2016-2019 Environmental Scan

Environmental Scan 2016-2019 Integrated Health Service Plans

03 September 2015 edition

28 August 2015 i

Table of Contents

Table of Contents i

Introduction 1

Alignment with Ontario Action Plan for Health 3

Access 3 Connect 4 Inform 4 Protect 5

Demographics and Census 7

Births and Mortality 39

General Health, Risk Factors, and Prevention 117

Chronic Conditions 135

Health Care Utilization 167

Acute Care Utilization 167 Emergency Department Visits 217 Day Surgery 265 Inpatient Rehab 283 Mental Health 301 Complex Continuing Care 351 Home Care 369

Long Term Care 401

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Primary Care 419

Health Human Resources 439

1 03 September 2015

Introduction

This Environmental Scan was prepared for use by all Local Health Integration Networks (LHINs) as an input for each LHIN’s fourth Integrated Health Service Plan (IHSP4). This Scan provides an overview of a number of key characteristics of local populations, services, utilization, and health impacts.

The document has not been designed for the general reader, but rather for LHINs and their funded Health Service Providers. It presents updated characteristics of health and healthcare in each LHIN as well as a comparison to Ontario overall and to other LHINs.

The development of each LHIN’s Integrated Health Service Plan requires more knowledge of and insight into the local environment than can be provided by a Scan of this nature. The Scan was developed to help support local discussion to further develop local priorities and activities, as well as to provide updated information on the measureable impact of targeted change.

The information presented in this Scan was proposed by the LHINs collectively and the information prepared by representatives of the Health Analytics Branch of the Ontario Ministry of Health and Long-Term Care.

The Working Group expresses its thanks to the representatives of the ministry and the LHINs who contributed to the creation of this Scan.

Ontario’s Local Health Integration Networks 1. Erie St. Clair 2. South West 3. Waterloo Wellington 4. Hamilton Niagara Haldimand Brant 5. Central West 6. Mississauga Halton 7. Toronto Central

8. Central 9. Central East 10. South East 11. Champlain 12. North Simcoe Muskoka 13. North East 14. North West

2 28 August 2015

3 03 September 2015

Alignment with Ontario Action Plan for Health

Each LHIN’s IHSP is developed as a cascade from the Ontario Action Plan for Health, with provincial priorities and strategies viewed through a local lens. The 2015 Action Plan for Health—Patients First—is divided into four sections: Access, Connect, Inform, and Protect. The tables below show the location of data within the Environmental Scan as they correspond to items in Patients First. Some of the priorities and strategies listed in Patients First are out of scope for LHINs. When this is the case, it has been noted in the tables below.

Access

Improve access – providing faster access to the right care.

Item Environmental Scan Location More same day and next day visits to family doctors or primary care providers

Primary Care LHIN Sections (pages 401-409)

Seeing a specialist sooner N/A

While there is information on specialists in the Health Human Resources section, data are not available on how quickly they are seen

Providing the right care for mental health and addiction Mental Health Section (pages 280-328)

Improving dementia support N/A

While there is information on deaths from dementia in the Mortality section, data are not available on dementia supports

Expanding scope/removing barriers to full practice N/A—out of scope for LHINs

More coordinated care for patients with complex medical conditions

Data are not currently available for this item. Future analysis of Health Links may provide this information.

Allowing nurse practitioners to prescribe assistive devices N/A—out of scope for LHINs

4 28 August 2015

Connect

Connect services – delivering better coordinated and integrated care in the community, closer to home

Item Environmental Scan Location Transforming home and community care Home Care Section (pages 346-377)

More rehabilitation therapy for seniors Complex Continuing Care Section (pages 329-345)

Inspections of long-term care homes N/A—out of scope for LHINs

Redeveloping older long-term care homes N/A—out of scope for LHINs

Supporting community paramedicine programs N/A—no current data available for these programs

Improvements for personal support workers N/A—no data available for this item

Additional convalescent care beds Long Term Care Section (pages 378-394)

Enhancing palliative care at home or out-of-hospital N/A

While there is information on palliative patients in the Mortality and Health Care Utilization sections, data are not available on palliative care

Inform

Support people and patients – providing the education, information and transparency they need to make the right decisions about their health

Item Environmental Scan Location Menu labelling to support healthier eating N/A—out of scope for LHINs

My CancerIQ online cancer risk assessment and prevention tool

N/A—out of scope for LHINs

Smoke Free Ontario N/A—out of scope for LHINs

Healthy Kids Strategy to support healthy habits from the start


Expanding mental health programs in schools and workplaces


Strengthening the effectiveness of Ontario’s immunization system, including better informing parents about their school-aged child’s immunization status


5 03 September 2015

Protect

Protect our universal public health care system – making decisions based on value and quality, to sustain the system for generations to come

Item Environmental Scan Location First Patient Ombudsman N/A—out of scope for LHINs

More public reports on health system performance N/A—out of scope for LHINs

More innovative approaches based on evidence N/A—out of scope for LHINs

More public information for patients N/A—out of scope for LHINs

Expanding patient engagement N/A—out of scope for LHINs

6 28 August 2015

7 03 September 2015

Demographics and Census

Socio‐Demographic Profile Notes: This document and the accompanying workbook contain analysis based on the 2006 and 2011 Census of Canada (Statistics Canada), 2011 National Household Survey, as well as population estimates and projections from the Ministry of Finance. Results are presented for Ontario and for Local Health Integration Networks (LHINs). Prepared June 2015

8 28 August 2015

ONTARIO Demographics

Ontario is home to 13.8 million people, an increase of 5.1% since 2010.

Ontario’s population is projected to experience growth over the next 5 and 10 years, increasing 5.3% between 2015 and 2020 and 11.1% between 2015 and 2025.

Seniors aged 65 years and over represent 16.1% of the Ontario population.

In 2011, 69.3% of the population of Ontario lived in large urban population centres (100,000+), while 14.1% lived in rural areas. Across the province’s LHINs, the rural population ranged from 0% in Toronto Central to almost 45% in the South East LHIN.

The overall population density in Ontario was 14.1 persons per square kilometre, ranging from 0.5 for North West LHIN to and 5,984.6 persons per square kilometer for Toronto Central LHIN.

Socio‐demographic characteristics, Ontario

Ontario Range across the LHINs

Population, 2015 13,809,683 235,870 ‐ 1,874,907 % population age 65+ 16.1% 12.1 ‐ 21.2% % population age 75+ 7.1% 4.8 ‐ 9.2%

Population growth, past 5 years (2010‐2015) 5.1% ‐1.2 ‐ 8.9% Projected population, 2020 14,546,659 235,955 ‐ 2,030,737Projected population, 2025 15,342,512 236,208 ‐ 2,195,401% growth forecasted, 2015‐2020 5.3% ‐0.6 ‐ 9.3% % growth forecasted, 2015‐2025 11.1% ‐1.0 ‐ 19.2%

% living in a rural area (2011) 14.1% 0 ‐ 44.8% % living in a large urban centre (2011) 69.3% 19.3 ‐ 100%

Socio‐demographic characteristics (% population)

English Mother Tongue 70.4% 51.7 ‐ 91.9% French Mother Tongue 4.4% 1.2 ‐ 23.2% No knowledge of English or French 2.3% 0.2 ‐ 4.9% Immigrants 28.5% 5.6 ‐ 48.6%

Recent immigrants (2006 ‐ 2011) 4.0% 0.3 – 7.3% Visible minorities 25.9% 1.8 ‐ 57.3% Aboriginal identity 2.4% 0.5 – 18.3% Labour force participation rate (age 15+) 65.5% 59.7 – 69.8% Unemployment rate, 2011 (age 15+) 8.3% 6.7 – 9.8% Without certificate/degree/diploma (age 25‐64) 11.0% 7.0 – 16.0% Completed post‐secondary education (age 25‐64) 64.8% 57.0 – 47.1% Living in low‐income 13.9% 11.5 – 18.5%

9 03 September 2015

Population characteristics

In 2011, 70% of the provincial population reported English and 4.4% reported French as their mother tongue. 2.3% of the population reported no knowledge of either official language.

