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Mississauga Halton LHINCSS and MH&A Sector
MeetingApril 27, 2011
MHLHIN Financial Update
Finance Team - MH LHIN, Paulette Zulianello and Mirella Semple
Q4 – OHRS/MIS Trial Balance -due May 31/11Q4 CAT on WERS – due June 7/11**Annual Reconciliation Report – due June 7/11** Q4 Supplementary Reporting for Initiatives
(Service Maximum and Aging at Home) – June 7/11Audited Financial Statements –due June 30/11 ** Note: extension till June 30/11
Finance Update Due Dates (As per Schedule C – MSAA):
MSAA MH LHIN Specific Performance Obligation –due June 7/11Template will be sent to all providers by MH LHIN Similar to last year
Finance Update
Other misc due dates:
Finance Update
Please Note the following:
Q4 CAT ToolNo change to the CAT Tool for Q4.Q4 should be up on WERS early May. Quick Reference Guide will also be on
WERS.
Finance Update Please Note the following (con’t):Annual Reconciliation ReportUser Guide for ARR will be on WERS ARR is similar to last year;- small minor changesNo training for ARR- Please read user guide!!!LHINs to support technical issues on the ARR, however, Financial Management Branch (FMB) to support policy
issues, etc.Audited Financial Statements- 1 copy to FMB and 1 copy
to the LHINs
Finance Update SRI – SELF REPORTING INITIATIVE
Replace WERS IBM –off the shelf software solution (FileNet Business
Process Manager Suite)Planning target is to have Q2 quarterly reports on SRIHealth Data Branch will be responsible for training
providers not LHINsDiscussions on when WERS will be turned off is still
pending.Stay tuned for further communication
Questions
Program Evaluation FindingsSDL and Restore Programs
CSS and MH&A Quarterly Meeting
Dr. David SheridanSHERCON ASSOCIATES INC.
www.shercon.ca
April 27, 2011
Study Overview
“Restore” program at MLC and 8 SDL programs
Followed ICES evaluation model
March 2010 - October 2010
Conducted by SHERCON ASSOCIATES INC.
Supervised by Project Oversight Group
Data Sources
1. Documents2. InterRAI CHA Data Base
3. Client Files4. Focus Groups
5. Key Informant Interviews
Data Quality
• Mix of quantitative and qualitative methods• Tests of statistical significance
• Comprehensive, representative samples• Consistent interview and focus group themes
• Good face validity of findings• Clear, consistent and converging evidence
Restore
• Chart abstractions• Monthly reports to LHIN
• CCAC pre/post assessment data• Client follow questionnaire
• Focus groups with referring organizations
Restore: MAPLe Scores Declined
MAPLe: Intake DischargeMild 0 13Moderate 62 65High 38 22
Restore: CHESS Scores Declined
CHESS: Intake Discharge0 17 311-2 78 583+ 6 11
Restore: Locomotion Scores Improved
SRI: Intake Discharge0 13 611-2 33 253+ 53 14
Other Restore Findings
Personal hygiene, bathing and ADL scores also improved
Low levels of hospital recidivism
High client satisfaction
Positive stakeholder perceptions
Some improvement opportunities related to intake and assessment
Restore Conclusions
1. Converging evidence that the program is achieving intended outcomes
2. Freeing up acute care beds by diverting people from LTC to lower cost
alternatives
Right care in the right setting at the right time for the right cost
Supports for Daily Living
• InterRAI CHA data base• 893 clients served by 8 programs
• MH LHIN data• Client satisfaction surveys
• Client focus group• Interviews with system stakeholders
Supports for Daily Living
2010 2008CCS 2+ 26 9MAPLe 4-5 40 23CHESS 3+ 21 5Hosp. Admits 1+ 31 15ER Visits 1+ 26 15SRI 1+ 80 69IADL 7+ 77 57DRS 3+ 19 10CPS 3+ 4 3
Hospital Use (Prev. 90 Days)
CHESS(Changes in Health, End-Stage Disease & Signs & Symptoms)
SDL Mobile
Mobile clients are:• More impaired
• More resource intensive• Higher MAPLe priorities
• More frail• More ER visits
• Less independent and self-reliant• More difficulty with IADL• More depressive disorders
All items are statistically significant
Other SDL Findings
ER visits diverted: 1,046
Clients returned from hospital sooner: 379
Clients removed from LTC wait lists: 54
Clients diverted from LTC: 224
Clients returned to community from LTC: 18
Other SDL Findings
High client satisfactionPositively viewed by system stakeholders
High level of coordination and collaborationImprovement opportunities related to upstream
communication, continued coordination, streamlined assessment
SDL Conclusions
1. Converging evidence that the program is achieving intended outcomes
2. Freeing up acute care beds, diverting ER visits and reducing demand for LTC
Right care in the right setting at the right time for the right cost
Moving Forward
1. Continued communication and coordination
2. Improved information management3. Leverage success of both programs
Utilizing SDL MH Evaluation Results from the CHA
What Have We Built in the Land of inter-RAI C.H.A.?
MAPLe REFRESHA Learning Opportunity
A Learning Opportunity
Term
M
A
P
L
e
Definition
• Method (of)• Assigning• Priority
}Levels
www.interrai.org
John P. Hirdes, Ph.D.
