8

Local Health Hub Profile – Greenstone

Thunder Bay District Integrated District Network

Spring 2013

North West LHIN  RLISS du Nord-Ouest

Local Health Hub Profile – Greenstone 2 North West LHIN  RLISS du Nord-Ouest

Table of Contents INTRODUCTION ...... 4 DEMOGRAPHICS AND POPULATION CHARACTERISTICS ...... 5

DEMOGRAPHICS...... 5 POPULATION HEALTH CHARACTERISTICS ...... 6 LHIN FUNDED HEALTH SERVICES ...... 8

ACUTE CARE ...... 8 LONG-TERM CARE (LTC) ...... 8 COMPLEX CONTINUING CARE (CCC) ...... 8 INPATIENT REHABILITATION ...... 9 INPATIENT MENTAL HEALTH ...... 11 COMMUNITY BASED CARE ...... 14 Primary Care ...... 14 Home Care ...... 15 ANALYSIS OF ACUTE CARE HOSPITAL DISCHARGES ...... 17 MARKET SHARE OF ACUTE CARE DISCHARGES ...... 17 HOSPITALIZATIONS RELATED TO DIABETES ...... 19 DIABETES AND AMPUTATIONS ...... 21 DEMENTIA PATIENT POPULATION ...... 23 HOSPITAL USE AT THE END OF LIFE (IN-HOSPITAL PALLIATIVE CARE) ...... 24 DISCHARGES FROM THE LOCAL HEALTH HUB’S ACUTE CARE HOSPITAL – GERALDTON DISTRICT HOSPITAL ... 26 ALTERNATE LEVEL OF CARE (ALC) LENGTH OF STAY (LOS) ...... 27 RE-ADMISSIONS FOR SELECT CONDITIONS ...... 27 ANALYSIS OF AMBULATORY CARE VISITS ...... 28

EMERGENCY (ED) VISITS ...... 28 EMERGENCY VISITS RELATED TO DIABETES ...... 32 NON-URGENT EMERGENCY VISITS ...... 32 ED WAIT TIMES ...... 33

Local Health Hub Profile – Greenstone 3 North West LHIN  RLISS du Nord-Ouest

Greenstone Local Health Hub Profile Introduction

This profile is one of a series of 14, corresponding to each of the 14 Local Health Hubs (LHHs) in the North West LHIN. The Greenstone LHH is one of five LHHs that are part of the Thunder Bay District Integrated District Network (IDN), which in turn is one of the five IDNs in the North West LHIN’s new integrated health system model.

The map below illustrates the location of the Local Health Hub communities and the Integrated District Networks.

Figure 1: Map of the North West LHIN

Local Health Hub Profile – Greenstone 4 North West LHIN  RLISS du Nord-Ouest

Demographics and Population Characteristics Demographics

The following table lists the communities (census subdivisions (CSDs)) that are aligned to the Greenstone Local Health Hub, as well as their respective population counts from the 2006 and 2011 censuses and the percentage population change over that time period. Table 1: Greenstone Local Health Hub Communities, 2006 and 2011 Census CSD/Community Type of CSD 2006 2011 % Change Census Census Greenstone Municipality 4,886 4,724 -3.3 Long Lake 58 Indian Reserve (IR) 417 367 -12.0 Whitesand IR 247 260 5.3 Ginoogaming First Nation IR 175 167 -4.6 Aroland 83 IR 325 361 11.1 Lake Nipigon IR 20 0 -100 Greenstone LHH Total 6,070 5,879 -3.1 Data Source: Statistics Canada. 2011 Census and 2006 Census.

The following table presents some of the demographic characteristics of all five LHHs in the Thunder Bay District IDN, including the Greenstone LHH, with comparisons to the overall North West LHIN population. Table 2: Population Characteristics, 2011 Census Indicator Marathon Terrace Nipigon Green- Manitou- Unassigned Thunder North Bay stone wadge CSDs1 Bay West District LHIN IDN1 Total Population 4,035 2,675 3,400 5,880 2,105 6,375 24,460 231,1202 % Age 65+ 9.5% 16.8% 18.1% 12.1% 15.9% 17.2% 14.3% 16.0% % Age 75+ 3.5% 7.7% 8.1% 4.9% 4.8% 8.5% 5.5% 7.3% % Aboriginal Identity3 20.2% 5.8% 29.2% 35.3% 5.7% 11.3% 19.9% 19.2% % Francophone 9.2% 6.4% 4.3% 22.2% 15.8% 3.9% 10.5% 3.4% Data Source: Statistics Canada. 2011 Census and 2006 Census. 1 The census subdivisions unassigned to a LHH but assigned to Thunder Bay District IDN in this profile will be removed from Thunder Bay District IDN moving forward. Two csds will move to Northern IDN and four csds will move to City of Thunder Bay IDN. 2Adjusted for incompletely enumerated Indian Reserve Census Subdivisions. 3 Based on 2006 Census; questions on Aboriginal identity not included in 2011 Census.

Key Findings: . The population of the Greenstone LHH is younger than in the broader Thunder Bay District IDN and North West LHIN; . The proportion of the residents who are francophone is higher than in any other LHH in the North West LHIN; . The proportion of the residents who self-identify as aboriginal is much higher than in the broader Thunder Bay District IDN and North West LHIN.

Local Health Hub Profile – Greenstone 5 North West LHIN  RLISS du Nord-Ouest

Population Health Characteristics The following table shows the latest health behaviour indicators from the Canadian Community Health Survey (CCHS) for the Northwestern Health Unit (NWHU), Thunder Bay District Health Unit (TBDHU), North West LHIN and Ontario. Note that residents living on Indian Reserve census subdivisions are not included in the CCHS.1

Table 3: Self-Reported Health Behaviours/Practices, Canadian Community Health Survey 2009/2010, age 12+

Thunder Bay Northwestern North Indicator District Health Health Unit West ON Unit (TBDHU) (NWHU) LHIN Overweight or obese, age 18+ (%) 60.2 65.5 61.7 52.0 Pain or discomfort that prevents activities (%) 18.8 19.6 19.0 13.5 Current smoker; daily or occasional (%) 24.6 22.4 23.9 18.9 Heavy drinking (%) 20.4 22.2 20.9 15.9 Leisure-time physical activity; moderately active or active (%) 57.3 59.7 58.0 50.5 Regular medical doctor (%) 84.4 81.3 83.5 91.1 Contact with a medical doctor in the past 12 months (%) 80.2 77.4 79.3 82.2 Source: Statistics Canada. 2011. Health Profile. Statistics Canada Catalogue no. 82-228-XWE. Ottawa. Released June 28 2011. http://www12.statcan.gc.ca/health-sante/82-228/index.cfm?Lang=E

Key Finding: . The rates of heavy drinking, smoking and being overweight in the TDBHU area are consistent with those of North West LHIN residents overall, and higher than provincial rates.

The following table gives an indication of the burden of chronic disease in the North West LHIN, based on self-reported chronic conditions.

Table 4: Self-Reported Prevalence of Chronic Conditions, Canadian Community Health Survey, 2009/10 Indicator Thunder Bay Northwestern North ON District Health Health Unit West Unit (TBDHU) (NWHU) LHIN Canadian Community Health Survey, 2009/10: % report being diagnosed by health professional Arthritis -age 15+ 20.5%1 26.6% 22.4% 17.3% -age 65+ 49.2% 57.8% 51.6% 46.7% Diabetes -age 12+ 6.7% 7.3% 6.9% 6.8% -age 65+ 19.2% 25.9% 21.1% 19.6% High blood pressure -age 12+ 19.2% 21.6% 19.9% 17.4% -age 65+ 57.9% 53.6% 56.7% 49.7% Chronic obstructive pulmonary disease 6.2% 4.2% (COPD) -age 35+ 7.3% 3.5% 11.5% 7.2% -age 65+ 14.2% 4.6%

1 There are two public health units in the North West LHIN area – Northwestern Health Unit (NWHU) and Thunder Bay District Health Unit (TBDHU). The NWHU area corresponds to the Northern, Kenora and Rainy River IDN areas of the North West LHIN. The TBDHU area corresponds to the City of Thunder Bay and the Thunder Bay District IDN areas of the North West LHIN.