In 2011, almost 30% of the Ontario population were immigrants and 4% were recent immigrants, having arrived in Canada between 2006 and 2011. Across the LHINs, the proportion of the population who were recent immigrants in 2011 ranged from 0.3% in the North East LHIN to 7.3% in the Central West LHIN.

Using the after‐tax low income measure, the proportion of residents living in low‐income households varied across the province, from 11.5% in the Waterloo Wellington and Mississauga Halton LHINs to 18.5% in Toronto Central. The proportion for Ontario was 13.9%.

10 28 August 2015

1. ERIE ST. CLAIR LHIN

Demographics

Erie St. Clair LHIN is home to approximately 636,000 people, or 4.6% of the population of Ontario.

In 2011, 45% of the LHIN’s population lived in large urban population centres (100,000+), 25% in medium urban population centres (population size 30,000‐99,999), and 19% lived in rural areas. Almost 45% of the Erie St. Clair LHIN population lived in Windsor and Sarnia.

In the past five years, the LHIN’s population decreased by 0.5%, while Ontario’s population increased by 5.1%.

The population of the LHIN is expected to decrease over the next 5 and 10 years, by 0.6% between 2015 and 2020 and by 0.8% between 2015 and 2020. In contrast, the province’s population is expected to grow by 5.3% and 11.1% over the respective time periods.

Seniors (aged 65+) accounted for just over 18% of the Erie St. Clair LHIN population, up from 16% in 2010.

Socio‐demographic characteristics, Erie St. Clair LHIN

Erie St. Clair LHIN

Ontario Comments†

Population, 2015 636,020 13,809,683 % population age 65+ 18.4% 16.1% % population age 75+ 8.1% 7.1%

Population growth, past 5 years (2010‐2015) ‐0.5% 5.1% 3rd lowestProjected population, 2020 632,214 14,546,659 Projected population, 2025 630,898 15,342,512 % growth forecasted, 2015‐2020 ‐0.6% 5.3% Lowest % growth forecasted, 2015‐2025 ‐0.8% 11.1% 2nd lowest

% living in a rural area (2011) 19.3% 14.1% % living in a large urban centre (2011) 44.6% 69.3%

Socio‐demographic characteristics (% population) English Mother Tongue 80.7% 70.4% French Mother Tongue 3.3% 4.4% No knowledge of English or French 1.3% 2.3% Immigrants 16.9% 28.5%

Recent immigrants (2006‐2011) 1.9% 4.0% Visible minorities 10.8% 25.9% Aboriginal identity 2.5% 2.4% Labour force participation rate (age 15+) 59.7% 69.5% Lowest Unemployment rate, 2011 (age 15+) 9.8% 8.3% Highest Without certificate/degree/diploma (age 25‐64) 12.8% 11.0% Completed post‐secondary education (age 25‐64) 57.0% 64.8% Lowest Living in low‐income 16.7% 13.9% 2nd highest

†Ranking in the province, compared to other LHINs.

11 03 September 2015


Nearly 81% of LHIN residents reported English and just over 3% reported French as their mother tongue in 2011.

In 2011, immigrants accounted for 17% of the population. Approximately 2% of Erie St. Clair LHIN residents were recent immigrants, having arrived in Canada between 2006 and 2011.

11% of the Erie St. Clair population was a visible minority, compared to 26% of Ontario’s population.

16.7% of Erie St. Clair LHIN residents lived in low‐income households, higher than the provincial rate of 13.9%.

Compared with other LHINs, Erie St. Clair had the lowest proportion of residents of working age who had completed post‐secondary education.

In 2011, Erie St. Clair LHIN had the highest unemployment rate in the province, at 9.8%, and the second lowest labour force participation rate (59.7%).

12 28 August 2015

2. SOUTH WEST LHIN

Demographics

South West LHIN is home to 971,500 people, or 7.0% of the population of Ontario.

In 2011, nearly 40% of LHIN residents lived in a large urban population centre (100,000+), and almost 30% lived in a rural area. An additional 21% lived in small population centres (population between 1,000‐29,999). The only large urban centre in South West LHIN is London.

Between 2010 and 2015 South West LHIN’s population increased by 2.6%, compared to 5.1% growth for Ontario overall.

Seniors (aged 65+) accounted for just over 18% of the LHIN’s population, compared to 16% in 2010.

The population of South West LHIN is projected to increase by 2.9% between 2015 and 2020, and 6.0% between 2015 and 2025. By comparison, the projected rates of growth for Ontario are 5.3% for 2015 to 2020 and 11.1% for 2015 to 2025.

Socio‐demographic characteristics, South West LHIN

South West LHIN

Ontario Comments†

Population, 2015 971,547 13,809,683 % population age 65+ 18.2% 16.1% % population age 75+ 8.1% 7.1%

Population growth, past 5 years (2010‐2015) 2.6% 5.1% Projected population, 2020 1,000,111 14,546,659 Projected population, 2025 1,030,265 15,342,512 % growth forecasted, 2015‐2020 2.9% 5.3% % growth forecasted, 2015‐2025 6.0% 11.1%


Socio‐demographic characteristics (% population) English Mother Tongue 85.8% 70.4% 3rd highestFrench Mother Tongue 1.3% 4.4% 3rd lowestNo knowledge of English or French 0.8% 2.3% Immigrants 14.0% 28.5%

Recent immigrants (2006‐2011) 1.6% 4.0% Visible minorities 7.6% 25.9% Aboriginal identity 2.0% 2.4% Labour force participation rate (age 15+) 65.4% 69.5% 3rd lowestUnemployment rate, 2011 (age 15+) 7.6% 8.3% Without certificate/degree/diploma (age 25‐64) 13.2% 11.0% Completed post‐secondary education (age 25‐64) 59.4% 64.8% Living in low‐income 14.0% 13.9%




About 86% of South West LHIN residents reported English and less than 2% reported French as their mother tongue in 2011.

In 2011, immigrants accounted for 14.0% of the South West LHIN population. 1.6% of residents were recent immigrants, having arrived in Canada between 2006 and 2011.

Less than 8% of the South West LHIN population was a visible minority, compared to 26% of Ontario’s population.

In 2011, the unemployment rate for South West LHIN residents (7.6%) was comparable to the provincial average (8.3%).

The proportion of South West LHIN residents living in low‐income households was 14.0%, similar to the provincial rate of 13.9%.

14 28 August 2015

3. WATERLOO WELLINGTON LHIN

Demographics

Waterloo Wellington LHIN is home to 778,700 people, or 5.6% of the population of Ontario.

Approximately 78% of LHIN residents lived in a large urban population centre (100,000+), while 11% lived in a rural area. Almost 80% of the LHIN’s population lived in Guelph, Cambridge, Kitchener or Waterloo.

The LHIN’s population growth over the past five years was similar to the provincial average, with the total population in the LHIN increasing by 5.4%, compared to 5.1% growth for Ontario overall.

Just over 14% of LHIN residents were seniors aged 65 years and over, higher than that in 2010 (11.6%).

