Appendix H South West LHIN Current State Data Validation South Region
South West LHIN Current State Data Validation South Region April 2009 A Healthier Tomorrow 1
Table of Contents Objectives Current State Highlights Data Sources Health Services Overview Health Human Resources Overview 2
Objectives of South West LHIN Current State Geographic Summaries This presentation includes a summary view of the current state analysis for a particular region. It presents quantitative and qualitative findings from multiple data sources, consultations, and surveys used to provide directional insight. This information has been included in the complete current state document. 3
Current State Highlights A Healthier Tomorrow 4
The following draft continuum of care definitions have been used to categorize services Promotive Care: Health promotion is the process of empowering people to increase control over, and to improve, their health" (World Health Organization, 1996). The focus is on amplifying a person s understanding, skills and resource awareness in order to help them make positive decisions regarding healthy choices and lifestyle. Access to education and information is necessary for both individuals and the community to participate in decision making. In addition, there must be a focus on modifying social, environmental and economic conditions to alleviate their impact on health. Preventive Care: Disease prevention includes measures that prevent the occurrence of disease, condition or illness, or stop the progress and reduce the consequences once a disease, condition or illness is established. Primary prevention is directed towards avoiding the initial occurrence of a disease. Secondary and tertiary prevention seek to stop or prevent changes to illness / condition and its effects through early detection and appropriate treatment; or to reduce the risk of a relapse or the onset of a chronic condition. Disease prevention is sometimes used as a complementary term to health promotion. Although there is frequent overlap between the two concepts, disease prevention typically refers to the action taken by health sector providers to support individuals or populations that are exhibiting risk factors. Curative Care: Curative care is episodic in nature and focuses on services aimed at relieving symptoms of an illness or injury, eliminating symptoms and restoring to good health, reducing the severity, or protecting against exacerbation and complications that could threaten life or normal function. Rehabilitative Care: Rehabilitative care focuses on improving functional levels for people who have had a recent illness or injury, have a chronic condition or require targeted rehabilitation at various life stages. This may include instances when a person s disease or impairment occurred in the past or has not been previously addressed. Rehabilitative care can be provided in the hospital, in the community or in a person s home. It also plays an important role in both prevention, recovery, and reactivation after an illness or hospital stay. Supportive Care: Supportive care is an umbrella term that covers a wide range of services, provided by a wide range of individuals and organizations. These services include self-help and peer support, assistance with activities of daily living, quality of life support, the provision of information and education, psychological support and therapy, pain and symptom control, social support, rehabilitation, complementary therapies, spiritual support, palliative care, end of life and bereavement care. Supportive care focuses on providing the necessary services to meet physical, functional, informational, emotional, psychological, social, spiritual, and practical needs. 5
Highlights of South Current State Assessment across Health Programs Preventive & Promotive Curative Rehabilitative Supportive Community and Inhome support services Chronic Disease Prevention & Mgmt For the south, SW CCAC provides the largest share of community home care and nursing-visiting services in comparison to other services. The South has the greatest number of Public Health Units & CHCs. It also has 3 FHTs. It is reported that 3% of Oxford, 11% London/Middlesex, 6% of Elgin residents are unattached which can impact management of chronic conditions For the south, SW CCAC provides the largest share of community home care and nursing-visiting services related to rehabilitation. There was a lower proportion of day services, assisted living and transportation services provided compared the rest of the region. The Canadian Hearing Society is located in London and provides services throughout the South West LHIN. Based on the population served, there is a proportionally lower number of meals delivered in the south and social and congregate dining services. The South has 4 CHCs, including the Southwest Ontario Aboriginal Health Access Centre and London Intercommunity Health Centre, to provide interdisciplinary services to the community. LTC & Complex Continuing Care CCC beds were primarily in the South with a total of 359 designated beds and 1,002 discharges in FY07-08. Patients fell into either the clinically complex or rehabilitation category South hospitals experienced ALC issues in both acute and non-acute sites The greatest proportion of designated rehabilitation beds is in the south. Currently, the south has the lowest proportion of LTC beds. However, with the addition of 608 beds, the ratio is more in line with the rest of the region (from 94 to 107 LTC beds per 1000 75+ years). FY07-08 CCAC report indicates that 62% of residents placed were from the south. Short stay utilization has been reported to be around 60.1% due to cancellations, outbreaks, etc Reported need for overnight caregiver support to alleviate burnout 6