Local Health Hub Profile – Greenstone 6 North West LHIN  RLISS du Nord-Ouest

Indicator Thunder Bay Northwestern North ON District Health Health Unit West Unit (TBDHU) (NWHU) LHIN Canadian Community Health Survey, 2009/10: % report being diagnosed by health professional Mood disorders - age 12+ 8.8% 7.1% 8.3% 6.8% - age 65+ 9.8% 9.0% 9.5% 6.0% 1. Bolded estimates are significantly different from the provincial estimate. Source: Statistics Canada. Table 105-0502 - Health indicator profile, two year period estimates, by age group and sex, Canada, provinces, territories, health regions (2011 boundaries) and peer groups, occasional CANSIM (database). (Accessed January 30, 2013).

Key Finding: . Rates of arthritis are higher in the North West LHIN, particularly in the Northwestern Health Unit area.

Diabetes

The table below shows the estimated number of adults (age 18 years and over) in North West LHIN with diabetes and the percentage that have had the recommended testing for diabetics.2

Table 5: Diabetes Prevalence, age 18+ and Testing Status based on Ontario's Baseline Diabetes Dataset Initiative (BDDI), as of March 31, 2011

% of Patients with Diabetes2

All patients All 3 tests AIC within LDL-C Retinal eye Area – Patient Residence 1 with Diabetes done past 6 within past exam within months year past 2 yrs Kenora District (Kenora & Northern IDNs) 6,146 31.4% 47.6% 55.1% 64.1% Rainy River IDN 1,770 33.6% 54.5% 56.4% 73.7% Thunder Bay District IDN 2,592 15.9% 52.9% 26.1% 70.2% City of Thunder Bay IDN 10,817 40.3% 59.8% 66.2% 69.4% North West LHIN Total 21,325 34.2% 55.0% 57.3% 68.3% Ontario Total 989,212 39.6% 56.5% 69.1% 67.6% Source: HAB. Chronic conditions, prevalence, mortality, hospitalizations (2012-07-25) data product. July 2012. Individuals are identified as having diabetes if they have had at least one hospitalization or two physician service claims over a two-year period with a diabetes related diagnostic code. Women with gestational diabetes are not included. Prevalence numbers are refined based on feedback from physicians who review patient lists and provide validation on diabetes status. 1. Testing rates for HbA1c and LDL-C only include tests conducted in community labs and captured in the Claims History Database (CHDB). Lab tests for A1C or LDL-C conducted in hospitals are not individually submitted and therefore cannot be analysed for diabetes patients. Analysis of Eye Exams is also based on CHDB. Only retinal eye exams where a fee-for-service claim was submitted are included. Exams that were paid out-of-pocket by the patient are not included. Some providers (i.e., ophthalmologists in alternate payment plans) may not submit claims. The percent of patients receiving exams may be underestimated in areas where there are a larger proportion of non-FFS providers conducting retinal eye exams

2 The Baseline Diabetes Database Initiative (BDDI) was created by the Ministry using a validated algorithm to identify Ontario residents, age 18+, with diabetes based on administrative data sources.

Local Health Hub Profile – Greenstone 7 North West LHIN  RLISS du Nord-Ouest

Key Findings: . The North West LHIN has a higher prevalence of diabetes at 11.3% of the adult population (age 18 and over) vs. 9.3% provincially; . As of March 31, 2012, the number has increased to 22,345, 11.8% of the adult population compared to 9.7% provincially.

LHIN Funded Health Services Acute Care

The Greenstone Local Health Hub has one acute care hospital – Geraldton District Hospital. Other acute care hospitals in Thunder Bay District IDN are located in Nipigon, Manitouwadge, Marathon and Terrace Bay. Four of the five facilities have been identified as providing French Language Services (FLS) – all but Nipigon District Memorial Hospital.

In addition to acute care beds, there are a number of other inpatient bed types located in the acute care facilities in the Thunder Bay District IDN.

Table 6: Bed Types in Acute Care Hospitals Inpatient Mental Newborn Hospital Acute CCC ELDCAP Rehab Health Bassinets Geraldton District Hospital 23 7 19

Manitouwadge General Hospital 9 9

Wilson Memorial General Hospital 9 12 1

Nipigon District Memorial Hospital 15 7 15

The McCausland Hospital 10 13 4

Thunder Bay District IDN 66 39 5 43

Source: Web Enabled Reporting System (WERS); extracted Jan. 2012.

Long-Term Care (LTC)

There are no Long-Term Care (LTC) homes in the Greenstone LHH area, and only one home, with 22 beds, within the Thunder Bay District IDN (Wilkes Terrace in Terrace Bay). Complex Continuing Care (CCC)

The type of patient occupying CCC beds varies from hospital to hospital within the LHIN and across the province and is reflected in the CCC bed rate per population 75+. The table below shows the 2010 bed rate in each Integrated District Network area within the North West LHIN.

Local Health Hub Profile – Greenstone 8 North West LHIN  RLISS du Nord-Ouest

Table 7: CCC Bed Rate per Population Age 75+, 2010

Beds per 1,000 IDN Area Population 75+ Thunder Bay District IDN 31

City of Thunder Bay City IDN 17

Kenora IDN 9 Northern IDN 9 Rainy River IDN 16

North West LHIN 16.1 Ontario 6.6 Data Source: Preyra Solutions Group. Complex Continuing Care in the North West LHIN. June 2012.

Key Findings: . In 2010, the CCC bed rate in the North West LHIN was more than twice the provincial average of 7 beds per 1,000 seniors age 75+; . Thunder Bay District IDN has the highest CCC bed rate of all IDNs within the North West LHIN; . The average frailty of acute discharges to CCC in North West is lower than the provincial average3. Inpatient Rehabilitation

St. Joseph’s Care Group (SJCG) located in the city of Thunder Bay has 50 Inpatient Rehabilitation beds which service all residents of the North West LHIN. The following tables show where patients admitted to SJCG for general rehab episodes and specialty rehab episodes live within the North West LHIN. Table 8a: Number of General Rehab Episodes for Inpatient Rehabilitation by Rehabilitation Client Group (RCG) and Patient Residence, Fiscal y\Years 2009/10 to 2011/12 Combined General Rehab Episodes at SJCG, fiscal years 09/10 - 11/12 combined, by RCG Category Rehab Client Greenstone TBay Dt CoTB Northern Kenora Rainy North Total Group LHH IDN IDN IDN IDN River West SJCG IDN LHIN AMPUTATION OF LIMB <5 12 32 <5 7 <5 59 61 ARTHRITIS 10 27 69 32 8 17 153 154 PAIN SYNDROMES <5 3 10 5 0 <5 20 22 ORTHOPAEDIC CONDITIONS 5 45 806 12 6 16 885 910 OTHER 0 <5 16 <5 0 <5 20 21 All RCGs 17 88 933 55 21 40 1137 1168 Data Source: Inpatient Rehabilitation Main Table, intelliHEALTH ONTARIO; extracted Jan. 2013.

3 Preyra Solutions Group. Complex Continuing Care in the North West LHIN. June 2012.

Local Health Hub Profile – Greenstone 9 North West LHIN  RLISS du Nord-Ouest

Key Findings: . Greenstone LHH residents accounted for 1.5% of general rehab episodes at SJCG; . Residents of Thunder Bay District IDN accounted for 7.5% of general rehab episodes; . Of all rehab episodes for IDN residents, more than half were for orthopedic conditions (51.1%) and almost a third for arthritis (30.7%).

