L-SAA 2013-2016 Indicators An Overview Ernie Jodoin Advisor, Quality and Risk Management HNHB LHIN January 10-11, 2013
2013-16 L-SAA Performance Framework Indicators Reflect Select Pan-LHIN System Imperatives : • Enhancing Coordination and Transitions of Care • Maintaining Achievements in Access, Accountability & Safety • Ensuring Sustainable Organizational Health Local Indicators Reflect HNHB LHIN System Priorities • Embedding a Culture of Quality – Improving Patient Experience • Best Practices…Integrating Service Delivery 2
Indicator Classifications Performance • Are associated with a target and standard and/or performance benchmark • Are valid, feasible measures of system performance Explanatory • Are complementary indicators – non performance • Support planning, negotiation or problem-solving at the provincial or LHIN level • Data will be provided through existing reporting systems • Health service providers will not be required to report on these through SAA reporting requirements. 3
Pan LHIN “Ontario” L -SAA Performance Indicators Pan LHIN System Imperative / Key Result Indicators Indicator Classification Area Enhancing Coordination and Percent Occupancy/ Performance Transitions of Care Long – Stay Utilization Maintaining Achievements in Median Wait Time To Access, Accountability & Explanatory Placement In LTCH Safety Compliance Status Performance Ensuring Sustainable Debt Service Coverage Explanatory – Year 1 Organizational Health Ratio Performance Year 2,3 4
Local HNHB LHIN Performance Indicators HNHB LHIN Priority Indicators Indicator Classification Development of a Embedding a Culture of Quality Improvement Quality – Improving Patient Plan (QIP) in Performance Experience Partnership with the HNHB LHIN Embedding a Culture of Training in the Health Quality – Improving Patient Performance Care Consent Act Experience 5
Status of Other Quality Indicators • Pressure ulcers, bladder control, falls, … • These quality indicators will not be part of the 2013-2016 L-SAA Performance Framework. • Will be maintained as part of provincial quality initiatives across the sector (e.g., HQO). 6
Pan LHIN Indicators - Imperative & Objective Enhancing Coordination and Transitions of Care • Objective: To Reduce ALC* Days • Indicator: Percent Occupancy/Long – Stay Utilization • Status: Performance Indicator 7
Enhancing Coordination and Transitions of Care Percent Occupancy/Long – Stay Utilization (Performance) • Higher occupancy rates will help alleviate ALC days in hospitals for those patients waiting for LTC placement. • This indicator, in conjunction with compliance monitoring, would provide an indication of a home's viability. • Considerations include the homes' legislative requirement and ability to accept referrals from the CCAC and the requirement to maintain 97% occupancy for full funding. 8
Pan LHIN Indicators - Imperative & Objective Maintaining Achievements in Access, Accountability & Safety • Objective: To Reduce Avoidable Hospital Admissions and Length of Stay (LOS) • Indicator: Median Wait Time To Placement In LTC Home • Status: Explanatory Indicator 9
Maintaining Achievements in Access, Accountability & Safety Median Wait Time To Placement In LTC Home (Explanatory) • Indicator Rationale (Reduce Admissions/LOS) • The Work Group supported this indicator as a system level indicator. Would help bring partners together to discuss improvement efforts • Additional work is underway to explore wait time indicators that provide increased focus on Long Term Care home activity 10
Pan LHIN Indicators - Imperative & Objective Ensuring Sustainable Organizational Health • Indicator: Compliance Status • Status: Performance Indicator • Indicator: Debt Service Coverage Ratio • Status: Explanatory Indicator Year 1, Performance Year 2 & 3 11
Ensuring Sustainable Organizational Health Compliance Status (Performance) • This indicator has been carried forward from the previous (2010-13) L-SAA Performance Framework. • In conjunction with Percent Occupancy/Long – Stay Utilization, it will provide information regarding the home's organizational health and viability. • The Compliance Status indicator captures activities in 11 key areas (see applicable “ Technical Specifications” for detailed listing). 12