Rate of Nursing Home Admissions Within 90 Days of Assessment by MAPLe Level, Ontario, Derivation Sample
MAPLe Comparisons
MAPLe Comparisons – Bricks & Mortar + MOBILE
CRUDE COMPLEXITY SCALE (CCS) REFRESH
A Learning Opportunity
Crude Complexity Scale (CCS)
3 Different summary
scales combined
CPS Score
ADL Score
CHESS Score
Understanding CCS – Random Threshold Selection
Random Threshold Selection
• CPS score of 3+(moderate to very severe cognitive impairment)
Random Threshold Selection
• ADL score of 1+ (set-up help required to full dependence)
Random Threshold Selection
• CHESS score of 2+ (moderate to high level of frailty & instability in health)
Understanding Crude Complexity Scale (CCS)
0 = None
• Does not exceed the thresholds of CPS/ADL/CHESS
1 = any single
domain
• Exceeds the threshold of either CPS/ADL/CHESS
2 = two or more domains
• Exceeds the thresholds of any 2 of CPS/ADL/CHESS
Sum the # of domains that exceed the threshold
Understanding CCS - Example
Exceeds CPS of 3+
Does not exceed
any other domain
Therefore, CCS = 1 Domain
CCS-What All SDL Looks Like
MOBILE + Bricks & Mortar CCS Comparisons
RESOURCE UTILIZATION GROUPS (RUGS) REFRESH
A Learning Opportunity
Understanding RUGS (III)
Indicates variable costs of caring for
persons with different needs
Most resource intensive is
assigned a RUGS Category
Those less resource intensive assigned a
lower level RUGS category
Those that do not fit in any of
the previous RUGS
categories, PA1 or PA2 given
Those assigned a PA1 or PA2
have lowest ADL impairment =
least resource intensive
RUGS Comparison – Which Colour is the Least Resource Intensive?
RUGS Comparison – Which Colour is the Least Resource Intensive?
Preventative Health Measures
Conclusions
Greater acuity of clients in SDL than was present in past
SDL has reduced or delayed referrals to LTC
Value (cost effectiveness & cost/benefit) for investment funding is evident
Conclusions
No SDL “MOBILE”
No SDL “Bricks & Mortar”
(1) 296 more clients utilizing
LTC beds
(2) $5.3 mill savings not
realized
Conclusions
SDL “MOBILE”
SDL “Bricks & Mortar”
(1) Viable alternative to LTC for appropriate
clients
(2) Community can support a higher level of need & risk with a “frequency” model of
care
A word about ALC & Roles of SDL
SDL a cornerstone piece of the ALC strategy
Target for the MH LHIN for 2010/2011 is 8.0% ALC utilization in Acute Care beds
Currently almost all other LHINs in Province are in double digit numbers for ALC rates
A word about ALC & Everyone’s Contribution
April 24th, 2011
5.5%
Thanks for Listening – and I Really Do Think We’ve Built a Better Model
LHIN Community Engagement Guidelines and Toolkit
April 27, 2011
55
Overview•The LHIN Role in Ontario’s Health Care System
•LHIN’s mandate to engage
•Best practices, consistent standards and performance obligations
56
57
The LHIN’s role
58
• Guided by published principles• Early identification of community/project stakeholders• Flexibility in approach – time, method, logistics
conducive to community involvement and the needs of the project
• Open & transparent process – including the sharing of inputs & outputs
• Continuous process improvement informed by evaluation
Best practices in Engagement
59
LHIN Community Engagement Guidelines and Toolkit
•Definition of Community Engagement•Definition of Stakeholders•Performance Obligations of the LHINs
60
• Community engagement refers to the methods by which LHINs and HSPs interact, share and gather information from and with their stakeholders.
• The purpose of community engagement is to inform, educate, consult, involve and empower stakeholders in both health care or health service planning and decision-making processes to improve the health care system.
• Community engagement activities can be ongoing or project specific, outbound or inbound
Defining Community Engagement
61
• Stakeholders are general public, communities, political entities or organizations that have an interest and what to share their views in the outcomes of the initiatives
• For the purpose of stakeholder identification, “communities” can be interpreted to mean geographic locations, communities of interest or communities of practice.
Defining Stakeholders
62
PerformanceObligations• An annual LHIN community engagement
strategy or plan that is publicly available and reviewed on an annual basis.• The LHIN uses the community engagement guidelines to support project
planning and decision making.• Participant evaluation must be integrated into every community
engagement plan and inform future engagement planning.• The LHIN will establish an evaluation committee including external
reviewers to which it will submit its completed community engagement templates at least once within every three- year planning cycle.
• The LHIN demonstrates how community engagement results have been tabled to LHIN decision-makers, including the Board for planning, funding and any decision-making process. Engagement can be rolled-up, where appropriate.
63
What does that mean for HSPs?
• Health service providers are encouraged to consider these principles in planning their own community engagement activities, although they are not mandatory.
Voluntary Integration• HSPs have to engage the stakeholders as part of any voluntary integration of services and a community engagement report has to be submitted with the proposed voluntary integration initiative.
