Primary Care Measures at the Sub-Region Level

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1 Primary Care Measures at the Sub-Region Level Trillium Primary Health Care Research Day May 31, 2017 Paul Huras South East LHIN

2 Overview The LHIN Mandate Primary Care Capacity Framework The South East LHIN: primary care and sub-region profiles

3 The LHIN Mandate

4 LHIN Mandate: Key Priorities Improve the patient experience Address the root causes of health inequities Create healthy communities Break down the silos Support innovation Integrated Health Care Planning and Responsible Fiscal Management

5 Priorities: Primary Care Continue to build primary care as the foundation of the health care system With health care providers, develop sub-region plans that: Use an equity lens Improve access to primary care providers Facilitate effective and seamless transitions Improve access to inter-professional health care providers Better link care coordinators and system navigators with family doctors Support the integration of Health Links into sub-regional planning

6 Primary Care Capacity Framework (in development): Objectives: 1. A common approach for LHINs to conduct a preliminary assessment of primary care service capacity and unmet need within sub-regions; 2. Primary care data reports will accompany the Framework, to assist LHINs in developing a baseline understanding of local primary care service capacity; 3. A platform that can be augmented in the future.

7 Primary Care Capacity Framework (in development): Assist LHINs in furthering their expanded role on primary care planning and performance monitoring; Many LHINs have started to assess local primary care capacity; consistency in approach would enable a common yard stick to understand their population health needs. Recent efforts to measure capacity (e.g., areas of high physician need) focus on counting providers and people; this approach is not sufficient to demonstrate true need for primary care and supply of services. LHINs have significant primary care data needs; a common set of primary care data reports can ensure the regular provision of data in a coordinated manner.

8 Primary Care Capacity Framework (in development): Overview of Proposed Approach Community Characteristics Socioeconomic status Languages Culture Geography Rural/urban Physical Environments Population mobility Population Need Population: # of people Health conditions Functional status Age Gender Risk Adjustment: CIHI Grouper quantifies population service needs Utilization Primary Care Service Volumes Service Levels: Calculation of the level of comprehensive primary care services delivered to this population Workforce # of health care providers Types of providers Clinical best practices Provider productivity Models of care Access to services Provider mobility Use of virtual services Service Needs Index Surplus/ Gap Service Utilization Index LHINs will incorporate knowledge of unique community characteristics, and use workforce information to better understand the gap between service needs and service utilization.

9 Primary Care Performance Measurement: (multiple) Classification Systems MOHLTC Performance and Data Work Stream proposed primary care indicators (2017) The MOHLTC Performance and Data (P&D) Work Stream is responsible for developing indicators to measure the Patients First initiative, including the primary care sector. Using the Health Quality Ontario quality dimensions, the P&D Work Stream proposed these primary care indicators Equitable Where possible, indicators will be stratified by population characteristics to address equitability Effective Rate of emergency visits best managed elsewhere per 1,000 population Cancer screening rates Patient-Centred Percentage of adults who report that their provider always or often involves them in decisions about their care (patient reported) Timely Safe Percentage of adults who were able to see their primary care provider on the same day or next day when they were sick (patient reported) Under development Efficient Under development

10 Primary Care Performance Measurement: (multiple) Classification Systems Framework for the Ontario Performance Measurement Initiative (2014) Equity crosses domains and is assessed in relation to economic and social variables such as income, education, gender, disability, mental health status, urban/rural location, age, sexual orientation/identity, language immigration, ethno-cultural identity and Aboriginal status Access Integration Efficiency Effectiveness Focus on Population Health Safety Patient-Centredness Appropriate Resources Extent of avoidable ED, walk-in clinic, UCC use Access to a regular primary care provider Timely access at regular place of care /etc Information sharing across the continuum of care including patients and families Follow-up with regular primary care provider post hospital discharge Waiting time for community services /etc Per capita health care cost (primary care, specialist care, diagnostics etc.) Unnecessary duplication of diagnostic tests/imaging Patient wait times in office /etc Management of chronic conditions Advanced disease/palliative care Negotiated care plan for patients with chronic conditions /etc Preventive care for infants and children Health and socio-demographic information about the population Chronic disease screening (e.g. diabetes, hypertension etc) /etc Recognition and management of adverse events including medical errors Medication management including medication reconciliation Infection prevention and control /etc Process to obtain patient/client and caregiver input regarding health services Coordination of care within primary care setting Process for addressing suggestions/complaints /etc Comprehensive scope of primary care practice Human resources availability, composition, and optimized scope of practice Funding and use of electronic systems to link with other settings /etc

11 The South East LHIN and the ongoing development of sub-region Profiles

Overview of the South East LHIN, by Sub-Region Divided into 5 sub-regions based on: comprehensive analysis of various data sources (with Health Links as an underlying construct) ICES analysis of

12 Overview of the South East LHIN, by Sub-Region Divided into 5 sub-regions based on: comprehensive analysis of various data sources (with Health Links as an underlying construct) ICES analysis of physician networks extensive engagement with primary care physicians across the LHIN As of 2015, the South East LHIN was home to approximately 495,000 people. This accounts for 3.6% of the population of Ontario, making the South East LHIN the third smallest LHIN based on total population. A quarter of the population lives in a large urban centre, while 45% live in a rural area, making the South East LHIN the most rural LHIN population in Ontario. According to the most recent Census data, there were more people aged 65 and over than those aged 15 and below in the South East LHIN in 2016

Interactive Sub-Region profiles developed by the South East LHIN include the following topics: South East LHIN Sub-Region Profiles Additional Detail available by scrolling down Geography &

13 Interactive Sub-Region profiles developed by the South East LHIN include the following topics: South East LHIN Sub-Region Profiles Additional Detail available by scrolling down Geography & Demographics Social Determinants of Health Health Status and Chronic Conditions Patient Experience Health System Utilization Health System Resources Performance (MLAA, Quality, etc.) Compared to the South East LHIN and Ontario, the Quinte sub-region has a larger proportion of population 65+ Sourced from the South East Data Centre

Additional Detail by sector (or relevant grouping in other topic areas) Additional Detail available by scrolling down South East LHIN Sub-Region Profiles Geography & Demographics Social Determinants

14 Additional Detail by sector (or relevant grouping in other topic areas) Additional Detail available by scrolling down South East LHIN Sub-Region Profiles Geography & Demographics Social Determinants of Health Health Status and Chronic Conditions Patient Experience Health System Utilization Health System Resources Performance (MLAA, Quality, etc.) The top 5 discharges in the Quinte sub-region were for Neonatology, Obstetrics, Cardiology, Pulmonary and Orthopedics. Sourced from the South East Data Centre

given indicator or identified issue 2 Understand local variation (and identify priorities across sub-regions) Results by

15 Focus on Primary Care Indicators by sub-region: ED Visits best managed elsewhere, FY2016/17-Q2 ED Visits best managed elsewhere: Results by LHIN Rate/1,000 (aged 1-74) 1 It is important to understand relative position across the province on a given indicator or identified issue 2 Understand local variation (and identify priorities across sub-regions) Results by Sub-Region 3 And the linkage to capacity issues or potential solutions that can be developed together Family Physicians/100,000 population

16 Questions?

Ministère de la Santé et des Soins de longue durée Bureau du ministre

Ministère de la Santé et des Soins de longue durée Bureau du ministre Ministry of Health and Long-Term Care Office of the Minister 10 th Floor, Hepburn Block 80 Grosvenor Street Toronto ON M7A 2C4 Tel 416-327-4300 Fax 416-326-1571 www.ontario.ca/health May 1, 2017 Ministère