WATERLOO WELLINGTON LOCAL HEALTH INTEGRATION NETWORK SYSTEM PERFORMANCE REPORT

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1 WATERLOO WELLINGTON LOCAL HEALTH INTEGRATION NETWORK SYSTEM PERFORMANCE REPORT Q1 2011/2012

2 Glossary of Terms WWLHIN Waterloo Wellington Local Health Integration Network CMH Cambridge Memorial Hospital GGH Guelph General Hospital GMCH Groves Memorial Community Hospital GRH Grand River Hospital LMH Louise Marshall Hospital PDH Palmerston District Hospital NWHC North Wellington Health Care SMGH St. Mary s General Hospital CIHI Canadian Institute for Health Information CHF Congestive Heart Failure COPD Chronic Obstructive Pulmonary Disease GI Gastrointestinal CARD Cardiovascular DM Diabetes Mellitus PNEU Pneumonia CVA Cerebrovascular Accident (Stroke) NACRS National Ambulatory Care Reporting System Census Data Data collected by hospitals that have not been screened and remain as open cases CCAC Community Care Access Centre MOHLTC Ministry of Health and Long-Term Care ED Emergency Department ALC Alternate Level of Care; when a patient has complete their inpatient acute care and is waiting for additional health care services in the community or long-term care LTC Long-Term Care Target an agreed upon level of performance outlined in the Ministry-LHIN Performance Agreement (MLPA) and/or Integrated Health Services Plan (IHSP) Variance calculated as a percentage change over a period timeframe

3 Reading the Report For each indicator, a graph depicting historic performance is displayed. Accompanying each graph is an agreed upon target and a table showing how the current period compares to the previous period and year. Variances are calculated lated based on the performance of the indicator from a year or quarter before, or from a baseline. Values in green denote improved system performance; values in red represent declining performance. Arrows are used to show if the variance is up or down and is based on the measurement employed.

4 Quality Hospital Standardized Mortality Rates Readmission Rates for Select Case Mix Groups & Chronic Diseases Wait Times for Surgical & Diagnostic Imaging

5 Hospital Standardized Mortality Rate WWLHIN HSMR Q Q Q WWLHIN % 110 CMH % 100 GGH % GMCH % Target: 90 GRH % LMH % PDH % SMGH % 70 Data Source: CIHI HSMR Reporting Notes: Standardized rate (or National Average) = Q1 04/05 Q1 05/06 Q1 06/07 Q1 07/08 Q1 08/09 Q1 09/10 Q1 10/11

6 Readmission Within 30 days For Select Case Mixed Groups % 17.0% 16.0% WWLHIN Readmission Within 30 days For Select Case Mixed Groups Q Q Q WWLHIN 13.6% 13.2% 13.5% 1% 15.0% 14.0% Data Source: Discharge Abstract Database; Readmission % of all ED Visits 13.0% 12.0% Target: 14% 11.0% 10.0% 0% Q1 05/06 Q1 06/07 Q1 07/08 Q1 08/09 Q1 09/10 Q1 10/11

7 Readmission Rates within 30 days for Specific Chronic Diseases % WWLHIN Readmission Rates within 30 WWLHIN days for Specific Chronic Diseases CVA 5.5% 7.6% 28% COPD 16.9% 18.5% 9% 20.00% CHF 18.2% 17.4% 5% 15.00% CHF COPD GI CARD 11.1% 12.4% 10% DM 9.3% 9.7% 4% 10.00% CARD DM PNEU GI 15.2% 15.4% 1% PNEU 8.3% 11.3% 27% CVA 5.00% Data Source: Discharge Abstract Database; Readmission % of all ED Visits Notes: These data refresh every fall for the previous calendar year. 0.00%

8 Cancer Surgery Wait Time WWLHIN Cancer Surgery Wait Time Mar 11 Feb 11 Mar 10 WWLHIN % CMH % GGH % SMGH % GRH % 50 Data Source: Wait Times Information Office/Access to Care- Cancer Care Ontario; 90 th Percentile Wait Time in days 40 Target: 49 days Aug '07 Feb '08 Aug '08 Feb '09 Aug '09 Feb '10 Aug '10 Feb '11

