APPENDIX 1: THE FRAMEWORK FOR PLANNING... 3 APPENDIX 2: THE PROVINCIAL CONTEXT... 5 APPENDIX 3: PROFILE OF THE MISSISSAUGA HALTON LHIN...

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2 Table of Contents APPENDIX 1: THE FRAMEWORK FOR PLANNING... 3 APPENDIX 2: THE PROVINCIAL CONTEXT... 5 APPENDIX 3: PROFILE OF THE MISSISSAUGA HALTON LHIN... 7 APPENDIX 4: ENVIRONMENTAL SCAN OF THE MISSISSAUGA HALTON LHIN APPENDIX 5: COMMUNITY ENGAGEMENT STRATEGY APPENDIX 6: COMMUNITY ENGAGEMENT STAKEHOLDERS APPENDIX 7: IHSP PRIORITY DEVELOPMENT AND CONTEXT APPENDIX 9: BIBLIOGRAPHY Contact Information Telephone Address 700 Dorval Drive, Suite 500 Oakville ON L6K 3V3 . mississaugahalton@lhins.on.ca Website. mississaugahaltonlhin.on.ca 2

3 APPENDIX 1: THE FRAMEWORK FOR PLANNING The Integrated Health Service Plan (IHSP), as directed by the Local Health System Integration Act, must align with provincial health priorities and also reflect local priorities based in part on information obtained through community engagement. The LHIN CEOs, through their joint discussions, also identified pan-lhin priorities that were to be addressed at a local level by all LHINs over the next three years. In consideration of these requirements, the Mississauga Halton LHIN identified a threepronged approach for the development of its IHSP: 1. Provincial Direction Alignment 2. Environmental Scan 3. Community Engagement Ensuring alignment with the province s direction and LHIN system imperatives required a comprehensive review of several foundational documents including: Ontario s Action Plan for Health Care The Walker Report The Drummond Report Changing the Conversation: Defining Future System-Wide Leadership Imperatives for the Health Care System - LHIN CEO Think Tank Summary Report, April 17, 2012 The Ministry of Health and Long-Term Care, Health Analytics Branch supported a provincial LHIN Environmental Scan, developing a comprehensive review of the demographics and health resource utilization for each LHIN. This detailed report is included within these appendices. A report reflecting the data for all LHINs will also be made available on the LHIN s website. This environmental scan, along with a review of specific programs and services/initiatives funded by the Mississauga Halton LHIN over the past six years, helped guide the identification of key priority areas for the upcoming three years. In preparation for engaging the broader community on local health system priorities, the LHIN reflected on the common themes within the foundational documents and also highlighted areas for future focus considering the progress made within the LHIN during the course of the two prior IHSPs and the current state of our health care system. Also taken into consideration was the fact that we are now embarking upon a time of significant change within health care in the Province of Ontario that will require a new focus. Draft priority areas were identified for community consultation. These priorities were not specific to any one population or group, but were designed to address issues that were common across the continuum of health care services, irrespective of the client group. This approach was intended to foster ideas that helped to reduce the silos within health care and provide a more integrated systems approach to service delivery. It was expected that initiatives identified to address specific priority areas may, however, be specific to unique populations or service types. 3

4 The proposed priority areas for our initial community engagement were: 1. Right Care, provided at the Right Time, in the Right Place 2. Faster Access and Stronger Linkages with Family Health Care 3. Ensuring Health Care Transitions are smooth 4. Increasing Community Capacity 5. Keeping our Citizens Healthy The community engagement strategy implemented by the LHIN is noted within Appendix 5. Following community consultation and a comprehensive review of the literature that aligned with the draft priorities (noted in Appendix 8), draft priorities were developed for the IHSP. For these draft priorities, key goals and strategies to achieve these goals were also developed, to help provide a framework that would support achievement of our local priorities. Big dot measures of success were also identified. A second round of consultation was conducted with key stakeholders, including a task group of members from the Mississauga Halton LHIN Board. Following these consultation sessions and incorporating feedback received, the final Mississauga Halton Integrated Health Service Plan was written, along with this accompanying Appendices document. 4

5 APPENDIX 2: THE PROVINCIAL CONTEXT Between and , health sector funding increased at an average rate of 6.1 percent annually, for a total increase of $17.9 billion. A key driver of future health care costs in addition to general inflation and changes in technology and a factor in the sustainability of the system is the fact that the population of Ontario is getting older, and as people age, they require more health care. Specifically, in 10 years there will be 43 percent more seniors in the province than there are now and in 20 years there will be twice as many 1. Without changing how we deliver care in Ontario, in 20 years the health care system would cost $24 billion dollars more per year than we currently spend 2. In light of substantial fiscal pressures, the provincial government has stated, Funding for the health care system cannot continue to grow at past rates. The way we currently operate must change. In order to address these concerns, the Ministry has articulated the following priorities within its Action Plan for Health: 1. Keeping Ontario Healthy This priority focuses on keeping people healthy by supporting healthy habits and lifestyle changes. In addition to tackling childhood obesity, smoking and cancer screening, the province will continue to work on better management of chronic conditions. This priority will also mean a renewed emphasis on preventative and proactive care so chronic conditions are managed, reducing the number of hospitalizations a person will require, 1 Ontario s Action Plan for Health Care, p.7 2 Ontario s Action Plan for Health Care, p. 7 easing the strain in emergency rooms and inpatient beds across the province. LHINs across Ontario have been working with local providers on chronic disease prevention and management strategies for many years and a strong foundation is in place to build upon. 2. Faster Access and a Stronger Link to Family Health Care This priority identifies faster access to primary care, more ways to access family health care resources and the introduction of quality measures to family health care as a key component to have a fully integrated system. In , the rate for unplanned readmissions to hospital was 15 percent in Ontario, which the Ministry considers high compared to other jurisdictions. Reducing hospital readmissions, to which primary care can play a large role, will have an important effect on the sustainability of the health care system. 3. Right Care, Right Time, Right Place The Right Care means care informed by what the best scientific evidence and clinical guidelines have determined is the best care for you. It eliminates unnecessary procedures and tests, making resources available for those who need them most. The province and the LHINs will work with Health Quality Ontario to translate evidence into tools and guidelines that can help providers person-centred and evidence-based care into practice. 5

6 Care At the Right Time means having faster access to the care you need. This could mean telemedicine or supports to help you stay at home longer, in your community, close to your family and friends. Care In the Right Place addresses several serious issues in the health care system. One of the most pressing is the challenge of Alternate Level of Care (ALC) consumers, who are in hospital beds but would be best cared for in the community with support services to help maintain and improve their quality of life. Community care costs a fraction of what it costs to keep an individual in a hospital bed. In addition, the province is launching a Seniors Strategy, building on the successes of the Aging at Home program. The Seniors Strategy places renewed focus on keeping people from being unnecessarily admitted to hospital. To support the Action Plan s goal of providing more community-based care for seniors, the 2012 provincial budget will increase funding for home and community service by four percent annually over the next three years 3. The expansion of community-based care and the call to empower LHINs to shift resources to where the need is greatest will be based on local needs and plans developed throughout this IHSP Ontario Budget, page 28 System Imperatives To support the high-level priorities of the Minister s Action Plan, Ontario s LHINs have collectively identified several system imperatives. These imperatives will guide decisions LHINs make regarding the allocation of resources among providers and the programs and projects to be funded at the local level. Enhancing Access to Family Health Care will not only ensure people have timely access to a primary care provider but will also support the appropriate use of hospital and clinic resources. Enhancing Coordination and Transitions of Care for Targeted Populations focuses on key populations of high-needs consumers and those at risk of becoming high-needs consumer. The health care system will provide coordinated plans of care for these targeted populations to assist them to get the right care when and where they need it. Implementing Evidence-Based Practice to Drive Quality will support consistent coordinated responses to high-priority quality issues in the system. By reducing adverse events in all care settings (e.g. hospital, long-term care, community/home) Ontario s LHINs can build on the many quality initiatives currently implemented by health care providers. In partnership with Health 6

