Final
Appendix 1c:
Health Services Inventory - Kenora District Final
Contents
Health Services Inventory - Kenora District 1
PopulationEstimatesandProjections 1 AcuteCareHospitalsinKenoraDistrict 2 Access to Health Services in Kenora District 3 Emergency Department Care 8 Long Term Care 10 Community Mental Health and Addictions 12 Emergency Department Use 14 Ambulatory Care Sensitive Conditions 19 HospitalAmbulatoryClinics 20 AlternateLevelofCareDays:Acute 21 Inpatient Days for External Causes 22 Forecasting Health Services in Kenora District 22 HBAM:ClinicallyAdjustedForecasts 26 Final
Kenora District: Summary of Empirical Analysis
Population Estimates and Projections
Kenora District accounts for 28 percent of the North West LHIN’s population and is expected to grow by 5 percent over the next 10 years. Expected growth rates vary by age group. For example, the population aged 0 to 19 is expected to decrease by 7 percent over the next 10 years while the population of 65 to 79 year olds expected to increase by 46 percent.
Kenora District
10-year Age Group 2009 2019 Growth
00-19 20,273 18,931 -7%
20-44 21,245 22,170 4%
45-64 17,575 18,288 4%
65-79 5,603 8,203 46%
80+ 1,755 2,088 19%
Kenora District Total 66,451 69,681 5%
NW LHIN Total 239,579 238,464 0%
Source: Ontario Ministry of Finance Population Estimates
Kenora is the only NW LHIN district with positive population growth expected over the next 10 years.
Comparison of 10-Year Population Growth Forecasts by sub-LHIN
Rainy Kenora Thunder Thunder North West Age Group River District Bay City Bay District LHIN District
00-19 -7% -11% -16% -17% -13%
20-44 4% -3% -7% -7% -3%
45-64 4% -10% -7% -8% -4%
65-79 46% 34% 42% 43% 42%
80+ 19% 4% 14% 14% 14%
Total 5% -3% -2% -4% 0%
Source: Ontario Ministry of Finance Population Estimates
Health Services Inventory: Kenora District: Final 1 Final
Acute Care Hospitals in Kenora District
The table below summarizes the 2009/10 admissions and inpatient days at Kenora district’s hospitals. The table includes acute care admissions for mental health diagnoses, but excludes admissions to designated mental health beds. Kenora hospitals accounted for 23 percent of the LHIN’s total admissions. Within the district, Lake of the Woods District Hospital was the largest acute care provider and accounted for 38 percent of the district’s total admissions.
Share of Share of Acute Hospital Admissions Days District's LHIN's Beds Admissions Admissions
Dryden Regional Health Centre 1,332 10,513 31 20% 5%
Kenora Lake-Of-The-Woods District 2,538 15,571 55 38% 9%
Red Lake Marg Cochenour Memorial 948 3,366 14 14% 3%
Sioux Lookout Meno-Ya-Win 1,942 9,422 39 29% 7%
Kenora Total 6,760 38,872 139 100% 23%
Source: North West LHIN Health Services Inventory; DAD 2009/10
The table below shows the number of hospital beds of each type at Kenora district hospitals. Lake of the Woods hospital is the only hospital outside of Thunder Bay City with designated mental health beds. All hospitals in the district had newborn bassinets.
Mental Newborn Hospital Acute CCC ELDCAP Total Health Bassinets
DRYDEN Regional 31 10 4 45
KENORALakeOfTheWoods 55 10 19 8 92
RED LAKE Marg Cochenour Memorial 14 4 2 40
SIOUX LOOKOUT Meno-Ya-Win H. C. 39 8 4 51
William A. “Bill” George Extended Care 20 Facility
Kenora District 139 32 19 18 20 248
Source: North West LHIN Health Services Inventory
Health Services Inventory: Kenora District: Final 2 Final
The table below shows that Kenora residents received most of their acute care from local hospitals. 76 percent of the total inpatient days among Kenora residents were provided by hospitals in Kenora district, while 22 percent of days were provided at Thunder Bay Regional Health Sciences Centre.
Market share of acute inpatient days by sub-LHIN 2009/10
Rainy Thunder Kenora Thunder Other Total Sub-LHIN of Patient River Bay District Bay City LHIN Days District District
Kenora District 76% 0% 22% 0% 2% 45,312
Rainy River District 4% 71% 22% 0% 3% 14,255
Thunder Bay City 0% 0% 93% 0% 7% 94,928
Thunder Bay District 1% 0% 42% 50% 6% 23,732
Total Days 35,407 10,531 111,248 12,057 8,984 178,227
Source: DAD 2009/10
Access to Health Services in Kenora District
Acute Inpatient and Day Surgery
The table below shows the ratio of actual to expected inpatient days by diagnosis chapter for each of the NW LHIN’s sub-LHINs. The expected controls for differences in the age and sex profiles of each sub-LHIN’s population and is based on the provincial average rate of inpatient days per capita in each chapter in 2009/10. For example, the number of inpatient days per capita in Kenora district for Endocrine, Nutritional, and Metabolic disorders was 2.41 times higher than expected.
