2009 Report on Ontariols Health System

2009 REPORT ON ONTARio’s HEALTH SYSTEM The quality of our health system is the responsibility of every Ontarian. We hope this report will help you understand the publicly funded health system better, and give you the information you need to keep up pressure for improvement. After all, it’s your health and your health system. This report is prepared in partnership with TABLE OF CONTENTS 1 INTRODUCTION AND SUMMARY 1 6 EQUITABLE 89 1.1 The report this year 1 6.1 Introduction 89 1.2 Promoting quality improvement 2 6.2 Equity in access 90 1.3 Our key findings 3 6.3 Equitable effective care 93 1.4 How we gather, assess and interpret data for 6.4 Equity in preventive health services 95 this report 5 6.5 Disparities in risk factors and healthy behaviours 98 2 ACCESSIBLE 7 2.1 Introduction 7 7 EFFICIENT 101 2.2 Access to emergency departments 8 7.1 Introduction 101 Success study: Saving time and making patients 7.2 Emergency department visits that might safer by improving flow in North York General’s have been avoided 102 emergency department 10 Success study: Nurse-practitioner outreach 2.3 Access to primary care 13 avoids ambulance transfers and emergency Success study: Cutting the wait for care by 63% 16 department visits 104 2.4 Waits for specialized procedures, tests 7.3 Use of low cost drugs that work as well as more and surgery 17 expensive ones 106 Success study: North York General Hospital 7.4 Reduce unnecessary tests 108 — Cancer waits 23 7.5 Patients’ perceptions of waste 110 2.5 Access to specialists 25 Success study: Linking information systems in 2.6 Access to long-term care 28 hospitals and primary care 112 Success Study: Home First eases the long wait for long-term care at Halton Healthcare Services 32 8 APPROPRIATE RESOURCES 115 8.1 Introduction 115 3 EFFECTIVE 35 8.2 Overall spending 116 3.1 Introduction 35 8.3 Health human resources 117 3.2 Getting the right drugs to manage chronic disease 36 8.4 Healthy workplace 121 3.3 Getting the right monitoring for chronic disease 41 8.5 Information technology 125 3.4 Reducing complications of chronic disease 42 Success study: Primary care asthma program 9 INTEGRATED 131 puts evidence into practice, reducing symptoms 9.1 Introduction 131 and visits to emergency departments 47 9.2 Smooth handoffs from hospital to other services: 3.5 Getting it right the first time: Avoiding returns Preparing patients for discharge 132 to hospital or emergency 49 9.3 Smooth handoffs from hospital to other services 134 3.6 Keeping people healthy in long-term care 51 Success study: Easing the flow of patients from 3.7 Cancer care 55 hospital to long-term care 137 9.4 How well is my primary care co-ordinated? 139 4 SAFe 59 4.1 Introduction 59 10 A FOCUS ON POPULATION HEALTH 145 4.2 Drug safety 60 10.1 Introduction 145 4.3 Avoiding harm — Reducing falls, ulcers and 10.2 Prevention and early detection of disease 146 infections in hospitals and long-term care 65 10.3 Risk factors and healthy behaviour 150 Success study: Catching up with falls: A program for prevention at Kensington Gardens 68 11 ENDNOTES 154 Success study: Getting the red out: Eliminating pressure ulcers at Wellesley Central Place 70 4.4 Missed diagnosis 72 12 ACKNOWLEDGEMENTS 165 5 PATIENT-CENTRED 75 13 MeMBERS OF THE ONTARIO HEALTH 5.1 Introduction 75 QUALITY COUNCIL 166 5.2 Patient experience with primary care 76 5.3 Client and family satisfaction in long-term care 80 5.4 Patient experience with acute-care hospital and emergency department care 85 1 1 INTRODUCTION AND SUMMARY There are almost 13 million people in Ontario, of every to give Ontarians an accurate picture of how the system is age and in every stage of health. Those of us who don’t doing and where it needs to improve. need healthcare on any given day certainly know someone who does — often someone close to us, too often with To prepare the report, we consult experts in various areas serious needs. For them and for ourselves, we all want a of health research to help choose good indicators that high-quality, high-performing health system. reflect the quality of care in Ontario and to understand what the results really tell us. These experts make up the The Ontario Health Quality Council is an independent Council’s Performance Measurement Advisory Board and agency created by the province in 2004. Our mandate the Performance Measurement Peer Review Panel. We is to help improve the publicly funded health system by collect data from a variety of sources, including surveys monitoring and reporting on its quality to the people of by the government and independent organizations such Ontario and by encouraging continuous improvement. as the Commonwealth Fund. Then