PROVINCE WIDE SERVICES Annual Report on Activities and Outcomes 2003 REVISED JULY 2004 Province Wide Services HEALTH AND WELLNESS Working Group Preface 2002/2003 fiscal year, and budget figures for 2003/2004 and 2004/2005.The primary data The Province Wide Services Annual Report is sources are: PWS annual reports from Capital compiled by the Health Funding and Costing Health and the Calgary Health Region; provincial Branch of Alberta Health and Wellness. Special hospital inpatient data; and information provided thanks to Backstreet Communications for the by the individual programs delivering Province report design and layout for the fourth Wide Services.The 2003 Annual Report also consecutive year. contains information on the activities and decisions The purpose of this report is to account of the Province Wide Services Working Group. for what is being achieved with the Each year the Annual Report provides an in-depth approximately $450 million in annual description of selected Province Wide Services. provincial government funding provided The Features section of the 2003 Annual Report for Province Wide Services - what are the highlights the trauma programs in both regions, types and volumes of funded activities, and and Capital Health’s Pediatric Cardiac Program. ultimately what are the health outcomes We would like to express our thanks to the achieved and value for money. representatives of these programs for their time Data is provided for Province Wide Services and commitment to producing these special reports. actual volumes and expenditures for the TABLE OF CONTENTS PREFACE . 2 2003 ANNUAL REPORT FEATURES . 34 1. ALBERTA TRAUMA PROGRAM PROFILE - TABLE OF CONTENTS . 3 CALGARY HEALTH REGION/CAPITAL HEALTH REGION . 34 OVERVIEW OF PROVINCE WIDE SERVICES . 5 2. PEDIATRIC CARDIAC SURGERY - PROVINCE WIDE SERVICE CAPITAL HEALTH. 41 MISSION STATEMENT . 6 CLINICS AND HOME SERVICES . 44 INVENTORY OF CURRENT PROVINCE WIDE Renal (Kidney) Dialysis . 44 SERVICES . 7 Dialysis Delay / Prevention . 46 Pre- and Post-Transplant. 46 PROVINCE WIDE SERVICES WORKING GROUP . 8 Islet Cell Transplant. 47 Medical Genetics . 48 PROVINCE WIDE SERVICES: HIGHLIGHTS . 9 HIV Clinics. 49 1. 2002/2003 Results . 9 Poison and Drug Information Service (PADIS). 51 2. 2004/2005 PWS Budget . 9 Home Enteral Nutritional Therapy. 52 3. Auditor General Review . 9 COMPRU. 53 4. PWS Outcomes Symposium . 10 Children with Complex Healthcare Needs (CCHN). 54 INPATIENT SERVICES. 13 Pediatric Transport . 55 Organ and Bone Marrow Transplants. 15 Heart and Lung Transplant. 16 HIGH COST DRUGS . 58 Kidney Transplant . 17 Liver Transplant . 18 HIGH COST DEVICES . 61 Bone Marrow Transplant. 20 Trauma and Burns . 21 OTHER PROVINCE WIDE SERVICES . 64 Neurosurgery . 23 APPENDICES. 66 Cardiovascular Services . 25 Neonatology . 28 Oncology . 31 OVERVIEW OF Province Wide Services Province Wide Services are a set of highly Province Wide Services are separated from specialized medical interventions.They include a regional health authority global population number of hospital inpatient procedures - such funding and funded under their own regime.This as heart surgeries, organ and bone marrow ensures that special attention and support is transplants – as well as clinics and home services provided to these key life-sustaining interventions, and high cost drugs and devices. and also allows for a provincial approach to planning. By bringing all parties to the table - Figure 1 illustrates the high-cost nature of Capital Health, Calgary Health Region, a rural inpatient Province Wide Services compared to region representative, and Alberta Health and other hospital inpatient services. (Note: the costs Wellness - Province Wide Services aims to shown are those incurred by the regional health improve collaboration in the provision of these authorities and exclude any physician fee-for- key life-saving interventions. service claims). Given the central mandate of Province Wide Because of their complexity, Province Wide Services to deliver services to all Albertans, this Services require specialized expertise and report will present extensive information on supporting infrastructure, as well as sufficient patient region of residence. volumes to maintain provider proficiency.Thus, these services are specialized in only the Capital and Calgary health regions, but serve all Albertans. Figure 1: Hospital Discharges - PWS cases vs.All Other Cases, 2002/2003 Province Wide Services 10,243 Total Inpatient Cases 3.1% of Total Inpatient Cases $15,714 Average Cost/Case All Other Cases 315,078 Total Inpatient Cases 96.9% of Total Inpatient Cases $5,291 Average Cost/Case Source: 2002/2003 Morbidity Data (Resource Intensity Weighting methodology used to estimate costs) PWS 2003 Annual Report on Activities and Outcomes 5 Province Wide Services Mission Statement Province Wide Services is intended to fund a narrow band of high cost services that, because of their nature, can only be effectively provided at one or two sites in the province. Province Wide Services are planned collaboratively between Alberta Health and Wellness, the Calgary and Capital health authorities, and all health regions to ensure these highly specialized services are provided in the best interests of the province as a whole, with proper medical and financial accountability. Province Wide Services are patient-focussed, equitably accessed by all Albertans, cost effective, cost efficient and with a process to enhance quality. 