The population of the LHIN is projected to increase by 5.6% between 2015 and 2020 and 11.5% between 2015 and 2025. By comparison, the projected rates of growth for Ontario are 5.3% for 2015 to 2020 and 11.1% for 2015 to 2025.

Socio‐demographic characteristics, Waterloo Wellington LHIN

Waterloo Wellington

LHIN

Ontario Comments†

Population, 2015 778,676 13,809,683 % population age 65+ 14.3% 16.1% 3rd lowest % population age 75+ 6.3% 7.1% 3rd lowest

Population growth, past 5 years (2010‐2015) 5.4% 5.1% Projected population, 2020 822,331 14,546,659 Projected population, 2025 868,262 15,342,512 % growth forecasted, 2015‐2020 5.6% 5.3% % growth forecasted, 2015‐2025 11.5% 11.1%



Recent immigrants (2006‐2011) 2.6% 4.0% Visible minorities 13.7% 25.9% Aboriginal identity 1.4% 2.4% Labour force participation rate (age 15+) 69.8% 69.5% Highest Unemployment rate, 2011 (age 15+) 6.7% 8.3% Lowest Without certificate/degree/diploma (age 25‐64) 12.3% 11.0% Completed post‐secondary education (age 25‐64) 62.0% 64.8% Living in low‐income 11.5% 13.9% Lowest




Nearly 79% of LHIN residents reported English and less than 2% reported French as their mother tongue in 2011.

In 2011, immigrants accounted for 20.5% of the Waterloo Wellington LHIN population. 2.6% of residents were recent immigrants, having arrived in Canada between 2006 and 2011.

Nearly 14% of the people living in the LHIN were visible minorities, compared to 26% of Ontario’s population.

Waterloo Wellington LHIN had the highest labour force participation rate among people age 15+ (69.8%), and the lowest unemployment rate of all LHINs.

Waterloo Wellington had the lowest proportion of residents living in low‐income households (11.5%). The rate for Ontario was 13.9%.

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4. HAMILTON NIAGARA HALDIMAND BRANT (HNHB) LHIN

Demographics

HNHB LHIN is home to 1,437,400 people, or 10.4% of the population of Ontario. It is the 3rd most populous LHIN in the province.

72% of HNHB LHIN residents lived in a large urban population centre (100,000+), while 12% lived in a rural area. 38% of the LHIN’s population lived in Hamilton.

Between 2010 and 2015, HNHB LHIN’s population increased by 3.4%, compared to a 5.1% increase for Ontario.

Seniors (aged 65+) accounted for 18.4% of the LHIN’s population, an increase from 16% in 2006.

The population of HNHB LHIN is projected to increase by 3.5% between 2015 and 2020 and 7.4% between 2015 and 2025. By comparison, the projected rates of growth for Ontario are 5.3% for 2015 to 2020 and 11.1% for 2015 to 2025.

Socio‐demographic characteristics, Hamilton Niagara Haldimand Brant LHIN

HNHB LHIN Ontario Comments†

Population, 2015 1,437,426 13,809,683 3rd highest % population age 65+ 18.4% 16.1% % population age 75+ 8.4% 7.1% 3rd highest

Population growth, past 5 years (2010‐2015) 3.4% 5.1% Projected population, 2020 1,487,124 14,546,659 3rd highestProjected population, 2025 1,543,202 15,342,512 3rd highest% growth forecasted, 2015‐2020 3.5% 5.3% % growth forecasted, 2015‐2025 7.4% 11.1%


Socio‐demographic characteristics (% population)English Mother Tongue 81.3% 70.4% French Mother Tongue 2.3% 4.4% No knowledge of English or French 1.0% 2.3% Immigrants 19.2% 28.5%

Recent immigrants (2006‐2011) 1.9% 4.0% Visible minorities 10.3% 25.9% Aboriginal identity 2.8% 2.4% Labour force participation rate (age 15+) 63.6% 69.5% Unemployment rate, 2011 (age 15+) 8.1% 8.3% Without certificate/degree/diploma (age 25‐64) 11.7% 11.0% Completed post‐secondary education (age 25‐64) 61.4% 64.8% Living in low‐income 13.2% 13.9%




Approximately 81% of HNHB LHIN residents reported English and 2.3% reported French as their mother tongue in 2011.

In 2011, immigrants accounted for 19.2% of the HNHB LHIN population. 1.9% of residents were recent immigrants, having arrived in Canada between 2006 and 2011.

About 10.3% of people living in the LHIN were visible minorities, compared to 25.9% of the population in Ontario.

The labour force participation rate among persons aged older than 15 years was 63.6%, lower than the rate for Ontario (69.5%). The unemployment rate for HNHB LHIN of 8.1% was comparable to the provincial rate (8.3%).

13.2% of HNHB LHIN residents were living in low‐income households, close to the Ontario proportion of 13.9%.

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5. CENTRAL WEST LHIN

Demographics

Central West LHIN is home to 922,000 people, or 6.7% of the population of Ontario.

85.5% of LHIN residents lived in a large urban population centre (100,000+), while 6.5% lived in a rural area.

The LHIN had higher than average population growth over the past five years. The population of Central West LHIN increased by 8.4% between 2010 and 2015, while the rate of growth for the province was 5.1%.

Central West LHIN is projected to have the highest rates of growth in the province, with 9.3% growth between 2015 and 2020 and 19.2% growth from 2015 to 2025. By contrast the projected rates of growth for Ontario are 5.3% for 2015 to 2020 and 11.1% for 2015 to 2025.

Compared to other LHINs, Central West had the lowest proportion of seniors. Only 12.1% of Central West LHIN residents were aged 65+, compared to 16.1% for Ontario.

Socio‐demographic characteristics, Central West LHIN

Central West LHIN

Ontario Comments†

Population, 2015 921,954 13,809,683 % population age 65+ 12.1% 16.1% Lowest % population age 75+ 4.8% 7.1% Lowest

Population growth, past 5 years (2010‐2015) 8.4% 5.1% 3rd highest Projected population, 2020 1,007,248 14,546,659 Projected population, 2025 1,099,075 15,342,512 % growth forecasted, 2015‐2020 9.3% 5.3% Highest% growth forecasted, 2015‐2025 19.2% 11.1% Highest


Socio‐demographic characteristics (% population) English Mother Tongue 58.2% 70.4% 2nd lowestFrench Mother Tongue 1.2% 4.4% LowestNo knowledge of English or French 4.2% 2.3% 2nd highest Immigrants 47.2% 28.5% 2nd highest

Recent immigrants (2006‐2011) 7.3% 4.0% Highest Visible minorities 57.3% 25.9% HighestAboriginal identity 0.7% 2.4% 3rd lowestLabour force participation rate (age 15+) 67.6% 69.5% Unemployment rate, 2011 (age 15+) 9.4% 8.3% Without certificate/degree/diploma (age 25‐64) 13.7% 11.0% Completed post‐secondary education (age 25‐64) 59.1% 64.8% 2nd lowest Living in low‐income 12.8% 13.9%




58.2% of Central West LHIN residents reported English and 1.2% reported French as their mother tongue in 2011. 4.2% of the LHIN’s population reported no knowledge of either official language, which was the second highest rate in the province.

In 2011, immigrants accounted for 47.2% of the Central West LHIN population. Approximately 7.3% of Central West LHIN residents were recent immigrants, having arrived in Canada between 2006 and 2011, which was the highest proportion among all the LHINs.

Over half of the people living in the LHIN were visible minorities. This was the highest proportion of visible minorities across the 14 LHINs.

The LHIN had a relatively high labour force participation rate among those aged 15+ (67.6%). The 2011 unemployment rate for Central West LHIN residents was among the highest in the province (9.4%).

