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  • 1. North Perth Family Health Team Business and Operational Plan September 5, 2006 Coulson and Associates, Health Services Consultants 9/5/06
  • 2. North Perth Family Health Team Business and Operational Plan 2 North Perth Family Health Team Business Plan I – Executive Summary...............................................................................................................3 II – Business Plan .......................................................................................................................5 Governance and Accountability ..................................................................................................5 Vision, Mission, Values and Strategic Objectives .......................................................................8 Population Characteristics and Health Status.............................................................................10 Health Status.............................................................................................................................11 Utilization of Health Services ...................................................................................................12 General Information and List of Programs and Services............................................................13 Core/Comprehensive Services...................................................................................................15 Summary of Program Staffing Requirements ............................................................................18 Implementation Timelines.........................................................................................................19 Location of Services and Programs ...........................................................................................22 Physical Facility Needs.............................................................................................................22 Location of After-Hours Services..............................................................................................23 Current and projected patient enrolment....................................................................................23 Five-Year Financial Forecast ....................................................................................................24 III- Operational Plan .................................................................................................................25 Strategic Planning Objectives....................................................................................................25 Enrollment of Patients...............................................................................................................26 Core Primary Care Services ......................................................................................................27 Chronic Disease Management...................................................................................................29 Primary Mental Health Services................................................................................................30 Substance Abuse (Adolescents and Young Adults) ...................................................................33 Health Promotion and Disease Prevention.................................................................................34 Case Management and System Navigation................................................................................37 Rehab Services .........................................................................................................................38 Summary of Staffing Requirements ..........................................................................................40 Linkages and Partnerships.........................................................................................................40 Human Resources .....................................................................................................................41 Collaborative Team Practice .....................................................................................................42 Extended Hours ........................................................................................................................44 Other Programs.........................................................................................................................44 Evaluation Mechanisms ............................................................................................................45 Consolidated Timelines for Implementation..............................................................................46 Physical Facilities .....................................................................................................................46 Information Technology............................................................................................................47 Annual Budget..........................................................................................................................49 Coulson and Associates, Health Services Consultants 9/5/06
  • 3. North Perth Family Health Team Business and Operational Plan 3 I – Executive Summary The North Perth Family Health Team (NPFHT) has been approved by the Ministry of Health to provide primary health care services to the community of North Perth and portions of the surrounding townships of Howick, Huron East, Minto, Mapleton, Wellesley and Woolwich. At present, the nine family physicians who work at the Listowel Medical Clinic as well as the nursing and support staff who work within this clinic provide most primary care services. After- hours and on weekends, the family physicians staff the Emergency Department of the Listowel Memorial Hospital and provide both true emergency and non-urgent primary care from this location. For many years, the Listowel Medical Clinic has operated as an independent health facility funded by the family physicians who own this facility. Several years ago the family physicians formed the Listowel Family Health Network and moved to a new, blended payment method of payment. All of the family physicians in Listowel are members of the Family Health Network (FHN). The physicians have enrolled approximately 15,000 patients to date. This Business and Operational Plan has been prepared in accordance with Ministry of Health guidelines for Family Health Teams. The Plan requests funding from the Ministry of Health for the recruitment of 16 FTE allied health professionals as well as 4.5 FTE administrative staff for the NPFHT as follows: Health Professionals Proposed Complement Family Physicians 12 Nurse practitioners 2 Registered Nurses 3.5 Registered Practical Nurses 3 Social workers 2 Youth Counselor 1 Case Managers 1 Dietician 1 Occupational therapist 0.5 Pharmacist 1 Health educator 1 FHT Administrator 1 Clerical staff 2 Clinical Coordinator 1 Data Analyst 0.5 Coulson and Associates, Health Services Consultants 9/5/06
  • 4. North Perth Family Health Team Business and Operational Plan 4 Based on the guidelines provided by the Ministry of Health, it is estimated that the NPFHT will require $1,134,365 for the first year (7 months) of its operation. This amount will increase in future years. In addition, the NPFHT is requesting one-time start-up costs of $174,200 for the purchase of supplies and equipment to implement the FHT. The NPFHT has developed a governance structure that requires the formation of a new, non- profit corporation that will be managed by a Board of Directors comprised of family physicians and representatives of the Listowel Memorial Hospital, the Huron Perth CCAC, the Perth Public Health Unit and other members of the community. Representatives of other allied health professionals will also be selected to become members of the Board of Directors. A Community Advisory Committee will be formed to assist the NPFHT in the ongoing development of programs and services. This Committee will be comprised of a number of organizations including: • The Listowel Memorial Hospital • Hospital Foundation • Perth CCAC (or its successor) • Perth District Health Unit • Community mental health services • Municipality of North Perth • Representative of the long-term care sector • Seniors services representatives • VON • Other community representatives as appropriate. An implementation plan has been developed that sets out the numerous activities that must be completed in order to ensure that the NPFHT is developed in a logical, effective, efficient and timely manner. The Steering Committee for the NPFHT is confident that this Business and Operational Plan will result in the successful development of a Family Health Team that will meet the primary health care needs of the citizens of North Perth and surrounding communities for many years. The Steering Committee looks forward to the opportunity of meeting with the Ministry of Health to discuss this Plan. Coulson and Associates, Health Services Consultants 9/5/06
  • 5. North Perth Family Health Team Business and Operational Plan 5 II – Business Plan This Business Plan has been prepared in accordance with guidelines provided by the Ministry of Health for the development of Family Health Teams. Governance and Accountability The North Perth Family Health Team (NPFHT) will be a mixed Family Health Team and will be governed by a Board of Directors comprised of representatives of the Listowel Family Health Network and other representatives of the community. A new non-profit corporation will be formed with a separate Board to manage the affairs of the NPFHT. At the present time, there are nine full-time family physicians in Listowel who are members of a non-incorporated professional Association, called the Listowel Family Health Network. The Listowel FHN receives funding from the Ministry of Health and Long Term Care under the terms of the FHN capitated payment mechanism. The Listowel Family Health Network is comprised of all physicians in Listowel and has been in operation for several years. The Listowel family physicians are all in a single clinic across the street from the Hospital. There is a governance structure in place to manage the business affairs of the Listowel Medical Clinic as well as a governance structure to manage the affairs of the FHN. Historically, there has always been a close working relationship between the Listowel Memorial Hospital and the Listowel family physicians. The formation of the NPFHT will build on this successful working relationship. In developing this Business and Operational Plan, a NPFHT Steering Committee was created comprised of representatives of the Listowel FHN as well as the CCAC, Public Health, the Hospital and the Municipality of North Perth. The Steering Committee has met on a monthly basis over the past several months to prepare this Business Plan. The Board of the FHT will be comprised of members of the FHN and representatives of the Listowel Memorial Hospital, the Municipality of North Perth, the CCAC and the Public Health Unit. The proposed governing Board for the NPFHT is shown in the chart below. Coulson and Associates, Health Services Consultants 9/5/06
  • 6. North Perth Family Health Team Business and Operational Plan 6 North Perth 3 - 5 members Family Health Team 10 to 12 Board members 3-5 members 3 members Listowel FHN Patient Care Council Community NP, RN, RPG, SW, PT, OT, Advisory Pharm, Diet. Committee Hospital, CCAC, Public Health, Municipality of North Perth As the NPFHT develops in the future, there may be a need to expand the Board of directors to include other representatives of primary care organizations in the community. The NPFHT Board of governors would select representatives from the following: • Representatives of the Listowel FHN. • Representatives from the Patient Care Council • Representatives from a Community Advisory Committee comprised of the Hospital, CCAC, mental health, public health, the Municipality of North Perth and other members of the community. Patient Care Council It will be important to provide an opportunity for all allied health members of the FHT to participate in the ongoing development of the FHT. In particular, it will be important for the FHT to focus on the best way to meet the needs of patients who require primary care services. To assist in the development of a collaborative practice model that focuses on the needs of patients, a Patient Care Council would be formed comprised of representatives of the following regulated health professional groups: • Family physicians • Nurse practitioners • Family practice nurses • Social workers • Mental health workers Coulson and Associates, Health Services Consultants 9/5/06
  • 7. North Perth Family Health Team Business and Operational Plan 7 • Pharmacists • Dieticians • Physiotherapists. As other primary health care professionals are added to the Family Health Team, they should be represented on the Patient Care Council. It may also be appropriate to have members of the Community Advisory Committee as ex-officio members of this Council. The responsibilities of the Patient Care Council would include the following: • Develop an approach to patient care that focuses on the needs of patients and their families • Develop a collaborative practice model for the NPFHT that recognizes the standards of clinical practice of each of the allied health professional groups • Provide advice on the NPFHT clinical human resource plan • Advise the Board on all matters pertaining to professional, clinical, and technical services • Review the effectiveness of the program delivery model used by the NPFHT and to identify any problems, challenges and barriers to the delivery of care • Develop a dispute resolution process for resolving any conflicts among the allied health professionals • Ensure that all patient/client programs are meeting their goals and objectives • Propose any new and expanded programs that should be developed by the FHT • Ensure that continuing education programs that focus on the development of a multi- disciplinary collaborative team are developed for the professional staff of the FHT • Participate in the ongoing assessment of the health care needs of the community and assess the FHTs role in meeting the needs of the Community • Assist in the development of an information system that links family physicians and allied health professionals • Advise the NPFHT Board of any clinical practice issues. Community Advisory Committee The Community Advisory Committee will be comprised of a number of organizations including: • The Listowel Memorial Hospital • Hospital Foundation • Perth CCAC (or its successor) • Perth District Health Unit • Community mental health services Coulson and Associates, Health Services Consultants 9/5/06
  • 8. North Perth Family Health Team Business and Operational Plan 8 • Municipality of North Perth • Representative of the long-term care sector • Seniors services representatives • VON • Other community representatives as appropriate. The responsibilities of this Community Advisory Committee CAC) will include the following: • Elect representatives to the Board of the NPFHT to represent the members of the CAC • Ensure that the member of all primary care health organizations have the opportunity to participate in the development of the strategic plan for the FHT • Ensure that all primary care stakeholders are aware of the activities of the NPFHT • Provide a form for discussion of issues of concern to the members • Participate in the ongoing development of programs and services for the NPFHT • Participate in the strategic planning process of the NPFHT • Receive reports from the NPFHT on its activities and future plans. A Transitional NPFHT Board The governing structure described above represents a long-term vision of the future structure of the NPFHT. In the short-term, a smaller governing Board will be formed to function as a transitional Board for the NPFHT. As the NPFHT develops in the future, additional members Vision, Mission, Values and Strategic Objectives The following vision and mission statements have been developed by the Steering Committee for the NPFHT to guide the work of the North Perth Family Health Team: • VISION: North Perth: A healthy rural community • MISSION: To provide high quality, comprehensive primary care services in a timely manner to the residents of North Perth. Values The development of the NPFHT will require considerable commitment from all health care providers within the FHT to work together in a collaborative and mutually respectful manner. To guide all members of the FHT, it is important that the team develop a common set of values that will be respected by all team members. The following guidelines have been developed by the Steering Committee for consideration by the FHT: • We value and are committed to delivering Patient-Centred Health Care Coulson and Associates, Health Services Consultants 9/5/06