7 Quality Ontario and other key stakeholders, LHINs will work to develop coordinated plans to reduce adverse incidents that impact the quality of care and embrace best evidence-based decision making. Holding the Gains will help Ontario s LHINs make sound choices about local projects by ensuring that achievements made to date are not lost as new priorities are developed and they are moved forward. A challenge for all organizations that periodically refresh their strategic directions, LHINs must be sure to protect the many advances they have made in improving wait-times, value for money, transparency and accountability. Enhancing Access to Family Health Care Enhancing Coordination & Transistions of Care for Targeted Populations SYSTEM IMPERATIVES Implementing Evidence-Based Practice to Drive Quality Holding the Gains 7

8 APPENDIX 3: PROFILE OF THE MISSISSAUGA HALTON LHIN Population Characteristics The total Mississauga Halton LHIN area is subdivided into six sub LHIN planning areas, identified as Halton Hills, Milton, Northwest Mississauga, Oakville, Southwest Mississauga and South Etobicoke. Our population is the fifth largest amongst all LHINs, representing 8.8 percent of the total provincial population. Between 2006 and 2011, the Mississauga Halton LHIN population increased by 12 percent. The average rate of growth in the Province of Ontario for this same period was 5.6 percent. The population of our LHIN is predicted to continue to grow above the provincial average between now and By 2015, we will grow by a rate of 10.1 percent, by 2020 we will grow 21.5 percent, and by 2030, it is projected we will have grown by 45.8 percent. Analysis of total population distribution in 2010 identified that the greatest population is located in Northwest Mississauga (371,036) followed by Southeast Mississauga (362,560), Oakville (191,138), South Etobicoke (110,457), Halton Hills (63,572) and Milton (62,150). Residents of Mississauga Halton predominately live within large urban centers (87 percent) with only 1.7 percent living in small rural areas. 8

9 Persons Aged 65+ by Dissemination Area (DA) Waterloo Wellington LHIN Central West LHIN This map shows the number of persons aged 65 or older by Dissemination Area in the MH LHIN, as per the 2006 Census. Mississauga Halton LHIN Hamilton Niagara Haldimand Brant LHIN The DAs with the largest numbers of persons aged 65 or older are found in Mississauga and South Etobicoke, but there are pockets with large numbers of seniors throughout the MH LHIN. The population of seniors within the LHIN will grow substantially over the upcoming years. In 2010 there were 71,659 people aged 65 to 74 and 57,966 people aged 75 years or greater. By the year 2030, it is projected that the population of people aged 75 years and greater will reach 82,000. This represents an increase of percent from Distribution of seniors across the Mississauga Halton sub LHIN areas shows that the greatest density of seniors aged 75 years and greater is located in South Etobicoke (6.9%), Oakville (5.5%), Northwest and Southeast Mississauga (4.6% each), Halton Hills (4.5%) and Milton (3.8%). Projected Change in MH LHIN Population Year Total LHIN Population LHIN Population Age 75+ # % Growth from 2010 # % Growth from 2010 % of Population Age ,160,904-57, % ,278, % 69, % 5.5% ,410, % 86, % 6.1% ,693, % 139, % 8.2% Source: intellihealth, Population Projections LHIN. Accessed July 26,

10 Diversity Cultural diversity within the Mississauga Halton LHIN continues to grow. Based upon the 2006 Canadian Census results, a total of 43.2 percent of the population identified themselves as immigrants, the third greatest in the province compared to a provincial average of 28.3 percent. Of this total group, 8.4 percent were recent immigrants who had arrived within the Mississauga Halton LHIN area between 2001 and The Mississauga Halton region is home to approximately 18,540 people who identified their mother tongue as French (2006 census). Under the inclusive definition of Francophones adopted by the Office of Francophone Affairs in January 2010, the number of Francophone people within the LHIN increased to 35,730. The city of Mississauga is a designated community under the French Language Services Act (FLSA), which requires identified agencies to provide services in French when required. The LHIN continues to work with the Francophone community to increase access to services in French. A significant advance in this area has been the collaboration with a Family Health Team in Mississauga. One of two sites operated by the team is funded for dedicated service in French for Francophone families. The MH LHIN is one of the most diverse LHINs, with 36% of the population being a visible minority. 10

11 Within the Mississauga Halton community, 0.4 percent of the population or approximately 4,400 people self-identify themselves as Aboriginal. The greatest numbers of Aboriginal people live within the Halton Hills community. The Mississauga Halton LHIN has one of the smallest numbers of Aboriginal residents compared to other LHIN areas, primarily due to the fact that there is no First Nation reserve located within the LHIN boundaries. Knowing that the Mississauga Halton LHIN is a culturally diverse community, it is important that we recognize that the health status and behaviours relating to accessing health services differ across the population. For example, the immigrant population is more likely to have visited their family doctor at least once in the past year and more likely to have an annual flu shot than Canadian-born citizens. When considering health risk factors, the immigrant population reported significantly lower rates of heavy drinking, obesity and smoking although they reported higher rates of physical inactivity than Canadian-born citizens. Rates for chronic conditions such as diabetes, heart disease and hypertension are higher in the immigrant population than Canadian-born population. 11

12 The residents of the Mississauga Halton LHIN are relatively healthier and have a greater life expectancy when compared to people living in other areas of the province. Although we do have lower rates for the incidence of certain diseases such as ischaemic heart disease (lowest in the province); lung cancer (3 rd lowest); colon, rectal, lymph and blood related cancers (all 2 nd lowest in the province), they do affect a large number of our residents and their families and place demands upon our health care delivery system. Mississauga Halton LHIN Health Profile, June 2011 MH LHIN compares unfavourably to Ontario *Per 100,000 population Source: Statistics Canada Health Profile. Statistics Canada Catalogue no XWE. Ottawa. Released June 28,

13 Mississauga Halton LHIN Health Profile, June 2011 MH LHIN compares unfavourably to Ontario Source: Statistics Canada Health Profile. Statistics Canada Catalogue no XWE. Ottawa. Released June 28, Mississauga Halton LHIN Health Profile, June 2011 MH LHIN compares unfavourably to Ontario Source: Statistics Canada Health Profile. Statistics Canada Catalogue no XWE. Ottawa. Released June 28,

14 Health Service Utilization - Hospitals The demand for hospital acute care services continues to rise. Between 2006 and 2011, the number of people accessing hospital based care rose by four percent. While residents from other surrounding LHIN areas received 20.8 percent of acute care services in Mississauga Halton LHIN hospitals, 24.7 percent of the acute care services in hospitals outside of our LHIN were provided to Mississauga Halton LHIN residents. The Mississauga Halton LHIN has significantly reduced that number of consumers waiting for ALC while in hospital. Between September 2008 and April 2012, there was a 45 percent reduction in the total number of hospital based ALC individuals. Within the same period there was a 79 percent reduction in the number of ALC consumers waiting for placement in a long-term care home. The percentage of people accessing a long-term care home from hospitals in Mississauga Halton was lower than the provincial average. This is a direct result of the introduction of the Home First philosophy and increased community based services and home care services to support people with higher care needs in their own home. Although this represents a significant improvement, the needs of people waiting for ALC continue to be a concern and area requiring improvement to ensure the provision of the right care in the right place at the right time. Emergency department pressures continue to exist. Between 2006 and 2011 there was a 13.4 percent increase in the number of visits to Mississauga Halton LHIN hospital emergency departments. Although this increase is locally significant, it is the second lowest increase in the Province of Ontario. Of significant concern is the number of people with mental health and/or substance abuse issues accessing hospital emergency departments. Between 2006 and 2011, visits noting mental health or substance abuse as the main reason for the visit increased by 16.9 percent. Visits for other main reasons by people who also had mental health or substance abuse issues increased by 23.4 percent. 14

