Toronto Central Referral Service

Year-End Report 2015 to 2016 (April 1, 2015 to March 31, 2016)

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1

Purpose of this Report

1. To support efforts of all stakeholders to connect individuals living with or at risk of type 2 diabetes to team-based care. 2. To build stronger linkages between diabetes services in the region 3. To support quality improvement initiatives relating to improving access to diabetes programs and services.

2 Referral Service Process

3 TCRS DEP Referrals

700

600 586 574

518 523 500 481 449 439 428 400 408 386 374 332

300 NumberofReferrals

200

100

0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2013-2014 2014-2015 2015-2016

2013-2014 2014-2015 2015-2016 Grand Total Number of Referrals 1500 (27%) 1866 (34%) 2132 (38%) 5498 4 TCRS Method of Referral (Total Referrals for 2015/2016)* Phone 7 (0.5%)

Online 311 (20.1%) 2015/2016

Q2 Q3 Q4

Fax 367 412 449 Online 81 106 124 Phone ≤5 ≤5 ≤5

Fax 1228 (79.4%)

*Data regarding method of referral was not available until Q2, 2015/2016.

5 TCRS Online DEP Referrals by Referral Source Type for 2015/2016*

250

(56%)

200 206

150

100 (24%) Number of Referrals of Number 90

50 (8%) (6%) (5%) 31 21 20 0 Other DPP Self-Referral Hospital/DEC Primary Care

*Quarterly data regarding method of referral was not available until Q2, 2015/2016. The category “Other” are referrals primarily from Eat Right Ontario, but also includes referrals from CDA, CAMH, Mississauga Central Intake, TPH, etc. Some referral source types where referrals were less than 5 were not included.

6 TCRS DEP Referrals – Type of Diabetes*

2014/2015 2015/2016 1800 1800 (87.6%) 1600 1600 1635 (70%)

1400 1400 1489

1200 1200

1000 1000

800 800

(30%) NumberofReferrals NumberofReferrals 600 600 630

400 400 (11.9%) 200 200 222 (0.5%) (1%) 0 9 0 13 Type 2 Prediabetes Other Type 2 Prediabetes Other

*Other category includes: Type 1, GDM, and undiagnosed.

7 TCRS Unique Referral Sources by Source Type (2015/2016)*

Other 9 (7%)

Hospital/DEC 15 (12%)

Primary Care 99 (80%)

*Referral source types with numbers less than or equal to 5 were excluded from the graph. Other category includes: ERO, CDA, CAMH, TPH, Mississauga Central Intake, COTA, First Family Wellness Ltd., Community Living Toronto, and Amputee Rehab Service. Each organization has been counted as 1 unique referral source regardless of the number of referral sources from within. 8 TCRS DEP Referrals by Source Type*

350

307 300 298

275 266 250 234 236

220 220

200 Primary Care* Hospital/DEC 162 Other Health Care Providers* 150 150 137 142 Community Organizations* NumberofReferrals 134 133 Self-Referral* 107 110 100 94 84 77 77 68 50 51 49 40 44 43 39 30 35 18 17 9 811 8 13 8 0 6 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2014/2015 2015/2016

*Pharmacists and DEPs/DPPs are included in the Other Health Care Providers category. Physicians, RNs, RDs, and Endocrinologists are included in the Primary Care Providers category. Community Organizations data for Q1 and Q2, 2014/15 are missing due to volumes of less than 5. Community Organizations include: ERO, CDA, CAMH, Mississauga Central Intake, TPH, etc. CCACs, blanks, and unknowns were less than 5 and were excluded from the graph. Thus the numbers above do no represent all DEP referrals. 9 TCRS DEP Referrals from Tertiary Care Centers (2015/2016)* Toronto Rehabilitation Institute Bridgepoint Active Healthcare St. Joseph's Health Women's College 10 7 Centre Hospital (2%) (1%) 6 6 Sunnybrook Hospital (1%) (1%) 11 (2%) Mount Sinai Hospital 32 (6%)