Rainy Thunder Thunder Kenora District River Bay Bay City District District
Inpatient Actual to Actual to Actual to Actual to Chapter Days Expected Expected Expected Expected
01 Infectious/Parasitic Diseases 827 1.21 1.77 1.09 0.97
02 Neoplasms 3,347 1.24 1.20 1.42 1.07
03 Blood and Immune 594 2.12 1.15 1.94 1.91
04 Endocrine, Nutrition, Metabolic 2,811 2.41 1.08 3.09 2.54
05 Mental and Behavioural 2,932 2.32 1.37 3.13 1.22
Health Services Inventory: Kenora District: Final 3 Final
Rainy Thunder Thunder Kenora District River Bay Bay City District District
Inpatient Actual to Actual to Actual to Actual to Chapter Days Expected Expected Expected Expected
06 Nervous System 955 1.38 1.12 1.18 1.08
07 Eye and Adnexa 50 2.01 1.31 1.24 2.87
08 Ear and Mastoid 162 2.81 2.64 3.11 2.45
09 Circulatory 6,533 1.43 1.00 2.43 1.50
10 Respiratory 3,919 1.56 1.18 2.15 1.40
11 Digestive 4,242 1.52 1.01 1.85 1.83
12SkinandSubcutaneousTissue 871 2.84 1.11 1.45 2.13
13 Musculoskeletal and Connective 2,183 1.68 1.31 1.38 1.25
14 Genitourinary 1,832 1.52 0.66 1.56 1.52
15 Pregnancy and Childbirth 3,502 1.21 1.04 1.37 1.12
16 Perinatal Period 1,030 0.56 0.23 1.53 1.61
17 Congenital and Chromosomal 76 0.24 0.38 1.05 1.27
19 Injury and Poisoning 4,432 1.60 1.06 2.04 1.39
20 External Causes 8,243 3.39 2.70 6.03 0.94
Source: DAD 2009/10
Access to acute inpatient and day surgery in the North West LHIN was measured using the HBAM framework. HBAM accounts for population size, socio-demographic characteristics (including rural geography and socioeconomic status) and health characteristics. In the table below, positive variances indicate higher use of acute inpatient and day surgery resources than expected and negative variances indicate lower use than expected. Under HBAM, expected service use is the provincial average service use conditional on the patient’s age, SES, rural geography, and disease group. Importantly, expected service use is conditional on admission. Variance therefore shows the difference between actual and expected services for patients admitted to hospital. Regions with high rates of hospital use, including the North West LHIN, do not automatically have high variances.
Health Services Inventory: Kenora District: Final 4 Final
Rainy Thunder Thunder North Kenora Chapter River Bay Bay LHIN District District District City Total
01 Infectious/Parasitic Diseases 3.1% -8.1% 9.3% -4.0% -1.8%
02 Neoplasms 2.2% -0.3% -1.3% 1.8% 1.3%
03 Blood and Immune -14.0% 19.7% -17.0% -9.1% -9.6%
04 Endocrine, Nutrition, Metabolic -1.0% -12.5% -9.5% 8.2% 2.7%
05 Mental and Behavioural 12.4% -38.1% 13.2% 15.5% 5.7%
06 Nervous System 3.7% 8.2% -5.6% -5.1% -1.3%
07 Eye and Adnexa 9.6% -0.1% -14.3% 4.1% 4.0%
08 Ear and Mastoid -6.8% -2.9% -2.3% -7.3% -6.1%
09 Circulatory -5.1% -0.9% 3.9% 5.9% 2.8%
10 Respiratory -2.7% 5.7% -15.3% -1.3% -3.0%
11 Digestive -0.8% -11.3% 16.9% 1.1% 1.4%
12 Skin and Subcutaneous Tissue -6.3% -5.5% -23.9% 2.3% -3.9%
13 Musculoskeletal and Connective -1.0% 2.7% -5.0% 3.0% 1.1%
14 Genitourinary 2.4% 5.0% -6.0% 3.3% 2.3%
15 Pregnancy and Childbirth -0.3% 0.1% 0.4% -1.0% -0.5%
16 Perinatal Period 0.0% 0.0% 0.0% 0.0% 0.0%
17 Congenital and Chromosomal -0.5% 17.7% 12.5% 0.6% 2.5%
19 Injury and Poisoning -0.7% -7.9% 1.0% -0.5% -1.1%
20 External Causes 0.8% -0.7% -0.8% -1.3% -0.4%
Total Variance -1.2% -2.1% -0.7% 1.8% 0.4%
Source: HBAM 2009/10
Overall, acute service use among Kenora district’s population was 1.2 percent less than expected. Variance from the population perspective assesses the actual use of services by the district or LHIN’s population regardless of where (in Ontario) they received care. Resource use was higher than expected in the nervous system and infectious / parasitic disease chapters. Resource use was lower than expected in the circulatory, skin and subcutaneous tissue, and respiratory chapters.
Health Services Inventory: Kenora District: Final 5 Final
The table below shows acute and day surgery variance by hospital. Overall, Kenora district hospitals provided 1.9 percent less service than expected given the characteristics of their patients. Red Lake Hospital had the largest negative variances of hospitals in Kenora district.
HBAM Acute Service Variance by Hospital, 2009/10
Actual Expected Hospital Name Weighted Weighted Variance Cases Cases
Dryden Regional Health Centre 1,659 1,687 -1.7%
Kenora Lake-Of-The-Woods District 2,617 2,653 -1.4%
Red Lake Marg Cochenour 597 633 -5.6% Memorial
Sioux Lookout Meno-Ya-Win 1,424 1,446 -1.5%
Kenora District 6,297 6,418 -1.9%
Atikokan General 313 333 -6.0%
Fort Frances Riverside Health Care 1,698 1,756 -3.3%
Rainy River District 2,011 2,088 -3.7%
Thunder Bay Regional Health 22,989 22,718 1.2% Sciences Centre
Thunder Bay City 22,989 22,718 1.2%
Geraldton District Hospital 594 644 -7.6%
Manitouwadge General 225 221 1.9%
Marathon Wilson Memorial 368 371 -0.7%
Nipigon District Memorial 410 436 -5.9%
Terrace Bay McCausland 240 249 -3.7%
Thunder Bay District 1,838 1,920 -4.3%
Total 33,135 33,145 0.0%
Source: HBAM 2009/10
Health Services Inventory: Kenora District: Final 6 Final
The table below shows the percentage of admissions by residents of North West LHIN that occurred at Manitoba hospitals. Overall, 16 percent of all acute care admissions among Kenora’s population were to hospitals in Manitoba. This percentage varies by clinical program. Among the large programs, the range is from 9 percent in respiratory to 31 percent in cancer.