Table 8b: Number of Specialty Rehab Episodes for Inpatient Rehabilitation by Rehabilitation Client Group (RCG) and Patient Residence, Fiscal Years 2009/10 to 2011/12 Combined Special Rehab Episodes at SJCG, fiscal years 09/10-11/12, by RCG Category Rehab Client Greenstone TBay Dt CoTB Northern Kenora Rainy North Total Group LHH IDN IDN IDN IDN River West SJCG IDN LHIN STROKE 12 50 251 21 42 15 379 385 BRAIN DYSFUNCTION <5 9 42 9 <5 5 69 73 NEUROLOGICAL CONDITIONS <5 5 28 <5 0 <5 36 36 SPINAL CORD DYSFUNCTION 0 5 8 <5 0 <5 15 15 OTHER 0 0 <5 <5 <5 0 6 6 All RCGs 15 69 333 34 47 22 505 515

Key Findings: . Greenstone LHH residents accounted for 2.9% of specialty rehab episodes at SJCG; . Residents of Thunder Bay District IDN accounted for 13.4% of specialty rehab episodes; . Of all rehab episodes for IDN residents, the majority were for stroke (72.5%).

The table below shows the breakdown of discharges and average length of stay for St. Joseph’s Care Group discharges by Rehab Client Group (RCG) for fiscal year 2010/11. Table 9: Rehab Discharges from St. Joseph’s Care Group, fiscal year 2010/11 NW Provincial North West # Total Weighted Rehab Client Group Average Average 'Excess' Discharges Days Cases LOS LOS Days (01.1) STROKE - LEFT BODY INVOLVEMENT (RIGHT BRAIN) 48 2,371 80 49 37 614 (08.11) ORTHOPAEDIC CONDITIONS - STATUS POST UNILATERAL HIP FRACTURE 57 2,016 63 35 25 597 (01.4) STROKE - NO PARESIS 31 1,367 42 44 27 542 (03.1) NEUROLOGICAL CONDITIONS - MULTIPLE SCLEROSIS 6 680 16 113 41 436 (02.22) BRAIN DYSFUNCTION - TRAUMATIC - CLOSED INJURY 5 563 21 113 41 357 (02.1) BRAIN DYSFUNCTION - NON- TRAUMATIC 8 679 26 85 41 350

Local Health Hub Profile – Greenstone 10 North West LHIN  RLISS du Nord-Ouest

NW Provincial North West # Total Weighted Rehab Client Group Average Average 'Excess' Discharges Days Cases LOS LOS Days (02.2) BRAIN DYSFUNCTION – TRAUMATIC 6 649 25 108 66 252 (08.61) ORTHOPAEDIC CONDITIONS - STATUS POST UNILATERAL KNEE REPLACEMENT 115 1,359 55 12 10 184 (08.51) ORTHOPAEDIC CONDITIONS - STATUS POST UNILATERAL HIP REPLACEMENT 77 1,235 48 16 14 152 (08.53) ORTHOPAEDIC CONDITIONS - STATUS POST REVISION OF UNILATERAL HIP REPLACEMENT (CIHI CATEGORY) 23 604 15 26 20 149 (08.3) ORTHOPAEDIC CONDITIONS - STATUS POST PELVIC FRACTURE 8 320 9 40 22 143 (04.130) NON-TRAUMATIC SPINAL CORD DYSFUNCTION – OTHER <5 233 8 58 27 127 (08.63) ORTHOPAEDIC CONDITIONS - STATUS POST REVISION OF UNILATERAL KNEE REPLACEMENT (CIHI CATEGORY) 10 245 5 25 13 115 Total 565 16,963 589 30 25 2838 Source: Preyra Solutions Group. Inpatient Rehabilitation in the North West LHIN. June 2012.

Key Findings: . St. Joseph’s Care Group rehab patients have longer lengths of stay than the provincial average, controlling for case mix (complexity of case) using RCGs; . SJCG focuses on post-acute IP rehabilitation for hip and knee replacement patients and stroke patients. Inpatient Mental Health

There are no designated Inpatient Mental Health beds in the Greenstone LHH area or the Thunder Bay District IDN. The following table contains the location of the Inpatient Mental Health beds in the North West LHIN.

Table 10: Designated (Adult) Mental Health Beds in North West LHIN Mental Provider Name IDN area Type Health Beds Lake of The Woods District Hospital Kenora Acute Psych. 19 Thunder Bay Regional Health Sciences Centre City of Thunder Bay Acute Psych. 30 Thunder Bay Regional Health Sciences Centre City of Thunder Bay Forensic 20

Local Health Hub Profile – Greenstone 11 North West LHIN  RLISS du Nord-Ouest

Mental Provider Name IDN area Type Health Beds St Joseph's Care Group (SJCG) City of Thunder Bay M.H. Rehab 714 North West LHIN Total 140 Source: PwC. Draft North West LHIN Blueprint Project Report. Dec. 2011.

The graphs in Figure 2 (a and b) show the distribution of patient residence for patients admitted to Lake of the Woods District Hospital and Thunder Bay Regional Health Sciences Centre (Acute Psychiatric beds). Figure 2a: Utilization of Designated (Adult) Mental Health Acute Psychiatric Beds in North West LHIN by Patient Residence Patients Admitted to LOTW District Hospital Acute Mental Health by IDN: 2009-10 - 2011-12

200 150 100 50 0

Number of Patients of Number Kenora Rainy River Northern Other City of Thunder District of Bay Thunder Bay Source: IP Adult MH Assessment, Treatment, Diagnosis, intelliHealth 2009/2010 2010/2011 2011/2012

Figure 2b: Utilization of Designated (Adult) Mental Health Acute Psychiatric Beds in North West LHIN by Patient Residence Patients Admitted to TBRHSC Acute Mental Health by IDN: 2009-10 - 2011-12

1500

1000

500

0 City of Thunder District of Northern Kenora Rainy River Other Number of Patients of Number Bay Thunder Bay Source: IP Adult MH Assessment, Treatment, Diagnosis, intelliHealth 2009/2010 2010/2011 2011/2012 Ontario; extracted March 22, 2013

4 The number of beds at SJCG is being reduced to 38. These mental health rehabilitation beds and related outpatient and outreach programs will serve people with serious mental illness, concurrent disorders, acquired brain injury, dual disorders and/or geriatric psychiatric illness.

Local Health Hub Profile – Greenstone 12 North West LHIN  RLISS du Nord-Ouest

Key Findings: . Most patients admitted to inpatient mental health acute psychiatric beds at Lake of the Woods District Hospital in Kenora and Thunder Bay Regional Health Sciences Centre are from the same IDN as where the hospital is located; . Very few adults from Thunder Bay District IDN are admitted to inpatient mental health beds.

The following graphs show the distribution of admissions to inpatient adult mental health beds, by primary reason for admission, over the three most recent years for which there is complete information.

