Hamilton Niagara Haldimand Brant LHIN Third Quarter MLPA - - PowerPoint PPT Presentation

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Hamilton Niagara Haldimand Brant LHIN Third Quarter MLPA Performance Report

Presentation to the HNHB LHIN Board of Directors

February 22, 2011

DOING WELL: LHIN has achieved target. ATTENTION AND MONITORING NEEDED: LHIN performance has improved since starting point but target has not been achieved. AT RISK, ACTION REQUIRED: Current LHIN performance has not improved since starting point and target has not been achieved. Source: MOHLTC February 2011

Indicators

• 1-7, & 9-11 Data Oct – Dec 2010
• 8 & 14 July – Sept 2010
• 12,13,15 Data April – June 2010

HAMILTON NIAGARA HALDIMAND BRANT LHIN PERFORMANCE INDICATORS February 11, 2011 Release

PI No. Performance Indicator (PI) Provincial Target LHIN Starting Point or Baseline LHIN FY2010/11 Target 13-Aug-10 12-Nov-10 11-Feb-11 1 90th Percentile Wait Times for Cancer Surgery 1 84 days 58 58 62 60 60 2 90th Percentile Wait Times for Cardiac By-Pass Procedures 1 182 days 48 48 33 27 32 3 90th Percentile Wait Times for Cataract Surgery 1 182 days 104 104 115 131 139 4 90th Percentile Wait Times for Hip Replacement 1 182 days 177 177 190 176 222 5 90th Percentile Wait Times for Knee Replacement 1 182 days 209 182 207 216 217 6 90th Percentile Wait Times for Diagnostic MRI Scan 1 28 days 100 95 112 122 126 7 90th Percentile Wait Times for Diagnostic CT Scan 1 28 days 49 43 42 45 41 8 Percentage of Alternate Level of Care (ALC) Days - By LHIN of Institution 2 9.46% 20.97% 11.00% 19.20% 16.10% 19.30% 9 90th Percentile ER Length of Stay for Admitted Patients 1 8 hours 35.50 28.30 35.37 39.93 36.78 10 90th Percentile ER Length of Stay for Non-Admitted Complex (CTAS I-III) Patients 1 8 hours 8.10 7.50 7.83 7.92 7.93 11 90th Percentile ER Length of Stay for Non-Admitted Minor Uncomplicated (CTAS IV-V) Patients 1 4 hours 5.10 4.50 4.80 4.78 4.72 12 Repeat Unplanned Emergency Visits within 30 Days for Mental Health Conditions 3 TBD 17.10% 15.40% 17.09% 16.29% 17.90% 13 Repeat Unplanned Emergency Visits within 30 Days for Substance Abuse Conditions 3 TBD 19.00% 17.10% 19.64% 21.39% 22.59% 14 90th Percentile Wait Time for CCAC In-Home Services - Application from Community Setting to first CCAC Service (excluding case management) 2, 4 TBD TBD NA 53.00 28.00 26.00 15 Readmission within 30 Days for Selected CMGs 3 TBD 15.10% 14.00% 13.64% 15.19% 15.17%

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90th Percentile Wait Time

• The 90th percentile applied to wait time reporting identifies how long it takes (time) to

provide the service to 90% of the individuals receiving the service.

• It is the maximum time in which 9 out of 10 people waited to receive the service; one (1 )
• ut of 10 people waited as long or longer.

An example:

• In November, 2010 Niagara Health System completed 87 total knee joint replacement

surgeries.

• All 87 cases are sorted by their wait time from the shortest to longest.
• The time that the 90th percentile case waited, i.e. case 79 (calculated as 87*.9 = 79) is

reported as the 90th percentile wait time

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Wait Time in Days # of Cases Cases < 182 days 72 Cases 1 ‐ 72 201‐300 days 13 Cases 73 ‐78 Case 79 Cases 80‐85 >300 days 2 Cases 86 & 87 Total # Cases 87

The 90th percentile wait time reported is the wait of the 79th case = 235 days

Source: HNS Performance Report to the LHIN January 2011

90th Percentile Wait Times for Cancer & Cataract Surgery

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Q 2 09/10 Q 3 09/10 Q4 09/10 Q1 10/11 Q2 10/11 Q3 10/11 HNHB 61 60 61 62 60 60 Target 50 50 50 58 58 58 Province 62 60 62 59 62 57

48 52 56 60 64 Days

90th Percentile ‐ Wait Time Cancer Surgery

Q 2 09/10 Q 3 09/10 Q4 09/10 Q1 10/11 Q2 10/11 Q3 10/11 HNHB 97 107 108 115 131 139 Target 103 103 103 104 104 104 Province 107 112 111 118 127 131

60 90 120 150 Days

90th Percentile Wait Time Cataract Surgery

Source: MOHLTC MLPA February 2011

Cancer Surgery

• Wait times have remained stable since Q2.
• The LHIN is 2 days away from its MLPA target
• Specific cancer surgery wait times are driving the

LHINs wait times Cataract Surgery

• In the Q2 report the LHIN projected that wait times

would continue to increase in Q3 as more long wait cases were completed. The province is seeing a similar trend

• For 2010-11, the net LHIN cataract volume funded

by the Wait Time Strategy was decreased – the decreased volumes have impacted wait times.

