Hamilton Niagara Haldimand Brant LHIN. Current State Health System Utilization and Performance by PAG

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1 Hamilton Niagara Haldimand Brant LHIN Current State Health System Utilization and Performance by PAG

2 A summary current state data profile has been collected for PAGs where data is available PAG level data is based on reported hospital activity, as data sources in other areas are limited and typically not aligned at the PAG level. PAG level data includes both inpatient and same-day surgery volumes. For inpatient activity, Case Mix Groups (CMGs) were aligned to each PAG as appropriate. Where an overlap of care responsibilities exists across PAGs for select CMGs, the CMG was assigned to one PAG (e.g. trauma CMGs assigned to ED/Trauma vs. orthopedics; oncology). From this process, there are three PAGs without associated inpatient level data (chronic pain, specialized geriatrics, and paediatrics). Similarly, for same-day surgery activity, Major Ambulatory Clusters (MACs) were aligned to each PAG. No volumes were identified for chronic pain, specialized geriatrics, or paediatrics. For specialized geriatrics patients, data for all patient ages, including 65 and above, have been included within all other PAGs. From this work, siting and sizing for this population will occur within the other PAG clinical areas. In the case of paediatrics, for the siting and sizing exercise, a review of tertiary and quaternary inpatient volumes will be conducted to evaluate the specialized resources needed to meet the needs of this patient population (patients aged 0-17 years). For the chronic pain PAG, service delivery considerations will be incorporated into the overall clinical services plan for the LHIN. For select PAGs, where additional data is available it has been included. This applies to: Emergency/Trauma PAG; Mental Health and Addictions PAG; Rehabilitation / Complex Continuing Care (CCC) PAG. -1- HNHB LHIN Clinical Services Plan

3 The current state data profile for each PAG provides high-level patient characteristics Data characteristics with PAG level data include: Hospital based activity for inpatients and same-day surgical activity for Average Resource Intensity Weight (RIW), as a measure of patient acuity. The average RIW for the LHIN in was 1.5. % Alternate Level of Care (ALC) to indicate the proportion of inpatient days spent in acute care where services could have been provided in a lower level of care setting. The % ALC days for the LHIN was 18%, and is now 25%. The hospitalization rate per 100,000 people to provide a measure of the incidence with which PAG-specific care is provided in each county of the LHIN. Hospitalization rates have been age adjusted across counties. Data is presented for both HNHB Hospitals and HNHB Patients as indicated below. County Hamilton Niagara Burlington Brant Haldimand & Norfolk Activity by Hospital County Separations Avg. RIW Hospital Service Utilization FY %ALC Cases Characteristics for patients treated at HNHB hospitals (including patients from outside the HNHB LHIN). Information is reported by county in which the hospital delivering services resides. Separations Avg. RIW Activity by Patient County % ALC Cases Hospitalizat ion Rate per 100,000 Characteristics of HNHB residents treated in hospital (hospital may be from outside the HNHB LHIN). Information is reported by county of patient residence. Information on the top 5 CMGs (by volume) for patient county of residence (based on the data on the right side of the table above) is also reported across the PAGs. -2- HNHB LHIN Clinical Services Plan

4 Cardiac PAG -3- HNHB LHIN Clinical Services Plan

5 The Cardiac PAG accounts for 13% of the acute activity from HNHB LHIN residents and 2% of same-day surgery cases The Cardiac PAG has a higher than average RIW for HNHB patients (1.9 vs. 1.5 for the LHIN), with the Hamilton area having the highest average acuity of cases both for its hospitals and its residents. Across LHIN residents, 82% of cases are primary or secondary while 18% are tertiary or quaternary. The Cardiac PAG has a lower proportion of ALC days than the LHIN average (11% vs. 18%) with greater variability across LHIN hospitals than across patient counties. The age-adjusted hospitalization rate is higher in Haldimand & Norfolk than across the rest of the LHIN, and is lowest in Burlington. There is a projected increase of 36% for inpatient activity in the next 15 years (LHIN average is 26%) and an increase of 33% for same-day surgical activity (LHIN average of 28%). County Activity by Hospital County Separations Avg. RIW Cardiac PAG Service Utilization FY %ALC Cases* Separations Avg. RIW Activity by Patient County % ALC Cases* Hospitalization Rate per 100,000 Hamilton 8, % 2,279 6, % 1, Niagara 3, % 310 5, % 1, Burlington 1, % 214 1, % Brant 1, % 47 1, % Haldimand & Norfolk 1, % 31 1, % 193 1,057 TOTAL 16, % 2,881 16, % 2, *Ambulatory volumes are reported in both Cardiac and Vascular PAGs (MAC: Diseases and disorders of the circulatory system) Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO. -4- HNHB LHIN Clinical Services Plan

6 Across counties, similar CMGs are in the top 5, and account for 53% of activity for the HNHB residents within the Cardiac PAG HNHB Resident Cardiac Inpatient Activity Overview by Patient County (FY ) Cases (% of Total Cases) Top CMGs Hamilton Niagara Burlington Brant Haldimand & Norfolk CMG 1 (196) Heart Failure w/o Cath 974 (15.4%) (196) Heart Failure w/o Cath 801 (15.2%) (196) Heart Failure w/o Cath 225 (12.9%) (196) Heart Failure w/o Cath 275 (17.4%) (196) Heart Failure w/o Cath 251 (22%) CMG 2 (208) Angina w/o Cath 818 (12.9%) (202) Arrhythmia w/o Cath 626 (11.9%) (208) Angina w/o Cath 222 (12.7%) (194) MI w/o Cath 268 (17.0%) (202) Arrhythmia w/o Cath 191 (17%) CMG 3 (202) Arrhythmia w/o Cath 586 (9.2%) (194) MI w/o Cath 545 (10.3%) (202) Arrhythmia w/o Cath 182 (10.4%) (202) Arrhythmia w/o Cath 185 (11.7%) (194) MI w/o Cath 177 (16%) CMG 4 (194) MI w/o Cath 678 (9.1%) (208) Angina w/o Cath 351 (6.7%) (194) MI w/o Cath 179 (10.2%) (208) Angina w/o Cath 104 (6.6%) (208) Angina w/o Cath 147 (13%) CMG 5 (175) PCI 384 (6.1%) (175) PCI 314 (6.0%) (174) Pacemaker Implant/remove 136 (7.8%) (204) Unstable Angina w/o Cath 104 (6.6%) (204) Unstable Angina w/o Cath 76 (7%) Total Cases 3,340 (52.7%) 2,637 (50.1%) 944 (54.0%) 936 (59.3%) 842 (75%) Total Cases Across Counties 8,699 (53%) Note: CMG names have been abbreviated from their original form. Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO. -5- HNHB LHIN Clinical Services Plan