The proportion of Central West LHIN residents living in low‐income households was 12.8%, slightly lower than the provincial rate (13.9%).

20 28 August 2015

6. MISSISSAUGA HALTON LHIN

Demographics

Mississauga Halton LHIN is home to 1,229,600 people, or 8.9% of the population of Ontario.

87% of the population of the LHIN lived in a large urban population centre (100,000+), while 1.7% lived in a rural area.

Between 2010 and 2015 the LHIN’s population increased by 8.9%, the highest growth rate of all LHINs. In comparison, Ontario’s population grew by 5.1% over the same period.

Mississauga Halton LHIN had a relatively low proportion of seniors aged 65+ (13.2%) compared to the province as a whole (16.1%). The proportion of seniors increased from 11.1% since 2010.

Mississauga Halton LHIN is projected to have the second highest population growth over the next 5‐10 years. The population is projected to increase by 8.4% between 2015 and 2020, with 17.6% growth between 2015 and 2025. In contrast, the projected rates of growth for Ontario are 5.3% for 2015 to 2020 and 11.1% for 2015 to 2025.

Socio‐demographic characteristics, Mississauga Halton LHIN

Mississauga Halton LHIN

Ontario Comments†

Population, 2015 1,229,590 13,809,683 % population age 65+ 13.2% 16.1% 2nd lowest % population age 75+ 5.6% 7.1% 2nd lowest

Population growth, past 5 years (2010‐2015) 8.9% 5.1% Highest Projected population, 2020 1,333,109 14,546,659 Projected population, 2025 1,445,742 15,342,512 % growth forecasted, 2015‐2020 8.4% 5.3% 2nd highest% growth forecasted, 2015‐2025 17.6% 11.1% 2nd highest

% living in a rural area (2011) 1.7% 14.1% 2nd lowest % living in a large urban centre (2011) 87.0% 69.3% 3rd largest

Socio‐demographic characteristics (% population) English Mother Tongue 59.2% 70.4% 3rd lowestFrench Mother Tongue 1.8% 4.4% No knowledge of English or French 2.7% 2.3% Immigrants 44.3% 28.5% 3rd highest

Recent immigrants (2006‐2011) 6.6% 4.0% Visible minorities 40.7% 25.9% 3rd highestAboriginal identity 0.6% 2.4% 2nd lowestLabour force participation rate (age 15+) 69.2% 69.5% 2nd highestUnemployment rate, 2011 (age 15+) 7.9% 8.3% Without certificate/degree/diploma (age 25‐64) 7.0% 11.0% Lowest Completed post‐secondary education (age 25‐64) 72.5% 64.8% 2nd highest Living in low‐income 11.5% 13.9% 2nd lowest




Compared to Ontario, a smaller proportion of Mississauga Halton LHIN residents reported English as their mother tongue (59% vs. 70% for Ontario). Slightly less than 2% of the LHIN’s population reported French as their mother tongue in 2011.

Immigrants accounted for 44.3% of Mississauga Halton LHIN residents. Over 6.6% of Mississauga Halton LHIN residents were recent immigrants, having arrived in Canada between 2006 and 2011, which was higher than the Ontario rate of 4.0%.

Nearly 41% of Mississauga Halton LHIN residents were visible minorities, compared to 25.9% for Ontario.

Educational attainment levels among LHIN residents of working age were high. Mississauga Halton LHIN had the lowest proportion of residents aged 25‐64 who did not have a completed certificate, diploma or degree and had the second highest proportion of the working age population with completed post‐secondary education.

Mississauga Halton LHIN had the second lowest rate (11.5%) of residents who lived in low‐income households in the province.

22 28 August 2015

7. TORONTO CENTRAL LHIN

Demographics

Toronto Central LHIN is home to 1,264,000 people, or 9.2% of the population of Ontario. The LHIN population is completely urban.

Between 2010 and 2015, the LHIN’s population increased by 7.7%, while the population of Ontario increased by 5.1%.

The population of the Toronto Central LHIN is projected to increase by 7.0% between 2015 and 2020 and 14.2% between 2015 and 2025. In contrast, the projected rates of growth for Ontario are forecasted to be 5.3% for 2015 to 2020 and 11.1% for 2015 to 2025.

About 15% of LHIN residents were seniors (aged 65+).

Socio‐demographic characteristics, Toronto Central LHIN

Toronto Central LHIN

Ontario Comments†

Population, 2015 1,264,037 13,809,683 % population age 65+ 15.1% 16.1% % population age 75+ 7.2% 7.1%


% living in a rural area (2011) 0% 14.1% Lowest% living in a large urban centre (2011) 100% 69.3% Highest

Socio‐demographic characteristics (% population) English Mother Tongue 62.4% 70.4% French Mother Tongue 2.3% 4.4% No knowledge of English or French 4.2% 2.3% 3rd highestImmigrants 38.4% 28.5%

Recent immigrants (2006 ‐ 2011) 6.8% 4.0% 3rd highest Visible minorities 33.6% 25.9% Aboriginal identity 1.0% 2.4% Labour force participation rate (age 15+) 68.5% 69.5% 3rd highestUnemployment rate, 2011 (age 15+) 8.3% 8.3% Without certificate/degree/diploma (age 25‐64) 8.9% 11.0% 3rd lowest Completed post‐secondary education (age 25‐64) 74.1% 64.8% Highest Living in low‐income 18.5% 13.9% Highest




Approximately 62% of Toronto Central LHIN residents reported English and 2.3% reported French as their mother tongue in 2011. 4.2% of the Toronto Central LHIN population reported no knowledge of either official language.

In 2011, immigrants accounted for 38.4% of the Toronto Central LHIN population. 6.8% of residents were recent immigrants, having arrived in Canada between 2006 and 2011.

33.6% of the Toronto Central LHIN residents were visible minorities, compared to 25.9% for Ontario.

Among all LHINs, Toronto Central LHIN had the highest proportion (74%) of working age residents who had completed post‐secondary education.

Toronto Central LHIN had the highest proportion (18.5%) of residents living in low‐income households in the province.

24 28 August 2015

8. CENTRAL LHIN

Demographics

Central LHIN is home to 1,874,900 people, or 13.6% of the population of Ontario. It is the most populous LHIN in Ontario.

88.8% of the population of the LHIN lived in a large urban centre (population 100,000+), while just 4.5% lived in a rural area. Almost 40% of the LHIN’s population lived in the city of Toronto, 17% in Markham, and 14% in Vaughan.

Between 2010 and 2015 the LHIN’s population increased by 8.4%, the 2nd highest growth rate among all LHINs. Ontario’s population grew by 5.1% over the same period.

Population growth is expected to remain high relative to the province over the next five and ten years. The LHIN’s population is projected to increase by 8.3% between 2015 and 2020 and 17.1% between 2015 and 2025.

