Central East LHIN Environmental Scan
November 2009 Table of Contents
1. Context for Environmental Scan
2. Overview of the Central East LHIN
3. Central East LHIN Priority Population Data
4. Central East LHIN Strategic Aims Context for Environmental Scan Integrated Health Service Plan (IHSP) Overview – 2010-2013
• The IHSP is a strategic document which will be used to guide the activities of the Central East Local Health Integration Network (CE LHIN) organization - staff and board - and its stakeholders over a three year period.
• The CE LHIN developed its first IHSP in 2006. That plan directed the priorities and strategies to be carried out until 2009.
• The CE LHIN has now developed a second IHSP to launch the strategic directions for 2010- 2013. The second IHSP was developed in consultation with health care providers and community residents and was approved by the Board of Directors of the Central East LHIN.
• The IHSP provides a blueprint for change for the local health care system that outlines shared priorities, strategies and proposed outcomes based on the Triple Aim Framework of improving the health of the population, enhancing the patient experience and reducing or at least controlling the per capita cost of care. Provincial Priorities
• The environmental scan is a document intended to provide a snapshot of the current health status of CE LHIN residents. • This environmental scan has a focus which is directly related to the Ministry of Health and Long-Term Care’s (MOHLTC) Strategic Priorities. These priorities are:
– Improving access to emergency department care by reducing the amount of time that patients spend waiting in the emergency department – Improving access to hospital care by reducing the amount of time that patients spend in alternate level of care beds – Improving access to integrated diabetes care by supporting the roll-out of the current diabetes strategy. CE LHIN Priorities – Strategic Aims
• The CE LHIN has established two strategic aims that will provide the strategic focus for health service providers, stakeholders and the Central East LHIN Board over the next three years of the IHSP.
Aim # 1: Save 1 million hours of patient time spent in emergency departments by 2013.
Aim # 2: Reduce the Impact of Vascular Disease by 10% by the year 2013.
• These aims are directly related to the MOHLTC provincial priorities. Overview of the Central East LHIN CE LHIN Overview
• The CE LHIN geography stretches from the culturally diverse and densely populated Scarborough planning zones to the rural and less populated areas of Haliburton Highlands, the northern sections of the City of Kawartha Lakes and Peterborough City and County.
• The majority of LHIN residents live in the Greater Toronto Area (GTA) and Scarborough, however, Durham region has experienced the greatest growth over the last 10 years.
• The population of the Central East LHIN is diverse in age distribution, ethno-cultural variables and in average household income. Map of Central East LHIN by Sub-Planning Zones and Cluster
The Central East LHIN map to
the left depicts the geographic
span and nine planning zones
within this region and were
updated to reflect “service
clusters.” CE LHIN Health Care Services
Mental Health Services Central Community Services • 3 Acquired Brain Injury Services East • 17 Supportive Housing programs • 19 Community Mental Health • 1 Community Care Access Centre programs L (CCAC) • 7 Supportive Housing sites • 7 Community Health Centres (CHC) • 6 Agencies for Drug and Alcohol • 42 Community Support Services and Problem Gambling Treatment H (CSS) services • 5 Elderly Persons Centres •2 Psychiatric out-patient medical I services N Planning Coordination Hospitals Long-Term Care Homes Integration Accountability • 10 Corporations operating on 16 sites • 68 Long-Term Care (LTC) facilities Performance (including 1 psychiatric hospital and 1 private • 9,572 LTC beds hospital) Funding Map of Central East LHIN Hospitals Map of Central East Community Care Access Centre Offices Map of Community Health Centres Map of Long-Term Care Homes A Snapshot of Central East LHIN Funding
Over $1.8 billion in healthcare spending (excluding physician payments, drug benefits, public health).
Central East LHIN, September 2009 Population Profile
• The Central East LHIN is home to 1,432,705* people. • Durham is the Central East LHIN’s fastest growing region at 22.4% growth in the last 10 years. • Within Central East LHIN regions, the communities showing the most growth were, the Hiawatha First Nations, Whitby and Ajax. • Peterborough has the highest proportion of seniors living alone within the LHIN. • In the Toronto region, 45% of residents speak a language other than French or English as their mother tongue. Toronto region also has the highest proportion of visible minorities in the LHIN. • Population density is the highest in the southwest region of the LHIN and becomes dispersed in the northern and eastern regions.