64
Community Engagement Guidelines
Available on the MH LHIN website at mississaugahaltonlhin.on.ca
Transitional Aged Youth Pilot for MH LHIN
April 27, 2011
65
SIGMHA and the MH LHIN have committed to the Transitional Aged Youth Protocol and 4 month pilot
• Pilot sites: one in Halton and another in Mississauga
• May-August 2011
• 22 participating agencies are using a client-focused, case conference model.
• PDSA process to evaluate, make improvements and recommendations for a LHIN-wide transition process
The Goal of the Pilot
• Is to implement a seamless transition for young people, 16-24 years with mental health or addictions from the youth sector into the adult sector.
• In order to attain our goal, agencies and service providers are working together to proactively coordinate services and ensure a seamless transition across various services and systems.
Roles and Responsibilities• The youth case manager/counselor is the “care coordinator or system
navigator” and is responsible to transition the client in a seamless and supportive manner.
• The care coordinator to attend the first visit to the adult agency to support & mentor the client and continue follow up for 3 months.
• Agencies review the common client referral and making the commitment to accept the client into their services
• Adult agencies to make every effort to accept client based on client needs and risk, not on agency waitlists.
• Adult agencies to look at services to create a more youth friendly approach
Mississauga Pilot co-leads:• Mary Lynn Porto at Trillium Health Centre. • Lisa Bachmeier at Associated Youth Services
of Peel,
Halton Pilot co-leads:• John Smith at Support and Housing Halton. • Kjeld Thomasen at Community Youth
Programs.
Hardest part in the pilot?Is the youth with a mental health or addiction problem…
trying to transition into the adult sector.
Home First Approach
Mississauga Halton LHIN
Philosophy and Approach
•A philosophy that requires shifting the health care team mindset to consider what will it take to get patient home
•If you came from home…we will do what we can to help you return home
•Providing care at home results in better outcomes
•Always consider “home first”
•LTC should only be considered after all other options have been eliminated
•LTC is a social process and the hospital is not the right place for this transition to occur
Implementation Initiatives
•Discussions started in Spring 2007 with LHIN about how to reduce ALC – Home First was not the first solution
•Great effort was put in to improving the LTC application process…and facilitating transfers to LTC
•September 2008 LHIN and CCAC did what was counter intuitive with LTC process and started the home first discussion and implementation at Halton Health Care
•Process was quickly replicated at Trillium Healthcare and Credit Valley Hospital
Implementation Initiatives
•Changed workflow processes and identified roles and responsibilities of the health care team
•Actively promoted a culture shift through education, coaching and consistent messaging
•Leveraged enhanced community resources through LHIN investments
ALC – Now What ?
•Identify barriers that may prevent timely discharge and refer to appropriate health care professional to resolve discharge related issues
•Consistent messaging to patient and family that when acute stay is over patient will be discharged home from hospital
•CCAC CM to assess all options in collaboration with hospital healthcare team for discharge home to support patient in safe transition – maximize use LHIN investments
•If no option for patient to return home exists, then and only then does the LTC application process being. Requires review and sign off by CCAC Hospital Manager and Hospital Manager of Patient Flow
MH LHIN Investments•Wait at Home (Enhanced and Long Term Care)
-Enhanced PSW services to facilitate hospital discharge with appropriate supports at home while planning/waiting for LTC or other destinations
•Stay at Home
-Program designed to prevent hospitalization or admission to LTC-Enables clients to remain in their homes with enhanced PSW service-Limited spaces (106)…so waitlisted
•Restore Program
-Specialized LTC unit for acute patients who require additional time to enable them to return home. Patients have higher acuity than a typical LTC resident-Not acute care or permanent…meant to be transition to home
MH LHIN Investments•Supports for Daily Living (SDL)
-Service provides an average of 1.5 hours of non-medical PSW services per day available at any point through the day, 365 days/year-Hours can be split up in to multiple visits during the day (i.e., 15 minutes later in the day and 30 minutes at night)-Services are designed for clients with overnights needs or more frequent visitation than offered by CCAC-Service includes attendant care for prescheduled tasks, homemaking services and safety/reassurance checks via phone or in person-Bricks and mortar, Mobile and hub models in MH LHIN area
•Expansion of Adult Day Program:
-Creation of specialized programs identified to meet a greater need such a patients with Alzheimer’s or patients requiring bathing programs
Hospital Executive Sponsorship
•Hospital management actively promoted culture shift through education, coaching and consistent messaging
•Hospitals were involved in the discharge committees
•Each Hospital VP met with LHIN and CCAC to discuss high level ALC strategy
•LHIN crafted a letter to all hospital CEO’s and CSS sector to identify that all parties were jointly responsible for the Home First approach…so in essence a contract was formed
•Hospital Senior Leadership was heavily involved in engaging physician/allied health by continuously communicating with them to reinforce the Home First philosophy
Physician Engagement
•It is essential for senior hospital leadership to be involved in engaging physicians to reinforce key messages
•Engagement strategies include initial and follow up meetings as well as communiques with physicians
•Physicians require a hospital point person to address any concerns, discharge challenges
•Physicians were provided with a script:“your active medical treatment in hospital is complete. The
health care team will now meet with you/family to discuss discharge options. Staying in hospital is not an option”
Supporting Home First Approach - Committees
•LHIN, CCAC and Hospital VP’s meet regularly to discuss element of Home First including high level strategy, funding and sustainability
•Monthly ALC Operational Committee enacts all the plans for Home First: Committee consists of CCAC Director, Hospital Managers, CCAC Hospital Managers, LHIN ALC Strategy Lead, Community Support Agencies, and Long Term Care
Joint Discharge Operations Committee (JDO)
