Mid-West Local Collaborative Priority Area: Kensington Chinatown, Focus on Low Urgency ED Visits

Mid-West Local Collaborative Priority Area: Kensington Chinatown, Focus on Low Urgency ED Visits Preliminary Results April 27, 2017

Contents 1. Kensington Chinatown map, background and methodology/considerations/limitations for this deep dive analysis 2. Key Highlights and Summary of Findings 3. Emergency Department use for residents focused on Low Urgency Visits 4. ED visits by Kensington Chinatown Residents to UHN Western and TGH Sites 5. Patient Journey for Residents with Low Urgency ED Visits who were admitted and had CCAC referral 6. Early Childhood Development Indicator Results 7. Acute Inpatient Discharges for residents of Kensington Chinatown 8. Health Service Providers serving Kensington Chinatown residents 9. Appendix A & B 2

Mid West Sub-Region - Kensington Chinatown Neighbourhood 3

Kensington Chinatown Background Information Highest rate of : persons living below low income measure (after-tax) (39.3%) people with no knowledge of English/French (17%) visible minorities (in private households) (62.1%) lone parent families with children (47.1%) Top three languages spoken at home other than English: Cantonese, Mandarin, Chinese n.o.s 4 Homeless shelters (1 Youth, 1 Women and 2 Co-ed, Total beds: 246 beds) Kensington-Chinatown experienced high growth from 2011 to 2015. High rates of ED use for low urgency for all ages, ages 0-4 and 65-74 (FY15/16) High % Low Continuity Among Ages 19+ (Enrolled and Not Enrolled) (25.3%) Comments from Providers There is a strong opportunity to build on locally tailored services such as immigration partnerships, indigenous support, and Chinese community supports and outreach 4

Methodology and Limitations of Analysis Several Data Sources were used for this analysis: 1. Toronto Central LHIN utilization data on emergency department visits (NACRS) with a focus on low urgency visits (CTAS IV Less Urgent and CTAS V Non-Urgent) for 2015/16. This data was based on identifying the number of ED visits from the postal codes in the Kensington Chinatown neighbourhood. 2. Discharge Abstract Database (DAD) for 2015/16. This data was based on identifying the number of discharges from the postal codes in the Kensington Chinatown neighbourhood Data for the above two sources are broken down by Age Groups and Gender where applicable 3. Custom request data of Low Urgency Visit data from UHN for patients from Kensington Chinatown who had low urgency visits to UHN Western and TGH sites in 2015/16. These were also broken down by those with frequent visits (5+) 4. Community Business Intelligence (CBI) data (2016) has been used to identify a small group of top HSPs in a neighbourhood, A list of top HSPs that serve 50% of the clients in a given neighbourhood is provided (this gives the top 4 to 6 CMHA HSPs and the top 1 or 2 CSS HSPs). However, it should be noted that most HSPs are serving small numbers in each neighbourhood, so this is just a fraction of the total HSPs involved in the neighbourhood. 5. Integrated Decision Support (IDS) was used to explore the patient journey Kensington Chinatown residents with Low Urgency ED Visits who were admitted and had CCAC referrals in 2015/16. IDS Measures Definitions can be found in Appendix B 5

Kensington Chinatown Key Highlights and Summary of Findings ED Visits overall There were a total of 7,511 Emergency Department (ED) visits for residents of Kensington-Chinatown during FY2015-16 Of those, 2,111 (28%) were Low Urgency ED Visits (CTAS IV-V) Of those 1,994 were visits for patients who had a valid health card number. There were a total of 1,490 unique patients. 117 visits were for patients who did not have a valid health card number Low urgency visits decreased with increasing age; nearly half of all ED visits for children 0-19 were low urgency compared to only 11% for seniors 75 years and over Females ages 20-44 had the highest number of low urgency ED visits in FY 2015/16 followed by males ages 20-44 Patients ages 20-44 who visited the ED for non-urgent conditions had the lowest rate of attachment to primary care with only 66% having a family physician while the 65-74 group had the highest (92%) Proportion of visits coming in evening/early night decreased with increasing age: one third of visits for children 0-19 were during this period compared to only 18% for seniors 75 and over Nearly 20% of the low urgency visits were repeat visits One-third of visits were for injury and poisoning, followed by 13% for symptoms and signs Most common hospital visited was UHN-Western site (35%) followed by Sinai Health System (31%) The majority of patients (93%) were discharged home with no supports 6

