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 14 performance indicators, seven monitoring indicators, and two indicators which are under development.
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 was good news for patients from the November 2016 performance report. Performance improved in 10 of 14 MLAA indicators. In addition, seven of the 14 indicators are within 10% of reaching provincial target.
This is the first of three years that the NE LHIN is working to achieve new provincial targets. The following are a few highlights:
- Mental Health and Substance Abuse: To better enable people with mental health conditions avoid unnecessary trips to the emergency department, the NE LHIN invests in mental health supports, including: housing for vulnerable population groups, a “Warm Line” which provides after-hours telephone access for people seeking assistance, harm-reduction programs in North Bay and Sudbury to name a few. The NE LHIN’s investment in a harm reduction strategy in Sudbury is helping to better support people with chronic and persistent alcohol abuse conditions who have been frequent ED visitors. Repeat unscheduled ED visits within 30 days for people with substance abuse issues improved from 28.6% to 26.5%. The NE LHIN’s performance for repeat unscheduled ED visits within 30 days for people with mental health conditions was 17.9%, above the target of 16.3%.
- 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 improved from 17.5% to 16.7%. 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 nine clinical leads to assist in the decision-making required to maintain the region’s health care priorities – including lowering readmission rates in the region’s hospitals, and ensuring people get the care they need in the most appropriate setting.
- Hip and Knee Replacements: The NE LHIN continues to work on improving wait times for Northerners needing hip and knee replacements. Over the past two years, wait times have greatly improved and now 87% of patients requiring a hip replacement and 83% of patients requiring a knee replacement receive treatment within provincial access targets of 90%. The goal is to achieve 90%. The NE LHIN’s multi-pronged strategy focuses on ensuring the right patients get to surgeons through the LHIN’s centralized joint assessment centres, monitoring the volume of completed surgeries, and completing a timely review of each hospital’s capacity and performance. In addition, the NE LHIN reallocates unused hip and knee surgery volumes as needed, from one hospital to another.
- Emergency Room (ER): Patients with minor uncomplicated conditions not admitted to hospital waited 4.02 hours, which is slightly above the provincial target of 4 hours. Patients with complex conditions who waited in the ER but were not admitted to hospital improved to 8.5 hours, above the target of 8 hours.
- 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 50% reduction in wait times in the past 12 months, from 76 to 38 days. The percentage of home care patients with complex needs who received their first personal support visit within five days of service authorization increased from 82.2% to 86.4%. The percentage of home care patients who received their first nursing visit within five days of service authorization also increased from 93.6% to 94.7%.
- MRI scans: Overall, the NE LHIN is among the top five performers in MRI wait time 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 decreased slightly to 41% of priority 2-4 (emergent, urgent, and less urgent) scans completed within access targets.
- CT scans: High demand also contributes to the ability of patients to receive their CT scan within the access target. Programs such as neurosurgery, trauma, cardiovascular surgery and advanced cancer diagnostics contribute to high demand for CT scans in Sudbury. The NE LHIN region also has CT scans in Sault Ste. Marie, North Bay, and Timmins. Regional performance increased from 73% to 76% of priority 2-4 (emergent, urgent, and less urgent) scans completed within access targets.
- 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, access to 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, and unique programs such as PATH (Priority Assistance to Transition Home), which helps older adults transition home after they have been discharged from hospital. The current ALC rate of 22.9% is an increase from 20.9%.
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.