Central East LHIN Clinical Services Plan, 2009 *Sub-LHIN planning area data may be aggregated from a different set of Census components compared to the LHIN-level Census tables, the sum of the sub-LHIN areas may differ from the LHIN totals. Ontario LHIN Populations*
1600000
1400000
1200000
1000000
800000
600000
400000
200000
0 Er ie. St. South West Waterloo Hamilton Central Mississauga Toronto Central Central EastSouth East Champlain North North East North West Clair Wellington Niagara West Halton Central Simcoe Haldimand Mus koka Brant
Source: Census 2006 *Sub-LHIN planning area data may be aggregated from a different set of Census components compared to the LHIN-level Census tables, the sum of the sub-LHIN areas may differ from the LHIN totals. Current Population by Sub-LHIN Area
300,000
250,000
200,000
150,000
100,000
50,000
- Haliburton Kaw artha Peterborough Northum Durham East Durham West Durham Scarborough Scarborough Highlands Lakes City and County berland- North/Central Agincourt - Cliffs- Havelock Rouge Scarborough Centre
*For Peterborough City and County, Census data for this sub-LHIN Planning Area does not include data for CSD 3515008 (Hiawatha First Nation). Source: Census 2006 Central East LHIN Population by Cluster
North East Cluster 292,015 or 20% Scarborough Cluster 576,955 or 41%
Durham Cluster 561,255 or 39% Population Projections for CE LHIN
• Population projections for the Central East LHIN were used to show the future state of the LHIN in 10-20 years. • Population projections were based on Ministry of Finance (MOF) projections and scenarios. The projections are used to show what the population of the LHIN will look like in 10-20 years. • Population projections were based on the past growth patterns in each area of the LHIN but also consider population density, population growth overall, aging and diversity. • The greatest proportion of the Central East LHIN population is in younger age cohorts, although the population of seniors (65+) is increasing. • Scarborough, although a distinct area in the Central East LHIN, is expected to show similar population growth patterns to Toronto. • Durham region is expected to have the highest growth in newborns over the next 20 years.
CE LHIN Clinical Services Plan, 2009 Although the proportion of the population over age 65 is increasing, the majority of CE LHIN residents are in younger age cohorts
. The age 65-74 and 75-84 cohorts are projected to have the greatest growth relative to the total population and are expected to use the most resources compared to other cohorts.
CE LHIN Clinical Services Plan, 2009 The future population profile will notably impact future health care demands - these factors will influence how the CE LHIN plans to meet this need Implications Population Density: The current and future population density is in the Southwest part of the LHIN making south Durham Region and Scarborough the most densely populated areas.
Population Growth: Durham Region is project to grow faster than the CE LHIN and provincial average of Future population profile (1.1%). (1.9% vs 1.3% respectively when comparing will influence the type, annualized growth between 2006 and 2030). location, quantity and Aging Population: The population is aging with the model of how services are 65+ age range increasing from the current 6.9% to delivered throughout the 11.9% by 2030. Of note, Durham Region is also the Central East LHIN. youngest in the LHIN.
Diverse Population: The population across the different counties is diverse with the largest proportion of visible minorities being concentrated in the southwest part of the LHIN.
CE LHIN Clinical Services Plan, 2009 Population density is the highest in the southwest region of the LHIN and becomes dispersed in the northern and eastern regions. Population Density Map of Central East LHIN – 2006 Census
CE LHIN Clinical Services Plan, 2009 Census Counts of Aboriginal Identity and Aboriginal Ancestry Populations – Central East LHIN, 2006
Central East LHIN Ontario
Total Aboriginal Identity Population 16,390 242,490 North American Indian single response 10,525 158,400
Metis single response 5,015 73,610 Inuit single response 210 2,035 Multiple Aboriginal response 100 1,905 Aboriginal responses not included elsewhere 600 6,540