Kensington Chinatown Key Highlights and Summary of Findings continued ED visits to UHN Western and Toronto General Hospital Majority of residents and high users from Kensington-Chinatown visited Toronto Western Hospital compared to Toronto General Hospital, with most visits being by residents aged 20-64 years A large majority of residents with low urgency visits speak English, followed by Chinese. However, among the high users, the second most common language was Korean. Many of the presenting complaints for low urgency visits can be addressed in a primary care setting: Top 3 presenting complaints for high frequency low urgency visits to UHN by Kensington-Chinatown residents were 1) minor complaints NOS (14%), 2) lower extremity pain (13%) and 3) prescription/medication request (11%) Acute Inpatient Discharges There were a total of 1296 discharges for residents of Kensington-Chinatown during FY2015-16. 95% of these discharges were for patients with a valid health card number Overall there was a higher proportion of females (57%) with most discharges being for patients aged 75+ (29 %) followed by 20-44 age group (25%). Residents ages 45-64 represent 20%. There were 974 Unique individuals from Kensington Chinatown discharged from a hospital bed during 2015/16. Of the 50 who had 3 or more discharges, the number of discharges ranged from 3 to 10. The majority of patients presenting at ED for low urgency visits were unknown to CCAC (i.e. not receiving home care services) 7

Emergency Department Visits NACRS FY2014-15 to FY2015-16 Overall Low Urgency CTAS IV Less Urgent CTAS V Non Urgent 8

ED Visits for Kensington-Chinatown residents by Age Group and Gender, FY 2015/16 Percent of ED Visits by Age Group and Urgency, FY 2015/16 Number of ED Visits by Age Group and Gender, FY 2015/16 75+ 89% 11% 75+ 367 561 65-74 273 392 65-74 76% 24% Age Group 45-64 848 959 Age Group 45-64 76% 24% 20-44 1309 1931 20-44 69% 31% 0-19 486 419 0-19 53% 47% 0 500 1000 1500 2000 2500 3000 3500 ED Visits Male Female Females in age group 20-44 have the highest number of ED Visits in FY 2015-16, representing 26% of all ED Visits in Kensington Chinatown Males in age group 20-44 have the second highest number of ED Visits 15-16, representing 17% of all ED Visits in Kensington Chinatown Among adults, females had the highest proportion of ED visits In the children 0-19 category this was the opposite 0% 20% 40% 60% 80% 100% Percentage (%) High Urgency (CTAS I-III) Low Urgency (CTAS IV&V) The age group 75+ has the highest proportion of high urgency ED Visits (CTAS I,II &III) in FY 2015-16 Children 0-19 had the highest proportion of the low urgency ED Visits (CTAS IV & V). Nearly half of all ED visits in that age group was low urgency compared to only 11% in the older seniors 75+ Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 9

Low Urgency (CTAS IV-V) Emergency Department Visits National Ambulatory Care Reporting System (NACRS), FY2015-16 10

Summary of ED Visits for Kensington-Chinatown residents by Age Group and Gender FY 2015/16 All ED Visits (CTAS I-V) Age Group # of Males # of Females % of Males % of Females 0-19 486 419 15% 10% 20-44 1309 1931 40% 45% 45-64 848 959 26% 23% 65-74 273 392 8% 9% 75+ 367 561 11% 13% Total 3282 4262 43% 56% 7,511 Total ED Visits 2,111 Total Low Urgency ED Visits Low Urgency (CTAS IV-V) ED Visits # of Visits % of Visits # of Unique Individuals Population (2011) Rate of Visits per 1,000 Population Age Group Males Females Total Males Females Males Females Total Males Females Males Females 0-19 235 185 420 56% 44% 140 167 307 1265 1240 186 149 20-44 459 545 1004 46% 54% 368 337 705 4920 4550 93 120 45-64 179 250 429 42% 58% 166 125 291 1905 2080 94 120 65-74 48 109 157 31% 69% 64 40 104 450 635 107 171 75+ 46 55 101 46% 54% 46 37 83 605 885 76 62 Total 1144 967 2111 54% 46% 784 706 1490 9145 9390 125 103 11

Low Urgency (CTAS IV-V) ED Visits for Kensington-Chinatown residents by Age Group and Gender FY 2015/16 Number of Low Urgency ED Visits by Age Group and Gender, FY 2015/16 Percent of Low Urgency ED Visits by Age Group and Gender, FY 2015/16 4675+ 55 75+ 46% 54% Age Group 179 48 65-74 45-64 109 250 Age Group 65-74 45-64 31% 42% 69% 58% 459 20-44 545 20-44 46% 54% 235 0-19 185 0-19 56% 44% 600 400 200 0 200 400 600 ED Visits MALE FEMALE 0% 20% 40% 60% 80% 100% Percentage (%) MALE FEMALE Females ages 20-44 had the highest number of low urgency ED visits in FY 2015/16 followed by males ages 20-44 Among adults, females had the highest proportion of Low Urgency ED visits. This was the reverse for Children 0-19 Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 12

Percentage (%) Low Urgency ED Visits (CTAS IV-V) for Kensington-Chinatown residents and Primary Care Provider by Age Group, FY 2015-16 Attachment to Primary Care of residents with Low Urgency ED Visits by Age Group, FY 2015/16 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 81% 10% 66% 27% 78% 16% 9% 7% 5% 92% 6% 79% 18% 2% 2% Age Group 0-19 20-44 45-64 65-74 75+ Age Group FAMILY PHYSICIAN NONE OTHER (E.G. FAMILY HEALTH TEAM, WALK-IN CLINIC) UNKNOWN/UNAVAILABLE (INCLUDES DOA; UNCONSCIOUS PATIENTS) Patients ages 20-44 who visited the ED for non-urgent conditions had the lowest rate of attachment to primary care with only 66% having a family physician The 65-74 age group had the highest proportion of having a physician Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 13