North West LHIN Patients Total Acute Admissions among NW Percentage Admitted to Manitoba Hospitalized in Manitoba LHIN Residents Hospitals
North North Thunde Rainy Kenor Thunde Rainy Kenor Clinical Program West West r Bay River a r Bay River a LHIN LHIN
01 Infectious/Parasitic Diseases 203 41 128 376 0% 5% 21% 8%
02 Neoplasms 1,028 149 393 1,578 1% 21% 31% 10%
03 Blood and Immune 210 27 91 330 1% 0% 3% 2%
04 Endocrine, Nutrition, 784 95 313 1,199 1% 11% 14% 5% Metabolic
05 Mental and Behavioural 513 139 339 998 1% 0% 3% 1%
06 Nervous System 311 67 161 543 0% 3% 22% 7%
07 Eye and Adnexa 40 14 36 90 50% 71% 72% 62%
08 Ear and Mastoid 115 25 43 184 0% 0% 2% 1%
09Circulatory 3,119 470 1,243 4,851 2% 14% 17% 7%
10 Respiratory 1,774 270 816 2,877 0% 4% 9% 3%
11 Digestive 2,260 317 934 3,559 0% 9% 12% 4%
12 Skin and Subcutaneous Tissue 219 35 127 384 1% 6% 9% 4%
13 Musculoskeletal and 913 162 381 1,465 0% 9% 20% 6% Connective
14 Genitourinary 1,056 142 455 1,666 1% 18% 22% 8%
15 Pregnancy and Childbirth 2,474 447 1,997 4,932 0% 5% 15% 7%
16 Perinatal Period 618 40 358 1,019 0% 28% 29% 11%
17CongenitalandChromosomal 125 14 47 186 2% 43% 55% 18%
19 Injury and Poisoning 1,709 264 915 2,904 1% 10% 18% 7%
20 External Causes 1,494 444 868 2,818 1% 7% 15% 6%
31,96 Total 18,965 3,164 9,648 1% 10% 16% 6% 4
Source: National DAD 2009/10, accessed via CIHI Portal by NW LHIN Staff
Health Services Inventory: Kenora District: Final 7 Final
Emergency Department Care
The table below shows HBAM emergency department variance for residents of the Kenora district. As in the acute and day surgery module, HBAM accounts for the socio-demographic and health characteristics of the district’s population. Service variance can be affected by two factors: 1) variance in resource use for each admission; and 2) variance in the number of ED visits per year.
2009/10 ED 2009/10 2012/13 Chapter Weighted Variance Variance Cases
01 Infectious/Parasitic Diseases 36 -8.5% -3.7%
02 Neoplasms 26 -8.2% -5.8%
03 Blood and Immune 15 -3.0% -0.7%
04 Endocrine, Nutrition, Metabolic 60 -0.6% 1.6%
05 Mental and Behavioural 133 4.5% 6.5%
06 Nervous System 51 -4.8% -2.8%
07 Eye and Adnexa 8 -2.3% 0.4%
08 Ear and Mastoid 37 -3.9% -2.0%
09 Circulatory 271 -5.4% -3.8%
10 Respiratory 340 -1.1% 1.2%
11 Digestive 197 -6.0% -4.5%
12 Skin and Subcutaneous Tissue 44 -9.9% -8.2%
13 Musculoskeletal and Connective 67 7.5% 9.5%
14 Genitourinary 107 -8.2% -7.0%
15 Pregnancy and Childbirth 36 -5.7% -7.5%
16 Perinatal Period 1 0.0% 5.0%
17 Congenital and Chromosomal 0 -0.3% -1.2%
19 Injury and Poisoning 330 -8.7% -7.0%
20 External Causes 219 -3.6% -2.1%
Kenora Population 1,980 -4.3% -2.5%
Rainy River Population 814 6.3% 11.0%
Thunder Bay District Population 1,071 17.6% 22.1%
Health Services Inventory: Kenora District: Final 8 Final
2009/10 ED 2009/10 2012/13 Chapter Weighted Variance Variance Cases
Thunder Bay City Population 4,042 18.3% 23.0%
NW Population 7,907 10.4% 14.2%
Source: HBAM 2009/10
Kenora district’s patients admitted to emergency departments in 2009/10 received 4.3 percent less service than expected. Service variance ranged across the clinical programs with Infectious / Parasitic Diseases, Neoplasms, and Injury and Poisoning have the highest negative variances. The Musculoskeletal and Connective and Mental and Behavioural chapters had high positive variances, indicating higher service use than expected. Kenora is the only district in the NW LHIN that had negative variance in emergency department care.
Emergency Department Variance by Hospital
2009/10 2012/13 Hospital Variance Variance
Dryden Regional Health Centre -5.9% -4.2%
Lake-of –the-Woods District Hospital -3.7% -2.0%
Red Lake Marg Cochenour Memorial -5.2% -3.2%
Sioux Lookout Meno-Ya-WIN -2.4% 0.0%
Atikokan General Hospital 9.7% 14.3%
Riverside Health Care 5.0% 9.6%
Thunder Bay Regional Health Sciences Centre 17.1% 21.5%
GeraldtonDistrictHospital 15.4% 21.4%
Manitouwadge General Hospital 23.3% 26.9%
Wilson Memorial General Hospital 15.1% 20.0%
Nipigon District Memorial Hospital 18.2% 21.4%
McCausland Hospital 17.3% 20.1%
NW LHIN Hospital Total 10.1% 13.8%
Source: HBAM 2009/10
Health Services Inventory: Kenora District: Final 9 Final
HBAM Variance: Complex continuing care, Inpatient Rehabilitation, Home care, and Inpatient mental health
The table below shows variance by district for complex continuing care, inpatient rehabilitation, home care and inpatient mental health. Variance for these programs was estimated using the HBAM framework.