Total Aboriginal Ancestry Population 34,515 403,795
Percent Population by Aboriginal Identity 1.2% 2.0%
Percent Population by Aboriginal Ancestry 2.4% 3.4%
Source: First nations people in Ontario: A demographic portrait. Health Analytics Branch. January, 2009. French-Speaking Population in Central East LHIN
Population who include French as % of population who include Sub-LHIN Planning Zone mother tongue – total responses French as mother tongue
1 Haliburton Highlands 265 1.7%
Kawartha Lakes 870 1.2%
Peterborough City and County 1,650 1.3%
Northumberland-Havelock 920 1.2%
Durham East 5,070 2.3%
Durham West 5,470 1.98%
Durham North/Central 555 1.1%
Scarborough /Agincourt-Rouge 2,250 0.8%
Scarborough Cliffs – Scarborough 3,285 1.2% Centre
Total 20,360 1.4% of CE LHIN population
1Census data for this sub-LHIN Planning Area does not include data for CSD 3515008 (Hiawatha First Nation). Source: Census 2006 Central East LHIN Socio-Economic Profile
Sub-LHIN Planning % of % with % Visible Unemploy- Proportion % of % of Population English Minority ment Rate of Population households Zone aged 65+ and as Mother (age 15+) population without headed by living alone Tongue living in low certificate, lone parent income degree, or diploma
Haliburton 24.4 92.4 1.1 7.5 10.4 24.9 22.5 Highlands
Kawartha Lakes 25.1 93.8 1.6 6.2 10.3 23.5 23.0
Peterborough City 26.8 92.9 2.5 7.1 12.8 20.2 27.0 and County
Northumberland- 26.0 93.4 2.2 5.9 8.1 23.6 24.2 Havelock
Durham East 25.7 88.3 6.9 6.8 10.4 21.0 27.4
Durham West 20.7 82.1 26.9 6.1 9.1 12.2 20.8
Durham 22.8 93.5 1.9 4.9 6.7 18.6 20.6 North/Central
Scarborough/ 14.8 41.3 78.8 8.7 23.2 18.5 25.2 Agincourt-Rouge
Scarborough Cliffs – 24.1 55.2 57.7 8.9 27.3 20.3 32.8 Scarborough Centre
Stats Canada, Census 2006 Central East LHIN Priority Population Data Life Expectancies at Birth and at Age 65, by Local Health Integration Network, 2005 Life Expectancy Life Expectancy LHIN at birth at age 65 Ontario 80.7 84.6
ERIE ST. CLAIR 79.7 83.9 SOUTH WEST 79.8 84.1 WATERLOO WELLINGTON 81.1 84.6 HAMILTON NIAGARA HALDIMAND BRANT (HNHB) 79.9 84.1
CENTRAL WEST 82.3 85.8 MISSISSAUGA HALTON 82.4 85.4 TORONTO CENTRAL 82.0 86.1 CENTRAL 83.2 86.2
CENTRAL EAST 81.4 85.3 SOUTH EAST 79.2 83.9 CHAMPLAIN 80.4 84.2 NORTH SIMCOE MUSKOKA 79.8 83.7
NORTH EAST 77.9 83.2 NORTH WEST 78.7 83.9
Source: IntelliHealth Ontario, deaths table, 2005; IntelliHealth Ontario, population estimates, 2005 Seniors Aged 65+ Years per each Sub-LHIN Planning Zone
60,000
40,000
20,000
0
Haliburton Highlands Kawartha Lakes Peterborough City and County Northumberland-Havelock Durham East Durham West Durham North/Central Scarborough Agincourt - Rouge Scarborough Cliffs - Scarborough Centre
Stats Canada, Census 2006 Burden of Chronic Conditions in the Central East LHIN Obesity (Body Mass Index (BMI) > 30)
Prevalence of Obesity in CE LHIN and Ontario by age
25 20 CE LHIN (2005) 15 CE LHIN (2007) % 10 ON (2005) 5 ON (2007) 0 75+ 18+ Total 18 to 44 45 to 64 65 to 74 population Age Prevalence of Obesity by LHIN (age 18+), 2007
22.9 22.7 25.0 20.4 20.7 18.8 19.4 19.1 19.4 20.0 16.4 15.8 14.1 13.8 14.4 12.9 15.0
% 9.9 10.0
5.0
0.0
%%%%%%%%%%%%%%%
ON Erie SW WW HNHB CW MH TC C CE SE Champ NSM NE NW Source: Canadian Community Health Survey, 2007 Overweight (Body Mass Index (BMI) 25.0-29.9)
Prevalence of Overweight in CE LHIN and Ontario by age
50 40 CE LHIN (2005) 30 CE LHIN (2007) % 20 ON (2005) 10 ON (2007) 0 Total 18 to 44 45 to 64 65 to 74 75+ population 18+ Age
Prevalence of Overweight by LHIN (age 18+), 2007
36.6 40.0 34.3 34.6 34.6 34.1 34.7 34.6 34.9 34.5 33.2 32.2 33.1 35.0 31.0 30.9 30.0 26.3 25.0
% 20.0 15.0 10.0 5.0 0.0
%%%%%%%%%%%%%%%
ON Erie SW WW HNHB CW MH TC C CE SE Champ NSM NE NW
Source: Canadian Community Health Survey, 2007 Smoking (daily or occasional)
Prevalence of Smoking in CE LHIN and Ontario by age
25 20 CE LHIN (2005) 15 CE LHIN (2007) % 10 ON (2005) 5 ON (2007) 0 75+ 12+ Total 12 to 44 to 12 64 to 45 74 to 65 population Age Prevalence of Smoking by LHIN (age 12+), 2007
30 25.6 23.8 24.3 24.3 25 21.8 20.8 20.0 20.3 18.7 18.5 20 17.3 17.3 14.7 15.1 13.4
% 15
10
5
0 %%%%%%%%%%%%%%%
ON Erie SW WW HNHB CW MH TC C CE SE Champ NSM NE NW