Figure 3a: Reasons for Admission to Designated (Adult) Mental Health Acute Psychiatric Beds at Lake of the Woods District Hospital Patients Admitted to LOTW Hospital Acute Mental Health by Primary Diagnosis: 2009-10 - 2011-12

80 70 60 50 40 30 20 2009/2010 10 0 2010/2011

2011/2012 Number of Unique of Patients Number

Source: IP Adult MH Assessment, Treatment, Diagnosis, intelliHealth Ontario; extracted March 22, 2013

Local Health Hub Profile – Greenstone 13 North West LHIN  RLISS du Nord-Ouest

Figure 3b: Reasons for Admission to Designated (Adult) Mental Health Acute Psychiatric Beds at Thunder Bay Regional Health Sciences Centre Patients Admitted to TBRHSC Acute Mental Health by Primary Diagnosis: 2009-10 - 2011-12

500 450 400 350 300 250 200 150 100 2009/2010 50 2010/2011 0 Number of Unique of Patients Number 2011/2012

Source: IP Adult MH Assessment, Treatment, Diagnosis, intelliHealth Ontario; extracted March 22, 2013

Key Findings:  Mood disorders accounted for the highest number of admissions at TBRHSC while schizophrenia and other psychotic disorders accounted for the most admissions at LOTW;  Substance-related disorders accounted for the second most number of admissions at TBRHSC while adjustment disorders accounted for the second most admissions at LOTW. Community Based Care

Primary Care

The table below shows the distribution of active physicians (as of December 2011) in the North West LHIN area. Table 11: 2011 Active Physicians in North West LHIN by Integrated District Network

Integrated District Network Number of Family Medicine Number of (IDN) Physicians Specialists

Kenora IDN 56 13

Rainy River IDN 22 2 Thunder Bay District IDN 25 0 City of Thunder Bay IDN 140 165

Local Health Hub Profile – Greenstone 14 North West LHIN  RLISS du Nord-Ouest

Integrated District Network Number of Family Medicine Number of (IDN) Physicians Specialists

Northern IDN 37 3 North West LHIN Total 280 183

Data Source: Ontario Physician Human Resources Data Centre Active Physician Registry, December 31, 2011.

Key Findings: . Within the Thunder Bay District IDN, as of Dec. 31, 2011, there were five active physicians in each of the Local Health Hub areas; . In addition to solo family physicians, the Greenstone Family Health Team (FHT) in Geraldton and four other FHTs provide services in the Thunder Bay District IDN; . The NorWest Community Health Centre has two satellite sites in Thunder Bay District IDN (Longlac and Armstrong) plus a Primary Care Mobile unit and a Diabetes Mobile Van that provides services to the Geraldton LHH area and the area north of the city of Thunder Bay; . There is no Aboriginal Health Access Centre in this IDN but Dilico Anishinabek Family Care provides service to Pic River and Pic Mobert First Nations communities.

Home Care

The following graph shows the number of distinct clients receiving Home Care services by fiscal year for each of the Integrated District Networks in the North West LHIN.

Figure 4: Number of Home Care Clients by Integrated District Network Number of Home Care (CCAC) Clients 7,000 25.0

6,000

20.0 5,000

4,000 15.0

3,000 10.0

2,000 # of # distinct clients

5.0 % Population Age 65+ 1,000

0 0.0 TBayDt IDN CoTB IDN Rainy River IDN Kenora IDN Northern IDN Integrated District Network Area 2008/09 2009/10 2010/11 %Age 65+ Data Source: Home Care Main Table, intelliHEALTH ONTARIO;extracted fall 2012.

Local Health Hub Profile – Greenstone 15 North West LHIN  RLISS du Nord-Ouest

Key Findings: . The Thunder Bay District IDN has seen an increase in the number of CCAC clients from 733 in fiscal year 2008/09 to 824 in 2010/11; . This increase accounts for 7.0%, 7.5% and 8.0% of North West CCAC’s clients in these three fiscal years respectively; . 211 Greenstone LHH residents received service in 2010/11.

The following table shows the distribution of CCAC clients living in the Greenstone LHH by service goals in fiscal year 2010/11.

Table 12: CCAC Clients from Greenstone LHH by Service Goal, fiscal year 2010/11

% Clients with Total Service # Distinct Service Goal Time (Hours) Clients Service Goal ( >= 1 goal) Acute (in-home) 63 30.0% 986.00 End of Life (In-home) 9 4.3% 479.25 Long-Term Care Placement 18 8.5% 33.00 Long-Term Supportive (in-home) 21 10.0% 4975.25 Maintenance (in-home) 72 34.1% 8529.75 Rehabilitation (in-home) 60 28.4% 773.25 Total 243 15,776.50 Data Source: Home Care Main Table, intellIHEALTH ONTARIO; extracted Jan. 9, 2013.

Each client may have more than one service goal, accounting for the total number of distinct clients for each service goal being higher than the actual number of unique individuals receiving service (243 compared to 211). The average service time for Marathon LHH clients is highest for palliative care clients (end of life service goal).

Service Activity by Service Goal

Almost all clients (94.3%) receive some case management service time. For patients with an End-of-Life service goal, 48.0% of service time was for “combined personal support and homemaking service” followed by 37.6% for nursing visits.

For clients with an acute (in-home) goal, two-thirds of service time (62.0%) was for nursing visits and 28.9% for “combined personal support and homemaking services”.

For clients with a service goal of long-term support (in-home), almost all service time was for combined personal support and homemaking services (94.1%). Similarly for clients with a maintenance (in-home) service goal, the majority of service time is for personal support and homemaking services (80.4%).

For CCAC clients with a rehabilitation (in-home) service goal, 42.2% of service time was for personal support and homemaking services and 21.3% for nursing visits. In terms of therapy services, 19.7% of service time was for speech language therapy, 10.0% for occupational therapy and 2.1% for physiotherapy.

Local Health Hub Profile – Greenstone 16 North West LHIN  RLISS du Nord-Ouest

Analysis of Acute Care Hospital Discharges Market Share of Acute Care Discharges

The following figure shows where residents of the Greenstone LHH went for acute care in fiscal years 2009/10 – 2011/12.

Figure 5: Distribution of Inpatient Acute Care Discharges for Greenstone LHH residents

Acute Care Discharges for Greenstone LHH Residents by Fiscal Year and Location of Hospital 1100 1000 58 34 900 58 64 40 43 800 700 461 Other Provinces

405 600 465 Other LHINs 500 Other North West LHIN 400 CoTB LHH (TBRHSC) 300 Greenstone LHH

# of # Discharges 478 200 427 389 100 0 2009-2010 2010-2011 2011-2012 Discharge Fiscal Year Data Source: DAD, CIHI Portal; extracted Feb. 2013

Key Findings: . Discharges from North West LHIN hospitals accounted 92.8% of acute care discharges to Greenstone LHH residents (2955 discharges over three years).

. A further 6.1% were from other LHIN hospitals and 1.1% from hospitals outside of Ontario.

In terms of discharges from the hospital located in the Greenstone Local Health Hub—Geraldton District Hospital—the following graph shows that 94% of annual discharges were to residents of the North West LHIN, and the volume from Greenstone LHH residents alone ranged from 91.9% to 89.4% to 90.0% in 2009/10, 2010/11 and 2011/12 respectively.

Local Health Hub Profile – Greenstone 17 North West LHIN  RLISS du Nord-Ouest

Figure 6: Distribution of Inpatient Acute Care Discharges from Geraldton District Hospital by Patient Residence and Fiscal Year

Geraldton District Hospital Discharges by Patient Residence and Fiscal Year 550

500 19 15 450 25 18 18 400 19 Other LHINs/OutofProv. 350 North East LHIN 300 Other North West LHIN 250 478 Axis Title Axis Greenstone LHH 421 200 387 150

100

50

0 2009/10 2010/11 2011/12 Discharge Fiscal Year

Data Source: Inpatient Discharge Main Table, intelliHEALTH ONTARIO; extracted Mar. 6, 2013.

The following table illustrates the extent of acute care service received by Greenstone LHH residents from Thunder Bay Regional Health Sciences Centre.