Toronto Western Hospital Toronto East General Hospital 55 170 (11%) (34%)

Toronto General Hospital 71 (14%)

St. Michael's Hospital 130 (26%)

*Princess Margaret Hospital’s DEP referral number was omitted because it was less than or equal to 5. 10 TCRS DEP Referrals from Tertiary Care

80 Centers*

74 70 66 63 60

55

50 50 47 Toronto East General Hospital 45 43 43 43 43 St. Michael's Hospital 40 UHN (Toronto General Hospital) 34 UHN (Toronto Western Hospital) 32 NumberofReferrals 30 Mount Sinai Hospital 27 26 Sunnybrook Hospital 22 20 19

13 13 12 13 10 11 10 11 8 8 9 7 7 7 6 7

0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2014/2015 2015/2016

*Tertiary care centers where referrals were less than 5 were not included. Mount Sinai Hospital data for Q4, 2014/15 , and UHN (Toronto General Hospital) Q1, 2014/15 data are missing due to volumes of less than 5. Most of Sunnybrook Hospital’s quarterly data are missing due to volumes of less than 5 except for Q4, 2014/15. 11 TCRS DEP Referrals from Diabetes Prevention Programs*

70

63 60

50

46

40 37 South Asian DPP 32

30 29 Unison Health DPP Numberof Referrals

20

15

10 8 5 6 6

0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2014/2015 2015/2016

*Anishnawbe Health DPP numbers were omitted because they were less than or equal to 5. Unison Health and Community Services DPP data were omitted for Q1-Q3, 2014/2015, and Q2-Q4, 2015/2016 because they were less than or equal to 5. 12 TCRS DEP Referrals by Other Sources*

80 75 70 71 65 60

50 50

40 39 Eat Right Ontario Mississauga Halton Central Intake Program

NumberofReferrals 30

20

10 7

0 Q4 Q1 Q2 Q3 Q4 2014/2015 2015/2016

*Other referral sources with numbers less than or equal to 5 were excluded from the graph, and included: CE CCAC, TC CCAC, CDA, TPH, CAMH, Community Living Toronto, COTA, First Family Wellness, and Amputee Rehabilitation Service. Other referral sources with more than 5 referrals did not start until Q4, 2014/2015. 13 TCRS DEP Referrals by Sub LHIN of CLIENT in 2015/2016*

300

250 (25%)

238 (22%) (21%) 200 213

(19%) 200 185

150 (14%)

133 NumberofReferrals 100

50

0 Mid West Sub LHIN East Sub LHIN West Sub LHIN North Sub LHIN Mid East Sub LHIN

*Division by Sub LHIN are estimations based on combining Health Links. Please see notes. More accurate Sub LHIN boundaries will be used in the future when available. The data above does not represent all referrals as some clients are located outside of Toronto or their postal code was provided. 14 TCRS DEP Referrals by Sub LHIN of REFERRER in 2015/2016*

300

250 (25%)

238 (22%) (21%) 200 213

(19%) 200 185

150 (14%)

133 NumberofReferrals 100

50

0 Mid West Sub LHIN East Sub LHIN West Sub LHIN North Sub LHIN Mid East Sub LHIN

*Division by Sub LHIN are estimations based on combining Health Links. Please see notes. More accurate Sub LHIN boundaries will be used in the future when available. The data above does not represent all referrals as some referrers are located outside of Toronto 15 Destination DEP for Referred Clients, by LHIN (2015/2016)*

26 16 9 8 6 6 33 (1.2%) (0.8%) (0.4%) (0.4%) (0.3%) (0.3%) Toronto Central (1.6%)

81 Central East (3.8%) 114 (5.4%) Central

Central West 179 (8.4%) Mississauga Halton

Hamilton Niagara Haldimand Brant Champlain 332 1313 (15.6%) (61.8%) Waterloo Wellington