Source: Canadian Community Health Survey, 2007 Physical Inactivity (daily energy expenditure based on self-reported frequency, duration and intensity of leisure time physical activity) Prevalence of Physical Inactivity in the CE LHIN and Ontario by age
70 60 50 40 % 30 20 CE LHIN (2005) 10 CE LHIN (2007) 0 ON (2005)
75+ ON (2007) 12+ Total 12 to 44 to 12 64 to 45 74 to 65 population Age Prevalence of Physical Inactivity by LHIN (age 12+), 2007
56.2 55.0 52.9 60 50.1 49.0 48.6 47.2 48.7 49.4 47.6 45.4 44.5 46.5 50 41.5 41.3 40
% 30 20
10
0
%%%%%%%%%%%%%%%
ON Erie SW WW HNHB CW MH TC C CE SE Champ NSM NE NW
Source: Canadian Community Health Survey, 2007 Poor Diet (self-reported consumption of less than 5 servings of fruits and vegetables a day) Prevalence of Poor diet in the CE LHIN and Ontario by age
70 60 CE LHIN (2005) 50 40 CE LHIN (2007) % 30 20 ON (2005) 10 0 ON (2007) 75+ 12+ Total 12 to 44 45 to 64 65 to 74 population Age Prevalence of poor diet (<5 servings fruit and veg.) (age 12+), 2007
63.4 70 56.5 57.6 57.3 55.6 58.2 55.1 53.8 53.3 54.1 52.6 53.7 60 52.3 50.7 50.2 50 40 % 30 20 10 0
%%%%%%%%%%%%%%%
ON Erie SW WW HNHB CW MH TC C CE SE Champ NSM NE NW
Source: Canadian Community Health Survey, 2007 Heavy Drinking (self-reported 5 or more drinks on one occasion, at least once a month within the last year)
Prevalence of Heavy Drinking by LHIN (age 12+), 2007
27.4 27.5 27.0 27.7 30.0 25.3 23.5 24.9 25.0 21.7 22.7 22.3 22.1 18.9 20.0 16.6 17.1 13.6
% 15.0 10.0 5.0 0.0 %%%%%%%%%%%%%%%
ON Erie SW WW HNHB CW MH TC C CE SE ChampNSM NE NW
Source: Canadian Community Health Survey, 2007 Total admissions to adult designated mental health units by age group of patient & LHIN of patient residence, 2006/07 LHIN of Patient Residence Age Group Total # Name 0-14† 15-24 25-44 45-64 65+ admissions 1 Erie St. Clair 28 469 1,268 962 326 3,053 2 South West 9 697 1,806 1,410 655 4,577 3 Waterloo Wellington 0 480 1,405 822 239 2,946 4 HNHB 49 852 2,354 1,640 492 5,387 5 Central West 11 467 1,066 582 221 2,347 6 Mississauga Halton 6 467 1,177 759 298 2,707 7 Toronto Central 5 743 2,933 1,985 514 6,180 8 Central <5 766 1,875 1,339 503 4,485 9 Central East <5 853 2,411 1,630 526 5,422 10 South East <5 329 884 735 280 2,229 11 Champlain 0 707 2,067 1,430 569 4,773 12 North Simcoe Muskoka <5 408 1,090 666 170 2,335 13 North East 40 561 1,344 1,127 226 3,298 14 North West <5 363 661 377 195 1,599 XX Unknown 5 189 479 268 51 992 YY Out-of-Province 0 174 461 252 40 927 Total 162 8,525 23,281 15,984 5,305 53,257 †Data includes patients treated in adult designated mental health beds only. Admissions to child/adolescent mental health units is captured in the Discharge Abstract Database. Source: Adult Mental Health Data, Ontario Ministry of Health & Long-Term Care, Provincial Health Planning Database. Unique Addictions Issues in the Central East LHIN
• Alcohol and illicit drug abuse in the CE LHIN have an estimated economic cost (direct and indirect) of $915.5 million dollars. This figure includes direct costs.
• Substance abuse is associated with a significant loss of productivity in the CE LHIN.
• Long-term disability losses related to alcohol and illicit drug dependence alone amounted to $520 million dollars and are 1.6 times as large as the total substance-related direct costs.
• The prevalence of addictions issues in the Central East LHIN is roughly equivalent to the overall rate in Ontario.
Source: Central East LHIN Addictions Scan, March 2009 Central East LHIN Strategic Aims Central East LHIN Strategic Aims
The 2010-13 IHSP is focused on two Triple Aim system-level initiatives or
“strategic aims” that will propel the achievement of the vision and strategic directions of the Ministry of Health and Long-Term Care and the Central East
LHIN. Relevance of Strategic Aims to Central East LHIN Residents
Source: Central East LHIN Telephone Poll, August 2009 Aim # 1 Save 1,000,000 Hours of Patient Waiting Time in the ED
• Our strategic aim is to save one million hours of time patients spend in Central East LHIN Emergency Departments by 2013. This goal aligns with the Ministry of Health and Long-Term Care (MOHLTC) priority to decrease time patients spend in the emergency department.