Day of Week/Time of Day for Low Urgency ED Visits for Kensington- Chinatown residents by Age Group, FY 2015-16 Age Group Sunday Monday Tuesday Wednesday Thursday Friday Saturday Grand Total Percent (%) 0-19 17% 13% 13% 12% 13% 16% 16% 420 100% 20-44 15% 16% 14% 14% 13% 13% 15% 1004 100% 45-64 12% 18% 13% 14% 16% 14% 13% 429 100% 65-74 13% 17% 10% 16% 12% 11% 20% 157 100% 75+ 16% 18% 10% 15% 20% 12% 10% 101 100% Grand Total 314 335 281 295 289 286 311 2111 Age Group 15% 16% 13% 14% 14% 14% 15% 100% Morning (6:00-11:59) Afternoon 12:00-17:59 Evening/Early Night 18:00-23:59 Late Night (0:00-5:59) Total # of Visits Percent (%) 0-19 21% 38% 33% 7% 420 100% 20-44 22% 34% 31% 14% 1004 100% 45-64 26% 33% 25% 16% 429 100% 65-74 29% 41% 19% 11% 157 100% 75+ 35% 43% 18% 5% 101 100% Total # of Visits 502 750 600 259 2111 Percent (%) 24% 36% 28% 12% 100% Overall Low urgency ED Visits occurred most on Monday s followed by Sunday and Saturday. The majority of visits took place in the afternoon and evening/early night. The 0-19 and 20-44age groups had the highest proportion of Low Urgency ED Visits in evenings and early night. Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 14

Disposition Status for Low Urgency ED Visits for Kensington- Chinatown residents, All Ages, FY 2015-16 Client Triaged But Left Without Being Seen (Patient Registered) or Client Triaged, Registered and Assessed But Left Before Treatment Completed, 6% Client Admitted As Inpatient to Other Units in Reporting Facility and, 1% Discharged Home (Private Dwelling Only, No Support Services), 93% N=2111 Most Low Urgency ED visits were discharged home (93%) and only 1% were admitted as expected. Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 15

Low Urgency ED Visits for Kensington-Chinatown residents by Hospital and LHIN of Visit, All Ages, FY 2015-16 Top 8 Hospitals for Emergency Department Visits by Kensington-Chinatown Residents (FY 2015/16) UNIVERSITY HEALTH NETWORK- WESTERN SITE, 33% OTHER, 6% SINAI HEALTH SYSTEM-MOUNT SINAI SITE, 30% TRILLIUM HEALTH PARTNERS- QUEENSWAY HLTH, 1% HOSPITAL FOR SICK CHILDREN (THE), 14% ST JOSEPH'S HEALTH CENTRE, 2% CENTRE FOR ADDICTION&MENTAL HLTH, 3% UNIVERSITY HEALTH NETWORK- GENERAL SITE, 5% ST MICHAEL'S HOSPITAL, 6% LHIN of Hospital Visit # of ED Visits % of Total Visits TORONTO CENTRAL 1989 94.2% CENTRAL 36 1.7% MISSISSAUGA HALTON 19 1.0% CENTRAL EAST 19 1.0% NORTH SIMCOE MUSKOKA 11 0.5% HAMILTON NIAGARA HALDIMAND BRANT (HNHB) 7 0.3% SOUTH WEST 6 0.3% SOUTH EAST 8 0.4% CHAMPLAIN 5 0.2% Other LHINs 11 0.4 % Grand Total 2111 100.0% Majority (63%) of Kensington-Chinatown residents visited UHN (Western Site) (33%) and Sinai Health System (30%) for nonurgent reasons. 14% of the residents visited Hospital for Sick Children Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 16

Top 10 reasons of low urgency ED Visits for Kensington-Chinatown Residents, All Ages, FY 2015-16 35% 33% 30% 25% 20% 15% 13% 10% 5% 4% 5% 5% 6% 6% 6% 7% 9% 0% One third of all low urgency ED visits were due to injury & poisoning & certain other consequences of external causes. 13% were due to symptoms, signs & abnormal clinical & lab. findings nec *See Appendix A for list of related conditions for the top 3 reasons for visits Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 17

Frequency of Low Urgency ED Visits for Kensington-Chinatown Residents by Age Group, FY 2015-16 90% 80% 70% 60% 78% Frequency of Low Urgency ED Visits by Unique Patients, FY 2015-16 82% 81% 80% 84% Percentage (%) 50% 40% 30% 20% 10% 0% 17% 13% 12% 14% 11% 5% 7% 5% 6% 5% 0-19 20-44 45-64 65-74 75+ 1 Visit 2 Visits 3+ Visits A large majority of patients across all age groups only visited the ED once for non-urgent reasons The proportion of individuals with 3 or more visits ranged from 5% - 7% Overall 81 patients had 3 or more non-urgent ED visits, ranging from 3 to 22 in 2015/16 Majority of patients were females (59%) and in the 20-44 age group (44%) Majority of the repeat ED visits were for diagnosis category: Injury & Poisoning & Certain other consequences external causes Factors Influencing Health Status & Contacts with Health Services Mental and Behavioral Disorders Symptoms, Signs & Abnormal Clinical & Lab Findings Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 18

