CENTRAL EAST LHIN MLPA PERFORMANCE INDICATOR DASHBOARD Performance effective as of December 2011

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1 LHIN Starting LHIN Indicator Provincial Point or Actual LHIN Current LHIN Reporting PI No. Performance Indicator (PI) FY211/12 Trend Data Source Type Target Baseline Performance Status Ranking Period Target 11/12 1 9th Percentile Wait Times for Cancer Surgery 1 Access 84 days WTIO, CCO Dec th Percentile Wait Times for Cataract Surgery 1 Access 182 days WTIO, CCO Dec th Percentile Wait Times for Hip Replacement 1 Access 182 days WTIO, CCO Dec th Percentile Wait Times for Knee Replacement 1 Access 182 days WTIO, CCO Dec th Percentile Wait Times for Diagnostic MRI Scan 1 Access 28 days WTIO, CCO Dec th Percentile Wait Times for Diagnostic CT Scan 1 Access 28 days WTIO, CCO Dec Percentage of Alternate Level of Care (ALC) Days - By LHIN of Institution 4 Integration 9.46% 2.22% 14.8% 16.9% 11 DAD 211/12Q1 8 9th Percentile ER Length of Stay for Admitted Patients 2 Access 25 hours ERNI Dec th Percentile ER Length of Stay for Non-Admitted Complex (CTAS I-III) Patients 2 Access 7 hours ERNI Dec 211 9th Percentile ER Length of Stay for Non-Admitted Minor Uncomplicated 1 (CTAS IV-V) Patients 2 Access 4 hours n 11 ERNI Dec NOTES: Repeat Unplanned Emergency Visits within 3 Days for Mental Health Conditions 5 Access TBD 17.5% 16.6% 17.5% 8 NACRS 21/11Q4 Repeat Unplanned Emergency Visits within 3 Days for Substance Abuse Conditions 5 Access TBD 19.6% 19.% 22.7% 6 NACRS 21/11Q4 9th Percentile Wait Time for CCAC In-Home Services - Application from Community Setting to first CCAC Service (excluding case management) 4, 6 Access TBD HCD 211/12Q1 Readmission within 3 Days for Selected CMGs 5 Q4 21/11 data (Jan, Feb, Mar 211) *Trend analysis comparison to prior reporting period No established Target, monitoring indicator only CENTRAL EAST LHIN MLPA PERFORMANCE INDICATOR DASHBOARD Performance effective as of December 211 Efficiency (Quality) Data sources may vary depending on the availability of data sources (e.g. WTIO vs CE LHIN WTSWG monthly survey) Data Source: WTIS = This month/quarter's data source via the Wait Times Information Office (WTIO), Cancer Care Ontario (CCO). *Hospital-specific waitlists for MRI & CT are a combination of either Hospital-submitted data and/or CCO. ALC = CIHI Inpatient Discharge Abstract Database (DAD), Intellihealth. Note: Jan, Feb, Mar source data is considered 'interim' until final data cut by ministry. ERNI = National Ambulatory Care Administrative Database (NACRS, CIHI) via Ontario s ER NACRS Initiative (ERNI-Level 1). NACRS = National Ambulatory Care Reporting System (NACRS). HCD = Home Care Database (HCD), OACCAC, Health Data Branch SAS EG Server. CE LHIN WTSWG = Central East LHIN's Wait Time Strategy Working Group monthly survey. *Trend analysis comparison to prior month and/or established baseline (where applicable) of current reporting period LHIN Ranking (1 = shortest, 14 = longest) indicates how the LHIN s current value compares against all other LHINs in the province. Q4 21/11 data - Most recent available data TBD 14.77% 14.5% 15.2% 8 DAD 21/11Q4