7 Emergency/Trauma PAG -6- HNHB LHIN Clinical Services Plan

8 Across the LHIN, there are close to 600,000 annual ED visits, which are projected to increase by 14% over the next 15 years HNHB Residents Emergency Visit Activity by County in Patient County ED Visit Volumes Rate of Visits per 1,000 Population Hamilton 207, Niagara 224, Burlington 45, Brant 59, Haldimand & Norfolk 58, TOTAL 596, Number of Cases per 1,000 population CTAS Level Ratios Per Population CTAS 1 3 per 1,000 population CTAS 4 5 per 1,000 population Hamilton Niagara Burlington Brant Haldimand and Norfolk There is variability in ED usage across the LHIN with ED visits per 1,000 population ranging from 260 in Burlington to 660 in Haldimand & Norfolk. Similarly, when looking at CTAS scoring*, there is variability between ED visits across counties. Burlington and Brant have the lowest proportion of CTAS 4-5 Haldimand & Norfolk have the highest proportions, which may speak to a lack of local primary care availability * CTAS Levels 1-3 include emergent and urgent patients vs. CTAS Levels 4-5 include non-urgent patients Source: Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO. -8- HNHB LHIN Clinical Services Plan

9 The top general categories for ED visits are similar across patients from all counties, and account for 38% of total ED visits HNHB Resident Emergency Department Visit Activity Overview by Patient County (FY ) Visits(% of Total Visits) Top CACs Hamilton Niagara Burlington Brant Haldimand & Norfolk CAC 1 (627*) Skin and Subcutaneous Tissue 24,074 (11.6%) (620*) General Gastrointestinal 22,581 (10.0%) (620*) General Gastrointestinal 5,331 (11.7%) (620*) General Gastrointestinal 5,618 (9.5%) (627*) Skin and Subcutaneous Tissue 6,163 (10.5%) CAC 2 (620*) General Gastrointestinal 21,255 (10.2%) (627*) Skin and Subcutaneous Tissue 19,560 (8.7%) (627*) Skin and Subcutaneous Tissue 3,333 (7.3%) (627*) Skin and Subcutaneous Tissue 5,166 (8.7%) (607*) General ENT 5,734 (9.7%) CAC 3 (607*) General ENT 11,951 (5.7%) (607*) General ENT 16,678 (7.4%) (611*) General Respiratory System 2,701 (5.9%) (607*) General ENT 5,011 (8.4%) (620*) General Gastrointestinal 5,363 (9.1%) CAC 4 (611*) General Respiratory System (5.4%) (611*) General Respiratory System 13,239 (5.9%) (612*) General Circulatory 2,340 (5.3%) (611*) General Respiratory System 4,460 (7.5%) (611*) General Respiratory System 3,692 (6.3%) CAD 5 (624*) Other Musculoskeletal 10,374 (5.0%) (624*) Other Musculoskeletal 11,999 (5.3%) (6800) Other Injuries 2,007 (4.4%) (636*) Genitourological Disorder 2,521 (4.2%) (624*) Other Musculoskeletal 2,533 (4.3%) Total Visits 78,828 (37.9%) 84,057 (37.4%) 15,712 (34.5%) 22,776 (38.3%) 23,485 (39.8%) Total Visits Across Counties 224,858 (37.7%) Note: CAC names have been abbreviated from their original form. Source: Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO. -9- HNHB LHIN Clinical Services Plan

10 The trauma activity of this PAG accounts for 3% of the acute inpatient activity from the LHIN The highest average acuity cases for trauma are in Hamilton, with the overall average RIW for this PAG being in-line with the average RIW for the LHIN. There is a range of ALC rates across counties, with Niagara having the highest rates by hospital and by patient county. Haldimand & Norfolk hospitals also have high ALC rates. The age-adjusted hospitalization rate for trauma is higher in Haldimand & Norfolk than for the rest of the LHIN residents. County Activity by Hospital County Separations Avg. RIW Trauma Service Utilization FY %ALC Cases Separations Avg. RIW Activity by Patient County % ALC Cases Hospitalization Rate per 100,000 Hamilton 1, % 995 1, % Niagara 1, % 739 1, % Burlington % % Brant % % Haldimand & Norfolk % % TOTAL 2, % 2,382 3, % 2, Categories with fewer than 100 cases have not been reported Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

11 Maternal / Newborn / Gynecology PAG -11- HNHB LHIN Clinical Services Plan

12 The Maternal / Newborn / Gyne PAG accounts for 27% of the acute activity from the LHIN, including both mothers and babies Acute volumes for the Maternal / Newborn / Gyne PAG are the most significant driver of overall inpatient volumes for the LHIN, when activity of both mothers and babies is included. These volumes are expected to grow by only 14% over the next 15 years vs. the overall inpatient activity growth of 26% for the LHIN. There are lower age-adjusted hospitalization rates for Haldimand & Norfolk, Niagara, and Brant residents than for Hamilton and Burlington. Acuity levels, measured by RIW are below the LHIN average (0.7 vs. 1.5). Across LHIN residents 97% of cases are primary or secondary, while 3% are tertiary. There are no reported ALC pressures within this PAG. County Separations * Maternal / Newborn / Gynaecology PAG Service Utilization FY Activity by Hospital County Avg. RIW %ALC Cases Separations * Activity by Patient County Avg. RIW % ALC Cases Hospitalization Rate per 100,000 Hamilton 16, % 1,925 13, % 1,496 3,024 Niagara 9, % 982 9, % 1,074 2,805 Burlington 3, % 152 4, % 281 3,073 Brant 3, % 263 3, % 366 2,852 Haldimand & Norfolk % 39 2, % 147 2,778 TOTAL 33, % 3,361 33, % 3,364 2,955 * Note: to accurately reflect activity for this PAG, both mother and baby separations are included Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

13 Across counties, similar CMGs are in the top 5, primarily focused on LDRP, accounting for 67% of Maternal / Newborn / Gyne PAG activity HNHB Resident Maternal / Newborn / Gynecology Inpatient Activity Overview by Patient County FY Cases (% of Total Cases) Top CMGs* Hamilton Niagara Burlington Brant Haldimand & Norfolk CMG 1 (545) Vaginal Delivery 3,285 (24%) (545) Vaginal Delivery, 2,220 (22%) (576) Normal Newborn 983 (23%) (545) Vaginal Delivery 877 (25%) (576) Normal Newborn 536 (24%) CMG 2 (576) Normal Newborn 3,126 (23%) (576) Normal Newborn 2,127 (21%) (545) Vaginal Delivery 946 (22%) (576) Normal Newborn 860 (25%) (545) Vaginal Delivery 524 (23%) CMG 3 (577) Normal Newborn C-Section 1,141 (8%) (577) Normal Newborn C-Section 780 (8%) (577) Normal Newborn C-Section 403 (9%) (577) Normal Newborn C-Section 233 (7%) (577) Normal Newborn C-Section 201 (9%) CMG 4 (537) Primary C-Section 979 (7%) (537) Primary C-Section 691 (7%) (537) Primary C-Section 345 (8%) (537) Primary C-Section 227 (7%) (537) Primary C-Section 152 (7%) CMG 5 (536) Repeat C-Section 634 (5%) (502) Hysterectomy, Non Malignant 672 (7%) (536) Repeat C-Section 217 (5%) (502) Hysterectomy, Non Malignant 191 (6%) (502) Hysterectomy, Non Malignant 141 (6%) Total Cases 9,165 (68%) 6,490 (65%) 2,894 (67%) 2,388 (69%) 1,554 (69%) Total Cases Across Counties 22,491 (67%) *To accurately reflect activity for this PAG, both mother and baby separations are included Note: CMG names have been abbreviated from their original form. Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