  • 9. North Perth Family Health Team Business and Operational Plan 9 • We are committed to ensuring Quality Care for all patients • We will strive to provide patients with Timely Access to care • We value Collaboration amongst all stakeholders within the Family Health Team • We are committed to ensuring a Balanced Work/Lifestyle for all FHT members • We are committed to individual and organizational Accountability • We will maintain and uphold Ethical practices. Patient-Centered Practice Model In serving the catchment area of North Perth, the Family Health Team is proposing to implement a patient-centered service delivery model. Within this approach, all services will be planned, coordinated and delivered based on the needs of patients and their families. Patients will have input into the scope and range of services to be provided by the NPFHT and service delivery will be flexible to respond to the changing needs of the patient population. The ongoing needs of patients will be managed within the FHT and the FHT will provide comprehensive care to patients at all times. Strategic Objectives To assist in the ongoing development of the NPFHT, the Steering Committee has set out a number of Strategic Objectives that will provide a framework to guide the future delivery of primary health care services by the North Perth Family Health Team. The Team will enhance and strengthen the high quality primary care services currently provided by the family physicians and the staff of the Listowel Medical Clinic. These enhancements will include: more effective management of chronic disease, greater focus on prevention of illness and injury, and reducing inappropriate hospital admissions. • Strategic Objective #1: To develop an integrated and patient-centred primary health care team • Strategic Objective #2: To provide patients with timely access to primary care services and effective coordination of those services • Strategic Objective #3: To provide quality health promotion and prevention services to reduce injury and disease (primary prevention) • Strategic Objective #4: To provide enhanced screening and early identification of disease (secondary prevention) • Strategic Objective #5: To effectively manage chronic disease in the catchment population served by the North Perth FHT Coulson and Associates, Health Services Consultants 9/5/06
  • 10. North Perth Family Health Team Business and Operational Plan 10 • Strategic Objective #6: To transform the existing electronic medical record currently shared by the hospital and medical clinic into a common electronic health record which is shared by all regulated health care professionals in North Perth. Population Characteristics and Health Status The NPFHT will service a geographic area that is very similar to the catchment population of the Listowel Memorial Hospital. This catchment population will include the municipality of North Perth plus portions of the following surrounding municipalities: • Howick Township, Huron County • Huron East, Huron County • Minto, Wellington County • Mapleton Township, Wellington County • Wellesley township, Regional Municipality of Waterloo • Woolwich Township, Regional Municipality of Waterloo. In 2001, the population of North Perth was 12,055 and the estimated population of the adjacent communities was estimated at 26,000. Further detailed demographic information about the catchment population to be served by the NPFHT is included in Appendix 1. Demographics Review of the socio-demographic characteristics of North Perth indicate a number of key features that will affect the future need for primary care services in the area. The median age of the 2001 population in North Perth was 36.6 years slightly below the provincial average of 37.2 years (Appendix 2). According to the Canadian Institute of Health Information, North Perth is located in a rural health region that has one of the oldest age profiles in Canada. According to CIHI, the Grey Bruce Huron Perth region ranks 1st in Ontario and 5th highest in the country in terms of the proportion of seniors over the age of 65 yrs. Average earnings for all working persons (both full-time and part-time) are $27,141, which is lower than the provincial average of $35,185 (Appendix 2). Median family income was reported as $57,442, which is again lower than the provincial average of $61,024. The percentage of the local population who has less than a high school graduation certificate is higher than the provincial average across all age groups (Appendix 2). Coulson and Associates, Health Services Consultants 9/5/06
  • 11. North Perth Family Health Team Business and Operational Plan 11 The proportion of the labour force employed in agriculture and other resource-based industries is 18% compared to the provincial average of 3% (Appendix 2). North Perth is home to a large Anabaptist community, specifically seven distinct Amish and Mennonite cultural groups (Appendix 3). As of 2002, there were approximately 540 families for a total Anabaptist population of over 3,000 individuals. Because of their religious beliefs, these individuals represent a significant challenge in terms of delivering primary health services. Health Status One of the standard indicators for a population’s overall health status is a mortality rate. In Appendix 4, age-standardized mortality rates and the standard measure of premature death (PYLL – potential years of life lost) are shown for the Grey Bruce Huron Perth planning area (i.e. the northern and central parts of the Southwest LHIN planning region) compared to the provincial average and the Thames Valley planning area (i.e. the southern part of the Southwest LHIN). On both of these mortality indicators, the rates for the residents of the Grey Bruce Huron Perth area are significantly higher than the provincial average and higher than the Thames Valley area. Another important source of information about a community’s health status is the results from the Canadian Community Health Survey. The results are based on a random survey of residents in each public health unit district. In terms of possible gaps in service, 8.8% of Perth residents reported that they had unmet health care needs which is less than the provincial average of 12.1%. In terms of lifestyle choices and health behaviours, the proportion of overweight males in Perth is higher than the provincial average but obesity levels are slightly less than the provincial average. These higher BMI scores may be attributable to levels of fitness and activity; and Perth residents are generally less physically active than the provincial average (Appendix 5). Hospital discharges summaries are another source of information about the health status of a community. Data from the Listowel Memorial Hospital is provided in Appendix 6. This data indicates that maternal and child-care account for the greatest number of inpatient hospital admissions. This data also indicates that chronic conditions such as cardiac conditions (heart failure, heart attack, chest pain), gastrointestinal problems, stroke and diabetes all account for a significant number of inpatient hospital admissions. Coulson and Associates, Health Services Consultants 9/5/06
  • 12. North Perth Family Health Team Business and Operational Plan 12 The Anabaptist communities have some specific health status issues that require special mention. These include but are not limited to: • Poor dental health (especially the low German speaking Mennonites from Mexico) • Lack of prenatal care • Lack of knowledge of preventive health care • Higher incidence of certain genetic disorders • Tendency to use alternate health practitioners before seeking medical attention. Because of their religious beliefs, some of these Amish/Mennonite groups do not have an Ontario health card, preferring to pay cash for their medical care. This means that health care access can be limited by a family’s financial situation. Utilization of Health Services Over the past three years, the Listowel Memorial hospital has seen a dramatic increase in ambulatory visits through its Emergency Department (Appendix 7). Between 2003-04 and 2005- 06, Emergency visits increased by over 40%. Many of these ambulatory cases are non-urgent and could be classified as primary care. Based on interviews with Hospital and medical staff, these significant increases in emergency volumes can be attributed to: • The shortage of family physicians leading to increasing numbers of ‘orphan’ patients and growing wait lists at the medical clinic • A greater in-migration from surrounding rural communities and townships. In the future, many of these patients will be cared for by the Family Health Team and this will allow the Listowel Memorial Hospital to better manage demands on its Emergency Department. Community Care Access Centre Caseloads for the CCAC are also increasing. In the three-year period from 2003-04 to 2005-06, the CCAC caseload from North Perth went from 452 clients to 556 clients, an increase of over 20%. This is not simply a result of population aging since half of the CCAC clients are less than 65 years old (Appendix 8). The mix of CCAC clientele is also changing over time with a declining proportion of acute care cases and increasing numbers of long term care and rehab clients. The lack of rehab resources in North Perth is well documented (Appendix 9). Coulson and Associates, Health Services Consultants 9/5/06
  • 13. North Perth Family Health Team Business and Operational Plan 13 Environmental Factors North Perth is a largely rural area centered around the town of Listowel. The health differentials between urban and rural populations have been well documented as well as the geographic challenges of ensuring equitable access to health services for rural residents.1 The Romanow report in 2002 highlighted that geography is indeed a ‘determinant of health’ and described the overall problem in terms of an Inverse Care Law: • “People in rural communities have poorer health status and (therefore) have greater needs for primary care, yet they are not as well served and have more difficulty accessing health care services than people in urban centres”2 Community Resources There are a number of primary care providers and community resources who provide services that will complement the services offered by the North Perth Family Health Team. These include: • Canadian Mental Health Association, Huron-Perth Branch • Chiropractors • Community Care Access Centre for Perth • Dentists • Fordwich Nursing Home, Royal Terrance (Palmerston) and Caressant Care (Listowel) • Listowel Memorial Hospital • Optometrists • Perth District Health Unit • Registered Massage Therapists • Victorian Order of Nurses, Huron-Perth Branch. General Information and List of Programs and Services Currently, the nine Listowel family physicians receive funding from a number different sources including capitation payments through the FHN contract, alternative funding arrangements (AFA) for Emergency Department work, fee-for-service for hospital care, non-rostered patients, etc, hospital on call coverage for OB, anesthesia and third party billing. The chart below 1 Romanow Commission, Building on Values: The Future of Health Care in Canada, 2002 and the Ministerial Advisory Committee on Rural Health, Rural Health in Rural Hands, 2002; Small Hospitals Provincial Advisory Group of the Ontario Hospital Association, “Ensuring Access to Care in Rural, Remote and Northern Communities”, August 2003 2 Romanow report, p. 162 Coulson and Associates, Health Services Consultants 9/5/06
  • 14. North Perth Family Health Team Business and Operational Plan 14 indicates the current status of each physician in terms of their FTE status and the services that they provide (e.g. FP = family practice, IN = inpatient, NH = nursing home, OB = obstetrics): • Dr. Annis: 1.0 FTE, FP, IN, ER, OB, NH • Dr. Connors: 0.5 FTE, ER, anesthesia only • Dr. Edmonds (currently on maternity leave): 1.0 FTE , FP, IN, ER, NH, anaesthesia, • Dr. Klassen: 0.5 FTE, FP, IN, NH, and 2 public health sexual health clinics • Dr. Latuskie: 1.0 FTE, FP, IN, ER, OB, NH • Dr. Matthews: 1.0 FTE, FP, IN, ER, OB, NH • Dr. Qureshi: 1.0 FTE, FP, IN, ER, OB, NH and is a coroner • Dr. Rutherford: 0.5 FTE, FP, IN, ER, NH, anesthesia, • Dr. Suggit: 1.0 FTE, FP, IN, ER, OB, NH • Dr. Warren: 1.0 FTE, FP, IN, ER, NH, anesthesia • Dr. Westen: 0.5 FTE, FP, IN, OB, NH All current staff at the Listowel Medical Clinic are paid for by the Listowel Family Health Network. The existing staffing complement includes: • 4.0 FTE Registered Practical Nurses • 3.5 FTE Registered Nurses • 3 FTE Receptionists • 5 FTE Office/Filing Staff. The nursing staff play an important role in the provision of patient care. As additional nursing staff are recruited, one of the RNs will play a role in assisting cancer patients by liasoning with the Ontario Breast Screening Program, helping patients navigate the system, arranging cancer check-ups, arranging a call-back system and answering patients questions related to their disease or their treatment. This nurse will also participate in patient care conferences that are held with the patient’s surgeon and pathologist. Population to be Served The catchment population for the North Perth FHT is estimated at 26,000. There are 15,000 individuals currently rostered with the Listowel Family Health Network. As the NPFHT is developed, it is expected that the physicians and nurse practitioners will enroll approximately 8,000 additional patients. Until the successful implementation of this Operational Plan and the recruitment of additional family physicians and nurse practitioners, there will continue to be orphans patients Coulson and Associates, Health Services Consultants 9/5/06
  • 15. North Perth Family Health Team Business and Operational Plan 15 who obtain their primary care either through the Hospital Emergency Department or who will have to travel greater distances to larger centres which are further away (i.e. Stratford, Kitchener). Core/Comprehensive Services The North Perth Family Health Team will provide the following comprehensive range of primary care programs and services: • Access to Prenatal, Obstetrical, Post-Natal and In-Hospital Newborn Care including the provision of maternity services including antenatal care to term, labour and delivery, and maternal and newborn care. • Arrangements for 24/7 Coverage including extended office hours and Telephone Health Advisory Services. • Coordination and Provision of Rehabilitative Services including referral to most appropriate rehab service provider, participation in planning and follow up, and care map development. • Chronic Disease Management including screening, diagnosis, treatment, management, and care coordination. • Diagnosis and Treatment of Episodic Illness and Injury including full range of acute primary illnesses and injuries. • Education and Support for Self Care including health education, telephone advice and direction, with a special emphasis on patients managing a chronic illness • Health Assessment including history taking, physical exams, laboratory/diagnostic evaluation. • Health Promotion including lifestyle counseling; • Illness Prevention including periodic exams, primary, secondary and tertiary prevention, screening patients at risk, early detection initiatives, risk reduction counseling, immunization programs and an electronic call back system. • Primary Reproductive Care including birth control counseling, pregnancy diagnosis, counseling re birth control and family planning, screening and treatment for sexually transmitted diseases; • Primary Mental Health Care including diagnosis and treatment of emotional and psychiatric problems/illness, monitoring, referral, and case management; • Primary Palliative Care including home visits, individual and family support, pain management, monitoring and case management. Coulson and Associates, Health Services Consultants 9/5/06
  • 16. North Perth Family Health Team Business and Operational Plan 16 • Support for Hospital, Home and Long-Term Care Programs including participation in discharge planning for FHT patients, rehabilitation services, outpatient follow up, and home care services. • System Navigation and Case Management including service coordination, monitoring and referral to other health care providers including specialists, rehabilitation services, home care and hospice programs, and diagnostic services. To-date, approximately 15,000 patients have rostered with the Listowel Family Health Network. Based on the current complement of 9.0 FTE physicians, this represents a ratio of 1,667 patients per full-time doctor. With the introduction of new FHT allied health professionals supporting and complementing existing physician practices, this ratio can be modestly increased. It is estimated that the total number of rostered patients could be increased to approximately 17,000 with existing family doctors. To increase roster size further will require new family physicians and nurse practitioners. As a result of physician shortages in North Perth and surrounding municipalities, there are an increasing number of ‘orphan’ patients who are receiving their primary care through the Hospital Emergency Department. Over the last three years, the number of ambulatory visits to the Emergency Department has increased by 40%. Many of these ambulatory visits are non-urgent and could be handled by primary care health professionals in a clinic setting. The NPFHT is requesting funding for three new family physicians (3.0 FTE); two Nurse Practitioners (2.0 FTE); one Registered Nurse (1.0 FTE); one Registered Practical Nurse (1.0 FTE and a part-time Pharmacist (0.5 FTE) to expand these service to care for more patients. It is estimated that each Nurse Practitioner could care for 800 additional patients and each family physician could care for an additional 1,700 patients. Chronic Disease Management Like many rural populations, North Perth has a high incidence of chronic diseases such as heart and stroke disease, diabetes, and COPD. Much of this disease burden is a result of unhealthy lifestyle choices including poor diet, smoking, alcohol abuse and lack of exercise. Better management of these chronic diseases will be a significant programmatic emphasis for the FHT, where allied health professionals will work collaboratively with patients and their families on customized care plans. In terms of program priorities, the FHT’s chronic disease management program will start with Diabetes because it has the potential to lead to other diseases if not properly managed and controlled. Coulson and Associates, Health Services Consultants 9/5/06