Highlights of South Current State Assessment across Health Programs (cont d) Preventive & Promotive Curative Rehabilitative Supportive Mental Health & Addictions There is an acknowledged gap in services for individuals with moderate MH illnesses, increasing the risk that their health may further deteriorate and place greater demands on services. There is also a growing demand for youth substance abuse services. SJHC s RMHC is the major MH referral centre for the region and overall the South has the greatest capacity in terms of designated MH beds, funded paediatric MH beds and specialized psycho-geriatric services. There is a reported challenge to accessing these services for the entire region. However, there is a recognized need for increased services for complex MH in youth. The South is the primary provider of the following services: Concurrent disorders Substance abuse residential treatment & supportive services Psycho-geriatric services However, there is a challenge with the South in supporting these services for the remainder of the South West LHIN. There is a reported limited availability of MH day programs in the South. Paediatrics There is a reported increase in complex cases and children with multiple chronic illnesses which may require more targeted services As LHSC is the only tertiary provider of paediatric services, the south provides 75% of total paediatric separations. LHSC has the highest ALOS which is impacted by the higher acuity of patients that it serves. There is a long waitlist at LHSC for these services SJHC has the only funded NICU beds of the entire region. SJHC and LHSC admitted 72% of total neonatal separations across the LHIN. There is a reported concern on the need for rehabilitation wrap around services targeted towards youth. Findings also reveal a limited supply of specialized disciplines offering rehab services Reported gap in services for child and youth for residential services. Consultations and survey findings suggest a need for health services to help youths with chronic illnesses or disabilities and their families to help them transition to adulthood Women s Health South is the only region reporting health promotion and education services targeted towards women s health South hospitals provide the majority of obstetric and gynaecology separations for the LHIN: 76% of total births 76% of total gynaecology separations SJHC reported challenges with sustaining high risk obstetrics/neonatal intensive care until the LHSC facilities are completed. Mental health services targeted towards women were offered mainly through south providers Cancer Care As the Regional Cancer program is located at LHSC, they had 55% of the oncology separations for the region. SW CCAC has an outreach team in partnership with LRCC LHSC reported the 79% of total chemotherapy day/night visits. LHSC s Regional Cancer program is the only site to deliver radiation therapy to LHIN residents. 7
Highlights of South Current State Assessment across Health Programs (cont d) Preventive & Promotive Curative Medicine* Surgical Services* Critical Care Emergency Services Organizations in the south provide preventive and promotive services, such as diabetes education, nutrition counseling, etc. Due to the overlap in programmatic areas, this information is covered in other areas. 62% of medicine separations were in the south. The top 3 PCCs were cardiology, gastro/hepatobiliary and general medicine. Among all PCCs, approx. 98% of south residents sought services locally. 9.1% of central residents were treated in the south for General Medicine services. 78% of surgical separations were in the south. The top 3 PCCs were general surgery, othopaedic and trauma admissions. As expected, the acuity was highest in the south for all PCCs. LHSC provided regional cardio-thoracic and neurosurgery services. A significant proportion of central residents were treated for general surgery (25.6%), orthopaedic (29.5%) and trauma (37%) in the south. There are divergent perspectives on the appropriateness of surgeries referred to the south. The south has 62% of level 2 and 87% of level 3 critical care beds 84% of total LHIN ICU days were in the south, of which 61% were at LHSC. LHSC is the only centre with respiratory therapists dedicated to the critical care unit. South saw 56% of the total emergency visits. However, the south had the lowest ratio of visits to 1000 population even though there were an equivalent proportion of family medicine physicians in the south. 42% of the visits were managing the higher acuity cases. * Rehabilitation services are provided to support these acute services. For analysis purposes, this commentary is included in the LTC / Complex Continuing Care programs. 8
Data Sources A Healthier Tomorrow 9
The following data sources were used to conduct population and service utilization analysis Health Data* Population Data Qualitative Information Sources* Community Data CCAC data submitted Fiscal Year 07-08 actual in CAPs 09-11 Long-Term Care Long-Term Care Home System Report January 2009 South West LHIN Long Term Care Beds Inventory Hospital Data Hospital Annual Planning submissions 2007/08 Intellihealth 2005/06 2007/08 Courtyard Group Emergency Department Analytics Physician Data OPHRDC Active Physician Registry 2007 Current and Historical Populations: Statistics Canada Census: 1996, 2001 and 2006 Population Estimates & Projections Intellihealth May 2008 Canadian Community Health Survey 2007 Consultation themes from interviews & focus groups CCC / Rehabilitation Strategic Resources Report March 2009 Critical Care Strategy for LHIN 2 Regional Chronic Disease System Model PAT Reports Community Annual Planning submissions 2009/10, 2010/2011 Hospital Annual Planning submissions 2008/09, 2009/2010 South West CCAC Fact Sheet FY 2007-08 Hospital and Community Blueprint Surveys 10