Inpatient Inpatient Home Patient Sub-LHIN CCC Mental Rehabilitation Care Health
Kenora District -17.5% -29.6% -9.7% 1.8%
Rainy River District 40.1% -69.9% -11.7% -0.4%
Thunder Bay District 46.6% -13.9% -13.6% 3.0%
Thunder Bay City 52.9% -6.5% -0.8% 1.3%
NW LHIN Population 39.9% -16.1% -4.6% 1.5%
Source: HBAM 2009/10
Based on their clinical and demographic characteristics, Kenora residents had 17.5 percent less access to CCC services than expected, 29.6 percent less access to inpatient rehabilitation services, 9.7 percent less home care services than expected, and 1.8 percent more inpatient mental health service than expected. The CCC picture is likely incomplete given that LTC and CCC beds may often be used as substitutes in the NW LHIN. The LTC picture in Kenora, presented later in this document, will help complete the assessment.
Long Term Care
The table below shows the number of LTC homes and beds available in the Kenora District. There were four LTC homes with a total of 351 beds in 2009/10. Twenty ELDCAP beds were also available in the district at the William A. "Bill" George Extended Care Facility, which is located in Sioux Lookout.
ELDCAP LTC LTC Home Total Beds Beds
Birchwood Terrace Nursing Home 96 96
Northwood Lodge Home for the Aged 32 32
Pinecrest Home for the Aged 126 126
Princess Court 97 97
William A. "Bill" George Extended Care Facility 20 20
Kenora District Total 20 351 371
Atikokan General Hospital 22 22
Fort Francis Riverside - Emo 12 12
Health Services Inventory: Kenora District: Final 10 Final
ELDCAP LTC LTC Home Total Beds Beds
Fort Francis Riverside - Rainy River 21 21
Rainycrest Long-Term Care 164 164
Rainy River District Total 55 164 219
Bethammi Nursing Home 110 110
Dawson Court Home for the Aged 150 150
Grandview Lodge Home for the Aged 150 150
Hogarth Riverview Manor 96 96
Pinewood Court 128 128
Pioneer Ridge Home for the Aged 150 150
Roseview Manor 157 157
Thunder Bay Interim Long-Term Care Centre 65 65
Versa Care Limited 131 131
Thunder Bay City Total 1,137 1,137
Geraldton District Hospital 19 19
Manitouwadge General Hospital 9 9
Nipigon District Memorial Hospital 14 14
Wilkes Terrace 22 22
Thunder Bay District Total 42 22 64
North West LHIN Total 117 1,674 1,791
Source: North West CCAC, August 31, 2011
The table below shows the difference between the actual and expected discharges from acute care to Long Term Care and Complex Continuing Care for each patient sub-LHIN. Expected discharges to LTC/CCC were calculated based on the provincial average discharge probabilities by patient frailty. For example, in 2009/10, 117 fewer patients from Kenora district were discharged to LTC/CCC than would have been the case at the provincial average discharge practice. While acute care patients from Kenora, Rainy River, and Thunder Bay District were less likely to be discharged to LTC/CCC, patients from Thunder Bay City were much more likely to be discharged to LTC/CCC. At the provincial average, 420 fewer Thunder Bay City patients would have been discharged to LTC/CCC in 2009/10. Put differently, low frailty patients from Thunder Bay city are much more likely to be discharged to LTC/CCC than patients elsewhere in the LHIN. That there were 192 more actual acute discharges to
Health Services Inventory: Kenora District: Final 11 Final
LTC/CCC than expected in the LHIN in 2009/10 suggests that the combined supply of LTC/CCC resources in the LHIN is adequate for the requirements of the acute population. The variation observed across the sub-LHIN areas suggests that the distribution or access to the LTC/CCC resources is inconsistent across the LHIN.
Actual and Expected Discharges to LTC and CCC, 2009/10
Long Term Care Complex Continuing Care CCC/LTC Combined Actual - Actual - Actual - Sub-LHIN of Patient Actual Expected Actual Expected Expected Expected Expected
Kenora District 88 151 -63 54 108 -54 -117
Rainy River District 14 79 -65 66 52 14 -51
Thunder Bay District 12 69 -57 48 50 -2 -59
Thunder Bay City 363 383 -20 694 254 440 420
NW LHIN 477 683 -206 862 464 398 192
Source DAD 2009/10
Community Mental Health and Addictions
The table below shows the CMH&A providers and their 2009/10 total operating expenses. Operating expenses were retrieved from MIS.
Operating CMH&A Provider Name Expenses 2009/10
Canadian Mental Health Association - Kenora Branch 2,030,714
Dryden Regional Health Centre 2,655,102
Keewatin Changes Recovery Homes 675,720
Keewatin Wassay-Gezhig 106,151
Kenora Kenora Association for CL 972,495
Kenora Lake-of-the-Woods District 3,235,123
Kenora Sexual Assault Centre 349,174
Kenora Sunset Country Psych Surv 525,599
Red Lake Marg Cochenour Memorial 803,562
Health Services Inventory: Kenora District: Final 12 Final
Operating CMH&A Provider Name Expenses 2009/10
Sioux Lookout Meno-Ya-Win 1,417,935
Kenora District 12,771,575
Source: North West LHIN Health Services Inventory
The table below shows the total number of CMH&A clinic visits by sub-LHIN.
CMH & Addictions
CMH&A Clinic Rainy Thunder Kenora Thunder Visits 2009/10 River Bay District Bay City District District
FacetoFace 77,152 74,780 113,895 3,376
Telephone 22,075 6,665 38,543 798
Total Visits 99,227 81,445 152,438 4,174
Source: North West LHIN Health Services Inventory
Ratio of Clinic Visits to Acute Inpatient Mental Health Admissions
Hospital CMH&A Sub-LHIN of Hospital/Clinic All MH Clinic Clinic Clinic
Kenora District 0 182 182
Rainy River District 0 590 590
Thunder Bay City 25 97 122
Thunder Bay District 0 22 22
North West 16 138 154
Province 13 96 109
Source: North West LHIN Health Services Inventory; DAD 2009/10; OMHRS 2009/10
The North West LHIN had 154 mental health clinic visits per inpatient admission which was 42 percent higher than the provincial average. The Kenora District had 182 visits per admission which was 18 percent higher than the LHIN average and 67 percent higher than the provincial average.