  • 17. North Perth Family Health Team Business and Operational Plan 17 The NPFHT are requesting funding for the following positions Registered Nurse (1.0 FTE); Registered Practical Nurse (1.0 FTE); Dietician (1.0 FTE); Case Manager (0.5 FTE - contracted); Pharmacist (0.5 FTE) to expand this program. Medical specialists such as paeditrician and a geriatrician will also assist in this program. Primary Mental Health Services For many years, the Ministry of Health’s reform of the mental health system has focused on treating and supporting the seriously mentally ill. As a result, for large numbers of patients who are suffering mild to moderate mental health problems, the only choices are private therapists or family physicians offering psychotherapy. For rural family physicians with large and busy practices, it is very difficult to find the time to provide the proper care and support to these challenging patients. Because of the large and increasing rural elderly population, health care providers in North Perth are dealing with a growing number of older patients with dementia. Funding for a part-time geriatrician has been requested to assist in this program. Substance Abuse (Adolescent/Young Adult) Choices for Change already provides a youth worker for North Perth (1 day per week) but this level of staffing has proven inadequate to deal with the significant number of substance abuse problems among teenage youth (both alcohol and drugs, such as crystal meth). The NPFHT is requesting funding for a Youth Addictions Counselor (1.0 FTE) to develop this program and for sessional fees for a child psychiatrist to assist in the provision of services. Health Promotion/Disease Prevention Two of the key strategic objectives of the NPFHT focus on the development of primary prevention (promotion of healthy lifestyles) and secondary prevention (enhanced screening and early identification of disease) programs and services. The NPFHT will develop a partnership with the Perth District Health Unit in planning for and delivering these programs. The NPFHT is requesting funding for a Registered Nurse (1.0 FTE) and a Health Educator (1.0 FTE) to provide these programs. Funding for a paediatrician has also been requested to assist in this program. Case Management/System Navigation One of the key strategic objectives of the NPFHT is to improve the coordination of services for patients both within the FHT and between the FHT and other service providers. Part of this coordination takes place at the point of triage where individuals may need help with Coulson and Associates, Health Services Consultants 9/5/06
  • 18. North Perth Family Health Team Business and Operational Plan 18 referrals/linkages with other service providers; and part of this coordination takes place in the management of customized care plans where a case manager works with patients and families to make sure that clinical goals are achieved (e.g. chronic disease management). These case management/system navigation strategies will be accomplished in partnership with the Perth Community Care Access Centre who currently employ case managers. The NPFHT is requesting funding for a Registered Practical Nurse (1.0 FTE) and a Case Manager (0.5 FTE) to provide this expanded case management service. Rehab Services To assist in the identification of the need for rehabilitation services in North Perth, a special rehab sub-committee of the FHT steering committee was formed. This committee has identified a number of gaps in local rehabilitation services (Appendix 9). The NPFHT is requesting funding for a part-time occupational therapist as the first stage in the development of a more comprehensive program that will be implemented in the second year of operation of the NPFHT. Summary of Program Staffing Requirements The chart below indicates the current and proposed number of allied health professionals who will be part of the NPFHT. Provider Type Existing FHN New FHT Family Physician 11 physicians (9 FTE) 14 physicians (12 FTE) Nurse Practitioner 0 2.0 FTE Registered Nurse 3.5 FTE 7.0 FTE (FHN funding) Registered Practical Nurse 4.0 FTE 7.0 FTE (FHN funding) Social Worker 0 2.0 FTE Youth Drug Counsellor 0 1.0 FTE Pharmacist 0 1.0 FTE Registered Dietician 0 1.0 FTE Case Manager / System 0 1.0 FTE contracted Navigator Coulson and Associates, Health Services Consultants 9/5/06
  • 19. North Perth Family Health Team Business and Operational Plan 19 Health Educator 0 1.0 FTE contracted Occupational Therapist 0 0.5 FTE contracted Specialist Consults: Paediatrician (Amish Visits/consults 1 – contract / sessional genetic) Child psychiatrist Visits/consults 1 – contract / sessional Geriatrician Visits/consults 1 – contract / sessional Administrative Staff In addition to the clinical staff that will be required for the operation of the NPFHT, there are a number of administrative support staff who will be required to ensure that the FHT is implemented and managed in an efficient and effective manner. The chart below summarizes these requirements. Administrative Existing Staffing Proposed FHT Support Requirements Administrator 0 1.0 FTE Receptionist 4.0 FTE 4.0 FTE Clerical staff 3.0 FTE 5.0 FTE IT programmer 0 1.0 FTE Implementation Timelines The development of the NPFHT will take time and a phased implementation plan has been created to ensure that staff are recruited and programs are developed in a systematic and logical manner. To accomplish the objectives that have been established for the NPFHT, a three-year Implementation Plan has been developed as set out in the chart below. YEAR ONE ACTVITIES Submit Business and Operational Plan to the Ministry Obtain approval from Ministry to proceed Coulson and Associates, Health Services Consultants 9/5/06
  • 20. North Perth Family Health Team Business and Operational Plan 20 Create an Interim NPFHT Governance Board and a management structure Prepare documents for the incorporation of the FHT Select a FHT Administrator to manage the ongoing development of the FHT Develop a detailed Implementation Plan Develop a detailed Strategic Plan for the NPFHT Confirm the Vision, Mission and Strategic Objectives for the FHT Confirm the key program priorities for the NPFHT Develop partnerships and linkages with community partners in accordance with the program priorities set by the FHT Board Continue to develop an Interdisciplinary Team model Recruit first group of FHT staff (e.g. NPs, RNs, Mental health workers) Develop detailed operating policies and procedures for each program and service including job descriptions and equipment requirements Develop detailed plan for the redevelopment of the Medical Clinic based on discussions with the Ministry of Health regarding the funding that will be available for this project Recruit additional family physicians for the FHT Develop and implement education programs for family physicians and other health care providers and stakeholders about the future plans for the FHT Develop a detailed plan for enrollment of additional patients and implement the plan Develop second year Business and Operational Plan Develop a detailed plan for providing access to the FHT information technology system for the allied health professionals Develop a community communication plan for residents and health providers Conduct audit of first year of operation and submit to Ministry of Health Hold annual meeting for the FHT Develop a detailed plan for the evaluation of the progress of the NPFHT and select an independent team of researchers to conduct the evaluation Coulson and Associates, Health Services Consultants 9/5/06
  • 21. North Perth Family Health Team Business and Operational Plan 21 evaluation YEAR TWO Develop a detailed plan for the redevelopment of the Medical Clinic based on approved Business Plan Develop program priorities for new and expanded programs Evaluate enrollment progress to date and adjust enrollment implementation plan as necessary Develop plans for satellite clinics Hire additional FHT staff Recruit additional family physicians Implement the communications plan developed in first year Expand scope of programs and services Evaluate progress to date Provide educational programs for staff regarding the interdisciplinary team model Prepare Business and Operational Plan for next year Evaluate progress to date on the implementation of the FHT Conduct audit of FHT and submit to the Ministry Hold annual meeting for the FHT Consider the feasibility of developing shared programs and services with other FHTs in the region YEAR THREE Expand NPFHT Board Review the strategic plan of the NPFHT and make any adjustments as appropriate Review the facilities plan to ensure that it meets the long range needs of the NPFHT Conduct evaluation of programs and services in meeting their objectives and implement appropriate changes based on the evaluation Recruit additional physicians Hire additional FHT staff Conduct audit of FHT Submit next year Business and Operational Plan Evaluate communications plan for FHT Evaluate structure of the Board Evaluate management structure Coulson and Associates, Health Services Consultants 9/5/06
  • 22. North Perth Family Health Team Business and Operational Plan 22 Revise strategic objectives Hold annual meeting of FHT This preliminary Implementation plan provides a starting point for setting out the numerous tasks and activities that will be required to ensure that the NPFHT is developed in an effective and efficient manner. When the Ministry of Health has approved this Business and Operational Plan, this Implementation Plan will be revised to reflect any changes that are proposed by the Ministry. Location of Services and Programs Initially, all NPFHT services and programs will be offered in Listowel at the Medical Clinic or other facilities within the Listowel. As part of its longer range strategic plan, the NPFHT will explore the feasibility of offering services in other communities in the rural townships. The NPFHT will explore the potential of offering selected services in other communities in order to ensure that patients who do not have access to transportation are able to access primary care services. Several other rural FHTs are currently operating satellite clinics in smaller communities and the NPFHT will review the experiences of these other FHTs as part of the planning for expanding services to other locations. Physical Facility Needs The Listowel Medical Clinic is out of date and requires expansion and upgrading to meet the needs of current family physicians. With plans to recruit additional family physicians and to add a number of other allied health professionals to the primary care team, there is a need for expanded facilities to accommodate these additional staff. A Facilities Design sub-committee of the FHT steering committee has been established to assess a number of options for the redevelopment of the Medical Clinic. The options that are being considered include the following: • Option 1 – Renovate the existing medical clinic, with an addition to the clinic either horizontally or as a second floor or both. • Option 2 – Demolish the current clinic and construct a new building on a new site. • Option 3- Renovate both the clinic and the Hospital outpatient building to meet the needs of the NPFHT. Coulson and Associates, Health Services Consultants 9/5/06
  • 23. North Perth Family Health Team Business and Operational Plan 23 The services of an architect and facilities planner have been engaged to review these options and to prepare cost estimates. In addition, the committee is considering how such a project might be funded and governed and the role that the Municipality, the Hospital, the family physicians and others may play in the redevelopment of these facilities. A business plan is being prepared that will set out both the capital cost requirements as well as the funding and governance factors that must be considered as part of this project. When the business plan is complete, it will be submitted to the Ministry of Health for consideration. The Ministry of Health has indicated that it is prepared to assist in the funding of capital projects related to the creation of FHTs. The NPFHT will present a plan to the Ministry for its consideration. Location of After-Hours Services At the present time, the Listowel FHN provides after-hours coverage for enrolled patients through the Hospital Emergency Department. It is expected that this arrangement will continue for some time until additional family physicians and nurse practitioners are recruited to the FHT. Physicians are remunerated for these services through an Alternative Payment Plan. When the North Perth Family Health Team is at fully staffed as set out in this Business Plan, the need for and the feasibility of establishing an after-hours primary care clinic will be assessed. There is the potential that such a clinic could be staffed by Nurse Practitioners and primary care nurses in collaboration with the family physicians. Current and projected patient enrolment There are 15,000 individuals rostered with the Listowel Family Health Network. Enrolment of additional patients is dependent on the successful recruitment of additional family physicians and nurse practitioners. Based on the projected recruitment of two new NPs, social workers and three new family physicians, it is estimated that patient enrolment could be increased by some 8,000 additional patients to over 23,000 patients by the end of 2009. The chart below indicates a time line for the enrollment of these additional patients based on the recruitment plans of the NPFHT. Coulson and Associates, Health Services Consultants 9/5/06
  • 24. North Perth Family Health Team Business and Operational Plan 24 North Perth FHT Patient Enrolment Timelines 25,000 20,000 No. of Patients 15,000 10,000 5,000 0 2006- 2007- 2007- 2007- 2007- 2008- 2008- 2008- 2008- 2009- 2009- 2009- 2009- Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Target Dates Five-Year Financial Forecast In accordance with Ministry of Health guidelines for the development of the Business and Operational Plan, a detailed operating budget has been prepared for the NPFHT for the next five years. This detailed budget is presented in Appendix 11. Some of the key features of this operating plan include the following: • In year one (7 months), the NPFHT will have an operating budget of $1,134,365 based on 16 FTE allied health professionals and 4.5 FTE support staff. • In year two, the NPFHT will have a projected operating budget of $1,568,426 • In year three, the NPFHT will have a projected budget of $1,646,847 • In year four, the NPFHT will have a projected budget of $1,726,061 • In year five, the NPFHT will have a projected budget of $1,812,364. Coulson and Associates, Health Services Consultants 9/5/06
  • 25. North Perth Family Health Team Business and Operational Plan 25 III- Operational Plan In this section, the Operational Plan for the North Perth FHT is described as required by the Ministry of Health and Long Term Care. Strategic Planning Objectives The specific objectives that have been developed for the NPFHT include the following: • Strategic Objective #1: To develop an integrated and patient-centered primary health care team. • Strategic Objective #2: To provide patients with timely access to primary care services and effective coordination of those services. • Strategic Objective #3: To provide quality health promotion and prevention services to reduce injury and disease (primary prevention). • Strategic Objective #4: To provide enhanced screening and early identification of disease (secondary prevention). • Strategic Objective #5: To effectively manage chronic disease in the catchment population served by the North Perth FHT. • Strategic Objective #6: To transform the existing electronic medical record currently shared by the hospital and medical clinic into a common electronic health record which is shared by all regulated health care professionals in North Perth. One of the key activities that the NPFHT will undertake as soon as the Ministry of Health approves this Business and Operational Plan is to develop a detailed strategic plan that will set out how the FHT will move from its current operation to an expanded operation. As part of this strategic planning process, the NPFHT will give consideration to a number of key activities that must be completed to ensure that this Business Plan is achieved. These activities include: • Development of an interim governance structure for the NPFHT that will integrate family physicians, allied health professionals and other providers of primary care services in the community. • Development of detailed program and services plans. • Development of strategic alliances and partnerships with the Listowel Memorial Hospital, the Public Health Unit and the CCAC to provide specific services to the FHT. • The recruitment of a team of allied health professionals that will provide services to target patient populations, especially those without family physicians. Coulson and Associates, Health Services Consultants 9/5/06