14 Rehabilitation and Complex Continuing Care PAG -14- HNHB LHIN Clinical Services Plan

15 Rehabilitation services availability and utilization vary across LHIN counties, with the majority of services provided across 5 hospitals County Hamilton Niagara Organization Admissions ( ) Hamilton Health Sciences Corporation 1,206 St. Joseph s Health Care System 466 The Religious Hospitallers of St. Joseph of the Hotel Dieu of St. Catherines Beds by County General Rehab Specialized Rehab Beds per 100,000 Population >20 yrs General Rehab Specialized Rehab Burlington Joseph Brant Memorial Hospital Brant Brant Community Healthcare Haldimand & Norfolk HNHB Total 2, Source: Hospital Indicator Tool. Ministry of Health and Long Term Care and Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO Rate per 100,000 population Hamilton Rehab Rates by County of Patient Residence Niagara Burlington Brant Haldimand Norfolk HNHB LHIN Ontario Notes: The inpatient rehabilitation rate is age-standardized. This means it is adjusted for variations in population age distributions over time and place. Source: HNHB LHIN (2007/08 Inpatient Rehabilitation, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH Ontario and 2007/08 average beds, Planning Decision Support Tool. Ministry of Health and Long-Term Care, Health Data Branch) -15- HNHB LHIN Clinical Services Plan

16 Complex continuing care availability and utilization varies across counties, with the majority of services provided across 10 hospitals County Organization Beds by County Hamilton St. Joseph s Health Care System St. Peter s Hospital Beds per 1,000 Population > 75 yrs Niagara Health System Niagara The Religious Hospitallers of St. Joseph of the Hotel Dieu of St. Catherines West Lincoln Memorial Hospital Burlington Joseph Brant Memorial Hospital Brant Brant Community Healthcare Haldimand War Memorial Hospital Haldimand & Norfolk General Hospital Norfolk West Haldimand General Hospital HNHB Total Source: Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO. Rate per 100,000 population Hamilton CCC Rates by County of Patient Residence Niagara Burlington Brant Haldimand Norfolk HNHB LHIN Ontario Notes: The Complex Continuing Care hospitalization rate is agestandardized. This means it is adjusted for variations in population age distributions over time and place. Source: HNHB LHIN (2007/08 Complex Continuing Care, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH Ontario and 2007/08 average beds, Planning Decision Support Tool. Ministry of Health and Long-Term Care, Health Data Branch) -17- HNHB LHIN Clinical Services Plan

17 Age-specific resourcing levels for CCC and Rehab beds in the LHIN are comparable across planning ratios and provincial averages Number of Beds per Target Population Ratio Comparison of the Number of Beds Per Target Population HRSC Planning Ratio Provincial HNHB CCC Beds Total Rehab Beds The following age-specific population ratios identified by the HSRC were used for comparison: CCC: # of Beds per 1,000 population over 75 years Rehab: # of Beds per 100,000 population over 20 years Across these ratios, there is close alignment of HNHB LHIN bed availability to the provincial average and HSRC planning targets. Type of Bed as Identified by the MOHLTC Inpatient Complex Continuing Care Beds per 1,000 Population Over 75 Years (Including Palliative Beds) Inpatient Rehabilitation Beds (Medical / / Combined) per 100,000 Population Over 20 Years HRSC Planning Ratios 2007/2008YE Provincial Rate** HNHB Rate** (21 General Rehab + 4 Specialized Rehab) 24.6* 26.1 (19.7 General Rehab Specialized Rehab) Source: * Ministry of Finance Ontario Population Projections. ** Hospital Indicator Tool. Ministry of Health and Long Term Care HNHB LHIN Clinical Services Plan

18 Although LHIN-wide bed resourcing levels are comparable to targets, there is variability across the counties of the HNHB LHIN Comparison of the Number of Beds Per Target Population Number of Beds per Target Population Ratio CCC Beds General Rehab Beds Hamilton Niagara Speical Rehab Beds Burlington Brant Haldimand & Norfolk The following age-specific population ratios were used for comparison: CCC: # of Beds per 1,000 population over 75 years Rehab: # of Beds per 100,000 population over 20 years Specialized rehab beds in Hamilton county are a regional resource across the LHIN and beyond. Type of Bed as Identified by the MOHLTC Hamilton Niagara Burlington Brant Haldimand & Norfolk IP LTC - Complex Continuing Care (per 1,000 population over 75 years) General IP Rehabilitation (Medical / / Combined) (per 100,000 population over 20 years) Specialized IP Rehabilitation (Regional Resource) (per 100,000 population over 20 years) Source: * Ministry of Finance Ontario Population Projections. ** Hospital Indicator Tool. Ministry of Health and Long Term Care HNHB LHIN Clinical Services Plan

19 Mental Health and Addictions PAG -20- HNHB LHIN Clinical Services Plan

20 Designated inpatient mental health activity is forecast to grow 11% over the next 15 years Haldimand & Norfolk patients do not have access to designated inpatient mental health facilities within their county and must travel for these services. Length of stay varies across the LHIN hospitals for mental health admissions, with the highest LOS in Hamilton (where there are specialized tertiary beds) and the lowest in Niagara. When considering the county of patient residence, the ALOS is highest for Hamilton and Burlington. Although not shown in the table below, 7% of HNHB residents receive care at Homewood Health Centre in the Waterloo Wellington LHIN. Hospitalization rate for inpatient mental health varies across the LHIN, with the highest rates in Hamilton and Niagara (not age adjusted). County Mental Health PAG Service Utilization FY Activity by Hospital County Activity by Patient County Admissions ALOS Admissions ALOS Hospitalization Rate per 100,000 Hamilton 3, , Niagara 1, , Burlington Brant Haldimand & Norfolk TOTAL 6, , Source: OHMRS and DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