More detailed information on the data sources In addition to the stakeholder consultations and various reports from PATS, regional program groups, published documents, and LHIN and Ministry websites, information from the following databases were utilized: *Community Annual Planning Submissions Depending on the service provided, volume indicators submitted to the LHIN for TPA-funded organizations varied and may include the following categories: Visits (face-to-face or telephone) Resident Days (days during which services are provided to a resident) Attendance Days (the number of days the organization provided to a client, where 1 or multiple encounters occur during a calendar day, depending on the client needs) Individuals Served (refers to the number of individuals served in the service/program) Hours of Care Number of Group Sessions FY 2007-08 findings were utilized so as to accurately compare to the acute care service data analyses. Intellihealth Inpatient separations Total Volumes Average Length of Stay (which includes total acute days and ALC days) Average Expected Length of Stay (provided by CIHI, where a proportion of days attributed to LOS may include ALC days) Proportion of residents admitted within own region or to other regions of the South West LHIN Ambulatory Visits Community Care Access Centre Service Recipient Categories Proportion of Referrals by Hospitals Proportion of Referral Sources Number of Clients by Service Type 11 Limitations in the usage of CAPs data: *Data in CAPS was submitted to South West LHIN for approval and information reported for each program was extracted directly from FY 2009-2011 CAPS for FY 2007-2008 actual by organization. Thus, we have used the actual submissions from 07/08 which does not account for the increased funding through aging at home and ER/ALC funding in 08/09 and 09/10. It is important to note that the data is dependent on the organization s self-reporting. Variations in MIS-coding and categorization of services may distort the interpretation of how these services are delivered. While these services may be associated with a single health program, it is important to note that they services may impact numerous health programs. Additionally, the CAPs information reflects funded visits, thus may not be reflective of the organization s entire A service Healthier portfolio. Tomorrow
Health Services Overview A Healthier Tomorrow 12
Overview of population projections and organization inventory in the South Age Grp (Census) Population 2007 2012 2017 2022 % of Total LHIN Population Population Overview of Population Projections % of Total LHIN Population Overall, the age cohort between 0-14 years is expected to decline over the years Population All other age cohorts are expected to increase, with the largest growth in the 65-75 age cohort % of Total LHIN Population Population % of Total LHIN Population 00-14 114,100 12% 108,506 11% 109,944 11% 114,954 11% 15-44 274,522 29% 275,609 28% 279,270 27% 281,640 27% 45-64 171,180 18% 189,042 19% 195,862 19% 195,712 19% 65-74 44,940 5% 54,492 6% 67,141 7% 78,527 7% 75-84 32,462 3% 32,884 3% 35,725 4% 44,188 4% 85+ 11,968 1% 14,354 1% 15,851 2% 16,738 2% South Total 649,172 69% 674,886 69% 703,793 69% 731,758 69% Source: MOF Projections May 2008 Health Organization Total Locations Overview of Organization Inventory Hospital Sites 13 Community Organizations 53 Long Term Care Organizations 37 Total 51 Source: South West LHIN 13 In addition to the inventory of organizations listed, organizations outside of the south also provided services to south residents In some cases, data was not available by both program and region, so the information has been aggregated.
Southern organizations provide an array of community support services, but proportionally less visits when population is taken into consideration South 14 Visits Ind. Served Community In-home Support Ratio per 1000 pop 75+ yrs South Ratio per 1000 pop 75+ yrs North Ratio per 1000 pop 75+ yrs Central Attendance Days Group Sessions Hours of Care Homemaking - 505 - - - 14,202-215,273 Personal Support / Independence Training Day Services Assisted Living 178 274 - - - - - 140,556 21,06 2 54,69 9 864 19.4 17.8 36.5 - - - 161 3.62 4.33 6.79 - - 4,628 Transportation 66,60 3 4,748 1,499 1,101 6,228 - - - HP&E - General Geriatrics 1,643 4,893 - - - - 45 - Hearing Impaired 3,664 - - - - - - Community In-home Support Services - Social and Congregate Dining Community In-home Support Services - Social and Congregate Dining Community In-home Support Services Meals Delivery Source: FY 2007-08 from CAPs 09-11 Visits Individuals Served Attendance Days Meals Delivered 5,368 8,205 8,435 6,466-2,856-146,784 Overview of Community & In-home Support Services Several organizations provided assistance to individuals within their home environment, including a high proportion of services facilitated by South West CCAC to clients across the LHIN overall Outreach organizations the in south appear to provide a lower concentration of assisted living programs, day services, and transportation compared to central. Transportation challenges have been reported by stakeholders. Community representatives stated a proportion of clients would cancel diagnostic and specialist appointments if unable to acquire assistance in travelling long distances It is recognized that the Canadian Hearing Society in London operates a regional program that provides services throughout the South West LHIN. As a result, the data provided does not clearly delineate the services to clients by region. Social and Congregate Dining: Consultations and surveys revealed that a number of these organizations operate at nearly maximum capacity and programs, such as meal delivery services, and do not have the capacity to meet projected needs. Based on the population served, there is a proportionally lower number of meals delivered in the south and social and congregate dining services.