Frequency of Low Urgency ED Visits for Kensington-Chinatown Residents by Age Group, FY 2015-16 # of Low Urgency ED Visits # of Individuals Age Groups 0-19 20-44 45-64 65-74 75+ % of Individuals # of Individuals % of Individuals # of Individuals % of Individuals # of Individuals % of Individuals # of Individuals % of Individuals 1 241 78% 577 82% 235 81% 83 80% 70 84% 2 51 17% 94 13% 35 12% 15 14% 9 11% 3 or more 15 5% 34 5% 21 7% 6 6% <5 5% # of low urgency ED Visits 420 1004 429 157 101 Total # of unique individuals 307 100% 705 100% 291 100% 104 100% 83 100% In the age 0-19 category, 51 patients (17%) patients visited ED twice in FY2015/16 for non-urgent reasons (CTAS IV-V) 94 patients (13%) ages 20-44 visited ED twice in FY2015-16 for non-urgent reasons (CTAS IV-V) and 34 patients (5%) had 3 or more ED visits for non-urgent reasons 21 patients (7%) ages 45-64 had had 3 or more ED visits for non-urgent reasons (CTAS IV-V) Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 19

ED visits by Kensington Chinatown Residents to UHN Western and TGH Sites UHN Overall, FY2015-16 Low Urgency 20

Low Urgency ED Visits to UHN by Kensington-Chinatown Residents, 2015/16 Overall ED Visits Low Urgency ED Visits UHN - Western Site UHN - TGH Total UHN UHN - Western Site UHN - TGH Total UHN Total ED visits 3,051 782 3,833 696 114 810 High users (5+ visits) 724 152 876 152 16 168 Low Urgency (CTAS 4-5) High Users (5+ visits) Low Urgency Total ED visits 810 168 Age 20-64 years 80% 69% 65+ 11% 25% Females 50% 69% Males 50% 31% Language - English 82% 75% Language - Chinese 9% Language - Korean 0% 6% Language - Unknown 5% 19% Discharged to place of residence 90% 83% Admitted 1% 3% Have a primary caregiver 51% 50% Living in private dwelling 87% Shelter 4% Majority of residents and high users from Kensington-Chinatown visited Toronto Western Hospital compared to Toronto General Hospital, with most visits being by residents aged 20-64 years A large majority of residents with low urgency visits speak English, followed by Chinese. However, among the high users, the second most common language was Korean. Source: UHN Electronic Patient Record (EPR), National Ambulatory Care Reporting System (NACRS), FY1516 21

Presenting Complaints for Low Urgency ED Visits to UHN by Kensington-Chinatown Residents, 2015/16 All Visits High Frequency Visits Top 20 Presenting Complaints (CEDIS) % Top 20 Presenting Complaints (CEDIS) Laceration / Puncture 9% Minor complaints NOS 14% Lower extremity pain 9% Lower extremity pain 13% Minor complaints NOS 8% Prescription / Medication request 11% Upper extremity injury 7% Upper extremity injury 5% Prescription / Medication request 6% Medical device problem 3% Lower extremity injury 6% Rash 3% Localized swelling/redness 4% Abdominal pain 3% Rash 3% Back pain 3% Imaging test / Blood test 3% Dental / Gum problem 2% Sore throat 3% Lower extremity injury 2% UTI complaints 3% Lumps, bumps, calluses 2% Dental / Gum problem 2% UTI complaints 2% Upper extremity pain 2% Wound check 2% Bite 2% Cough/congestion 2% Abdominal pain 2% Earache 2% Back pain 2% Headache 2% Lumps, bumps, calluses 2% Insomnia 2% Cough/congestion 2% Localized swelling/redness 2% Earache 2% Upper extremity pain 2% Wound check 1% Other skin conditions 2% Other 23% Other 20% n= 876 Many of the presenting complaints for low urgency visits can be addressed in a primary care setting Top 3 presenting complaints for high frequency low urgency visits to UHN by Kensington-Chinatown residents were 1) minor complaints NOS (14%), 2) lower extremity pain (13%) and 3) prescription/medication request (11%) n= 168 Source: UHN Electronic Patient Record (EPR), National Ambulatory Care Reporting System (NACRS), FY1516 22

