Ministry-LHIN Priority Indicators Quality and Safety Committee September 18, 2013 Hamilton Niagara Haldimand Brant (HNHB) Local Health Integration Network (LHIN) Leadership Team MLPA 2013-2015 Structure The Ministry of Health and Long-term Care (MOHLTC) and Local Health Integration Networks (LHINs) will enter into a new Ministry LHIN Performance Agreement (MLPA) for 2013-2014 and 2014-2015. The Agreement (2013-15) includes the following schedules: o Main Agreement o Schedule 1: General o Schedule 2: Local Health System Program Specific Management o Schedule 3: Long-Term Care Homes o Schedule 4: Funding and Allocations o Schedule 5: Local Health System Performance o Schedule 6: Integrated Reporting 1
MLPA 2013-2015 Highlights Alignment with Provincial Priorities The agreement is updated to reflect Ontario s Action Plan for Health care, and associated strategies including Health Links, Seniors Strategy, Mental Health Strategy, and Health System Funding Reform. Formal LHIN role in Quality Improvement The agreement requires LHINs to align health service provider Quality Improvement Plans (QIP) required by Health Quality Ontario (HQO) with health system priorities. Formalized inter-agency cooperation The agreement requires LHINs to work with other health system managers: Cancer Care Ontario ehealth Ontario Health Quality Ontario Ontario Agency for Health Protection and Promotion MLPA 2013-2015 Highlights Performance Obligations The agreement requires continued partnership between the ministry and LHINs on issues such as Service Accountability Agreements and the allocation and distribution of Quality Based Procedures (QBP). Funding and Allocation The agreement provides a more effective process for the management of base and health service provider specific funding. Long Term Care The agreement clarifies license regulations for closed beds, transfers between LHINs, and revoked liscenses. 2
MLPA 2013-2015 Highlights Key MLPA (2013-15) indicators are grouped into the following shared system goals: To enhance person-centred care To improve system integration and enhance coordination and transitions of care To implement evidence-based practice to drive quality, value and improved health outcomes Financial Sustainability Methodology changes for FY13-14 Indicators Surgery and Diagnostic Imaging (DI) Wait Times Repeat Unscheduled Emergency Visits within 30 Days for Mental Health/Substance Abuse HNHB LHIN Results of Ministry-LHIN Performance Agreement (MLPA) Indicators Not within acceptable range but has improved from baseline Within acceptable range Not within acceptable range 3
Meeting Focus Methodology changes for FY13-14 Indicators Surgery and Diagnostic Imaging (DI) Wait Times Repeat Unscheduled Emergency Visits within 30 Days for Mental Health/Substance Abuse Indicator Review (where not currently meeting target) % of Priority IV Cases Completed Within Access Target for: Cataract Surgery, Knee Replacement, MRI Scans, CT Scans 90 th Percentile Emergency Room (ER) Length of Stay (LOS) for Admitted patients Percentage of Alternate Level of Care (ALC) Days 90 th Percentile Wait Time for CCAC In-Home Services Repeat Unscheduled ER Visits within 30 Days for Mental Health/Substance Abuse Conditions Readmission within 30 Days for Selected CMGs Key Changes to MLPA Surgery/DI Wait Time Indicators Focus on Priority 4 ( P4, Non-Urgent ) cases Previously: P2, P3 and P4 cases combined New measures: percent of P4 cases completed within Access Target Previously: 90 th Percentile Wait Time for P2-4 cases 4
