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1 Central LHIN Health Service Needs Assessment and Gap Analysis: Appendix O: Analysis on Hospital Rehab Services November, 2008

2 Canadian Hospital Rehab Statistics and Highlights Nationally, the vast majority of clients were successful in their rehabilitation programs; 89% of them returned to their pre-admission living setting following discharge from inpatient rehabilitation, with 84% returning to a private house or apartment. 91% of clients were determined to have sufficiently met their service goals upon discharge. Almost half (47%) of all clients received rehabilitation relating to orthopaedic conditions. An additional 16% received rehabilitation services following a stroke. Greater gain, on average, in Total Function Score is seen for clients in major multiple trauma (29.6) and burn (22.6) Rehabilitation Client Groups (RCGs) Lesser gain, on average, in Total Function Score is seen for clients in pulmonary (11.3) and arthritis (11.6) RCGs. Source: Canadian Institute for Health information, Inpatient Rehabilitation in Canada, (Ottawa: CIHI, 2008).

3 Canadian Rehab Statistics and Highlights Clients in the brain dysfunction, spinal cord injury and burn RCGs, among others, were much more likely to be admitted to a specialty facility than to a general facility, whereas clients in the orthopaedic, debility and arthritis RCGs, among others, were much more likely to be admitted to a general facility. Clients admitted with spinal cord dysfunction had the longest median length of stay (43 days), while clients admitted with orthopaedic conditions had the shortest median length of stay (12 days). Among clients admitted for stroke, the median length of stay was 34 days, with 25% of clients being discharged within 18 days and 75% of clients being discharged within 51 days. Overall, 84% of all clients that lived at home prior to admission returned home upon discharge. Ninety-two percent of clients admitted for major multiple trauma and 89% for orthopaedic conditions returned home, compared with 79% for medically complex, 78% for brain dysfunction and 75% for stroke. Source: Canadian Institute for Health information, Inpatient Rehabilitation in Canada, (Ottawa: CIHI, 2008).

4 Central LHIN Hospital Rehab Highlights Rehab admits totaled 4449 cases for Central LHIN patients in 2006/07. The top 10 rehab services by RCG volume grouping cumulatively account for greater than 70% of all rehab cases (72.8%). The majority of all rehab cases (52%) are to do with Orthopaedic conditions related to Hip and Knee. This is compared to 47% nationally. Stroke related rehab accounts for a total of 8.5% of all Central LHIN cases, compared to 16% nationally. We are unable to answer at this time why stroke numbers significantly lower than the national experience However, this is a potential issue and can be identified as a Gap. It was noted that St John s does not accept serious stroke cases. Overall, 85.3% of all clients (compared to 84% nationally) that lived at home prior to admission returned home upon discharge. An additional 8% met their service goals and were returned to another unit or facility (i.e. not returned to the community) Age grouping that use rehab services used more predominately by females with spikes in rehab utilization by ages greater than 65. We believe that this may be related to Osteoporosis.

5 Central LHIN Patient Age Groups Using Hospital Rehab Services Rehab services are used more predominately by females with spikes in Rehab utilization by ages greater than 65. Greater likelihood of Osteoporosis may account for Females. The greatest volumes (12.7% of all cases) are in the aged category. Age Group Total % Female % Male % 0.1% % 0.3% % 0.9% % 0.7% % 2.9% % 5.8% % 9.4% % 12.7% % 4.3% Total % 37.2%

6 Rehab Hospitals Used by Central LHIN Patients Central LHIN residents predominantly used 3 hospitals for rehab services, St. John s, York Central and Southlake. Most Central LHIN residents sought rehab treatments within the Central LHIN. Complex cases are most likely to receive treatment outside of the Central LHIN. The top 10 hospitals for rehab services are listed below. Rank Institution Name Cases Percent 1 ST JOHN'S REHABILITATION HOSPITAL % 2 YORK CENTRAL HOSPITAL % 3 SOUTHLAKE REGIONAL HEALTH CENTRE % 4 HUMBER RIVER REGIONAL HOSP-HUMBER MEM % 5 TORONTO REHABILITATION INST-QUEEN ELIZAB % 6 WEST PARK HEALTHCARE CENTRE (YORK CITY) % 7 MARKHAM STOUFFVILLE HOSPITAL % 8 PROVIDENCE HEALTHCARE (SCARBOROUGH) % 9 SUNNYBROOK HEALTH SCIENCES CENTRE-ORTHOP % 10 BAYCREST HOSPITAL (NORTH YORK) %

7 Central LHIN Rehab Patient Groups by RCG Codes About RCG Codes: Within the National Rehabilitation Reporting System (NRS), a client is categorized into one of 17 health condition groups, known as Rehabilitation Client Groups (RCGs). The RCG selected for a particular client is based on the condition that best describes the primary reason for the client s admission to the inpatient rehabilitation unit or facility, such as stroke or limb amputation. Some RCGs are further sub-divided in order to facilitate more specific analysis of groups that contain large numbers of rehabilitation clients. The limb amputation RCG, for example, is further subdivided into groups that denote which limb was amputated and at what level the amputation occurred. The top 10 Rehab services by RCG cumulatively account for greater than 70% of all rehab cases (72.8%). The majority of all rehab cases are to do with Orthopaedic conditions related to Hip and Knee. Stroke related rehab accounts for a total of 8.5% of all Central LHIN cases.