• Saving 1,000,000 hours will be accomplished by reducing the number of visits to the emergency department (reducing emergency department demand), improving the flow within the emergency department (improving emergency department capacity and performance), and providing more appropriate levels of care in the community for patients who no longer require acute care services within the hospital (reducing ALC and improving bed utilization). Projected ED Hours by Cluster
Projected ED Hours (09/10-12/13)
900,000
880,000
860,000
840,000 NE Cluster Total Durham Cluster Total 820,000 Scarborough Cluster Total
Hours (Projected) 800,000
780,000
760,000 2009/10 2010/11 2011/12 2012/13 Years
Source: Ministry of Health and Long-Term Care; Intellihealth; accessed Q3 2009 Central East LHIN ED Visits by Patient Category (2008/2009)
Percent of CE LHIN Average Length of Stay Percent discharged within Category visits (Hours) Ministry Guidelines *
Admitted Patients 10% 18.7 33%
Non-Admitted Patients 11% 4.9 86% (CTAS I-II)
Non-Admitted Patients 37% 4.1 82% (CTAS III)
Non-Admitted Patients 42% 2.6 82% (CTAS IV-V)
*Ministry Guidelines: Admitted patients ≤ 8 hours; Non-Admitted patients (CTAS I-II) ≤ 8 hours; Non-Admitted patients (CTAS III) ≤ 6 hours; Non-Admitted patients (CTAS IV-V) ≤ 4 hours
Source: Emergency Department Reporting System; accessed Q3 2009 ED Visits in the Central East LHIN (2008/09)
ED Visits by CTAS Level Total Percent
ALL CTAS Levels 460,083 100%
CTAS I 2,617 0.6%
CTAS II 68,220 14.8%
CTAS III 202,027 43.9%
CTAS IV 159,660 34.7%
CTAS V 27,513 6.0%
CTAS I to III 272,864 59.3%
CTAS IV and V 187,173 40.7%
Source: Emergency Department Reporting System; accessed Q3 2009 Central East LHIN ED Visits by Site (2008/09)
Hospital ED Visits (08/09) Percent (08/09)
Campbellford Memorial Hospital 19,665 4.3%
Ross Memorial Hospital 39,846 8.7%
Peterborough Regional Health Centre 68,634 14.9%
Northumberland Hills Hospital 29,953 6.5%
Lakeridge Health - Bowmanville 30,176 6.6%
Lakeridge Health - Port Perry 16,301 3.5%
Lakeridge Health - Oshawa 78,131 17.0%
Rouge Valley Health System - Ajax Site 43,636 9.5%
Rouge Valley Health System - Centenary 44,346 9.6%
The Scarborough Hospital - General site 51,062 11.1%
The Scarborough Hospital - Birchmount site 38,333 8.3%
Total 460,083 100%
Source: Emergency Department Reporting System; accessed Q3 2009 ED Utilization and Length of Stay by CTAS Level (2008/09)
Level Percent of Total ED Visits Average ED Length of Stay
CTAS I 0.6% 8.0 hours
CTAS II 14.8% 8.1 hours
CTAS III 43.9% 5.8 hours
CTAS IV 34.7% 2.9 hours
CTAS V 6.0% 2.4 hours
Source: Emergency Department Reporting System; accessed Q3 2009 Season, Day & Time of ED Visits in the Central East LHIN (2007-08)
Number and Proportion of Visits by Season
Season of Visit
Spring Summer Autumn Winter Total (March-May) (June-August) (September-November) (December-February)
# % # % # % # % #
133,150 25.2 139,193 26.3 129,954 24.6 126,014 23.9 528,311
Number and Proportion of Visits by Day of the Week
Day of Week of Visit Total Sunday Monday Tuesday Wednesday Thursday Friday Saturday
# % # % # % # % # % # % # % #
77,820 14.7 82,191 15.6 74,557 14.1 73,894 14.0 72,972 13.8 74,283 14.1 72,594 13.7 528,311