Diagnoses for Low Urgency ED Visits to UHN by Kensington- Chinatown Residents, 2015/16 All Visits High Frequency Visits Top ICD-10 Diagnoses (by Chapter) % ICD-10 Diagnoses (by Chapter) Injury, poisoning and certain other consequences of external causes Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified Factors influencing health status and contact with health services 33% 14% Musculoskeletal system and connective tissue 10% Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) Factors influencing health status and contact with health services (Z00-Z99) 24% 17% 11% Musculoskeletal system and connective tissue (M00-M99) 14% Injury, poisoning and certain other consequences of external causes (S00-T98) Skin and subcutaneous tissue 7% Skin and subcutaneous tissue (L00-L99) 8% Genitourinary system 5% Mental and behavioural disorders (F00-F99) 8% Respiratory system 4% Certain infectious and parasitic diseases (A00-B99) 4% Digestive system 4% Digestive system (K00-K93) 3% Mental and behavioural disorders 3% Genitourinary system (N00-N99) 3% Certain infectious and parasitic diseases 2% Respiratory system (J00-J99) 3% Ear and mastoid process 2% Circulatory system (I00-I99) 2% Eye and adnexa 2% Nervous system (G00-G99) 2% circulatory system 1% Endocrine, nutritional and metabolic diseases (E00-E90) 1% Nervous system 1% Ear and mastoid process (H60-H95) 1% Endocrine, nutritional and metabolic diseases 0% Eye and adnexa (H00-H59) 1% Pregnancy, childbirth and the puerperium 0% n= 876 11% n= 168 Top 3 diagnosis for high frequency low urgency visits to UHN by Kensington-Chinatown residents were 1) symptoms & signs (24%), 2) factors influencing health status (17%) and 3) musculoskeletal system and connective tissue(14%) Source: UHN Electronic Patient Record (EPR), National Ambulatory Care Reporting System (NACRS), FY1516 23

Patient Journey for Residents with Low Urgency ED Visits Integrated Decision Support (IDS), FY2015-16 Low Urgency ED visits that resulted in acute inpatient admission by Frequent and non Frequent users Low Urgency ED visits by Frequent and non Frequent users and Use of CCAC (Home Care) services 24

Definition of Measures Used in IDS Data on Patient Journey Is ED Frequent Visitor Patient Is Yes when the patient has visited the ED four or more times in the past 12 months CCAC Home Care Status NACRS Admitted to CCAC (A): means this patient is admitted to CCAC from a Home Care Referral at the time of the NACRS registration Known to CCAC (K): not CURRENTLY admitted, but this patient has had a CCAC Home Care Referral Start, Referral End or Admission within one year prior to the current NACRS registration Unknown to CCAC (U): mean the patient has not been admitted or referred for Home Care to the CCAC as defined by the two above criteria. A patient would be "Unknown to CCAC" if they had had a Referral more than one year prior to the NACRS registration Is CCAC Home Care Referral From NACRS Visit NACRS A CCAC Home Care Referral was generated during the NACRS visit, or the day pre or two days post. Linked data is available regarding the CCAC referral. A Reliability Score is a assigned to the link based on number of points of matching data between the NACRS visit and the CCAC Referral information. 25

Total Low Urgency ED Visits (CTAS IV and V) for Kensington-Chinatown Residents that Resulted in an Admission (FY 2015/16) Is the patient an ED Frequent visitor No Yes Total CTAS Level CTAS IV-V CTAS IV CTAS IV-V Age # of Cases # of Cases # of Cases 0-17 Years <5 - <5 18-59 Years 10 4 14 60+ Years 10 <5 12 Grand Total 21 6 27 In 2015/16, a total of 27 ED visits from Kensington Chinatown resulted in admission to inpatient. 6 (22%) were frequent visitors to the ED 52% were between the ages of 18-59 and 44% were 60 years and older Source: Integrated Decision Support (IDS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 26

Total Low Urgency Visits (CTAS 4 and 5) for FY 2015/16, Kensington-Chinatown and their associated CCAC Home Care Status Non Frequent visitors Frequent ED visitors Overall Total CCAC Home Care Staus Admitted to CCAC Known to CCAC Known to CCAC Unknown to CCAC Unknown to CCAC Total Admitted to CCAC Known to CCAC Unkno wn to CCAC Total CCAC Home Care referral from NACRS Visit No No Yes No Yes No No No Age Total Cases Total Cases Total Cases Total Cases Total Cases Total Cases Total Cases Total Cases 0-17 Years 1 7 336 344 12 12 356 18-59 Years 14 18 0 1,125 6 1163 29 7 180 216 1379 60+ Years 32 21 3 177-233 42 11 27 80 313 Grand Total 47 46 3 1,638 6 1740 71 18 219 308 2048 % of Total 85% 15% 100% In 2015/16, there were a total of 2,048 low urgency ED visits for Kensington Chinatown residents captured in IDS. 15% of these were for frequent visitors to the ED (i.e had visited the ED 4 or more times in the year). Two-thirds of the visits were for patients 18-59 years Among the 1,740 non frequent visits (i.e. had between 1-3 ED visits in the year): The majority 1,644 were unknown to CCAC and 6 of those resulted in a home care referral 47 (3%) were admitted to CCAC from a Home Care Referral at the time of the ED registration 49 were known to CCAC (i.e. not CURRENTLY admitted, but this patient has had a CCAC Home Care Referral Start, Referral End or Admission within one year) prior to the current ED registration), and of those only 3 got a referral to home care at the time of the visit Among the 308 visits for Frequent visitors: 71 were admitted to CCAC from a Home Care Referral at the time of the ED registration 18 were known to CCAC (i.e. not CURRENTLY admitted, but this patient has had a CCAC Home Care Referral Start, Referral End or Admission within one year) None of the visits for the frequent visitors resulted in a CCAC referral at the time of the ED visit. Source: Integrated Decision Support (IDS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 27