we work with expert Making consistent, system-wide upgrades in quality can researchers at the Institute for Clinical Evaluative Sciences only happen when plans for change are linked to clear tar- to analyze the data. gets and deadlines for improvement and progress toward those targets is measured and reported. By reporting the As in the past, the report presents information in catego- benefits of that progress — and the consequences when we ries, the “nine attributes” we distilled from what Ontarians still fall short — the Ontario Health Quality Council can told us a high-performing health system should be — encourage change and reinforce efforts to improve quality. accessible, effective, safe, patient-centred, equitable, efficient, integrated, focused on population health and with the appropriate resources to get the job done. 1.1 The report this year In previous years we have focused on particular areas we know need improvement. One year, it was the need for This is our fourth annual report on the state of Ontario’s better information technology; other years it’s been flaws publicly funded healthcare system. In it, we review and in how we care for chronic disease. This year we are revis- update previous findings and add some new indicators iting these two areas, but also adding new information on (aspects of healthcare we can measure and keep track of) problems with access throughout the healthcare system. 1 1.2 | PROMOTINg qUALITY IMPROVEMENT 1.2 Promoting quality The success studies are closely tied to the rest of the work we’re doing to improve the health system and the overall improvement health of the people of Ontario. You can learn more about it in our strategic plan but, briefly, we aim to co-ordinate Reporting on indicators and goals is an important part our work with those who manage the healthcare system, of improving quality, but the Council’s work doesn’t stop so the measures of quality you see in this report will be there. The second part of our mandate, to support con- the same ones leaders will be taking seriously in their day- tinuous quality improvement, requires the Council to act to-day planning activities. We’ve also made a commitment as a catalyst for change. So the report also includes a series to increase the healthcare system’s capacity to improve by of examples of quality improvement initiatives around the promoting the use of quality improvement tools, by bring- province, which we call “success studies.” ing groups working on similar quality issues together and These are not just accounts of interesting ideas that by encouraging decision makers to set improvement goals have been implemented. We’ve used the “Model for and plan the actions needed to achieve them. Improvement” developed by the Institute for Healthcare Improvement, a not-for-profit organization in Cambridge, Massachusetts. The model says that, in order to succeed, quality improvement projects should have a clear aim and track specific measures that demonstrate whether specific changes lead to an improvement. This provides solid evidence to other organizations when they’re looking for ways to improve quality. 2 OUR KEY FINDINGS | 1.3 1.3 Our key findings We’re very worried that waits for places in long-term care have doubled in the past two years, from 49 to 106 days. Ontario’s publicly funded healthcare system improves People waiting to get into long-term care homes are too health and saves lives every day. It is staffed by well-trained frail to live independently. If they are waiting at home, professionals, many of whom keep working long shifts at they likely aren’t getting the care they need. If they are tough jobs because they believe in what they’re doing for waiting in hospital, their condition may worsen because their fellow citizens. Their hard work and our care come at of immobility and lack of support to regain as much a high cost: spending on healthcare in 2009/10 is expected independence as they can. Families are stressed in either to be $42.4 billion, accounting for almost half of all pro- case. Other provinces have kept wait lists low while using vincial spending. fewer long-term care beds, by providing alternative living arrangements. Some places in Ontario are successfully We know poor-quality care wastes money and increases getting people to return home with more support instead suffering. The waste takes many forms, from a person get- of going straight to long-term care. We can manage wait ting sicker because they weren’t monitored and given rela- times better, just by spreading these good ideas across tively simple treatments in time to avoid worse problems, Ontario more effectively.

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