8 Central LHIN Rehab Patient Groups by RCG Codes Central LHIN Rehab Patients Top 10 Admits by RCG Codes Description Assessments Percent Cumulative Percent ORTHOPAEDIC CONDITIONS - STATUS POST UNILATERAL KNEE REPLACEMENT % 22.4% ORTHOPAEDIC CONDITIONS - STATUS POST UNILATERAL HIP REPLACEMENT % 37.9% ORTHOPAEDIC CONDITIONS - STATUS POST UNILATERAL HIP FRACTURE % 46.1% ORTHOPAEDIC CONDITIONS OTHER % 52.0% STROKE - LEFT BODY INVOLVEMENT (RIGHT BRAIN) % 56.3% STROKE - RIGHT BODY INVOLVEMENT (LEFT BRAIN) % 60.5% ORTHOPAEDIC CONDITIONS - STATUS POST BILATERAL KNEE REPLACEMENT % 64.4% MEDICALLY COMPLEX - OTHER % 67.7% CARDIAC % 70.4% ORTHOPAEDIC CONDITIONS - STATUS POST REVISION OF UNILATERAL HIP REPLACEMENT (CIHI CATEGORY) % 72.8%

9 Central LHIN Rehab Patient Groups by DHC Codes About DHC Codes: DHC is a description of the Diagnostic Health Condition. This attribute is similar to the Most Responsible Diagnosis in Inpatient Discharges and Main Problem in Ambulatory Visits. It is defined as the diagnosis describing, the most significant condition which causes the client s rehabilitation stay in hospital. Note: Unlike Inpatient Discharges and Ambulatory Visits, which use ICD10-CA; this attribute uses the Diagnostic Health Conditions (DHC) coding system, which is unique to NRS. Over 35% of all DHC codes are related to Musculoskeletal System Arthritic And Connective Tissue Disorders. Musculoskeletal, Injuries Related to Trauma and Cerebral Circulation account for over 50% of all Central LHIN rehab admits.

10 Central LHIN Rehab Patient Groups (by DHC Codes) Central LHIN Rehab Top 10 Admits by DHC Diagnostic Health Condition Code Description Admit Assessment Percent Cumulative Percent MUSKULOSKELETAL SYSTEM ARTHRITIC AND CONNECTIVE TISSUE DISORDERS - OSTEOARTHRITIS AND ALLIED DISORDERS % 35.8% INJURY AND TRAUMA FRACTURES AND DISLOCATIONS - FRACTURE OF NECK OF FEMUR/HIP, UNILATERAL % 46.2% CIRCULATORY SYSTEM VASCULAR - CEREBRAL INFARCTION % 51.1% MUSKULOSKELETAL SYSTEM DISORDERS OF JOINT REPLACEMENT - STATUS POST JOINT REPLACEMENT-KNEE, UNILATERAL % 55.1% MUSKULOSKELETAL SYSTEM DISORDERS OF JOINT REPLACEMENT - STATUS POST JOINT REPLACEMENT-HIP, UNILATERAL % 57.3% SYMPTOMS, SIGNS AND ILL-DEFINED CONDITIONS - COMPLICATIONS OF MEDICAL AND SURGICAL CARE, NOT ELSEWHERE CLASSIFIED % 59.4% INJURY AND TRAUMA FRACTURES AND DISLOCATIONS FRACTURE OF PELVIS % 60.6% RESPIRATORY SYSTEM - CHRONIC OBSTRUCTIVE PULMONARY DISEASE- UNSPECIFIED % 61.6% CIRCULATORY SYSTEM VASCULAR - INTRACEREBRAL HAEMORRHAGE % 62.5% CIRCULATORY SYSTEM VASCULAR - OCCLUSION OF CEREBRAL ARTERIES % 63.5%

11 Central LHIN Rehab Patient Length of Stay The average LOS is 18.6 Days for all Central LHIN rehab cases. Spinal or Brain related rehab episodes account for the longest average length of stay, while clients admitted with orthopaedic conditions had the shortest average length of stay. The Top 10 LOS table below illustrates that orthopaedic and stroke rehab dominate the use of rehab services and available beds. The top 10 listed below account for 60% of Total Length of Stay for all Rehab discharges. Hip and Knee replacements alone account for 20% of the Total LOS. Complex cases may have a direct impact on ALC, because of the average LOS.

