Central East LHIN Strategic Aims

Transcription

1 Central East LHIN Strategic Aims Mental Health and Addictions Strategic Aim Update December 16, 2015 Presented By: Dr. Ian Dawe, Jai Mills and Marilee Suter

2 Agenda Background and Overview Aim Metrics Update Priority Projects Expansion of Established Initiatives Status of New Initiatives Next Steps 2

3 Background and Overview Central East LHIN Mental Health and Addictions Strategic Aim 3

4 Background and Overview Aim: Strengthen the system of supports for people with Mental Health and Addictions issues so they spend 15,000 more days at home in their communities by

5 Background and Overview (cont d) Increasing Community Supports and Capacity will: Reduce the number of Psychiatric In-Patient hospital days; Reduce the number of Unscheduled Return Visits for Mental Health and Addictions Issues within 30 days of the first visit; Improve the service user experience; and Support people in returning to their natural supports and communities sooner. 5

6 Aim Metrics Update Central East LHIN Mental Health and Addictions Strategic Aim 6

7 Patient Days Cumulative Days Saved Aim Metrics Update Mental Health & Addictions 30,786 35,000 30, ,426 25,000 20,000 15, ,416 10,000 5, Cumulative Days Saved Estimated Patient Days Projected Patient Days - Cumulative Days Saved: the purple bars represent the difference between the projected total number of patient days (red line) and the actual total number of patient days (blue line). Estimated Patient Days: the red line represents a projection of what the total number of patient days would potentially be based on 3 years of historical data. Projected Patients Days: the blue line on the graph represents what the actual number of total patient days is for each fiscal year. Until the actual values are known, estimated values based on the aim assumptions are used. 7

8 Supporting Indicators Definitions Terms Baseline Central East LHIN Target Current Performance Current Status Direction Definition Where there is sufficient data, the baseline is the average of the two most recent fiscal years. The formal Central East LHIN target for that indicator (typically developed for use in existing scorecards, such as the MLPA). This formal target is indicated by bold formatting. Where there is no formal target, the baseline less 10% is used as an informal Central East LHIN Target. The Central East LHIN performance for the indicator using the most current data available. The current performance is compared with the CE LHIN target and the result is summarized by a colored dot following the parameters below: A red dot indicates that the current performance deviates from the desired target by more than 10%. A yellow dot indicates that the current performance is within 10% of the target A green dot indicates that the current performance meets the target or is performing better than the desired target The direction of the data uses all the data from the baseline and any additional data, up to and including the most current data available. A gray arrow indicates that there are at least 7 data points available to calculate the direction of the data. A white arrow indicates that there are fewer than 7 data points available. The direction of data should be interpreted with caution. 8

9 Mental Health and Addictions Aim Supporting Indicators Indicator Baseline CE LHIN Target Time Period for Current Performance Current Performance Current Status Trend CMH&A - Repeat Unscheduled Emergency Visits Within 30 Days For Mental Health Conditions (Goal: decrease) 18.2% 17.0% 15/16 Q1 19.6% CMH&A - Repeat Unscheduled Emergency Visits Within 30 Days For Substance Abuse Conditions (Goal: decrease) 23.5% 22.5% 15/16 Q1 28.6% Proportion of discharges sent home rather than to an institution for patients with a behaviour support diagnosis (Goal: increase) 60.9% 67.0% 15/16 Q1 62.6% Transfers from LTC to ED; MH patients only, Rate per 1000 (Goal: decrease) /15 Q Note: Bold text indicates a formal Central East LHIN Target 9

10 Summary Central East LHIN continues to struggle to meet the target for Repeat Emergency Department (ED) visits for both Mental Health and Substance Abuse conditions. This is partially due to data collection and methodology issues. Central East LHIN continues to perform better than the Province for discharges sent home rather than to an institution for patients with a behaviour-support related diagnosis home. This positive achievement may be attributed to the Nurse Practitioners Supporting Teams Averting Transfers (NPSTAT) and Behavioural Supports Ontario (BSO) programs in Long-Term Care Homes (LTCH). Although there has been an increase in the number of transfers from LTCH to ED in Q4, we are within normal variation and it is expected that this rate will decrease in FY 2015/16. 10

11 PRIORITY PROJECTS: Expansion of Established Initiatives Status of New Initiatives Central East LHIN Mental Health and Addictions Strategic Aim 11

12 Priority Projects Central East LHIN Mental Health and Addictions Coordinating Council provides monitoring and oversight to the Central East LHIN s Mental Health and Addictions Strategy. Each Priority Project is aligned with each Central East LHIN Health Link. Central East LHIN Mental Health and Addictions Physician Lead, Dr. Ian Dawe is the Council Co-Chair and provides outreach and expert advice to the sector and the system. 1. Community Crisis Review Priority Project completed its first phase as of March 31, 2015, and has now entered Phase Child and Adolescent Hospital Based Services Project has completed its Implementation Plan and is now entering its Implementation Phase. 3. ACTT Together Priority Project submitted its Project Report to the Central East LHIN on May 31, 2015, and is now providing oversight to ensure continued Quality Improvement. 12