• As a mitigation strategy, in January 2011, the LHIN

reallocated unused total joint surgery wait time strategy funds to support an additional 610 cataract cases, which is expected to decrease wait times in Q4

90th Percentile Wait Times for Total Joint Replacement Surgery (Hip &Knee)

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Source: MOHLTC MLPA February 2011

Total Joint Replacement Surgery

• Wait times for knee surgery remained stable in Q3,

while wait times for hip replacement surgery increased by 46 days

• In the Q2 report the LHIN projected that wait times

would increase in Q3 as LHIN hospitals targeted long wait cases (2 Hamilton hospitals reported 20 - 25% of their completed cases were long wait cases)

• Two LHIN hospitals (Hamilton Health Sciences Centre

and Joseph Brant Memorial Hospital) returned wait time strategy funding for these services due to bed availability – patient flow pressures

• Hamilton hospitals experienced increase patient flow

pressure from increased emergency room visits and

• utbreaks at 7 long term care homes preventing

discharge of individuals

• The LHIN expects wait times will remain stable in Q4

Q 2 09/10 Q 3 09/10 Q4 09/10 Q1 10/11 Q2 10/11 Q3 10/11 HNHB 220 213 201 207 216 217 Target 182 182 182 182 182 182 Province 177 180 176 183 201 203

50 100 150 200 250 DAYS

90th Percentile Wait Times Total Knee Replacement Surgery

Q 2 09/10 Q 3 09/10 Q4 09/10 Q1 10/11 Q2 10/11 Q3 10/11 HNHB 168 182 174 190 176 222 Target 182 182 182 177 177 177 Province 160 162 161 170 175 195

100 150 200 250 Days

90th Percentile Wait Times Total Hip Replacement Surgery

90th Percentile Wait Times for MRI Service

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Source: MOHLTC MLPA February 2011

MRI Services

• Wait times increased slightly in Q3, consistent

with provincial trends

• In the Q2 report the LHIN projected wait times

would decrease by March 31, 2011

• The LHIN has received additional funding to

support 3,053 additional MRI hours. This funding is targeted for elective MRI cases which have the longest wait times.

• The LHIN expects wait times to decrease by

the end of Q4

• The LHIN Chiefs of Diagnostic Imaging (DI)

agreed to begin to adopt standardization protocols for CT and MRI.

Q 2 09/10 Q 3 09/10 Q4 09/10 Q1 10/11 Q2 10/11 Q3 10/11 HNHB 99 101 106 112 122 126 Target 87 87 87 95 95 95 Province 107 114 116 114 122 121

60 80 100 120 140 Days

90th Percentile Wait Times MRI

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Percentage Alternate Level of Care

Note: Percentage Alternate Level of Care Days is Calculated

using HNHB LHIN Hospital Discharge Abstract Database and is not the same methodology used to calculate and report on current LHIN performance. Q 1 09/10 Q 2 09/10 Q 3 09/10 Q4 09/10 Q1 10/11 Q2 10/11 ALC (DAD Data) 23.24 23.11 18.07 19.2 16.1 19.3 ALC (LHIN Internal Data ‐ last month

• f the quarter)

21.8 17.1 15.2 14.3 13.3 15.3 Target 14 14 14 11 11 11 5 10 15 20 25 30 Days

Acute ALC Rate

• The Q3 performance report is based on July – September

2010 data.

• Acute ALC Rate (DAD Data) is the length of time an

individual waits in an acute care bed starting from the time their acute care treatment ended to the time they were discharged to their most appropriate destination (e.g., rehab, complex care, long term care (LTC))

• In the Q2 report the LHIN projected that the Acute ALC

Rate (DAD Data) would increase in Q3.

• This is a result of placing 89 individuals waiting longer

than 40 days in hospital to LTC care during this period. Of the 89 individuals placed, 25 accumulated 10,666 ALC days .

• The LHIN anticipates the ALC (DAD) will continue to

increase in the next quarter as hospitals discharge more individuals with long waits.