Community organizations and SW CCAC provide a breadth of in-home support services of which are in high demand in the south SW CCAC In-home support services Individuals Served Attendance Days Hours of Care Homemaking 5,539 14,202 215,273 Personal Support/ Independence Training Source: FY 2007-08 from CAPs 09-11 11,253 19,467 783,468 South West CCAC - Individuals Served 2007/08 Services Provided Oxford County Elgin County London / Middlesex County Nursing - Visiting 3204 2,091 10,191 Nutrition/Dietetic 184 211 565 Occ. Therapy 1,827 1,241 5,175 Physiotherapy 1,089 848 3,854 Speech Lang. 218 187 Path. 372 Com.Hom 1,988 2,420 5,192 Total 8,537 7,012 25,456 Overview of Community & In-home Support Services In-home care: Aside from nursing-related services, CCAC assisted residents in obtaining in-home rehabilitation type services in order to manage their chronic illnesses and potentially other functional challenges London/Middlesex county receives almost triple the volume of services compared to residents of Oxford and Elgin residents. This could be mainly due to the population distribution across the counties. Source: SW CCAC 15 Source: FY 07-08 Actual from CAPS 2008-09
Southern health organizations provide the majority of chronic disease prevention & management services Overview of Chronic Disease Prevention and Management Services The changes in prevalence from selected chronic conditions for South West LHIN residents from 2005 are not statistically significant. Of note are the following: South West LHIN residents have reported a lower prevalence in arthritis & rheumatism and obesity in 2007 compared to 2005, though the average remains higher than the provincial average. The prevalence of asthma, high blood pressure and smoking have increased compared to 2005, which are higher than the provincial average. Diabetes has increased in the South West LHIN but the reported prevalence is currently lower than the Ontario average. Foot care services will continue to be utilized in projected years, as seniors, especially those with diabetes, manage their health issues at home. Consultations revealed a consensus among stakeholders regarding the value of these programs and the waitlist issues encountered in all regions. Consultations reveal that physicians support the concept of case management with persons who have chronic diseases and conditions, however many physicians stated that they did not have the resources to do this nor do it well, especially when so many of their persons have co-morbidities. 16
Long term care and complex continuing care service utilization Long Term Care Homes Retirement Residences # of Orgs # of Orgs 37 5 Ratio of LTC Beds to 1000 Population 75+ years Region # of Beds Ratio per 1000 pop 75+ North 1,325 106 Central 1,331 119 South 4,163 94 Source: South West LHIN Long Term Care Homes Placement # placed in FY 07-08 1,487 LTC Short Stay Utilization FY 2007-08 # of Beds Utilization Source: South West CCAC 44 60.1% Overview of Long Term Care Services The South West LHIN experienced consistent admissions between ages 18-65. According to CCAC, this is mainly due to the lack of appropriate supportive housing and wrap around services in rural areas. Currently, the south has the lowest proportion of beds. However, with the addition of 608 beds, the ratio is more in line with the rest of the region (from 94 to 107 LTC beds per 1000 75+ years). 62% of LTC residents placed were from south. Survey findings and consultations speak to an increased need for LTC or supportive housing to accommodate under 18 population that is the need for 24/7 support. Survey findings and consultations raise the concern for more specialized units, especially around Psycho-geriatrics, Alzheimer, and Transitional Care Units. Due to the fluidity of services provided to the elderly population, a populationbased analysis warrants the consideration of all service types including community based support services. (i.e. psycho geriatric services, day services, transportation, health promotion and education, meals delivery, foot care, visiting hospice services, hearing impaired, and social & congregate dining) CCC Service Utilization # of beds Discharges Avg LOS 359 1,002 45.8 Rehab Service Utilization # of beds Admits 128 1,017 Source: Intellihealth FY 2007-08 17 Overview of Complex Continuing Care Services Need for complex care is rising due to elongated life spans and births with multiple disabilities. Overall the CCC populations was 55% female, which was similar to provincial level. Average age in CCC was almost 78 years. 67% of CCC patients fell into either the clinically complex or rehabilitation category Organizations in both acute and non-acute sites experience ALC issues (Tillsonburg District Memorial Hospital, St. Thomas-Elgin General Hospital, Woodstock Hospital, and Strathroy Middlesex General Hospital) South has 128 designated rehabilitation beds. When compared to population, it provides the lowest proportion at.20 beds per 1000 adults