13 Community Crisis Review Approach: Extensive consultations were held throughout the LHIN in order to obtain feedback from a wide variety of service users and potential service users. A data review and utilization analysis were completed. Recommendations: 10 Priority recommendations including: Standardization of services and processes across the LHIN; Improved communication; and Collaboration between Health Service Providers and across the system generally, collaboration with other service providers to develop a Shared Care Model. Status: Central East LHIN has endorsed the request of the Steering Committee to proceed to Phase 2. Next Steps: Phase 2 has been initiated and will develop an Implementation Plan for the recommendations and identified early opportunities for investment in the Summer/Fall of Full report will be completed by March 31,

14 Child and Adolescent Hospital Based Mental Health Services Project Objective: Develop recommendations regarding the future state of child and adolescent hospital based Mental Health Services in the Central East LHIN. Approach (Completed in Phases 1 and 2): Identified the current state of how children and adolescents are accessing mental health services and forecasted future demand; Conducted an environmental scan of international leading practices; and Formed an Advisory Committee to develop a future state model to better address gaps and an implementation plan for that model. Future State Model (as of March 31, 2016): Status: Has identified opportunities to close gaps. Next Steps: The LHIN has provided approval to move to the implementation stage. The project will oversee the standardization of hospital based services, access, branding and eligibility across all sites within the Central East LHIN. 14

15 ACTT Together 90 clients across the LHIN have been transitioned to the Stepped Care service exceeding the Project Target of 1-2 clients per month. An additional 104 Clients have been admitted to ACTT service across the Central East LHIN. These newly admitted clients had a combined total of over 17,700 Psychiatric Hospital Bed Days in the two years prior to their admission to ACTT. 50% of the three year target has been achieved in Year 1 of implementation. 95% of the clients who have transitioned to Stepped Care have maintained their level of recovery and report an increased level of satisfaction with services. 15

16 Expansion of Established Initiatives: Hospital to Home Hospital to Home, (H2H) is an evidence-based Emergency Department, (ED) diversion model intended to connect frequent ED visitors with the services they require in order to reduce their multiple visits for the same issue. H2H has expanded from Lakeridge Health Oshawa to include full implementation at: o o o The Scarborough Hospital; Rouge Valley Health System Centenary Site; and Peterborough Regional Health Centre. With less intensive implementation at Northumberland Hills Hospital. H2H has now been implemented in all Health Link communities across the LHIN. 16

17 Expansion of Established Initiatives: Hospital to Home (cont d) Consultations have been held with the Aboriginal communities throughout the LHIN which have resulted in a recruitment strategy for the Aboriginal Outreach Workers. These workers are now in place in the Durham and Northeast Clusters. A reporting mechanism is now in place. As of January 2016, Peer Support will be added to the H2H Teams located at Lakeridge Oshawa, and Ross Memorial Hospital. Peer Support refers to an evidence driven model of providing Recovery based services to people with Mental Health and/or Additions issues using Lived Experience as a skill set. 17

18 Status of New Initiatives As approved by the Central East LHIN Board on December 17, 2014 Children s Developmental Assessment Increase: TSH has implemented this improvement. Rental Supplements and Intensive Case Management : 12 new Rental Supplement Units; 1.5 FTE Intensive Case Management Supports; and Year 2 Allocations continue to be pending Ministry approval. Housing Now Projects: Full implementation has been achieved. Housing Coordinators: In place and working to establish relationships with their respective municipalities. Base Funding and Expansion of the New Leaf Peer Support Program: Implemented. 18

19 Next Steps Central East LHIN staff will partner with cross-sectorial partners to implement the expected Rent Supplement and attached Intensive Case Management resources pending Ministry funding letter, anticipated this fiscal year. Implementation of a wrap around Support within Housing service in Scarborough that will support precariously housed people residing in Toronto Community Housing. The addition of Peer Support to the Durham and Northeast Hospital to Home Programs. 19

20 Next Steps (cont d) Implementation of the Mental Health and Addictions Shelter Outreach Pilot in Oshawa. This Pilot was approved by the Board on November 23, 2015 and will repurpose the Oshawa Community Crisis Bed funds for one year to support Mental Health and/or Addictions Outreach to the Violence Against Women and Homelessness Shelters located throughout the East Durham area. Alignment of Mental Health and Addictions Priority Projects within each of the Health Link communities. The Central East LHIN Mental Health and Addictions Coordinating Council will develop their Strategic Aim Achievement workplan for IHSP 4:

21 Discussion Central East LHIN Mental Health and Addictions Strategic Aim 21

22 Appendix Supporting Indicators Central East LHIN Mental Health and Addictions Strategic Aim 22

23 13/14 Q2 13/14 Q3 13/14 Q4 14/15 Q1 14/15 Q2 14/14 Q3 14/14 Q4 15/16 Q CMH&A - Repeat Unscheduled Emergency Visits Within 30 Days For Mental Health Conditions (Goal - decrease) UCL LCL CE LHIN Center UCL LCL 5.00 Prov Target 0.00 Analysis: From Q1 14/15 to Q1 15/16, there has been very little change in the rate of repeat ED visits for Mental Health conditions. Comparing to LHINs with similar geography, demographics and service availability, interim data shows that Central East LHIN had a higher percentage of returning patients than Central LHIN but a lower percentage than Central West LHIN in Q1 15/16. Central East LHIN did not meet the new Provincial target of 16.30%. Data Source: MLPA Supplementary Data by HAB, MOHLTC 23

24 13/14 Q2 13/14 Q3 13/14 Q4 14/15 Q1 14/15 Q2 14/14 Q3 14/14 Q4 15/16 Q CMH&A - Repeat Unscheduled Emergency Visits Within 30 Days for Substance Abuse Conditions (Goal - decrease) UCL LCL CE LHIN Center UCL LCL Prov Target 0.00 Analysis: From Q3 14/15 to Q1 15/16 there has been an increase from 23.05% to 28.61%. The Provincial rate also increased during this time and is currently 33.8%. H2H Outcome Evaluation did show an overall reduction in returns, but a high and increasing number of new ED visitors at LHO. This is attributable to: transitory nature of the community, economic challenges, proximity of court and correctional facilities, most affordable rent in Durham, and the presence of a Tertiary Care Centre that serves two LHINs. Oshawa is the most affordable community so people tend to settle there following discharge from Ontario Shores. Lakeridge Health has been tracking these new visitor numbers and they are quite significant. Comparing to LHINs with similar geography, demographics and service availability, interim data shows that Central East LHIN had a lower percentage of returning patients in Q1 15/16 (data not shown). Central East LHIN did not meet the new Provincial target of 22.40%. Data Source: MLPA Supplementary Data by HAB, MOHLTC 24

25 11/12 Q1 11/12 Q2 11/12 Q3 11/12 Q4 12/13 Q1 12/13 Q2 12/13 Q3 12/13 Q4 13/14 Q1 13/14 Q2 13/14 Q3 13/14 Q4 14/15 Q1 14/15 Q2 14/15 Q3 14/15 Q4 15/16 Q1 80.0% Proportion of discharges sent home rather than to an institution for patients with a behaviour-support related diagnosis home (Goal - increase) 70.0% 60.0% UCL LCL 50.0% 40.0% 30.0% 20.0% CE LHIN Center UCL LCL Ontario 10.0% 0.0% Analysis: There has been a slight increase in percentage of inpatients with a behaviour-support related diagnosis who were discharged home rather than to an institution in the last three quarters from 60% in Q4 14/15 to 62.6% in Q1 15/16. The separation between MH and SA is increasingly artificial since many people are living with both conditions. Added to the rationale for a high number of revisits is the presence of a Provincial Addictions Treatment Facility (Pinewood) with a large number of methadone registrants in the areas immediately adjacent to both LHO and PRHC. It has also become evident that a large number of highly complex people are using the Durham shelter system These facilities are not able to adequately support the needs of these people, so they often visit the LHO emergency department as a result. Data Source: DAD, CIHI from IntelliHealth, MOHLTC 25

26 10/11 Q1 10/11 Q2 10/11 Q3 10/11 Q4 11/12 Q1 11/12 Q2 11/12 Q3 11/12 Q4 12/13 Q1 12/13 Q2 12/13 Q3 12/13 Q4 13/14 Q1 13/14 Q2 13/14 Q3 13/14 Q4 14/15 Q1 14/15 Q2 14/15 Q3 14/15 Q4 Rate per Transfers from LTC to ED; MH patients only, Rate per 1000 (Goal - decrease) UCL LCL CE LHIN Center UCL LCL Ontario 0.0 Analysis: For the past two fiscal years, Central East LHIN has been below the provincial transfer rate per 1000 long-term care residents. Most recently, while remaining within the range of normal variation, the Central East LHIN rate increased from 8.1 in Q4 14/15 to 10.2 in Q1 15/16 for mental health reasons. This increase may be related to the growing complexities of those admitted to LTC, along with issues related to the management of Responsive Behaviours and their legal implications. Data Source: NACRS, CIHI from CIHI Portal 26