9 Cardiac Surgery Wait Time WWLHIN Cardiac Surgery Wait Time Feb11 Jan 11 Feb 10 WWLHIN % Data Source: Wait Times Information Office/Access to Care- Cancer Care Ontario; 90 th Percentile Wait Time in days Notes: SMGH is the only source for cardiac wait times data Target: 34 days 0 Aug '07 Feb '08 Aug '08 Feb '09 Aug '09 Feb '10 Aug '10 Feb '11

10 Cataract Surgery Wait Time WWLHIN Cataract Surgery Wait Time Mar 11 Feb 11 Mar 10 WWLHIN % 110 CMH % 100 GGH % 90 SMGH % Target: 76 days Data Source: Wait Times Information Office/Access to Care- Cancer Care Ontario; 90 th Percentile Wait Time in days Aug '07 Feb '08 Aug '08 Feb '09 Aug '09 Feb '10 Aug '10 Feb '11

11 Hip Replacement Wait Time WWLHIN Hip Replacement Wait Time Mar 11 Feb 11 Mar 10 WWLHIN % CMH % GGH % GRH % Data Source: Wait Times Information Office/Access to Care- Cancer Care Ontario; 90 th Percentile Wait Time in days 80 Target: 103 days Aug '07 Feb '08 Aug '08 Feb '09 Aug '09 Feb '10 Aug '10 Feb '11

12 Knee Replacement Wait Time WWLHIN Knee Replacement Wait Time Mar 11 Feb 11 Mar 10 WWLHIN % CMH % GGH % 200 GRH % Target: 115 days Data Source: Wait Times Information Office/Access to Care- Cancer Care Ontario; 90 th Percentile Wait Time in days 50 0 Aug '07 Feb '08 Aug '08 Feb '09 Aug '09 Feb '10 Aug '10 Feb '11

13 CT Scan Wait Time WWLHIN CT Scan Wait Time Mar 11 Feb 11 Mar 10 WWLHIN % 50 CMH % 40 GGH % SMGH % 30 GRH % 20 Target: 28 days Data Source: Wait Times Information Office/Access to Care- Cancer Care Ontario; 90 th Percentile Wait Time in days 10 0 Aug '07 Feb '08 Aug '08 Feb '09 Aug '09 Feb '10 Aug '10 Feb '11

14 MRI Scan Wait Time WWLHIN MRI Scan Wait Time Mar 11 Feb 11 Mar 10 WWLHIN % GGH % GRH % Data Source: Wait Times Information Office/Access to Care- Cancer Care Ontario; 90 th Percentile Wait Time in days Target: 28 days 20 0 Aug '07 Feb '08 Aug '08 Feb '09 Aug '09 Feb '10 Aug '10 Feb '11

15 Emergency Department Emergency Department Utilization & Diversion Repeat Unplanned ED Visits for Mental Health and Substance Abuse Conditions Referring Residents to Primary Care Providers Emergency Department Performance by Hospital

16 Admitted Patients All Acuity WWLHIN 90th Percentile ED Length of Stay (hours) and Proportion Seen Within Target of 8 hours for Admitted Patients 80% Feb 11 Jan 11 Feb 10 CMH % % GRH % Target: 20 hours Target: 90% 40% 20% GMCH % 0.0 0% GGH % SMGH % Admitted Patients - 90th Percentile ED Length of Stay (hours) Admitted Patients - Proportion Seen Within Target WWLHIN Feb 11 Jan 11 Feb 10 ED Length of Stay % Data Source: NACRS; 90 th Percentile Wait Time in hours Proportion Seen Within Target 39% 41% 49% 20%

