The following are the highlights of the Champlain Local Health Integration Network (LHIN) Board of Directors meeting held at the Eastern Ontario Health Unit in Cornwall, Ontario on October 25, 2017.
Performance Report for First Quarter 2017-18
The Champlain LHIN analyzes the performance of the health system each quarter in a report that focuses on 13 indicators. As part of our agreement with the Ministry of Health and Long-term Care, these indicators reflect how well Champlain’s regional health system is doing in a number of areas: home and community care, system access and integration, quality and sustainability of care, and health and wellness.
The performance report for the first quarter of 2017-18 (April to June 2017) illustrated a number of positive developments. For example, the length of time spent in the emergency department decreased for patients with complex issues. As well, the rate of repeat emergency room visits decreased for people with problematic substance use. Allison Lampi (Champlain LHIN Senior Performance Specialist) told the Board about a relatively new, Champlain LHIN-funded outpatient clinic at The Royal that is helping people with addictions issues, including those who return to the emergency room frequently.
The Alcohol Medical Intervention Clinic provides quick follow-up services for people with significant, potentially life-threatening alcohol problems. The clinic, a two-year pilot project that opened in May 2016, provides medically supported withdrawal management for people who are referred by The Ottawa Hospital’s emergency department. It was developed collaboratively with the LHIN, The Ottawa Hospital, The Royal, Montfort Renaissance, Canadian Mental Health Association, primary care providers and other community partners, such as the Ottawa Paramedic Service.
Clients receive assessment, triage, treatment, and transitions to appropriate levels of care (sometimes rapid admission to medically managed inpatient beds), and navigation to other addiction services, including connection to a primary care provider, if needed. According to a September 2017 evaluation report on the clinic, there was:
- A statistically significant reduction in the severity of alcohol use and in mental health symptoms in the 30 days after clients present to the clinic
- An 80% reduction in repeat visits for clients in the program who had more than two visits to the emergency room in the previous 30 days, and
- An overall 10% reduction in alcohol-related emergency visits at The Ottawa Hospital, compared to the previous year.
The first-quarter 2017-18 performance report also showed where improvements are needed in the health system. For example, there is still work to do to discharge hospital patients to alternate levels of care after they have completed their acute-care treatment. To help address this, the LHIN is planning new ways to distribute and expand certain services, as outlined in the Champlain LHIN Sub-Acute Care Capacity Plan, which proposes the realignment of resources such as rehabilitation, complex continuing care, and convalescent care.
This performance report supports the LHIN’s strategic direction of sustainability - increasing the value of the health system for the people it serves.
Sub-Region Population Health Profiles Report
In the months since sub-regions were established, the Champlain LHIN and health system partners - including public health, hospitals, and community health-service providers - collaborated to develop helpful data for each sub-region. The result of these efforts, the Sub-Region Population Health Profiles Report, provides key indicators that impact the health of Champlain LHIN residents.
The LHIN Board learned about this new resource from Louise Simmons (Manager of Foundational Standards, Eastern Ontario Health Unit) and Brian Schnarch (Special Advisor and Manager, Health System Performance, Champlain LHIN).
There are five sub-regions in Champlain: Western Champlain, West Ottawa, Central Ottawa, East Ottawa, and Eastern Champlain. The goal of the report is to provide baseline information that helps identify each sub-region’s strengths, challenges, and needs. It supports priority setting and planning, and is intended to be a general resource for stakeholders. The report includes information on population characteristics and health status, distribution and capacity of health service providers, and system performance. Some highlights include:
- Population Characteristics. The Champlain LHIN, compared to Ontario, has a much higher proportion of Francophones, particularly in the Eastern sub-regions. Central Ottawa is the most culturally diverse area, with the highest proportion of visible minorities, immigrants, same sex couples, and people with a mother tongue other than English and French. Eastern Champlain and Western Champlain have proportionately fewer visible minorities and immigrants.
- Population Health Status. Chronic disease rates overall in Champlain are comparable to the provincial averages, with rates generally lower in the three Ottawa sub-regions and higher in Western Champlain and Eastern Champlain. The incidence of Chronic Obstructive Pulmonary Disease (COPD) also shows wide variance across the region, with the highest rates in Eastern Champlain and, in particular, in the Cornwall area.