Health Services Inventory: Kenora District: Final 13 Final
The results for Thunder Bay district may be spurious because of services provided by agencies located in Thunder Bay city to residents of Thunder Bay district are assigned to Thunder Bay City. Lack of consistent client level data in this sector precludes identifying the sub-LHIN of the service recipient. It may therefore be more accurate to combine the activity for Thunder Bay City and Thunder Bay district for this analysis. The ratio of mental health clinic visits to inpatient admissions is 113 for the combined regions, which is approximately the provincial average. It is also important to note that discussions with the LHIN revealed that there may be agencies providing service that do not report data to Ontario Ministry of Health and Long Term Care’s MIS system.
On Reserve Expenses per Expenses per Sub-LHIN Expenses Population Aboriginal Capita - Off Capita Population Reserve
Kenora District $12,771,575 66,451 19,303 $192 $271
Rainy River District $5,833,696 21,767 2,204 $268 $298
Thunder Bay City $24,875,719 124,945 2,825 $199 $204
Thunder Bay District $3,694,196 26,416 923 $140 $145
North West LHIN Total $47,175,186 239,579 25,255 $197 $220
Source: MIS 2009/10; Ontario Ministry of Finance Population Estimates and Projections
The table above shows Community Mental Health and Addictions spending per capita by sub-LHIN. In all sub- LHINs spending per capita far exceeded the provincial average of $78. Because some Community Mental Health and Addiction providers located in Thunder Bay City provide services to residents of Thunder Bay District, it might be more accurate to combine these districts for this analysis. Spending per capita in the combined Thunder Bay City and Thunder Bay District sub-LHINs was $189.
Emergency Department Use
The table below shows the volume 2009/10 volume of emergency department visits by residents of the Kenora District.
2009/10 ED Visits by Residents of the Kenora Sub-LHIN
4 - 1 - 2 - 3 - 5 - Non- Kenora CTAS Level Less- Resuscitation Emergent Urgent urgent Total urgent
Atikokan General Hospital 7 16 2 25
Dryden Regional Health Centre 26 511 4,330 9,005 2,207 16,079
GeraldtonDistrictHospital 1 1 4 8 11 25
Lake of the Woods District Hospital 31 465 4,870 9,872 3,225 18,463
Health Services Inventory: Kenora District: Final 14 Final
2009/10 ED Visits by Residents of the Kenora Sub-LHIN
4 - 1 - 2 - 3 - 5 - Non- Kenora CTAS Level Less- Resuscitation Emergent Urgent urgent Total urgent
Manitouwadge General Hospital 3 2 5
McCausland Hospital 1 3 2 6
Nipigon District Memorial Hospital 2 3 2 7
RedLakeMemorialHospital 8 100 550 1,118 816 2,592
Riverside Health Care – EMO 2 12 20 34
RiversideHealthCare-LAVERENDRYE 1 2 58 249 166 476
Riverside Health Care - RAINY RIVER 1 2 14 53 70
Sioux Lookout Meno Ya Win Health 12 125 1,660 7,607 3,397 12,801 Centre
Thunder Bay Regional Health Sciences 38 562 1,549 670 85 2,904 Centre
Wilson Memorial General Hospital 1 3 4 2 10
Kenora Total 117 1,768 13,038 28,584 9,990 53,497
Source: NACRS 2009/10
This table shows 2009/10 CTAS level 1 and 2 ED visits by district of patient.
District of NW LHIN Resident
Rainy Thunder Thunder Kenora Facility Period of Admission to ED River Bay Bay Total District District City District
Weekday between 10pm and 7am 3 3 Atikokan General Weekday between 7am and 10pm 28 4 32 Hospital Weekend 12 12
Weekday between 10pm and 7am 81 1 82 Dryden Regional Weekday between 7am and 10pm 303 2 305 Health Centre Weekend 153 2 155
Geraldton Weekday between 10pm and 7am 1 23 24
Health Services Inventory: Kenora District: Final 15 Final
District of NW LHIN Resident
Rainy Thunder Thunder Kenora Facility Period of Admission to ED River Bay Bay Total District District City District
District Weekday between 7am and 10pm 2 6 111 119 Hospital Weekend 1 52 53
Weekday between 10pm and 7am 101 1 102 Lake of the Woods District Weekday between 7am and 10pm 257 6 263 Hospital Weekend 138 138
Weekday between 10pm and 7am 1 1 Manitouwadge Weekday between 7am and 10pm 18 18 General Hospital Weekend 3 3
Weekday between 10pm and 7am 7 7 McCausland Weekday between 7am and 10pm 14 14 Hospital Weekend 6 6
Weekday between 10pm and 7am 5 5 Nipigon District Memorial Weekday between 7am and 10pm 3 36 39 Hospital Weekend 4 13 17
Weekday between 10pm and 7am 22 22 Red Lake Memorial Weekday between 7am and 10pm 56 2 58 Hospital Weekend 30 1 1 32
Weekday between 10pm and 7am RIVERSIDE HEALTH CARE Weekday between 7am and 10pm 3 3 FAC-EMO SITE Weekend
RIVERSIDE Weekday between 10pm and 7am 2 66 68 HEALTH CARE Weekday between 7am and 10pm 124 3 127 FAC- LAVERENDRYE Weekend 1 97 2 100
RIVERSIDE Weekday between 10pm and 7am 5 5 HEALTH CARE Weekday between 7am and 10pm 28 28 FAC-RAINY RIVER Weekend 1 17 18
Health Services Inventory: Kenora District: Final 16 Final
District of NW LHIN Resident
Rainy Thunder Thunder Kenora Facility Period of Admission to ED River Bay Bay Total District District City District
Weekday between 10pm and 7am 15 15 Sioux Lookout Meno Ya Win Weekday between 7am and 10pm 86 1 1 88 Health Centre Weekend 36 1 37
Weekday between 10pm and 7am 127 20 2,658 142 2,947 Thunder Bay Regional Health Weekday between 7am and 10pm 294 82 11,106 520 12,002 Sciences Centre Weekend 179 31 5,220 226 5,656
Weekday between 10pm and 7am 2 14 16 Wilson Memorial Weekday between 7am and 10pm 7 110 117 General Hospital Weekend 1 4 48 53
Total 1,885 525 19,030 1,350 22,790
Source: NACRS 2009/10
Visits per Person among Emergency Department Users
This table shows the average annual number of visits to the ED among people with at least one ED visit. Overall, ED users in Kenora had an average of 2.3 visits per person which is 27 percent higher than the provincial average of 1.8 visits per person. ED visits per person for Mental and Behavioural diagnoses was 3.1 in Kenora, and was 38 percent higher than the provincial average of 2.3. Visits per person for Endocrine, Nutritional and Metabolic disorders was 34 percent higher in Kenora than the provincial average.