21 Top DSM categories for admission are similar across all 5 patient counties and account for more than 90% of cases HNHB Resident Designated Mental Health Inpatient Activity Overview by Patient County (FY ) Cases (% of Total Cases) Top DSMs Hamilton Niagara Burlington Brant Haldimand & Norfolk DSM 1 Mood Disorders 938 (42%) Mood Disorders 597 (35%) Mood Disorders 246 (56%) Mood Disorders 179 (55%) Mood Disorders 95 (53%) DSM 2 Schizophrenia and Psychotic Disorders 654 (29%) Schizophrenia and Psychotic Disorders 450 (26%) Schizophrenia and Psychotic Disorders 78 (18%) Schizophrenia and Psychotic Disorders 71 (22%) Schizophrenia and Psychotic Disorders 39 (22%) DSM 3 Substance Related Disorders 249 (11%) Substance Related Disorders 298 (18%) Substance Related Disorders 55 (13%) Substance Related Disorders 43 (13%) Substance Related Disorders 16 (9%) DSM 4 Personality Disorders 111 (5%) Anxiety Disorders 120 (7%) Cognitive Disorders 12 (3%) Impulse Control Disorders 17 (5%) Anxiety Disorders 9 (5%) DSM 5 Cognitive Disorders 87 (4%) Cognitive Disorders 70 (4%) Personality Disorders 11 (3%) N/A Adjustment Disorders 6 (3%) Total Cases 2,039 (92%) 1,535 (90%) 402 (92%) 310 (96%) 165 (92%) Total Cases Across Counties 4,451 (91%) Note: DSM names have been abbreviated from their original form. Categories with fewer than 5 cases are not reported. Source: OHMRS, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

22 Endocrine PAG -24- HNHB LHIN Clinical Services Plan

23 The Endocrine PAG accounts for 2% of the acute activity from the LHIN, with an overall higher rate of ALC days than the LHIN average Although endocrine volumes are a lower driver of inpatient activity within the LHIN, the majority of counties within the LHIN are experiencing relatively high rates of ALC days, except for Burlington and Brant which are below the LHIN average of 18%. The acuity for endocrine patients is highest for Hamilton as well as Haldimand & Norfolk residents, as measured by average RIW. Across LHIN residents, 91% of cases are primary or secondary while 9% are tertiary or quaternary. The Endocrine PAG has higher ALC rates than the LHIN average, with the highest rates in Haldimand & Norfolk, Niagara, and Hamilton. There is some variability in age-adjusted hospitalization rates with the highest in Brant and the lowest in Burlington. County Activity by Hospital County Separations Avg. RIW Endocrine PAG Service Utilization FY %ALC Cases Separations Avg. RIW Activity by Patient County % ALC Cases Hospitalization Rate per 100,000 Hamilton 1, % 255 1, % Niagara % % Burlington % % Brant % % Haldimand & Norfolk % % TOTAL 2, % 344 2, % Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

24 Across counties, similar CMGs are in the top 5, and account for 84% of inpatient activity for HNHB residents within the Endocrine PAG HNHB Resident Endocrine Inpatient Activity Overview by Patient County FY Cases (% of Total Cases) Top CMGs Hamilton Niagara Burlington Brant Haldimand & Norfolk CMG 1 (437) Diabetes 411 (40%) (437) Diabetes 452 (47%) (437) Diabetes 95 (40%) (437) Diabetes 182 (56%) (437) Diabetes 102 (44%) CMG 2 (436) Disorder Of Electrolyte Balance 198 (19%) (436) Disorder Of Electrolyte Balance 154 (16%) (436) Disorder Of Electrolyte Balance 40 (17%) (438) Dehydration 41 (13%) (438) Dehydration 36 (15%) CMG 3 (438) Dehydration 146 (14%) (438) Dehydration 125 (13%) (438) Dehydration 39 (16%) (436) Disorder Of Electrolyte Balance 35 (11%) (436) Disorder Of Electrolyte Balance 34 (15%) CMG 4 (435) Disorder Of Metabolism 54 (5%) (402) Diabetes With Foot Ulcer 41 (4%) (433) Disorder Related To Nutrition 13 (5%) (433) Disorder Related To Nutrition 19 ( 6%) (402) Diabetes With Foot Ulcer 15 (6%) CMG 5 (910) Unrelated Intervention 44 (4%) (440) Disease of Thyroid / Parathyroid 40 (4%) (440) Disease of Thyroid / Parathyroid 11 (5%) (402) Diabetes With Foot Ulcer 17 (5%) (435) Disorder Of Metabolism 13 (6%) Total Cases 853 (83%) 812 (84%) 198 (83%) 294 (91%) 200 (85%) Total Cases Across Counties 2,357 (84%) Note: CMG names have been abbreviated from their original form. Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

25 Otolaryngology (ENT) PAG -27- HNHB LHIN Clinical Services Plan

26 The ENT PAG accounts for 2% of the acute activity from the LHIN, and 6% of surgical day-night cases Acute volumes for the ENT PAG are a low driver of total inpatient activity for the LHIN. Acuity levels, measured by RIW are low across all areas except Hamilton hospitals where the average RIW is similar to the LHIN overall average RIW of 1.5. Across LHIN residents, 90% of cases are primary or secondary while 10% are tertiary or quaternary. The ENT PAG is experiencing ALC rates below the LHIN average, except in Haldimand & Norfolk where it is higher. There is some variability in age-adjusted hospitalization rates with the highest in Burlington and the lowest in Hamilton. County Activity by Hospital County Separations Avg. RIW ENT PAG Service Utilization FY %ALC Cases Separations Avg. RIW Activity by Patient County % ALC Cases Hospitalization Rate per 100,000 Hamilton 1, % 2, % 2, Niagara % 2, % 3, Burlington % 1, % 1, Brant % 1, % Haldimand & Norfolk % % TOTAL 2, % 8,207 2, % 8, Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

27 Similar CMGs are in the top 5 across counties and account for 53% of activity for HNHB residents within the ENT PAG HNHB Resident ENT Inpatient Activity Overview by Patient County FY Cases (% of Total Cases) Top CMGs Hamilton Niagara Burlington Brant Haldimand & Norfolk CMG 1 CMG 2 CMG 3 CMG 4 CMG 5 Total Cases (098) Dysequilibrium/ Hearing Loss 122 (14%) (086) Oral/Pharynx Intervention 113 (13%) (424) Thyroid/Parathyroid/ Thymus Intervention 86 (10%) (097) Acute Upper Respiratory Infection 85 (10%) (078) Musculoskeletal Intervention On Head 80 (9%) 486 (56%) Total Cases Across Counties (098) Dysequilibrium/ Hearing Loss 132 (17%) (424) Thyroid/Parathyroid/ Thymus Intervention 107 (13%) (103) Tonsillitis/Pharyngitis 59 (7%) (104) Croup 56 (7%) (086) Oral/Pharynx Intervention 51 (6%) 405 (51%) Note: CMG names have been abbreviated from their original form. (424) Thyroid/Parathyroid/ Thymus Intervention 39 (15%) (086) Oral/Pharynx Intervention 31 (12%) (078) Musculoskeletal Intervention On Head 25 (10%) (098) Dysequilibrium/ Hearing Loss 21 (8%) (103) Tonsillitis/Pharyngitis 20 (8%) 136 (53%) 1,271 (53%) Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO. (104) Croup 43 (15%) (086) Oral/Pharynx Intervention 33 (12%) (098) Dysequilibrium/ Hearing Loss 28 (10%) (424) Thyroid/Parathyroid/ Thymus Intervention 19 (7%) (103) Tonsillitis/Pharyngitis 18 (6%) 141 (51%) (098) Dysequilibrium/ Hearing Loss 31 (17%) (086) Oral/Pharynx Intervention 29 (16%) (078) Musculoskeletal Intervention On Head 18 (10%) (424) Thyroid/Parathyroid/ Thymus Intervention 16 (9%) (087) Nose/Nasal Intervention 9 (5%) 103 (57%) -29- HNHB LHIN Clinical Services Plan

