WATERLOO WELLINGTON LOCAL HEALTH INTEGRATION NETWORK SYSTEM PERFORMANCE REPORT Q1 2011/2012
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
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.
Quality Hospital Standardized Mortality Rates Readmission Rates for Select Case Mix Groups & Chronic Diseases Wait Times for Surgical & Diagnostic Imaging
Hospital Standardized Mortality Rate 5 120 WWLHIN HSMR Q3 10 11 Q2 10 11 Q3 09 10 WWLHIN 81 76 77 5% 110 CMH 84 87 67 25% 100 GGH 91 84 93 2% GMCH 62 103 99 37% 90 80 Target: 90 GRH 79 71 75 5% LMH 103 55 54 91% PDH 70 74 35 100% SMGH 74 67 74 0% 70 Data Source: CIHI HSMR Reporting Notes: Standardized rate (or National Average) = 100 60 Q1 04/05 Q1 05/06 Q1 06/07 Q1 07/08 Q1 08/09 Q1 09/10 Q1 10/11
Readmission Within 30 days For Select Case Mixed Groups 6 18.0% 17.0% 16.0% WWLHIN Readmission Within 30 days For Select Case Mixed Groups Q1 10 11 Q4 09 10 Q1 09 10 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
Readmission Rates within 30 days for Specific Chronic Diseases 7 25.00% WWLHIN Readmission Rates within 30 WWLHIN 2009 2008 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% 2006 2007 2008 2009
Cancer Surgery Wait Time 8 90 80 WWLHIN Cancer Surgery Wait Time Mar 11 Feb 11 Mar 10 WWLHIN 48 44 48 0% CMH 43 53 48 10% 70 60 GGH 44 40 51 14% SMGH 35 45 41 15% GRH 55 48 56 2% 50 Data Source: Wait Times Information Office/Access to Care- Cancer Care Ontario; 90 th Percentile Wait Time in days 40 Target: 49 days 30 20 Aug '07 Feb '08 Aug '08 Feb '09 Aug '09 Feb '10 Aug '10 Feb '11
Cardiac Surgery Wait Time 9 60 50 WWLHIN Cardiac Surgery Wait Time Feb11 Jan 11 Feb 10 WWLHIN 22 14 23 4% 40 30 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. 20 10 Target: 34 days 0 Aug '07 Feb '08 Aug '08 Feb '09 Aug '09 Feb '10 Aug '10 Feb '11
Cataract Surgery Wait Time 10 130 120 WWLHIN Cataract Surgery Wait Time Mar 11 Feb 11 Mar 10 WWLHIN 119 78 97 23% 110 CMH 49 53 50 2% 100 GGH 165 150 101 63% 90 SMGH 79 76 91 13% 80 70 Target: 76 days Data Source: Wait Times Information Office/Access to Care- Cancer Care Ontario; 90 th Percentile Wait Time in days 60 50 40 Aug '07 Feb '08 Aug '08 Feb '09 Aug '09 Feb '10 Aug '10 Feb '11
Hip Replacement Wait Time 11 200 180 WWLHIN Hip Replacement Wait Time Mar 11 Feb 11 Mar 10 WWLHIN 166 127 71 134% 160 140 CMH 183 375 123 49% GGH 167 96 74 126% GRH 62 78 56 11% 120 100 Data Source: Wait Times Information Office/Access to Care- Cancer Care Ontario; 90 th Percentile Wait Time in days 80 Target: 103 days 60 40 Aug '07 Feb '08 Aug '08 Feb '09 Aug '09 Feb '10 Aug '10 Feb '11
Knee Replacement Wait Time 12 350 300 250 WWLHIN Knee Replacement Wait Time Mar 11 Feb 11 Mar 10 WWLHIN 167 178 94 78% CMH 271 141 200 36% GGH 162 189 106 53% 200 GRH 76 90 67 13% 150 100 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
CT Scan Wait Time 13 60 WWLHIN CT Scan Wait Time Mar 11 Feb 11 Mar 10 WWLHIN 27 26 28 4% 50 CMH 27 27 24 13% 40 GGH 18 18 50 64% SMGH 15 15 26 42% 30 GRH 28 28 29 3% 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
MRI Scan Wait Time 14 180 160 WWLHIN MRI Scan Wait Time Mar 11 Feb 11 Mar 10 WWLHIN 59 63 94 37% 140 120 GGH 36 43 64 44% GRH 114 81 79 44% 100 80 Data Source: Wait Times Information Office/Access to Care- Cancer Care Ontario; 90 th Percentile Wait Time in days 60 40 Target: 28 days 20 0 Aug '07 Feb '08 Aug '08 Feb '09 Aug '09 Feb '10 Aug '10 Feb '11
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
Admitted Patients All Acuity 16 40.0 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 31.4 34.7 37.5 16% 30.0 60% GRH 34.3 30.5 32.6 5% 20.0 10.0 Target: 20 hours Target: 90% 40% 20% GMCH 18.1 14.8 10.5 72% 0.0 0% GGH 21.6 27.2 20.2 7% SMGH 33.3 34.1 25.3 32% 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 30.3 30.1 28.7 6% Data Source: NACRS; 90 th Percentile Wait Time in hours Proportion Seen Within Target 39% 41% 49% 20%
