Hips & Knees Priority Action Team

Hips & Knees Priority Action Team Current State Data Refresh September 5, 27 Overview Population Profile Health Status Utilization of Hip & Knee Total Joint Services 1 1

Population Profile 2 SouthWest LHIN Population Estimates by Age Group 22 26 4, 35, 3, 25, 2, 15, 1, 5, to 6 7 to 18 19 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85+ 3 2

SouthWest LHIN Population Projections by Age Group 27 212 217 4, 35, 3, 25, 2, 15, 1, 5, to 6 7 to 18 19 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85+ 4 26 Population Estimates by Planning Community 1% 8% North Central South 6% 72% 72% 74% 71% 68% 65% 68% 68% 71% 4% 2% % 14% 14% 13% 13% 13% 14% 15% 16% 13% 13% 15% 13% 16% 19% 21% 18% 16% 15% to 6 7 to 18 19 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85+ All Ages 5 3

217 Population Projections by Planning Community 1% 8% North Central South 6% 72% 72% 75% 73% 69% 66% 67% 69% 72% 4% 2% % 14% 14% 13% 12% 13% 13% 13% 15% 13% 14% 14% 13% 15% 18% 21% 2% 16% 15% to 6 7 to 18 19 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85+ All Ages 6 Health Status 7 4

Hip & Knee Population - Arthritis The incidence of arthritis is increasing, and factors such as overall pop n growth and expansion of the older cohort will drive these rates The literature suggests that current demand for rehab services is not being met, and that lack of access has an affect on mobility and function of clients. The effectiveness of rehab appears to be established for clients with both OA and RA. As such, the demand for rehabilitation within this condition is expected to increase. Landry et al. (26) 8 Community Rehabilitation demand for LHIN 9 5

Hip & Knee Population - Orthopaedics Two distinct trends from literature: 1) increase in prevalence of hip fractures in the aging pop n over 75 years; 2) number of total joint replacement (TJR) surgeries performed are increasing significantly. Demand to provide rehab post hip fracture and TJR is significant. Strategies to manage increased demand: decreasing length of acute care and rehab stay, wait time strategies, implementing specialized geriatric rehab units, tele-rehab consultation and increasing home care services. Need for integrated pathways of care across the continuum of care while decreasing the length of stay in hospital to provide costefficient and effective rehab to clients. Landry et al (26) 1 Utilization of Hip & Knee Total Joint Services 11 6

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Hip s by Patient Residence 22/3 23/4 24/5 25/6 26/7 12 1 8 6 4 2 North Central South 14 Volumes by Geography Hip Knee Hip and Knee s (Main Procedure)* Discharges Year of Discharge Planning Communities 22/3 23/4 24/5 25/6 26/7 North 291 33 322 329 344 Central 26 232 39 292 266 South 827 96 969 1,3 1,45 SouthWest LHIN 1,324 1,441 1,6 1,651 1,655 North 297 289 348 481 518 Central 171 245 256 352 332 South 65 72 823 1,126 1,213 SouthWest LHIN 1,118 1,254 1,427 1,959 2,63 *PHPDB Inpatient Records 8 Aug 7 15 8

Hip Age-adjusted Rate/1, residents 22/3 23/4 24/5 25/6 26/7 6. 5. 4. 3. 2. 1.. North Central South unweighted ave 16 17 9

18 Knee s by Patient Residence 22/3 23/4 24/5 25/6 26/7 14 12 1 8 6 4 2 North Central South 19 1

Volumes by Geography Hip Knee Hip and Knee s (Main Procedure)* Discharges Year of Discharge Planning Communities 22/3 23/4 24/5 25/6 26/7 North 291 33 322 329 344 Central 26 232 39 292 266 South 827 96 969 1,3 1,45 SouthWest LHIN 1,324 1,441 1,6 1,651 1,655 North 297 289 348 481 518 Central 171 245 256 352 332 South 65 72 823 1,126 1,213 SouthWest LHIN 1,118 1,254 1,427 1,959 2,63 *PHPDB Inpatient Records 8 Aug 7 2 Knee Age-adjusted Rate/1, residents 22/3 23/4 24/5 25/6 26/7 5. 4. 3. 2. 1.. North Central South unweighted ave 21 11