28 GI / Hepatobiliary PAG -30- HNHB LHIN Clinical Services Plan

29 The GI / Hepatobiliary PAG accounts for 14% of the acute activity from the LHIN, and 27% of same-day surgery cases Acute volumes for the GI / Hepatobiliary PAG are a significant driver of overall inpatient activity for the LHIN. This PAG is the most significant driver of same-day surgery activity for the LHIN overall. Acuity levels, measured by RIW are highest for Burlington residents and lowest for Brant residents. Across LHIN residents, 90% of cases are primary or secondary while 10% are tertiary or quaternary. The GI / Hepatobiliary PAG is experiencing ALC rates below the LHIN average. Age-adjusted hospitalization rates are highest in Brant and Haldimand & Norfolk and lowest in Burlington. County GI / Hepatobiliary PAG Service Utilization FY Activity by Hospital County Separations Avg. RIW %ALC Cases Separations Avg. RIW Activity by Patient County % ALC Cases Hospitalization Rate per 100,000 Hamilton 7, % 16,209 6, % 13,928 1,076 Niagara 4, % 11,877 5, % 13,128 1,088 Burlington 1, % 4,655 1, % 4, Brant 1, % 3,264 1, % 3,670 1,204 Haldimand & Norfolk 1, % 2,721 1, % 3,065 1,203 TOTAL 16, % 38,726 17, % 38,779 1,062 Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

30 Across counties, similar CMGs are in the top 5, although only account for 38% of cases overall for the PAG (top 10 are 59%) HNHB Resident GI / Hepatobiliary Inpatient Activity Overview by Patient County FY Cases (% of Total Cases) Top CMGs Hamilton Niagara Burlington Brant Haldimand & Norfolk CMG 1 (257) Symptom Of Digestive System 694 (11%) (249) Enteritis 590 (10%) (257) Symptom Of Digestive System 169 (9%) (257) Symptom Of Digestive System 247 (14%) (257) Symptom Of Digestive System 177 (12%) CMG 2 CMG 3 CMG 4 CMG 5 (249) Enteritis 444 (7%) (255) Gastrointestinal Obstruction 363 (6%) ((256) Esophagitis/Gastritis Digestive Disease 342 (5%) (254) Gastrointestinal Hemorrhage 339 (5%) (257) Symptom Of Digestive System 532 (9%) (254) Gastrointestinal Hemorrhage 415 (7%) (228) Complex Hernia Repair 382 (7%) (256) Esophagitis/Gastritis Digestive Disease 264 (6%) (249) Enteritis 148 (8%) (234) Simple Appendectomy 125 (7%) (228) Complex Hernia Repair 125 (7%) (254) Gastrointestinal Hemorrhage 114 (6%) (249) Enteritis 212 (12%) (254) Gastrointestinal Hemorrhage 120 (7%) (256) Esophagitis/Gastritis Digestive Disease 117 (6%) (288) Disorder Of Biliary Tract 106 (6%) (249) Enteritis 115 (8%) (256) Esophagitis/Gastritis Digestive Disease 109 (8%) (254) Gastrointestinal Hemorrhage 83 (6%) (278) Laparoscopic Cholecystectomy 82 (6%) Total Cases 2,182 (34%) 2,283 (40%) 681 (37%) 802 (44%) 566 (40%) Total Cases Across Counties 6,514 (38%) Note: CMG names have been abbreviated from their original form. Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

31 Neurosciences PAG -33- HNHB LHIN Clinical Services Plan

32 The Neurosciences PAG accounts for 5% of the acute activity from HNHB LHIN residents Inpatient volumes for the Neurosciences PAG are projected to increase by 29% vs. the overall inpatient increase for LHIN residents of 26% over the next 15 years. Acuity, as measured by RIW, is higher for this PAG that the LHIN overall. Across counties, the acuity is highest in Hamilton and Haldimand & Norfolk. Across LHIN residents, 79% of cases are primary or secondary while 21% are tertiary or quaternary. ALC pressures are higher for this PAG than for the LHIN overall (28% ALC days vs. the LHIN average of 18%), although Burlington is lower (10%). Age-adjusted hospitalization rates are highest in Brant and Haldimand & Norfolk and lowest in Burlington. County Neurosciences PAG Service Utilization FY Activity by Hospital County Separations Avg. RIW % ALC Cases Separations Activity by Patient County Avg. RIW % ALC Cases Hospitalization Rate per 100,000 Hamilton 3, % 1,440 2, % 1, Niagara 1, % 365 1, % Burlington % % Brant % % Haldimand & Norfolk % % TOTAL 6, % 2,100 6, % 2, Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

33 Across counties, similar CMGs are in the top 5, and account for 47% of inpatient activity for HNHB residents within the Neurosciences PAG HNHB Resident Neurosciences Inpatient Activity Overview by Patient County FY Cases (% of Total Cases) Top CMGs Hamilton Niagara Burlington Brant Haldimand & Norfolk CMG 1 CMG 2 CMG 3 CMG 4 CMG 5 Total Cases (026) Ischemic Event Of CNS 384 (17%) (040) Seizure Disorder 284 (13%) (029) Transient Ischemic Attack 151 (7%) (028) Unspecified Stroke 144 (6%) (025) Hemorrhagic Event Of CNS 115 (5%) 1,078 (48%) (026) Ischemic Event Of CNS 327 (17%) (040) Seizure Disorder 201 (10%) (028) Unspecified Stroke 89 (14%) (040) Seizure Disorder 79 (13%) (026) Ischemic Event Of (028) Unspecified Stroke CNS 172 (9%) 52 (8%) (029) Transient Ischemic Attack 117 (6%) (025) Hemorrhagic Event Of CNS 112 (6%) 929 (47%) (029) Transient Ischemic Attack 43 (7%) (025) Hemorrhagic Event Of CNS 34 (5%) 297 (47%) (028) Unspecified Stroke(028) Unspecified Stroke 103 (16%) 56 (11%) (040) Seizure Disorder 82 (13%) (029) Transient Ischemic Attack 53 (8%) (026) Ischemic Event Of CNS 50 (8%) (025) Hemorrhagic Event Of CNS 34 (5%) 322 (49%) (026) Ischemic Event Of CNS 54 (10%) (040) Seizure Disorder 52 (10%) (029) Transient Ischemic Attack 40 (8%) (037) Other Dysfunction Of CNS 30 (6%) 232 (44%) Total Cases Across Counties 2,858 (47%) Note: CMG names have been abbreviated from their original form. Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