Ensuring Sustainable Organizational Health Debt Service Coverage Ratio (Explanatory Year 1, Performance Year 2 & 3) • Debt service coverage measures the ability to pay obligations related to long-term debt principal payments and interest expense. • A positive value greater than 1.0 indicates cash flow greater than current fixed charge payments. • A positive value less than 1.0 (or a negative value) indicates cash flow less than current fixed charge payments. 13
Technical Specifications Percent Occupancy/Long – Stay Utilization Description : Percentage of Long-stay Long-Term Care home beds occupied by clients (adjusted for Long-Term Care homes where bed openings or closings are occurring) in the LHIN/CCAC area on the month-end report date. Effective July 2010, Long-Stay Utilization excludes interim beds. Calculation : Average number of Long-stay Long-Term Care home beds occupied by clients (adjusted for Long-Term Care homes where bed openings or closings are occurring) in the LHIN/CCAC area based on three month-end data. Data Source: OCCM (Occupancy Monitoring Database) Inclusions/Exclusions : Includes : # of Occupied Long Stay beds i.e. Basic beds, Semi-Private beds, and Private beds; Excludes : Occupied Interim beds (effective July 2010 Interim beds are considered short stay beds). 14
Technical Specifications Percent Occupancy/Long – Stay Utilization Target : Maintain or improve baseline performance. (Baseline rate equal to the average % occupancy achieved by the LTC Home in the calendar year, 2011.) Performance Corridors : If the Performance Target is less than 97.00% then the Lower Corridor = Performance Target less 2.00% in absolute terms; e.g., a performance target of 96.50% would have a lower corridor of 94.50%. If the Performance Target is between 97.00% and 98.00% then the Lower Corridor is 97.00%. If the Performance Target is greater than 98.00% then the Lower Corridor = Performance Target less 1.0% in absolute terms; e.g., a performance target of 98.70% would have a lower corridor of 97.70%. 15
Examples: Occupancy Performance Targets LTCH Average Low High LTCH Below 97% 91.2 89.2 93.2 LTCH Below 97% 96.6 94.6 98.6 LTCH Above 97% 97.2 97.0 99.2 LTCH Above 97% 97.8 97.0 99.8 LTCH Above 97% 98.0 97.0 100.0 LTCH Above 97% 98.5 97.5 99.5 LTCH Above 97% 99.0 98.0 100.0
Technical Specifications Median Wait Time To Placement In LTC Home Description : This indicator measures the median time that clients in Ontario are waiting for placement in a Long-Term Care (LTC) Home. Median wait time is the point at which half the patients have been placed, and the other half are still waiting. Calculation : Time to Placement (TTP) is calculated as the time from the earlier of LTC Home Application Date or Consent Date until the date of placement. The median TTP is taken for each group (e.g. geography) for which the measure is reported. Data Source: Client Profile Database (CPRO) 17
Technical Specifications Median Wait Time To Placement In LTC Home Inclusions/Exclusions : Includes: All non-crisis clients (priority category 3A, 3B, 4A, 4B from the CPRO) placed from locations other than LTC Homes; Clients placed from hospitals (e.g. acute, rehabilitation, etc.), supportive housing, retirement homes, private homes and other. Excludes : Clients who transferred from one home to another; Clients whose "Admitted from" and/or "Prior Location Code" is unknown are excluded. Baseline Date : Baseline data will not be available until late December 2012 or early January 2013, due to an unavoidable delay in compiling this data. 18
Technical Specifications Compliance Status Description : The Compliance Indicator status of a long-term care home under the LSAA is defined as either: Substantially compliant in key risk areas, or Chronically non-compliant* in one or more key risk areas. Calculation . 1. Identify homes that were issued a non compliance with Order in a key risk area as a result of an inspection in the last quarter; 2. Identify if any of the homes from (1) have also had a prior order issued for the same Legislation/ Regulation; 3. Any homes that satisfy (2) are given a status of ‘Triggered’. Of the remaining homes, those that have had at least one inspection since July 1, 2010 are recorded as ‘Not Triggered’, while the rest have the status ‘Not Applicable’ 4. Service Area Office Manager(s) review: a) the list of ‘Triggered’ homes to ensure that the second or successive finding of non-compliance was a result of a failure on the part of the licensee to rectify the first finding and b) The overall accuracy of the information in the list. 19
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