Bed-Equivalents @ 9% in 26/7 North Central South SouthWest LHIN 4 35 3 25 2 15 1 5 Hip Knee 22 Surgeries Completed in the LHIN Hip and Knee Inflow by SouthWest LHIN Residents Five years combined 22/3 to 26/7 Hip Knee Patient LHIN Inflow as % Inflow as % ERIE ST. CLAIR 439 6% 388 6% SOUTH WEST 6,32 87% 6,179 88% WATERLOO WELLINGTON 162 2% 155 2% HAMILTON NIAGARA HALDIMAND BRANT (HNHB) 116 2% 12 1% CENTRAL WEST 37 1% 6 % MISSISSAUGA HALTON 1 % 11 % TORONTO CENTRAL 5 % 8 % CENTRAL 11 % 7 % CENTRAL EAST 11 % 14 % SOUTH EAST 15 % 12 % CHAMPLAIN 5 % 2 % NORTH SIMCOE MUSKOKA 84 1% 19 2% NORTH-EAST 49 1% 35 % NORTH-WEST 3 % 3 % Combined 7,249 1% 7,31 1% *PHPDB 8 Aug 7 23 12

Where LHIN Residents had Surgery Hip and Knee Outflow from SW LHIN (Four years combined 22/3 to 25/6) Hip Knee LHIN of Institution Ouflow as % Ouflow as % ERIE ST. CLAIR 149 3% 22 4% SOUTH WEST 4,933 83% 4,544 8% WATERLOO WELLINGTON 435 7% 53 9% HAMILTON NIAGARA HALDIMAND BRANT (HNHB) 12 2% 138 2% CENTRAL WEST 18 % 17 % MISSISSAUGA HALTON 32 1% 28 % TORONTO CENTRAL 165 3% 138 2% CENTRAL 32 1% 26 % CENTRAL EAST 2 % 42 1% SOUTH EAST 4 % 5 % CHAMPLAIN 6 % % NORTH SIMCOE MUSKOKA 23 % 14 % NORTH-EAST % 3 % NORTH-WEST % 2 % Combined 5,937 1% 5,657 1% PHPDB Jul 7 24 Surgeries Completed in by Category Hip and Knee Replacments Inflow by Admit Category Five years combined 22/3 to 26/7 Patient LHIN Elective Not Elective % elective ERIE ST. CLAIR 739 88 89% SOUTH WEST 1,417 2,64 83% WATERLOO WELLINGTON 291 26 92% HAMILTON NIAGARA HALDIMAND BRANT (HNHB) 2 18 92% CENTRAL WEST 22 21 51% MISSISSAUGA HALTON 18 3 86% TORONTO CENTRAL 11 2 85% CENTRAL 11 7 61% CENTRAL EAST 23 2 92% SOUTH EAST 26 1 96% CHAMPLAIN 6 1 86% NORTH SIMCOE MUSKOKA 179 14 93% NORTH-EAST 75 9 89% NORTH-WEST 6-1% All LHINs 12,24 2,256 84% *PHPDB 8 Aug 7 25 13

LHIN Resident Surgeries by Category Hip and Knee s Outflow by Admission Category (Four years combined 22/3 to 25/6) Institution LHIN Elective Not Elective % Elective ERIE ST. CLAIR 342 9 97% SOUTH WEST 7,837 1,64 83% WATERLOO WELLINGTON 91 28 97% HAMILTON NIAGARA HALDIMAND BRANT (HNHB) 239 19 93% CENTRAL WEST 34 1 97% MISSISSAUGA HALTON 59 1 98% TORONTO CENTRAL 285 18 94% CENTRAL 52 6 9% CENTRAL EAST 62-1% SOUTH EAST 7 2 78% CHAMPLAIN 5 1 83% NORTH SIMCOE MUSKOKA 31 6 84% NORTH-EAST 3-1% NORTH-WEST 2-1% All LHINs 9,868 1,731 85% PHPDB Jul 7 26 Combined Hip and Knee s Discharges by Age Group 22/3 23/4 24/5 25/6 26/7 12 1 8 6 4 2 19 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85+ 27 14