34 Oncology PAG -36- HNHB LHIN Clinical Services Plan

35 The Oncology PAG accounts for 4% of the acute activity from the LHIN and 8% of same-day surgery cases Same-day surgery volumes for the Oncology PAG are projected to increase by 38% for HNHB residents vs. the overall inpatient increase for the LHIN of 28% over the next 15 years. Acuity, as measured by RIW, is higher for this PAG that the LHIN overall. Across counties, the HNHB LHIN resident acuity is lowest in Niagara and Haldimand & Norfolk. Across LHIN residents, 79% of cases are primary or secondary while 21% are tertiary or quaternary. ALC pressures are lower for this PAG than for the LHIN overall (9% ALC days vs. the LHIN average of 18%). This is driven mostly by hospital results from Hamilton and Burlington. Age-adjusted hospitalization rates are similar for residents across all LHIN counties. County Activity by Hospital County Separations Avg. RIW Oncology PAG Service Utilization FY %ALC Cases Separations Activity by Patient County Avg. RIW % ALC Cases Hospitalization Rate per 100,000 Hamilton 2, % 5,769 1, % 4, Niagara % 3,731 1, % 4, Burlington % % 1, Brant % 1, % 1, Haldimand & Norfolk % % TOTAL 4, % 11,799 4, % 12, Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

36 Across counties, a range of CMGs are in the top 5, and account for 53% of inpatient activity for HNHB residents within the Oncology PAG HNHB Resident Oncology Inpatient Activity Overview by Patient County FY Cases (% of Total Cases) Top CMGs Hamilton Niagara Burlington Brant Haldimand & Norfolk CMG 1 (638) Chemotherapy/ Radiotherapy Session 210 (12%) (635) Other Anemia 261 (18%) (638) Chemotherapy/ Radiotherapy Session 61 (12%) (638) Chemotherapy/ Radiotherapy Session 72 (18%) (635) Other Anemia 90 (25%) CMG 2 (390) Other Breast Intervention 186 (11%) (633) Agranulocytosis 180 (13%) (635) Other Anemia 53 (10%) (635) Other Anemia 46 (11%) (390) Other Breast Intervention 35 (10%) CMG 3 (635) Other Anemia 173 (10%) (638) Chemotherapy/ Radiotherapy Session 146 (10%) (387) Total Excision Of Breast 51 (10%) (633) Agranulocytosis 38 (9%) (387) Total Excision Of Breast 35 (10%) CMG 4 (387) Total Excision Of Breast 143 (8%) (388) Partial Excision Breast 117 (8%) (390) Other Breast Intervention 40 (8%) (390) Other Breast Intervention 35 (9%) (112) Open Thoracic Lung Resection 35 (10%) CMG 5 (633) Agranulocytosis 130 (8%) (387) Total Excision Of Breast 88 (6%) (633) Agranulocytosis 38 (7%) (112) Open Thoracic Lung Resection 27 (7%) (388) Partial Excision Breast 27 (8%) Total Cases 842 (50%) 792 (56%) 243 (47%) 218 (53%) 222 (62%) Total Cases Across Counties 2,317 (53%) Note: CMG names have been abbreviated from their original form. Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

37 Ophthalmology PAG -39- HNHB LHIN Clinical Services Plan

38 The Ophthalmology PAG has limited inpatient activity but accounts for 13% of same-day surgery cases for HNHB LHIN patients Inpatient activity for the Ophthalmology PAG is limited, with relatively low acuity (measured by RIW) as compared to cases overall for the LHIN. Across LHIN residents, 92% of cases are primary or secondary while 8% are tertiary or quaternary. Ophthalmology is a significant driver of same-day surgery activity for the LHIN, and this activity is projected to increase by 42% in the next 15 years vs. an overall same-day surgery increase of 28% for the LHIN. Age-adjusted hospitalization rates are lower in Hamilton and Burlington than for other LHIN residents. County Ophthalmology PAG Service Utilization FY Activity by Hospital County Separations Avg. RIW %ALC Cases Separations Activity by Patient County Avg. RIW % ALC Cases Hospitalization Rate per 100,000 Hamilton % 7, % 6, Niagara % 5, % 6, Burlington % 2, % 2, Brant % 2, % 2, Haldimand & Norfolk 0 0 0% % 1, TOTAL % 18, % 19, Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

39 Across counties, the top 5 CMGs account for 85% of ophthalmology inpatient activity for residents of the HNHB LHIN HNHB Resident Ophthalmology Inpatient Activity Overview by Patient County FY Cases (% of Total Cases) Top CMGs Hamilton Niagara Burlington Brant Haldimand & Norfolk CMG 1 CMG 2 CMG 3 CMG 4 (063) Inflammation Of Orbit 19 (26%) (065) Other Ophthalmology Disorder 18 (24%) (064) Major Ophthalmology Disorder 10 (14%) (052) Vitrectomy 8 (11%) (052) Vitrectomy 34 (31%) (063) Inflammation Of Orbit 32 (29%) (065) Other Ophthalmology Disorder 13 (12%) (050) Orbit / Eyeball Intervention 7 (6%) (052) Vitrectomy 7 (33%) N/A (052) Vitrectomy 10 (29%) (063) Inflammation Of Orbit 6 (17%) (064) Major Ophthalmology Disorder 6 (17%) (050) Orbit / Eyeball Intervention 5 (14%) (052) Vitrectomy 11 (44%) CMG 5 (050) Orbit / Eyeball Intervention 7 (9%) (053) Extraocular Intervention 7 (6%) N/A Total Cases 62 (84%) 93 (84%) 18 (86%) 30 (86%) 23 (92%) Total Cases Across Counties 226 (85%) CMGs with fewer than 5 cases have not been reported Note: CMG names have been abbreviated from their original form. Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