17 Non-Admitted High Acuity Patients WWLHIN 90th Percentile ED Length of Stay (hours) and Proportion Seen Within Target of 8 hours for Non-Admitted High Acuity Patients 100% Feb 11 Jan 11 Feb 10 CMH % 7.5 Target: 6.8 hours Target: 90% 75% GRH % GMCH % % GGH % Non-Admitted CTAS th Percentile ED Length of Stay (hours) SMGH % Non-Admitted CTAS Proportion Seen Within Target WWLHIN Feb 11 Jan 11 Feb 10 ED Length of Stay % Data Source: NACRS; 90 th Percentile Wait Time in hours Proportion Seen Within Target 91% 91% 84% 8%

18 Non-Admitted Low Acuity Patients WWLHIN 90th Percentile ED Length of Stay (hours) and Proportion Seen Within Target of 4 hours for Non-Admitted Low Acuity Patients Target: 4.1 hours Target: 90% 100% 75% 50% 25% 0% Feb 11 Jan 11 Feb 10 CMH % GRH % GMCH % GGH % SMGH % Non-Admitted CTAS th Percentile ED Length of Stay (hours) Non-Admitted CTAS Proportion Seen Within Target WWLHIN Feb 11 Jan 11 Feb 10 ED Length of Stay % Data Source: NACRS; 90 th Percentile Wait Time in hours Proportion Seen Within Target 80% 79% 80% 0%

19 Time to Physician Initial Assessment WWLHIN Time to Physician Initial Assessment Target: 4.5 hours Feb 11 Jan 11 Apr 10 Apr 10 Baseline WWLHIN % CMH % GRH % GMCH % GGH % SMGH % Data Source: NACRS; 90 th Percentile Wait Time in hours Notes: Time to Physician i Initial i Assessment (PIA) is measured through 4 performance indicators. Presented is the P4R indicator; Time to Physician Initial Assessment: Triage date/time to date/time of Physician Initial assessment.

20 Repeat Unplanned ED Visits within 30 days for Mental Health Conditions % WWLHIN Repeat Unplanned ED Visits within 30 days for Mental Health Conditions FY 09/10 FY 08/09 WWLHIN** 12.7% 14.5% 12% GGH 12.8% 15.3% 16% 20.0% CMH 15.3% 14.7% 4% 15.0% GRH 11.3% 14.1% 20% GMCH 11.0% 19.9% 45% 10.0% Target: 11.6% SMGH 14.0% 14.0% 0% 5.0% Q1 07/08 Q3 07/08 Q1 08/09 Q3 08/09 Q1 09/10 Q3 09/10 Q1 10/11 LMH 12.1% 10.3% 17% PDH 10.8% 7.1% 52% Q Q Q WWLHIN* 13.2% 10.9% 12.4% 6% Data Source: NACRS, Ontario MOHLTC; Readmission % of all ED Visits Notes: *By Patient LHIN; **By Hospital

21 Repeat Unplanned ED Visits within 30 days for Substance Abuse Conditions % 20.0% 15.0% 10.0% WWLHIN Repeat Unplanned ED Visits within 30 days for Substance Abuse Conditions Target: 16.8% FY 09/10 FY 08/09 WWLHIN** 19.4% 19.4% 0% GGH 14.1% 16.2% 13% CMH 13.0% 19.3% 33% GRH 22.9% 21.1% 9% SMGH 27.0% 23.7% 14% 5.0% Q1 07/08 Q3 07/08 Q1 08/09 Q3 08/09 Q1 09/10 Q3 09/10 Q1 10/11 Q Q Q WWLHIN* 24.9% 18.1% 21.4% 16% Data Source: NACRS, Ontario MOHLTC; Readmission % of all ED Visits Notes: *By Patient LHIN; **By Hospital Volumes small for GMCH, LMH, and PDH

22 Health Care Connect Patients referred 22 to Physician i WWLHIN Health Care Connect 80.00% Referrals to Physician 70.00% 60.00% 50.00% 40.00% 30.00% Mar 11 Feb 11 Mar 10 WWLHIN % 39.5% 43.2% 21% WWLHIN % 44.7% 39.1% 13% 20.00% 10.00% 0.00% Initial AgSept Aug-Sept Dec '09 Feb '10 Apr-May Jl July-Aug Ag Dec '10 Feb '11 '09 '10 '10 Data Source: Health Care Connect Notes: 1 Monthly Referrals; 2 Cumulative Referrals Percentage of registered Health Care Connect patients referred to physician - Monthly Percentage of registered Health Care Connect patients referred to physician since program inception (Feb '09)

