Infrastructure of Rural Vitality:

Transcription

1 Infrastructure of Rural Vitality: The Future of Rural Health Services Jim Whaley Rural Vitality Conference (May 23, 2008)

2 Presentation Overview Rural Health Reality Hard Infrastructure: E-health Soft Infrastructure: Regionalized Networks of Care

3 Rural Reality

4 Report Conclusion Rural residents in Canada are more likely: to be in poorer socioeconomic conditions; to have lower educational attainment; to be involved in economic activities with higher health risks (e.g. farming, mining, logging etc.) and to exhibit less desirable health behaviours.

5 Conclusion (cont d) These factors may be compounded by less access to prevention, early detection, treatment or support services to make good health status even more difficult to achieve in rural or remote areas.

6 Inverse Care Law Inverse Care Law = people in rural communities have poorer health status and greater needs yet they have greater difficulty accessing required health services Romanow report, 2002

7 Key Findings from SE LHIN s Integrated Health Services Plan (Fall 2006) Oldest population profile of any LHIN Most rural population in Southern Ontario Limited access to primary health care High risk factors for many chronic diseases Transportation for non-urgent medial care is a major problem

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9 Population per Square Kilometre for SE LHIN Sub-Areas SE LHIN Sub-Area Belleville Kingston and Islands Quinte West Brockville SE Leeds Grenville Tyendinaga Napanee Grand Total Smiths Falls, Perth, Lanark Prince Edward County Gananoque Leeds Stone Mills Loyalist South Frontenac Rideau Lakes Central Hastings North Hastings Addington N/C Front Population per Sq. Km

10 The Geography of Health In the past few years, increasing attention has been given to the role of place in shaping people s health experiences. However, most of the theoretical work on place and health has been based on studies of urban environments. CIHI, How Healthy Are Rural Canadians?, 2006, p. i

11 Place is now recognized as a determinant of health

12 E-Health and Rural Health Care? What happens if we remove geography from the delivery of health care?

13 The Death of Distance? The Internet offers a glimpse of the future a world where transmitting information costs almost nothing, where distance is irrelevant, and where any amount of content is instantly accessible.

14 TELEHEALTH the future is now! The use of electronic information and communications technologies to: 1. Provide and support healthcare at a distance 2. Collect, organize & share information & knowledge among providers & patients

15 Dr. Robert Filler, Hospital for Sick Children, President of Canadian Society for Telehealth

16 Electronic Healthcare Applications MEDICINE AT A DISTANCE DATA TRANSFER E-HEALTH INFORMATION TELEPHONE TRIAGE EDUCATION & TRAINING TELE-HOMECARE

17 With nearly 200 partners in Ontario including: academic health science centres, community hospitals, psychiatric hospitals, clinics, nursing stations, medical and nursing schools, professional organizations, Community Care Access Centres, LHINs, long-term care homes, educational facilities and public health, Ontario Telemedicine Network (OTN) membership provides access to the world's largest collaborative community of telemedicineenabled organizations, enabling participation in clinical, educational and administrative events.

18 Benefits of Telehealth in Rural Ontario Improved access to care Health professional recruitment / retention Reduce cost of patient/physician travel

19 International Telehealth Links

20 21st Century Healthcare Community Services Family Doctor Hospital EHR

21 Shared Electronic Health Records Connecting the Community of Providers in Listowel, Ontario

22 CSTAR Robotic Surgery Canadian Surgical Technologies & Advanced Robotics (CSTAR) is a collaborative research program of London Health Sciences Centre and Lawson Health Research Institute, located at the University of Western Ontario.

23 (Ontario Medical Review May 2000)

24 How can we improve coordination in health care? Can you say LHINs.

25 Health Regionalization across Canada (number = year of implementation) Local Health Integration Networks

26 Local Health Integration Networks LHIN Areas: 3. Erie St. Clair 4. South West 5. Waterloo Wellington 6. Hamilton Niagara Haldimand Brant 7. Central West 8. Mississauga Halton 9. Toronto Central 10. Central 11. Central East 12. South East 13. Champlain 14. North Simcoe Muskoka 15. North East 16. North West

27 South East Local Health Integration Network (SE LHIN)

28 LHIN Mandate LOCAL HEALTH SYSTEM PLANNING ACCOUNTABILITY & PERFORMANCE MANAGEMENT INTEGRATION & SERVICE COORDINATION FUNDING & ALLOCATING COMMUNITY ENGAGEMENT

29 SE LHIN Priorities for Change Access to Care Primary care, rehab services, mental health & addiction services, transportation to/from care Availability of Long Term Care Services Integration of Services along Continuum of Care Integration of e-health Regional Health Human Resource Planning

30 Rural Partnership Models Integrated Networks Alliances Partnerships Driven by the financial imperatives of reduced costs and increased efficiencies. Mutual need is the glue that bonds an Alliance Partnerships are motivated by the need to integrate a fragmented system or improve community well-being

31 Successful Partnerships Created voluntarily as opposed to mandated More likely in communities with more resources (economic + social capital ) Driven by shared vision & mission Requires action planning for community or system change Strong civic leadership & technical support for volunteer decision-making

32 LHIN Questions? Will LHINs be able to better coordinate care between urban and rural health facilities? Will LHINs be able to better coordinate care between rural health providers in same community? (e.g. hospital, medical clinic, homecare, long term care etc.) Will LHIN planning emphasize transportation or e-health solutions?