2 9 9th Percentile Wait Times for Cancer + Waitlist (# of Patients Waiting) 1,5 8 1,25 7 1, Jan 11 Feb 11 Mar 11 Apr 11 May 11 Jun 11 Jul 11 Aug 11 Sep 11 Oct 11 Nov 11 Dec 11 PRHC Waitlist LHC Waitlist RVHS Waitlist RMH Waitlist NHH Waitlist TSH Waitlist PRHC LHC RVHS RMH NHH TSH CE LHIN Target Provincial Target CE LHIN ACTUALS PROVINCIAL ACTUALS As of Dec 211, CE LHIN Cancer Wait Times (9th percentile) was 34 days, vs the 211/12 negotiated target = 48 days. Funding/Allocations: In 211/12, LHC & NHH were the only 2 CE LHIN hospitals that received one-time incremental funding from CCO. Action/Strategy: 1) Hospitals & CE LHIN implemented on-going Data Quality Improvement Initiatives with specific key strategies underway (e.g. Lunch & Learn sessions at each hospital, chart audits, etc.). 2) Engagement sessions with Hospital Physicians/Surgeons are in development (e.g. Medical Advisory Councils, Chief of Staff/Surgery). 3) Wait Time Performance Indicators have been incorporated into the Hospital Service Accountability Agreement with Hospital-specific Negotiated Targets. 4) One-on-One meetings with each hospital including CFO, Chief of Surgery, CE LHIN WTS Working Group member & WTIS Coordinator are held as needed. 5) TSH is reviewing if the historical base is irrelevant to service its current demand. * Wait list data is based on Oncology from iport. * Where applicable, wait time is approximated as the average of the last 3 months, when wait time is not reported.

3 28 9th Percentile Wait Times for Cataract + Waitlist (# of Patients Waiting) 7, 24 6, 2 5, 16 4, 12 3, 8 2, 4 1, Jan 11 Feb 11 Mar 11 Apr 11 May 11 Jun 11 Jul 11 Aug 11 Sep 11 Oct 11 Nov 11 Dec 11 PRHC Waitlist LHC Waitlist RVHS Waitlist RMH Waitlist NHH Waitlist TSH Waitlist PRHC LHC RVHS RMH NHH TSH CE LHIN Target Provincial Target CE LHIN ACTUALS PROVINCIAL ACTUALS As of Dec 211, CE LHIN Cataract Wait Times (9th percentile) was 93 days, vs the 211/12 negotiated target = 14 days. Hospital-Specific Issues/Best Practice: In Dec 211, all CE LHIN hospitals' wait times went down and remained below the CE LHIN target. CE LHIN wait times decreased from 131 days in October to 93 days in December, as a result of the following actions/strategies. Action/Strategy: 1) Hospitals & CE LHIN implemented on-going Data Quality Improvement Initiatives with specific key strategies underway (e.g. Lunch & Learn sessions at each hospital, chart audits, etc.). 2) Engagement sessions with Hospital Physicians/Surgeons are in development (e.g. Medical Advisory Councils, Chief of Staff/Surgery). 3) Wait Time Performance Indicators have been incorporated into the Hospital Service Accountability Agreement with Hospital-specific Negotiated Targets. 4) One-on-One meetings with each hospital including CFO, Chief of Surgery, CE LHIN WTS Working Group member & WTIS Coordinator are held as needed. 5) A meeting with TSH was held to discuss the impact of the identified and consider solution. Additional $312,2 was approved by the LHIN for 543 cases on top of the inter-lhin in-year reallocations. 6) Additional funding at $2k to improve data quality for each hospital was approved. * Where applicable, wait time is approximated as the average of the last 3 months, when wait time is not reported.

4 4 9th Percentile Wait Times for Hip + Waitlist (# of Patients Waiting) Jan 11 Feb 11 Mar 11 Apr 11 May 11 Jun 11 Jul 11 Aug 11 Sep 11 Oct 11 Nov 11 Dec 11 PRHC Waitlist LHC Waitlist RVHS Waitlist RMH Waitlist NHH Waitlist TSH Waitlist PRHC LHC RVHS RMH NHH TSH CE LHIN Target Provincial Target CE LHIN ACTUALS PROVINCIAL ACTUALS As of Dec 211, CE LHIN Hip Replacement Wait Times (9th percentile) was 153 days, vs the 211/12 negotiated target = 179 days. Funding/Allocations: Comparing to 21/11, RVHS' funded incremental volume for hips & knees revision dropped to zero from 5, and TSH also experienced a significant reduction of funded incremental volumes for Hip & Knee revision from 38 to 6, in 211/12. Hospital-Specific Issues/Best Practice: In Dec 211, all hospitals' wait times went down and remained below or equal to the 211/12 CE LHIN target except RVHS (improved from last month). Action/Strategy: 1) Hospitals & CE LHIN implemented on-going Data Quality Improvement Initiatives with specific key strategies underway (e.g. Lunch & Learn sessions at each hospital, chart audits, etc.). 2) Engagement sessions with Hospital Physicians/Surgeons are in development (e.g. Medical Advisory Councils, Chief of Staff/Surgery). 3) Wait Time Performance Indicators have been incorporated into the Hospital Service Accountability Agreement with Hospital-specific Negotiated Targets. 4) One-on-One meetings with each hospital including CFO, Chief of Surgery, CE LHIN WTS Working Group member & WTIS Coordinator are held as needed. 5) Additional funding at $2k to improve data quality for each hospital was approved. * Where applicable, wait time is approximated as the average of the last 3 months, when wait time is not reported.