Table 14: % Acute Care Discharges for Greenstone LHH residents from TBRHSC by Most Responsible Diagnosis Chapter, fiscal years 2009/10 – 2011/12 Combined

Total # Acute Care Discharges for ICD10 Chapter LHH Residents % Discharges from (all hospitals) TBRHSC Certain conditions originating in the perinatal period (P00-P96) 106 93.4% Neoplasms (C00-D48) 104 81.7% Pregnancy, childbirth and puerperium (O00- O99) 225 78.7% Diseases of the musculoskeletal system and connective tissue (M00-M99) 130 68.5% Diseases of the genitourinary system (N00-N99) 143 58.0% Diseases of the ear and mastoid process (H60- H95) 14 57.1%

Local Health Hub Profile – Greenstone 18 North West LHIN  RLISS du Nord-Ouest

Total # Acute Care Discharges for ICD10 Chapter LHH Residents % Discharges from (all hospitals) TBRHSC Injury, poisoning and other consequences of external causes (S00-T98) 209 54.5% Factors influencing health status and contact with health services (Z00-Z99) 363 52.1% Diseases of the nervous system (G00-G99) 42 47.6% Diseases of the digestive system (K00-K93) 303 45.9% Congenital malformation, deformations and chromosomal abnormalities (Q00-Q99) 24 37.5% Certain infectious and parasitic diseases (A00- B99) 47 34.0% Diseases of the eye and adnexa (H00-H59) 6 33.3% Diseases of the circulatory system (I00-I99) 316 32.3% Endocrine, nutritional and metabolic diseases (E00-E90) 89 27.0% Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) 43 25.6% Diseases of the respiratory system (J00-J99) 334 24.0% Diseases of the skin and subcutaneous tissue (L00-L99) 44 22.7% Mental and behavioural disorders (F00-F99) 153 20.3% Symptoms, signs and abnormal clinical and laboratory findings (R00-R99) 260 16.5% All Discharges 2955 45.0% Data Source: DAD, CIHI Portal; extracted Jan. 4, 2013.

Key Findings:  Over the last three complete fiscal years, 45% of all discharges for Greenstone LHH residents (including those out-of-province and out of North West LHIN) were from TBRHSC;

 83.4% of discharges related to certain conditions originating in the perinatal period (P00-P96) and pregnancy and childbirth (O00-O99) are from TBRHSC rather than the LHH hospital or District health campus. Hospitalizations Related to Diabetes

The number of discharges and total length of stay for North West LHIN patients with a most responsible diagnosis of diabetes have consistently been double that of the province, based on crude rates as illustrated in the following table.

Local Health Hub Profile – Greenstone 19 North West LHIN  RLISS du Nord-Ouest

Table 15a: Discharges and Total Length of Stay for Diabetes (Most Responsible Diagnosis) in Ontario Hospitals, Fiscal Years 2008/09 – 2010/11

North West LHIN Ontario # Discharge Length IP_Days Discharge IP_Days Discharges Rate of Stay Rate Rate Rate (Days) 2008 513 214.0 5,179 2,160.5 97.8 1,002.9 2009 508 212.4 5,342 2,233.7 96.3 988.4 2010 497 208.2 4,944 2,070.6 93.1 923.9 Source: HAB. Chronic conditions, prevalence, mortality, hospitalizations (2012-07-25) data product. July 2012.

Key Finding: . The hospitalization rate for diabetes in the North West LHIN is more than double that of the province. The table below shows the distribution of discharges and length of stay for fiscal year 2010/11 by IDN area.

Table 15b: Discharges and Total Length of Stay for Diabetes (Most Responsible Diagnosis), Fiscal Year 2010/11 by Patient Residence Inpatient Area - Patient Residence Inpatient Length Discharges of Stay (Days)

Kenora District (Kenora & Northern IDNs) 140 1,757

Rainy River IDN 60 590

Thunder Bay District IDN 69 745

City of Thunder Bay IDN 228 1,852

North West LHIN Total 497 4,944 Source: HAB, MOHLTC. Chronic conditions, prevalence, mortality, hospitalizations (2012- 07-25) data product. July 2012.

Key Findings: . Of the 497 discharges from Ontario hospitals in 2010/11, with a most responsible diagnosis of diabetes, 58 of those involved amputations, accounting for 1,203 days length of stay. Less than five of these discharges were from Geraldton District Hospital and a total of 49 were from all hospitals in the Thunder Bay District IDN. The majority was discharges from Thunder Bay Regional Health Sciences Centre (270 or 54.3%);5

5 Inpatient Discharge Main Table, intellIHEALTH ONTARIO; extracted July 20, 2012.

Local Health Hub Profile – Greenstone 20 North West LHIN  RLISS du Nord-Ouest

The following graph shows the distribution of discharges with most responsible diagnosis by hospital location (including all of Canada) by the last three fiscal years 2009/10 to 2011/12.

Figure 7: Distribution of Inpatient Acute Care Discharges with Most Responsible Diagnosis of Diabetes by Hospital Location and Fiscal Year

Inpatient Discharges with Most Responsible Diagnosis of Diabetes by Hospital Location and Fiscal Year 300

250

200 2009-2010 2010-2011 150 2011-2012

100 # of Discharges of # 50

0 Kenora Rainy NorthernCoTB IDN TBayDt Other Other IDN River IDN IDN IDN LHINs Prov. Hospital Location Data Source: DAD, CIHI Portal: extracted Jan 29, 2013

Key Findings: . If the 88 diabetes discharges (most responsible diagnosis) from hospitals across Canada for North West LHIN residents is included, the number of diabetes discharges for North West LHIN residents increases 17.7 %, from 497 in 2010/11 to 585; . During fiscal year 2011/12 there were 496 discharges for North West LHIN residents from Ontario facilities and 548 overall; . The majority of out-of-province discharges occur in Manitoba. Out-of-province discharges accounted for 13.5%, 15.0% and 9.5% of total diabetes discharges in 2009/10, 2010/11 and 2011/12 respectively; . Thunder Bay District IDN hospitals saw 69, 49 and 50 discharges with most responsible diagnosis of diabetes in 2009/10, 2010/11 and 2011/12 respectively. The corresponding values for Geraldton District Hospital specifically were 22, <5 and 8. Diabetes and Amputations

Complications from diabetes can lead to amputation of limbs in some cases. The North West LHIN had almost three times the rate of major amputations among diabetics than the provincial average in fiscal year 2009/10, based just on amputations done in Ontario hospitals.6

6 PwC. North West LHIN: Health Services Blueprint: Building Our Future Final Report. Feb. 2012.

Local Health Hub Profile – Greenstone 21 North West LHIN  RLISS du Nord-Ouest

The following graph shows the distribution of these discharges by hospital location and fiscal year.

Figure 8: Distribution of Inpatient Acute Care Discharges with Most Responsible Diagnosis of Diabetes and Amputation Intervention by Hospital Location and Fiscal Year

Inpatient Discharges with Most Responsible Diagnosis of Diabetes and Amputation Intervention 60

50 40 30 20

# of # Discharges 10 0 CoTB IDN Other North West Other LHINs Manitoba LHIN IDNs Hospital Location 2009-2010 2010-2011 2011-2012 Data Source: DAD, CIHI Portal, extracted Jan. 29, 2013

Key Findings . There were 80 discharges to North West LHIN residents in 2011/12 for patients with a most responsible diagnosis of diabetes and a principal intervention of amputation; . The majority of these interventions were done at Thunder Bay Regional Health Sciences Centre (63.78%), while 12.5% were done in Manitoba facilities and 21.3% at hospitals in other IDNs in the North West LHIN; . None of these discharges occurred in Thunder Bay District IDN hospitals.

The following graph shows the number of discharges to North West LHIN residents that involved a most responsible diagnosis of diabetes and an amputation intervention.