15 MH LHIN Emergency Room Utilization This graph illustrates the number of visits to an Emergency Department in the Mississauga Halton LHIN over the past four years by hospital site. Five of the six hospital sites in the MH LHIN saw an increase in the number of ED Visits in 2010/11 from 2009/10, which is reflective of the increase of total ED Visits in the MH LHIN (up to 344,732 in 2010/11 from 330,489 in 2009/10). The Credit Valley Hospital recorded the highest volume of ED Visits in 2010/11 for the Mississauga Halton LHIN. Source: NACRS, CIHI. Ambulatory All Visits Main Table. Health Service Utilization - Community The number of people receiving home care services provided by the Mississauga Halton Community Care Access Centre (MH CCAC) increased by 8.6 percent from 2006 to The most significant increase, 29.8 percent, was in clients aged 85 years and older. The second largest increase, 12.1 percent was in the age group of 75 to 84 years. The increase in clients over the age of 75 years was targeted through programs such as Stay at Home and Wait at Home that were designed to assist older people to remain living in their individual homes and delay or even prevent the need for long-term care home placement. Although there has been an increase in the number of CCAC clients over time, the rate of clients per 1000 population is the lowest in province. A focus on supporting individuals with high needs and utilizing the support of community support service agencies to assist people who do not require intensive CCAC services has influenced this lower client rate. Along with the increased focus on higher need seniors by the CCAC, Community Support Service (CSS) agencies also focused on individuals with increased need levels more than previous. This increased attention to seniors with higher levels of care was predominantly experienced by the adult day service, respite service, and service for daily living (SDL) agencies. The provision of enhanced services in the community has resulted in a decrease in the 15

16 number of people on the wait list for placement into a long-term care home. Mississauga Halton has the lowest rate of long-term care beds per 1000 people aged 75 years and greater. This low rate of beds has created a situation of having the third longest median wait time to placement in the province. Long-term care homes within the MH LHIN operated at 99.5 percent utilization in The provision of enhanced community services has also assisted to ensure that those people placed into a long-term care home have immediate need for the services provided. Long-term care homes have also seen an upward shift in the needs level of their clientele. The introduction of people with different and greater needs has required homes to increase the skill set and capacity of staff to support the clients being accepted. Additional supports provided through programs such as the nurse led outreach teams in long-term care and Behaviour Supports Ontario (BSO) have supported long-term care homes through this transition. These are all examples of how service providers in the Mississauga Halton LHIN are working together to ensure that people in our community receive the right services in the right place at the right time. Health Human Resources in the Mississauga Halton LHIN One of the main limitations in the development and delivery of additional amounts of service to meet the growing needs of our community is related to the availability of qualified people to deliver the services. Of primary concern for residents of Ontario and the Mississauga Halton LHIN is timely access to a family physician. In 2010 there were 893 family physicians and 716 specialist physicians in the community which represents a 10.6 percent increase from Mississauga Halton has the fourth lowest supply of family physicians for every 10,000 people. This rate has not changed significantly from the level in The availability of registered nurses in the Mississauga Halton LHIN is significantly lower than the average for the Province of Ontario. In 2010, the rate of registered nurses for every 100,000 people was 600 as compared to the provincial average of 953. The relatively low number of nursing staff has significant implications for both hospital and community based care. Nursing service represents the highest number of service visits of home care service provided by the MH CCAC. When comparing the availability of other selected health care professionals to the provincial levels, Mississauga Halton LHIN has lower availability for midwives, occupational therapists and optometrists. The Mississauga Halton LHIN has a higher availability of pharmacists as compared to the provincial average. 16

17 APPENDIX 4: ENVIRONMENTAL SCAN OF THE MISSISSAUGA HALTON LHIN This Environmental Scan was prepared for use by all Local Health Integration Networks (LHINs) as a key background paper for each LHIN s third Integrated Health Service Plan. This scan provides an overview of a number of key characteristics of local populations, services, utilization and health impacts. The document has not been designed for the general reader, but rather for providers, public organizations (both governmental and non-governmental) and health service providers. It presents both key characteristics of health and health care in each LHIN as well as a comparison to Ontario overall and to other LHINs. The development of a local Integrated Health Service Plan requires far more insight than can be provided by a scan of this nature. However, it was developed to help begin to set local priorities and activities and further discussions around them. As well, it was designed to support the development of measureable baselines to assess the impact of targeted change. The information presented in this scan was proposed by the LHINs collectively and the information prepared by members of the Health Analysis Branch of the Ontario Ministry of Health and Long-Term Care. For the first time, readers are able to understand the status of many important health system attributes and directly compare them. Demographics (Ministry of Finance estimates and projections) In 2011, the Mississauga Halton LHIN was home to 1,179,800 people, 8.8% of the population of Ontario. Between 2006 and 2011 the LHIN s population increased by 12%, the highest growth rate among LHINs in the province. In 2011, compared to other LHINs, Mississauga Halton had a relatively low proportion of seniors aged 65+ (11.3%). This has increased slightly from 10% since By 2016, seniors will account for 13.0% of the LHIN s population; by 2021, it will be 14.6%. Mississauga Halton is projected to have high population growth over the next 5-10 years. Between 2011 and 2016 the population is projected to increase by 121,800 residents (an additional 10.3%); by 2021 the population will have increased by 21.6% (compared to a projected increase of 13% for Ontario overall). Population characteristics (Census) In 2011, 87% of the population of the LHIN lived in a large urban population centre (100,000+), while only 1.7% lived in a rural area. In 2006, compared to Ontario, a smaller proportion of residents report English as their mother tongue (60% vs. 70% for Ontario) and 1.7% of the population include French as their mother tongue. 17

18 Population characteristics cont d In 2006, a large proportion of the population was immigrants (43.2%). Over 8% were recent immigrants, having arrived in Canada between 2001 and 2006 (higher than the Ontario rate of 4.8%). In 2006, 36.2% of the people living in the LHIN were visible minorities compared to 22.8% in Ontario overall. In 2006, educational attainment levels among LHIN residents of working age were high. Less than 10% of the population aged do not have a completed certificate, diploma or degree (the lowest rate in the province) and close to 70% of the working age population has a completed postsecondary education (the second highest rate provincially). The 2011, the unemployment rate was among the lowest in the province. In 2006, the proportion of those living in low-income was 13.3%; lower than the provincial rate of 14.7%. Socio-demographic characteristics, Mississauga Halton LHIN Mississauga Halton LHIN Ontario Comments Population, 2011 (MinFin)* 1,179,791 13,372,996 % population aged % 14.2% 2 nd lowest LHIN % population aged % 6.6% 2 nd lowest LHIN Population growth, past 5 years ( ) (MinFin) 12.0% 5.6% Highest LHIN Projected population, ,304,262 14,195,099 Projected population, ,438,419 15,067,531 % growth forecasted, % 6.2% 2 nd highest LHIN % growth forecasted, % 12.7% 2 nd highest LHIN % living in a rural area (2011) (Census) 1.7% 14.1% % living in a large urban centre (2011) (Census) 87.0% 69.3% 3 rd highest LHIN Socio-demographic characteristics (% population) English Mother Tongue 59.1% 69.8% French Mother Tongue 1.7% 4.4% No knowledge of English or French 2.6% 2.2% Immigrants 43.2% 28.3% 3 rd highest LHIN Recent immigrants ( ) 8.4% 4.8% 3 rd highest LHIN Visible minorities 36.2% 22.8% 3 rd highest LHIN Aboriginal Identity 0.4% 2.0% 2 nd lowest LHIN Labour force participation rate (aged 15+) 70.9% 67.1% 2 nd highest LHIN Unemployment rate, 2011 (aged 15+) 6.8% 7.8% 3 rd lowest LHIN Without certificate/degree/diploma (aged 25-64) 9.0% 13.5% Lowest LHIN Completed post-secondary education (aged 25-64) 68.8% 61.4% 2 nd highest LHIN Living in low-income 13.3% 14.7% *(MinFin) Ministry of Finance estimates and projections 18

