement plan (validate
strategies / tactics and confirm performance targets)
• Refine strategies and targets based on community engagement
input
• Receive and review the PAN LHIN environmental scan (socio-
demographic and utilization information)
• Prepare final draft copy of the IHSP 4 for ESC LHIN Board review
and approval 44
Questions…
45
46
Thank you
Ralph Ganter
1-866-231-5446 Ext. 3205
www.eriestclairlhin.on.ca 47