6 PWS 2003 Annual Report on Activities and Outcomes INVENTORY OF CURRENT Province Wide Services Inpatient Services Pulmonary Hypertension (Detailed Case Mix Groups (CMGs) for 2003 are listed in Appendix "A") High-Cost Devices • Organ and Bone Marrow Transplants • Implanted Cardiac Defibrillators • Selected Tertiary Services for: • Cranioplasty •Trauma and Burns • Cochlear Implants • Neurosurgery APPROACH • Cardiovascular Procedures • Neonatology (Low Birthweight • Funding to support the Alberta Provincial Procedures) Project for Outcomes Assessment in • Oncology Coronary Heart Disease Clinics and Home Services Rosehaven Provincial Program • Dialysis and Renal Program • The Rosehaven Program (centered in Camrose) • Dialysis Prevention supplies special behavioural care within the •Pre-and-Post Transplant Activities continuing care system throughout Alberta • Medical Genetics • Islet Cell Transplantation Ocular Photodynamic (Visudyne) Therapy • HIV Clinics • Laser-activated drug (Visudyne) treatment of • STD/TB Clinics classic wet age-related macular degeneration • 1-800 AIDS Hotline •Poison and Drug Information Services (PADIS) • Home Enteral Nutritional Therapy • Craniofacial Osseointegraton (COMPRU) • Children with Complex Health Care Needs • Education Resource Centre • Paediatric Transport High-Cost Drugs • Immunosuppressants (Cyclosporine, Tacrolimus, Sirolimus, Mycophenolate, Basiliximab, Daclizumab, OKT-3,ATGAM, Ondansetron and Filgrastim) • HIV Antiretrovirals • Human Growth Hormone for Chronic Renal Failure and Growth Hormone Deficiency • Pulmozyme for Cystic Fibrosis • Flolan and Tracleer for Primary PWS 2003 Annual Report on Activities and Outcomes 7 PROVINCE WIDE SERVICES Working Group The Province Wide Services Advisory • Chief Financial Officer and Chief Medical Committee, reporting to the Minister of Health, Officer of the Calgary Health Region was established in 1997 with a mandate to • One representative from a non-urban develop Province Wide Services (PWS) budget health region recommendations, review proposals for new • Assistant Deputy Minister of Finance services, ensure the development of action plans and Corporate Services for Alberta Health for the provision of services, and promote and Wellness accountability and monitor performance • Secretariat and staff support by Alberta Health outcomes for these activities. and Wellness In March 2002, the Advisory Committee was (see Appendix B for current membership of the PWS replaced with a smaller Province Wide Services Working Group) Working Group reporting to the Deputy Minister of Health and Wellness. Membership consists of: • Chair appointed by the Minister of Health and Wellness • Chief Financial Officer and Chief Medical Officer of Capital Health 8 PWS 2003 Annual Report on Activities and Outcomes PROVINCE WIDE SERVICES Highlights 1 2002/2003 Results 2 2004/2005 PWS Budget Inpatient Services: A Province Wide Services Budget totalling CAPITAL HEALTH - results for the $454.3 million for 2004/2005 was announced 2002/2003 fiscal year showed Capital on March 24, 2004, representing a 9.0 per discharging 5,511 Province Wide Services cent increase from the previous year hospital patients (excluding comparable budget. neuromodulation). Although comparisons to the previous year are complicated by service coding and grouping changes in Auditor General Review 2002/2003, this appears to represent about 3 a 3.0 per cent increase for this set of In the Fall of 2002,Alberta Health and services.The increase resulted primarily Wellness requested the Office of the Auditor from a 14.0 per cent increase in cardiac General to verify whether the Province angioplasties.The actual inpatient results Wide Services process was resulting in a were 97 cases above the funded level. fair and equitable allocation of funding Again, this was attributable to cardiac between the Calgary and Capital regional angioplasties (1,927 actual cases versus health authorities.The Auditor General 1,805 funded cases). completed its audit in September 2003, making the following recommendations: CALGARY