Seniors (aged 65+) accounted for 14.3% of the LHIN’s population. Socio‐demographic characteristics, Central LHIN

Central LHIN Ontario Comments†

Population, 2015 1,874,907 13,809,683 Largest % population age 65+ 14.3% 16.1% % population age 75+ 6.3% 7.1%

Population growth, past 5 years (2010‐2015) 8.4% 5.1% 2nd highest Projected population, 2020 2,030,737 14,546,659 Highest Projected population, 2025 2,195,401 15,342,512 Highest% growth forecasted, 2015‐2020 8.3% 5.3% 3rd highest% growth forecasted, 2015‐2025 17.1% 11.1% 3rd highest

% living in a rural area (2011) 4.5% 14.1% 3rd lowest % living in a large urban centre (2011) 88.8% 69.3% 2nd highest

Socio‐demographic characteristics (% population) English Mother Tongue 51.7% 70.4% Lowest French Mother Tongue 1.3% 4.4% 2nd lowestNo knowledge of English or French 4.9% 2.3% Highest Immigrants 48.6% 28.5% Highest

Recent immigrants (2006‐2011) 6.9% 4.0% 2nd highestVisible minorities 46.9% 25.9% 2nd highestAboriginal identity 0.5% 2.4% Lowest Labour force participation rate (age 15+) 65.8% 69.5% Unemployment rate, 2011 (age 15+) 8.1% 8.3% Without certificate/degree/diploma (age 25‐64) 9.8% 11.0% Completed post‐secondary education (age 25‐64) 69.0% 64.8% Living in low‐income 14.5% 13.9%




51.7% of Central LHIN residents reported English and 1.3% reported French as their mother tongue in 2011. Central LHIN had the highest proportion of residents with no knowledge of either official language (4.9%) in the province in 2011.

Among all LHINs, Central LHIN had the highest proportion of residents who were immigrants (48.6%). 6.9% of residents were recent immigrants, having arrived in Canada between 2006 and 2011, which was the 2nd highest proportion in the province.

Among all LHINs, Central LHIN had the 2nd highest proportion of residents who were visible minorities (46.9%).

Central LHIN had a slightly higher proportion of residents who lived in low‐income households (14.5%) compared to the province (13.9%).

26 28 August 2015

9. CENTRAL EAST LHIN

Demographics

Central East LHIN is home to approximately 1,603,200 people, or 11.6% of the population of Ontario.

In 2011, 72% of the population lived in a large urban centre (population 100,000+), while 13% lived in rural areas. The LHIN includes the eastern section of the city of Toronto (i.e., Scarborough), which accounted for approximately 42% of the LHIN’s population. Oshawa, Whitby, Pickering and Ajax together accounted for an additional 30% of LHIN residents.

Between 2010 and 2015, Central East LHIN’s population increased by 4.6%. In comparison, Ontario’s population grew by 5.1% over the same period.

Central East LHIN’s population is projected to increase by 4.7% between 2015 and 2020 and 9.9% between 2015 and 2025, which is lower than the projected growth rates for Ontario for the same time periods.

Seniors (aged 65+) accounted for 16.3% of the Central East LHIN population. Socio‐demographic characteristics, Central East LHIN

Central East LHIN

Ontario Comments†

Population, 2015 1,603,249 13,809,683 2nd largest % population age 65+ 16.3% 16.1% % population age 75+ 7.3% 7.1%

Population growth, past 5 years (2010‐2015) 4.6% 5.1% Projected population, 2020 1,678,056 14,546,659 2nd highestProjected population, 2025 1,761,822 15,342,512 2nd highest % growth forecasted, 2015‐2020 4.7% 5.3% % growth forecasted, 2015‐2025 9.9% 11.1%



Recent immigrants (2006‐2011) 4.1% 4.0% Visible minorities 37.2% 25.9% Aboriginal identity 1.4% 2.4% Labour force participation rate (age 15+) 63.7% 69.5% Unemployment rate, 2011 (age 15+) 9.6% 8.3% 2nd highestWithout certificate/degree/diploma (age 25‐64) 11.2% 11.0% Completed post‐secondary education (age 25‐64) 61.7% 64.8% Living in low‐income 14.6% 13.9% 3rd highest




Approximately 73% of Central East LHIN residents reported English and 1.5% reported French as their mother tongue in 2011. Compared with Ontario, Central East LHIN had a larger proportion of residents with no knowledge of English or French.

In 2011, immigrants accounted for 33.2% of the Central East LHIN population. Approximately 4% of LHIN residents were recent immigrants, having arrived in Canada between 2006 and 2011.

Central East LHIN had the 2nd highest unemployment rate in the province at 9.6%, compared to 8.3% for Ontario.

Nearly 15% of Central LHIN residents were living in low‐income households, which was the 3rd highest proportion among the 14 LHINs.

28 28 August 2015

10. SOUTH EAST LHIN

Demographics

South East LHIN is home to about 496,400 people, or 3.6% of the population of Ontario.

A quarter of the population lived in a large urban centre, while 45% lived in a rural area, making the South East LHIN the most rural LHIN in Ontario. 40% of the population lived in Kingston, Belleville or Brockville; however, Kingston was the only area with a population greater than 100,000.

Between 2010 and 2015 South East LHIN’s population increased by only 1.4%, much less than the Ontario growth rate of 5.1%.

Seniors (aged 65+) accounted for 21% of South East LHIN residents, an increase from 18% in 2006. South East LHIN had the highest proportion of seniors in Ontario.

The LHIN’s population is projected to increase by 2.2% between 2015 and 2020 and 4.6% between 2015 and 2025. In contrast, the projected rates of growth for the province are expected to be 5.3% for 2015 to 2020 and 11.1% for 2015 to 2025.

Socio‐demographic characteristics, South East LHIN

South East LHIN

Ontario Comments†

Population, 2015 496,419 13,809,683 3rd highest % population age 65+ 21.2% 16.1% Highest % population age 75+ 9.2% 7.1% Highest

Population growth, past 5 years (2010‐2015) 1.4% 5.1% Projected population, 2020 507,416 14,546,659 3rd highestProjected population, 2025 519,145 15,342,512 3rd highest % growth forecasted, 2015‐2020 2.2% 5.3% % growth forecasted, 2015‐2025 4.6% 11.1% % living in a rural area (2011) 44.8% 14.1% Highest % living in a large urban centre (2011) 24.6% 69.3% 2nd lowest

Socio‐demographic characteristics (% population) English Mother Tongue 91.9% 70.4% HighestFrench Mother Tongue 3.0% 4.4% No knowledge of English or French 0.2% 2.3% 2nd lowestImmigrants 8.5% 28.5% 3rd highest

Recent immigrants (2006‐2011) 0.7% 4.0% 3rd highest Visible minorities 3.4% 25.9% 3rd highest Aboriginal identity 3.9% 2.4% Labour force participation rate (age 15+) 61.0% 69.5% 3rd highestUnemployment rate, 2011 (age 15+) 8.0% 8.3% Without certificate/degree/diploma (age 25‐64) 12.5% 11.0% Completed post‐secondary education (age 25‐64) 59.9% 64.8% Living in low‐income 14.1% 13.9%




Approximately 92% of South East LHIN residents reported English as their mother tongue, which was the highest proportion among all LHINs, in 2011. 3.0% of residents reported that French was their mother tongue. South East LHIN residents had the 2nd lowest proportion of residents with no knowledge of English or French.

In 2011, only 8.5% of South East LHIN residents were immigrants, compared to 28.5% for Ontario. Less than 1% of residents were recent immigrants who arrived in Canada between 2006 and 2011.

3% of South East LHIN residents were visible minorities, compared to 26% provincially.

The unemployment rate of 8.0% was similar to the Ontario average (8.3%). South East LHIN residents had the 3rd lowest labour force participation rate among the 14 LHINs.

14.1% of South East LHIN residents were living in low‐income households, similar to the proportion for Ontario (13.9%).

30 28 August 2015

11. CHAMPLAIN LHIN

Demographics

Champlain LHIN is home to about 1,319,900 people, or 9.6% of the population of Ontario.

65% of the population of Champlain LHIN lived in a large urban population centre with a population of 100,000+ (i.e., Ottawa), while 20% lived in a rural area.

Between 2010 and 2015 the population of the Champlain LHIN increased by 5.2%, similar to the provincial growth rate of 5.1%.