  • 26. North Perth Family Health Team Business and Operational Plan 26 • Development of a management structure to assist in the ongoing development of the FHT. • Development of management and operational guidelines for the Board and the management team to guide the ongoing development of the FHT. • Creation of a patient care philosophy and a collaborative practice model that will ensure that all allied health professionals are working together to best meet the needs of patients. • Development of a business plan for the redevelopment of the Listowel Medical Clinic. The completion of these tasks will be critical next steps for the NPFHT. The new NPFHT Board and the management team must ensure that these tasks are undertaken in a timely fashion. Enrollment of Patients It is expected that each new family physician within the NPFHT will be able to enroll approximately 1700 patients each. As new physicians are recruited to the community, the number of patients enrolled will increase. It is estimated that each Nurse Practitioner will be able to enroll approximately 800 patients. The chart below indicates the number of new patients the FHT expects to enroll over the next three years. Number of # of # of new # of NPs # of new Total # of Months physicians patients patients patients Assumptions 1 physician assume 1700 1 NP added (assume 800 added patients per every patients per every 6 physician 6months NP) months Start 11 0 0 0 6 12 1700 1 800 2500 12 12 1700 1 800 2500 18 13 3400 2 2800 8000 24 13 3400 2 3500 10,000 30 14 5100 2 4200 12,000 Based on these projections, the NPFHT should be able to enroll 2,500 patients within six months and 8,000 new patients within the first eighteen months. The first priority of the NPFHT will be to enroll ‘orphan’ patients; however, other patients will also be enrolled as they seek medical attention and as they utilize the services of the family physicians and the nurse practitioners. Coulson and Associates, Health Services Consultants 9/5/06
  • 27. North Perth Family Health Team Business and Operational Plan 27 To assist in the enrollment process, the NPFHT will develop a communication strategy that will inform local residents of the implementation of the NPFHT and will encourage these residents to enroll with the family physicians and the nurse practitioners. Community enrollment days will be organized to promote the enrollment of patients. As the Team evolves and matures, it is expected that it will achieve further clinical efficiencies and that by Year Three, existing family doctors will be able to carry somewhat higher caseloads. Core Primary Care Services In this section of the Operational Plan, the programs and services that will be provided by the NPFHT are described in detail. Comprehensive Care Services The North Perth Family Health Team will improve access to primary health care through the creation of an interdisciplinary health team that will offer a broad range of integrated programs and services. The core programs that will be offered by the North Perth Family Health Team either directly or in partnership with other community service providers are described below. Comprehensive care requires that the ongoing needs of patients be considered within the context of patients’ family and social needs. None of the identified core or special programs will function independently. The North Perth Family Health Team will provide all of the identified mandatory comprehensive care services, in addition to a range of optional and special services, targeted at the prevention and early identification of disease. The comprehensive care provided by the Family Health Team will include the following services: • Health Assessment including history documentation, physical examinations and diagnostic evaluation. • Diagnosis and Treatment of Episodic Illness and Injury including acute minor and complex illness, acute minor and complex injury. • Diagnosis and Treatment of Chronic Illness and injury, initial diagnosis and treatment, treatment adjustments, and monitoring. • Primary Reproductive Care including birth control counseling, pregnancy diagnosis, counseling re birth control and family planning, screening and treatment for sexually transmitted diseases. • Access to Prenatal, Obstetrical, Post-Natal and In-Hospital Newborn Care including the provision of maternity services including antenatal care to term, labour and delivery, and maternal and newborn care. Coulson and Associates, Health Services Consultants 9/5/06
  • 28. North Perth Family Health Team Business and Operational Plan 28 • Illness Prevention including periodic exams, primary, secondary and tertiary prevention, screening patients at risk, early detection initiatives, risk reduction counseling, immunization, assessments. • Health Promotion including Lifestyle counseling re determinants of health. • Education and Support for Self Care including health education, telephone advice and direction. • Primary Mental Health Care including diagnosis and treatment of emotional and psychiatric problems/illness, treatment adjustment, monitoring, referral, and case management. • Primary Palliative Care including home visits, individual and family support, initial treatment, treatment adjustment, monitoring, referral, and case management. • Support for Hospital, Home and Long-Term Care Programs including assisting with discharge planning, rehabilitation services, outpatient follow up, and home care services. • System Navigation and Case Management including service coordination, monitoring and referral to other health care providers including specialists, rehabilitation and physiotherapy services, home care and hospice programs, and diagnostic services. Collaborate on medical treatment and monitor status. • Coordination and Provision of Rehabilitative Services including referral to rehab services, participate in planning and follow up, education and advocacy, and care map development. • Chronic Disease Management including screening, diagnosis, treatment, management, and care coordination. • Arrangements for 24/7 Response including combining regular office hours with extended office hours and Telephone Health Advisory Services. Patients without Family Physicians There are an increasing number of orphan patients in the North Perth catchment area and many of these patients are currently being cared for in the Hospital Emergency Department. In the future, it is expected that the NPFHT will care for an increasing number of these patients. Some of the patients will be referred to the NPFHT following their discharge from the Hospital and others will be referred to the NPFHT following treatment in the Emergency Department. Others will be referred to the NPFHT as the community becomes more aware of the types of programs and services offered by the FHT. All family physicians in Listowel currently provide inpatient hospital care for their patients. Coulson and Associates, Health Services Consultants 9/5/06
  • 29. North Perth Family Health Team Business and Operational Plan 29 Chronic Disease Management The Province of Ontario is pursuing and supporting a number of chronic disease management initiatives in areas such as diabetes, heart disease, stroke, cancer, osteoporosis, asthma, arthritis, Alzheimer Disease and others dementias and mental health that are aimed at enhancing patient’s health and quality of life while reducing costs to the health care system. Over 80% of Ontarians over age 45, or 3.7 million people, are living with a chronic disease (Statistics Canada, 2003). Almost 70% of those individuals are living with two or more chronic conditions. In Ontario, diabetes is responsible for 25 – 33% of heart attacks, 34% of cases of heart failure, 30% of strokes, 64% of amputations, and 51% of new referrals for dialysis. As of the 2001 census, there were 1,700 residents aged 65 years and older in North Perth. The 2006 census results will confirm that Perth’s senior’s population has grown significantly and is forecast to increase even more rapidly. The aging population means that there will be an increasing challenge in meeting the needs of people with chronic diseases. Illnesses such as cardiovascular disease, diabetes and arthritis are becoming more prevalent and demands for care are rising. Consultation with providers in North Perth has identified the need for improved coordination and management of a variety of chronic diseases, specifically: arthritis, cancer, congestive heart failure, diabetes, hypertension, respiratory diseases (such as chronic obstructive lung diseases and asthma), osteoporosis and chronic renal failure. Program Description Chronic disease management is a proactive, population-based approach that addresses chronic diseases early in the disease cycle to prevent disease progression and reduce potential health complications. Multiple strategies are used to improve the health of all patients diagnosed with specific conditions and, as such, the team concept inherent in Family Health Teams is advantageous. This approach reduces the subsequent need for acute interventions in the future and allows people to maintain their independence and remain healthy for as long as possible. The Family Health Team will develop chronic disease management programs that: • Are evidence-based • Use multiple strategies and interventions • Are patient-centered • Empower individuals to increase control over and improve their health Coulson and Associates, Health Services Consultants 9/5/06
  • 30. North Perth Family Health Team Business and Operational Plan 30 • Promote collaboration among providers, organizations, individuals, families, and community groups • Include an evaluation component to ensure that programs are achieving their objectives. The Family Health Team steering committee recognizes the importance of effectively managing all these chronic diseases and recommends a phased-in approach, with an initial program emphasis on Diabetic patients. Staffing for this program will consist of a Registered Nurse (1.0 FTE); Registered Practical Nurse (1.0 FTE); Dietician (1.0 FTE); Case Manager (0.5 FTE - contracted) and a Pharmacist (0.5 FTE). Primary Mental Health Services The reform of Ontario’s mental health system has been in process for decades. The most recent step in this long-standing reform process was the establishment of Regional Mental Health Implementation Task Forces by the previous Conservative government. These Task Forces made extensive recommendations to enhance the capacity of local non-institutional services to provide more community-based care. These initiatives support the need to ensure that all Ontarians have access to a range of mental health services that embrace the following integral components of a comprehensive mental health system: community focus, comprehensive, individualized and flexible, an integrated system, and geographically and culturally relevant. The spectrum of functions that comprise a complete mental health system include: • Identification • Treatment and Crisis Support • Consultation • Coordination • Residential Support • Case Management • Social Support • Vocational Support • Self-Help/Peer Support • Family Support • Advocacy. Broad-based prevalence studies suggest that over 2% of the total population in Ontario have some form of severe mental illness (SMI). Further, it is estimated that only about half of the Coulson and Associates, Health Services Consultants 9/5/06
  • 31. North Perth Family Health Team Business and Operational Plan 31 SMI group actually access the health system. Considerably more individuals suffer from chronic and less severe mental health problems, often categorized as “mild to moderate mental illness”. The most recent Ontario Health Survey indicates that 18% to 20% of the total population in the province reports either a substance abuse or mental health problem. This translates into over 5,000 individuals in the North Perth area who would benefit from mental health services and supports. Historically, physicians have served as a first point of contact for patients with mental health needs but for rural family doctors with large practices, it has been difficult to provide these patients with the time and support they require. Accordingly, the North Perth Family Health Team will develop a comprehensive primary mental health program in partnership with existing mental health service providers in Perth County. Mental Health Services in North Perth There are two Ministry of Health-funded mental health agencies serving North Perth: • Huron-Perth branch of the Canadian Mental Health Association (CMHA); and • Outreach/Outpatient services of the Huron Perth Healthcare Alliance. The CMHA has one community support worker working with SMI clients in North Perth to ensure that there are appropriate resources in place (e.g. income, housing etc.) so that these individuals can be integrated into the community. This support worker has established strong working relationships with the Amish and Mennonite communities. The CMHA also manages a supportive housing unit in Listowel that has three apartments. The Huron Perth Healthcare Alliance (based at the Stratford hospital) currently provides the following services to all residents of Perth County: • Inpatient psychiatric unit at the Stratford hospital • Seniors mental health program • Sexual assault program • Psychiatric day/evening program (for individuals that can travel to their Stratford clinic). The Huron Perth Healthcare Alliance (Stratford hospital) has also been providing outreach mental services to the Listowel area for many years. These services are provided in the outpatient building across from the Listowel hospital. Currently, there are 2.5 FTE clinicians (social workers) that provide individual, group and family counseling; crisis case management and community outreach and education. Some of their practice is office-based and for some Coulson and Associates, Health Services Consultants 9/5/06
  • 32. North Perth Family Health Team Business and Operational Plan 32 clients, they travel to the home to provide services and supports. One of the clinicians works specifically with Mennonite and Amish families in which an individual has been diagnosed with a serious mental illness. Outreach services to North Perth also include visits from a Stratford psychiatrist (1 day per week) and a psycho geriatrician (1 day per week). There are a number of unmet mental health needs in North Perth that require priority consideration and additional resources: • Services for patients with primary/secondary prevention of mental health problems (i.e. without timely intervention, mild to moderate mental health problems can become SMI often requiring hospitalization) • Services for elderly patients who have mental health problems • Services for victims of sexual abuse (both male and female victims). Program Description The North Perth Family Health Team will work in partnership with Outpatient Mental Health Services and the Huron-Perth Branch of the Canadian Mental Health Association to meet the needs of the community and to ensure that there is no duplication of current services. North Perth Family Health Team’s primary mental health program will employ the same screening methods and direct services to individuals who suffer from mild to moderate mental illness, thereby addressing a significant unmet need in the community. Together with the primary care physicians, the FHT’s new mental health professionals will work towards reducing the negative impact of mental illness and improving the health functioning of persons who experience a wide range of mental health disorders. The NPFHT will provide the following mental health services: • Early identification, assessment and screening • Conduct bio-psycho-social assessments • Prepare a recommended plan of intervention and treatment • Share the assessment and plan with the primary care physician for review and modification. • Implement agreed upon recommendations • Ongoing review of medications and adjustments as required • Provide case coordination and linkages with other services • Primary and secondary prevention, and public education. To provide these services the NPFHT requires two Social Workers (1.0 FTE – psychogeriatrics; 1.0 FTE – adults with moderate mental illness) a part-time Registered Nurse Coulson and Associates, Health Services Consultants 9/5/06