Age breakdown over 5 years Hip and Knee s (Main Procedure)* Five-Year Totals (22/3 to 26/7) Age Grouping Discharges Days ALC Days PAC Weight to 6 7 to 18 4 24-8 19 to 44 345 1,762 55 727 45 to 54 1,15 5,743 25 2,32 55 to 64 2,738 14,431 436 5,647 65 to 74 4,429 26,337 1,287 9,551 75 to 84 4,47 34,676 3,297 1,84 85+ 1,313 14,895 2,762 3,988 All Ages 14,341 97,868 8,42 33,63 as percentages of all ages Age Grouping Discharges Days ALC Days PAC Weight to 6 % % % % 7 to 18 % % % % 19 to 44 2% 2% 1% 2% 45 to 54 8% 6% 3% 7% 55 to 64 19% 15% 5% 17% 65 to 74 31% 27% 16% 29% 75 to 84 31% 35% 41% 33% 85+ 9% 15% 34% 12% All Ages 1% 1% 1% 1% *PHPDB Inpatient Records 8 Aug 7 28 Entry Route over 5 years Entry Route over 5 year period Hip Knee Planning Community Entry Type North Central South SouthWest LHIN Via Clinic 11 6 2 37 Direct from Admitting 1,347 1,18 3,685 6,212 From ER 229 118 1,71 1,418 Via Day Procedure/Surgery 2 1 1 4 All Entry Types 1,589 1,35 4,777 7,671 Via Clinic 4 1 7 12 Direct from Admitting 1,924 1,35 4,487 7,761 From ER 5 5 37 47 Via Day Procedure/Surgery - - 1 1 All Entry Types 1,933 1,356 4,532 7,821 Hip Knee as percent Planning Community Entry Type North Central South SouthWest LHIN Via Clinic 1% % % % Direct from Admitting 85% 9% 77% 81% From ER 14% 9% 22% 18% Via Day Procedure/Surgery % % % % All Entry Types 1% 1% 1% 1% Via Clinic % % % % Direct from Admitting 1% 1% 99% 99% From ER % % 1% 1% Via Day Procedure/Surgery % % % % All Entry Types 1% 1% 1% 1% 29 15

Entry Route Likelihood over 5 years Hip Knee likelihood Planning Community Entry Type North Central South SouthWest LHIN Via Clinic 1.44.95.87 1. Direct from Admitting 1.5 1.12.95 1. From ER.78.49 1.21 1. Via Day Procedure/Surgery 2.41 1.47.4 1. All Entry Types 1. 1. 1. 1. Via Clinic 1.35.48 1.1 1. Direct from Admitting 1. 1. 1. 1. From ER.43.61 1.36 1. Via Day Procedure/Surgery - - 1.73 1. All Entry Types 1. 1. 1. 1. 3 Admissions over 5 years Admission Category over five year period Hip Knee Hip Knee Planning Community Admission Category North Central South SouthWest LHIN Elective/Planned 1,169 1,64 3,352 5,585 Life Threatening/Urgent 42 241 1,425 2,86 All Entry Types 1,589 1,35 4,777 7,671 Elective/Planned 1,911 1,341 4,458 7,71 Life Threatening/Urgent 22 15 74 111 All Entry Types 1,933 1,356 4,532 7,821 as percent Planning Community Admission Category North Central South SouthWest LHIN Elective/Planned 74% 82% 7% 73% Life Threatening/Urgent 26% 18% 3% 27% All Entry Types 1% 1% 1% 1% Elective/Planned 99% 99% 98% 99% Life Threatening/Urgent 1% 1% 2% 1% All Entry Types 1% 1% 1% 1% Hip Knee likelihood Planning Community Admission Category North Central South SouthWest LHIN Elective/Planned 1.1 1.12.96 1. Life Threatening/Urgent.97.68 1.1 1. All Entry Types 1. 1. 1. 1. Elective/Planned 1. 1. 1. 1. Life Threatening/Urgent.8.78 1.15 1. All Entry Types 1. 1. 1. 1. 31 16