Wait Time Priority Levels Priority is the outcome of an assessment performed by clinicians on each non-emergency patient to determine their urgency of care General descriptions: Priority 1 Priority 2 Priority 3 Priority 4 Immediate/ Emergent (Emergency) Urgent Semi-Urgent Non-Urgent (Higher) Urgency (Lower) Wait Time Access Targets Each Service Area (ie., Cataract Surgery, MRI Scan, etc) has an associated Access Target, the best practice length of time within which patients should have surgery/diagnostic imaging Access Targets are set for each combination of Service Area and Priority Level Examples: Service Area Priority 1 (Immediate) Priority 2 (Urgent) Priority 3 (Semi-Urgent) Priority 4 (Non-Urgent) Cataract Surgery Within 24 Hours Within 6 Weeks (42 Days) Within 12 Weeks (84 Days) Within 26 Weeks (182 Days) MRI Scan Within 24 Hours Within 48 Hours (2 Days) Within 10 Days Within 4 Weeks (28 Days) 5
Comparison of Performance Targets & Results OLD (FY12-13) NEW (FY13-14) 90 th Percentile Wait Time, P2-4 Cases % of P4 completed within Access Target Target Annual Target Q1 Result Result Cancer 58 days 57 days 90% within 84 Days 91.74% Cardiac By-Pass 48 days 36 days 90% within 90 Days 99.00% Cataract Surgery 150 days 189 days 90% within 182 Days 85.75% Hip Replacement 182 days 249 days 85% within 182 days 86.74% Knee Replacement 182 days 331 days 80% within 182 days 76.76% MRI Scan 75 days 61 days 60% within 28 days 37.84% CT Scan 41 days 38 days 82% within 28 days 71.66% Target (w/ Corridor) achieved Target (w/ Corridor) not achieved Key Changes to MLPA Repeat ED Visits for Mental Health and Substance Abuse Indicators Beginning August 2013, the time period for reporting of the indicator has changed to avoid the delay in reporting The reporting period for the indicator now includes visits occurring within the first 60 days of the reported quarter plus the last 30 days of previous quarter Implications: More timelier reporting of the indicator Some minor changes in the repeat visit rate across LHINs Slight impact in overall LHIN rankings 6
Comparing the performance ranking for HNHB LHIN FY2011-12 Annual Mental Health New Methodology Old Methodology Repeat Visit (%) Ranking Repeat Visit (%) Ranking 19.6 12 19.5 12 Substance Abuse New Methodology Old Methodology Repeat Visit (%) Ranking Repeat Visit (%) Ranking 23.4 8 24.2 9 Source: MOHLTC, Health Analytics Branch Percentage of Priority IV Cases Completed Within Access Targets for: Cataract Surgery Knee Replacement MRI Scans CT Scans 7
Cataract Surgery: LHIN Comparison (FY11/12 Q1 - FY13/14 Q1) Cataract Surgery: HNHB Facilities (FY11/12 Q1 - FY13/14 Q1) FY13/14 Target: 90% 8
Cataract Surgery: HNHB LHIN (April 2009 July 2013) Old Indicator: 90th Percentile Wait Time (Days) Cataract Surgery: Improvement Process Intensive Monitoring Process: Weekly calls initiated April 2013, now changed to monthly Goal of the Process: Standardized wait list management processes and accurate wait list data Result: 3 out of 5 hospitals now exceed the target, with improvements displayed in the other two Confirmation that data and wait lists are accurate Confirmation that Ophthalmologists are utilizing consistent clinical criteria when placing individuals on the wait list Each hospital is as efficient as possible 9
Knee Replacement: LHIN Comparison (FY11/12 Q1 - FY13/14 Q1) Knee Replacement: HNHB Facilities (FY11/12 Q1 - FY13/14 Q1) FY13/14 Target: 80% 10
Knee Replacement: HNHB LHIN (April 2009 July 2013) Old Indicator: 90th Percentile Wait Time (Days) Knee Replacement: Improvement Process Intensive Monitoring Process: Weekly calls initiated April 2013, now changed to monthly Goal of the Process: Standardized wait list management processes and accurate wait list data Result: 3 out of 5 hospitals now exceed the target Confirmation that data and wait lists are more accurate Patient choice greatly impacts the wait time; a process is being developed to capture and report this information 11