North East

North Simcoe Muskoka

Erie St. Clair LHIN

*LHINs with less than 5 referrals were not included. LHINs listed in the legend are organized based on the number of referrals received with the Toronto Central LHIN listed at the top with the most number of referrals and Erie St. Clair LHIN listed at the bottom with the least number of referrals. The LHINs in the pie chart are also organized from largest to smallest in a clockwise direction starting with Toronto Central LHIN on the right-hand side. 16 TCRS DEP Referrals – Program Destinations* 2014/2015 2015/2016 Diabetes Education Program

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

West Sub LHIN

Parkdale CHC 12 6 8 8 16 7 15 9 WTDEP 31 36 48 46 65 41 55 60 Mid-West Sub LHIN

Central Toronto CHC 11 8 7 12 20 11 15 17 Mount Sinai Academic FHT 8 10 9 12 14 7 ≤5 6 Taddle Creek FHT 10 15 7 12 11 14 15 8 North Sub LHIN

Anne Johnston Health Station 10 9 5 12 9 12 19 30

Sunnybrook FHT ( SUNDEC) 7 ≤5 ≤5 7 ≤5 ≤5 ≤5 ≤5

Unison Health & Community Services 75 59 70 75 61 72 81 72

*Any data where referrals for the quarter were less than or equal to 5 are shown in the table as ≤5. Some DEPs have satellite locations in more than one sub LHIN: West Toronto CHC, South Riverdale CHC, and Unison Health CHC. West Toronto and South Riverdale CHC are categorized under a Sub LHIN with the highest number of their satellite locations, and Unison Health CHC is categorized under a Sub LHIN with their largest site. 17 TCRS DEP Referrals – Program Destinations (cont.)* 2014/2015 2015/2016 Diabetes Education Program

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Mid-East Sub LHIN Regent Park CHC 10 17 16 9 19 11 12 10 Sherbourne FHT 22 21 17 16 23 19 23 17 East Sub LHIN

Bridgepoint FHT 8 ≤5 ≤5 ≤5 ≤5 7 ≤5 8 Don Mills DEP 43 35 37 31 45 35 50 46 South Riverdale CHC (DECNET) 47 48 70 73 55 30 32 52 Population-Based Programs

Anishnawbe Health Toronto ≤5 ≤5 ≤5 ≤5 ≤5 ≤5 ≤5 ≤5 Centre Francophone de Toronto ≤5 ≤5 ≤5 ≤5 ≤5 ≤5 ≤5 ≤5

Women’s Health in Women’s Hands CHC ≤5 ≤5 ≤5 ≤5 ≤5 9 8 ≤5

*Any data where referrals for the quarter were less than or equal to 5 are shown in the table as ≤5. Some DEPs have satellite locations in more than one sub LHIN: West Toronto CHC, South Riverdale CHC, and Unison Health CHC. West Toronto and South Riverdale CHC are categorized under a Sub LHIN with the highest number of their satellite locations, and Unison Health CHC is categorized under a Sub LHIN with their largest site. 18 TCRS DEP Referrals – Preferred Language*

Language 2014/2015 As a % of Total Referrals 2015/2016 As a % of Total Referrals Preferred Total in 2014/2015 Total in 2015/2016

English 1757 94% 1865 87%

Cantonese 33 2% 49 2% and/or Mandarin Tamil 13 1% 30 1.4% ≤5 - 24 1.1% Dari and/or Farsi Spanish ≤5 - 24 1.1% Hindi, Urdu, 13 1% 23 1.1% and/or Gujarati Punjabi ≤5 - 18 0.8% Portuguese ≤5 - 16 0.8% Tagalog ≤5 - 15 0.7% Italian 7 0.4% 11 0.5% Other 28 2% 45 2% Total 1866 2132

*Languages that had less than or equal to 5 are shown in the table as ≤5. Languages included in the Other category for 2015/2016 are: Albanian, Amharic, Arabic, Azerbanjani, Bengali, Croatian, Filipino, French, Greek, Hebrew, Hungarian, Korean, Ormo, Persian, Polish, Russian, and Serbian. 19 TCRS DEP Referrals by Gender, Age, and Reported Service Access Challenges (2015/2016) Reported Service Access Gender Age Group Challenges* 90 1400 1200