•Each hospital holds “Joint Discharge Operations” (JDO) meeting daily or 3x/week. Membership includes Hospital Discharge planners/social workers and CCAC Case Managers. Chaired jointly by Hospital Manager of Patient Flow and Hospital CCAC Manager
•Purpose of JDO to discuss each ALC patient, identify barriers to discharge, assign accountabilities and work toward timely discharge
Funding
•MH LHIN has committed to funding the community investments in place as long as the evidence is provided that they are providing results
•MH LHIN is continuously looking at the results where their funding is going to maximize investments (i.e. evaluating the community investments)
•MH LHIN will continue to fund CCAC for service maximums (for WAH programs) with evidence to support need. Currently have over 700 clients receiving enhanced services in the community
Risks and Challenges
•Sustaining cultural shift is the key challenge of Home First
•Home First requires a transformation change in the way healthcare is delivered
•Physician Resistance: Physicians need to be supported to understand the quality of care provided in the community
•Issues of perceived risk when sending patients home and how well the patient’s care needs will be supported
Addressing Challenges
•Must improve communication systems between community partners, hospital and CCAC (Kaizen event November 2010)
•Must be more proactive in getting clients to community programs and services
•Must focus more on admission avoidance
Results to date – 2009/10
Restore program has saved the equivalent of 35 acute care beds
250 people have been diverted from LTC placement
700+ patients discharged through Home First Approach
60% decrease in ALC-LTC days from 08/09 to 09/10
30% reduction in new LTC applications from all hospitals
10% decrease in LTC waitlist in 2009
Questions ?
Contact information:Janet ParksED/ALC Strategy LeadMississauga Halton LHINJanet.parks@LHINS.on.ca905-337-7131 ext. 226
Mississauga HaltonDiabetes Regional Coordination Centre
MH Community Services
April 27th 2011
Provider SupportDecision
Information Management Systems
Service SystemDesign
Personal Skills andSelf Management
Supports
RegionalCoordination
Centre
InterdisciplinaryCare Team Defined Roles and Responsibilities
Patient is a Partner in Care
Evidence Based Practice
Mississauga Halton Regional Diabetes Coordination Centre
Client RegistryEMR
Provider Portals
Educating the public, especially
those at risk about diabetes and ways to prevent it (ODS)
Support patients managing their disease (ODS)
Educating the public, increasing the adoption of approved practice guidelines and proven care and
treatment (ODS)
Continually improving local health coordination
(ODS)
Identifying gapsin health care and addressing them
(ODS)
Setting targets for clinical performance, enhancing
accountability and monitoring (system) performance (ODS)
Organization FrameworkMinistry of Health
And Long Term Care
Halton Healthcare Services
Diabetes RegionalCoordination Program
Regional Director Diabetes Regional Coordination Centre
Clinical OutreachCoordinator
Health InformationConsultant
Primary Care Physician Lead
Self Management Project Manager
Self ManagementCoordinator
Administrative Lead
Self Management Project Agreement
MOHLTC _ HHS
DRCC Agreement MOHLTC – HHS
MH DRCC Regional Goals• The DRCC will work with the MOHLTC to develop accessible current information
resources to support care provider/individual self management of diabetes and measurement of Mississauga Halton diabetes care system performance
– Web enable knowledge resource– Web enable secure linkages between diabetes care providers and related services– GIS based information in each sub-LHIN area
• Enable the client to be an active partner in the planning and delivery of his/her health care – Client, family and care provider education to promote use of self management tools by people
with/at-risk of diabetes and their health care professionals – workshops, certifications, CME’s
• The DRCC will promote implementation of clinical/provider interventions in the treatment of diabetes that are based upon proven best practices to
– Link Healthcare and other providers of diabetes and related to services to establish and comprehensive and connected network of quality services to individual with or at-risk of diabetes, their families.
– Engagement of physicians and other primary care practitioners in the adoption of electronic systems access and uptake in the MH LHIN.
– Standardize the approaches taken to Diabetes care in MH region to align with evidence based best practices
• Develop an integrated System of Diabetes Care capable of planning and delivering comprehensive high quality services in a coordinated and efficient manner
MH DRCC Accomplishments to Date– Provider engagement in primary care, foot care, community pharmacy,
Diabetes Education Programs, CCAC and hospitals– Service Inventories of DEP, CCAC and FHT diabetes programs– Service inventories of foot care providers and community pharmacy in
progress– Engagement of CDA, OMA and Renal Network– 3 – year Regional Plan for Implementation of ODS in Mississauga
Halton– Newsletter Release in May– Completion of capacity analysis for MH region diabetes services– Establishment of key networks
• Diabetes CONNECT – a network of leaders in diabetes programs• Foot Care Network – cross region representatives from foot care sector• Community Pharmacy Network – cross region pharmacists keenly interested
in advancing the potential of community pharmacy• Primary Care and Endocrinology engagement
Initial High Level Inventory FindingsInventory of Diabetes Education/Management Programs/Family Health Teams
CCAC, Chiefs of Family Practice – November/January 2010• MH region is well resourced re: diabetes education programs (5) but programs are not always located close
to needs, nor do they offer the same services – Funding resources widely vary– Mix of Pubic and Private models
• Family Health Teams (7) vary with respect to their vision for care, especially Chronic Disease, and how effectively they use their internal diabetes management resources but generally potential resources are available for growth and development,
• Referral to diabetes programs in Halton are slightly declining, while referrals are growing in Mississauga neither pattern is well understood at this point (total patients in 2009 - 22,650 of 76,658 people with diabetes are registered in Diabetes Education Programs and/or through FHT services, likely includes double reporting)
• A common referral form and care pathway is needed to ensure access and follow up for patients and families
• Diabetes/healthcare provider roles are not clearly understood nor are they consistently utilized
• Services are not easy to find for clinicians or clients
• Information is offered in many different ways (good!) but messaging is not always consistent (not so good!)