Complexity by Geography Hip Knee Hip Knee Complexity of Care Planning Community CMG Complexity North Central South SouthWest LHIN NO COMPLEXITY 1,34 1,96 3,722 6,122 CHRONIC CONDITIONS 121 93 48 694 SERIOUS IMPORTANT CONDITIONS 94 72 278 444 LIFE THREATENING CONDITIONS 62 42 285 389 All Complexity Types 1,581 1,33 4,765 7,649 NO COMPLEXITY 1,784 1,233 4,48 7,65 CHRONIC CONDITIONS 85 62 249 396 SERIOUS IMPORTANT CONDITIONS 41 44 165 25 LIFE THREATENING CONDITIONS 23 17 69 19 All Complexity Types 1,933 1,356 4,531 7,82 as percent Planning Community CMG Complexity North Central South SouthWest LHIN NO COMPLEXITY 82% 84% 78% 8% CHRONIC CONDITIONS 8% 7% 1% 9% SERIOUS IMPORTANT CONDITIONS 6% 6% 6% 6% LIFE THREATENING CONDITIONS 4% 3% 6% 5% All Complexity Types 1% 1% 1% 1% NO COMPLEXITY 92% 91% 89% 9% CHRONIC CONDITIONS 4% 5% 5% 5% SERIOUS IMPORTANT CONDITIONS 2% 3% 4% 3% LIFE THREATENING CONDITIONS 1% 1% 2% 1% All Complexity Types 1% 1% 1% 1% 32 Discharge Disposition over 5 years Disposition Hip Knee Planning Community Disposition North Central South SouthWest LHIN Acute Facility 675 517 81 1,993 LTC Facility 113 115 915 1,143 Other Facility Type 17 4 42 63 HomeCare 318 316 1,571 2,25 Home 445 337 1,335 2,117 LAMA - - 2 2 Deceased 21 16 111 148 All Dispositions 1,589 1,35 4,777 7,671 Acute Facility 424 296 31 1,3 LTC Facility 57 34 224 315 Other Facility Type 17 8 18 43 HomeCare 555 488 1912 2,955 Home 877 529 261 3,467 LAMA - Deceased 3 1 7 11 All Dispositions 1,933 1,356 4,532 7,821 as percent Planning Community Disposition North Central South SouthWest LHIN Acute Facility 42% 4% 17% 26% LTC Facility 7% 9% 19% 15% Other Facility Type 1% % 1% 1% HomeCare 2% 24% 33% 29% Home 28% 26% 28% 28% LAMA % % % % Deceased 1% 1% 2% 2% All Dispositions 1% 1% 1% 1% Acute Facility 22% 22% 7% 13% LTC Facility 3% 3% 5% 4% Other Facility Type 1% 1% % 1% HomeCare 29% 36% 42% 38% Home 45% 39% 45% 44% LAMA % % % % Deceased % % % % All Dispositions 1% 1% 1% 1% Hip Knee 33 17

Discharge Disposition Likelihood Hip Knee Disposition likelihood Planning Community Disposition North Central South SouthWest LHIN Acute Facility 1.64 1.52.65 1. LTC Facility.48.59 1.29 1. Other Facility Type 1.3.37 1.7 1. HomeCare.7.84 1.14 1. Home 1.1.94 1.1 1. LAMA - - 1.61 1. Deceased.68.64 1.2 1. All Dispositions 1. 1. 1. 1. Acute Facility 1.67 1.66.52 1. LTC Facility.73.62 1.23 1. Other Facility Type 1.6 1.7.72 1. HomeCare.76.95 1.12 1. Home 1.2.88 1.3 1. LAMA Deceased 1.1.52 1.1 1. All Dispositions 1. 1. 1. 1. 34 Hip and Knee Episode Characteristics Five year totals Hip and Knee Episodes* LHIN Geographic Communities Total Acute Length of Stay (Episodic) Total ALC Days in Acute Care (Episodic) Total PAC Weight (Episodic) Episodes Admits (Episodic) North 1,466 1,92 12,884 1,565 4,159 Hip Central 1,148 1,373 8,765 611 2,962 South 4,599 4,744 42,872 5,36 12, Combined 7,213 8,19 64,521 7,536 19,122 North 1,922 2,225 11,134 571 4,196 Knee Central 1,346 1,524 8,9 211 2,894 South 4,513 4,593 25,216 1,28 8,781 Combined 7,781 8,342 44,359 1,99 15,872 * based on procedure performed. If subsequent revision or second procedure is performed, it is considered another episode. 35 18