- Distribution and Capacity of Health Service Providers. In general, health care services are clustered in Central Ottawa. Most of the Central Ottawa providers, however, serve large numbers of clients and patients from other areas. Western Champlain has the fewest family practitioners on a per capita basis, followed by Eastern Champlain. Eastern Ottawa has the highest proportion of people who seek primary care in other sub-regions.
- System Performance. The rate of hospital readmission within 30 days for certain chronic conditions is impacted by a patient’s health, the quality of hospital care, discharge planning, the effectiveness of handoffs between hospitals and primary care, and the accessibility and quality of supports in the community. Champlain, as a whole, performs better than Ontario on this indicator. The best performing sub-regions related to hospital readmissions are Eastern Ottawa and Western Ottawa.
The report also includes information that is specific to:
- People in different socio-economic groups
LHIN Board Chair, Jean-Pierre Boisclair, expressed his appreciation to the LHIN and its partners for their extensive efforts in putting together such a thorough and insightful report. “We are thankful to have the talent, the partners and the collaboration needed to dig into this data. You have provided us with relevant, meaningful information, which is what we need to make evidence-based decisions about our health care system.”
Work that supports sub-regions aligns with the LHIN’s mission of building a coordinated, integrated and accountable health system for people where and when they need it.
Limoges Health Hub
“As we move forward with our work in sub-regions, the development of the Limoges Health Hub is a great case study of what can happen when you work at the community level - harnessing local stakeholders, knowledge and resources to improve health care,” said Cal Martell, Champlain LHIN Vice President of Integration. Mr. Martell then introduced Shirley Racine, President, Limoges Health Hub Volunteer Committee, who spoke to the LHIN Board about how a local group brought the vision of a health hub to life.
Limoges is a community situated 30 minutes east of Ottawa in the Nation Municipality of Prescott-Russell. With no health services available in the municipality, residents of this rapidly growing town had to travel to surrounding communities or Ottawa to receive emergency services and other health programs. Limoges’ population expanded from 1,250 in 2008 to 4,500 this year, and it continues to grow. Identifying a significant need, in 2012, a group of concerned citizens organized themselves around the idea of creating a local health hub.
“We knew that people were buying land and the developers were coming, we knew we needed to do something. When we consulted with people in our community, we heard that they needed doctors, but also needed other services – things like speech therapy and a local pharmacy,” Ms Racine said, explaining that in particular, the numbers of seniors and young families were on the rise.
Shirley Racine addresses the LHIN Board
and meeting attendees
The group first approached the Champlain LHIN in 2015 to improve its understanding about how health services are organized, and how that fit with their dream of creating a health hub in Limoges. The evolution of those conversations included securing the interest of the LHIN-funded community health centre, Centre de santé communautaire de l’Estrie (CSC Estrie), to provide inter-disciplinary primary care in Limoges. Perhaps most importantly for that community where 75% of its residents are Francophone, CSC Estrie provides these services in French.
More than 325 people attended the official grand opening of the Limoges Health Hub on October 13, 2017. The hub provides a wide range of services, including primary care, dental care, pharmacy, mental health, social services, diabetes care, and more. The new 15,000 square foot, three-story complex was made possible with publicly and privately-funded partners, including Nation Municipality, Prescott-Russell Community Development Corporation, Desjardins Caisse populaire Trillium, Limoges Citizens Committee, Saint Joseph Developments, KB Media Corporation, Government of Ontario, and the Champlain LHIN.
When describing the hub’s activity, Ms. Racine explained, “We have over 400 patients in our dental clinic; 550 people who’ve transferred their nearly 2,000 prescriptions to the pharmacy; CSC Estrie is active and already out in the community to determine the additional programming that is needed. Beginning in September, doctors started seeing patients. There are currently four physicians with a caseload of approximately 500 patients each. There will be eight physicians at the hub by the end of April 2018. The physicians are sending their patients downstairs to CSC Estrie to benefit from their programs, like diabetes clinics. They are working together - it’s a real beehive; a real hub – the energy is incredible. We are very, very proud and we thank the LHIN for its support,” she said.