  • 33. North Perth Family Health Team Business and Operational Plan 33 (0.5 FTE) and psychiatric and psycho-geriatric consultation services provided by medical specialists. Linkages/Partnerships Both the CMHA and the Huron Perth Healthcare Alliance have indicated their strong support for partnering with the North Perth Family Health Team to provide the services described above. Substance Abuse (Adolescents and Young Adults) The only Ministry of Health-funded addictions treatment agency serving Perth County is Choices for Change. This organization provides assessment, referral and community counselling for individuals impacted by their own or someone else’s substance use/abuse and problem gambling for persons age 12 and over. Their head office is in Stratford but they do have satellite office space in Listowel. According to statistics provided by Choices for Change, substance abuse among teenagers and young adults continues to escalate, in part because of the now well-documented crystal meth. problem.3 quot;Crystal Methquot; (methamphetamine) is a designer amphetamine that simulates dopamine and norepinephrine. Patients are at risk for hyperthermia, hypertensive emergencies, dysrhythmias, myocardial ischemia, and hyperkalemia associated with rhabdomyolysis. Patients become paranoid, hyperalert, agitated and exhibit very bizarre delusional and/or violent behavior. According to Choices for Change, crystal meth now accounts for approximately 20% of agency admissions. Top five 2005-06 admissions to the Choices for Change program from North Perth are listed below for adults and youth (up to age 18): Substance Abuse Problem Adults Youth Alcohol 64 22 Cannabis 28 28 Methamphetamine 27 12 3 Starting in 2005, Perth County was identified as “Ontario’s Crystal Meth Capital” following busts of 11 separate drug labs in the area (Source: Society for Rural Physicians of Canada, The Rural News, Vol. #7, Issue #23, October 28, 2005). Coulson and Associates, Health Services Consultants 9/5/06
  • 34. North Perth Family Health Team Business and Operational Plan 34 Cocaine 24 6 Crack 9 - Ecstasy - 7 There are several resources available to deal with this growing list of substance abuse problems. Choices for Change has one youth worker who visits the local high school one day per week. There is also an addictions counselor who provides services to adult clients three days per week. This level of service is inadequate to deal with the prevalence of substance abuse problems in the North Perth area. Program Description The North Perth Family Health Team will partner with Choices for Change to provide an enhanced addictions treatment service for adolescents and young adults with substance abuse problems. The FHT program will consist of two key components: • Assessment: A process of mutual investigation or exploration that provides the clinician with more detailed information for the purpose of determining specific client needs, goals, characteristics, problems and/or stage of change. Based on the information gathered, a treatment plan is developed. • Community Counseling. Includes brief intervention, lifestyle and personal counselling to assist the client to develop skills to manage substance abuse problems, and/or maintain and enhance treatment goals. A variety of modalities will be utilized such as Cognitive Behaviour Counselling, Social Learning, Narrative Therapy etc. The NPDFHT is requesting funding for a Youth Addictions Counselor (1.0 FTE) to develop this program. Linkages/Partnerships Choices for Change has indicated that it will partner with the North Perth Family Health Team to provide the services described above. Health Promotion and Disease Prevention The health and wellness of individuals is determined by a number of factors including biology and genetic endowment, the physical environment, living and working conditions, personal health practices and coping skills, and health services. Many of these determinants of health are Coulson and Associates, Health Services Consultants 9/5/06
  • 35. North Perth Family Health Team Business and Operational Plan 35 beyond the control of the North Perth Family Health Team and it would not be reasonable to expect the Family Health Team to be able to make an impact in all of these areas. However, it is reasonable to expect the Family Health Team to partner with its patients and staff of the Perth District Health Unit to assume responsibility for addressing the broad determinants of health through advocacy, coalition building, and a broad range of protection, promotion and prevention activities. Programs to promote health, prevent illness and to assist the general population to make healthy lifestyle choices are needed in every service sector. Too often, these types of preventive initiatives take a back seat to direct care and treatment. The Family Health Team’s holistic, wellness-oriented program spectrum will be able to make a significant contribution to this important need. The Perth District Health Unit has a satellite office in Listowel with 6.5 FTE health unit staff serving the North Perth area providing the following range of services. One of the staff members is allocated specifically to work with the Amish/Mennonite families in the area. Promoting Preventing Injury Protecting Indivduals Healthy Lifestyle and Disease and Families Choices Health Eating Communicable Disease Alcohol and Substance Investigation and Abuse Prevention Outbreak Control Food Safety Parenting Cancer Prevention Public Health Physical Activity Child Safety Emergency Response Pregnancy Support Immunization Rabies Investigation Stop Smoking West Nile Virus Safe Drinking Water Support Monitoring Measures Workplace School-based Programs Wellness Program Smoke-free Public Places Coulson and Associates, Health Services Consultants 9/5/06
  • 36. North Perth Family Health Team Business and Operational Plan 36 Program Description The North Perth Family Health Team will design and deliver wellness-oriented, health promotion and prevention services as part of all program/services offered through the Family Health Team. These initiatives will be undertaken in partnership with existing public health programs to ensure ready access to a broad range of prevention/promotion strategies that will include: • Individualized risk assessment and counseling, re: reproductive, maternal, child and family health • Well-baby visits and childhood immunization • A broad range of screening initiatives i.e. breast, cancer etc. • Prevention of communicable diseases, e.g. flu shots • Chronic disease prevention (therapeutic counseling addressing specific diseases and illnesses i.e. diabetes, heart disease, obesity) • Smoking Cessation • Programs for at-risk individuals and groups • Alcohol and drug abuse • Sexually transmitted diseases • Skills development education sessions to small groups, and group support programs in response to local needs (e.g. postpartum depression) • Stress reduction. It is expected that the FHT will complement outreach programs services offered by the PDHU through mandatory programs and Early Child Development initiatives. Through this wellness program, the NPFHT will also develop special prevention and promotion strategies for the Anabaptist communities, which have special service delivery challenges. This will require the skills of a Health Educator with broad-based community experience since some services will need to be provided through home visits and remote outreach sites but still integrated with existing programs. Because the Anabaptist communities have higher rates of congenital anomalies, there is a pressing need for better genetic screening and counseling. In addition to the nursing services offered through the FHT’s ‘Health Promotion and Disease Prevention’ program, the FHT will also require regular consultations from paediatricians in Stratford. Because of the special health needs of the Amish and Mennonite communities, there is an opportunity for the North Perth FHT Coulson and Associates, Health Services Consultants 9/5/06
  • 37. North Perth Family Health Team Business and Operational Plan 37 to collaborate with the Stratford and Perth Family Health Teams through a strong working relationship with the Perth District Health Unit. Staffing requirements for this program include a Registered Nurse (1.0 FTE); Health Educator (1.0 FTE - contracted) and paediatric consultations for Amish/Mennonite families. Linkages/Partnerships The Perth District Health Unit has indicated strong support for partnering with the North Perth Family Health Team to provide the services described above. Case Management and System Navigation With the increasing number of health programs planned for North Perth and the increasing complexity of the health care system, there is a need for enhanced system navigation and case management services to assist patients and their families to access current and new services. Patients with complex, chronic health problems will require linkages and referrals to multiple agencies and services to ensure that their care is coordinated and monitored on an ongoing basis. The Ministry of Health and Long-Term Care has identified “system navigation” as a top priority within the program structure of the fourteen new Community Care Access Centres across Ontario. Case management services are required both at the individual discipline level and across the entire health service system. Most current programs provide a measure of case management within their specific discipline. Broader system navigation services have been embraced by Perth Community Care Access Centre where workers have developed case management skills that cut across all disciplines, given their broad range of responsibilities and partnerships with multiple providers throughout the community. The range of services provided by the Perth County CCAC includes: • Personal Support • Nursing care • Occupational Therapy • Physiotherapy • Social services • Speech Therapy • Nutritional counseling • Case Management • Placement Coordination. Coulson and Associates, Health Services Consultants 9/5/06
  • 38. North Perth Family Health Team Business and Operational Plan 38 Program Description The North Perth Family Health Team will contract with Community Care Access Centre to provide in-house case management/system navigation services, recognizing the need to have an experienced case management worker at the Family Health Team well linked to all community partners. The Community Care Access Centre through its ongoing referral program has developed strong working relationships with all existing components of the service spectrum. The CCAC is knowledgeable of changes in the system, has an ongoing inventory of information, and a standing relationship with the community partners that will be serving the Family Health Team members. In addition, CCAC will develop a comprehensive database, enabling them to provide the Family Health Team with specific information about clients and their progress through the system. Generally, case managers or “system navigators” have a degree in a regulated health profession, often a nurse or therapist. The case manager with the Family Health Team may, subject to workload, be able to perform home visits for the purpose of establishing the initial needs, with other professionals from the CCAC following up. Staffing required for this program will include a Registered Practical Nurse (1.0 FTE) and a Case Manager (0.5 FTE) who will be contracted from the CCAC. Linkages/Partnerships The Perth CCAC has indicated strong support for partnering with the North Perth Family Health Team to provide the services described above. Rehab Services With the announcement of a Family Health Team for North Perth, rehab professionals in the area approached the FHT steering committee to ask if they could strike a time-limited sub-committee, which could provide input about local rehab needs. With the support of the steering committee, the rehab sub-committee met on several occasions in May and June 2006 (Appendix 9) in order to accomplish the following: • Prepare an up to date inventory of local rehab services • Compile rehab services statistics from different providers • Identify local gaps in rehab services • Identify opportunities for greater collaboration and integration. Like many rural areas, North Perth suffers from a shortage of rehab professionals. With respect to physiotherapy, there are long waiting lists at the Hospital for outpatient physio for both Coulson and Associates, Health Services Consultants 9/5/06
  • 39. North Perth Family Health Team Business and Operational Plan 39 adults and children. Priority is given to more acute cases so chronic patients have to wait longer. There is a private physiotherapy provider in North Perth (New Horizons Rehab) but many local residents do not have private insurance coverage and so depend on publicly funded services. There are an increasing number of patients (e.g. stroke patients, patients with joint replacements etc.) whose successful recovery depends on accessible rehab services. In terms of occupational therapy, the situation is even more critical because of the lack of local therapists. There is notable service gap between what the CCAC can offer and what is needed. Pediatric coverage is poor and only allows for one treatment every six weeks. School- age children and mild cases have almost no coverage for occupational therapy and autistic children do not receive services. It is estimated that 10% of the preschool population have speech problems. Inpatients have priority in terms of service. School-aged children often have to wait and often the number of visits is limited. There are two distinct groups of childhood cases: (1) children with language delays; (2) children with motor-related speech problems and both are underserviced, especially compared to what they receive through the pre-school speech initiative (Small Talk). While there are unmet local needs in all three therapies, the Rehab Subcommittee recommends that, if additional rehab can be offered through the Family Health Team, occupational therapy services should be enhanced as a first priority. Program Description In terms of geriatric FHT clients, the enhanced OT program offered through the FHT will be able to offer to patients following hospital discharge, services such as: hand-splinting, stroke recovery and education. The enhanced staffing will also allow the FHT to explore the development of a new vascular health clinic. Finally, the FHT may also be able to collaborate with the CCAC to provide additional home follow-up to help with “activities of daily living”. The NPFHT is requesting a part-time occupational therapist (0.5 FTE) with the expectation that this position would commence in Year 2. Linkages/Partnerships The creation of the time-limited rehab sub-committee has already spawned a number of new opportunities for multi-disciplinary collaboration and integration, which the FHT will continue to Coulson and Associates, Health Services Consultants 9/5/06
  • 40. North Perth Family Health Team Business and Operational Plan 40 explore and support as it becomes operational. In terms of possible ‘early wins’, the following initiatives are already under discussion: • Implement the current electronic medical record system (developed by the physicians) to local rehab professionals so that rehab services are better linked to other hospital and medical services • Increase the use of local chiropractors in the assessment, diagnosis (incl. x-rays) and treatment of FHT patients with arthritis and related conditions • Work with local industry to develop strategies to address the large number of workplace injuries, which produce high costs for both the private sector and the health care industry. Summary of Staffing Requirements In the previous section of this Business Plan, each program has been described and the human resource requirements for each program have been set out. The chart below summarizes the human resource requirements of each program and indicates the total number of allied health professionals required by the NPFHT. The FHT is requesting funding for 16 FTE allied health professionals. Program NP RN RPN Social Youth Dietician Pharmacist Health Case OT Worker Counselor Educator Manager Primary Care – 2 1 1 0.5 Orphan Patients Chronic Disease 1.5 2 1 0.5 0.5 Management Primary Mental 2 Health Service Youth Substance 1 Abuse Health Promotion 0.5 1 Case 0.5 0.5 Management Rehab Services 0.5 Total Number of 2.0 3.5 3.0 2.0 1.0 1.0 1.0 1.0 1.0 0.5 allied health professionals Linkages and Partnerships The North Perth Family Health Team has developed a strategy that will build on existing linkages and partnerships with current providers of primary care services in the community. In some cases, the NPFHT will contract with these agencies to provide primary care services. The FHT practitioners will carry out their primary health care function in partnership with a number of successful programs that are currently operating. These programs are accessible to the entire Coulson and Associates, Health Services Consultants 9/5/06