5 th Percentile Wait Times for Knee + Waitlist (# of Patients Waiting) Jan 11 Feb 11 Mar 11 Apr 11 May 11 Jun 11 Jul 11 Aug 11 Sep 11 Oct 11 Nov 11 Dec 11 PRHC Waitlist LHC Waitlist RVHS Waitlist RMH Waitlist NHH Waitlist TSH Waitlist PRHC LHC RVHS RMH NHH TSH CE LHIN Target Provincial Target CE LHIN ACTUALS PROVINCIAL ACTUALS As of Dec 211, CE LHIN Knee Replacement Wait Times (9th percentile) was 179 days, vs the 211/12 negotiated target = 179 days. Funding/Allocations: Comparing to 21/11, RVHS' funded incremental volume for hips & knees revision dropped to zero from 5, and TSH also experienced a significant reduction of funded incremental volumes for Hip & Knee revision from 38 to 6, in 211/12. Hospital-Specific Issues/Best Practice: In Dec 211, all CE LHIN hospitals wait times went down and remained below CE LHIN target except RVHS (improved from last month). Action/Strategy: 1) Hospitals & CE LHIN implemented on-going Data Quality Improvement Initiatives with specific key strategies underway (e.g. Lunch & Learn sessions at each hospital, chart audits, etc.). 2) Engagement sessions with Hospital Physicians/Surgeons are in development (e.g. Medical Advisory Councils, Chief of Staff/Surgery). 3) Wait Time Performance Indicators have been incorporated into the Hospital Service Accountability Agreement with Hospital-specific Negotiated Targets. 4) One-on-One meetings with each hospital including CFO, Chief of Surgery, CE LHIN WTS Working Group member & WTIS Coordinator are held as needed. 5) Additional funding at $2k to improve data quality for each hospital was approved. * Where applicable, wait time is approximated as the average of the last 3 months, when wait time is not reported.

6 9th Percentile Wait Times for CT + Waitlist (# of Patients Waiting) 7 6, 6 5, , 3, 2, 1 1, Jan 11 Feb 11 Mar 11 Apr 11 May 11 Jun 11 Jul 11 Aug 11 Sep 11 Oct 11 Nov 11 Dec 11 PRHC Waitlist LHC Waitlist RVHS Waitlist RMH Waitlist NHH Waitlist TSH Waitlist PRHC LHC RVHS RMH NHH TSH CE LHIN Target Provincial Target CE LHIN ACTUALS PROVINCIAL ACTUALS As of Dec 211, CE LHIN CT Wait Times (9th percentile) was 24 days, vs the 211/12 negotiated target = 28 days. Hospital-Specific Issues/Best Practice: In Dec 211, all CE LHIN hospitals remained below the CE LHIN target except PRHC (not material). Action/Strategy: 1) Business proposals for new CT machines that are more efficient has been endorsed by the CE LHIN Board of Directors with letter of approval sent to the Ministry. 2) CE LHIN DI Group monthly meetings including action on Data Improvement Initiative. 3) Hospitals & CE LHIN implemented on-going Data Quality Improvement Initiatives with specific key strategies underway (e.g. Lunch & Learn sessions at each hospital, chart audits, etc.). 4) Engagement sessions with Hospital Physicians/Surgeons are in development (e.g. Medical Advisory Councils, Chief of Staff/Surgery). 5) Wait Time Performance Indicators have been incorporated into the Hospital Service Accountability Agreement with Hospital-specific Negotiated Targets. 6) One-on-One meetings with each hospital including CFO, Chief of Surgery, CE LHIN WTS Working Group member & WTIS Coordinator are held as needed. 7) Additional funding at $2k to improve data quality for each hospital was approved. 8) The CE LHIN board has approved the business proposal for a new CT machine in HHHS. Note: Data is dependent on how hospitals report data to WTIS (data is used as submitted). PRHC reported lower wait list starting from September 211 as a result of data quality improvement.