Community Stroke Rehabilitation Program in Eastern Champlain
The Community Stroke Rehabilitation Program in Stormont, Dundas, Glengarry and Akwasasne began in April 2016 to address the limited access to outpatient stroke-rehabilitation services in our region. Prior to the existence of this new program, there was only one outpatient clinic located in Ottawa at Bruyère Continuing Care - Élisabeth Bruyère site (there are currently three inpatient stroke-rehabilitation sites at Pembroke Regional Hospital, Bruyère Continuing Care - Élisabeth Bruyère site, and Glengarry District Memorial Hospital).
The program is the result of the collaborative efforts of multiple stakeholders, including the LHIN, Centre de santé communautaire de l’Estrie, Seaway Valley Community Health Centre, Cornwall Community Hospital, Glengarry District Memorial Hospital, Champlain Regional Stoke Network, and the Life After Stroke Support Group in Alexandria.
|Jeanne Bonnell and Leah Bartlett
Champlain LHIN Senior Integration Specialist, Leah Bartlett and Clinical Care Manager, Jeanne Bonnell, provided the LHIN Board with highlights of the community program. As of March 2017:
- With a focus on individual client goals and integration into community programs and services, 76 clients recovering from stroke received intense, time-limited rehabilitation services once or twice weekly for 8 – 12 weeks in their home and/or the community clinic at Centre de santé communautaire de l’Estrie in Cornwall.
- The majority of clients received occupational therapy and physiotherapy, followed by speech-language and social work support. Once they completed the program, clients were connected to services in their communities, as needed – for example, to a stroke exercise program.
- Preliminary analysis showed overall improvement in all clinical outcome measures including depression, ability and satisfaction with performing everyday tasks, and reintegration to normal living post stroke (i.e., physical, social, psychological elements).
- Based on a patient-experience survey, the program received high ratings: 92% rated the program as excellent/very good overall, 96% agreed they can now manage their condition and recover after stroke, 100% agreed the therapists provided them with good advice and information to help manage their conditions and recovery at home.
An expansion of the community stroke-rehabilitation program is being reviewed as part of the implementation of the Champlain LHIN Sub-Acute Capacity Plan.
Champlain LHIN CEO, Chantale LeClerc, explained that in 2014, the LHIN discussed the need for stroke rehabilitation with stakeholders. “Some said the solution was more beds,” she said. “But when the LHIN did more research into the data, we discovered there were stroke patients in hospital beds who would benefit more from outpatient rehabilitation services in their community – but the option wasn’t available ... This is a perfect example of the role of the LHIN: digging deeper into the data; segmenting the population, looking to see if there is more than one option to make the best use of our resources to meet patient needs. This is definitely a success, and we are looking at how we can expand programs like these.”
The outpatient stroke-rehabilitation program supports the LHIN’s strategic direction of access - ensuring health services are timely and equitable.
Home and Community Care Update
Catherine Butler, Champlain LHIN Vice President of Home & Community Care, provided an update on home and community care to the LHIN Board. She shared that the home and community care management and care coordination teams have been aligned to support each of the five sub-region geographies.
Ms. Butler also explained that efforts are being made to modernize the home-care model. “At least in this province, we have a model of home care and care coordination that was designed 20-30 years ago, and since then the model has changed incrementally. Modernizing is what we need to do to drive us forward, and provide better services to our patients and families in the region. The current model doesn’t meet the needs of the often complex patients we are seeing today.”
Research is ongoing into what the new model would look like. So far, it shows the new model will need to be more holistic and include a focus on wellness. To support the new model, there will need to be other key changes, including more:
- Integration (for example, with public health and the other areas of health care that are working with patients to understand and respond to health care trends)
- Education and skills development for people working with patients to understand and support the new model; and
- Technology advances that make the most of resources while supporting direct client care.
The next steps are to develop a concept paper, which will be brought to the LHIN’s executive leadership team for review and discussion. Board Chair Jean-Pierre Boisclair said, “We are delighted that this process is now underway. This is the beginning of something very exciting for patient-centred care.”
This work supports the LHIN's strategic direction of sustainability – increasing the value of our health system for the people it serves by continuing to implement innovative models of care.