Ministry/LHIN Accountability Agreement (MLAA)
One of the ways the success of our LHIN performance is measured is through our accountability agreement with the Ministry of Health and Long-Term Care, now known as our Ministry-LHIN Accountability Agreement, or MLAA. The most significant change in system performance indicators in this agreement is that targets have shifted from MOHLTC-LHIN negotiated targets to provincial targets for each LHIN’s local health system. Embedded in our MLAA are 13 performance indicators, eight monitoring indicators, and two indicators which are under development.
Monitoring indicators are measures used by the Ministry and the NE LHIN to monitor system integration and access, such as rate of emergency visits for conditions best managed elsewhere and access to cataract surgeries and MRI and CT scans.
Indicators under development are measures used by the Ministry and the NE LHIN to monitor areas of interest, such overall satisfaction with health care and percent of palliative care patients discharged from hospital with home supports; however, there are data limitations that limit the usefulness of the information.
In the spirit of transparency and accountability, the NE LHIN posts these provincial targets and our achievements each quarter.
For patients, improved performance by health care providers as measured by the new MLAA equates to improved access to surgeries, diagnostic imaging and home care; fewer days waiting for their next destination in the health system; and access to alternatives so the ED is not their only choice for conditions best managed in another care location.
In the North East LHIN region, there is good news for people living in Northeastern Ontario further to the March 2018 health system performance report. Our three-year track to make health system improvements in targeted areas continues with performance improved in 7 of 13 MLAA indicators this past quarter. The following are a few highlights:
- Mental Health and Substance Abuse: As a means to help people with mental health conditions avoid unnecessary trips to hospital emergency departments (ED’s), the NE LHIN invests in several mental health supports for Northerners. A few of these include: housing for vulnerable population groups, a “Warm Line” which provides after-hours telephone access for people seeking assistance, harm-reduction programs, peer support workers in larger hospital ED’s, to name a few. The NE LHIN’s performance for repeat unscheduled ED visits within 30 days for people with mental health conditions was 18.2%, slightly above the target of 16.3%. Repeat unscheduled ED visits within 30 days for people with substance abuse issues decreased from 29.2% to 28.6% this quarter.
- Hospital Readmissions within 30 days: This indicator monitors the rate of hospital readmissions within 30 days for seven key chronic illnesses. The NE LHIN’s performance reached 17.1%. A key strategy to improve readmission rates is improving the rate at which patients have a follow-up visit with a physician within seven days of discharge from hospital. The NE LHIN works closely with ten clinical leads to help increase faster access to primary care for fellow Northerners – including lowering readmission rates in hospitals, and ensuring people get the care they need in the most appropriate setting, whether it is home, community, hospital or long-term care.
- Hip and Knee Replacements: Continued work in the NE LHIN means that Northerners requiring hip and knee replacements receive the treatment they need. Northerners now wait 174 days for hip replacements, and 258 days for knee replacements – an improvement from a previous high of close to 300 and 400 days respectively. 69.9% of hip replacements and 71.9% of knee replacements are now done on time; however, with the provincial target of 90%, there is still work to do. The NE LHIN’s approach to helping Northerners get quicker access to hip and knee care includes getting patients through one of five Joint Assessment Centres, actively monitoring the volume of completed surgeries so that any unused surgeries can be reallocated to better meet the demand, and completing a timely review of each hospital’s capacity and performance.
- Emergency Room (ER): Nine out of ten patients with minor uncomplicated conditions who were not admitted to hospital waited 4 hours, which meets the provincial target of 4 hours. Nine out of ten patients with complex conditions who waited in the ER but were not admitted to hospital decreased slightly to 8.08 hours, above the target of 8 hours. The NE LHIN will continue to work with hospitals to make further improvements on this indicator.
- Home Care: The NE LHIN continues to work to improve wait times for home and community care. Through a focused approach on improving access to therapy services, there has been an overall reduction in wait times in the past 24 months, from 76 to 31 days. This means that patients are waiting less for the care they need in home or community. The percentage of home care patients with complex needs who received their first personal support visit within five days of service authorization decreased slightly from 96% to 95.4%. The percentage of home care patients who received their first nursing visit within five days of service authorization decreased slightly from 99.1% to 98.8%, which means patients are receiving home nursing care when they need it.
- MRI scans: The NE LHIN is among the top five performers in MRI wait times in the province, yet demand across the four hospitals providing MRI services is high and has an impact on the ability to achieve target, despite maximizing hours of operation. Performance remained stable at 72% of priority 2-3 (emergent and urgent) scans completed within access targets. The LHIN continues to support a second MRI for the region.
- CT scans: Regional performance remained stable at 82% of priority 2-3 (emergent and urgent) scans completed within access targets. This means that even with a high demand for CT scans, 82% of patients receive their CT scans on time.
- Alternate Level of Care (ALC): The ALC “rate” focuses on patients who have completed their acute hospital treatment and await the availability of their next care level or “alternate level of care.” For example, some patients are waiting for long-term care beds, rehabilitative beds or assisted living services. The NE LHIN’s focus is on building community capacity to support seniors in communities through programming such as assisted living, which helps people with activities and daily living, Telehomecare which provides people with access to a nurse through technology in their home, and PATH (Priority Assistance to Transition Home), which helps older adults transition home after they have been discharged from hospital. The current ALC rate of 25.1% is a slight decrease from 25.3%. The NE LHIN is implementing its recently completed Patient Flow Strategy that engages health providers both at the regional and sub-region levels to address common projects and priorities across the region while also addressing unique local needs. A NE LHIN full-time staff person is currently overseeing the implementation of this strategy.
Things You Should Know About Performance Indicators
What is a performance indicator? A performance indicator is a measure of local health system performance relative to a target. Each LHIN is held accountable to the Ministry for achieving this target.
What is a provincial target: This is an optimal performance result for an indicator.
What is the 90th percentile? The 90th percentile is the time that the ninth out of 10 patients waited. In other words, 90% waited less and 10% waited longer.