(56%) 80 (40%) 1200 (47%) 1202 1000 77 1001 70

1000 (33%) (42%)

800 (35%) 60 63

906 752 800 50 600

600 40

Number of Referrals of Number

Numberof Referrals Numberof Referrals 400 30 400 (13%) (10%) 286 20 200 20 200 (7%) 14 (5%) (3%) 10 (1%) (1%) 72 9 0 24 0 21 Female Male Blank 0-17 18-44 45-64 65+ Blanks 0 Mental Health Mobility Issues No Family Immigration Problematic Challenges Doctor/NP Status Drug and/or Alcohol Use 20 *Service access challenges with referrals less than or equal to 5 were not included. TCRS DEP Referrals Not Resulting in an Appointment (2015/2016)

Client needs cannot be met 7 (5%)

Client did not attend 2014/2015 2015/2016 26 Reasons Total Total (18%) Total 22 147

Client was unreachable Total DEP Referrals 1866 2132 76 (52%) As a % of all DEP Referrals 1.18% 6.90%

Client declined 38 (26%)

21 TCRS DPP Referral Statistics

22 TCRS DPP Referrals*

2014/2015 2015/2016 DPP Referrals * Total Total

Total Referrals ≤5 18

TCRS DPP Referrals – Destination DPP

2014/2015 2015/2016 Destination DPP* Total Total

Anishnawabe ≤5 ≤5 Flemingdon Health Centre ≤5 ≤5 Unison Health & Community ≤5 15 Services

*TCRS began collecting DPP referrals in Q3 of 2014/2015.

23 TCRS DPPs – Unique Referral Sources*

2014/2015 2015/2016 Unique Referral Sources* Total Total

New ≤5 13 Total (in database) ≤5 16 Active (used referral service within the last ≤5 ≤5 6 months)

2014/2015 2015/2016 Referral Source Type* Total Total Primary Care Providers ≤5 11 (Physicians) Hospital/DEC ≤5 ≤5 Community Organizations ≤5 ≤5 (TPH) Self-Referral ≤5 ≤5

*TCRS began collecting DPP referrals in Q3 of 2014/2015. Unique referral sources and referral source types with numbers less than or equal to 5 are shown as ≤5.

24 TCRS DPP Referrals – Gender, Languages, and Age (2015/2016)* Gender Languages* Age* 14 18 10 (89%) 16 9 (67%) 12 16 12 14 8 (39%) (39%)

10 7

12 7 7 6 8 10 5 (33%) 8 6

6 4

Numberof Referrals NumberofReferrals NumberofReferrals 6 4 3 4 2 2 2 1

0 0 0 Female Male English 18-44 45-64

*TCRS began collecting DPP referrals in Q3 of 2014/2015. *Languages and age groups with less than or equal to 5 referrals were not included.

25 TCRS Updates

Changes Made in Q4 Plans for Q1, 2016/2017: • Toronto Central Self- • TCRS referral process will Management Program be revised in was added to the services collaboration with key supported by the TCRS. stakeholders to ensure • A Quality Improvement that the individual being Plan was created by the referred is connected to Toronto Central Diabetes the most appropriate Program to support program to meet his/her increased access to needs. diabetes programs and services.

26 TCRS Contact Information

TCRS Administrator Outreach Facilitator

Michelle Ing Lori Sutton Central Referral Services and Data Outreach Facilitator – Diabetes & Administrator Chronic Disease Toronto Central LHIN Diabetes Toronto Central LHIN Diabetes Program Program South Riverdale Community South Riverdale Community Health Centre Health Centre T: 416-778-0676 x 242 T: 416-778-0676 x 320 E: [email protected] E: [email protected] F: 416-778-1305 F: 416-778-1305

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