• Web enabled services offer excellent potential for patient learning, skill development and communication between care givers…and patients but are not in use (except in isolated cases)
• We have great opportunities to develop an excellent service system in MH Region!
MH Region and Diabetes
Diabetes Prevalence in MH Region 8.8%/76,658 people (9th highest)
Diabetes Prevalence in Ontario 9.3%/961,204 people
Percent of Ontarians with Diabetes Who Received Tests within Guideline Periods
0%20%40%
60%80%
100%
Test for HbA1c Test for Lipid (LDL-C) Retinal Eye Exam All 3 tests within timelines
0%20%40%
60%80%100%
Ontario MH Region Target
TARGET
MOHLTC/ICES – October 2010Does not include hospital lab data
Working with the DRCC Partnership Opportunities
Promotion of evidenced based clinical/service provider best practices
Healthcare consumer education and skill development
Public and provider information sharing
Measure Ontario MH Region Ranking Comment
Number % Number % N=14
Est. # People with Diabetes 961,204 9.3% 76,658 8.8% 5 Aug-10
Rate of Inactivity (2008-09) 51.2% 50.8% 7 2008-9
% Overweight/Obesity (BMI 25+) 51.7% 45.4% 2 2008-9
% People Attached to Primary Care MD
96.4% Not available
Physician Use of Incentive Management Codes
36.9% 33.8% 11 March 2010 MD payment for quality care
ER visit for hyper/hypoglycaemia per 100,000 pop with Diabetes
1,111 783 3 Aug-10
Dialysis rate per 100,000 pop. with diabetes
780 692 3 2008-9
Infection/ulcers/amputation per 100,000 pop. with diabetes
3,244 2,692 2 2008-9
Heart Attack per 100,000 pop. with diabetes
1,163 829 1 2008-9
Other Measures of Interest – ICES, October 2010
Self Management (SM) and SM Supports are core components of Ontario’sChronic Disease Prevention and Management Framework - Each LHIN hasa SM strategy in place, based with the DRCC in MH Region – Project fundingto support regional programs has been provided in 2011-12 for one year.
PROVINCIAL GOALImproving health outcomes for Ontarians through the provision of selfmanagement education and skills training to • individuals with chronic disease and • Healthcare and community service professionals and staff
Mississauga Halton Self Management Strategy/Project
Self Management Goals for MH LHIN• 300 individuals through Maximize Your Health Programs offering
Stanford model
– Generic ‘evidence based’ program offering life skills including positive thinking, communication, goal setting, problem solving, working with healthcare professionals, nutrition, exercise, peer support
– Taught by certified leaders (clinicians and volunteers experiencing chronic disease)
– 25 6-week workshops/2.5 hour sessions/12 people
– Materials and instruction at
Healthcare/Service Provider Training• 300 Clinicians/Staff offered ‘Choices and Changes’ evidence based
model developed by the Institute for Healthcare Communication Canada
– Communication skills aimed at reinforcing self management during clinical interactions
– 4.5 or 6 hours sessions direct instruction offered at sites of employment or alternate locations
– 150 clinicians/staff will receive follow up mentoring through on-line, direct session, peer study applied to work setting
– Materials and instruction at
In order to build regional training capacity, the MH DRCC Self Management
Strategy also includes
• Opportunities to become certified leaders for individual based programs AND opportunities to become certified staff trainers without costs, all training related expenses are supported including
– Travel and accommodation
– Tuition
– Materials
– Training opportunities to consolidate skills
For more information please Contact the MH DRCC Self Management Strategy
Megan Suddergaard, Project Manager905-338-4432 Ext. 4872msuddergaard@haltonhealthcare.on.caOr,Betty Clara, Project Coordinator905-338-4432 Ext. 4871bclara@haltonhealthcare.on.ca
Please take a
Business Card
mailto:msuddergaard@haltonhealthcare.on.camailto:bclara@haltonhealthcare.on.ca
Mississauga Halton LHINIntegration Framework
CSS and MH&A Quarterly MeetingApril 27, 2011
LHIN Integration
LHINS are responsible for taking care of the full range of people’s health care needs. No one organization or
sector can create the continuum of services that people need. LHINS are the local group that
organizes services together, fill in gaps and help people access the services they need.
103
Integration: Why?
• The LHIN is responsible for planning, funding and integrating its local health system.
• LHSIA provides the tools that enable the LHIN to fulfill its statutory obligations.