Characteristics Per Episode Hip and Knee Episodes* Five year totals Acute care data only Hip Knee LHIN Geographic Communities Acute Admits per Episode ALC Days per Episode Episodes Acute LOS per Episode PAC Weight per Episode North 1,466 1.3 8.8 1.1 2.8 Central 1,148 1.2 7.6.5 2.6 South 4,599 1. 9.3 1.2 2.6 Combined 7,213 1.1 8.9 1. 2.7 North 1,922 1.2 5.8.3 2.2 Central 1,346 1.1 6..2 2.2 South 4,513 1. 5.6.3 1.9 Combined 7,781 1.1 5.7.3 2. * based on procedure performed. If revision, considered another episode. 36 Episode Characteristics by Site Hip Knee Five year totals Institution Performing Procedure Episodes Admits (Episodic) Total Acute Length of Stay (Episodic) Total ALC Days in Acute Care (Episodic) Total PAC Weight (Episodic) ST THOMAS-ELGIN GENERAL HOSPITAL 544 551 4,688 486 1,364 ALEXANDRA MARINE AND GENERAL HOSPITAL 3 3 46 8 9 ST.JOSEPHS HEALTH CARE,LONDON 699 729 7,37 1,719 1,946 STRATHROY MIDDLESEX GENERAL HOSPITAL 44 45 419 17 121 WOODSTOCK GENERAL HOSPITAL 351 356 2,696 271 823 STRATFORD GENERAL HOSPITAL 532 68 4,216 385 1,357 LONDON HLTH SCIENCES CTR-UNIVERSITY SITE 2,66 2,81 27,214 3,119 7,274 GREY BRUCE HEALTH SERVICES-OWEN SOUND 1,116 1,495 9,489 967 3,196 GREY BRUCE HEALTH SERVICES-MARKDALE SITE 19 23 347 4 79 GREY BRUCE HEALTH SERVICES-MEAFORD SITE 47 6 937 361 21 Combined 5,961 6,68 57,359 7,373 16,371 ST THOMAS-ELGIN GENERAL HOSPITAL 367 368 2,176 46 713 ST.JOSEPHS HEALTH CARE,LONDON 634 657 3,78 458 1,295 STRATHROY MIDDLESEX GENERAL HOSPITAL 49 5 198-89 WOODSTOCK GENERAL HOSPITAL 514 517 2,88 81 978 STRATFORD GENERAL HOSPITAL 56 618 3,578 117 1,212 LONDON HLTH SCIENCES CTR-UNIVERSITY SITE 2,489 2,585 14,462 57 4,93 GREY BRUCE HEALTH SERVICES-OWEN SOUND 1,66 1,964 9,616 59 3,72 Combined 6,273 6,759 36,618 1,781 12,919 * based on procedure performed. If subsequent revision or second procedure is performed, it is considered another episode. 37 19

Characteristics Per Episode by Site Acute care data only Acute Admits per Episode PAC Weight per Episode Institution Performing Procedure Episodes Acute LOS per Episode ALC Days per Episode ST THOMAS-ELGIN GENERAL HOSPITAL 544 1. 8.6.9 2.5 ALEXANDRA MARINE AND GENERAL HOSPITAL 3 1. 15.3 2.7 3.2 ST.JOSEPHS HEALTH CARE,LONDON 699 1. 1.5 2.5 2.8 STRATHROY MIDDLESEX GENERAL HOSPITAL 44 1. 9.5.4 2.8 WOODSTOCK GENERAL HOSPITAL 351 1. 7.7.8 2.3 STRATFORD GENERAL HOSPITAL 532 1.1 7.9.7 2.6 LONDON HLTH SCIENCES CTR-UNIVERSITY SITE 2,66 1.1 1.4 1.2 2.8 GREY BRUCE HEALTH SERVICES-OWEN SOUND 1,116 1.3 8.5.9 2.9 GREY BRUCE HEALTH SERVICES-MARKDALE SITE 19 1.2 18.3 2.1 4.2 GREY BRUCE HEALTH SERVICES-MEAFORD SITE 47 1.3 19.9 7.7 4.3 Combined 5,961 1.1 9.6 1.2 2.7 ST THOMAS-ELGIN GENERAL HOSPITAL 367 1. 5.9.1 1.9 ST.JOSEPHS HEALTH CARE,LONDON 634 1. 5.8.7 2. STRATHROY MIDDLESEX GENERAL HOSPITAL 49 1. 4. - 1.8 WOODSTOCK GENERAL HOSPITAL 514 1. 5.6.2 1.9 STRATFORD GENERAL HOSPITAL 56 1.1 6.4.2 2.2 LONDON HLTH SCIENCES CTR-UNIVERSITY SITE 2,489 1. 5.8.2 2. GREY BRUCE HEALTH SERVICES-OWEN SOUND 1,66 1.2 5.8.3 2.2 Combined 6,273 1.1 5.8.3 2.1 * based on procedure performed. If subsequent revision or second procedure is performed, it is considered another episode. 38 Total Hip Wait Times: Ontario & LHIN 39 2

Total Knee Wait Times: Ontario & LHIN 4 LHIN Rankings April/May 27 LHIN Name Hip Knee Rank 9th Rank Median Rank 9th Rank Median Erie-St.Clair 6 11 13 1 1 4 1 6 Waterloo Wellington 7 7 5 5 Hamilton Niagara Haldimand Brant 8 9 9 12 Central West 11 13 7 11 Mississauga Halton 3 6 4 8 Toronto Central 1 3 1 1 Central 5 1 3 4 Central East 9 12 8 9 South East 12 8 12 3 Champlain 14 14 14 14 North Simcoe Muskoka 2 2 2 2 North East 13 5 11 13 North West 4 1 6 7 41 21