Local Health Hub Profile – Greenstone 22 North West LHIN  RLISS du Nord-Ouest

Figure 9: Distribution of Inpatient Acute Care Discharges with Most Responsible Diagnosis of Diabetes and Amputation Intervention by Patient Residence and Fiscal Year Diabetes and Amputation Discharges by Patient Residence (IDN) 40 35 50

30 40 25 20 30 15 20 # Discharges # 10 10 5 0 0 Northern Kenora IDN Rainy River CoTB IDN TBayDt IDN

IDN IDN % 2011 LHIN CensusPopulation Pt. Residence IDN 2009-2010 2010-2011 2011-2012 % LHIN pop. Data Source: DAD, CIHI Portal; extracted Jan. 29, 2013

Key Finding: . Residents of Thunder Bay District IDN account for 7.5% of these discharges in 2011/12, slightly less than the IDN’s 10.6% population proportion. Dementia Patient Population

The number of dementia patients in acute care is projected to increase by 19% from 284 (in 2009/10) to 338 (in 2019/20)7.

Table 16: Inpatient Acute Care Dementia Patients, North West LHIN, Fiscal Year 2009/10 Average Total Dementia ALC Avg. Length of Stay Area – Patient Residence Cases LOS days (LOS)days Kenora District (Kenora and 98 29 19 Northern IDNs) Rainy River IDN 63 13 7 Thunder Bay District IDN 27 46 30 City of Thunder Bay IDN 95 27 16 North West LHIN Total 284 26 16 Source: PwC. North West LHIN: Health Services Blueprint: Building Our Future Final Report. Feb. 2012.

Key Finding: . In 2009/10 Thunder Bay District IDN patients with dementia had much longer lengths of stay than other areas of the LHIN.

7 PwC. North West LHIN: Health Services Blueprint: Building Our Future Final Report. Feb. 2012.

Local Health Hub Profile – Greenstone 23 North West LHIN  RLISS du Nord-Ouest

Hospital Use at the End of Life (In-Hospital Palliative Care) The following table shows the number of discharges for North West LHIN residents over 2009/10 – 2010/11 that involved any palliative care diagnosis (ICD-10 code Z51.5).

Table 17: Acute Care Discharges with Diagnosis of Palliative Care, Fiscal Years 2009/10&2010/11 Combined Received Palliative Care Expected # All Discharges discharges Integrated District Network Discharges with diagnosis Actual over Difference in with diagnosis of Patient Residence (Total Acute of palliative Expected Discharges of palliative Care) care (Actual) care

Rainy River IDN 4,485 204 234 0.87 -30

Thunder Bay District IDN 5,709 185 253 0.73 -68

City of Thunder Bay IDN 24,824 1,286 1,116 1.15 170

Kenora IDN 7,490 304 360 0.84 -56

Northern IDN 3,755 85 149 0.57 -64

North West LHIN Total 46,263 2,064 2,112 0.98 -48

Source: Preyra Solutions Group. Palliative Care in the North West LHIN. June 2012.

Key Findings: . Access to hospital-based palliative care for the North West LHIN population is at the provincial average, controlling for case mix; . Within the North West LHIN, Thunder Bay District IDN residents had less access to hospital- based palliative care, after adjusting for case mix (Actual over Expected = 0.73).

The following table shows the actual number of discharges with a diagnosis8 of palliative care (most responsible diagnosis9 or other) for North West LHIN residents in fiscal year 2010/11. Table 18: Acute Care Discharges with Diagnosis of Palliative Care, Fiscal Year 2010/11 All Most Responsible Any Secondary Dx of All Discharges with Dx of Discharges Diagnosis (MRDx) of Palliative Care Palliative Care (MRDx or Palliative Care Co-morbidity) # # % All # % All # % All IDN Area Discharges Discharges Discharges Discharges Discharges Discharges Discharges Kenora 4,566 53 1.2 90 2.0 143 3.1

8 Most Responsible Diagnosis is the primary reason for the hospital stay.

Local Health Hub Profile – Greenstone 24 North West LHIN  RLISS du Nord-Ouest

Northern 2,975 18 0.6 28 0.9 46 1.5 Rainy 2,769 53 1.9 47 1.7 100 3.6 River Thunder 3,464 28 0.8 50 1.4 78 2.3 Bay District City of 15,038 181 1.2 489 3.3 670 4.5 Thunder Bay LHIN 28,812 333 1.2 704 2.4 1,037 3.6 Total Source: Preyra Solutions Group. Palliative Care in the North West LHIN. June 2012.

Key Finding: . Thunder Bay District IDN residents had a slightly lower % of discharges with a diagnosis of palliative care compared to all North West LHIN residents in 2010/11 (2.3% versus 3.6%).

The following figure shows the distribution of discharge destinations for those patients with a diagnosis of palliative care and discharged from acute care over the last five fiscal years. Figure 10: Discharge Destination of Acute Care Discharges with Diagnosis of Palliative Care Discharge Destination of Palliative Care Acute Care Patients, North West LHIN 100% % discharged elsewhere 90% 80% % discharged to other type of 70% facility 60% % discharged to continuing 50% care facility 40% % discharged to home with no 30% support services 20% % discharged to home with support services % % Palliative Care Patients 10% % PC patients who died in 0% hospital 2006 2007 2008 2009 2010 Data Source: Inpatient Discharge Main Table, intelliHEALTH Ontario; extracted April 4, 2012. Fiscal Year

Key Findings: . The percentage of palliative care patients dying in hospital has been decreasing over the last few years with 42.5% of palliative care patients dying in hospital in 2010/11; . Just under one-third (30.4%) of palliative care patients were discharged home (with or without support).

Local Health Hub Profile – Greenstone 25 North West LHIN  RLISS du Nord-Ouest

End of life services at home, provided by the North West CCAC, and were discussed earlier in the profile.

Discharges from the Local Health Hub’s Acute Care Hospital – Geraldton District Hospital

The following table shows the most responsible diagnosis (MRDx) categories for people discharged from Geraldton District Hospital over the last three fiscal years.

Table 19: Most Responsible Diagnoses for Acute Care Discharges from Geraldton District Hospital - % of Discharge, 2009/10 – 2011/12 Combined

ICD10 Chapter % Discharges X. Diseases of the respiratory system (J00-J99) 18.2% XVIII. Symptoms, signs and abnormal clinical and laboratory findings (R00-R99) 14.2% IX. Diseases of the circulatory system (I00-I99) 11.0% XXI. Factors influencing health status and contacts with health services (Z00-Z99) 10.8% V. Mental and behavioural disorders (F00-F99) 8.9% XI. Diseases of the digestive system (K00-K93) 8.9% XIX. Injury, poisoning and certain other consequences of external causes (S00-T98) 6.3% XIV. Diseases of the genitourinary system (N00-N99) 3.7% IV. Endocrine, nutritional and metabolic diseases (E00-E90) 3.6% XII. Diseases of the skin and subcutaneous tissue (L00-L99) 2.8% XV. Pregnancy, childbirth and the puerperium (O00-O99) 2.7% III. Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) 2.3% I. Certain infectious and parasitic diseases (A00-B99) 2.1% XIII. Diseases of the musculoskeletal system and connective tissue (M00-M99) 1.8% VI. Diseases of the nervous system (G00-G99) 1.3% II. Neoplasms (C00-D48) 0.7% VIII. Diseases of the ear and mastoid process (H60-H95) 0.4% XVI. Certain conditions originating in the perinatal period (P00-P96) --* VII. Diseases of the eye and adnexa (H00-H59) --* Annual Average Number of Discharges 474 Data Source: Inpatient Discharge Main Table, intelliHEALTH Ontario; extracted Dec. 27, 2012. * - Number of Discharges < 5.

Local Health Hub Profile – Greenstone 26 North West LHIN  RLISS du Nord-Ouest

Alternate Level of Care (ALC) Length of Stay (LOS) The following table shows the indicators related to Alternate Level of Care (ALC) length of stay (LOS) at Geraldton District Hospital.