7 9th Percentile Wait Times for MRI + Waitlist (# of Patients Waiting) 16 12, 14 1, , 8 6, 6 4, 4 2 2, Jan 11 Feb 11 Mar 11 Apr 11 May 11 Jun 11 Jul 11 Aug 11 Sep 11 Oct 11 Nov 11 Dec 11 PRHC Waitlist LHC Waitlist RVHS Waitlist RMH Waitlist NHH Waitlist TSH Waitlist PRHC LHC RVHS RMH NHH TSH CE LHIN Target Provincial Target CE LHIN ACTUALS PROVINCIAL ACTUALS As of Dec 211, CE LHIN MRI Wait Times (9th percentile) was 94 days, vs the 211/12 negotiated target = 63 days. Funding/Allocations: Comparing to 21/11, both of RVHS and TSH's funded volumes reduced by 166 (7%), in 211/12 initial allocation. LHC's funded base hours were adjusted to 5,2 instead of 6,24, due to an adjustment for a MOH error. But due to delays in opening, all hospitals' funded volume increased ranging from 11% to 43% from 21/11 to 211/12. Hospital-Specific Issues/Best Practices: In Dec 211, all CE LHIN hospitals' wait times went down and remained below CE LHIN target except LHC, TSH and RVHS mainly driven by the high demand. 1) Both of RVHS and TSH have received their new MRI and have started operation in late Q2. LHC has also received the replacement for the aged MRI machine in August, and has started operation since then. 2) Ministry initiative MRI PIP: Six CE LHIN hospitals will be participating in this initiative for this fiscal year in various waves (e.g. phases), starting with PRHC, including LHC and NHH (best practice) and RMH, RVHS and TSH. 3) PRHC, two staff have completed their exams successfully which will allow an increase in the number of scans that will be completed. Action/Strategy: 1) Hospitals & CE LHIN implemented on-going Data Quality Improvement Initiatives with specific key strategies underway (e.g. Lunch & Learn sessions at each hospital, chart audits, etc.). 2) Engagement sessions with Hospital Physicians/Surgeons is in development (e.g. Medical Advisory Councils, Chief of Staff/Surgery). 3) Wait Time Performance Indicators have been incorporated into the Hospital Service Accountability Agreement with Hospital-specific Negotiated Targets. 4) One-on-One meetings with each hospital including CFO, Chief of Surgery, CE LHIN WTS Working Group member & WTIS Coordinator have been conducted. 5) In 211/12, the Ontario Ministry of Health and Long-Term Care introduced Ontario Breast Screen Program, which will have an impact on wait times. Detailed impact is unavailable at this moment. 6) On top of the 1,97 scans valued $285,, CE LHIN Board approved another 3,627 MRI scans valued $942k to assist wait times in 211/12. Additional funding of $2k for each hospital to improve data quality was also approved. 7) Best practices has been collected and distributed to all hospitals in 211/12 Q3. 8) CE LHIN has informed the ministry that residents are seeking local MRI services with installation of new machines (repatriation) which is negatively affecting MRI performance. Note: Data is dependent on how hospitals report data to WTIS (data is used as submitted). PRHC reported lower wait list starting from September 211 as a result of data quality improvement.