Data Source: CIHI DAD, Hospital Weekly ALC Reports

Source: HNHB CCAC ALC Report 2011 131 156 109 84 74 72 60 43 44 62 53 48 69 59 55 68 59 85 65 47 63 20 40 60 80 100 120 140 160 180 Number Months

Newly Designated ALC-LTC in Acute Care Beds

96 82 106103 71 44 44 51 41 40 70 48 54 62 33 20 33 76 51 88 87 20 40 60 80 100 120 140 Number Months

Hospital Patients Discharged to LTCH from all Hospital Beds

ALC – Achievements

• The number of individuals newly identified

as needing to wait in hospital for long term care home (LTCH) admission is lower than the number of individuals that are discharged from hospital to LTCH

• For the LHIN to sustain and continue to

reduce the ALC rate the number of individuals newly identified must be lower than the number discharged to LTCH

Source: HNHB CCAC ALC Report 2011

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Individuals Waiting in Hospital for Admission to LTC

Definition: Count of patients (ALC-LTC only) on the last day of the month who are currently in a hospital (acute and other inpatient beds) and who are on a waitlist for a long-stay LTCH bed.

333 325 337 351 360 308 289 269 236 50 100 150 200 250 300 350 400 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Number Months

Hospital Patients Active for LTCH Placement Placed

• Number of individuals waiting

in hospital for long term care placement lowest in 9 months ( 236)

• Of the 257 individuals

indentified by the Ministry of Health and Long Term Care’s long wait survey in the July 2010, only 40 remain in hospital as of January 21, 2011.

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90th Percentile ER Admitted Patient Length of Stay (LOS)

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Q 2 09/10 Q 3 09/10 Base Line Q1 10/11 Q2 10/11 Q3 10/11 HNHB 31.6 33.3 37.7 35.4 39.9 36.78 Target 28.3 28.3 28.3 Province 30.28 30.78 32.15

5 10 15 20 25 30 35 40 45 Hours

90th percentile Emergency Room Length

• f Stay for Admitted Patients

Source: MOHLTC MLPA February 2011

ER LOS for Admitted Patients

• The ER LOS improved in Q3 by 3.2 hours, in contrast to the

province where ER LOS increased

• Factors that impact this indicator include: availability of inpatient

beds, increased high acuity volumes, infection control practices and outbreaks (hospital & LTCH)

• The Niagara Health System has made substantial improvement

at three of its sites for this indicator ranging from 8 – 17 hours.

• The LHIN continues to meet with those hospitals that are

reporting high wait times i.e 79 hours

• The CCAC is working with LHIN hospitals to facility discharge of

individuals to the most appropriate level of care

• In Q4, the LHIN projects improvement but does not expect to

meet the MLPA target.

90th Percentile High & Low Acuity Non Admitted ER

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Source: MOHLTC MLPA February 2011

ER High Acuity and Low Acuity LOS

• Wait times for high acuity individuals remained

stable in Q3, while wait times for low acuity individuals showed slight improvement

• These indicators were impacted by increased ER

demand related to flu like conditions in Q3, which continued in to January 2011

• Of note the Pay for Results performance

measures shows that LHIN hospitals are increasing the percent of individuals treated within recommended wait time (different measurement methodology)

• The LHIN expects that the wait times for these

indicators will remain stable or decreased slightly in Q4.

Q 2 09/10 Q 3 09/10 Q4 09/10 Q1 10/11 Q2 10/11 Q3 10/11 HNHB 8 7.9 8 7.8 7.9 7.93 Target 7.5 7.5 7.5 Province 7.62 7.55 7.52 3 6 9 Hours

90th percentile Emergency Room Length of High Acuity NonAdmitted Patients

Q 2 09/10 Q 3 09/10 Q4 09/10 Q1 10/11 Q2 10/11 Q3 10/11 HNHB 5 5.1 5 4.8 4.8 4.72 Target 4.5 4.5 4.5 Province 4.4 4.38 4.27 2 4 6 8 Hours

90th percentile Emergency Room Length of Low Acuity NonAdmitted Patients

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MLPA Indicators for Mental Health (MH), Substance Abuse (SA) Conditions & Readmission Rates for Selected CMGs

• All three are LHIN priorities
• The LHIN’s performance aligns with the provincial trend for all three
• The data reported for these indicators is for April – June 2010 (9 months behind)
• The LHIN is working with MH and SA providers to identify factors contributing to the

percent of unplanned ER visits for this population, however strategies implemented in 2010-11 will not be reflected until 2011-12

• The indicator targeting readmission rates includes multiple clinical conditions (25) and it

will take time to initiate behavioural change, as such improvement in this indicator is expected to be seen over the long term.

• LHIN funding programs targeting these population include: transitional recovery unit at

Salvation Army, Wayside house, Claremont House, Internal Medicine Rapid Assessment Clinic, Triple Aim

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Questions?