LHIN - Hip Wait Time 9th Percentile (days) 6 5 4 SW LHIN 3 2 Ontario Provincial Priority Target 1 Aug- Sep 5 Oct- Nov 5 Dec- Jan 6 Feb- Mar 6 Apr- May 6 Jun-Jul 6 Aug- Sep 6 Oct- Nov 6 Dec 6-Jan 7 Feb- Mar 7 Apr- May 7 42 LHIN Hospital Hip Wait Time 9th Percentile (days) 525 St. Joseph's Health Care, London 425 325 Strathroy Middlesex General St. Thomas-Elgin General Stratford General 225 125 Woodstock General London Health Sciences Centre Grey Bruce Health Services 25 Aug- Sep 5 Oct- Nov 5 Dec- Jan 6 Feb- Mar 6 Apr- May 6 Jun-Jul 6 Aug- Sep 6 Oct- Nov 6 Dec 6-Jan 7 Feb- Mar 7 Apr- May 7 43 22

LHIN - Knee Wait Time 9th Percentile (days) 6 5 4 SW LHIN 3 2 Ontario Provincial Priority Target 1 Aug- Sep 5 Oct- Nov 5 Dec- Jan 6 Feb- Mar 6 Apr- May 6 Jun-Jul 6 Aug- Sep 6 Oct- Nov 6 Dec 6-Jan 7 Feb- Mar 7 Apr- May 7 44 LHIN Hospital Knee Wait Time 9th Percentile (days) 725 625 525 425 St. Joseph's Health Care, London Strathroy Middlesex General St. Thomas-Elgin General Stratford General 325 Woodstock General 225 125 London Health Sciences Centre Grey Bruce Health Services 25 Aug- Sep 5 Oct- Nov 5 Dec- Jan 6 Feb- Mar 6 Apr- May 6 Jun-Jul 6 Aug- Sep 6 Oct- Nov 6 Dec 6-Jan 7 Feb- Mar 7 Apr- May 7 45 23

Joint Wait Time Allocations Hospital Name Grey Bruce Health Services London Health Sciences Centre St. Joseph's Health Care St. Thomas Elgin General Stratford General Hospital Strathroy Middlesex General Hospital Woodstock General Hospital Base Volume 529 968 278 154 228 12 25/6 Volume 43 296 24 93 25 25/6 Funding $1,676,154 $2,728,196 $ $168,996 $172,5 26/7 Volume 243 21 $699,36 1 6 26/7 Funding $1,672,3 3 $2,734,4 $187,5 $ $688,2 $422,5 27/8 Volume 27/8 Funding 225 $1,548,5 36 $3,336,6 $ $ 178 $1,253,7 15 $1,32,3 6 $414,8 27/8 Funding per Case $6,882.22 $9,268.33 $ $ $7,43.26 $6,882. $6,913.33 46 Reported Additional Capacity for Hip and Knee Surgery in the LHIN 27/8 Hospital Name Grey Bruce Health Services London Health Sciences Centre St. Joseph's Health Care St. Thomas Elgin General Stratford General Hospital Strathroy Middlesex General Hospital Woodstock General Hospital Base Volume 529 968 299 154 228 12 Requested Volume 225 395 172 N/A 3 Allocated Volume 225 36 178 15 23 6 Total 2298 1322 973 Additional Capacity 15 5 Total Capacity 754 1328 299 154 46 3 23 2 3471 47 24

Total Number of Primary & Revision Hip & Knee Cases 26/7 Revisions Primary Knee Primary Hip 14 12 1 8 6 4 2 London Health Sciences Centre St. Joseph's Health Care Woodstock General Hospital Stratford General Hospital St. Thomas Elgin General Hospital Grey Bruce Health Services Strathroy Middlesex General Hospital 48 Target (Funded) Hip and Knee Volumes Compared to Actual Volumes 26/7 CCAC volumes 49 25

Percent of Total Patients Enrolled in the Arthritis Society s PreHab Program 26/7 Arthritis Society data 5 Next Steps for Data 1. PAT Discussion Overall comments Anything missing? Additional data needs? 2. Update at October PAT meeting 51 26

Hips & Knees Priority Action Team Inventory of Hip & Knee Services September 5, 27 Availability & Use of Hip and Knee Services What s out there? How is it being used/accessed? Geographic distribution? 53 27