  • 41. North Perth Family Health Team Business and Operational Plan 41 community and the Family Health Team’s entry into these areas will be of a supplementary and complementary nature. Human Resources The roles and qualifications of allied health professionals referred to in this Business Plan are set out in the preliminary job descriptions e included in Appendix 12 . These job descriptions are based on those currently used by the Listowel Memorial Hospital and job descriptions that have been developed by other Family Health Teams. Recruitment Plan The Listowel Memorial Hospital will provide human resource management assistance to the NPFHT on a contract basis. The Human Resource Department of the Hospital will assist the FHT management team in the following activities: • Development of advertisements for these positions • Assisting in the finalization of job descriptions • Confirming salary and benefit arrangements • Confirming employment arrangements • Receiving and screening job applications • Short-listing qualified candidates • Developing selection criteria and interview questions • Assisting senior management in interviewing preferred candidates • Production of letters of offer to selected candidates • Arranging for orientation for new employees • Documentation of new employees for compensation, employee benefits, pension, etc. The Hospital Human Resource Department currently provides these services for all Hospital employees and is familiar with industry requirements for the recruitment of employees. Compensation of Allied Health Professionals Allied health professionals will be compensated on a salary basis using the guidelines provided by the Ministry of Health. In some cases, it may be necessary to use hospital industry salary levels that have been negotiated with the union which represent various health care professionals. Benefits for these professionals will be based on 20% of salary. Coulson and Associates, Health Services Consultants 9/5/06
  • 42. North Perth Family Health Team Business and Operational Plan 42 Compensation of Physicians All of the family physicians in Listowel are currently members of the Listowel FHN and they will continue to be compensated on a blended payment mechanism as members of the FHT. Some specialist physicians will be compensated on sessional basis. Collaborative Team Practice The North Perth FHT is in the process of developing a collaborative practice model that will be used to guide the ongoing development of the FHT as physicians and allied health professionals work together to meet the needs of their patients. A Patient Care Council will be created to provide a forum for the ongoing identification and resolution of issues and problems related to development of the collaborative practice model. Each member of the FHT will be represented on the Patient Care Council, which will meet monthly. Minutes of meetings will be circulated to all members of the FHT. To assist in the coordination, communication and resolution of professional practice issues, a Collaborative Practice Leader will be appointed to assist in the ongoing development of the Collaborative Practice Model employed by the NPFHT. The collaborative practice model that will be adopted by the NPFHT will be based on the health care literature and models that have been developed in other teams. Some of the key principles that will be considered in developing the patient care model will include: • Respect for the scope of practice as defined by each of the regulated health professionals governing bodies. • A commitment to work together with mutual respect for the qualifications of each member and to clarify areas of conflict or disagreement in a mutually agreeable manner. • Open communication will be critical to the ongoing success of the FHT and each member of the team will ensure that issues are identified and referred to the Professional Practice Council for discussion and resolution. • Standards of practice for each health professional group will be circulated to all members of the team. • Protocols will be developed for all patient care programs and services that set out the agreed treatment practices for the care of patients and the role of each health discipline. • Job descriptions setting out the roles and responsibilities of each health professional group will be developed and circulated to each member of the allied health team. • Education programs will be developed that focus on collaborative practice issues and these sessions will be held on a quarterly basis for all members of the FHT. Coulson and Associates, Health Services Consultants 9/5/06
  • 43. North Perth Family Health Team Business and Operational Plan 43 • Each health professional will be responsible for reporting any differences of opinion or conflicts that may arise regarding issues of collaborative practice to the Collaborative Practice Leader. • Each member of the FHT will be expected to consult with other members of the FHT including the patients family physician regarding any issues that are beyond the scope of practice of his/her regulated profession. • Monthly case conferences will be held with appropriate members of the FHT to review the progress of patients. • Guidelines for collaboration will be developed for each patient care program and these guidelines will be reviewed and revised on an annual basis. • All members of the FHT will participate in quarterly education sessions that focus on the ongoing development of a collaborative practice model and the clarification of any issues that may arise and problems that may occur. • All members of the allied health team will be expected to participate in collaborative practice education sessions offered by their professional association and other educational institutions. • Guidelines will be developed that set out the procedures for requesting consultations from other allied health professionals, the circumstance when consultations must be requested, diseases and disorders that must be referred to another allied health professional, documentation of the request for consultation and documentation of the results of the consultation. • Patient communication programs will be developed for all patient programs and services that ensure that patients clearly understand the roles and responsibilities of the members of their treatment team. • An ongoing quality assurance program will be developed to include annual environmental scans, data collection, patient surveys, chart audits, team member program reviews and team member peer reviews. The Role of the Nurse Practitioner in the Family Health Team Family practitioners and the nurse practitioners can work autonomously as the first point of entry for the Family Health Team, performing triage and delivering a broad range of primary care services. However, the expectation of the North Perth Family Health Team is that new Nurse Practitioners will initially work closely with the family doctors so that strong clinical relationships can be built. Nurse practitioners, while providing primary care and responding to Coulson and Associates, Health Services Consultants 9/5/06
  • 44. North Perth Family Health Team Business and Operational Plan 44 acute care needs, will also provide illness prevention and health promotion services. Nurse practitioners will provide a wide range of patient care services including: • Administering/monitoring therapeutic interventions and regimens • Assessment of health indicators/needs, self-care empowerment, education and support • Management of client health/illness status • Identifying acute/chronic disease • Recommending diagnostic/therapeutic interventions • Reassessment and management of client’s needs • Providing emotional/informational support to clients and families • Ongoing assessment, monitoring and management of client care • Providing follow-up care to monitor patient progress. Collaboration and consultation are critical themes that characterize all elements of nurse practitioner care. Educational Programs To ensure that this collaborative practice model is successfully implemented, it will be important to provide continuing education programs and services for the FHT staff on an ongoing basis. Funding has been requested to provide ongoing education programs for all FHT to ensure that interdisciplinary team care is provided in the most effective and efficient manner. Extended Hours Family physicians in the Listowel Family Health Network currently provide emergency coverage for the Hospital and are exempt from providing after-hours services in their offices. When additional family physicians and nurse practitioners are recruited as part of the family health team, there is the potential that a plan for providing after-hours coverage for patients during evenings and on weekends at the medical clinic may be considered. Other Programs In this section, a number of other programs that will be available to FHT patients are described. Laboratory and Radiology Services The Listowel Memorial Hospital provides a full range of laboratory and diagnostic imaging services for patients on both an inpatient and outpatient basis. These services will be available to Coulson and Associates, Health Services Consultants 9/5/06
  • 45. North Perth Family Health Team Business and Operational Plan 45 all patients enrolled in the NPFHT. A private specimen collection station is also located within the Medical clinic and this would be available for a FHT patients. Pulmonary Function Testing The Listowel Memorial Hospital provides pulmonary function testing, EKG and other diagnostic services for both inpatients and outpatients. All of these services will be available for patients enrolled with the NPFHT. Day Surgery Services The Listowel Memorial Hospital provides a full range of day surgery services for ambulatory care patients. These services will be available to all members of the NPFHT. Medical Specialists The Listowel Memorial Hospital has access to a full range of medical and surgical specialists. Family physicians within the NPFHT will continue to refer patients to these medical and surgical specialists when appropriate. To assist in selected programs, the NPFHT has requested funding for stipends and travel expenses for a paediatrician, geriatrician and a child psychiatrist to work with the family physicians and other allied health team members. Evaluation Mechanisms Evaluation of the effectiveness and efficiency of the programs and services that will be provided by the NPFHT will be critical to ensure that the FHT meets its objectives. The NPFHT will develop an evaluation framework for measuring the effectiveness and efficiency of programs and services provided by the FHT. The evaluation framework will include: • Patient satisfaction surveys • Provider satisfaction surveys • Level of collaboration • Management of health conditions • Changes in access to care • Achievement of program objectives • External evaluation of governance and management structure. A detailed Workplan for the evaluation process will be developed as part of the program implementation process, after new FHT professionals are hired. Data will be collected regarding each program in order to measure the success of the various programs and services in meeting Coulson and Associates, Health Services Consultants 9/5/06
  • 46. North Perth Family Health Team Business and Operational Plan 46 their objectives. Because the Listowel FHN already has an electronic medical record system, a computer programmer will work with Team members to develop customized reports for each FHT program which will include: • Number of patients seen • Disease incidence/prevalence estimates • Services used • Wait times • Clinical outcomes. Based on the primary care programs and services that are proposed for the NPFHT, a number of expected patient outcomes have been identified but will need to be refined as the Ministry develops its reporting templates. The NPFHT will monitor these patient outcomes during the development of the FHT and will report to the Ministry on these outcomes. Consolidated Timelines for Implementation During the first eighteen months of operation, the NPFHT will focus on the recruitment of allied health professionals, the recruitment of family physicians, the enrollment of patients and the establishment of expanded programs. A detailed implementation plan will be developed setting out the activities and timing for each activity when the Ministry of Health has approved this Business Plan. The first year of operation will also focus on the creation of a new, non-profit Board to govern the FHT and the development of a management structure to provide daily management of the FHT as new staff are hired and new programs are prepared. Within six months of commencing operation, the FHT will also begin the planning process for the preparation of a detailed operating budget for the second year of operation of the FHT. With a new FHT Board in place, a new Community Advisory Committee and new staff, the preparation of the Operating Plan for the second year of operation of the FHT will be more complex and more time consuming. Physical Facilities The Listowel Medical Clinic is out of date and requires expansion and upgrading to meet the needs of current family physicians. With plans to recruit additional family physicians and to add a number of other allied health professionals to the primary care team, there is a need for expanded facilities to accommodate these additional staff. Coulson and Associates, Health Services Consultants 9/5/06
  • 47. North Perth Family Health Team Business and Operational Plan 47 A Facilities Design sub-committee of the FHT steering committee has been established to assess a number of options for the redevelopment of the Medical Clinic. The options that are being considered include the following: • Option 1 – Renovate the existing medical clinic, with an addition to the clinic either horizontally or as a second floor or both. • Option 2 – Demolish the current clinic and construct a new building on a new site. • Option 3- Renovate both the clinic and the Hospital outpatient building to meet the needs of the NPFHT. The services of an architect and facilities planner have been engaged to review these options and to prepare cost estimates. In addition, the committee is considering how such a project might be funded and governed and the role that the Municipality, the Hospital, the family physicians and others may play in the redevelopment of these facilities. A business plan is being prepared that will set out both the capital cost requirements as well as the funding and governance factors that must be considered as part of this project. When the business plan is complete, it will be submitted to the Ministry of Health for consideration. The Ministry of Health has indicated that it is prepared to assist in the funding of capital projects related to the creation of FHTs. The NPFHT will present a plan to the Ministry for its consideration. Information Technology Unlike most other Family Health Teams, the Listowel FHN has already implemented a shared electronic medical record with the Listowel Memorial Hospital. The Listowel FHN physicians have developed and refined their electronic medical record (EMR) system over many years using the resources of Purkinje systems. Recently, OntarioMD has provided funding to the FHN for the ongoing operation of this system and the expansion of this system to include all family physicians. The next stage of development of this EMR system has two components: • Allow other allied health professionals in North Perth to access the system (referred to as the ‘community roll-out’) • Allow new members of the FHT to access the system. The NPFHT believes that the ‘roll-out’ of the EMR to other allied health professionals would be an enormous improvement in patient care. In particular, access to an updated patient profile, Coulson and Associates, Health Services Consultants 9/5/06
  • 48. North Perth Family Health Team Business and Operational Plan 48 medication list, and test results would benefit all allied health professionals. It is recognized that each caregiver may have different needs; for example, local chiropractors would find access to a medication list useful as well as access to x-ray reports. Nursing homes would appreciate access to Emergency reports and discharge summaries when their residents are treated at the Hospital. The FHT steering committee created a time-limited focus group to discuss the EMR ‘community roll-out’ and there was widespread support among local health care professionals (Appendix 10). Expanding access to the current EMR will require modifications to the current system software to ensure that there is adequate confidentiality within the system and there are appropriate IT interfaces with computer networks used by other health care professionals. A computer programmer is required to make these IT changes. This individual will work with the resources of OntarioMD and there would not be a duplication of effort in undertaking this task. The Listowel Hospital currently has an IT resource person but additional staffing resources will be required in conjunction with the Hospital IT staff to perform this work. Additional programming work will also be required to develop customized EMR reports that monitor the utilization and outcomes of the programs and services offered by the NPFHT (discussed in more detail under ‘Evaluation Mechanisms’). In addition, access to secure e-mail for all North Perth health professionals and caregivers has been identified as a key communication tool that will improve the coordination of patient care. Patients of the NPFHT would be the first to benefit from this system, but as more patients are enrolled and as more health professionals and community health agencies participate in the system, it is envisioned that the entire North Perth community would eventually be included within the system. Ultimately, the goal is to create a community health record for all North Perth residents that links all caregivers and health care organizations. In addition to the computer programming requirements, the FHT steering committee has identified privacy of patient records as a key EMR implementation issue. Even though written consent may not be necessary from a strict interpretation of current federal and provincial health information/privacy legislation, the steering committee believes that expanded use of the EMR system will require some type of overt consent to ensure that patients are comfortable with an expanded use of a shared health record. Initial Family Health Team education at inception of the team about appropriate levels of access to the EMR plus some patient education at the time of enrollment are both seen as necessary steps to address these privacy issues. Even though health care professionals already use several different patient consent forms which allows them to share patient information, a new consent mechanism may need to be developed for patients who have Coulson and Associates, Health Services Consultants 9/5/06