Seniors (aged 65+) accounted for 16% of Champlain LHIN residents, slightly higher than in 2010 when it was 14%.

The LHIN’s population is projected to increase by 6.0% between 2015 and 2020 and 12.4% between 2015 and 2025. These growth rates are slightly higher than those for Ontario.

Socio‐demographic characteristics, Champlain LHIN

Champlain LHIN

Ontario Comments†

Population, 2015 1,319,923 13,809,683 % population age 65+ 15.9% 16.1% % population age 75+ 6.8% 7.1%



Socio‐demographic characteristics (% population) English Mother Tongue 66.8% 70.4% French Mother Tongue 18.8% 4.4% 2nd highest No knowledge of English or French 1.0% 2.3% Immigrants 18.5% 28.5%

Recent immigrants (2006‐2011) 2.8% 4.0% Visible minorities 17.7% 25.9% Aboriginal identity 2.7% 2.4% Labour force participation rate (age 15+) 68.0% 69.5% Unemployment rate, 2011 (age 15+) 7.0% 8.3% 2nd lowestWithout certificate/degree/diploma (age 25‐64) 8.6% 11.0% 2nd lowestCompleted post‐secondary education (age 25‐64) 69.5% 64.8% Living in low‐income 11.8% 13.9% 3rd lowest




Approximately 67% of Champlain LHIN residents reported English as their mother tongue in 2011. Among all LHINs, Champlain had the 2nd highest proportion of residents (18.8%) who reported that their mother tongue was French.

Champlain LHIN had a lower proportion of immigrants, recent immigrants, and visible minorities compared to Ontario overall. In 2011, 18.5% of Champlain LHIN residents were immigrants and less than 3% of residents were recent immigrants, having arrived in Canada between 2006 and 2011. 17.7% of Champlain LHIN residents were visible minorities, compared to 23% provincially.

Champlain LHIN has the 2nd lowest unemployment rate among LHIN areas. The LHIN also had the 2nd lowest proportion of working age residents who did not have a certificate, degree or diploma.

Champlain LHIN had a smaller proportion (11.8%) of residents who lived in low‐income households compared to Ontario (13.9%).

32 28 August 2015

12. NORTH SIMCOE MUSKOKA LHIN

Demographics

The North Simcoe Muskoka LHIN is home to just under 475,700 people, or 3.4% of the population of Ontario.

38% of the population of the LHIN lived in a large urban population centre (100,000+), while 32% lived in a rural area. 31% of LHIN residents lived in Barrie.

Between 2010 and 2015, the population of the LHIN increased by 5.5%, similar to the provincial growth rate of 5.1%.

Seniors (aged 65+) accounted for 19% of North Simcoe Muskoka LHIN residents, an increase from 16% in 2006.

The LHIN’s population is projected to increase by 5.1% between 2015 and 2020 and 10.7% between 2015 and 2025. These growth rates are comparable to those for Ontario for the same time periods.

Socio‐demographic characteristics, North Simcoe Muskoka (NSM) LHIN

NSM LHIN Ontario Comments†

Population, 2015 475,676 13,809,683 2rd smallest % population age 65+ 18.8% 16.1% % population age 75+ 8.2% 7.1%

Population growth, past 5 years (2010‐2015) 5.5% 5.1% Projected population, 2020 500,151 14,546,659 2rd smallest Projected population, 2025 526,486 15,342,512 3rd smallest% growth forecasted, 2015‐2020 5.1% 5.3% % growth forecasted, 2015‐2025 10.7% 11.1%

% living in a rural area (2011) 32.0% 14.1% 3rd largest % living in a large urban centre (2011) 37.9% 69.3% 3rd lowest

Socio‐demographic characteristics (% population) English Mother Tongue 90.2% 70.4% 2nd highestFrench Mother Tongue 2.8% 4.4% No knowledge of English or French 0.3% 2.3% 3rd lowest Immigrants 10.4% 28.5%

Recent immigrants (2006‐2011) 0.8% 4.0% Visible minorities 4.1% 25.9% Aboriginal identity 4.3% 2.4% 3rd largestLabour force participation rate (age 15+) 64.5% 69.5% Unemployment rate, 2011 (age 15+) 8.5% 8.3% Without certificate/degree/diploma (age 25‐64) 12.1% 11.0% Completed post‐secondary education (age 25‐64) 59.5% 64.8% Living in low‐income 12.0% 13.9%




Among all LHINs, North Simcoe Muskoka LHIN had the 2nd largest proportion (90.2%) of residents who reported English as their mother tongue. 2.8% of LHIN residents reported French was their mother tongue in 2011, while 0.3% reported having no knowledge of either English or French.

In 2011, 10.4% of North Simcoe Muskoka LHIN residents were immigrants, compared to 28.5% for Ontario. Less than 1% of LHIN residents were recent immigrants, having arrived in Canada between 2006 and 2011.

Only 4.1% North Simcoe Muskoka LHIN residents were visible minorities, compared to 25.9% in Ontario overall.

Compared with Ontario residents aged 25‐64, a smaller proportion of North Simcoe Muskoka LHIN residents had completed post‐secondary education.

The proportion of North Simcoe Muskoka LHIN residents who lived in low‐income households (12.0%) was smaller than the provincial average (13.9%).

34 28 August 2015

13. NORTH EAST LHIN

Demographics

The North East LHIN is home to just under 564,400 people, or 4.1% of the population of Ontario.

Among all LHINs, North East LHIN had the lowest proportion of residents (19.3%) who lived in a large urban population centre. 30% of North East LHIN residents lived in a rural area in 2011. 39% of LHIN residents lived in either Sudbury or North Bay.

North East LHIN had the second highest proportion of seniors in the province, with 19.9% of residents being aged 65 or older.

Between 2010 and 2015, the population of North East LHIN declined by 1.2%. In comparison, the Ontario population grew by 5.1% over the same period.

The population of North East LHIN is projected to decrease by 0.6% between 2015 and 2020, and between 2015 and 2025, to decrease by 1.0%.

Socio‐demographic characteristics, North East LHIN

North East LHIN

Ontario Comments†

Population, 2011 564,389 13,809,683 % population age 65+ 19.9% 16.1% 2nd highest % population age 75+ 8.6% 7.1% 2nd highest

Population growth, past 5 years (2010‐2015) ‐1.2% 5.1% Lowest Projected population, 2020 561,121 14,546,659 Projected population, 2025 558,592 15,342,512 2nd smallest% growth forecasted, 2015‐2020 ‐0.6% 5.3% 2nd lowest% growth forecasted, 2015‐2025 ‐1.0% 11.1% Lowest

% living in a rural area (2011) 30.2% 14.1% % living in a large urban centre (2011) 19.3% 69.3% Lowest

Socio‐demographic characteristics (% population) English Mother Tongue 72.0% 70.4% French Mother Tongue 23.2% 4.4% Highest No knowledge of English or French 0.2% 2.3% Lowest Immigrants 5.6% 28.5% Lowest

Recent immigrants (2006‐2011) 0.3% 4.0% Lowest Visible minorities 1.8% 25.9% Lowest Aboriginal identity 11.0% 2.4% 2nd highestLabour force participation rate (age 15+) 59.8% 69.5% 2nd lowest Unemployment rate, 2011 (age 15+) 9.5% 8.3% 3rd highest Without certificate/degree/diploma (age 25‐64) 14.4% 11.0% 2nd highestCompleted post‐secondary education (age 25‐64) 59.9% 64.8% Living in low‐income 13.9% 13.9%




72.0% of the North East LHIN residents reported that English was their mother tongue. North East LHIN had the largest proportion of residents who reported that French was their mother tongue (23.2%) and the lowest proportion (0.2%) who reported no knowledge of either English or French in 2011.