Number and Proportion of Visits by Visit Time
Visit Time Total Monday-Friday 9-5 All Other Times
# % # % #
183,968 34.8 344,343 65.2 528,311
Source: MOHLTC National Ambulatory Care Reporting System; accessed Q3 2009 Top 5 reasons people visited the ED in the CE LHIN and Ontario (2008/2009)
Main Problem Group Central East Ontario
# % # %
Injury, poisoning & other consequences of external 137,035 25.9 1,283,291 24.2 causes
Symptoms, signs & abnormal clinical & laboratory 108,352 20.5 1,074,304 20.2 findings
Diseases of the respiratory system 53,119 10.1 563,678 10.6
Diseases of the digestive system 35,750 6.8 333,128 6.3
Diseases of the musculoskeletal system & connective 31,017 5.9 329,138 6.2 tissue
Source: Ministry of Health and Long-Term Care; Intellihealth; accessed Q3 2009 Percent ALC Days
Percent ALC Days in CE LHIN and Ontario (08/09)
20.0 17.1 16.516.1 16.0 15.615.2 14.8 15.0 12.2 CE LHIN
% 10.0 Ontario 5.0
0.0 Q1 Q2 Q3 Q4 2008/09
Source: CIHI-DAD; accessed Q3 2009 Top 5 Case Mix Groups for ALC Days in the Central East LHIN (06/07)
Case Mix Group (CMG) Description Cases Total Days Total ALOS Total Cases ALC ALC Days Avg LOS ALC of Days % ALC Total Days in CMG of Days % ALC Days ALC All DEMENTIA WITH OR WITHOUT 270 9,375 34.7 174 5,824 33.5 62.1% 9.6% DELIRIUM WITH A XIS III DIA GNOSIS SPECIFIC CEREBROV A SCULA R DISORDERS EXCEPT TRA NSIENT 1,484 17,847 12.0 283 4,944 17.5 27.7% 8.1% ISCHEMIC A TTA CKS OTHER FA CTORS CA USING 438 5,372 12.3 142 3,333 23.5 62.0% 5.5% HOSPITA LIZA TION HEART FAILURE 1,846 15,945 8.6 137 2,292 16.7 14.4% 3.8% DEMENTIA WITH OR WITHOUT DELIRIUM WITHOUT A XIS III 138 3,230 23.4 75 2,279 30.4 70.6% 3.8% DIA GNOSIS
Source: Provincial Health Planning Database; accessed Q3 2009 TE H IALTEAPY THERA L SICA PHY OTHER RCT INFA OR GE EMORRHA SPEC HA NOT STROKE CEREBRA L INFA RCTION UNSPECIFIED RCTION INFA L CEREBRA UNSPECIFIED DEMENTIA OGSI E TF ILURE FA RT E HEA CONGESTIV East LHIN(06/07) Top 5MostReasonableDiagnosis Source: Provincial Health Planning Database; accessed Q3 2009 accessed Database; Planning Health Source: Provincial ,8 69890140 9.0 16,938 1,881 6 ,1 12.7 7,212 569 1 ,8 13.8 4,283 311 5 ,8 6395 36.3 5,585 154 038742.7 3,847 90 Total Cases for ALCDaysintheCentral Total Days
Total ALOS 114 19 79 ALC Cases 2,284 2,473 1,534 1,447 3,937 ALC Days 003.%3.8% 4.1% 31.7% 20.0 14.6% 17.7 073.%2.5% 39.9% 80.7 833.%2.4% 33.8% 18.3 147.%6.5% 70.5% 41.4 Avg ALC LO S
% ALC Days of T o ta l D a y s in C M G
% ALC Days of All ALC Days Days from ALC Designation to Discharge Destination
Number of Days from ALC Designation to Discharge Destination in CE LHIN (2008/09, 90th percentile)
100 80 Acute Care 60 Complex Continuing Care
Days 40 Home with Support 20 Home without Support 0 Long Term Care Q1 Q2 Q3 Q4 Rehab 2008/09
Source: CIHI-DAD, ER/ALC Quarterly Stocktake Report, July 2009 Aim # 2 Reducing the Impact of Vascular Disease
• Our strategic aim is to reduce the impact of vascular disease on individuals and the health care system in Central East LHIN by 10% by 2013. Reducing the risk of people developing and effectively and efficiently managing vascular disease will reduce the impact of vascular disease on individuals and the health care system.