• However if the LHIN doesn’t recognize when to use these tools, the LHIN may miss opportunities.
104
Integration: Why?
• Improve the patient experience.
• Optimize access to care and coordination of services – “Right care, right time, right place.”
• Administer a safe, high quality health care system.
• Ensure public accountability, transparency and stewardship of public resources.
105
Legislative Context• The Local Health Services Integration Act, 2006 (LHSIA) S.24
provides that each LHIN and each health service provider (HSP) shall separately and in conjunction with each other identify opportunities to integrate the services of the local health system to provide appropriate, co-ordinated, effective and efficient services.
• The LHSIA S.23 broadly defines a “service” to include all services or programs provided by HSPs to the public:
• A service or program offered directly to people
• A service or program supporting a direct service (laundry)
• A function that supports an organization that provides either a direct or a supporting service or program (payroll).
106
Legislative ContextThe LHSIA S. 2 defines “integrate” to include:
•Coordinating services/interactions between different persons and entities
•Partnering with others in providing services or conducting operations
•Transferring, merging or amalgamating services, operations, or entities
•Starting or ceasing to provide services
•Ceasing to operate, dissolving or winding-up operations
107
LHSIA provides LHINs, the Minister and HSPs with several tools to integrate services:
Integration Type Description
LHIN FundingLHSIA S.19
The LHIN uses its funding authority to promote integration of services with/between HSPs.
Facilitated/Negotiated IntegrationLHSIA S.25
The LHIN and/or HSPs explore appropriate integration strategies and the LHIN facilitates or negotiates integration with the HSPs. LHIN issues a written integration decision.
Required Integration LHSIA S.26 The LHIN orders HSPs to integrate services.
Voluntary IntegrationLHSIA S.24 & 27
A HSP at their own initiative, plan to integrate services funded by the LHIN. LHIN may issuea stop order within 60 days
Minister’s OrderLHSIA S.28
The Minister orders a HSP to integrate i.e. cease to operate, dissolve, wind-up its operations, amalgamate or transfer operations.
108
PatientExperience
Back-office / Non-clinical
Clinical Services
Organizational
Awareness Coordination Full Integration/ Amalgamation
Mississauga Halton LHINIntegration Framework
LEVEL
CAT
EG
OR
Y
109
MH LHIN Integration Framework
• Incorporates patient-focused, high-quality care concepts, as per “Excellent Care for All” and other provincial strategies.
• Assists in organizing and assessing the value of current integration initiatives.
• Enables the identification and prioritization of future integrations.
110
Integration: LevelsConsolidation of responsibilities, resources, and financing in a
single organization or system
Structured, inter-organizational collaboration; allowing providers to retaining separate business models and/or entities
Informal or formal exchange of knowledge, best practices, policies and proceduresAwareness
Coordination
Full Integration / Amalgamation
111
Back Office / Non-clinical• IT infrastructure• Finance and Accounting• Purchasing• Administration & HR
Clinical Services• Clinical practices & standards• HHR• Delivery of service
Organizational• Relationships between organizations (e.g. MOUs)• Polices and procedures• Vision & Mission• Organizational culture
Integration: Category
112
Integration: Principles
Improving the patient experience• Increasing patient satisfaction.
• Promoting client engagement and empowerment.• Reducing caregiver burden.
• Maximizing quality of life.
113
Integration: Principles (cont.)Optimizing access to care and coordination of
services – “Right care, right time, right place”
• Determining appropriate capacity and siting of services• Delivering equitable and fair service• Reducing unnecessary touches in the system and
duplication of service• Optimizing handoffs and reducing wait times
114
Integration: Principles (cont.)Administering a safe, high quality healthcare system
• Maximizing positive health outcomes• Eliminating adverse events• Integrating evidence-based best practices and
standardized care• Establishing “Centres of Excellence”; culture of sharing,
continuous improvement and innovation
115
Ensuring public accountability, transparency and stewardship of public resources
• Fiscally accountable, value-added, cost-effective service delivery
• Properly administered service agreements and obligations
• Efficient and effective performance evaluation and risk assessments
• Maintained, responsive and accurate performance monitoring systems
Integration: Principles (cont.)
116
Integration Type: MH LHIN ExamplesIntegration Type Examples
LHIN FundingLHSIA S.19
Clinical : Regional Specialized Geriatric ServicesEnhanced Community Palliative CareLTC Behavioural Unit
OrganizationalRegional Antibiotic Stewardship Program
Back OfficeMedworxx Clinical Utilization Tool
Facilitated/Negotiated IntegrationLHSIA S.25
Back OfficeCommon IT/IM Director for THC & CCAC
Required Integration LHSIA S.26 N/A
Voluntary IntegrationLHSIA S.24 & 27
ClinicalRegional Renal Program
OrganizationalRegional hospital physician Credentialing
Back OfficeShared Hospital DI Scheduling co-ordination
Minister’s OrderLHSIA S.28 N/A 117
Integration: Future Opportunities
Integration Opportunities under consideration for 2011/12Clinical Services
Regional Complex Continuing Care and Rehab ServicesEnhanced CCAC role
OrganizationalPalliative Integrated Client Care Project
Back Office/ Non-clinicalE-referral Resource Matching & Referral (RM&R) tool
118
An Update from the MH LHIN Steering CommitteeApril 27th, 2011
Every client who receives Community Support Services (CSS) will have an initial standard assessment and appropriate reassessments completed according to established guidelines.