While the south provides a greater volume of mental health community services, it provides less visits for certain services when compared to population distribution Community Crisis Intervention Visits Mental Health Community Services Individu als Ratio per 1000 South Ratio per 1000 North Ratio per 1000 Central Resident Days Group Sessions Attendance Days 45,182 5,046 92.1 32.9 93-6 27 Case Management 68,120 1,818 138.8 73.7 187-529 - Community Health Promotion Education Mental Health Awareness Primary Care Services for Concurrent Disorders Primary Care Services for Child/Adolescent Primary Care Services for Psycho-geriatric* 1,259 - - - - - - 66 3,643 237 - - - - - - 4,798 1,232 - - - 4,162 - - 6,031-135.7-249.1 - - 1,612 * Psycho-geriatrics: ratio is of the age cohort: adults 75+ years of age Substance Abuse Primary Care Substance Abuse Residential Treatment Services Visits Addictions Community Services Ratio per 1000 South Ratio per 1000 North Ratio per 1000 Central Individuals Group Sessions Attendance Days 4,310 8.8 38.6 20.5-1,066 500 4,602 - - - 3,298 55 1,848 Substance Abuse Residential - 707 - - - 3,060 602 627 Supportive Services Source: FY 07-08 actual from CAPS 09-11 18 Overview of Mental Health Community Services General Trends: Consultation and survey findings reveal an increase in youth with complex mental health needs. As well, reported concerns about rising substance abuse and problem gambling. among the elderly and youth. Mental Health: Data findings reveal that the south received the largest volume of community mental health services. However, when compared to population proportions, the south received less services than central residents for crisis intervention, case management, and psycho-geriatrics. Woodstock General Hospital (CMH&A) was the only organization to report primary care mental services for the paediatric and adolescent population. Wait times to access specialty programs are lengthy. During consultations, stakeholders acknowledged that the narrowing of the mandate of the community mental health system has compromised the ability to provide early identification and intervention for those with moderate mental health problems. Consultations reveal limited primary care capability and capacity to screen for mental health and substance abuse issues which may resort in requiring acute care services. Addictions: The South offered a high volume of substance abuse services, providing the largest volume of residential treatment services. When compared to population proportions, it offered less primary care visits than the north and central regions.
Overall, the south provides the majority of acute mental health services Overview of Mental Health Acute Services Mental Health Beds Designated Beds Region Beds Ratio to Population >19 years per 10,000 South 537 10.9 North 30 2.4 Central 38 3.7 Source: HAPs FY 2007-08 actual in 09-11 General trends: Long waitlists for mental health specialists. Increasing volumes result in long wait lists for geriatric mental health services to manage specialized dementia Designated & Undesignated Beds: The south has more beds per adult population when compared to the other regions. In comparison to the other regions, the South saw more paediatric patients, but less adults and seniors in the undesignated beds When analyzing the population admitted to undesignated mental health beds (based on patients admitted under the PCC Psychiatry in the DAD), separations attributed to seniors comprised the highest population proportion among all regions. Paediatric and Adolescent Mental Health: LHSC and SJHC are the only organizations with funded paediatric mental health beds. LHSC has a total of 11 beds, designated for acute and eating disorder cases. SJHC has 12 beds. SJHC had on average the highest ALOS which speaks to the complexity of cases covered Paediatric and Adolescent Admissions to Designated Beds - Service Utilization FY 2007-08 Region Total Separations Avg. LOS %ALC Days South* 248 8.94 7.9% SJHC 89 Source: Intellihealth FY 2007-08 37.69 0% 19
The child and youth population receives a breadth of community services from the SW CCAC Population Projections for Paediatrics 2007-2022 Overview of Paediatric Services 2007 2012 2017 2022 182,863 176,029 172,529 175,351 Source: MOF Projections May 2008 South West CCAC - Private/Home School Support Visits Ratio per 10,000 population 5-19 years of age Individuals Group Sessions Attendance Days* Hours of Care Personal Services - - 17-84 5,132 Nursing - Shift - - 4-133 926 Nursing - Visiting 112 6.2 1 - - - Occupational 366 Therapy 20.1 85 - - - Physiotherapy 199 11.0 34 - - - Speech Lang. 790 Path. 43.5 123 - - - General All regions are projected to follow similar declining growth patterns for the paediatric and adolescent cohorts aged 19 years and below between now and 2022. Community Services: Students who were home-schooled or attended private schools received a variety of multidisciplinary support in the community. SLP services comprised the largest proportion of services delivered to this population, which may be targeted to the younger school-aged children as they tend to require these services during early developmental stages. The largest proportion of paediatric community services were driven from the occupational therapy program for publicly funded schools. South West CCAC - Publicly Funded Schools Visits Ratio per 10,000 population 5-19 years of age Individuals Group Sessions Attendance Days* Hours of Care Nursing - Visiting 3,848 211.8 65 - - - Nutrition/Dietetic 40 2.2 14 - - - Occ. Therapy 16,380 901.4 2,828 - - - Physiotherapy 7,827 430.7 1,097 - - - Speech Lang. 13,874 1,428 - - - Path. 763.5 * Report number of service delivery days (count once per 24-hour calendar day) which primary service recipient activities are provided. Service may be provided by provider employees or by external personnel. Source: FY 07-08 actual from CAPS 09-11 20