Rainy Thunder Thunder Kenora District River Bay Bay Ontario District District City
Visits Visits Visits Visits Visits Chapter Visits per per per per per Person Person Person Person Person
01 Infectious/Parasitic Diseases 1,496 2.0 2.3 2.2 1.8 1.7
02 Neoplasms 379 2.6 5.5 3.8 3.0 2.4
03 Blood and Immune 130 2.3 2.5 5.5 2.7 2.3
Health Services Inventory: Kenora District: Final 17 Final
04 Endocrine, Nutrition, Metabolic 866 2.7 2.5 5.9 2.2 2.1
05 Mental and Behavioural 2,836 3.1 3.1 3.7 2.8 2.3
06 Nervous System 1,335 2.5 3.0 3.4 2.1 2.0
07 Eye and Adnexa 783 1.8 2.2 2.4 1.8 1.6
08 Ear and Mastoid 2,194 2.1 2.3 2.3 1.9 1.7
09 Circulatory 3,299 2.3 2.9 3.0 2.1 1.8
10 Respiratory 9,329 2.2 2.2 2.7 2.0 1.8
11 Digestive 3,753 2.4 2.5 2.8 2.1 1.8
12 Skin and Subcutaneous Tissue 3,221 2.5 3.0 3.5 2.8 2.2
13 Musculoskeletal and Connective 3,748 2.3 2.7 3.1 2.1 1.8
14 Genitourinary 3,148 2.4 2.6 2.8 2.2 1.9
15 Pregnancy and Childbirth 814 2.6 2.8 3.1 2.2 2.0
16 Perinatal Period 64 2.3 4.0 2.2 3.0 1.8
17 Congenital and Chromosomal 13 1.9 7.0 4.3 1.6 2.0
19 Injury and Poisoning 11,003 2.0 2.2 2.4 1.8 1.6
20 External Causes 6,978 2.6 3.1 4.0 2.3 2.0
Total 55,389 2.3 2.6 3.0 2.1 1.8
Source: NACRS 2009/10
Health Services Inventory: Kenora District: Final 18 Final
Ambulatory Care Sensitive Conditions
The table below shows by district of patient, the hospital admissions for ambulatory care sensitive conditions that would have been avoided if the district had had the provincial average standardized admission rate.
Potentially Avoidable 2009/10 Hospital Admissions at Provincial Average Standardized Admission Rate
Rainy Thunder Thunder Ambulatory Care Sensitive Kenora River Bay Bay Total Condition District District District City
Influenza / pneumonia 167 57 111 394 729
Alcoholrelated 136 24 41 45 246
Angina 53 24 30 84 192
COPD 50 38 57 266 411
Diabeteswithcomplications 45 27 52 79 203
Cellulitis 44 13 12 87 155
Atrial fibrillation 36 28 16 98 178
Kidney / Urinary 34 5 11 159 208
CHF 32 19 23 141 216
Dehydration / 30 4 20 7 61 Gastroenteritis
Total Kenora Top 10 ACSC 626 238 372 1,361 2,597
All ACSC 701 324 403 1,439 2,867
Source: DAD 2009/10
Kenora patients with influenza / pneumonia had high rates of admission to acute hospitals. At the provincial average rate of admission, controlling for the age and sex profile of the district’s population, Kenora patients would have had 167 fewer admissions for influenza / pneumonia in 2009/10. Kenora’s top 10 ACSC by potentially avoidable admissions accounted for 626 of 701 total potentially avoidable admissions.
The rate of admissions to acute care hospitals for alcohol related mental disorders was the highest in Kenora district. The admission rate in Kenora was nearly 11 times the provincial average rate.
Health Services Inventory: Kenora District: Final 19 Final
Hospital Ambulatory Clinics
The high rates of admissions for ambulatory care sensitive conditions observed in Kenora and throughout the NW LHIN prompts an examination of the availability of ambulatory care. The table below shows the ratio of hospital- based ambulatory clinic visits to inpatient admissions in 2009/10. These ratios aim to assess the mix of ambulatory and inpatient activity at each hospital.
Hospital Ambulatory Clinic Visits per Inpatient Admission, 2009/10.
Diabetes , Combined Mental Cardiac Geriatric Oncology Endocrinology All Sub-LHIN of Hospital Medical / Health Clinics Clinics Clinics and Metabolic Clinics Surgical Clinics Clinics
Kenora District 3.3 0.0 0.0 0.0 18.2 0.0 3.8
Rainy River District 0.3 0.0 0.0 0.0 10.9 0.0 0.7
Thunder Bay City 3.1 31.8 4.3 1.2 30.5 8.8 9.6
Thunder Bay District 1.2 0.0 0.0 0.0 3.9 0.0 1.3
North West LHIN Total 2.8 27.0 2.8 0.7 26.9 5.5 7.1
Provincial LHIN 5.2 17.3 2.9 0.5 18.5 13.0 8.6 AVERAGE
Source: North West LHIN Health Services Inventory; DAD 2009/10
The table shows that Kenora’s hospitals had fewer ambulatory clinic visits per admission for combined medical/surgical, mental health, cardiac, geriatric, diabetes. Kenora district had approximately the rate of clinic visits per admission for cancer care. Overall, the ratio of clinic visits per admission was less than half the provincial average.