19 Population Health A: Births, Life Expectancy, Deaths Births and Maternal Outcomes During FY 2009/10, there were 12,845 births to 12,650 women in Mississauga Halton LHIN hospitals. 63% of births were to women over the age of 30 (higher than the provincial proportion of 54.8%) and 9.8% were to women under the age of 25 (lower than the provincial average of 17%). The rate of smoking during pregnancy among women giving birth in the LHIN is among the lowest in the province while the rate of breastfeeding right after birth is among the highest. The rate of caesarean deliveries is lower than the provincial average. The percentage of newborns classified as small for gestational age is higher than the provincial average, whereas the percentage classified as large for gestational age is lower. The rate of pre-term births is among the lowest in the province. Births and Maternal Outcomes FY 2009/10 (unless otherwise noted) Indicator Mississauga Halton Ontario Total births in Mississauga Halton LHIN hospitals 12, ,775 Total births by Mississauga Halton LHIN residents 12, ,720 Number of women who gave birth in Mississauga Halton LHIN hospitals 12, ,221 Number of Mississauga Halton LHIN women who gave birth 12, ,169 % of women who smoked during their pregnancy 6% 12% % of mothers breastfeeding right after birth, % 88% Distribution of maternal age (%) < >= Rate of Caesarean delivery (%) Rate of pre-term birth less than 37 weeks (%) % births small for gestational age (%) % births large for gestational age (%)

20 Mortality & Potential Years of Life Lost (PYLL) Mississauga Halton residents have a higher life expectancy (at birth and at age 65) compared to Ontario overall. Crude mortality and PYLL rates are lower than the province. This may be because there is a lower percentage of elderly residents in the LHIN than in Ontario. Ischaemic heart disease and cancers (Lung, Breast, Colon, rectum, anus, lymph, and blood) are leading causes of death and PYLL. The top 10 leading causes of death account for 52% of deaths. Mortality and PYLL rates for many of the specific leading causes are the lowest or among the lowest in the province. Injury related deaths (Transport accidents, Intentional self-harm) are in the top 10 leading causes of PYLL. Together these account for 335 PYLL for every 100,000 residents (higher than the PYLL rate for Ischaemic heart disease, which is the leading cause). Life Expectancy, Mortality and Potential Years of Life Lost Mississauga Halton Ontario Comment Life expectancy at birth (yrs), 2007/ rd highest in province Life expectancy at age 65 (yrs), 2007/ Mortality (2007) 1 Total deaths, ,848 86,945 2 nd lowest in province All cause mortality rate per 100,000 population % of deaths that were premature (age <75) 39.7% 37.7% Top 10 leading causes of death, 2007 (rate per 100,000) Ischaemic heart disease Lowest in province Dementia and Alzheimer disease Cancer of lung & bronchus rd lowest in province Cerebrovascular diseases Lowest in province Cancer of colon, rectum, anus nd lowest in province Cancer of lymph, blood & related nd lowest in province Chronic lower respiratory diseases nd lowest in province 20

21 Mississauga Halton Ontario Comment Cancer of breast Influenza and pneumonia nd lowest in province Diabetes Lowest in province Age specific mortality rate, average Lowest in province Lowest in province nd lowest in province , , nd lowest in province 75+ 5, ,619.9 Potential Years of Life Lost (PYLL), 2007 PYLL rate, per 100,000 population , , nd lowest in province Top 10 Leading causes of PYLL (rates per 100,000 age 0-74) Ischaemic heart disease nd lowest in province Perinatal conditions Cancer of lung & bronchus rd lowest in province Intentional self harm Cancer of breast Congenital malformations, deformations, chromosomal Cancer of colon, rectum, anus nd lowest in province Cancer of lymph, blood & related nd lowest in province Transport accidents nd lowest in province Cirrhosis and other liver diseases nd lowest in province 1. Mortality/PYLL numbers and rates for Mississauga Halton may be under-estimated because 196 deaths of city of Mississauga residents and 1,202 deaths of city of Toronto residents could not be assigned to a LHIN area because of missing postal codes. 21

22 Population Health B: General Health & Risk Factors General Health Three out of five Mississauga Halton LHIN residents say they have very good or excellent health, and three out of four report very good or excellent mental health. This proportion decreases with age. Among those aged 75+ only 36% report very good/excellent health. Approximately 9% of LHIN residents say they usually experience moderate or severe pain/discomfort (lower than most other LHINs), and 26% say they experience activity limitations because of long-term physical or mental health problems. Not surprisingly, prevalence of pain/discomfort and activity limitation increases with age. 27% of residents report that most days were quite a bit or extremely stressful, the second highest prevalence among LHINs in the province. Risk Factors Approximately 17% of LHIN residents are smokers, 17% are heavy drinkers. Almost half the population (49%) is overweight or obese. Mississauga Halton has lower rates of smokers, heavy drinkers, and overweight/obesity than most other LHINs. Mississauga Halton LHIN residents are also more likely to consume 5+ servings of fruits/vegetables per day (i.e., the rate of inadequate fruit/vegetable consumption is the second lowest among LHINs and significantly lower than the provincial average). Approximately half the population is physically inactive (similar to provincial average). 91% of LHIN residents report having a regular medical doctor (same as the provincial average). 26% of LHIN residents received a flu shot in the past year; significantly lower than the provincial rate of 31%. However, the rate of flu shots is higher among the LHIN s seniors (60% among those aged 65-74, and 67% among those aged 75+). Over time, the proportion of residents getting a flu shot has declined. 22

23 General health, risk factor prevalence: Mississauga Halton LHIN % of population, aged 12+ Miss. Halton LHIN Ontario LHIN Rank (1-14) LHIN Trend over time Very good or excellent self perceived health (+) Very good or excellent self perceived mental health (+) Days that are quite a bit or extremely stressful (age 15+) (-) With moderate or severe pain/discomfort (-) With participation/activity limitations sometimes/often (-) Have a regular medical doctor (+) Received flu shot in the past year (+) unfavourable Risk Factors Are daily or occasional smokers (-) Are heavy drinkers (-) Are overweight or obese (aged 18+) (-) Are physically inactive (-) Consume < 5 servings of fruits/vegetables daily (-) LHIN result is significantly higher than Ontario. LHIN result is significantly lower than Ontario. Ranks: Low ranks (e.g., 1) is better 23

24 CHRONIC CONDITIONS: Prevalence, Mortality, Hospital Separations and Hospital Days of Stay for Selected Chronic Conditions 33% of Mississauga Halton residents (aged 12+) have a chronic condition and 12% have multiple conditions. The prevalence of arthritis (12%) and multiple chronic conditions (12%) is significantly lower in the Mississauga Halton LHIN as compared to the province, and ranks the lowest as compared to other LHINs. Prevalence of multiple chronic conditions increases dramatically with age; 45% of LHIN residents aged and 51% of those aged 75+ have two or more chronic conditions. Chronic conditions account for six out of 10 deaths, one out of five acute hospital separations, and one out of four acute hospital days for LHIN residents. Hospitalization rates for arthritis, diabetes, IHD and stroke are the lowest in Ontario. 14% of the population aged has heart disease. The prevalence increases to 20% among those aged 75+. The LHIN s mortality rate from diabetes and stroke is decreasing and ranks the lowest in Ontario. Cancer mortality rates are also the second lowest in Ontario. The rates of hospitalization for arthritis, asthma, cancer and IHD have been decreasing over the period of 2005/06 to 2010/11. Heart disease (including ischemic heart disease (IHD) and congestive heart failure (CHF) and stroke account for 11% of all hospital days and 7% of all acute care separations for LHIN residents. However the LHIN s mortality and hospitalization rates for these conditions (as well as all other chronic conditions except asthma) are lower than provincial rates. 24