Availability & Use of Hip and Knee Services Population Health: Public Health Units, Family physicians, Arthritis Society Referral to surgery: Family physicians, Community Health Centres Secondary Prevention: Community Care Access Centre, Arthritis Society, etc. 54 Availability & Use of Hip and Knee Services Diagnostic Imaging Clinics Hospital, Public & Private clinics Pre-Op, Surgery, Post-Op, Discharge Academic Health Science Centres, Community Hospitals Rehabilitation Inpatient/Outpatient hospital Community CCAC, Public & Private Clinics Transportation 55 28

Availability and Use of Rehab Services Access to Community Rehabilitation The medium wait time for publicly funded OT or PT community services in LHIN is 25 days. This is 1 days longer than the median wait time for Ontario. There is approximately the same number of private clinics for every public clinic offering community rehabilitation services. 56 Availability and Use of Rehab Services Access to Community Rehabilitation Access to either public or private OT clinics is lacking in the Tobermory area and east of Owen Sound, suggesting people living in these regions would have to travel to access community OT. Community PT services are evenly distributed throughout the LHIN. 57 29

Availability and Use of Rehab Services Community Based Rehab - Occupational Therapy The highest concentration of both publicly and privately funded service is located in the London and surrounding area. There are 28 private community OT settings located throughout the LHIN. The ratio of private to public clinics providing OT services in the South West LHIN is 1.1 compared to Ontario which is 2.2 (# of private clinics/(tas AREP+CHC+OPD) 58 Availability and Use of Rehab Services Community Based Rehabilitation - Occupational Therapy 1.6% of the LHIN population consulted at least once with an occupational therapist (OT) compared to 1.3% for the province (this value includes at least one consultation with a speech language pathologist, audiologist or occupational therapist) for inpatient and community rehabilitation 23. It is important to note that these variables do not differentiate between consultations occurring in institutional or community settings. There were 38.2 OTs for every 1, people living in the LHIN in 26. This is 22% more than the overall provincial provision rate. 59 3

Availability and Use of Rehab Services Community Based Rehabilitation Physiotherapy The greatest allocation of community rehab staff work at hospital outpatient departments and provide PT services. The highest concentration of both publicly and privately funded PT services is located in the London and surrounding area. There are 66 private community PT clinics located throughout the LHIN. The ratio of private to public clinics providing PT services in the LHIN is 1.6 compared to Ontario which is 2.9 (# of private clinics/(tas AREP+CHC+DPC+OPD) 6 Availability and Use of Rehab Services Community Based Rehabilitation Physiotherapy 8.8% of the LHIN population consulted at least once with a physiotherapist (PT) in either an inpatient or community rehabilitation setting in 23. The LHIN has greater utilization than that of the province (7.8%). It is important to note that these variables do not differentiate between consultations occurring in institutional or community settings. The availability of PTs in 26 was just over 45 PTs per 1, population, which is slightly greater than the Ontario rate at 43.4. 61 31

Utilization of Rehabilitation Services Reason for Admission to Hospital Inpatient Rehab Observations for 3 year period General Rehab Units: Orthopaedic (~5%) Stroke (~25%) Debility and Medically Complex (each ~5%) 62 Utilization of Rehabilitation Services Reason for Admission to Hospital Inpatient Rehab Observations for 3 year period Special Rehab: Amputation (~4%) Brain Dysfunction (~25%) Spinal Cord Dysfunction (~2%) Major Multiple Trauma (~7%) 63 32

Utilization of Rehabilitation Services Hospital Inpatient Rehabilitation Discharges per year Observations for 3 year period: 86% of rehabilitation is for General Rehabilitation in the LHIN General Rehabilitation: Residents from North PC had between 29 and 213 discharges per year. Residents from Central PC had between 19 and 221 discharges per year. Residents from South PC had between 737 and 81 discharges per year. Over the five-year period, there were 3,569 total discharges from General Rehabilitation for LHIN residents. 64 Utilization of Rehabilitation Services Hospital Inpatient Rehabilitation Average Length of Net Stay Observations for 3 year period: For general rehab, the net average length of stay is consistently lowest for North PC residents (22-26) and highest for South (32-35) PC residents. 65 33

Utilization of Rehabilitation Services Hospital Inpatient Rehab Beds @ 95% Occupancy Observations for 3 year period: There are between 16 and 114 general rehabilitation beds used at 95% for LHIN residents. Actual number of beds is 12. 66 Utilization of Rehabilitation Services Hospital Inpatient Rehab Volume of ALC Observations for 3 year period: The highest volume of Alternative Level of Care was in 24/5. On average for South residents, just over 4 general rehabilitation beds were for patients ready for discharge, but not discharged. The other volumes are rather small. 67 34