The south manages the largest proportion of paediatric inpatient services and handles the majority of complex cases across the LHIN South 21 Paediatric Inpatient Separations Total Separations Avg. LOS Avg. ELOS %ALC Days Hospital s with unfunded NICU Beds Level 3 St. Josephs Health Care Level 2 London Health Sciences Centre St. Thomas Elgin General Hospital Level 1 Strathroy Middlesex General Hospital Woodstock General Hospital Avg. RIW Pulmonary* 126 2.17 2.46-0.68 Trauma* 80 1.60 1.94-0.87 General Surgery* 75 6.40 2.27-1.35 Neonate (in NICU)** 135 5.16 7.40 0% 3.59 LHSC Pulmonary 448 4.22 2.70-0.93 Trauma 535 3.63 3.17 0.2% 1.27 General Surgery 478 6.64 4.10-1.78 Neonate (in NICU) 421 10.59 9.32 0% 1.46 SJHC Neonate (in NICU) 559 20.85 24.06 0% 3.59 *excludes LHSC, ** excludes LHSC and SJHC Source: Intellihealth FY 2007-08 Overview of Paediatric Services Paediatric Inpatient Services: London Health Sciences Centre is the only Children s Hospital in the LHIN focusing on an array of services (tertiary level care). Based on the differences between the average LOS and RIWs, it is assumed that the critical paediatric cases were transferred to trauma centre in the south. LHSC admitted 75% of the LHIN s total separations to their specialized trauma program. Additionally, 81% of paediatric surgeries were performed at LHSC. Consultations reveal that LHSC does not have the capacity to admit all cases from throughout the region and there is an opportunity to expand the capacity of hospitals outside of London, particularly to manage lower acuity cases Neonates Utilization: Total neonate separations in the South, which includes normal, healthy newborns, is 8,274 for FY 2007-08. This represents 76% of the entire regions neonate separations. SJHC and LHSC admitted 72% of these total separations to their sites. Emergency Department Utilization: In FY 2007-08, there was a total of 164,070 paediatric ED visits across the LHIN, with the South accounting for 56.9% Children have the potential to deteriorate quickly during the acute phase of their illnesses, therefore, EDs must have the appropriate resources to adequately monitor these patients based on the high proportion of those under 15 years of age.
South organizations provide a breadth of women s health services while managing the most complex cases 22 Population Projections for females 15 years and older 2007-2022 2007 2012 2017 2022 314,122 331,529 346,927 359,791 Source: MOF Projections May 2008 Community Services targeted towards Women Visits Individuals Group Sessions Attendance Days Mental Health Women 5,260-275 330 Mental Health Abuse Services 1,845 210 243 - Source: FY 07-08 actual from CAPS 09-11 South South West LHIN Separations FY 2007-08 Total Separations Avg LOS Avg ELOS %ALC Days Avg RIW Obstetrics** 1,768 2.04 2.11 0 0.59 Gynaecology 1,941 2.81 2.73 0.59% 1.05 LHSC Obstetrics 2,990 2.24 2.10 0 0.61 SJHC Obstetrics 3,542 3.34 2.29 0 0.72 ** excludes LHSC and SJHC South South West LHIN Hospital Births FY 2007-08 Separations ST.JOSEPH'S HEALTH CARE,LONDON 3,542 LONDON HLTH SCIENCES CTR-UNIVERSITY HOSP 2,990 REMAINING SOUTH HOSPITALS 1768 SOUTH TOTAL 8,300 Source: Intellihealth FY 2007-08 General Trends: Overview of Women s Health Services The south is expected to have the high growth rates, 15%, in population for women of child bearing ages between 2007 and 2022 Obstetrics: South West LHIN hospitals cared for 95% of the total births for their residents during FY 2007-08. Overall 76% of obstetric separations were managed by hospitals in the southern areas, which is likely due to the population densities and age cohorts in this region. In addition, high-risk pregnancies contribute to the obstetric volumes in this area. The southern hospitals delivered the most births across the LHIN, with SJHC and LHSC leading with the highest volume. Although an effective model, SJHC has identified challenges with sustaining high risk obstetrics and the neonatal intensive care until facilities at LHSC are able to take on patient volumes. Stakeholders report that there is an increase in births in the south over recent years impacting, not only acute care sites but, also CHCs and FHTs in management of maternal-newborn needs. Gynaecology: The LOS and minimal ALC days suggest that the majority of cases associated with these separations were relatively shortstay admissions.