25 Condition MISSISSAUGA HALTON Ontario Comment Trend Prevalence (2009&2010), rate per 100, aged 12+ Arthritis (aged 14+) Lowest - Asthma Cancer NA COPD (aged 35+) Decreasing Diabetes Increasing High blood pressure Increasing Heart disease NA Suffer from effects of stroke NA Have a chronic condition rd lowest NA Have multiple chronic conditions Lowest NA Diabetes prevalence, aged 18+ (BDDI) NA LHIN result is significantly higher than Ontario. LHIN result is significantly lower than Ontario. High sampling variability-estimate must be used with caution Mortality rate per 100,000 Hosp separation rate per 100,000 Hosp days rate per 100,000 LHIN Trends Condition MH LHIN Ontario MH LHIN Ontario MH LHIN Ontario Mortality Seps Days Arthritis Decreasing Asthma Decreasing Decreasing Cancer Decreasing Decreasing CHF Increasing COPD Decreasing Diabetes Decreasing Hypertension Increasing Decreasing IHD Decreasing Decreasing Decreasing Stroke Decreasing 25

26 Current utilization projections by LHIN of Patient Residence based on Population Demographics to FY 2015/16 Population change and aging Mississauga Halton LHIN s population is expected to increase 10.1% over the next five years, substantially greater than Ontario overall (6.2%). By 2015, its population will be just over 1,278,000 people, compared to 1,160,000 in Of all LHINs, the Mississauga Halton LHIN will have the third largest percentage population growth, after Central and Central West. Despite high growth, it is expected that the population aged 65 and older in the LHIN will have increased by a proportion slightly less than that of the province overall (1.7% versus 1.8%). Projected utilization, FY 2015/16 In percentage terms, all sectors included in this analysis will likely have higher growth than the province overall. All sectors will have growth above 10% over five years. As with many LHINs (and the province overall), the highest percentage change is likely to be in those sectors associated with aging such as long-term care and complex continuing care. However, Mississauga Halton LHIN s population is notable because of potentially higher percentage change in some high-volume sectors such as acute care separation and total days and emergency department visits. Mississauga Halton actual (FY 2010/11) and projected (FY 2015/16) utilization, by sector Sector Measure FY 2010/11 (Actual) FY 2015/16 (Projected) Change % change Acute Separations 79,416 92,081 12, % Total days 424, ,643 80, % Ambulatory oncology and renal dialysis clinics Visits 89, ,003 18, % Emergency departments Visits 321, ,473 39, % Day surgery and cardiac catheterization Visits 91, ,255 14, % Complex continuing care Active cases 1,725 2, % Days 164, ,425 37, % Long-term care Active cases 7,032 8,941 1, % Days 1,677,446 2,090, , % Mental health Active cases 2,948 3, % Rehabilitation Admissions 2,614 3, % Home care Active clients 42,652 50,694 8, % 26

27 ANALYSIS OF ACUTE CARE UTILIZATION There were 64,062 acute separations, 322,522 acute days, and 360,498 total days from Mississauga Halton LHIN hospitals in FY 2010/11. Separations and total days increased between FY 2006/07 and FY 2010/11, while acute days remained stable. ALC separations and ALC days both increased by 47% for Mississauga Halton hospitals over the same period. The average total and acute lengths of stay and the average RIW were lower in Mississauga Halton LHIN hospitals compared to Ontario. Residents of other LHINs accounted for 20.8% of the acute separations from Mississauga Halton LHIN hospitals in FY 2010/11. The percentage of ALC days in Mississauga Halton hospitals was the second lowest in the province in FY 2010/ % of ALC days from Mississauga Halton LHIN hospitals were discharged to LTC, which was smaller than the corresponding proportion for Ontario hospitals (34.8%). Compared with the province, greater proportions of ALC discharges from Mississauga Halton LHIN hospitals went to CCC and rehabilitation. Mississauga Halton LHIN residents had the lowest acute separation rate in the province. Compared with the province, LHIN residents had lower acute separation rates for all age groups. 24.7% of separations by Mississauga Halton LHIN residents were from hospitals outside the LHIN in FY 2010/11. ALC separations and ALC days for Mississauga Halton LHIN residents increased by 54.6% and 57.4%, respectively between FY 2006/07 and FY 2010/11. Mississauga Halton LHIN hospitals had the largest proportion of acute days in the province for two CMGs: 545-Vaginal delivery, no other intervention, and 026-Ischemic event of central nervous system. 27

28 Acute care hospital utilization, Mississauga Halton LHIN, 2010/11 Indicator Mississauga Halton LHIN Ontario % change LHIN, 2006/07 to 2010/11 LHIN of hospital Acute separations 64, , Total days 360,498 6,276, Average total LOS Acute days 322,522 5,230, Average acute LOS Average RIW % Inflow acute separations 20.8 ALC separations 2,987 54, ALC days 37,976 1,046, Average ALC LOS % ALC days (of total days) Proportion of total ALC days by discharge destination: Home without support Home with support Long-term care Complex continuing care Rehabilitation Another facility Deceased LHIN of patient Acute separations 67, , Acute separations/1,000 population Age-specific acute separation rates/1,000 population Total days 394,075 6,218, Average total LOS Acute days 350,645 5,174, Average acute LOS Average RIW % Outflow acute separations 24.7 ALC separations 3,272 54, ALC days 43, Average ALC LOS LHIN of patient results for Ontario exclude out-of-province residents Includes acute and ambulatory facilities 28

29 Acute care days by top 10 CMGs, by Mississauga Halton LHIN hospitals, FY 2010/11 Mississauga Halton LHIN Ontario Comment Case Mix Group+ # % # % (545) Vaginal Delivery, No Other Intervention 12, , Largest % in province (196) Heart Failure Without Coronary Angiogram 9, , (138) Viral/Unspecified Pneumonia 8, , (810) Palliative Care 8, , (139) Chronic Obstructive Pulmonary Disease 7, , (026) Ischemic Event Of Central Nervous System 7, , Largest % in province (321) Unilateral Knee Replacement 5, , (537) Primary Caesarean Section 5, , (487) Lower Urinary Tract Infection 5, , Not in provincial top 10 (654) Other/Unspecified Septicemia 3, , Not in provincial top 10 All Other CMGs 248, ,163, Total 322, ,230, Emergency Department Utilization In FY 2010/11, there were 344,732 ED visits to Mississauga Halton LHIN hospitals and 13.4% of these visits were by residents of other LHINs. Between FY 2006/07 and FY 2010/11 there was 13.4% growth in ED visits to Mississauga Halton LHIN hospitals compared to 6.4% growth for Ontario. From FY 2006/07 to FY 2010/11 in Mississauga Halton LHIN hospitals, the number of visits in all triage levels increased with growth of 15.1% for CTAS IV & V, 8.6% for CTAS III, and 21.7% for CTAS I & II. In Ontario hospitals over the same time period, CTAS IV & V visits decreased by 10.3%. Among all LHINs, Mississauga Halton LHIN hospitals had the second largest proportion of ED visits in CTAS I & II and the third lowest proportion of CTAS IV & V visits in FY 2010/11. The 90 th percentile EDLOS was slightly longer in Mississauga Halton LHIN hospitals (8.9 days) compared to Ontario hospitals (8.2 day) sin FY 2010/11. There were 322,511 ED visits by Mississauga Halton LHIN residents in FY 2010/11, and 15.1% of these visits occurred in other LHINs. Between FY 2006/07 and FY 2010/11, 29