Early Development Indicator Results, 2015 Child Developmental Health in Toronto 2005 to 2015 Toronto Public Health 28

Kensington-Chinatown Early Development Indicator* Results Percent of overall Vulnerability and Percent Vulnerable on each Domain, Senior Kindergarten Students, Toronto, 2015 Neighbourhood Overall Vulnerability^ Physical Health and Well-Being Social Competence Emotional Maturity Language and Cognitive Development Communication Skills and General Knowledge Kensington- Chinatown 25.9% 19.8% 16.0% 23.5% 16.0% 21.0% City of Toronto 13.6% 14.7% 9.5% 10.7% 6.8% 11.5% Kensington-Chinatown has a higher percentage of overall vulnerability compared to the City of Toronto Kensington-Chinatown also has higher percentage of vulnerability in each of the five domains compared to the City of Toronto and more than double the percentage in both the Emotional Maturity and Language and Cognitive Development domains. Notes: *The Early Development Instrument (EDI) is a tool used to measure overall vulnerability at the population-level. The EDI can be used to monitor healthy childhood development over time and to assess areas where children and families may benefit from additional supports and services. It measures development in five areas or domains: Physical Health and Well-Being, Social Competence, Emotional Maturity, Language and Cognitive Development, Communication Skills and General Knowledge. ^Overall vulnerability refers to the percent of children who were vulnerable on two or more domains of the Early Development Instrument.. Children with identified special needs were excluded from this table. Source: Child Developmental Health in Toronto 2005 to 2015 Toronto Public Health 29

Acute Inpatient Discharges Discharge Abstract Database (DAD) FY2015-16 30

Summary of Acute Inpatient Discharges for Kensington- Chinatown residents by Age Group and Gender FY 2015/16 Acute Inpatient Discharges # of Discharges % of Discharges # of Unique Individuals Population (2011) Rate of Visits per 1,000 Population Age Group Males Females Total Males Females Males Females Total Males Females Males Females 0-19 104 80 184 57% 43% 95 69 164 1265 1240 82 65 20-44 64 263 327 20% 80% 49 206 255 4920 4550 13 58 45-64 157 106 263 60% 40% 98 84 182 1905 2080 82 51 65-74 80 66 146 55% 45% 54 52 106 450 635 178 103 75+ 153 221 374 41% 59% 104 163 267 605 885 253 249 Total 558 736 1294 43% 57% 400 574 974 9145 9390 82 78 1294 - Acute Inpatient Discharges 2 - Discharges that do not belong to any age group (Unknown) 1296 - Total number of Acute Inpatient Discharges Source: Discharge Abstract Database (DAD), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 31

# of Discharges Number of Acute Inpatient Discharges for Kensington- Chinatown Residents by Age Group, FY 2015/16 400 350 300 250 200 150 100 50 0 184 327 263 146 374 0-19 20-44 45-64 65-74 75+ Age Group The age group 75+ has the highest number of discharges in 2015/16, representing 29% of all discharges in Kensington Chinatown Residents ages 20-44 represent 25% of all discharges in Kensington Chinatown followed by residents ages 45-64 representing 20% 153 157 104 80 64 75+ 65-74 45-64 20-44 0-19 200 100 0 100 200 300 Overall more women than men were discharged in 75+ and 20-44 age groups during fiscal 2015/16 80 66 Number of Discharges F M 106 221 263 Source: Discharge Abstract Database (DAD), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 32

Most Responsible Diagnosis for Acute Inpatient Discharges Ages 0-19 for Kensington-Chinatown Residents, FY 2015/16 Breakdown of Factors Influencing Health Status & Contacts with Health Services Source: DAD 2015-16 Most discharges fall within two groupings of most responsible diagnosis in the age group 0-19: Factor influencing Health Status & Contacts with Health Services (60%), of which 93% were for regular newborns (single born vaginal delivery and caesarian section) Certain Conditions Originating in Perinatal Period (21%) 33 Source: Discharge Abstract Database (DAD), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017)

Most Responsible Diagnosis for Acute Inpatient Discharges, Ages 20-44 for Kensington-Chinatown Residents, FY 2015/16 INJURY & POISONING & CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES, 9% SYMPTOMS, SIGNS & ABNORMAL CLINICAL & LAB. FINDINGS NEC, 2% FACTORS INFLUENCING HEALTH STATUS & CONTACTS WITH HEALTH SERVICES, 7% CERTAIN INFECTIOUS & PARASITIC DISEASES, 2% OTHER, 2% PREGNANCY, CHILDBIRTH & THE PUERPERIUM, 44% NEOPLASMS, 6% ENDOCRINE, NUTRITIONAL & METABOLIC DISEASES, 4% MENTAL AND BEHAVIOURAL DISORDERS, 5% DISEASES OF CIRCULATORY SYSTEM, 2% DISEASES OF RESPIRATORY SYSTEM, 3% DISEASES OF DIGESTIVE SYSTEM, 9% DISEASES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE, 2% DISEASES OF GENITOURINARY SYSTEM, 3% Almost half of discharges for residents ages 20-44 (44%) were related to pregnancy, childbirth & the puerperium Source: Discharge Abstract Database (DAD), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 34