Non-Admitted High Acuity Patients 17 10.0 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 7.2 6.7 8.0 10% 7.5 Target: 6.8 hours Target: 90% 75% GRH 8.6 8.8 8.1 6% GMCH 5.8 5.7 5.2 12% 5.0 50% GGH 6.5 6.2 6.6 2% Non-Admitted CTAS 1-3 - 90th Percentile ED Length of Stay (hours) SMGH 8.6 9.0 6.9 25% Non-Admitted CTAS 1-3 - Proportion Seen Within Target WWLHIN Feb 11 Jan 11 Feb 10 ED Length of Stay 7.7 7.8 7.4 4% Data Source: NACRS; 90 th Percentile Wait Time in hours Proportion Seen Within Target 91% 91% 84% 8%
Non-Admitted Low Acuity Patients 18 7.0 6.0 5.0 4.0 3.0 2.0 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 4.4 3.9 4.6 4% GRH 6.1 6.6 6.8 10% GMCH 4.7 4.2 3.8 24% GGH 4.7 4.7 5.0 6% SMGH 5.5 5.7 4.9 12% Non-Admitted CTAS 4-5 - 90th Percentile ED Length of Stay (hours) Non-Admitted CTAS 4-5 - Proportion Seen Within Target WWLHIN Feb 11 Jan 11 Feb 10 ED Length of Stay 5.2 5.4 5.1 2% Data Source: NACRS; 90 th Percentile Wait Time in hours Proportion Seen Within Target 80% 79% 80% 0%
Time to Physician Initial Assessment 19 5.0 4.8 4.6 4.4 4.2 4.0 WWLHIN Time to Physician Initial Assessment Target: 4.5 hours Feb 11 Jan 11 Apr 10 Apr 10 Baseline WWLHIN 4.7 4.8 4.2 14% CMH 3.5 3.4 3.4 3% GRH 5.7 6.0 5.9 3% GMCH 3.2 3.0 2.6 23% GGH 3.6 3.2 3.3 9% SMGH 5.9 5.8 4.3 37% 3.8 36 3.6 3.4 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.
Repeat Unplanned ED Visits within 30 days for Mental Health Conditions 20 25.0% 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% Q1 10 11 Q4 09 10 Q1 09 10 WWLHIN* 13.2% 10.9% 12.4% 6% Data Source: NACRS, Ontario MOHLTC; Readmission % of all ED Visits Notes: *By Patient LHIN; **By Hospital
Repeat Unplanned ED Visits within 30 days for Substance Abuse Conditions 21 25.0% 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 Q1 10 11 Q4 09 10 Q1 09 10 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
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 1 34.3% 39.5% 43.2% 21% WWLHIN 2 44.1% 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)
Alternate Level of Care Acute and All ALC Days Discharge Destination of ALC Home First Philosophy
Acute ALC Days 24 5000 4500 4000 3500 3000 2500 2000 1500 WWLHIN Acute ALC Days Mar 11 Feb 11 Mar 10 WWLHIN 3260 3210 3524 7% CMH 895 652 853 5% GGH 626 749 1183 47% GMCH 36 89 84 57% GRH 850 742 773 10% NWHC 67 53 142 53% SMGH 786 925 489 61% 1000 500 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
Acute ALC % 25 WWLHIN % Acute ALC 25.00% 20.00% Q2 10 11 Q1 10 11 Q2 09 10 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 Time to Discharge of Acute ALC Patients and Discharge Destination of Acute ALC 60 50 40 30 20 10 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% Q3 10 11 Q2 10 11 Quarter WWLHIN 33 31 6% GMCH 50 38 32% CMH 55 79 15% GGH 28 22 27% SMGH 32 58 45% GRH 31 32 3% 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
All ALC Days 27 7000 WWLHIN All ALC Days Mar 11 Feb 11 Mar 10 WWLHIN 4092 3968 6145 33% 6000 CMH 914 664 1889 52% 5000 4000 GGH 626 749 1183 47% GMCH 64 139 84 24% GRH 1635 1438 2358 31% 3000 2000 NWHC 67 53 142 53% SMGH 786 925 489 61% 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
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)
Number of New LTC Placement Rf Referrals Done in Hospital itl 29 WWLHIN Number of New LTC Placement Rf Referrals Done in Hospital itl 80 70 60 Mar 11 Feb 11 Mar 10 WWLHIN 47 41 45 4% 50 40 Data Source: CCAC/WWLHIN Home First Scorecard 30 Target: 19 20 10 0 Apr '09 July '09 Oct '09 Jan '10 Apr '10 July '10 Oct '10 Jan '11
30 90 th Percentile Wait Time for CCAC In-Home Services Application from Community Setting to First CCAC Service (excluding case management) 80 70 WWLHIN 90th Percentile Wait Time in days for CCAC In-Home Services - Application from Community Setting to First CCAC Service (excluding case management) Q2 10 11 Q1 10 11 Q2 09 10 WWLHIN 29 27 59 51% 60 50 Data Source: Home Care Database, Ontario MOHLTC; 90 th Percentile Wait Time in days 40 30 20 Q4 08/09 Q1 09/10 Q2 09/10 Q3 09/10 Q4 09/10 Q1 10/11 Q2 10/11