40 Orthopaedics PAG -42- HNHB LHIN Clinical Services Plan

41 The Orthopaedics PAG accounts for 10% of inpatient and same-day surgical cases for the LHIN Inpatient activity from orthopaedics is expected to increase by 32% over the next 15 years vs. an overall increase of 26% for inpatient activity from HNHB LHIN residents. Acuity, as measured by RIW, is higher for this PAG than the LHIN overall (2.0 vs 1.5 average RIW). Average RIW is consistently high across counties. Across LHIN residents, 88% of cases are primary or secondary while 12% are tertiary or quaternary. ALC days vary across counties, with Niagara and Haldimand & Norfolk having the highest ALC rates. Age-adjusted hospitalization rates are highest in Haldimand & Norfolk and lowest in Burlington. County Orthopaedics PAG Service Utilization FY Activity by Hospital County Separations Avg. RIW % ALC Cases Separations Activity by Patient County Avg. RIW % ALC Cases Hospitalization Rate per 100,000 Hamilton 6, % 9,910 4, % 6, Niagara 3, % 2,609 4, % 3, Burlington 1, % 886 1, % 1, Brant 1, % 996 1, % 1, Haldimand & Norfolk % 125 1, % 1, TOTAL 12, % 14,526 12, % 14, Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

42 Across counties, the top 5 CMGs account for 48% of orthopaedic inpatient activity for HNHB residents HNHB Resident Orthopaedics Inpatient Activity Overview by Patient County FY Cases (% of Total Cases) Top CMGs Hamilton Niagara Burlington Brant Haldimand & Norfolk CMG 1 CMG 2 CMG 3 CMG 4 CMG 5 Total Cases (321) Unilateral Knee Replacement 944 (20%) (320) Unilateral Hip Replacement 478 (10%) (727) Fixation/Repair Hip/Femur 313 (6%) (739) Repair Upper Body/Limb Except Shoulder 300 (6%) (747) Repair Of Ankle/Foot 229 (5%) 2,264 (47%) (321) Unilateral Knee Replacement 772 (18%) (320) Unilateral Hip Replacement 439 (10%) (727) Fixation/Repair Hip/Femur 324 (8%) (747) Repair Of Ankle/Foot 242 (6%) (739) Repair Upper Body/Limb Except Shoulder 236 (6%) 2,013 (47%) (321) Unilateral Knee Replacement 321 (23%) (320) Unilateral Hip Replacement 216 (15%) (727) Fixation/Repair Hip/Femur 103 (7%) (739) Repair Upper Body/Limb Except Shoulder 76 (5%) (726) Hip Replacement With Complication 55 (4%) 771 (54%) (321) Unilateral Knee Replacement 272 (21%) (320) Unilateral Hip Replacement 147 (11%) (727) Fixation/Repair Hip/Femur 89 (7%) (313) Spinal Vertebrae Intervention 60 (5%) (739) Repair Upper Body/Limb Except Shoulder 56 (4%) 624 (48%) (321) Unilateral Knee Replacement 188 (18%) (320) Unilateral Hip Replacement 122 (12%) (727) Fixation/Repair Hip/Femur 58 (6%) (747) Repair Of Ankle/Foot 55 (5%) (739) Repair Upper Body/Limb Except Shoulder 46 (4%) 469 (45%) Total Cases Across Counties 6,141 (48%) Note: CMG names have been abbreviated from their original form. Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

43 Respiratory PAG -45- HNHB LHIN Clinical Services Plan

44 The Respiratory PAG accounts for 7% of inpatient activity for the LHIN Inpatient activity from respiratory is expected to increase by 33% over the next 15 years vs. an overall increase of 26% for inpatient activity throughout the LHIN. Acuity, as measured by RIW, is comparable for this PAG and the LHIN overall (1.6 vs. 1.5 average RIW). Average RIW is higher in Hamilton than in other counties. Across LHIN residents, 93% of cases are primary or secondary while 7% are tertiary or quaternary. ALC rates are similar for the respiratory PAG to the LHIN overall, although ALC rates are higher in Niagara and Haldimand & Norfolk and lower in Burlington. Age-adjusted hospitalization rates are significantly higher in Brant and lowest in Burlington. County Respiratory PAG Service Utilization FY Activity by Hospital County Separations Avg. RIW % ALC Cases Separations Activity by Patient County Avg. RIW % ALC Cases Hospitalization Rate per 100,000 Hamilton 3, % 354 3, % Niagara 2, % 119 2, % Burlington % % Brant 1, % 35 1, % Haldimand & Norfolk % % TOTAL 8, % 581 8, % Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

45 Across counties, similar CMGs are in the top 5, and account for 77% of inpatient activity for HNHB residents within the Respiratory PAG HNHB Resident Respiratory Inpatient Activity Overview by patient County FY Cases (% of Total Cases) Top CMGs Hamilton Niagara Burlington Brant Haldimand & Norfolk CMG 1 CMG 2 CMG 3 CMG 4 CMG 5 Total Cases (139) COPD 1,027 (32%) (138) Viral/Unspecified Pneumonia 774 (24%) (132) Malignant Neoplasm Of Respiratory System 254 (8%) (147) Asthma 210 (6%) (135) Aspiration Pneumonia 150 (5%) 2,415 (74%) (139) COPD 1,050 (37%) (138) Viral/Unspecified Pneumonia 580 (19%) (141) Upper/Lower Respiratory Infection 276 (9%) (147) Asthma 234 (8%) (132) Malignant Neoplasm Of Respiratory System 180 (6%) 2,320 (78%) (138) Viral/Unspecified Pneumonia 220 (29%) (139) COPD 198 (26%) (132) Malignant Neoplasm Of Respiratory System 72 (9%) (147) Asthma 59 (8%) (141) Upper/Lower Respiratory Infection 41 (5%) 590 (77%) (139) COPD 382 (34%) (138) Viral/Unspecified Pneumonia 254 (23%) (147) Asthma 105 (9%) (141) Upper/Lower Respiratory Infection 79 (7%) (200) Pulmonary Embolism 45 (4%) 865 (78%) (139) COPD 286 (37%) (138) Viral/Unspecified Pneumonia 221 (29%) (132) Malignant Neoplasm Of Respiratory System 47 (6%) (147) Asthma 40 (5%) (149) Symptom/Sign Of Respiratory System 26 (3%) 620 (81%) Total Cases Across Counties 6,810 (77%) Note: CMG names have been abbreviated from their original form. Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

46 Urology / Renal / CKD PAG -48- HNHB LHIN Clinical Services Plan

47 The Urology / Renal / CKD PAG accounts for 5% of inpatient activity, and 13% of same-day surgical cases Inpatient activity from urology / renal / CKD is expected to increase by 33% over the next 15 years vs. an overall increase of 26% for inpatient activity for HNHB LHIN residents. This PAG is also a significant driver of the same-day surgical cases within the LHIN. Of the reported same-day medical cases for the LHIN, this PAG is the most significant driver of activity with 52% of the total cases. Acuity for this PAG, as measured by RIW, is consistent with the LHIN average. Across LHIN residents, 91% of cases are primary or secondary while 9% are tertiary or quaternary. ALC rates are similar for the Urology / Renal / CKD PAG to the LHIN overall, although ALC rates are higher for Niagara and Brant residents and lowest for Burlington residents. County Urology / Renal / CKD PAG Service Utilization FY Activity by Hospital County Separations Avg. RIW %ALC Cases Separations Activity by Patient County Avg. RIW % ALC Cases Hospitalization Rate per 100,000 Hamilton 3, % 7,377 2, % 6, Niagara 1, % 7,031 2, % 7, Burlington % 1, % 1, Brant % 2, % 2, Haldimand & Norfolk % % 1, TOTAL 6, % 18,488 6, % 19, Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