Most Responsible Diagnosis for Acute Inpatient Discharges, Ages 45-64 for Kensington-Chinatown Residents, FY 2015/16 CERTAIN INFECTIOUS & PARASITIC DISEASES, 3% FACTORS INFLUENCING HEALTH STATUS & CONTACTS WITH HEALTH SERVICES, DISEASES OF CIRCULATORY SYSTEM, 19% DISEASES OF GENITOURINARY SYSTEM, 4% ENDOCRINE, NUTRITIONAL & METABOLIC DISEASES, 5% DISEASES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE, 5% DISEASES OF DIGESTIVE SYSTEM, 18% DISEASES OF RESPIRATORY SYSTEM, 6% Other, 6% NEOPLASMS, 10% SYMPTOMS, SIGNS & ABNORMAL CLINICAL & LAB. FINDINGS NEC, 12% INJURY & POISONING & CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES, 10% Most discharges fall within five groupings of most responsible diagnosis in the age group 45-64: Diseases of Circulatory System Diseases of Digestive System Symptoms, Signs & Abnormal Clinical & Lab. Findings Neoplasms Injury & Poisoning & Certain Other Consequences of External Causes Source: Discharge Abstract Database (DAD), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 35

Most Responsible Diagnosis for Acute Inpatient Discharges, Ages 65-74 for Kensington-Chinatown Residents, FY 2015/16 FACTORS INFLUENCING HEALTH STATUS & CONTACTS WITH HEALTH SERVICES 3% ENDOCRINE, NUTRITIONAL & METABOLIC DISEASES 4% CERTAIN INFECTIOUS & PARASITIC DISEASES 4% OTHERS 12% DISEASES OF CIRCULATORY SYSTEM 19% DISEASES OF GENITOURINARY SYSTEM 6% DISEASES OF RESPIRATORY SYSTEM 12% SYMPTOMS, SIGNS & ABNORMAL CLINICAL & LAB. FINDINGS NEC 8% DISEASES OF DIGESTIVE SYSTEM 9% NEOPLASMS 11% DISEASES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE 12% Source: DAD 2015-16 Most discharges fall within four groupings of most responsible diagnosis in the age group 65-74: Diseases of Circulatory System Diseases of Respiratory system Diseases of musculoskeletal system & connective tissue Neoplasms Source: Discharge Abstract Database (DAD), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 36

Most Responsible Diagnosis for Acute Inpatient Disharges, Ages 75+ for Kensington-Chinatown Residents, FY 2015/16 Most discharges fall within four groupings of most responsible diagnosis in the age group 75+: Disease of Circulatory System Disease of Respiratory system System, Signs & Abnormal Clinical & Lab Findings nec Injuring & Poisoning Certain Other Consequences of External Causes 37 Source: Discharge Abstract Database (DAD), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017)

Age Group Discharge Disposition for Kensington-Chinatown Residents, FY 2015-16 75+ 65-74 45-64 3% 20-44 0% 0-19 0% 3% 10% Discharge Disposition for Kensington-Chinatown Residents, FY 2015-16 33% 55% 66% 87% 94% 1% 1% 2% 1% Discharge Disposition 0-19 20-44 45-64 65-74 75+ Deceased 0 1 7 5 39 52 Discharged to home (no support services) 173 286 174 81 122 836 Discharged to home with support services 2 21 40 37 114 214 Left against medical advice 2 11 14 2 4 33 Transferred - acute inpatient facility 4 1 7 2 6 20 Transferred - continuing care facility 2 5 20 17 87 131 Transferred - other facility 1 2 1 2 2 8 Total: 184 327 263 146 374 1294* 30% 25% 1% 2% 15% 23% 1% 1% 5% 3% 6% 12% 8% 1% 1% 0% 3% 0% 2% 1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Deceased Discharged to home with support services Transferred - acute inpatient facility Transferred - other facility Discharged to home (no support services) Left against medical advice Transferred - continuing care facility Source: Discharge Abstract Database (DAD), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) A significant proportion of patients across all age groups were discharged to home with no support services in 2015/16 In the 75+ age group, a significant proportion of patients were discharged home with support services (30%) were transferred to a continuing care facility (23%) 10% of patients aged 75+ passed away in inpatient facilities 38 * 2 Discharges do not belong to any age group (Unknown)