Of the 14 LHIN areas, North East LHIN has the lowest proportion of immigrants, recent immigrants and visible minorities.

11% of North East LHIN residents reported having Aboriginal identity, the second highest proportion in the province.

The unemployment rate for LHIN residents was higher than the provincial average. North East LHIN had the 2nd lowest labour force participation rate among the 14 LHINs.

North East LHIN had the second highest proportion of working age residents who were without a certificate, degree or diploma.

Almost 14% of North East LHIN residents lived in low‐income households, the same as the provincial rate.

36 28 August 2015

14. NORTH WEST LHIN

Demographics

The North West LHIN is home to about 235,900 people, or 1.7% of the population of Ontario. It is the least populous LHIN in Ontario.

46% of the North West LHIN population lived in a large urban population centre (100,000+), while 34% lived in a rural area. Almost half of LHIN residents lived in Thunder Bay.

Seniors (aged 65+) accounted for 17% of the North West LHIN population.

Between 2010 and 2015, the LHIN’s population declined by 0.5%. In comparison, the Ontario population grew by 5.1% over the same period.

Over the next 5 and 10 years the population of the LHIN is expected to remain stable. The population of Ontario is projected to increase by 5.3% between 2015 and 2020 and 11.1% between 2015 and 2025.

Socio‐demographic characteristics, North West LHIN

North West LHIN

Ontario Comments†

Population, 2011 235,870 13,809,683 Least populous % population age 65+ 17.3% 16.1% % population age 75+ 7.5% 7.1%

Population growth, past 5 years (2010‐2015) ‐0.5% 5.1% 2nd lowest Projected population, 2020 235,955 14,546,659 SmallestProjected population, 2025 236,208 15,342,512 Smallest% growth forecasted, 2015‐2020 0.0% 5.3% 3rd lowest% growth forecasted, 2015‐2025 0.1% 11.1% 3rd lowest

% living in a rural area (2011) 34.2% 14.1% 2nd highest % living in a large urban centre (2011) 46.0% 69.3%

Socio‐demographic characteristics (% population) English Mother Tongue 85.8% 70.4% French Mother Tongue 3.5% 4.4% 3rd highest No knowledge of English or French 0.4% 2.3% Immigrants 7.3% 28.5% 2nd lowest

Recent immigrants (2006‐2011) 0.6% 4.0% 2nd lowestVisible minorities 2.2% 25.9% 2nd lowestAboriginal identity 18.3% 2.4% Highest Labour force participation rate (age 15+) 62.1% 69.5% Unemployment rate, 2011 (age 15+) 9.2% 8.3% Without certificate/degree/diploma (age 25‐64) 16.0% 11.0% Highest Completed post‐secondary education (age 25‐64) 59.2% 64.8% 3rd lowestLiving in low‐income 12.9% 13.9%




About 86% of North West LHIN residents reported English and 3.5% reported French as their mother tongue in 2011.

Of the 14 LHIN areas, North West LHIN had the second lowest proportions of immigrants, recent immigrants, and visible minorities. In 2011, 7.3% of residents were immigrants compared to 28.5% for Ontario. Less than 1% of North West LHIN residents were recent immigrants, having arrived in Canada between 2006 and 2011. Only 2.2% of the people living in the LHIN were visible minorities, compared to 25.9% for Ontario.

North West LHIN had the largest proportion of residents reporting Aboriginal identity in the province at 18.3% of residents.

Among all LHINs, North West LHIN had the largest proportion of residents without a certificate/degree or diploma and a relatively low proportion with completed post‐secondary education.

North West LHIN residents had the 3rd lowest labour force participation rate in the province. Nearly 13% of North West LHIN residents lived in low‐income households, slightly lower than the Ontario rate of 13.9%.

38 28 August 2015


Births and Mortality

Notes: This document and the accompanying workbook contain analysis of births and maternal outcomes from the Better Outcomes Registry & Network (BORN) Ontario, and the Canadian Institute for Health Information (CIHI); and analysis of mortality and potential years of life lost (PYLL) using data from Statistics Canada and the Ontario Registrar General.

40 28 August 2015

ONTARIO Births and Maternal Outcomes

In FY 2011/12 there were 139,386 births in Ontario hospitals to Ontario women.

Provincially, 3.2% of the women who gave birth were under 20 years of age and 22.0% were aged 35 years or older. These proportions varied greatly across LHINs. In North West LHIN, 10.9% of women giving birth were under 20 years age, compared to 1.1% in Mississauga Halton LHIN. In Toronto Central LHIN, 33.4% of women giving birth were 35 years or older, compared with 10.8% of women in North East LHIN. Teen mothers and their infants may be at greater risk for pre‐term deliveries 229‐943and/or low birth weight and increased perinatal mortality due to factors such as inadequate prenatal care, increased likelihood of social deprivation, drug use and smoking, poor nutrition resulting in poor maternal weight gain and anemia and premature termination of education. Higher maternal age is associated with increased maternal morbidity (including gestational hypertension and diabetes), Caesarean delivery, multiple gestation pregnancy, and adverse pregnancy outcomes (including chromosomal abnormalities, miscarriage, low birth weight, being small for gestational age, pre‐term birth, perinatal mortality, and serious neonatal morbidity).

In FY 2011/12, Caesarean deliveries accounted for 28.4% of all births. The highest rate of Caesarean deliveries occurred in the Central West LHIN (32.3%) and the lowest rate was found in the South West LHIN (23.4%). In addition to Central West LHIN, three other LHINs also had rates of Caesarean delivery of 30% or higher (Toronto Central, North Simcoe Muskoka, and North East). The rate of Caesarean deliveries has important implications on service requirements and capacity issues.

In Ontario, women have a range of care providers whom attend hospital births. Provincially, most hospital births were attended by an obstetrician (84.7%) although this varied greatly among the LHINs, ranging from 41.2% in the North West LHIN to 93.1% in the Erie St. Clair LHIN. Family physicians attended 8.6% of hospital births provincially and this also varied greatly among the LHINs with the largest proportion of family physician hospital births occurring in the North West LHIN (43.7%) and the smallest proportion occurring in the Erie St. Clair LHIN (2.2%). Provincially, 5.2% of women had their hospital birth attended by a midwife, with the highest proportion of midwife‐attended births occurring in the North West LHIN (12.2%) and the lowest occurring in the Central West LHIN (2.8%).

8.0% of births in Ontario hospitals were pre‐term (less than 37 weeks gestation) ranging from 5.7% (in Waterloo Wellington) to 11.5% (in Toronto Central). Babies who are born pre‐term are more likely to die or experience health problems during the first year after birth. There are immediate costs associated with intensive hospital care that is required at birth, as well as additional costs related to long‐term complications such as respiratory problems, motor and sensory impairment, and neurocognitive impairment.

Provincially, 9.4% of newborns were classified as “small for gestational age”, and 10.0% were “large for gestational age”. Infants who are small for gestational age are at increased risk for morbidity and mortality in the perinatal period, childhood, adolescence, and beyond. Infants who are large for gestational age are associated with adverse perinatal outcomes such as episiotomy, operative vaginal delivery, Caesarean delivery, shoulder dystocia, infant fracture, and brachial plexus injuries in the newborn.

