Ontario Wait Time Strategy
Conference on Timely Access to
Health Care
February 9, 2007
Alan R. Hudson, OC, FRCSC
Transformation
MOHLTC
•Authority
•Responsibility
Community
Surgeons
Board
•Accountability
Hospital CEO
Wait Times Project
OHA
Pay for Performance
Additional $
Global $
Global Budget
Implementation
WTIS-EMPI Phases (5 clinical foci)
Objectives
Achievements
100+ Hospitals
Phase 3
Phase 2
100% of Funded Cases
~77 Hospitals
by June/07
80% of funded cases
~55 Hospitals
by Dec ‘06
Phase 1/Beta
20% of cases
5 Hospitals
Implemented
Mar/06
Phase I/Beta: March
D ’06
TE
¾18% of funded cases
N
E surgical cases
M
¾300 surgeons,
36,000
E
L
P
¾250,000
IM MRI and CT scans
¾6 EMPI sources, 21 EMPI sites
Phase II: Dec ’06
D
¾90% of funded cases
E
T
N
E surgical cases
¾1,400 surgeons, 235,000
M
LE
¾1.1 million MRI
and CT scans
P
M
¾48 EMPIIsources,
90 EMPI sites
Phase III: Summer ’07
¾~77 hospitals
¾1,700 surgeons, 255,000 surgical cases
¾1.2 million MRI and CT scans
A
pr
07
05
O
ct
/N
ov
D
05
ec
05
/J
an
06
Fe
b/
M
ar
06
A
pr
/M
ay
06
Ju
ne
/J
ul
y
06
A
ug
/S
ep
06
O
ct
/N
ov
D
ec
06
06
/J
an
07
Fe
b/
M
ar
07
A
ug
/S
ep
t
Days
90% of Cataract Surgeries Completed Within
350
300
250
trendline
200
150
100
50
0
Cataract Surgery Wait Times
Cataract Surgery Wait Times
Aug/Sept 2005 vs. Oct/Nov 2006
6000
Median
4500
4000
Priority 4
Target
90% Completed Within
3500
3000
2500
2000
1500
1000
Aug/Sept 05
Oct/Nov 06
Weeks Waited for Procedure
> 104
96-100
88-92
80-84
72-76
64-68
56-60
48-52
40-44
32-36
24-28
16-20
8-12
500
0
0-4
# of People Treated
5500
5000
System Creation
•Kensington
Current State (Oct/Nov 2006 data)
% cases completed within target
Cancer Surgery
100%
91%
CT
Bypass Surgery
71%
100%
Target
0%
Actual
87%
MRI
43%
Cataract Surgery
66%
78%
Knee Replacement
Hip Replacement
Note: Priority 4 targets used in absence of priority-level data.
Source: Interim wait times database, Wait Times Information Office
Progress to Date
Provincial Trend 90th Percentile Analysis - Oct/Nov '06 Wait Times Data
Service
…90% Completed Within…
Baseline
Cancer surgery
(Aug/ Sept
'05)
81 days
Current
Access
Target**
(Oct/ Nov '06)
(Days)
%
Completed
Within
Target**
78 days
84
Current vs. Baseline
Net change
% change
91% 9
-3
-3.7
Angiography
56
26
-
-
-30
-53.6
Angioplasty
28
20
-
-
-8
-28.6
Bypass surgery
49
47
182
100% 9
-2
-4.1
Cataract surgery
311
209
182
87%
-102
-32.8
Hip replacement
351
278
182
78%
-73
-20.8
Knee replacement
440
357
182
66%
-83
-18.9
MRI
120
113
28
43%
-7
-5.8
CT
81
70
28
71%
-11
-13.6
**Priority Level 4 Target
Toronto Central LHIN Progress to Date
Toronto Central LHIN Wait Time Trend Analysis - Oct/Nov '06 Data
Service
…90% Completed Within…
Access
Target**
Baseline
Current
(Aug/ Sept
'05)
(Oct/ Nov
'06)
LHIN
Rank*
85 days
69 days
Angiography
33
Angioplasty
Current vs. Baseline
(Days)
% Completed
Within
Target**
Net
change
%
change
6
84
93% 9
-16 days
-18.8
26
8
-
NA
-7
-21.2
22
19
8
-
NA
-3
-13.6
Bypass surgery
48
42
3
182
100% 9
-6
-12.5
Cataract surgery
400
188
7
182
90% 9
-212
-53.0
Hip replacement
343
201
4
182
88%
-142
-41.4
Knee replacement
481
265
3
182
78%
-216
-44.9
MRI
85
127
10
28
49%
42
49.4
CT
88
75
9
28
75%
-13
-14.8
Cancer surgery
**Priority 4 Access Target
Case in Point: Cataract Surgery
Toronto Central
Oct - Nov 06
Hospital Name
Provincial
Toronto Central LHIN
The Toronto East General Hospital
(Toronto)
Hospital for Sick Children (Toronto)
University Health Network (Toronto)
Mount Sinai Hospital (Toronto)
The Kensington Eye Institute
(Toronto)
St. Joseph's Health Centre (Toronto)
St. Michael's Hospital (Toronto)
Sunnybrook Health Sciences Centre
(Toronto)
Wait times
(days)
209
188
Median Wait Priority Access
Time (days) Target (days)
60
182
57
120
124
126
134
52
29
61
52
188
53
254
272
81
69
323
73
Variation in 90th percentile wait times for cataract
surgery by LHIN
No rth West,
562
600
Central West,
438
Central West, No rth West,
401
400
No rth West,
446
Central West,
Central West,
401
389
No rth West,
366
Days
400
200
Erie St Clair,
160
Erie St Clair,
186
Erie St Clair,
93
Erie St Clair, Erie St Clair,
128
124
Erie St Clair, Erie St Clair,
Erie St Clair,
82
79
65
0
Aug/ Sept Oct/ Nov
'05
'05
Dec '05/
Jan '06
Feb/ Mar
'06
Apr/ May
'06
Jun/ July
'06
Aug/ Sept
'06
Oct/ Nov
'06
The Kensington Eye Institute
Cataract Surgery
* Median wait times
Toronto East General Hospital
Angiography
Cataract Surgery
* Median wait times
Sustainability
Top 10, in no particular order
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Accountability
Transparency
System Change
W.T.I.S.
Funding
Non-M.D. Health Care Providers
Expansion of Program
Expert Panels/Coaching Teams
Quality and Safety (Results)
Physician Behaviour Change
Prevention/Screening
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