MRI Scans: LHIN Comparison (FY11/12 Q1 - FY13/14 Q1) MRI Scans: HNHB Facilities (FY11/12 Q1 - FY13/14 Q1) FY13/14 Target: 60% 12
MRI Scans: HNHB LHIN (April 2009 July 2013) Old Indicator: 90th Percentile Wait Time (Days) CT Scans: LHIN Comparison (FY11/12 Q1 - FY13/14 Q1) 13
CT Scans: HNHB Facilities (FY11/12 Q1 - FY13/14 Q1) FY13/14 Target: 85% CT Scans: HNHB LHIN (April 2009 July 2013) Old Indicator: 90th Percentile Wait Time (Days) 14
Diagnostic Imaging: Improvement Process Short Term: Standardizing protocols to be utilized by DI technologists Improving no show appointments Implementing escalation process, monitored weekly by the LHIN Working with front-line staff/leadership to assist in standardization, collaboration, and improved patient experience Long Term: Developing/implementing a LHIN-wide centralized intake process that will ensure the right study, at the right place, at the right time Developing/implementing an appropriateness protocol that will ensure the correct test is being requested by physicians 90th Percentile ER Length of Stay (LOS) Admitted Population 15
LHIN Comparison (FY08/09 Q1 - FY13/14 Q1) HNHB Sites (FY08/09 Q1 - FY13/14 Q1) FY13/14 Target: 28 hours 16
Drivers of LHIN s Performance for this reporting period (April 1- June 30, 2013) 4 LHIN ER sites - 2 hospital corporations - Niagara Health System (NHS) and Joseph Brant Hospital (JBH) that together represent approximately 37% of the admitted patient volumes & consistently reported wait times ranging from 40-60 hours in Q1. HNHB LHIN Actions HNHB LHIN CEO formally requested all HNHB LHIN hospitals and the CCAC make the ED Action Plan for admitted population a priority. LHIN s focus is on the 4 LHIN ER sites driving LHIN performance. LHIN has completed an in-depth analysis of each hospitals ER admitted populations to identify factors contributing to increase demand and patient flow. Discussions have taken place with ER management and ER Chiefs within the NHS to address the issue of admitted patients and to create plans to change the situation. LHIN has implemented weekly monitoring of Pay for Result sites. Percentage of Alternate Level of Care (ALC) Days 17
LHIN Comparison (FY08/09 Q1 FY12/13 Q4) HNHB Sites (FY08/09 Q1 - FY12/13 Q4) FY13/14 Target: 12% 18
Drivers & Actions Drivers of LHIN s Performance for this reporting period (Jan1 March 31, 2013) In Q4 12/13, LHIN hospitals experience a seasonal surge of the admitted population. The total Acute ALC days in Q4 was 31,159 with 2,033 separations - second highest in the province following closely the TC LHIN with 2,100 separations. 3 hospital sites accounted for 52% of the total Acute ALC days for the LHIN Hamilton General (5,585), Juravinski (5,276) and SJHH (5,329). ALC throughput for SJHH, Juravinski, and St. Peter's Hospitals dropped below 1.0 (0.98 / 0.98 / 0.82) which impeded outflow during a time when inflow of acute medical patients surged. In Q4, 67 long stay patients (>30 days ALC) were discharged to LTC representing 8,883 ALC days. 5 individuals were discharged with >300 ALC days that combined represent 5,000 ALC days (2 individuals accounted for 957 days). LHIN Actions The LHIN is reviewing data for Hamilton hospitals for factors contributing to the increased number of ALC days Continued implementation of the ALC Action Plan 90th Percentile Wait Time for CCAC In-Home Services Application from Community Setting to First CCAC Service (excluding case management) 19