This will:◦ Enable appropriate care planning and service
navigation◦ Ensure the right service at the right time◦ Facilitate data sharing and reduce repeated story
telling◦ Provide high quality data for reporting at
client/HSP/LHIN/Provincial levels◦ Identify potential areas for process redesign and
streamlining
CCIM engaged to support rollout of interRAI-CHA to CSS Sector across Ontario
Time-limited project
Originally project timeline extended by 8 months
Provincial CAP project to conclude December 2013
Some larger Provincial and/or National CSS Agencies have opted out of a regional implementation and chosen to work with CCIM from a Provincial level
Goal is to achieve efficiencies and consistency in implementation across the Province
Includes:◦ Red Cross◦ VON◦ CNIB◦ Ontario March of Dimes◦ Canadian Hearing Society
MH LHIN EA’s unique in the Province as only SDL Program implemented not agency-wide
EA’s provided opportunity to enroll in modified training with CCIM OR take full module training with Phase 1 group
EA’s began CSS CAP training with CCIM in November 2010 and will be completed in May 2011
The screener tool should:◦ Capture a minimum data set for all CSS clients
(quick snapshot)◦ Help to navigate clients to the right door(s) for
service◦ Identify need for further assessment◦ Identify risk
Goal is to avoid unnecessary over assessment of a client
Provincial Working Group evaluated 4 screener tools
None of the tools met all purposes Recommended 1 tool met most of the criteria Recommendation included testing the draft
tool to ensure its appropriateness for its diverse use within the CSS sector
Provincial Steering Committee recommendation still before MOHLTC awaiting approval
interRAI-CHA Either CHA or Screener Screener Assessment Recipient
Adult Day Services, Personal Support, Respite,
Assisted Living, Supportive Housing,Attendant Outreach, Caregiver Support
Caregiver Support, CrisisIntervention, Homemaking,Overnight Care
Meals on Wheels, Congregate
Dining, Transportation, Home Maintenance, Vision Impaired Services, Deaf, Deafened and Hard of Hearing Care Services
Psycho Geriatric, Aphasia,Hospice
interRAI – CHA Clients requiring comprehensive
assessment to inform care planning – ADL/IADL
support EitherClients may require a
screener or a comprehensive
assessment
ScreenerClients requiring
single service for low intensity support
Assessment RecipientClients have completed assessment – program
supports care plan
MH LHIN Steering Committee assigned MH LHIN CSS agencies (in some cases, programs) to either Screener or interRAI-CHA categories based on:◦ Complexity of needs of clients served◦ Model of service delivery
Some agencies have programs that fall into both interRAI-CHA and Screener◦ Begin with the CHA and implement Screener for
programs as necessary later
Steering Committee learned portion of funds was available to support CHA implementation in 2010/11 (also some funds available in 2011/12)
Removed CSS Agencies in MH LHIN from 10/11 funding pool:◦ Early Adopters (previously funded)◦ Provincial Implementers (funded at Provincial level)◦ Screener Agencies (to be funded at later date)
Informally surveyed those agencies left to see if they were ready or eager to implement quickly (able to spend some funds prior to March 31, 2011) – those became Phase 1 group
Those who were not ready to implement quickly were placed into Phase 2 group – eligible for 2011/12 funds
Steering Committee set out allotments to fund for hardware and software licenses (based on previous experience with Early Adopters) from 2010/11 implementation funding
Late in process learned that software licensing allotment may not be enough to support newpurchase of vendor software – need more time to evaluate
Decision: Hardware - fund Phase 1 and some Phase 2 agencies for hardware to support implementation from 2010/11 funding
Decision: Software - only fund Phase 1 agencies who require licensing for existing software from 2010/11 funding
MH LHIN Phase 1Group◦ kick-off on May 5th , 2011◦ complete implementation by October 27th, 2011
MH LHIN Phase 2 Group ◦ dates still to be confirmed◦ Projected to begin late August 2011 and conclude in February 2012
Provincial Working Group met 2 days in January 2011 and 2 days in March 2011
Developed Guiding Principles, Benefits, Definitions and Evaluation Criteria
Drafted a shared assessment model – model to be finalized in May and presented to Provincial Steering Committee for approval at May meeting.