Health Services Inventory: Kenora District: Final 20 Final
Alternate Level of Care Days: Acute
The table below shows the top case mix groups by ALC among Kenora district’s hospitalized patients. Rehabilitation, Convalescence, Awaiting Placement, and Dementia accounted for the highest number of ALC days among Kenora’s hospitalized patients.
Kenora Sub-LHIN High ALC Users Low ALC Users
Total ALC ALC ALC ALC CMG ALC Patients Days Patients Days Days
805 Rehabilitation 7 765 39 728 1,493
806 Convalescence 4 603 43 613 1,216
809 Await Placement 5 775 15 421 1,196
670 Dementia 3 403 22 493 896
135-139 Pneumonia/COPD 2 221 15 158 379
06 Digestive System - Other 1 150 14 210 360
193-194, 196 Myocardial Infarction/HeartFail 1 100 15 224 324
812 Other Factors 1 236 7 81 317
810 Palliative 0 0 17 301 301
037-038 Central Nervous System 1 284 1 10 294
811 General Symptom/Sign 1 91 5 176 267
19 Significant Trauma - Other 0 0 11 262 262
726-729 Orthopedic Surgery 1 70 9 192 262
025-028 Stroke 1 75 14 169 244
01 Nervous System - Other 1 63 5 162 225
437 Diabetes 1 140 3 83 223
20 Other Reasons For Hospitalization - Other 1 215 0 0 215
132 Malignant Neoplasm of Respiratory System 1 164 3 41 205
09 Skin, Subcutaneous Tissue And Breast - Other 1 181 3 23 204
761 Fracture/Dislocation/Rupture of 0 0 8 178 178 Pelvis/Sacrum/Coccyx
Other CMGs 5 313 97 1,379 1,692
Total 38 4,849 346 5,904 10,753
Source: DAD 2009/10
Health Services Inventory: Kenora District: Final 21 Final
The table above shows that Kenora patients had long ALC days in hospital for rehabilitation, awaiting placement, and convalescent care. These findings are consistent, and are likely associated, with those presented earlier showing that residents of Kenora district had less access to CCC, inpatient rehabilitation, and home care services. It was also shown earlier that Kenora’s post-acute population had less access than expected to CCC and LTC.
Inpatient Days for External Causes
As presented earlier, Kenora’s standardized rate of inpatient days per capita for in ‘External Causes’ was 3.1 times the provincial average in 2009/10. The table below shows that the majority of days in External Causes were associated with rehabilitation care, awaiting placement, convalescence, and palliative care.
Kenora District: Top Diagnoses by total days in External Causes
2009/10 Diagnosis Inpatient Days
OTHER PHYSICAL THERAPY (Rehabilitation care; fitting of prostheses; and 1,891 adjustment of devices)
PERSON AWAITING ADMISSION TO ADEQUATE FACILITY ELSEWHERE 1,343
CONVALESCENCE FOLLOWING SURGERY 1,228
PALLIATIVE CARE 940
CONVALESCENCE FOLLOWING OTHER TREATMENT 478
CONVALESCENCE FOLLOWING TREATMENT OF FRACTURE 317
Kenora's top External Cause diagnoses 6,197
Total Days in External Causes 8,243
Share of top diagnoses 75%
Source: DAD 2009/10
Forecasting Health Services in Kenora District
The table below shows 10 year forecast growth by clinical chapter for residents of the Kenora District. Kenora District has the LHIN highest expected growth rate, which is consistent with the expectations for population growth presented earlier.
Because requirements for health services in the Kenora district are expected to grow faster than the LHIN average, the district will gradually increase its share of the LHIN’s health care resources.
Health Services Inventory: Kenora District: Final 22 Final
Among the larger programs, growth is expected to be highest in Circulatory care (27 percent), cancer care (28 percent), and respiratory care (18 percent).
10-year Growth Forecast by Chapter for Acute Inpatient and Day Surgical Care, 2009/10
2009/10 Activity Expected 10-year Growth
Chapter Cases Days RIW Cases Days RIW
01 Infectious/Parasitic Diseases 152 1,072 271 20% 25% 22%
02 Neoplasms 335 3,704 717 25% 29% 28%
03 Blood and Immune 66 487 84 14% 16% 15%
04 Endocrine, Nutrition, Metabolic 279 2,997 486 19% 25% 24%
05 Mental and Behavioural 20 135 29 34% 38% 38%
06 Nervous System 132 1,037 225 9% 16% 15%
07 Eye and Adnexa 11 57 8 27% 35% 36%
08 Ear and Mastoid 33 119 22 12% 18% 12%
09 Circulatory 1,133 7,016 1,437 25% 27% 27%
10 Respiratory 797 4,236 911 16% 20% 18%
11Digestive 721 3,739 759 12% 16% 14%
12 Skin and Subcutaneous Tissue 104 817 129 6% 3% 4%
13 Musculoskeletal and Connective 311 2,103 479 19% 21% 22%
14 Genitourinary 294 1,624 332 13% 21% 20%
15 Pregnancy and Childbirth 1,682 3,476 658 11% 12% 11%
16 Perinatal Period 245 1,016 117 10% 9% 10%
17 Congenital and Chromosomal 20 77 32 9% 4% 6%
19 Injury and Poisoning 794 4,872 1,049 11% 16% 14%
20 External Causes 516 6,728 864 18% 24% 24%
Kenora District Total 7,645 45,312 8,608 16% 21% 20%
Rainy River District Total 2,700 14,255 2,905 8% 11% 10%
ThunderBayDistrictTotal 3,357 23,732 4,562 8% 15% 14%
Thunder Bay City Total 14,736 94,928 19,394 9% 14% 13%
NWLHINTotal 28,438 178,227 35,468 11% 16% 15%
Source: HBAM 2009/10; DAD 2009/10
Health Services Inventory: Kenora District: Final 23 Final
Growth by Hospital