• While success will be measured in terms of hospital patient days, success will require the collective effort of patients, health care clinicians, community-based agencies and hospitals. Vascular Disease
Vascular Disease includes: • Cardiovascular • Heart Disease • Hypertension • Ischemic Heart Disease • Peripheral Vascular Disease • Cerebrovascular • Pulmonary Heart Disease • Stroke • Vascular Dementia • Cardiac Rehabilitation • Exams for Risk Factors and Vascular Disease and related Conditions of Diabetes (Type 1, Type 2 and Gestational), Amputation, and Renal Disease Diabetes
Prevalence of Diabetes in the CE LHIN and Ontario
25 20 CE LHIN (2005) 15 CE LHIN (2007) % 10 ON (2005) 5 ON (2007) 0 75+ 12+ Total 12 to 44 45 to 64 65 to 74 population Age
Prevalence of Diabetes by LHIN (age 12+), 2007
10 8.9 9 7.3 7.3 7.3 8 6.7 7.0 6.8 6.1 7 6.1 6.0 5.4 5.2 6 5.1 4.2 % 5 4.1 4 3 2 1 0
%%%%%%%%%%%%%%%
ON Erie SW WW HNHB CW MH TC C CE SE Champ NSM NE NW Source: Canadian Community Health Survey, 2007 Diabetes Quality of Care Indicators by LHIN
LHIN Individuals living A1C Test in last 6 LDL Test in last 12 Retinal Exam in last All 3 Indicators within with diabetes months (%) months (%) 24 months (%) guidelines (%)
Ontario 906,577 55.1 67.8 64.3 35.9
Erie St.Clair 47,304 47.8 59.4 67.7 31.2
South West 59,570 54.2 60.5 68.9 35.5
Waterloo Wellington 41,675 63.5 69.9 68.3 42.8
Hamilton Niagara 92,745 57.0 69.1 67.6 38.2 Haldimand Brant
Central West 52,768 53.6 70.0 56.3 32.7
Mississauga Halton 72,206 55.6 72.6 61.3 36.9
Toronto Central 101,319 53.5 68.9 60.1 33.7
Central 121,418 57.3 73.9 60.0 37.0
Central East 116,241 59.0 74.0 62.9 38.5
South East 33,444 62.0 68.7 70.2 41.6
Champlain 77,956 51.0 65.6 66.1 34.0
North Simcoe Muskoka 25,439 48.0 55.4 67.3 30.6
North East 45,330 47.7 53.8 71.6 32.6
North West 17,558 53.7 54.5 70.7 32.3
Note: 1604 individuals living with diabetes in Ontario that could not be matched to a LHIN were omitted from the analysis Source: Ehealth Ontario Diabetes Care Report July 2009 Hypertension
Prevalence of Hypertension in the CE LHIN and Ontario (age 12+)
60 50 40
% 30 20 CE LHIN (2005) 10 CE LHIN (2007) 0 ON (2005)
75+ ON (2007) 12+ Total 12 to 44 to 12 64 to 45 74 to 65 population Age Prevalence of Hypertension by LHIN (age 12+), 2007
25.0 19.8 20.8 18.0 18.5 19.4 18.5 20.0 16.4 17.3 16.3 17.0 15.1 14.8 13.2 13.4 14.6 15.0 % 10.0 5.0 0.0 %%%%%%%%%%%%%%%
ON Erie SW WW HNHB CW MH TC C CE SE ChampNSM NE NW
Source: Canadian Community Health Survey, 2007 Hypertension • Prevalence – Approximately 22% of the Canadian adult population has hypertension [1]. – 42% are unaware of their condition – Only 16% have it treated and under control. • 90% of CE LHIN residents who reported having high blood pressure reported taking medication for high blood pressure, a similar proportion to Ontario (86%) [2]. • Among Ontario residents (aged 12+) who reported having hypertension [2]: – 59% had at least one other chronic condition – 24% had 2 or more other chronic conditions – 39% had arthritis/rheumatism – 17% reported having been diagnosed with diabetes – 15% had heart disease
Sources: [1] Heart and Stroke Foundation of Ontario, http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3483991/k.34A8/Statistics.htm. Accessed September 16, 2008. [2] Canadian Community Health Survey, 2007 Stroke
Prevalence of Stroke in the CE LHIN and Ontario by Age
10 8 CE LHIN (2005) 6 CE LHIN (2007) % 4 ON (2005) 2 ON (2007) 0 75+ 12+ Total 12 to 44 to 12 64 to 45 74 to 65 population Age
Prevalence of Stroke by LHIN (age 12+), 2007
2.5 2.1
2 1.7 1.6 1.5 1.4 1.4 1.5 1.3 1.3 1.1
% 1.0 0.9 0.9 1
0.5 Data unavailable Data unavailable 0 Data unavailable %%%%%%%%%%%%%%%
ON Erie SW WW HNHB CW MH TC C CE SE Champ NSM NE NW
Source: Canadian Community Health Survey, 2007 Stroke
• 1.2% of CE LHIN residents suffered from the effects of a stroke in 2005, similar to the provincial prevalence of 1.1% [1]. • Among Ontario residents (aged 12+) who reported having suffered the effects of a stroke [1]: – 84% had at least one other chronic condition – 56% had 2 or more other chronic conditions – 55% had hypertension – 32% reported having been diagnosed with heart disease – 27% had diabetes • Getting rehabilitation quickly after a stroke can help patients rebuild capabilities. 31% of CE LHIN stroke patients were discharged from acute care to inpatient rehabilitation (05/06). Ontario’s Stroke Strategy’s goal is 60% [2].