23 Alternate Level of Care Acute and All ALC Days Discharge Destination of ALC Home First Philosophy

24 Acute ALC Days WWLHIN Acute ALC Days Mar 11 Feb 11 Mar 10 WWLHIN % CMH % GGH % GMCH % GRH % NWHC % SMGH % Data Source: Hospital Monthly Reports Census Data; sum of each Acute ALC patient s length of stay 0 Jan '09 July '09 Jan '10 July '10 Jan '11

25 Acute ALC % 25 WWLHIN % Acute ALC 25.00% 20.00% Q Q Q WWLHIN 18.56% 14.77% 16.81% 10% 15.00% Target: 12.51% 10.00% Data Source: CIHI-Discharge Abstract Data 5.00% 0.00% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 08/09 08/09 08/09 08/09 09/10 09/10 09/10 09/10 10/11 10/11

26 26 Time to Discharge of Acute ALC Patients and Discharge Destination of Acute ALC WWLHIN 90th Percentile days from ALC Designation to Discharge by Discharge Destination WWLHIN ALC Days: Acute Beds by Destination (FY 10/11) Retirement Home/Return Home 5.0% Rehab 20.7% Palliative 8.7% Restorative 1.4% Other 7.4% 0 Q3 08/09 Q1 09/10 Q3 09/10 Q1 10/11 Q3 10/11 1.0% Mental Health/ Neurobehavioural CCAC 6.1% Complex Medicine 3.0% Convalescent Care 2.3% LTC/Nursing Home 44.5% Q Q Quarter WWLHIN % GMCH % CMH % GGH % SMGH % GRH % Data Sources: Access to Care-Cancer Care Ontario (left; 90 th Percentile Length of Acute ALC stay) and Hospital Monthly Reports Census Data (above; sum of each Acute ALC patient s length of stay based on for which h destination i they are waiting) i

27 All ALC Days WWLHIN All ALC Days Mar 11 Feb 11 Mar 10 WWLHIN % 6000 CMH % GGH % GMCH % GRH % NWHC % SMGH % 1000 Data Source: Hospital Monthly Reports Census Data; sum of each ALC patient s length of stay 0 Apr '09 Oct '09 Apr '10 Oct '10

28 Discharge Destination of All ALC 28 WWLHIN ALC Days: All Beds by Destination (FY 10/11) Retirement Home/Return Home 3.7% Restorative 1.0% Rehab 15.4% Other 5.9% CCAC 4.5% Complex Medicine 2.2% Convalescent Care 1.7% Palliative 6.5% Mental Health/ Neurobehavioural 0.8% LTC/Nursing Home 58.3% Data Source: Hospital Monthly Reports Census Data; sum of each ALC patient s length of stay based on for which destination they are waiting)

29 Number of New LTC Placement Rf Referrals Done in Hospital itl 29 WWLHIN Number of New LTC Placement Rf Referrals Done in Hospital itl Mar 11 Feb 11 Mar 10 WWLHIN % Data Source: CCAC/WWLHIN Home First Scorecard 30 Target: Apr '09 July '09 Oct '09 Jan '10 Apr '10 July '10 Oct '10 Jan '11

30 30 90 th Percentile Wait Time for CCAC In-Home Services Application from Community Setting to First CCAC Service (excluding case management) WWLHIN 90th Percentile Wait Time in days for CCAC In-Home Services - Application from Community Setting to First CCAC Service (excluding case management) Q Q Q WWLHIN % Data Source: Home Care Database, Ontario MOHLTC; 90 th Percentile Wait Time in days Q4 08/09 Q1 09/10 Q2 09/10 Q3 09/10 Q4 09/10 Q1 10/11 Q2 10/11

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