8 % Repeat Visits Number of Repeat Visits 35. Repeat Emergency Visits Within 3 Days for Mental Health Conditions + Number of Repeat Visits by Site /11 Q1 21/11 Q2 21/11 Q3 21/11 Q4 TSH - GEN # OF REPEAT VISITS TSH - BIRCH # OF REPEAT VISITS PRHC # OF REPEAT VISITS CMH # OF REPEAT VISITS RVHS - CEN # OF REPEAT VISITS RVHS - AJAX # OF REPEAT VISITS LHC - BOW # OF REPEAT VISITS LHC - OSHAWA # OF REPEAT VISITS LHC - PP # OF REPEAT VISITS RMH # OF REPEAT VISITS NHH # OF REPEAT VISITS HHHS - HAL # OF REPEAT VISITS HHHS - MINDEN # OF REPEAT VISITS CMH % VISITS RVHS - CEN.% VISITS RVHS - AJAX.% VISITS LHC - BOW.% VISITS LHC - OSHAWA.% VISITS LHC - PP.% VISITS RMH % VISITS HHHS - MINDEN.% VISITS NHH % VISITS HHHS - HAL.% VISITS TSH - GEN. % VISITS TSH - BIRCH.% VISITS PRHC % VISITS CE LHIN TARGET CE LHIN ACTUALS Provincial Actuals Central East LHIN performance has decreased slightly from last quarter (17.5%). The Provincial Target = 16.6%. The methodolgy for calculating this indicator has been revised to account for changes in the data source. The methodology more precisely measures the days between 2 consecutive ER visits. The impact to this indicator increases the rate by 8% for Ontario for all LHINs. Past (Q /11): Initiatives have performed as expected. Additional Crisis Beds have provided an alternative to admisison at Rouge Valley Health System. However, no such service exists in close proximity to the Lakeridge Health Oshawa Emergency Department. Current (Q4 1/11): Repeat Unplanned Emergency Visits within 3 days for Mental Health in Q4 1/11 have increased in comparison to the last quarter and last year. Central East performance is higher than the provincial performance of It has been noted that there is an increase in high acuity MH patients at Lakeridge Health Oshawa, but no rationale has been noted. It is not clear how implemented initiatives or strategies explain the current performance. The target lines for these indicators do not correspond with the periods that they are measuring the target line for 11/12 is superimposed over the performance for the last two quarters of 1/11. Future (Q1 11/12): We expect to reduce Annual Visit Return Rates by 1% by Q1FY 212/13.

9 % Repeat Visits Number of Repeat Visits Repeat Emergency Visits Within 3 Days for Substance Abuse Conditions + Number of Repeat Visits by Site /11 Q1 21/11 Q2 21/11 Q3 21/11 Q4 TSH - GEN # OF REPEAT VISITS TSH - BIRCH # OF REPEAT VISITS PRHC # OF REPEAT VISITS CMH # OF REPEAT VISITS RVHS - CEN # OF REPEAT VISITS RVHS - AJAX # OF REPEAT VISITS LHC - BOW # OF REPEAT VISITS LHC - OSHAWA # OF REPEAT VISITS LHC - PP # OF REPEAT VISITS RMH # OF REPEAT VISITS NHH # OF REPEAT VISITS HHHS - HAL # OF REPEAT VISITS HHHS - MINDEN # OF REPEAT VISITS CMH % VISITS RVHS - CEN.% VISITS RVHS - AJAX.% VISITS LHC - BOW.% VISITS LHC - OSHAWA.% VISITS LHC - PP.% VISITS RMH % VISITS HHHS - MINDEN.% VISITS NHH % VISITS HHHS - HAL.% VISITS TSH - GEN. % VISITS TSH - BIRCH.% VISITS PRHC % VISITS CE LHIN TARGET CE LHIN ACTUALS Provincial Actuals As of 21/11Q4, Central East LHIN performance is22.7% vs the CE LHIN negotiated target = 17.5%. The methodolgy for calculating this indicator has been revised to account for changes in the data source. The methodology more precisely measures the days between 2 consecutive ER visits. The impact to this indicator increases the rate by 3% for Ontario for all LHINs. Past (Q4 9/1-Q31/11): Initiatives have performed as expected. Strategies for providing Concurrent Disorder Services have been implemented across the Central East LHIN. Current (Q4 1/11): Repeat Unplanned Emergency Visits within 3 days for Substance abuse conditions have increased in Q4 1/11 in comparison to the last quarter and last year. Central East performance is lower than the provincial performance of 27.. No initiatives have been implemented during Q4 FY 11/12. Future (Q1 211/12): ED Diversion Initiative seeks to reduce ED Return Visits for CD by Q4 FY 12/13.