Funds were provided to develop training centre for use by all CSS providers in MH LHIN to support the Common Assessment Project
Hardware was purchased prior to March 31, 2011 to furnish the Centre
Space is provided by Alzheimer’s Society of Peel
Location is: 385 Brunel Road, Mississauga, ON L4Z 1Z5 (Kennedy & Britannia) Software/licensing still to
be determined
CCIM has developed some useful resources –can be found on their website:
www.ccim.on.ca(select CSS, then interRAI-Community Health Assessment, then
select “Member Area”)
Includes materials in the following areas:Forms and GuidesPreparing for ImplementationManaging ImplementationEducation and TrainingTechnologyPrivacy and Security
http://www.ccim.on.ca/
LHIN newsletters: In Progress◦ Highlights CCIM Common Assessment project activities
(IAR, CSS CAP, CMH CAP, and LTCH CAP)◦ Timing: Quarterly◦ Audience: LHINs and HSPs◦ Available: https://www.ccim.on.ca/LHIN/default.aspx
CSS CAP Updates◦ Provides information regarding CSS CAP Steering
Committee decisions and implementation progress across the province
◦ Timing: Every 2 months◦ Audience: CSS Sector◦ Available: https://www.ccim.on.ca/default.aspx
https://www.ccim.on.ca/LHIN/default.aspxhttps://www.ccim.on.ca/default.aspx
Name Agency Service AreaTheresa Greer Heart House Hospice HospiceAllison Price LInks2Care Various (Home Help, Home
Maintenance, SH, Respite etc.)Lorena Smith Seniors Life Enhancement
CentresAdult Day Services
Laurie Martovich Region of Halton Adult Day Services & SDLJoanne Hawkins Acclaim Health Home Care Support ServicesChris Rawn Kane Alzheimer Society of Peel Specialized SupportCaroline Countryman VON Home Care Support Services &
SDLSteve Kavanagh Peel Senior Link SDLLisa Gammage Nucleus Independent Living SDL & Attendant OutreachJudy Bowyer MH LHIN N/aAshim Rizki CCIM N/a
Mississauga Halton LHIN�CSS and MH&A Sector Meeting�Slide Number 2MHLHIN �Financial Update�Slide Number 4 Finance Update � Finance Update � Finance Update �Questions Study Overview Data Sources Data Quality Restore Restore: MAPLe Scores Declined Restore: CHESS Scores Declined Restore: Locomotion Scores Improved Other Restore Findings Restore Conclusions Supports for Daily Living Supports for Daily LivingHospital Use (Prev. 90 Days)CHESS�(Changes in Health, End-Stage Disease & Signs & Symptoms) SDL Mobile Other SDL Findings Other SDL Findings SDL Conclusions Moving ForwardUtilizing SDL MH Evaluation Results from the CHAMAPLe RefreshA Learning Opportunity Slide Number 33Rate of Nursing Home Admissions Within 90 Days of Assessment by MAPLe Level, Ontario, Derivation SampleMAPLe ComparisonsMAPLe Comparisons – Bricks & Mortar + MOBILECrude Complexity Scale (CCS) RefreshCrude Complexity Scale (CCS)Understanding CCS – Random Threshold SelectionUnderstanding Crude Complexity Scale (CCS)Understanding CCS - ExampleCCS-What All SDL Looks LikeMOBILE + Bricks & Mortar �CCS ComparisonsResource Utilization Groups (RUGS) RefreshUnderstanding RUGS (III)RUGS Comparison – Which Colour is the Least Resource Intensive?RUGS Comparison – Which Colour is the Least Resource Intensive?Preventative Health MeasuresConclusionsConclusionsConclusionsA word about ALC & Roles of SDLA word about ALC & Everyone’s ContributionThanks for Listening – and I Really Do Think We’ve Built a Better ModelLHIN Community Engagement �Guidelines and Toolkit��April 27, 2011OverviewSlide Number 57Slide Number 58Slide Number 59Slide Number 60Slide Number 61Slide Number 62Slide Number 63Slide Number 64Slide Number 65Slide Number 66The Goal of the PilotRoles and ResponsibilitiesSlide Number 69Hardest part in the pilot?Home First Approach�� Mississauga Halton LHIN��Philosophy and ApproachImplementation InitiativesImplementation InitiativesALC – Now What ?MH LHIN InvestmentsMH LHIN InvestmentsHospital Executive SponsorshipPhysician EngagementSupporting Home First Approach - CommitteesJoint Discharge Operations Committee (JDO)FundingRisks and ChallengesAddressing ChallengesResults to date – 2009/10Questions ?Mississauga Halton�Diabetes Regional Coordination CentreSlide Number 88Organization FrameworkMH DRCC Regional GoalsMH DRCC Accomplishments to DateInitial High Level Inventory Findings�Inventory of Diabetes Education/Management Programs/Family Health Teams�CCAC, Chiefs of Family Practice – November/January 2010MH Region and DiabetesSlide Number 94Slide Number 95Slide Number 96Mississauga Halton Self Management Strategy/ProjectSlide Number 98Slide Number 99Slide Number 100Slide Number 101Mississauga Halton LHINLHIN Integration Integration: Why?Integration: Why?Legislative ContextLegislative ContextLHSIA provides LHINs, the Minister and HSPs with several tools to integrate services:Mississauga Halton LHIN�Integration FrameworkMH LHIN Integration FrameworkIntegration: LevelsIntegration: CategoryIntegration: PrinciplesIntegration: Principles (cont.)Integration: Principles (cont.)Integration: Principles (cont.)Integration Type: MH LHIN ExamplesIntegration: Future Opportunities CSS Common Assessment ProjectCSS CAP Overall ObjectiveProvincial TimelineProvincial ImplementationEarly AdoptersPurpose of a Screener ToolSelection of a Screener ToolCSS Assessment Needs by Client & ProgramScreener vs. CHA in MH LHINCSS CAP Implementation Funding 2010/2011Phase 1 vs. Phase 2Funding Plan ChangesCHA Implementation TimelinesShared Assessments UpdateIntegrated Assessment RecordRegional Training CentreHelpful ResourcesAdditional ResourcesQuestionsMH LHIN CSS CAP Steering Committee
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