Table 20: Annual Alternate Level of Care (ALC) Indicators for Discharges (excluding newborns and stillborns) from Geraldton District Hospital, Fiscal Years 2009/10 – 2011/12

Indicator 2009/10 2010/11 2011/12 Total # Discharges (excluding newborns and stillborns) 508 468 425 Total LOS (Days) 4,859 3,649 3,435 ALC LOS (Days) 2,170 800 950 % ALC 44.7 21.9 27.7 # ALC Discharges 5 12 10 Data Source: DAD, CIHI Portal; extracted Jan. 2, 2013.

Key Findings: . There was an annual average of 9 ALC patients over last three fiscal years; . In the last two fiscal years, nine of the 22 ALC cases were discharged to a continuing care facility (Geraldton District Hospital) and accounted for 1212 ALC LOS days (69.3% of the ALC days). ALC Designation Within Two Days There were no instances of patients being designated ALC within 2 days of admission to Geraldton District Hospital over the three year fiscal period10. Re-admissions for Select Conditions

Reduction in avoidable hospitalizations--of which hospital readmissions play an important part --is a key strategic focus of the Ministry’s Excellent Care for All Strategy in Ontario. Readmissions also contribute to increased emergency room pressures and wait times11.

The cases included in this indicator are discharges for patients age >=45 with diagnosis of stroke, chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF), those age >= 40 with select cardiac conditions, all ages with pneumonia, diabetes and gastro-intestinal disorders. The following table shows the re-admission rates of these cases for hospitals in the Thunder Bay District IDN and for all North West LHIN hospitals combined for fiscal year 2011.

Table 21: Re-admissions Within 30 days for Select Conditions, Calendar Year 2011, Thunder Bay District IDN Hospitals

# Readmitted Index % Re- To Any Cases admits Facility Hospital Wilson Memorial General Hospital 66 10 15.15% Nipigon District Memorial Hospital 119 28 23.53%

10 CIHI Portal. DAD. Jan. 2013. 11 MOHLTC. MLPA Indicators Technical Documentation. December 2010.

Local Health Hub Profile – Greenstone 27 North West LHIN  RLISS du Nord-Ouest

# Readmitted Index % Re- To Any Cases admits Facility Hospital The McCausland Hospital 50 3 6.00% Manitouwadge General Hospital 30 6 20.00% Geraldton District Hospital 115 16 13.91% North West LHIN Total 5,198 850 16.35%

Source: HAB. MLPA Supplemental Information. Nov. 2012.

Key Findings: . Over the calendar year 2011 the North West LHIN was very close to its target value of 16.0%12 for 2011/12; . The re-admission rates vary greatly between hospitals: Geraldton District Hospital’s rate was lower than the North West LHIN’s target value; . The North West LHIN target value for 2012/13 is 16.86%.

Analysis of Ambulatory Care Visits Emergency (ED) Visits

Table 22 shows the volume of ambulatory care visits to Geraldton District Hospital by fiscal year and type of ambulatory care visit. Table 22: Ambulatory Care Visits by Visit Type to Geraldton District Hospital Ambulatory Care Visit Type 2009/10 2010/11 2011/12 Emergency 10,149 9,520 9,782 Oncology Clinic 0 97 56 Other Ambulatory Care 0 0 1 Total 10,149 9,617 9,839 Data Source: NACRS, CIHI Portal; extracted Dec. 27, 2012.

The following figure shows who went to Wilson Memorial General Hospital for emergency visits (unscheduled, unplanned), for fiscal years 2009/10 to 2011/12.

12 The MLPA indicator is known as Readmissions within 30 days for Selected CMGs. Case Mix Groups (CMGs) methodology assigns hospital discharges into categories based on diagnosis and patient characteristics.

Local Health Hub Profile – Greenstone 28 North West LHIN  RLISS du Nord-Ouest

Figure 11: % of Emergency Visits to Geraldton District Hospital by Patient Residence % of Emergency Visits to Geraldton District Hospital by Patient Residence and Fiscal Year 100% 12,000 Geraldton LHH

90%

10,000 80% North East LHIN 70% 8,000 60% Other 50% 6,000 40% 4,000 City of Thunder 30% Bay IDN

Emergency Visits EmergencyVisits (%) 20% 2,000 TotalEmergency Visits Other Thunder 10% Bay District IDN 0% 0 Total Emergency 2009/2010 2010/2011 2011/2012 Visits

Key Findings: . Approximately 90% of unscheduled emergency visits to Geraldton District Hospital were by residents of the Greenstone LHH, and slightly less than one percent from other Thunder Bay District IDN residents; . 3.7% of emergency visits came from North East LHIN residents in 2011/12.

The following table shows the distribution of all emergency visits to Geraldton District Hospital by Main Problem (ICD10 Chapter, listed in decreasing order of visits in 2011/12.

Table 23: Emergency Visits to Geraldton District Hospital by Main Problem (% Visits) Rank ICD10 Chapter (2011/12) 2009/10 2010/11 2011/12 Factors influencing health status and contact with 1 health services (Z00-Z99) 24.06% 24.51% 27.82% Symptoms, signs and abnormal clinical and 2 laboratory findings (R00-R99) 12.90% 11.66% 12.34% Injury, poisoning and certain other consequences of 3 external causes (S00-T98) 13.61% 13.38% 11.86% 4 Diseases of the respiratory system (J00-J99) 12.86% 10.82% 10.26% Diseases of the musculoskeletal system and 5 connective tissue (M00-M99) 7.87% 8.72% 7.43% Diseases of the skin and subcutaneous tissue (L00- 6 L99) 4.79% 5.61% 6.43% 7 Diseases of the digestive system (K00-K93) 4.22% 5.12% 5.04% 8 Diseases of the genitourinary system (N00-N99) 4.26% 4.59% 4.29% 9 Mental and behavioural disorders (F00-F99) 3.10% 3.97% 3.75% 10 Diseases of the ear and mastoid process (H60-H95) 2.92% 2.96% 2.54%

Local Health Hub Profile – Greenstone 29 North West LHIN  RLISS du Nord-Ouest

Rank ICD10 Chapter (2011/12) 2009/10 2010/11 2011/12 11 Certain infectious and parasitic diseases (A00-B99) 2.47% 2.04% 2.00% 12 Diseases of the circulatory system (I00-I99) 1.91% 2.28% 1.54% 13 Diseases of the eye and adnexa (H00-H59) 1.70% 1.57% 1.36% Endocrine, nutritional and metabolic diseases (E00- 14 E90) 0.90% 0.64% 0.99% 15 Diseases of the nervous system (G00-G99) 0.80% 0.82% 0.82% 16 Pregnancy, childbirth and the puerperium (O00-O99) 0.80% 0.45% 0.53% 17 Neoplasms (C00-D48) 0.36% 0.39% 0.42% Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism 18 (D50-D89) 0.25% 0.27% 0.29% Congenital malformations, deformations and 20 chromosomal abnormalities (Q00-Q99) 0.08% 0.08% 0.08% Certain conditions originating in the perinatal period 21 (P00-P96) --* 0.00% --* Total # Emergency Visits 10,149 9,520 9,782 Data Source: NACRS, CIHI Portal; extracted Mar. 7, 2013. * - Number of visits <5.

Key Findings: . Factors influencing health status and contact with health services accounted for 28% of emergency visits in 2011/12. This category includes attention to surgical sutures and dressings, chemotherapy, follow-up exams and counselling; . Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified accounted for 12% of emergency visits in 2011/12. This category includes pains, nausea and vomiting.