Utilization of Rehabilitation Services Hospital Inpatient Rehab Discharges/1 age-adjusted Observations for 3 year period: General Rehabilitation The discharge rate for Central PC residents dropped significantly between 24/5 and 25/6 to almost the North PC rates which remain the lowest in the LHIN (reduction of 3/18 beds). The discharge rate for South PC residents continues to increase slightly and was 1.27 times the 25/6 rate for North PC residents. The latest unweighted discharge rate per 1, was 3.3 across LHIN. 68 Utilization of Rehabilitation Services Hospital Inpatient Rehab ALOS by Reason and Unit Type Observations over 3 year period: Generally, lengths of stay have varied considerably across Chapters and over time. In General Rehabilitation, strokes tend to have the longest average lengths of stay Some Chapters (Brain/Neurological/Spinal Cord Dysfunction, Amputation of Limb, Orthopaedic Conditions, Cardiac, Pulmonary, Major Multiple Trauma) are treated in both general and specialized units. 69 35

Utilization of Rehabilitation Services Hospital Inpatient Rehab Admission and Discharge FIM Scores/ Reason/ Type Observations for 3 year average: General Rehab Greatest average gains seen for burns (3) with Stroke, Spinal Cord, Amputation, Orthopaedic, Major Multiple Trauma, Medically Complex all around 2. Least average gains seen in Brain Injury, Arthritis, Pain, Cardiac 7 Utilization of Rehabilitation Services Hospital Inpatient Rehab Admission and Discharge FIM Scores/ Reason/ Type Observations for 3 year average: The admission average overall is higher (suggesting more capable patients at admission) in Special Rehabilitation than in General Rehabilitation. The discharge average overall is higher (suggesting more capable patients at discharge) in Special Rehabilitation than in General Rehabilitation. 71 36

Utilization of Rehabilitation Services Hospital Inpatient Rehab Avg Change in FIM score/ ALOS/ Reason/ Unit Type Observations: The overall FIM score improvement per day is.64 in General Rehabilitation, compared to.46 in Special Rehabilitation. General Rehabilitation improvement per day is 1.4 times the Special Rehabilitation improvement. Orthopaedic conditions show the highest improvement per day at.81 to 1.27, with Special Rehabilitation higher. 72 Utilization of Rehabilitation Services Differences in Hospital Inpatient Rehab Access Patterns between Planning Communities Observations based on CMG s accounting for 52% of transfers to rehab over a 5 year period: Overall between 1.1% and 1.4% of acute discharges are transferred to a rehabilitation unit. If the CMG in acute care includes trauma, the likelihood of a transfer to rehabilitation is much higher for South PC residents than for either North or Central PC residents. Although not shown, a review of all CMGs does not show that North PC residents get more transfers to rehabilitation from other CMGs (such as Rehabilitation ). 73 37

Rehabilitation Needs of Population Factors that Affect Demand for Rehabilitation: External Factors Aging population Increasing chronicity and complexity of conditions Overall population growth Increasing public expectations Informants agreed that External Factors will drive future demand Landry et al, (26) 74 Rehabilitation Needs of Population Factors that Affect Demand for Rehabilitation: Controllable Factors Advances in health care Expanding scope of rehabilitation practices Availability of resources (funding and delivery) Emphasis on health promotion and disease prevention Altering controllable factors may initially increase demand for rehab services along the continuum of care but providing these rehab services may reduce demand for other health and surgical services. Landry et al, (26) 75 38

Rehabilitation Needs of Population Factors that Affect Demand for Rehabilitation services following Hip and Knee : External Factors Increasing absolute # of clients undergoing JRT Changing profile of clients (increased age and co-morbidities, greater complexity) Controllable Factors Implementing benchmarks Innovations in delivery (e.g. prehab, expanding role of therapist) Human and financial resources Landry et al, (26) 76 Rehabilitation Needs of Population Overall there is not sufficient information or data regarding utilization rates to accurately forecast demand for rehabilitation services. However, the results indicate that: Current supply is not meeting demand Demand is expected to increase across most conditions and settings Future demand estimates must adjust for current unmet demand; and incorporate the complexities of a public/private mix of funding for rehab Landry et al, (26) 77 39

Next Steps for Inventory of Services 1. PAT Discussion Overall comments What are we missing? Plan for collecting missing information? 2. Update at October PAT meeting 78 Questions? 4