30 there was 13.1% growth in ED visits, and 2.6% growth in the ED visit rate for LHIN residents. Mississauga Halton LHIN residents had the second lowest ED visit rate in the province in FY 2010/11. ED visit rates for residents were much lower than the provincial average for all age groups. In FY 2010/11, Mississauga Halton LHIN residents had the second largest proportion of CTAS I & II visits in the province. Among all LHINs, Mississauga Halton LHIN resident had the third lowest rate of ED visits best treated in alternative primary care settings, much lower than the provincial rate in FY 2010/11 (7.3 versus 23.3). Among all LHINs, Mississauga Halton LHIN hospitals had the smallest proportion of ED visits for examination and other health factors and the largest proportion for kidney and genitourinary tract diseases. 30

31 Unscheduled emergency department visit utilization, Mississauga Halton LHIN, FY 2010 / 2011 Indicator Mississauga Halton LHIN Ontario % change LHIN, FY 2006/07-FY 2010/11 LHIN of hospital Visits 344,732 5,582, # visits by CTAS level I & II (resuscitation/emergent) 74, , III (urgent) 152,598 2,301, IV & V (less urgent/non urgent) 116,985 2,387, % visits by CTAS level I & II (resuscitation/emergent) III (urgent) IV & V (less urgent/non urgent) th percentile EDLOS (hours) % Inflow visits 20.6 LHIN of patient Visits 322,511 5,488, ED visit rate/1,000 population Age-specific ED visit rates/1,000 population 0-19 years years years years years # visits by CTAS level I & II (resuscitation/emergent) 71, , III (urgent) 146,162 2,267, IV & V (less urgent/non urgent) 104,188 2,339, % visits by CTAS level I & II (resuscitation/emergent) III (urgent) IV & V (less urgent/non urgent) % Outflow visits 15.1 ED visits best treated in alternative primary care settings /1,000 population age 1-74, age-standardized LHIN of patient results for Ontario exclude out-of-province residents Includes visits with missing/unknown CTAS level

32 Unscheduled emergency department visits by top 10 Major Ambulatory Clusters, Mississauga Halton LHIN hospitals, FY 2010 / 2011 Mississauga Halton LHIN Ontario Comment Major Ambulatory Cluster (MAC) # % # % (21) Trauma, coma and toxic effects 80, ,112, (06) Diseases and disorders of the digestive system 44, , (05) Diseases and disorders of the circulatory system 29, , (09) Diseases and disorders of the skin and subcutaneous tissue and breast 26, , (03) Diseases and disorders of the ear, nose, mouth and throat 24, , (11) Diseases and disorders of kidney and genitourinary tract 22, , Largest % in province (08) Diseases and disorders of the musculoskeletal system and connective tissue 20, , (01) Diseases and disorders of the nervous system 20, , (04) Diseases and disorders of the respiratory system 19, , (20) Examination and other health factors 12, , Smallest % in province All other MACs 43, , Total 344, ,582,

33 Analysis of Day Surgery and Cardiac Catheterization Visits In FY 2010/11, there were 85,516 day surgery and ambulatory cardiac catheterization visits to Mississauga Halton LHIN hospitals. Residents of other LHINs accounted for 24.0% of the visits in FY 2010/11. Between FY 2006/07 and FY 2010/11, there was 10.3% growth in Mississauga Halton LHIN hospital day surgery and cardiac catheterization visits. There were 91,059 day surgery and ambulatory cardiac catheterization visits for Mississauga Halton LHIN residents, and 28.6% of these visits occurred in hospitals outside the LHIN. There was growth in the number of visits for LHIN residents over the period, but a decrease in the visit rate. This indicates that the increase in visits was less than the rate of population growth during the period. The day surgery visit rate for Mississauga Halton LHIN residents was less than the provincial average. The day surgery visit rate was highest for residents aged 75 and older. The Mississauga Halton LHIN rate for this age group was comparable to the provincial average, while rates were lower than the province for all other age groups. Day surgery and ambulatory cardiac catheterization visits, Mississauga Halton LHIN and Ontario, FY 2010/11 Indicator Mississauga Halton LHIN Ontario % Change FY 2006/07-FY 2010/11 LHIN of hospital Visits 85,516 1,238, % Inflow 24.0 LHIN of patient Visits 91,059 1,230, % Outflow 28.6 Visits per Age Specific Visits per 1,000 population 0-19 years years years years years

34 Analysis of Inpatient Rehabilitation Utilization Adult Inpatient Rehabilitation In FY 2010/11, there were 2,434 admissions to inpatient rehabilitation units in Mississauga Halton LHIN hospitals and residents of other LHINs accounted for 16.8% of these admissions. Between FY 2006/07 and FY 2010/11 admissions to Mississauga Halton LHIN hospital rehabilitation units decreased by 2.5%. In FY 2010/11, there were 2,614 inpatient rehabilitation admissions for Mississauga Halton LHIN residents, and nearly 23% were treated in hospitals outside the LHIN. While the number of admissions increased 3.1% for LHIN residents between FY 2006/07 and FY 2010/11, the admission rate declined by 16.4%. The inpatient rehabilitation admission rate for Mississauga Halton LHIN residents was higher than the provincial average. Residents aged 85 and older had the highest rehabilitation admission rate. Compared with the province, Mississauga Halton LHIN residents had lower admission rates for those aged 18 to 64 years and had higher rates for residents aged 65 and older. Mississauga Halton LHIN had the highest admission rates in the province for residents aged 75 and older. Adult inpatient rehabilitation admissions, Mississauga Halton LHIN and Ontario, FY 2010/11 Indicator Mississauga Halton LHIN Ontario % change FY 2006/07-FY 2010/11 LHIN of hospital General admissions 2,434 26, Special admissions 3,403 Total admissions 2,434 29, % Inflow 16.8 LHIN of patient Total admissions 2,614 29, % Outflow 22.5 Admissions per 100,000 aged Age-specific admissions per 100, years years years years 2, , years 4, ,

35 Analysis of Mental Health Indicators Mental Health and Substance Abuse Emergency Department Visits In FY 2010/11, there were 9,677 unscheduled ED visits for Mississauga Halton residents where the main problem was a MH/SA condition. There were 11,988 visits in total or 2,311 additional visits with a MH/SA condition in any of the diagnostic fields. Between FY 2006/07 and FY 2010/11, there was 16.9% growth in visits with a MH/SA main problem diagnosis and 23.4% growth in visits with a MH/SA condition in any diagnostic field. Mississauga Halton LHIN residents had the lowest MH/SA ED visit rates in the province. The main problem visit rate increased by 6.1% over the period, while there was 12.0% growth in the any problem visit rate, between FY 2006/07 and FY 2010/11. Visits with a MH/SA main problem diagnosis accounted for 3.0% of all ED visits for Mississauga Halton LHIN residents. The ED visit rates for MH/SA conditions were highest for residents aged years. The MH/SA ED visit rates for Mississauga Halton LHIN residents were lower than the provincial average for all age groups. Unscheduled emergency department utilization for mental health and substance abuse conditions, Mississauga Halton LHIN and Ontario Residents, FY 2010/11 Indicator Mississauga Halton LHIN Ontario % change FY 2006/07-FY 2010/11 LHIN of patient Main problem visits 9, , % of total ED visits Any problem visits 11, , % of total ED visits Main problem, visits per 1, Any problem, visits per 1, Main problem, age-specific visit rates per 1,000 Age