48 Across counties, similar CMGs are in the top 5, and account for 58% of inpatient activity for the Urology / Renal / CKD PAG HNHB Resident Urology / Renal / CKD Inpatient Activity Overview by Patient County FY Cases (% of Total Cases) Top CMGs Hamilton Niagara Burlington Brant Haldimand & Norfolk CMG 1 CMG 2 CMG 3 CMG 4 CMG 5 Total Cases (487) Lower Urinary Tract Infection 410 (17%) (464) Partial Excision of Prostate 386 (16%) (477) Renal Failure 312 (13%) (456) Minor Intervention On Upper Urinary Tract, 169 (7%) (462) Radical Excision Of Prostate 150 (6%) 1,427 (58%) (487) Lower Urinary Tract Infection 432 (20%) (477) Renal Failure 291 (14%) (464) Partial Excision of Prostate 241 (11%) (456) Minor Intervention On Upper Urinary Tract, 144 (7%) (462) Radical Excision Of Prostate 135 (6%) 1,243 (59%) (487) Lower Urinary Tract Infection 102 (18%) (464) Partial Excision of Prostate 80 (14%) (462) Radical Excision Of Prostate 57 (10%) (477) Renal Failure 53 (9%) (459) Intervention On Lower Urinary Tract 35 (6%) 327 (58%) (487) Lower Urinary Tract Infection 116 (18%) (477) Renal Failure 78 (12%) (456) Minor Intervention On Upper Urinary Tract 70 (11%) (464) Partial Excision of Prostate 58 (9%) (488) Upper Urinary Tract Infection 47 (7%) 369 (58%) (464) Partial Excision of Prostate 75 (15%) (477) Renal Failure 72 (15%) (487) Lower Urinary Tract Infection 71 (15%) (462) Radical Excision Of Prostate 41 (8%) (456) Minor Intervention On Upper Urinary Tract 36 (7%) 295 (60%) Total Cases Across Counties (58%) Note: CMG names have been abbreviated from their original form. Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

49 Vascular PAG -51- HNHB LHIN Clinical Services Plan

50 The Vascular PAG accounts for 1% of inpatient activity and 2% of same-day surgical cases for the LHIN Although current inpatient activity is not a significant driver of overall activity for the LHIN, it is expected to increase by 40% over the next 15 years vs. an overall increase of 26% for inpatient activity for HNHB LHIN residents. Similarly, same-day surgical volumes are expected to increase by 33% for this PAG vs. 28% for the LHIN overall. The Vascular PAG has a significantly higher acuity, measured by RIW, than average for the LHIN with an average RIW of 3.0 vs. 1.5 for the LHIN. Across LHIN residents, 52% of cases are primary or secondary while 48% are tertiary or quaternary. Age-adjusted hospitalization rates are highest in Brant and Haldimand & Norfolk. County Activity by Hospital County Separations Avg. RIW Vascular PAG Service Utilization FY %ALC Cases* Separations Activity by Patient County Avg. RIW % ALC Cases* Hospitalization Rate per 100,000 Hamilton % 2, % 1, Niagara % % 1, Burlington % % Brant % % Haldimand & Norfolk % % TOTAL 1, % 2,881 1, % 2, *Ambulatory volumes are reported in both Cardiac and Vascular PAGs (MAC: Diseases and disorders of the circulatory system) Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

51 Across counties, similar CMGs are in the top 5, and account for 84% of inpatient activity for HNHB residents within the Vascular PAG HNHB Resident Vascular Inpatient Activity Overview by Patient County FY Cases (% of Total Cases) Top CMGs Hamilton Niagara Burlington Brant Haldimand & Norfolk CMG 1 (181) Abdominal Aorta Intervention 102 (27%) (181) Abdominal Aorta Intervention 97 (25%) (181) Abdominal Aorta Intervention 30 (26%) (181) Abdominal Aorta Intervention 28 (29%) (182) Bypass/Extraction Of Vein/Artery 15 (16%) CMG 2 (182) Bypass/Extraction Of Vein/Artery 80 (21%) (182) Bypass/Extraction Of Vein/Artery 85 (22%) (185) Other Vascular Intervention 28 (25%) (185) Other Vascular Intervention 15 (16%) (181) Abdominal Aorta Intervention 28 (29%) CMG 3 (185) Other Vascular Intervention 67 (18%) (185) Other Vascular Intervention 57 (15%) (012) Open Carotid Endarterectomy 16 (14%) (182) Bypass/Extraction Of Vein/Artery 15 (16%) (180) Amputation of Limb Except Hand/Foot 12 (14%) CMG 4 (012) Open Carotid Endarterectomy 40 (11%) (211) Deep Vein Thrombophlebitis 45 (11%) (182) Bypass/Extraction Of Vein/Artery 14 (12%) (211) Deep Vein Thrombophlebitis 13 (14%) (185) Other Vascular Intervention 28 (25%) CMG 5 (211) Deep Vein Thrombophlebitis 35 (9%) (012) Open Carotid Endarterectomy 43 (11%) (211) Deep Vein Thrombophlebitis 13 (11%) (012) Open Carotid Endarterectomy 9 (9%) (211) Deep Vein Thrombophlebitis 13 (14%) Total Cases 324 (86%) 327 (83%) 101 (89%) 80 (84%) 69 (79%) Total Cases Across Counties 901 (84%) Note: CMG names have been abbreviated from their original form. Source: DAD, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO HNHB LHIN Clinical Services Plan

52 Deloitte, one of Canada's leading professional services firms, provides audit, tax, consulting, and financial advisory services through more than 7,700 people in 57 offices. Deloitte operates in Québec as Samson Bélair/Deloitte & Touche s.e.n.c.r.l. Deloitte & Touche LLP, an Ontario Limited Liability Partnership, is the Canadian member firm of Deloitte Touche Tohmatsu. Deloitte refers to one or more of Deloitte Touche Tohmatsu, a Swiss Verein, and its network of member firms, each of which is a legally separate and independent entity. Please see for a detailed description of the legal structure of Deloitte Touche Tohmatsu and its member firms. Deloitte & Touche LLP and affiliated entities HNHB LHIN Clinical Services Plan