Southern hospitals provide the majority of cancer care services Region Oncology Service Utilization by Region FY 2007-08 Total Separations Avg. LOS Avg. ELOS % of ALC Days Avg. RIW South* 363 10.75 8.23 15.6% 2.01 LHSC 1,544 9.23 6.70 3.3% 1.80 *Excludes LHSC separations Source: Intellihealth FY 2007-08 Overview of Cancer Care Services The Regional Cancer program at LHSC addressed a large proportion of the LHIN s inpatient oncology needs overall at 54%. Chemotherapy services were provided in all three regions of the LHIN, with LHSC conducting 79% of total visits. LHSC s Regional Cancer program is the only site to deliver radiation therapy to LHIN residents. 23
Southern hospitals provide the largest proportion of acute services for the majority of its own residents and specialty care of neighboring individuals across the LHIN Top 5 Medicine Service Utilization FY 2007-08 Total Separations Avg. LOS Avg. ELOS % ALC Days Avg. RIW Cardiology 4,388 6.28 4.73 7.2% 1.16 Gastrohepatobiliary 3,973 5.64 4.09 7.7%.87 General Medicine 3,638 9.72 5.80 13.1% 1.71 Pulmonary 2,873 7.74 5.87 12.4% 1.44 Source: Intellihealth FY 2007-08 Overview of Medicine Services 62% of medicine separations were in the south. The top 3 PCCs were cardiology, gastro/hepatobiliary and general medicine. Majority of south residents, over 98%, are receiving care from south providers 9.1% of central residents were treated in the south for General Medicine services. Cardiology LOS in the south may be reflective of the specialized services only offered at urban sites, which may also contribute to the higher average RIW associated with these separations For all PCCs, the average LOS in all regions was higher than the national ELOS for these categories. Top Surgical Services Utilization FY 2007-08 Total Separations Avg. LOS Avg. ELOS %ALC Days Avg. RIW General Surgery 5,268 9.05 6.13 6.1% 2.25 Orthopaedic 4,352 5.52 4.06 11.2% 1.71 Trauma 3,112 9.02 5.67 16.2% 2.14 Urology 2,860 4.22 3.40 5.9% 1.17 Source: Intellihealth FY 2007-08 Overview of Surgical Services 78% of surgical separations were in the south. The top 3 PCCs were general surgery, orthopaedic and trauma admissions. As expected, the acuity was highest in the south for all PCCs. LHSC provided regional cardio-thoracic and neurosurgery services. A significant proportion of central residents were treated for general surgery (25.6%), orthopaedic (29.5%) and trauma (37%) in the south. There are divergent perspectives on the appropriateness of surgeries referred to the south. LHSC provides 24/7 support for the LHIN for emergent cases. 24
Southern hospitals provide the largest proportion of critical care and emergency services utilization Total Number Critical Care Beds Region Level 2 Level 3 South 68 84 Source: Inventory of Critical Care Services An Analysis of LHIN-level Capacities, 2006 Total Number of ICU Patient Days LONDON HLTH SCIENCES CTR- UNIVERSITY HOSP 27,527 South ST.JOSEPH'S HEALTH CARE,LONDON 8,071 ST THOMAS-ELGIN GENERAL HOSPITAL 3,085 TILLSONBURG DISTRICT MEMORIAL HOSPITAL 2,189 WOODSTOCK GENERAL HOSPITAL 1,763 ALEXANDRA HOSPITAL 1,106 STRATHROY MIDDLESEX GENERAL HOSPITAL 1,078 South Total 44,819 Source: Intellihealth FY 2007-08 Overview of Critical Care Services Within the South West LHIN, approximately 58% of the critical care beds (Level 3) are vented beds, which is below the Ontario average of 62%. 84% of ICU patient days were in the south, with 61% of those days at LHSC University Hospital. This is to be expected as the hospitals in the south have the tertiary / quaternary capability of neurosurgery, cardiac surgery & acute dialysis. Currently, LHSC is the only referral centre in the LHIN capable of acute dialysis. The remaining 6 hospitals with Level 3 critical care units do not have acute dialysis capability which necessitates the transfer of critically ill patients requiring acute dialysis LHSC. LHSC is the only trauma, burn, cardiac surgery and neurosurgical referral centre for this large region, it is imperative to maintain accessibility of LHSC s ICU beds for the purposes of receiving referrals to these sub-specialties. LHSC continues to be closed to regional referrals with the exception of regional trauma, renal and stroke care. 25 Source: Intellihealth FY 2007-08 Overview of Emergency Services South saw 335,997 emergency department visits in FY 2007-08. 42% of visits to southern hospitals were comprised of the higher acuity cases (CTAS 1-3). Several of the hospitals in the south capture a significant market share of its local community. Consultations and surveys indicated challenges in providing Mental Health crisis intervention support. Crisis intervention services are provided throughout the LHIN by both the hospital and community sectors, but there are reported challenges in consistency of access to these resources across the LHIN.