  • 49. North Perth Family Health Team Business and Operational Plan 49 information placed in the system that they want to keep confidential from other caregivers (e.g. visit to a sexual health clinic). To address this issue, the FHT will establish a Privacy Committee to examine the potential problems and solutions related to these privacy concerns. The implementation of an expanded system will be undertaken on a phased basis so that these issues can be dealt with in a timely manner. For example, the provision of secure e-mail would be immediately beneficial to many health professionals and would be part of a first phase of implementation. Also, the roll-out of the EMR to solo health care professionals (e.g. chiropractors, dentists, optometrists etc.) is scheduled as part of Phase 1 implementation (Appendix 10) since designing the interface between these solo practices and the current EMR system will be more straightforward than connecting to larger health care organizations (e.g. CCAC) that already have more complex IT systems in place. Annual Budget In Appendix 11, a detailed operating budget has been prepared in accordance with Ministry guidelines using Schedules 1, 2, 3, 4 and 5. Operating costs for the first seven months of the year are estimated as follows: • Human Resource costs are estimated at $960,532 • Operating expenses are estimated at $173,833 • One-time start-up costs are estimated at $174,200. We look forward to meeting with the Ministry of Health to answer any questions regarding this Business and Operational Plan for the North Perth Family Health Team. –––––––––––––––––––––––––––––––––––––––––––– Coulson and Associates, Health Services Consultants 9/5/06
  • 50. North Perth Family Health Team Business and Operational Plan 50 APPENDIX 1 Current and Projected Catchment Area Population for Listowel Memorial Hospital Age %Change %Change %Change Group 2003 2008 2003-2008 2013 2008-2013 2017 2013-2017 0-14 5,474 4,866 -11.1% 4,634 -4.8% 4,866 5.0% 15-19 2,232 2,100 -5.9% 1,909 -9.1% 1,449 -24.1% 20-44 9,125 9,243 1.3% 9,542 3.2% 9,907 3.8% 45-65 5,941 6,636 11.7% 6,807 2.6% 6,709 -1.4% 65-74 1,841 1,937 5.2% 2,193 13.2% 2,407 9.8% 75-84 1,233 1,254 1.7% 1,309 4.4% 1,344 2.7% 85+ 494 575 16.4% 601 4.5% 653 8.7% Total 26,340 26,611 1.0% 26,995 1.4% 27,335 1.3% Source: Master Plan, Listowel Memorial Hospital, 2003 Municipal Populations Contributing to Catchment Area Population for North Perth Family Health Team North Howick Huron Mapleton Minto Wellesley Woolwich Perth East Population in 2001 12,055 3,779 9,680 9,303 8,164 9,365 18,201 Population in 1996 11,808 3,685 9,937 8,827 7,854 8,664 17,325 1996-2001 pop. change (**) 2.1% 2.6% -2.6% 5.4% 3.9% 8.1% 5.1% Pop. density per square km. 24.4 13.1 14.5 17.4 27.2 33.7 55.8 Land area (square km) 493.2 287.4 669.2 534.7 300.4 277.9 326.0 Source: Statistics Canada, www.statscan.ca **Average population growth (1996-2001) across 7 municipalities = 3.6% Coulson and Associates, Health Services Consultants 9/5/06
  • 51. North Perth Family Health Team Business and Operational Plan 51 APPENDIX 2 North Perth Ontario Population and Dwelling Counts Total Total Population in 2001 12,055 11,410,046 Population in 1996 11,808 10,753,573 1996 to 2001 population change (%) 2.1 6.1 Total private dwellings 4,529 4,556,240 Population density per square km. 24.4 12.6 Land area (square km) 493.18 907,655.5 North Perth Ontario Age Characteristics Total Male Female Total Male Female Total - All persons 12,055 5,925 6,130 11,410,050 5,577,055 5,832,990 Age 0-4 730 385 350 671,250 343,340 327,905 Age 5-14 1,815 915 900 1,561,500 801,355 760,145 Age 15-19 1,035 535 495 769,420 394,915 374,500 Age 20-24 825 395 430 718,420 359,645 358,775 Age 25-44 3,205 1,605 1,600 3,518,010 1,724,535 1,794,480 Age 45-54 1,545 790 760 1,635,280 801,540 833,740 Age 55-64 1,100 550 550 1,064,000 520,565 543,430 Age 65-74 945 440 510 818,165 383,625 434,545 Age 75-84 655 260 400 503,930 202,265 301,665 Age 85 and over 190 50 140 150,075 45,260 104,810 Median age of the population 36.6 35.4 37.5 37.2 36.4 38.0 % of the population ages 15 and over 78.9 78.1 79.6 80.4 79.5 81.3 North Perth Ontario Earnings in 2000 Total Male Female Total Male Female All persons with earnings (counts) 6,970 3,710 3,260 6,319,535 3,311,105 3,008,425 Average earnings (all persons with earnings ($)) 27,141 33,300 20,127 35,185 42,719 26,894 Worked full year; full time (counts) 4,155 2,535 1,620 3,527,045 2,061,355 1,465,690 Average earnings (worked full year; full time ($)) 35,047 40,377 26,700 47,299 53,937 37,962 Median family income ($)- all census families 57,442 61,024 Median family income ($)- couple families 60,611 66,476 Coulson and Associates, Health Services Consultants 9/5/06
  • 52. North Perth Family Health Team Business and Operational Plan 52 Median family income ($) – lone-parent families 34,642 33,724 North Perth Ontario Highest Level of Schooling Total Male Female Total Male Female % of population aged 20-34 with less than a high school graduation certificate 20.0 19.9 20.0 13.2 14.9 11.0 % of population aged 35-44 with less than a high school graduation certificate 23.9 27.6 20.5 17.3 18.8 16.0 % of population aged 45-64 with less than a high school graduation certificate 39.1 42.3 35.1 27.5 26.5 28.0 North Perth Ontario Occupation Total Male Female Total Male Female Total labour force 6,730 5,992,765 Agriculture and other resource- based industries 1,190 191,020 Manufacturing and construction industries 1,910 1,316,580 Wholesale and retail trade 1,125 950,730 Finance and real estate 290 401,445 Health and education 775 902,990 Business services 705 1,145,910 North Perth Ontario Income in 2000 Total Total Persons 15 years of age and over with income 9,140 8,598,560 Median total income of persons 15 years of age and over ($) 22,688 24,816 Composition of total income (100%) 100.0 100.0 Earnings - % of income 75.7 78.7 Government transfers - % of income 12.1 9.8 Other money - % of income 12.2 11.5 Coulson and Associates, Health Services Consultants 9/5/06
  • 53. North Perth Family Health Team Business and Operational Plan 53 APPENDIX 3 Amish and Mennonite Communities in North Perth and East Perth Cultural Population Families Location Health Sources of Community (townships) Insurance? Health Care Old Order Amish 931 150 Mornington, Most have Chiropractors, Elma, Northeast health card Osteopaths, Hope Homeopaths, Naturopaths, Midwives, Massage Therapists, Physicians Old Order Mennonite 350 64 Mornington, Do not use Chiropractors first, Perth East OHIP then Physicians; Use of Midwives for hospital births Amish Mennonite 338 58 Mornington, 75% have Primarily use Elma, Ellice health card Physicians with some use of Chiropractors, Massage Therapists, Midwives Conservative/Markham 870 145 Mornington, Conservative – Physicians, Mennonite Wallace 80% have Chiropractors health card; Markham – 50% Church of God in Christ 250 50 Mornington, 100% have Primarily use Mennonite Wallace, health card Physicians, with Blanshard, some use of Fullarton Chiropractors, Midwives David Martin Mennonite 150 25 Mornington, 100% have Physicians, Wellesley (near health card Chiropractors, Linwood) Midwives Low German Speaking 300 50 Mornington (but Most have Physicians, Mennonites from a more transient health card Chiropractors, Mexico group) (once they Midwives receive landed immigrant status) Totals: 3,189 542 Source: “A Descriptive Profile of Amish and Mennonite Communities in Perth County”, Perth District Health Unit, October 2002 Coulson and Associates, Health Services Consultants 9/5/06
  • 54. North Perth Family Health Team Business and Operational Plan 54 APPENDIX 4 4 Age standardized mortality rates for total mortality (all causes of death) are listed below for the Grey Bruce Huron Perth district compared to the Thames Valley district and the Province of Ontario. The key finding is that age standardized mortality rates for residents of Grey Bruce Huron Perth counties are significantly higher5 than Ontario and also higher than the Thames Valley planning area (including London). Within the 4-county district, Perth County has the lowest age standardized rate for total mortality. Potential Years of Life Lost (PYLL) The potential years of life lost (PYLL) is a calculation of the years of life “lost” when a person dies from any cause before the age of 75 years6. In other words, PYLL represents the amount of premature death in any given population before age 75 years. The amount of premature death among residents of the Grey Bruce Huron Perth area is significantly higher than the Thames Valley planning area and the Province of Ontario. Age Standardized Potential Years of Life Lost (PYLL) /100,000 Population Aged 0-74 Years, All Causes, GBHP, Thames Valley and Ontario, 1995-97 5,900 5,800 PYLL/100,000 Population 5,700 5,600 5,502.5 5,500 5,400 5,300 GBHP 5,179.4 5,200 TV 5,090.2 5,100 Ontario 5,000 4,900 4,800 4,700 All Causes of Death Source: Statistics Canada, Vital Statistics, Death Database and Demography Division (population estimates), 2003 4 Age standardized rates involve a set of mathematical techniques used to remove, as much as possible, the effects of differences in age and other confounding variables when comparing two or more populations. 5 To determine whether differences are of statistical significance (i.e. the difference is not due solely to random error), 95% confidence intervals were examined for overlap. 6 PYLL – The age of 75 years was used since it is closest to the current life expectancy at birth as well as being the accepted standard method for calculating this indicator Coulson and Associates, Health Services Consultants 9/5/06
  • 55. North Perth Family Health Team Business and Operational Plan 55 APPENDIX 5 Results of Canadian Community Health Survey for Perth County Leisure-time physical activity, by sex, household population aged 12 and over, Canada, provinces, territories, health regions and peer groups, 2000/01 Moderately Physical activity, Leisure-time Total Physically active Physically inactive active not stated physical activity Number Number % Number % Number % Number % Perth Health Unit 62,847 8,688 13.8 12,522 19.9 38,229 60.8 3,407 5.4 (Peer group G) Males 31,075 4,238 13.6 6,318 20.3 17,926 57.7 2,594 8.3 Females 31,771 4,451 14.0 6,204 19.5 20,303 63.9 na na Ontario 9,877,292 2,101,583 21.3 2,104,850 21.3 4,918,534 49.8 752,324 7.6 Males 4,846,436 1,163,856 24.0 1,018,854 21.0 2,172,826 44.8 490,900 10.1 Females 5,030,856 937,728 18.6 1,085,996 21.6 2,745,708 54.6 261,424 5.2 Coulson and Associates, Health Services Consultants 9/5/06
  • 56. North Perth Family Health Team Business and Operational Plan 56 APPENDIX 6 Most Common Admissions to the Listowel Memorial Hospital, 2003-04 (> 20 cases) CMG Title Cases Weighted Cases 648 Normal newborn delivery 126 27.7 611 Vaginal delivery 123 88.7 294 Gastrointestinal/digestive disease 45 31.5 143 Simple pneumonia 39 46.7 847 Other specified aftercare 39 93.6 851 Other factors causing hospitalization 34 34.5 222 Heart failure 33 42.6 841 Rehabilitation 32 91.8 646 Low birth weight with caesarean 30 11.5 290 GI obstruction 27 43.9 242 Chest pain 26 11.9 647 Newborn with minor problem 24 9.3 13 Cerebrovascular disorder 22 52.3 237 Arrhythmia 22 16.9 329 Biliary tract disease 22 26.2 438 Diabetes 22 32.5 208 AMI w/o specific cardiac condition 21 17.8 609 Vaginal delivery with complications 21 18.4 Total Cases 1243 1295.4 % of Total = 57% Coulson and Associates, Health Services Consultants 9/5/06
  • 57. North Perth Family Health Team Business and Operational Plan 57 APPENDIX 7 Listowel Memorial Hospital Ambulatory Care Statistics (2003-04 to 2005-06) (cases >100 in 2005-06) CAC# Clinical Category 2003-04 2004-05 2005-06 % Increase 310 General ENT Management 861 942 1261 46.4576074 53 Skin Procedures 740 771 724 -2.1621622 915 Skin and Subcutaneous 413 641 691 67.3123487 420 General Respiratory Management 353 431 466 32.0113314 835 Other Musculosketetal Management 266 350 465 74.8120301 320 Otitis Media 345 376 431 24.9275362 2124 Sprains 256 330 403 57.421875 2050 Follow-up or Convalescence 81 264 345 325.925926 2130 Contusion 182 257 321 76.3736264 2010 Prophylactic Vaccination 67 187 318 374.626866 630 General GI Management 196 229 300 53.0612245 910 Skin and Subcutaneous 142 243 296 108.450704 1165 Other Genitourological Management 191 213 282 47.6439791 2112 Fractures and Dislocations 204 238 246 20.5882353 2005 Management General Symptoms 135 211 245 81.4814815 2166 Other Major Injuries 187 227 239 27.8074866 620 General GI Management 108 171 226 109.259259 640 General GI Management 122 192 222 81.9672131 2118 Open Wounds w-o Complications 225 148 214 -4.8888889 510 General Circulatory Management 129 146 188 45.7364341 210 Opthalmology Management 103 118 176 70.8737864 1810 Systemic Infection Management 106 155 163 53.7735849 410 General Respiratory Minor Investigation 99 119 156 57.5757576 2163 Other Moderate Injuries 119 149 148 24.3697479 1992 Personality and Mood Disorders 98 114 145 47.9591837 430 General Respiratory Management 76 90 138 81.5789474 120 Migraine Headache 76 80 131 72.3684211 6 Eye - Grade 1 80 95 129 61.25 2015 Therapeutic Counselling 68 138 129 89.7058824 340 Dental and Oral Disorders 95 101 126 32.6315789 520 Vascular Problems 35 89 125 257.142857 2115 Head Injury 80 111 122 52.5 610 General Gastro Minor Investigation 76 106 110 44.7368421 500 General Circulatory Minor Investigation 75 78 109 45.3333333 175 Management Vertigo 68 88 107 57.3529412 sub-totals: 6457 8198 9897 % of total cases 75% 76% 80.00% Total Cases 8,651 10,649 12,355 42.8158594 Coulson and Associates, Health Services Consultants 9/5/06
  • 58. North Perth Family Health Team Business and Operational Plan 58 APPENDIX 8 CCAC Caseload for North Perth clients Age Group 2003-04 2004-05 2005-06 < 20 years 100 132 146 20-59 years 75 71 92 60-85 years 179 188 217 >85 years 98 86 101 Total cases: 452 477 556 Type of Care % acute care 30% 23% 21% % long term care 25% 27% 28% % rehab 19% 30% 44% % other 26% 20% 7% Coulson and Associates, Health Services Consultants 9/5/06
  • 59. North Perth Family Health Team Business and Operational Plan 59 APPENDIX 9 Rehab Subcommittee of The North Perth Family Health Team Steering Committee Membership: Paul Hemingway D.C., Committee Co- Chair June Williamson P.T., Committee Co-Chair Rob Annis M.D., Lead FHT Physician Linda Collinson P.T. Sharon Davie, S-LP Brent Foisy, Human Resources, LTI Joanne Haines D.C. Barb Kerr, O.T. Name Employer Profession Telephone Email Joanne Haines Self Chiropractor 291-3441 jbhaines@wightman.ca Brent Foisy LTI (local industry) Health and Safety 291-9900 (225) brent_foisy@listech.on.ca Barb Kerr CCAC Occupational 291-6014 barb.kerr@hpc.ccac-ont.ca Therapist Linda Collinson Listowel Memorial PT 291-3125 (212) linda.collinson@lwha.ca Hospital Sharon Davie Listowel Memorial Speech-Language 291-3125 (282) sharon.davie@lwha.ca Hospital Pathologist Paul Hemingway Self-employed Chiropractor 291-3640 hemingway@personainternet.com June Williamson New Horizons Physiotherapist 291-5410 june@newhorizonsrehab.com Rehab Rob Annis LMH/Clinic Family doctor 291-4200 annis@cyg.net Meetings May 2, 15, June 5 plus special meeting on July 15 between Rehab subcommittee members and local industry representatives to discuss WSIB and other issues of mutual concern. Inventory of Local Rehab Services Physiotherapy provides treatment to a broad range of conditions: • Musculoskeletal – degenerative conditions of peripheral and spinal joints; traumatic injuries of peripheral joints, the spine and muscles, including fractures; osteoporosis; surgical procedures such as joint replacements. • Neurological – congenital (e.g. CP and Spina Bifida); acquired (e.g. CVA, ABI); degenerative (e.g. MS, ALS, Parkinson’s) • Respiratory – COPD, medical conditions, post-operative care • Cardiac – post-MI rehab • Other areas include sports injury rehab. Coulson and Associates, Health Services Consultants 9/5/06