10-year Growth Forecast by Hospital for Acute Inpatient and Day Surgical Care, 2009/10
Actual 2009/10 Activity Expected 10-year Growth
Hospital Name Cases Days RIW Cases Days RIW
Dryden Regional Health Centre 1,287 9,759 1,659 19% 21% 21%
Kenora Lake-Of-The-Woods District 2,366 14,208 2,617 18% 22% 21%
Red Lake Marg Cochenour Memorial 784 3,153 597 14% 23% 19%
Sioux Lookout Meno-Ya-Win 1,849 8,966 1,424 12% 20% 17%
Kenora District Total 6,286 36,086 6,297 16% 22% 20%
Atikokan General 302 2,005 313 8% 13% 13%
Fort Frances Riverside Health Care - Emo 71 490 84 15% 16% 16%
Fort Frances Riverside Health Care - 1,764 7,298 1,492 8% 11% 11% Laverendrye
Fort Frances Riverside Health Care - Rainy 114 782 122 14% 13% 14% River
Rainy River District Total 2,251 10,575 2,011 9% 12% 12%
Thunder Bay Regional Health Sciences 17,721 113,294 22,989 9% 14% 13%
Thunder Bay City Total 17,721 113,294 22,989 9% 14% 13%
Geraldton District Hospital 465 3,700 594 9% 21% 22%
Manitouwadge General 136 1,599 225 15% 26% 25%
Marathon Wilson Memorial 278 2,462 368 6% 15% 14%
Nipigon District Memorial 365 2,808 410 17% 26% 23%
Terrace Bay McCausland 192 1,645 240 14% 14% 14%
Thunder Bay District Total 1,436 12,214 1,838 12% 20% 20%
NW LHIN Hospital Total 27,694 172,169 33,135 11% 16% 15%
Source: DAD 2009/10; HBAM 2009/10
Forecast 10-year Growth
Mental Complex Inpatient Health Home Care Long Term Continuing Rehabilitation Inpatient Expenses Care Care Days Days Days
Kenora District 12% 17% 18% 18% 22%
Health Services Inventory: Kenora District: Final 24 Final
Rainy River District 4% 7% 9% 16% 11%
Thunder Bay District 8% 13% 18% 15% 20%
Thunder Bay City 3% 15% 19% 19% 20%
North West LHIN 5% 14% 18% 18% 20% Total
10-Year Forecasts of Community Sector Growth in Expenses
2009/10 Expenses
Assisted Living Community CMH & Services in Support Addiction Total Supportive Services Agencies Housing
Kenora District $2,156,444 1,052,037 12,771,575 28,825,341
Rainy River District 566,320 22,295 5,833,696 12,600,102
Thunder Bay City 9,413,310 3,015,528 27,160,288 82,419,298
Thunder Bay District 348,533 1,409,627 2,586,888
North West LHIN 12,484,607 4,089,860 47,175,186 126,431,628
Forecast 10-Year Growth
Assisted Living Community CMH & Services in Support Addiction Total Supportive Services Agencies Housing
Kenora District 17% 17% 12% 17%
Rainy River District 7% 7% 4% 8%
ThunderBayCity 15% 15% 3% 14%
Thunder Bay District 13% 8% 13%
North West LHIN 15% 15% 6% 14%
10 Year Forecast Expenses
Assisted Living Community CMH & Services in Support Addiction Total Supportive Services Agencies Housing
Health Services Inventory: Kenora District: Final 25 Final
Kenora District $2,523,206 1,230,964 14,360,570 33,792,831
Rainy River District 605,211 23,826 6,074,536 13,559,855
Thunder Bay City 10,789,773 3,456,475 28,024,450 93,880,628
Thunder Bay District 393,982 1,527,949 2,918,356
North West LHIN 14,312,171 4,711,264 49,987,505 144,151,669
Source: North West LHIN Health Services Inventory; HBAM 2009/10
HBAM: Clinically Adjusted Forecasts
The table below shows naïve and HBAM-CAP forecasts of inpatient days by clinical chapter for residents of Kenora district. Chapters with large differences between the HBAM and HBAM-CAP forecasts are those where rates of hospital service use in Kenora are very different from the provincial reference rates. For example, under the naïve HBAM forecasts, acute inpatient days required by Kenora’s population for cancer care are expected to increase by 29 percent over the next 10 years. The naïve forecasts are based on Kenora district’s 2009/10 rate of acute inpatient days for neoplasms and account for population growth and aging. HBAM-CAP forecasts also account for population changes, but assume that the Kenora district will move towards the 2009/10 provincial 25th percentile rate of inpatient days for neoplasms. Under the HBAM-CAP assumptions, the number of inpatient days for neoplasms would decrease by 15 percent over the next 10 years.
10-year Growth
Share of HBAM- Chapter 2009/10 HBAM CAP Days
01 Infectious/Parasitic Diseases 2% 25% 48%
02 Neoplasms 7% 29% -15%
03 Blood and Immune 1% 16% 5%
04 Endocrine, Nutrition, Metabolic 6% 25% 27%
06 Nervous System 2% 16% 6%
07 Eye and Adnexa 0% 35% -13%
08 Ear and Mastoid 0% 18% -19%
09 Circulatory 14% 27% -7%
10 Respiratory 9% 20% 4%
11 Digestive 9% 16% 8%
12 Skin and Subcutaneous Tissue 2% 3% -6%
Health Services Inventory: Kenora District: Final 26 Final
10-year Growth
Share of HBAM- Chapter 2009/10 HBAM CAP Days
13 Musculoskeletal and Connective 5% 21% 14%
14 Genitourinary 4% 21% 9%
15 Pregnancy and Childbirth 8% 12% -6%
16 Perinatal Period 2% 9% -2%
17 Congenital and Chromosomal 0% 4% 28%
19 Injury and Poisoning 10% 16% 11%
20 External Causes 18% 24% 2%
Kenora District Total 100% 21% 4%
Rainy River District Total 100% 11% -2%
Thunder Bay District 100% 15% 3%
Thunder Bay City Total 100% 14% 0%
North West LHIN Total 100% 16% 1%
Source: HBAM, HBAM-CAP 2009/10
Health Services Inventory: Kenora District: Final 27