10 Hours 9th Percentile EDLOS Admitted Patients 1. 5, 4,5 8. 4, 3,5 6. 3, 2,5 4. 2, 1,5 2. 1, 5. Dec 1 Jan 11 Feb 11 Mar 11 Apr 11 May 11 Jun 11 Jul 11 Aug 11 Sep 11 Oct 11 Nov 11 Dec 11 CMH(Volume) LHB (Volume) LHO (Volume) LHPP (Volume) NHH (Volume) PRHC (Volume) RMH (Volume) RVAP (Volume) RVC (Volume) TSB (Volume) TSG (Volume) CMH (9th) LHB (9th) LHO (9th) LHPP (9th) NHH (9th) PRHC (9th) RMH (9th) RVAP (9th) RVC (9th) TSB (9th) TSG (9th) CE LHIN Target (9th) Provincial Target (9th) CE LHIN Actuals (9th) Provincial Actuals (9th) In December of FY211, Central East LHIN performance at the 9th percentile in length of stay in the Emergency Department for Admitted patients continues to decrease and current performance at 9th percentile is 35.6 hours. 5 facilities are performing longer than the FY211 MLPA target of 39 hours in this indicator: LHO, RVAP, RVC, RMH and PRHC. The other 6 sites are performing below the CE LHIN target. In Decemberr 211, LHC-PP was the top performer in this indicator at 18.6 hours

11 Hours 9th Percentile EDLOS Non-Admitted Low Acuity Patients 1. 2, 18, 9. 16, 8. 14, 7. 12, 1, 6. 8, 5. 6, 4, 4. 2, 3. Dec 1 Jan 11 Feb 11 Mar 11 Apr 11 May 11 Jun 11 Jul 11 Aug 11 Sep 11 Oct 11 Nov 11 Dec 11 CMH(Volume) LHB (Volume) LHO (Volume) LHPP (Volume) NHH (Volume) PRHC (Volume) RMH (Volume) RVAP (Volume) RVC (Volume) TSB (Volume) TSG (Volume) CMH (9th) LHB (9th) LHO (9th) LHPP (9th) NHH (9th) PRHC (9th) RMH (9th) RVAP (9th) RVC (9th) TSB (9th) TSG (9th) CE LHIN Target (9th) Provincial Target (9th) CE LHIN Actuals (9th) Provincial Actuals (9th) In December of FY211, Central East LHIN performance at the 9th percentile in length of stay in the Emergency Department for non-admitted low acuity patients was hours 4.3 hours In February 211, all LHC sites had data quality issues with this indicator (all sites reporting longer stays than actual) In December 211, LHPP, LHB and RMH were the only facilities meeting the LHIN target of 4. hours In December 211, LHB was the top performer in this indicator, at 3.1 hours

12 Hours Trend lines that dip down to are an indication that the hospital's outcomes have been FOI'd due to small case counts and/or no data available for that reporting period. 9th Percentile EDLOS Non-Admitted High Acuity Patients , , , 8. 8, , 5. 4, 4. 2, Dec 1 Jan 11 Feb 11 Mar 11 Apr 11 May 11 Jun 11 Jul 11 Aug 11 Sep 11 Oct 11 Nov 11 Dec 11 CMH(Volume) LHB (Volume) LHO (Volume) LHPP (Volume) NHH (Volume) PRHC (Volume) RMH (Volume) RVAP (Volume) RVC (Volume) TSB (Volume) TSG (Volume) CMH (9th) LHB (9th) LHO (9th) LHPP (9th) NHH (9th) PRHC (9th) RVAP (9th) RVC (9th) TSB (9th) TSG (9th) CE LHIN Target (9th) Provincial Target (9th) CE LHIN Actuals (9th) Provincial Actuals (9th) RMH (9th) In December 211, Central East LHIN performance at the 9th percentile in length of stay in the Emergency Department for non-admitted high acuity patients was 6.7 hours, lower than the Central East LHIN MLPA target of 7. hours In December 211, LHO, PRHC and RMH were performing longer than the target In December 211, LHPP and RVAP were the top performers at 5.6 for this indicator

13 Readmission Rate Number of Readmission within 3 days 3 Day Readmission Rate - Select CMGs 5 23.% 21.% 4 19.% 17.% 3 15.% 2 13.% 11.% 1 9.% 7.% Q1 21/11 Q2 21/11 Q3 21/11 Q4 21/11 CMH RMH PRHC HHHS LHC NHH RVHS TSH CMH RMH PRHC HHHS LHC NHH RVHS TSH Central East Actuals There has been a slight decrease in the 3 day Readmission Rate for Select CMG from last quarter, Q Hospitals are looking to Institute for Healthcare Innovation (IHI) for screening tools that will identify risk of readmission and recommended best/promising practices to guide development of plans to support follow uppost discharge. Numerous hospitals are working on plans to roll out self management support training strategically throughout the hospital. Hospitals (LHC, NHH, TSH, RVHS) are using LEAN/Kaizen and QI processes and events to assess current practice. CECCAC is assessing how they can assist with hospital 3 day readmission rates. Currently reviewing reports (onefor all CCAC clients and another identifying enhanced services in support of the Home First philosophy) that will indicate which of our hospital discharged clients have been readmitted to hospital within 3 days of discharge. These reports are in the process of being validated. Once the reports are completed the CCAC will analyze the data to identify any trends such as diagnosis, hospital site, and clients with no physician. CHF and COPD order set use being reviewed and tracked by many hospital sites. Objectives are to re-educate, track and sustain use. In November, a 3-Day Readmission Provincial Advisory Committee will be releasing report findings to be shared with hospitals.