  • 60. North Perth Family Health Team Business and Operational Plan 60 Physiotherapy services in North Perth are provided through the Listowel Memorial Hospital (in- patient and out-patient services), Perth CCAC, and to children through regional services such as Thames Valley Children’s Centre in London. Private physiotherapy is provided through New Horizons Rehabilitation Services Inc. Occupational Therapy There are 1.4 FTEs serving North Perth (1 full-time OT for adults and 1 paediatric OT doing 2 days per week). For School Services paeds, there is an OT working 2 days per week to cover Listowel, Elma, Wallace, Christian, and St. Mary’s RC. The schools in Milverton/Mornington and Mitchell and Howick area have an OT the equivalent of one day per week. According to the CCAC Case Manager for those schools, there are approximately 230 children on their caseload and while not all are OT clients, that is the majority and the largest growing sector of the new referrals. Chiropractic Chiropractors diagnose and treat musculoskeletal conditions which include arthritis and related conditions (ARC). ARC are a varied group of problems affecting the musculoskeletal system and one of the most common conditions affecting Ontarians.7 In 2000-01, arthritis and back problems were ranked second and third behind non-food related allergies. Prevalence increases with age but 3 in 5 affected are of working age. The crude prevalence of ARC in the Grey Bruce Huron Perth planning district is about 20% of those surveyed which is similar to the provincial average. The associated costs related to the management of ARC are second only to cardiovascular disease. The majority of costs are related to the indirect costs of disability and its consequent effect on work productivity. Improving the coordination and continuity of care in patients suffering from ARC would reduce the societal costs by reducing pain and suffering that hopefully would more than offset increases in health care expenditures.8 There are 3 chiropractors serving the Municipality of North Perth which represents a ratio of 1 chiropractor per 4,522 residents. This level of service availability is worse than the average for all of Perth County (1:3537) and only slightly better than the provincial average (1:5063). The utilization rate of chiropractors can be affected by regional variations in the prevalence and severity of musculoskeletal conditions, the number of chiropractors, the availability of other rehab professionals, and the availability of insurance coverage now that chiropractors have been de-listed from OHIP coverage. Service Gaps and Other Key Issues: At the hospital, the waiting list for Physiotherapy is currently 8 months. Priority is given to acute injuries, post op., and fractures while chronic patients fall through the gaps. Pediatrics is another gap in service. Current service is limited to infrequent visits (e.g. once every six weeks). The waiting list causes a lot of pressure and care can be affected (i.e. quality and time given gets rushed). 7 ICES Practice Atlas for Arthritis, Sept. 2004 8 Bradley et al, Arthritis and related conditions in Ontario Coulson and Associates, Health Services Consultants 9/5/06
  • 61. North Perth Family Health Team Business and Operational Plan 61 The number of new patients who were started on out-patient physiotherapy at LMH for the period April 1/05 – March 30/06 was 394; for the same period the number of new patients started on physiotherapy at New Horizons Rehabilitation Services Inc was 307 (243 – extended health care; 29 – WSIB). Consequently a total of 701 patients were started on physiotherapy treatment in that period. In addition, 183 in-patients were provided with care at LMH. There is an ongoing need for publicly funded physiotherapy to maintain mobility and functional health in the populations identified above. For example, stroke patients benefit significantly by access to physiotherapy care to optimize, then maintain motor recovery, and consequently function with respect to transfers, ambulation and activities of daily living, allowing that individual to live independently for a longer period of time. Individuals who undergo joint replacement, have degenerative joint and spine conditions require access in a timely fashion to treatment to optimize their recovery and maintain independence. Though some of North Perth residents have private insurance to access private care, a significant part of the population does not have this benefit and consequently rely on the public system to provide care. In addition some conditions require ongoing treatment (ex: congenital paediatric conditions and strokes) which can not be fully covered by private insurance. In summary, there is need for additional physiotherapy services in North Perth. Occupational Therapy This is a significant issue locally as a result of OT shortages and poor funding provided for OT’s provincially. There is notable service gap between what the CCAC can offers and what is needed. Pediatric coverage is poor (it allows for only 1 treatment every 6 weeks). School age children and mild cases have almost no coverage for OT’s and autistic children ‘fall through the cracks’. Geriatric OT clients are mostly things like hand-splinting, stroke recovery and education. There is a vascular health clinic that has had a hard time getting started. With respect to stroke patients, needs differ between age groups (i.e. 50 vs. 80 year old stroke patient). The follow-up after discharge is lacking. Additional funding might be able to help provide home follow up to help with things like ADL’s (activities of daily living). A lot of times patients are reliant on caregiver support just to get to rehab (the CCAC does it at home but it is much less intensive care than at the hospital). In summary, there is need for additional occupational therapy services in North Perth. Speech Language Pathology Pre-school children get service within three weeks (Small Talk). Ten percent of the preschool population have speech problems. Inpatients have priority. School-aged children often have to wait (this is the gap) and often the number of visits is limited. There are two distinct groups of childhood cases: (1) children with language delays; (2) children with motor-related speech problems and both are underserviced, especially compared to what they receive through the pre- school speech initiative. Coulson and Associates, Health Services Consultants 9/5/06
  • 62. North Perth Family Health Team Business and Operational Plan 62 A formal system is in place to transition preschool children into the school based system but adequate amount of service may be challenge. The Board of Education also has problems with SLP staffing, which means that often not enough is done in the school. Adult outpatients are fewer in number and access the service without significant wait times. In summary, there is need for additional speech language pathology services in North Perth. Use Of Chiropractic Services Chiropractic services have been recently de-listed by the provincial government, even with strong evidence to the contrary (esp. lower back pain, WSIB stats). Chiropractors are one of the 5 regulated health professions that have the ability to diagnose (i.e. neuromusculoskeletal conditions -NMS) and to take and read x-rays. With the introduction of the FHT, local chiropractors believe there is an opportunity to work more closely with physicians and other professionals to order proper examinations (i.e. x-ray, Doppler) for patients with ARC so that they can be more quickly diagnosed and begin treatment sooner. This would have the positive effect of reducing wait times to see physicians. Chiropractors can also help reduce system costs in their treatment of ARC patients. Partnering With Local Businesses To Reduce Negative Impacts Of Workplace Injuries Worker injuries are a huge cost to the health system and a significant drain on business productivity. In terms of provincial statistics, the average lost-time injury in 2006 cost $98,000 (up 66% from 2002). This includes both direct and indirect costs. Direct (WSIB) costs are 20% ($19,560). From 1996-2004, WSIB approved more than 382,000 MSD claims which led to 27 million days off and a direct cost to business of $3.3 billion. Indirect costs are 4 times greater estimated at $12 billion and include: overtime, lost productivity, equipment modifications, administration, retraining and compliance costs. Local industry in North Perth has huge costs related to WSIB. A lot of their employees come from out of town and local employers would like to refer to local practitioners to cut down on lost work time (e.g. having to miss a whole day of work for 1 treatment) and to keep the business local. Local employers are anxious to provide safe and suitable ‘return to work’ (RTW) for injured workers. There is a possibility of financial support from local industry especially if it can make sense to their bottom line (i.e. cut WSIB costs, reduce indirect costs etc.). Important statistics from local industry are as follows related to musculoskeletal disorders (MSD): • they cause the majority of injuries in North Perth • 42% of all lost-time claim costs • 50% of all lost-time days SYSTEM WEAKNESSES - Lack of OT (for stroke, splints, etc.) - Inadequate speech therapy (done through Board of Ed. and CCAC presently) - Lack of physio access; plus some physio is covered publicly and some is not Coulson and Associates, Health Services Consultants 9/5/06
  • 63. North Perth Family Health Team Business and Operational Plan 63 - Patient’s aren’t sure where to access the system/who to see - Industry doesn’t always access the system appropriately (i.e. frequently to ER) - Communication between providers - Inability of chiropractors to order x-rays POTENTIAL OPPORTUNITIES - Involve other “partners”, e.g. exercise facilities, Arthritis society, Fibromyalgia Group etc. - Pain management post rehab care (chronic pain management) - Work with industry to offer multidisciplinary rehab appropriate care where funding is costs-shared (WSIB, industry, OHIP, and the FHT) - Move “OT” care (for stroke, for example) close to home - Improve system navigation for patient - EMR roll out so rehab professionals are linked to a common patient medical record Coulson and Associates, Health Services Consultants 9/5/06
  • 64. North Perth Family Health Team Business and Operational Plan 64 APPENDIX 10 Focus Group on EMR Community Implementation Membership: Dr. Peter Trainor, dentist Dr. Betty Fretz, optometrist Kathy Scanlon, CCAC Jason Shaw, pharmacist Dr. Joanne Haines, chiropractor Cathy Healy, Caressant Care NH June Williamson, physiotherapist Brent Boschart, LMH Information Technology Mike Lapaine, LMH acting CEO Stephen Lafferty, Purkinje Dr. Russell Latuskie, Listowel FHN Dr. Rob Annis, Listowel FHN Meetings: March-April 2006 plus stakeholder survey (see below) Phased Implementation of EMR Community Roll-out: Phase 1 (September – December 2006) Listowel community health professionals who have indicated their support for the Family Health Team project and are prepared to be part of ‘Phase 1’9 community roll-out of the Listowel Electronic Medical Record (EMR): • Dr. Fretz (optometrist) • Tony Gangl (chiropractor) (519-291-1566) • Joanne Haines (chiropractor) (519-291-3441) • Dr. Paul Hemingway (chiropractor) (519-291-3640) • Dr. Rod MacKenzie (optometrist) (519-291-1511) • Dr. Peter Trainor (dentist) (519-291-3811) • June Williamson (physiotherapist) Phase 2 (2007) ‘Phase 2’ of community roll-out of the Listowel EMR will focus on larger health care organization who have expressed interest in working with the Listowel Family Health Team and accessing the EMR but the computer interface and/or patient confidentiality issues are more complex and will require additional time and resources to resolve: • Canadian Mental Health Association (Perth-Huron branch) 9 ‘Phase 1’ of EMR community roll-out will focus on solo health care professionals in Listowel that meet the following criteria: (1) written support for the FHT project and interest in using selected data elements from the EMR (based on April 2006 questionnaire); (2) already established policies to protect confidentiality of patient records/charts Coulson and Associates, Health Services Consultants 9/5/06
  • 65. North Perth Family Health Team Business and Operational Plan 65 • Community Care Access Centre for Perth County • Fordwich Village Nursing Home • Perth District Health Unit • Victorian Order of Nurses (Perth-Huron branch) Summary of Responses to EMR Roll-Out Survey (April 2006): -Dr. Fretz (optometry), Joanne Haines (chiropractor), Tony Gangl (chiropractor), R. Mackenzie, Dennis Nuhn (dentist), Peter Trainor (dentist), June Williamson (physiotherapist) 1. What data elements in the current Listowel EMR would you most like to have access to in terms of the patient care you provide? a. Diagnostic imaging results b. Access to lab results c. Current medications plus allergies d. Pertinent general health history e. Communicable diseases f. Intelligent data searches for relevant topics (e.g. headaches, back pain etc.) g. Messaging system 2. What patient information do you collect now that could potentially be added as new data elements to the EMR? a. Patient record would be more comprehensive if visits to allied health professionals are documented (incl. chief complaint, frequency of visits, treatment parameters, outcomes) – true community record would create greater efficacy and improved patient safety b. Pertinent ocular history c. Patients bring in copies of reports/x-rays from other centers or insurance information (WSIB) and these reports could be scanned into record d. Could contribute digital radiographs electronically – this could be beneficial for panographic radiographs (sinus and full TMJ areas) 3. Do you have a signed patient consent form which deals with sharing of patient information? a. Yes (5) b. No (2) 4. What are your main concerns about participating in the community roll-out of the Listowel EMR? a. Uncharted waters? b. Patient understanding of community health record is key to success c. What will the sharing of information look like in the end? d. Assuring patients that their privacy is secure e. The privacy issue is very significant – I feel that each participant must be prepared to educate the patient on the purpose and process of the EMR in order to generate patient comfort and ‘buy-in’ with the system Coulson and Associates, Health Services Consultants 9/5/06
  • 66. North Perth Family Health Team Business and Operational Plan 66 5. Will you be able to contribute to the ‘start-up’ and/or ongoing costs of an expanded Listowel EMR? a. Yes, but need more information on costs and benefits. b. I have not thought much about this. Anything that is beneficial to our community is something that I would be prepared to support financially. However, having said that, I feel that the providers of health services should not be looked at for ongoing financial support. I believe the users of the system and the community at large is where funding must come from. c. Costs and benefits to patients and individual practitioners are linked – all parties should benefit from the sharing of information; dollars need to be known and discussed d. What extent of cost-sharing is involved? It will be necessary to a cost-benefit analysis in order to make prudent decisions. 6. Other comments? a. This initiative is of major clinical safety and importance to me at this time since the delisting of chiropractic services by the government in Dec. 2004….chiropractors must use appropriate means of determining treatment efficacy based on a multitude of clinical and diagnostic tests – the x-ray being of paramount importance to those who deal with the musculoskeletal system. The integration of the EMR may provide an avenue for us to send an x-ray request to the patient’s physician to be reviewed and signed off to streamline this process. This has the potential to increase patient safety and I can give various instances where unstable fractures and osseous tumours were located by chiropractors and then treated with the appropriate allopathic medical intervention. Health Organizations Responding -Fordwich Village Nursing Home, VON, CCAC _______________________________________________________________________ 7. What data elements in the current Listowel EMR would you most like to have access to in terms of the patient care you provide? a. Diagnostic imaging results b. Lab results c. Current meds d. History/discharge summaries e. Basic health information f. Treatment orders pertaining to nursing g. Specialist reports 8. Please list the other key regulated health professionals in your organization that would benefit from some type of access to the Listowel EMR? a. Physicians, dentists, dieticians, occupational therapists, physiotherapists Coulson and Associates, Health Services Consultants 9/5/06
  • 67. North Perth Family Health Team Business and Operational Plan 67 b. Nursing, community support services (especially adult day programs) 9. What patient information do you collect now that could potentially be added as new data elements to the EMR? a. Residents advance care directive b. Community support services access to basic health information 10. Do you have a signed patient consent form which deals with sharing of patient information? a. Yes (3) 11. What are your main concerns about participating in the community roll-out of the Listowel EMR? a. Main concern is to ensure the security of resident/patient records 12. Will you be able to contribute to the ‘start-up’ and/or ongoing costs of an expanded Listowel EMR? a. Would depend on the costs involved b. Need to know more specifics Coulson and Associates, Health Services Consultants 9/5/06