Acute Inpatient Discharges for Kensington-Chinatown residents by Hospital and LHIN of Visit, All Ages, FY 2015/16 Top 7 Hospitals for Acute Inpatient Discharges by Kensington-Chinatown Residents (FY 2015/16) SUNNYBROOK HEALTH SCIENCES ST. JOSEPH'S CENTRE, 2% HEALTH CENTRE, 4% TORONTO EAST GENERAL HOSPITAL (THE), 4% HOSPITAL FOR SICK CHILDREN (THE), 1% OTHER, 4% LHIN of Hospital Stay # of Discharges % of Total Discharges TORONTO CENTRAL 1236 95% CENTRAL 35 3% CENTRAL EAST 12 1% OTHER LHINs 13 1% Grand Total 1296 100% ST MICHAEL'S HOSPITAL, 14% SINAI HEALTH SYSTEM, 28% UNIVERSITY HEALTH NETWORK, 42% Majority (44%) of Kensington-Chinatown residents were Discharged from UHN and Sinai Health System had (29%) in FY 2015/16 14% of the residents were discharged from St. Michael s Hospital Source: Discharge Abstract Database (DAD), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 39

Frequency of Acute Inpatient Discharges for Kensington- Chinatown Residents by Age Group, FY 2015-16 Frequency of Discharges by Unique Patients, FY 2015-16 Percentage (%) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 93% 89% 80% 80% 74% 16% 18% 13% 12% 7% 7% 8% 8% 3% 0% 0-19 20-44 45-64 Age Group 65-74 75+ 1 Admission 2 Admissions 3+ Admissions Most individuals were discharged only once from an inpatient unit The proportion of individuals with 3 or more acute inpatient discharges ranged from 0% - 8% Overall 50 patients had 3 or more acute inpatient discharges ranging from 3 to 10 in 2015/16 with patients ages 75+ representing 40% of those discharges Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 40

Frequency of Discharges for Kensington-Chinatown Residents by Age Group, FY 2015-16 Age Groups # of Discharges 0-19 20-44 45-64 65-74 75+ # of Individuals % of Individuals # of Individuals % of Individuals # of Individuals % of Individuals # of Individuals % of Individuals # of Individuals % of Individuals 1 152 93% 227 89% 146 80% 85 80% 197 74% 2 12 7% 21 16% 23 13% 13 12% 48 18% 3 or more 0 0% 7 3% 13 7% 8 8% 22 8% Total # of Discharges 184 327 263 146 374 Total # of Unique Individuals 164 100% 255 100% 182 100% 106 100% 267 100% The frequency of 2 discharges per patient is high (18%) in the age 75+ category In the age 20-44 category, a significant number of patients had 2 discharges (16%) A significant number of patients (8%) had 3 discharges in 75+ age category Source: Discharge Abstract Database (DAD), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 41

CMHA and CSS Providers Providing Services in Kensington- Chinatown Community Business Intelligence (CBI) 2016/17 42

Top CMHA and CSS Providers that Serve at least 50% of Clients in Kensington-Chinatown CMHA Providers University Health Network 19% St. Stephen's Community House 14% Progress Place Rehabilitation Centre (Metropolitan Toronto) Inc. 7% LOFT Community Services 5% Community Resource Connections of Toronto 4% Centre for Addiction and Mental Health 4% + 36 other HSPs CSS Providers West Neighbourhood House 59% + 16 other HSPs Kensington-Chinatown is served by at least 42 CMHA providers and 17 CSS providers Source: Community Business Intelligence, extracted Feb. 22, 2017 43

Appendix List of top 3 conditions (Injury & Poisoning & Certain Other Consequences of External Causes; Symptoms, Signs & Abnormal Clinical & Lab. Findings; Factors Influencing Health Status & Contacts with Heath Services) and related Lead Cause Group can be found in Appendix A 44

Appendix A List of Conditions (MDx Chapter & MDx Lead Cause Group) (18) XVIII. SYMPTOMS, SIGNS & ABNORMAL CLINICAL & LAB. FINDINGS NEC (R00-R99) (111) PAIN IN THROAT AND CHEST (112) ABDOMINAL AND PELVIC PAIN (114) OTHER SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS (19) XIX. INJURY & POISONING & CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES (S00-T98) (115) INTRACRANIAL INJURY (116) OTHER INJURIES TO THE HEAD (117) FRACTURE OF FOREARM (118) FRACTURE OF FEMUR (119) FRACTURE OF LOWER LEG, INCLUDING ANKLE (120) OTHER INJURIES (121) BURNS AND CORROSIONS (122) POISONINGS BY DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES AND TOXIC E (123) COMPLICATIONS OF SURGICAL AND MEDICAL CARE, NOT ELSEWHERE CLASSIFIED (125) OTHER AND UNSPECIFIED EFFECTS OF EXTERNAL CAUSES (21) XXI. FACTORS INFLUENCING HEALTH STATUS & CONTACTS WITH HEALTH SERVICES (Z00-Z99) (126) MEDICAL OBSERVATION AND EVALUATION FOR SUSPECTED DISEASES AND CONDITIO (129) OTHER MEDICAL CARE (INCLUDING RADIOTHERAPY AND CHEMOTHERAPY SESSIONS) (130) OTHER FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVIC 45