. Injury, poisoning and certain other consequences of external causes also accounted for 12% of emergency visits in 2011/12. This category includes open wounds, superficial and unspecified injuries, fractures, sprains, dislocations and poisoning;

The following table shows the leading problems in the top chapter in terms of volume of emergency visits for fiscal year 2011/12.

Table 24a: Top Problems in Factors influencing health status and contact with health services (Z00-Z99) Chapter, Fiscal Year 2011/12

Problem Number % Chapter % All of Visits Visits Visits

Attention to surgical dressings and sutures (Z480) 721 26.5% 7.4% Procedure not done patient decline other/unspecified 563 20.7% 5.8% reason (Z532) Follow-up exam after unspecified treatment for other 352 12.9% 3.6% condition (Z099) 265 Other specified medical care (Z5188) 9.7% 2.7%

Local Health Hub Profile – Greenstone 30 North West LHIN  RLISS du Nord-Ouest

Problem Number % Chapter % All of Visits Visits Visits 178 Other chemotherapy (Z512) 6.5% 1.8% 150 Issue of repeat prescription (Z760) 5.5% 1.5% Total Visits classified as Factors influencing 2,721 27.8% health status and contact with health services Data Source: NACRS, CIHI Portal; extracted Dec. 27, 2012.

Key Finding: . Over one-quarter (226.5%) of visits in this category were for “attention to surgical dressing and sutures”. As noted in Table 23, 3.8% of unscheduled emergency visits to Geraldton District Hospital are for Mental and Behavioural Disorders (ICD10 Codes F00-F99).

The following table shows the number of repeat visits within 30 days for mental health (F00-F09, F20- F99) and Substance Abuse (F10-19) conditions.

Table 25: Repeat Visits within 30 Days for Mental Health and Substance Abuse Conditions to Wilson Memorial General Hospital

Emergency Visits for Mental Health Conditions Total # Repeat Visits within 30 North West North West Emergency Visits days for this condition LHIN target LHIN actual for this condition # % 2010/11 244 50 20.5 13.7% 19.3% 2011/12 220 55 25.0 17.4% 18.2% Emergency Visits for Substance Abuse Conditions 2010/11 130 25 19.2 22.2% 32.3% 2011/12 128 25 19.5 29.1% 28.4% Data Source: Health Analytics Branch. MLPA Supplemental Information – MH and SA conditions. Jan. 2013.

Key Findings: . The repeat visit rate within 30 days for mental health and substance abuse conditions is high in the North West LHIN; . Geraldton District Hospital’s repeat visit rate for mental health conditions is slightly higher than the overall North West LHIN actual rate and higher than the target rate; . Geraldton District Hospital’s repeat visit rate for substance abuse conditions is lower than the North West LHIN actual and target rates.

The North West LHIN’s 2012/13 target for repeat visits within 30 days for mental health conditions is 16.4% and for substance abuse conditions – 26.6%. The provincial targets have not yet been determined.

Local Health Hub Profile – Greenstone 31 North West LHIN  RLISS du Nord-Ouest

Emergency Visits Related to Diabetes

The following table outlines the number of unscheduled visits to Geraldton District Hospital with diabetes as the main problem. The first section breaks the visits down by type of diabetes (type I, type II or unspecified) and the second section breaks the visits down by type of complication.

Table 26: Emergency (unscheduled) Visits to Geraldton District Hospital with Diabetes as Main Problem, Fiscal Years 2009/10 to 2011/12 2009/10 2010/11 2011/12 By type of Diabetes Mellitus (DM) E100-E109 - Type I DM Visits <5 0 0 E110-E119 - Type II DM Visits <5 0 <5 E140-E149 - Unspecified DM Visits 44 24 61

(E10-E14) DM Total Visits 52 24 64 Number of Patients 36 22 53 By type of Complication DM with Foot Ulcer, DM with Foot Ulcer with Gangrene, DM with other Multiple Complications 34 14 47 DM other complications 8 <5 12 DM no (mention of) complications 10 8 5 (E10-E14) DM Total 52 24 64 Number of Patients 36 22 53 Data Source: Ambulatory Care Main Table, intelliHEALTH ONTARIO; extracted Jan. 31, 2013.

Key Findings: . The majority of visits for Diabetes related problems were unclassified as to type of diabetes Mellitus; . The majority of complications resulting in emergency visits were those involving foot ulcers. Non-Urgent Emergency Visits

The following graph shows the high percentage of emergency visits that are non-urgent in the Thunder Bay District IDN hospitals.

Local Health Hub Profile – Greenstone 32 North West LHIN  RLISS du Nord-Ouest

Figure 12: % of Emergency Visits (Unscheduled) that are Minor/uncomplicated (CTAS IV & V) Non-Urgent Emergency Visits

100% % CTAS IV & V 12,000

90% Number Visits ED of Number 80% 10,000

70% 8,000 60% 50% 6,000 40% % ED %ED Visits 30% 4,000 20% 2,000 10% 0% 0

Hospital

% ED Visits 2009/10 2010/11 2011/12 2009/10 2010/11 2011/12

Data Source: Ambulatory Care Main Table, intelliHEALTH ONTARIO; extracted Dec. 27, 2012.

Key Findings: . At Geraldton District Hospital, the % of emergency visits that were classified as CTAS IV & V levels has decreased slightly over the last three fiscal years from 80.0% to 79.4% to 76.4% respectively; . Geraldton District Hospital has the second lowest rate of CTAS IV&V emergency visits in the Thunder Bay District IDN; . For all facilities in the North West LHIN in 2011/12, CTAS IV & V emergency visits accounted for 46.5% of unscheduled emergency visits; . TBRHSC accounts for over half of the emergency visits in the North West LHIN and 30.3% of emergency visits are classified as CTAS IV&V; . Provincially, 41.2% of emergency visits are classified as CTAS IV &V in fiscal year 2011/12. ED Wait Times

There are three provincial indicators related to emergency room wait times that all LHINs and their respective hospitals are accountable for. These indicators are 90th percentile ER length of stay for admitted patients, 90th percentile ER length of stay for non-admitted complex patients (CTAS I-III) and 90th percentile ER length of stay for non-admitted minor/uncomplicated patients (CTAS IV-V).

The following table shows the indicator values for Geraldton District Hospital along with the overall North West LHIN’s target time and the provincial target time.

Local Health Hub Profile – Greenstone 33 North West LHIN  RLISS du Nord-Ouest

Table 27: ED Visit (unscheduled, emergency) Wait Times at Geraldton District Hospital

# of Visits 90th percentile North West LHIN Ontario wait time (hours) Target Target Emergency Visit Wait Times for Admitted Patients 2009/10 427 10.3

2010/11 387 10.4 8 hrs. (interim 25.0 hrs.) 25.0 hrs. 2011/12 301 13.2 8 hrs. (interim 25.0 hrs.) 25.0 hrs. Emergency Visit Wait Times for Non-Admitted Patients, Complex (CTAS I-III) 2009/10 1,113 8.6 2010/11 1,103 7.9 6.6 hrs. 2011/12 1,416 9.6 6.5 hrs. 7.0 hrs. Emergency Visit Wait Times for Non-Admitted Patients, non-complex (CTAS IV-V) 2009/10 7,972 4.6 2010/11 7,421 4.5 4.0 hrs. 4.0 hrs. 2011/12 7,104 4.3 4.0 hrs. 4.0 hrs. Data Sources: NACRS, CIHI Portal; extracted Jan.31, 2013.

Key Findings: . The 90th percentile wait times at Geraldton District Hospital for admitted patients and non- admitted complex patients are higher than the North West LHIN targets; . The 90th percentile wait time for non-admitted, non-complex patients at Geraldton District Hospital is very close to the North West LHIN and provincial target of four hours.

Local Health Hub Profile – Greenstone 34