12 Central LHIN Rehab Patient Length of Stay (LOS) Central LHIN Rehab Top 10 RCGs by Total LOS (Days) Description Discharges Total LOS (for Discharged Cases) Average LOS ORTHOPAEDIC CONDITIONS - STATUS POST UNILATERAL KNEE REPLACEMENT ORTHOPAEDIC CONDITIONS - STATUS POST UNILATERAL HIP REPLACEMENT ORTHOPAEDIC CONDITIONS - STATUS POST UNILATERAL HIP FRACTURE STROKE - LEFT BODY INVOLVEMENT (RIGHT BRAIN) STROKE - RIGHT BODY INVOLVEMENT (LEFT BRAIN) ORTHOPAEDIC CONDITIONS OTHER MEDICALLY COMPLEX - OTHER ORTHOPAEDIC CONDITIONS - STATUS POST HIP FRACTURE MAJOR MULTIPLE TRAUMA - OTHER ORTHOPAEDIC CONDITIONS - STATUS POST REVISION OF UNILATERAL HIP REPLACEMENT (CIHI CATEGORY)

13 Central LHIN Rehab Patient Length of Stay (LOS) Central LHIN Rehab Top 10 RCGs by Average LOS (Days) Description Discharges Total LOS (for Discharged Cases) Average LOS (Days) NON-TRAUMATIC SPINAL CORD DYSFUNCTION - QUADRIPLEGIA, INCOMPLETE C5-8 Less than TRAUMATIC SPINAL CORD DYSFUNCTION - PARAPLEGIA, INCOMPLETE Less than NON-TRAUMATIC SPINAL CORD DYSFUNCTION - QUADRIPLEGIA, INCOMPLETE C1-4 Less than NON-TRAUMATIC SPINAL CORD DYSFUNCTION - PARAPLEGIA, UNSPECIFIED Less than TRAUMATIC SPINAL CORD DYSFUNCTION - QUADRIPLEGIA, INCOMPLETE C5-8 Less than NON-TRAUMATIC SPINAL CORD DYSFUNCTION - PARAPLEGIA, INCOMPLETE BRAIN DISFUNCTION TRAUMATIC - OPEN INJURY Less than TRAUMATIC SPINAL CORD DYSFUNCTION - PARAPLEGIA, COMPLETE Less than TRAUMATIC SPINAL CORD DYSFUNCTION - QUADRIPLEGIA, COMPLETE C5-8 Less than NEUROLOGICAL CONDITIONS POLYNEUROPATHY Less than

14 Central LHIN Rehab Patient Length of Stay (LOS) Central LHIN Rehab Bottom 10 RCGs by Average LOS Description Discharges Total LOS (for Discharged Cases) Average LOS (Days) ORTHOPAEDIC CONDITIONS - STATUS POST KNEE REPLACEMENT ORTHOPAEDIC CONDITIONS - STATUS POST BILATERAL KNEE REPLACEMENT BRAIN DYSFUNCTION - OTHER Less than ORTHOPAEDIC CONDITIONS - STATUS POST UNILATERAL HIP REPLACEMENT ARTHRITIS - OTHER ARTHRITIS Less than ORTHOPAEDIC CONDITIONS - STATUS POST REVISION OF UNILATERAL KNEE REPLACEMENT (CIHI CATEGORY) ORTHOPAEDIC CONDITIONS - STATUS POST UNILATERAL KNEE REPLACEMENT ARTHRITIS - OSTEOARTHRITIS Less than AMPUTATION OF LIMB - SINGLE UPPER EXTREMITY ABOVE THE ELBOW (AE) Less than NEUROLOGICAL CONDITIONS - PARKINSONISM Less than

15 Central LHIN Patient Rehab Discharge Reasons Over 85% of service goals were met and released to the community. Slightly higher than the national average. A further 8% met their service goals and were released/transferred to another facility. Note: 6.2 % of service goals are NOT met. An additional 0.5% withdraws, die during rehab treatment, or move. Discharge Reason Code Description Discharges % SERVICE GOALS MET AND DISCHARGED TO COMMUNITY (PERMANENT LIVING SETTING) % SERVICE GOALS MET AND REFERRAL/TRANSFER TO OTHER UNIT/FACILITY % SERVICE GOALS NOT MET AND REFERRAL/TRANSFER TO OTHER UNIT/FACILITY OR DISCHARGED % PERSON WITHDREW (AGAINST PROFESSIONAL ADVICE) % PERSON DECEASED 9 0.2% PERSON MOVED Less Than 5 0.0%

16 Central LHIN Rehab Transfers The table below reflects volumes of transfers of Central LHIN patients from hospital settings to a rehab institute. Toronto hospitals reflect the more complex patients being transferred. Institution Type Hospital Name Transfer Counts % Acute SOUTHLAKE REGIONAL HEALTH CENTRE % Acute YORK CENTRAL HOSPITAL % Acute NORTH YORK GENERAL HOSPITAL % Acute SUNNYBROOK HEALTH SCIENCES CENTRE % Acute HUMBER RIVER REGIONAL HOSP-HUMBER MEM % Acute MARKHAM STOUFFVILLE HOSPITAL % Acute ST MICHAEL'S HOSPITAL % Acute UNIVERSITY HEALTH NETWORK % Acute HUMBER RIVER REGIONAL HOSP-YORK-FINCH % UNDEFINED %