LHIN Comparison (FY09/10 Q1 FY12/13 Q4) FY13/14 Target: 28 days Drivers & Actions Drivers of LHIN s Performance for this reporting period (Jan 1- June 31, 2013) The wait time for this metric has for the past two fiscal years increased during this reporting period as the LHIN provides CCAC with one time funding to clear the low acuity wait list. The LHIN has demonstrated continual improvement in the wait time reported over the last three Q4s as a result of the LHIN s increased investment in base funding which has eliminated the need to wait list clients. LHIN Actions The HNHB LHIN anticipates improvement in Q1 Continue to monitor this metric the LHIN did meet its MLPA target for fiscal year 2012-13 20
Repeat Unscheduled Emergency Visits within 30 Days for: Mental Health Conditions Substance Abuse Conditions Mental Health Conditions: LHIN Comparison (FY10/11 Q4 FY12/13 Q3) FY 13/14 Target: 17% 21
Substance Abuse Conditions: LHIN Comparison (FY10/11 Q4 FY12/13 Q3) FY13/14 Target: 22.7% Mental Health & Addictions Improvement Process Enhanced Medical Collaboration Create Mental Health & Addictions physician network Develop and implement care path for hospitals and community Enhance System Performance: Develop and implement score cards for hospitals and community (includes satisfaction surveys) Target Regional Priority Populations Regionally develop and implement concurrent disorder & early intervention strategies for hospitals and community Enhance Integration and Collaboration Niagara zone pilot on community integration 22
Readmission Within 30 Days for Selected CMGs LHIN Comparison (FY11/12 Q1 FY12/13 Q3) 23
HNHB Facilities (FY11/12 Q1 FY12/13 Q3) FY13/14 Target: 15.4% Clinical Cohorts: HNHB LHIN (FY11/12 Q1 FY12/13 Q3) 24
Drivers & Actions Drivers of LHIN s Performance for this reporting period (Oct 1- Dec 31, 2012) The LHIN has shown an improvement quarter over quarter for this indicator since the same reporting period in 2011. This indicator reports on readmission rates for 25 selected case mix groups across 7 medical categories. The LHIN is focusing on the 2 medical categories with the highest rate and high volumes congestive heart failure and chronic obstructive lung disease. LHIN Actions The LHIN has implemented a number of activities that have the potential to impact this metric, these include: HQO - Discharge Transition Bundle (DTB) The Rapid Response Transition Team (RRTT) Early intervention screening for high risk seniors Health Links Diabetes Action Plan Remaining MLPA Indicators 25
Cancer Surgery: LHIN Comparison (FY11/12 Q1 - FY13/14 Q1) Cancer Surgery: HNHB Facilities (FY11/12 Q1 - FY13/14 Q1) FY13/14 Target: 90% 26
Cancer Surgery: HNHB LHIN (April 2009 July 2013) Old Indicator: 90th Percentile Wait Time (Days) Hip Replacement: LHIN Comparison (FY11/12 Q1 - FY13/14 Q1) 27
Hip Replacement: HNHB Facilities (FY11/12 Q1 - FY13/14 Q1) FY13/14 Target: 85% Hip Replacement: HNHB LHIN (April 2009 July 2013) Old Indicator: 90th Percentile Wait Time (Days) 28
Cardiac By-Pass Surgery: LHIN Comparison (FY12/13 Q1 FY13/14 Q1) FY13/14 Target: 90% Cardiac By-Pass: HNHB LHIN (April 2009 July 2013) Old Indicator: 90th Percentile Wait Time (Days) 29
90th Percentile ER Length of Stay (LOS) for Non-Admitted Complex (CTAS IV-V) patients LHIN Comparison (FY08/09 Q1 - FY13/14 Q1) 30
HNHB Sites (FY08/09 Q1 - FY13/14 Q1) FY13/14 Target: 7.5 hours 90th Percentile ER Length of Stay (LOS) for Non- Admitted Minor Uncomplicated (CTAS IV-V) Patients 31
LHIN Comparison (FY08/09 Q1 - FY13/14 Q1) HNHB Sites (FY08/09 Q1 - FY13/14 Q1) FY13/14 Target: 4.5 hours 32
Thank You 65 33