.
Sources: [1] Canadian Community Health Survey, 2005 [2] QMonitor: Ontario Health Quality Council. 2008 Report on Ontario’s Health System Heart Disease
Prevalence of Heart Disease in the CE LHIN and Ontario
30 25 CE LHIN (2005) 20 CE LHIN (2007)
% 15 10 ON (2005) 5 ON (2007) 0 75+ 12+ Total 12 to 44 45 to 64 65 to 74 population Age
Prevalence of Heart Disease by LHIN (age 12+), 2007
8 6.8 6.6 6.8 7 5.7 6.0 5.0 5.1 5.1 6 4.6 4.9 4.7 5 3.9 3.6 3.3 3.6 % 4 3 2 1 0 %%%%%%%%%%%%%%%
ON Erie SW WW HNHB CW MH TC C CE SE Champ NSM NE NW
Source: Canadian Community Health Survey, 2007 Heart Disease
• Every 7 minutes in Canada, someone dies from heart disease or stroke [1]. • Cardiovascular disease accounted for (2004) [1]: – 32% of all deaths in Canada (72,338 deaths – or more than 72,000) – 31% of all male deaths – 33% of all female deaths • Of all cardiovascular deaths (2004) [1]: – 54% were due to ischemic heart disease – 20% to stroke – 25% to heart attack • Approximately 16% of patients do not survive the year after diagnosis of congestive heart failure (2002/03 – 2005/06). This value decreases to approximately 13% for first heart attack). This is higher than for many forms of cancer [2]. • 28% of people with either diabetes or heart disease are obese (2005). This has increased from 26% in 2003 [1]. • 14% of people with either diabetes or heart disease smoke daily (2005). This has remained unchanged since 2003 [2].
Sources: [1] Heart and Stroke Foundation of Ontario, http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3483991/k.34A8/Statistics.htm. Accessed September 16, 2008 [2] QMonitor: Ontario Health Quality Council. 2008 Report on Ontario’s Health System. Inpatient Days
Projected Inpatient Days for Vascular and Related Conditions in Central East LHIN Hospitals (age 15+)
109,000 108,538 108,000 107,000 105,856 106,000 105,000 104,000 103,357 103,000 102,000
Inpatient(projected) Days 101,000 100,000 2010/11 2011/12 2012/13 Years
Source: MOHLTC Intellihealth; accessed Q3 2009 Rate of Vascular Inpatient Days for CE LHIN Residents per 1,000 Population (08/09)
Rate of Vascular Inpatient Days for CE LHIN Residents per 1,000 population Age 15+ (2008/09) 160 150.9 140
120 106.5 100 94.1 80
60
40
Rate perRate 1,000 Population 20
0 Durham Scarborough Northeast Cluster
Note: 2006 population data applied in Scarborough
Source: MOHLTC Intellihealth; accessed Q3 2009 Inpatient Discharges
Projected Inpatient Discharges for Vascular and Related Conditions (2009/10 - 2012/13)
15,500 15,275 14,907 15,000 14,563 14,500 14,229 Years 14,000
13,500 2009/10 2010/2011 201 1/2012 2012/2013 Inpatient Discharges
Source: Ministry of Health and Long-Term Care; Intellihealth – accessed Q3 2009 Inpatient Discharges for Vascular and Related Conditions in the CE LHIN (08/09) NE Cluster Total Cluster NE Durham Cluster Total Scarborough Cluster Total CE LHIN Total Diabetes 471 390 851 1,712 Renal 324 328 506 1,158 Vascular 2,961 3,273 4,783 11,017
Total Inpatient Discharges Vascular and Related 3,756 3,991 6,140 13,887
Source: MOHLTC Intellihealth; accessed Q3 2009 Alternate Level of Care (ALC) Days for Vascular and Related Conditions in the CE LHIN (08/09) NE Cluster Total Cluster NE Total Cluster Durham Total Cluster Scarborough Total Hospital LHIN CE Diabetes 968 537 416 1,921 Renal 849 292 272 1,413 Vascular 5,103 4,575 3,823 13,501
Total ALC Days for Vascular and Related Conditions 6,920 5,404 4,511 16,835
Source: MOHLTC Intellihealth; accessed Q3 2009 Critical Care Cases for Vascular and Related Conditions (08/09) NE Cluster Total Total Cluster Durham Scarborough Cluster Total CE LHIN Hospital Total Diabetes 130 38 83 251 Renal 45 27 57 129 Vascular 1,270 885 1,692 3,847 Total Critical Care Cases Vascular and Related 1,445 950 1,832 4,227
Source: MOHLTC Intellihealth; accessed Q3 2009