36 Utilization of Adult Designated Mental Health Beds In FY 2010/11, there were 2,490 admissions to and 2,615 active cases that received treatment in adult designated mental health units in Mississauga Halton LHIN hospitals. There were 2,466 discharges from these units with a total length of stay of 37,879 days. The average length of stay in Mississauga Halton LHIN mental health units was 15.4 days compared to 31.2 days for Ontario. Residents from other LHINs accounted for 21.8% of the active cases treated in Mississauga Halton LHIN. Active cases, admissions, discharges, and days increased for Mississauga Halton LHIN hospitals between FY 2006/07 and FY 2010/11. Mood disorders (41.7%) and schizophrenia and psychotic disorders (33.8%) accounted for the largest proportions of active cases in Mississauga Halton LHIN hospitals in FY 2010/11. Compared with the provincial average, Mississauga Halton had smaller proportions of active cases for mood disorders and substance related disorders and larger proportions of active cases for cognitive disorders and all other conditions. There were 2,949 active cases, 2,770 admissions, and 2,765 discharges for Mississauga Halton LHIN residents from Ontario adult designated mental health units. Approximately 27% of Mississauga Halton LHIN resident active cases received treatment in hospitals outside the LHIN. Compared with the provincial average, Mississauga Halton LHIN residents had lower rates of active cases, admissions, discharges, and total days per 100,000. While the number of active cases, admissions, discharges, and total days for Mississauga Halton LHIN residents increased between FY 2006/07 and FY 2010/11, the active case, admission and discharge rates for residents declined. Compared with the province, Mississauga Halton LHIN residents had lower rates of active cases for all age groups. 36

37 Adult designated mental health unit utilization, Mississauga Halton LHIN hospitals and residents, FY 2010/11 Indicator Mississauga Halton LHIN Ontario % change FY 2006/07-FY 2010/11 LHIN of hospital Active cases 2,615 58, Admissions 2,490 53, Discharges 2,466 53, Total Days 37,879 1,677, Average Length of Stay % Inflow Active Cases 21.8 % of Active Cases by SCIPP Group Schizophrenia & Psychotic Disorders Cognitive Disorders Mood Disorders Personality Disorders Substance Related Disorders All other LHIN of patient Active cases 2,949 55, Admissions 2,770 51, Discharges 2,765 51, Total Days 57,135 1,623, Average Length of Stay % Outflow Active Cases 27.2 Active Cases per 100, Admission per 100, Discharges per 100, Total days per 100,000 6, , Age-Specific Active Case Rates per 100,

38 CIHI Mental Health Indicators The following indicators were taken from the CIHI Health Indicators 2012 edition. The CIHI analysis uses different selection criteria and data sources; therefore, results may differ from those shown in the utilization of adult designated mental health units section. In FY 2010/11, the rates of mental illness hospitalizations and patient days for Mississauga Halton LHIN residents were significantly lower than those for the province. Mississauga Halton LHIN had the lowest rate of self-injury hospitalizations in the province in FY 2010/11. Mental Health Indicators, Mississauga Halton LHIN, FY 2010/11 Indicator Mississauga Halton LHIN Ontario Mental illness hospitalizations (rate per 100,000, 15+) Mental illness patient days (rate per 10,000, 15+) Patients with repeat hospitalizations for mental illness, (%, 15+) day readmission for mental illness (%, 15+) Self-injury hospitalizations (rate per 100,000, 15+) With the exception of patients with repeat hospitalizations for mental illness, which is for FY 2009/10. Wait Time for Community Services In FY 2011/12, vocational/employment programs and ACT teams had the longest median wait times among the community MH services in Mississauga Halton LHIN. The median wait times for Mississauga Halton ACT teams, case management, counselling/treatment, early intervention, and vocational programs were greater than the medians for Ontario. Among the SA services provided in Mississauga Halton LHIN, residential treatment and case management had the longest median wait times in FY 2011/12. The median wait time in the LHIN was longer than that for the province for case management, community treatment, initial assessment/ treatment planning, and residential treatment. For problem gambling services provided in Mississauga Halton LHIN, initial assessment and community treatment had median wait times of four days each. 38

39 Median wait time to next available treatment slot for community mental health, substance abuse and problem gambling services by service type, Mississauga Halton LHIN service providers, FY 2010/ FY 2011/2012 Mississauga Halton LHIN Ontario Service Type Community Mental Health Services FY 2010/11 FY 2011/12 FY 2010/11 FY 2011/12 Abuse Service 0 2 Assertive Community Treatment Team Case Management Counselling and Treatment Diversion and Court Support Early Intervention Short-Term Crisis Support Beds Support Within Housing Vocational/Employment Substance Abuse Services Case Management Community Day/Evening Treatment 1 5 Community Medical/Psychiatric Treatment Community Treatment Community Withdrawal Management Level Community Withdrawal Management Level Initial Assessment/Treatment Planning Residential Medical/Psychiatric Treatment Residential Supportive Level Residential Supportive Level Residential Treatment Problem Gambling Services Community Day/Evening Treatment Community Treatment Initial Assessment/Treatment Planning Public Awareness 1 1 Residential Treatment

40 ANALYSIS OF COMPLEX CONTINUING CARE (CCC) UTILIZATION Complex Continuing Care In FY 2010/11, there were 1,625 CCC active cases treated in Mississauga Halton LHIN hospitals. Residents of other LHINs accounted for 11.8% of these active cases. Mississauga Halton LHIN hospital active cases increased by 24.9% between FY 2006/07 and FY 2010/11. In FY 2010/11, there were 1,725 CCC active cases for Mississauga Halton LHIN residents, and nearly 17% were treated in hospitals outside the LHIN. There was substantial growth in both the number and rate of active cases for LHIN residents over the period. Mississauga Halton LHIN residents CCC active case rate was lower than the provincial average. The active case rate was highest for residents aged 90 and older. The CCC rates for Mississauga Halton LHIN residents were higher than the provincial average for those aged 85 and older, but were lower than the province for the younger age groups. Table: Complex continuing care active cases, Mississauga Halton LHIN and Ontario, FY 2010/11 Indicator Mississauga Halton LHIN Ontario % change FY 2006/07-FY 2010/11 LHIN of hospital Active cases 1,625 28, % Inflow 11.8 LHIN of patient Active cases 1,725 28, % Outflow 16.9 Active cases per 100,000 population Age specific active cases per 100,000 population 0-64 years years years 1, , years 1, , years 3, , years 5, ,

41 HOME CARE UTILIZATION Active Home Care Clients In FY 2010/11, there were 42,652 active home care clients in the Mississauga Halton LHIN. Compared to all LHINs, Mississauga Halton had the lowest rate of home clients, at 36.7 home care clients per 1,000 population.* The rate per 1,000 population of active home care clients in the LHIN, however, increased slightly by 1.2% between FY 2007/08 and FY 2010/11. The number of home care clients in the LHIN increased by 8.6% between FY 2007/08 and FY 2010/11. The largest increase was seen in clients aged 85 and older (29.8% increase) followed by those aged (12.1% increase). Compared to Ontario, the rates of active clients per 1,000 population were lower in the Mississauga Halton LHIN for all age groups. * CCAC Services by Type In the Mississauga Halton LHIN, there were 516,879 home care visits and 1,671,158 home care service hours provided in FY 2010/11. Nursing visits accounted for the largest number of home care visits and combined personal support work and homemaking hours accounted for the largest number of home care hours in the LHIN. The rate per 1,000 population of home care service visits (445.2) was the second lowest in the province and the rate of home care service hours (1,439.5) was the third lowest in the province in Mississauga Halton LHIN in FY 2010/11. Mississauga Halton LHIN had the lowest rates per 1,000 population for nutrition and dietetic visits, speech language therapy visits, and social work visits in Ontario. It also had the second lowest rate per 1,000 population for nursing visits in the province in FY 2010/11. 41

42 Home Care Clients and Services in Mississauga Halton, FY 2010/11 Indicator Mississauga Halton Ontario Number of Active Clients % change LHIN, FY 2007/08 to FY 2010/11 All ages 42, , % <=18 6,116 92, % ,682 53, % , , % , , % , , % >=85 8, , % Rate of Active Clients per 1,000 Population All ages % <= >= Number of Visits All Visits 516,879 8,563,029 Nursing Visit 359,202 5,701,931 Respiratory Services 123 Nutrition and Dietetic 1,437 45,249 Physiotherapy 28, ,841 Occupational Therapy 31, ,130 Speech Language Therapy 10, ,645 Social Work 1,309 51,783 Psychology 339 Case Management 83,958 1,622,364 Placement Services 6,624 Number of Hours All Hours 1,671,158 22,361,396 Nursing Shift Hours 102,202 1,617,524 Personal Support Work (PSW) 10,285 1,744,611 Homemaking (HM) Hours 74,686 Combined PSW & HM Hours 1,543,068 18,632,255 Respite Hours 15, ,320 42