Community Health Centres Public Health Units Community Health Centres Family Health Teams South 4 2 plus 2 under development 3 Currently, in the South West LHIN, there are two existing CHCs and one Aboriginal Health Access Centre that are funded by the LHIN: London InterCommunity Health Centre Main site on Dundas Street Satellite on Huron Street, part of 2004 satellite expansion West Elgin Community Health Centre Located in West Lorne and serves West Elgin, including Dutton-Dunwich Southwest Ontario Aboriginal Health Access Centre Two locations in London and one in Muncey Not funded by the LHIN but receive some funding under Community Support Services program There is also one non-lhin funded CHC, the North East London Community Health Partnership Drop-In. Two more Community Health Centres are under development: Central (Elgin) Woodstock and Area Proposed Catchment Central Elgin - St. Thomas Woodstock, Ingersoll & Tillsonburg Board Incorporation Sept. 2008 Jan. 2008 Community Engagement Report Completed LHIN Board Jan. 2009 LHIN Board Oct. 2008 26 Pre-operational Phase Source: South West LHIN Moving into pre-operational phase
Health Human Resources Overview A Healthier Tomorrow 27
Southern organizations maintain the largest share of physicians Ratio of Physicians to 1000 Population FY 2007-08 All Family Medicine Specialists North 1.27 0.83 0.44 Central 1.35 0.84 0.51 South 2.18 0.85 1.34 Ratio of Specialists to 1000 Population FY 2007-08 Specialty North Central South Internal Medicine 0.06 0.09 0.06 0.09 0.34 Paediatrics 0.03 <0.03 0.10 0.11 Surgery 0.15 0.18 0.17 0.19 0.32 Laboratory Medicine <0.03 0.04 0.05 0.06 Other Specialty 0.15 0.17 0.14 0.17 0.51 Specialist Total 0.44 0.51 1.34 Source: Ontario Physician Registry 2007 provided by the Ontario Physician Human Resources Data Centre December 2007 Overview of HHR Overall the South has the majority of physicians and concentrated distribution of specialists when compared to other regions. This aligns with the south being the hub of tertiary and specialty services. Many of these specialists often serve the role of visiting physicians in other regions For psychiatry, South has a ratio of 0.18-0.19 psychiatrists to 1000 population. Other specialty total includes anesthesiology, community medicine, critical care medicine, diagnostic radiology, emergency medicine, medical genetics, nuclear medicine, physical medicine & rehab, psychiatry and radiation oncology. 28
The percentage of registered professionals in the South West LHIN is proportional to the population Increasingly aging demographic shift with both patient and clinician populations will exacerbate the HHR shortage crisis Increasing need for interdisciplinary teams to play the primary care role within the health system Practitioners will need to work to their full scope of practice, which will impact legislation and organizational policies/practices Given that 7% of the population of Ontario resides in the South West LHIN, there appears to be a proportionate distribution of registered professionals, with the only exception being Nurse Practitioners. Overview of Ontario Distribution & Characteristics of Registered Professionals Registered Members South West LHIN % % 45-54 years overall >54 years overall Chiropodists 480 n/a 22% 10% Midwives 334 7% 25% 7% Registered Nurses 89,054 9% 32% 21% Registered Practical Nurses 24,482 11% 35% 21% Nurse Practitioners 594 5% 29% 3% Occupational Therapists 4,010 10% 20% 7% Physiotherapists 6,080 10% 23% 13% Source: HealthForceOntario HHR Toolkit: April 2007 29
Regulated nurses represent the largest group of regulated health professionals in Canada Registered nurses account for 78% of the total regulated nursing workforce, compared to 21% for licensed practical nurses and 2% for registered psychiatric nurses (registered psychiatric nurses are regulated separately in Manitoba, Saskatchewan, Alberta and British Columbia). In each of the regulated nursing professions, the average age of entry into the workforce has increased. Regulated nurses are now often older than 30 years of age when they graduate and begin their nursing careers. In 2007, the baby boomer generation (age 43 to 61) dominated the nursing professions; this generation constituted 54% of the RN workforce, 58% of the LPN workforce and 64% of the RPN workforce. Overview of the Distribution & Characteristics of the Various Regulated Nurses Annual Growth Rate Ratio per 100,000 Average Age in Ontario Average Age of New Graduates Hospital Employment Sector of Nurses in Ontario Communit y Health Nursing Home / LTC Other Educated Outside of Canada Registered Nurses 2% 782 45.9 years 26.5 years 64.7% 16.3% 8.9% 10.1% 8% Licensed Practical Nurses 10% 211 44.9 years 31.1 years 46.0% 10.8% 37.1% 6.1% 2% Registered Psychiatric Nurses* <1% 51 Source: CIHI 2007 * Data is for Canada, unless otherwise specified 47.2 years 29 years 40.7% 25.8% 20.8% 12.8% 7% 30