14 Percentage of Alternate Level of Care (ALC) Days Q Q Q Q Q CMH PRHC RMH HHHS NHH LHC - O LHC - PP LHC - B RVHS - A RVHS - C TSH - G TSH - B CE LHIN Actual CE LHIN Target In Q1 11/12, there were a total of 1,8 Acute ALC discharges, a decrease of 371 discharges from Q4. A lower %ALC suggests that the discharged patients spent less time in the ALC designation. A comparison of open cases in the same period is required to determine whether the experience of the discharged patients is reflective of overall system improvement. In Q1, there were 422 open ALC cases on the waitlist in the Central East LHIN, a decrease of 37 from Q4. This decrease suggests that the decrease in %ALC was not a result of maintaining ALC patients in acute beds rather than discharging them. However, there could have been an increase in ALC patients designated in post-acute beds, or moved to post-acute beds from acute beds, which would not be reflected in any of the data available for that period.

15 Days 1 9th Percentile Home Care Wait Time from Application to First Service from 'Community' and 'Hospital' PENDING Q Q Q Q Q Q Q Q Q Community Central East LHIN Target Q1 11/12 performance has decreased to closer to the target, but remains artificially low as the CECCAC has not been able to allocate funds to remove clients from the community waitlist. CECCAC continued commitment to the roll out and sustainability of Home First and ED/ALC strategies means that more people are added to the community waitlist, and fewer are provided with service. The CECCAC is committed to continuing to seek innovative solutions to address our significant community waitlist including discussion with the LHIN regarding potential funding opportunities. The CECCAC is making use of Community Support Services(CSS) throughout the CCAC catchment area, and will be working in collaboration with the LHIN and CSS to initiate Assisted Living Programs throughout CCAC area. Once the Assisted Living Programs are initiated, the CECCAC will be able to refer appropriate clients to this new initiative with the anticipated result of freeing up resources to address the community waitlisted clients CECCAC will continue to work towards achievement of the target however it is important to note that the waittimes may continue to flucuate as our community waitlist continues to grow related our commitment to Home First and ED/ALC strategies. Our waitlisted community clients have been waiting for a significant period of time and therefore should funds become available in Q3-Q4 and the services are initiated their long wait times will then be counted, increasing significantly the wait time from assessment to initiation of service.

16 Performance effective as of November 211 Hospital Site 1. The Scarborough Hospital - General Campus 2. Rouge Valley Health System - Centenery 3. Lakeridge Health Corporation - Oshawa Distance Between Wait Time Hospitals in Central East LHIN 1. The Scarborough Hospital - General Campus 2. Rouge Valley Health System - Centenery 3. Lakeridge Health Corporation - Oshawa 4. Ross Memorial Hospital 5. Peterborough Regional Health Centre 6. Northumberland Hills Hospital 7. Campbellford Memorial Hospital 6 km 38 km 16 km 11 km 91 km 157 km 6 km 36 km 13 km 19 km 88 km 155 km 38 km 36 km 7 km 74 km 58 km 125 km 4. Ross Memorial Hospital 16 km 13 km 7 km 42 km 81 km 11 km 5. Peterborough Regional Health Centre 6. Northumberland Hills Hospital 7. Campbellford Memorial Hospital 11 km 19 km 74 km 42 km 5 km 55 km 91 km 88 km 58 km 81 km 5 km 58 km 157 km 155 km 125 km 11 km 55 km 58 km Note: The following hospitals are part of the Central East Local Health Integration Network but do not provide Wait Time services: Haliburton Highlands Health Services and Ontario Shores Centre for Mental Health Sciences.