43 Indicator Mississauga Halton Ontario Rate of Service Visits per 1,000 Population All Visits Nursing Visit Respiratory Services Nutrition and Dietetic Physiotherapy Occupational Therapy Speech Language Therapy Social Work Psychology 0.03 Case Management Placement Services 0.5 % change LHIN, FY 2007/08 to FY 2010/11 Rate of Service Hours per 1,000 Population All Hours 1, ,692.7 Nursing Shift Hours Personal Support Work (PSW) Homemaking (HM) Hours 5.7 Combined PSW & HM Hours 1, ,410.4 Respite Hours *The rate of visits noted does not reflect on the level of intensity of service provided; MH LHIN visits are provided at a higher level of intensity, but lower frequency level 43

44 Long-Term Care: Supply, Demand, and Time to Placement Mississauga Halton LHIN has the lowest LTC bed supply rate and the second lowest rate of LTC residents. Additionally, the rate of clients waitlisted is lower than the provincial average. Therefore, the demand rate for LTC beds is the lowest in the province. Although the rate of waitlisted clients is relatively low, the LHIN has the third highest overall median time to placement (TTP) and the highest TTP for clients from the community. For clients from acute care, the median TTP has increased steadily from 24 days in 2006/07 to 64 days in 2011/12. LTC supply, residents, waitlist and demand (number and rate per 1,000 population aged 75+); Median TTP placement, Dec 31, 2011 LTC Bed Supply Mississauga Halton Ontario Comments (for LHIN) # Rate 1 # Rate Long stay beds, including interim 4,103 76,769 Short stay respite & convalescent care Total beds in operation 4, , Lowest 2 LTC residents 4, , nd lowest LTC beds waitlist 1, , LTC demand (residents + waitlist) 5, , Lowest Median time to LTC Placement (in days) Overall rd highest From Acute Care only From Community Highest 1 Rate per 1,000 population aged In Ontario; in comparison to other LHIN areas Primary Care Groups and Enrolment Health Care Connection (HCC) Registrations & Referrals (All and Complex/Vulnerable Patients) 834,200 Mississauga Halton LHIN residents (71% of eligible residents) are enrolled with a primary care enrolment model (PEM). This is an increase of 2% over the past year. 589 physicians in the LHIN are part of a primary care group. There are 46 primary care groups in the LHIN. The Health Care Connect Program began in February Between February 44

45 2009 and April 2012, approximately 4,250 LHIN residents have registered with the program and 89% have been referred to a family health care provider. In the past year (2011/12), there were almost 2,000 registrations and 81% of them (1,600) were referred. Approximately 6% of those registered with HCC are categorized as complex vulnerable. In 2011/12 there were 127 complex vulnerable people who registered with HCC (6%) and 97% of them (123) were referred to a family health care provider. HEALTH CARE SYSTEM AND PATIENT SATISFACTION Health Care System Satisfaction Almost 70% of residents in the Mississauga Halton LHIN believe that the quality of care in the province is excellent or good. Mississauga Halton LHIN residents reported the highest levels of excellent or good availability of care in their community (76.4%). 80% rated the quality of care in their community as excellent or good. 45

46 Patient Satisfaction with Health Care Services Among those who had received some kind of health care services in the past year, just under 90% rated the quality of that care as excellent or good. The LHIN had the lowest proportion of residents who reported that the quality of care received from a hospital was excellent or good (76.9%). Among those who had received hospital care in the past year, the Mississauga Halton LHIN had the lowest proportion of residents who reported being very or somewhat satisfied with the care provided. Mississauga Ontario Halton LHIN Health care system satisfaction Availability of care in the province Excellent/Good 69.7% 67.2% Quality of care in the province Excellent/Good 78.1% 75.4% Availability of care in the community Excellent/Good 76.4% 66.4% Quality of care in the community Excellent/Good 80.0% 75.4% Patient Satisfaction with Health Care Services Quality of care received - Excellent/Good 89.7% 88.4% Patient satisfaction with care provided - Very/Somewhat satisfied 87.9% 88.1% Quality of hospital care received - Excellent/Good 76.9% 83.9% Patient satisfaction with hospital care provided - Very/Somewhat satisfied 76.6% 83.3% Quality of physician care received - Excellent/Good 91.3% 91.2% Patient satisfaction with physician care provided - Very/Somewhat satisfied 89.2% 91.2% Significantly lower than Ontario Significantly higher than Ontario 46

47 Human Resources Physicians From 2006 to 2010, the total number of physicians in Mississauga Halton LHIN increased by 10.6% from 1,455 to 1,609. Over the same period, Mississauga Halton population grew at a similar rate (10.2%). The total number of physician to population rate remains relatively unchanged at physicians per 100,000 population in 2006 and in The number of family physicians to population rate in Mississauga Halton was slightly lower than the province in 2010, but had much less specialists per 100,000 population. Nurses increased by 12.3% reaching 6,966 from 6,203 while the nurse to population rate increased from nurses per 100,000 population to Compared to the province, Mississauga Halton had much lower RNs, RPNs, and NPs rates per 100,000 population in The number of NPs in Mississauga Halton increased by five-fold (437.5%) between 2006 (8) to 2010 (43). Regulated health professionals In 2009, Mississauga Halton had less midwives and occupational therapists per 100,000 population than the province, but similar rates in the other regulated health professions. From 2006 to 2010, the total number of nurses in Mississauga Halton Physicians, nurses and regulated health professionals, 2009 and 2010: MH LHIN Mississauga Halton LHIN, 2010 # Professionals Rate per 100,000 population, 2010 LHIN % change Mississauga Halton LHIN Ontario Family physicians % Specialists % Total physicians 1, % Registered Nurses (RNs in general class) 5, % Registered Practical Nurses (RPNs) 1, % Nurse Practitioners (NPs = RNs in extended class) % Total Nurses 6, % Selected professions: # Professionals, 2009 Rate per 100,000 population, 2009 Midwife Occupational Therapist Optician Optometrist Pharmacist Notes: Audiologist and speech-language pathologist data were not available by LHIN in Psychologist and dentist data in 2009 were not reported due to issues with LHIN assignment, with more than 50% of data reported in the unknown LHIN category. 47

48 APPENDIX 5: COMMUNITY ENGAGEMENT STRATEGY Community feedback and input on local needs and priorities was solicited to help define the LHIN s priorities and respective strategies or action plans to be articulated within the IHSP. Consultation was conducted on the following five themes: 1. Right Care, provided at the Right Time, in the Right Place 2. Faster Access and Stronger Linkages with Family Health Care 3. Ensuring Health Care Transitions are Smooth 4. Increasing Community Capacity 5. Keeping our Citizens Healthy Reach Out and Touch Campaign Echoing the community engagement slogan, our team reached out to the Mississauga Halton community through a variety of engagement forums and received considerable input on the five proposed health care priorities as well as feedback in general on the local health care system. Over a nine week period from May to July 2012, the Mississauga Halton LHIN connected with stakeholders using seven different approaches: 21 presentations about the IHSP were delivered to existing committees which the LHIN chairs or participates in, inviting feedback through the online survey 14 focus group sessions were held within existing committees which the LHIN chairs or participates in 44 focus groups were held within community based organizations or groups 5 community forums throughout the MH LHIN were held, open to the general public Television spot on Aging in Peel inviting feedback Online and paper based survey Friends and family social media campaign inviting feedback through the online survey 48