Provincially, the rate of exclusive breastfeeding at discharge among term live births was 63.2% with the highest proportion in the Central East LHIN (73.6%) and the lowest proportion found in the Central West LHIN (48.2%). Breastfeeding offers numerous short term and long‐term benefits


for infants (e.g., growth, immunity, and cognitive development) and for mothers (e.g., reduced postpartum bleeding, delayed resumption of ovulation, and improved bone remineralisation.

The 30‐day obstetric readmission rate for Ontario residents was 1.7% but ranged from a low of 1.1% for Erie St. Clair LHIN residents to a high of 2.7% for North West LHIN residents.

Births and Maternal Outcomes 2011/12 Indicator ONTARIO Range across LHINs

Total births in Ontario hospitals to Ontario women 139,386 2,448 ‐ 20,432

Distribution of maternal age (%) < 20 3.2 1.1% ‐ 10.9%≥ 35 22.0 10.8% ‐ 33.4%

Rate of Caesarean delivery (%) 28.4 23.4% ‐ 32.3%

Distribution of care provider who attended the hospital birth (%)Obstetrician 84.7 41.2% ‐ 93.1%Family physician 8.6 2.2% ‐ 43.7%Midwife 5.2 2.8% ‐ 12.2%

Rate of pre‐term birth (< 37 weeks) (%) 8.0 5.7% ‐ 11.5%

% births small for gestational age 9.4 6.8% ‐ 11.7%

% births large for gestational age 10.0 7.7% ‐ 16.3%

Rate of exclusive breas eeding at discharge among term live births (%) † 63.2 48.2% ‐ 73.6%

30‐day obstetric readmission rate, LHIN of patient (%) 1.7 1.1% ‐ 2.7%† Between 10% and 30% of records and missing informa on were excluded from calcula ons in HNHB and Central West LHINs. Individual hospitals in Waterloo Wellington, Toronto Central, Central, Central East, and North East LHIN that did not collect information on breastfeeding at discharge from hospital or had more than 30% of missing records on this variable and were excluded from the denominator used for these calculations.

Maternal smoking, alcohol and drug use during pregnancy among all women who live in Ontario and who had a live birth or stillbirth (LHIN of maternal residence), 2013/14 (BORN)

In 2013 there were 138,120 births in Ontario to women who were Ontario residents regardless of birth location (hospital, home, birth centre, other) †.

Provincially, the rate of women who reported smoking at first prenatal visit was 10.8% (n= 13,173) with the highest proportion in the North West LHIN (34.7%) and lowest proportion found in the Central LHIN (3.5%) (with the exception of the Mississauga Halton LHIN)††.

The prevalence of smoking at first prenatal visit ≥20, 10‐19, and 1‐9 cigarettes per day were 0.6 percent, 3.6 percent, and 6.0 percent, respectively.

89.2% (n= 108,619) of the women were nonsmokers in their first prenatal visit.

The proportion of women who reported smoking at time of admission was 8.4% (n=11,330) with the highest proportion in the North West LHIN (30.9%) and lowest proportion in the Central LHIN (2.5%).

The prevalence of smoking at admission for birth ≥20, 10‐19, and 1‐9 cigarettes per day were 0.4 percent, 2.8 percent, and 4.8 percent, respectively.

91.6% (n=122,876) of the women were nonsmokers at time of admission for birth. The rate has increased since at first prenatal visit by 13.1% from 108,619 to 122,876††.

1.6% (n=2,072) of the women reported drinking alcohol and 2.0% (n=2,610) using drugs during pregnancy.

42 28 August 2015

There is a considerable variation across LHINs in the proportion of women who reported drinking alcohol and using drugs. The proportion was lowest in the Central LHIN (0.7% and 0.6%, respectively) and highest in the North West LHIN (5.3% and 13.4%, respectively).


Maternal smoking at first prenatal visit ONTARIO Range across LHINs

All pregnancies with live birth or stillbirth (LHIN of residence) † 121,792 2,490‐16,874

Number of women who reported smoking >20 cigarettes/day 765 11‐142

% women who reported smoking >20 cigarettes/day 0.6% 0.1% ‐1.5%

Number of women who reported smoking 10‐20 cigarettes/day 4,352 61‐691

% women who reported smoking 10‐20 cigarettes/day 3.6% 0.5% ‐9.6%

Number of women who reported smoking <10 cigarettes/day 7,288 229‐943

% women who reported smoking <10 cigarettes/day 6.0% 1.8% ‐23.6%

Number of women who reported unknown amount of cigarettes smoked/day 768 8‐163

% women who reported unknown amount of cigarettes smoked/day 0.6% 0.2% ‐1.3%

Number of nonsmokers 108,619 1,626‐16,276

% nonsmokers 89.2% 65.3% ‐96.5%

Maternal smoking at time of admission

All pregnancies with live birth or stillbirth (LHIN of residence)* 134,206 2,483‐16,865

Number of women who reported smoking >20 cigarettes/day 593 9‐109

% women who reported smoking >20 cigarettes/day 0.4% 0.1% ‐1.2%

Number of women who reported smoking 10‐20 cigarettes/day 3,703 40‐605

% women who reported smoking 10‐20 cigarettes/day 2.8 0.3% ‐8.3%

Number of women who reported smoking <10 cigarettes/day 6,407 177‐783

% women who reported smoking <10 cigarettes/day 4.8 1.3% ‐22.3%

Number of women who reported unknown amount of cigarettes smoked/day 627 8‐133

% women who reported unknown amount of cigarettes smoked/day 0.5 0.2% ‐1.0%

Number of nonsmokers 122,876 1,715‐16,438

% nonsmokers 91.6 69.1% ‐97.5%

Self‐reported consumption of alcoholic beverages during pregnancy


Number of women who self‐reported consumption of alcoholic beverages 2,072 80‐360

% women who self‐reported consumption of alcoholic beverages 1.6 0.7% ‐5.3%

Self‐reported drug and substance use during pregnancy


Number of women who self‐reported drug or substance use 2,610 95‐326

% women who self‐reported drug or substance use 2.0 0.6% ‐13.4%

All pregnancies for women who were Ontario residents were included regardless of birth location (hospital, home, birth centre, other). †Records with missing values for any variables required to calculate the denominator were excluded. The sum of the LHIN pregnancies will not add up to the Ontario total. Missing LHIN of maternal residence is due to missing maternal address or unmatched postal code and are included into ON total. †† The Mississauga Halton LHIN had >30% of records with missing information on maternal smoking at first prenatal visit therefore were excluded from the analysis.

44 28 August 2015

Mortality and PYLL

88,967 Ontario residents died in 2011, an increase of 2.3% in the number of deaths from 2007.

The crude all‐cause mortality rate in 2011 was 670.8 per 100,000 population for Ontario residents; a decrease of 1.3% since 2007. Across the LHINs, this rate decreased by 9.4% for Champlain LHIN residents and increased by 15.6% for North West LHIN residents.

The leading causes of death for Ontario residents overall were ischaemic heart disease, dementia and Alzheimer disease, and cancer of lung & bronchus. The top 10 causes of death accounted for 54.0% of the total deaths in Ontario.

37.2% of Ontario residents’ deaths in 2011 were premature (occurred in those aged younger than 75 years).

In 2011, 536,071 potential years of life were lost by Ontario residents. Potential years of life lost (PYLL) is an estimate of the average years a person would have lived if they had not died prematurely. A premature death is considered one before the age of 75, so a death at the age of 55 represents 20 ‘potential’ years of life lost. High PYLL rates indicate elevated levels of premature mortality. There was a decrease of 3.4% in PYLL in 2011 since 2007 for Ontario residents.

The PYLL rate per 100,000 population aged less than 75 was 4,327.0 in 2011 for Ontario residents, ranging from 2,963.9 for Central LHIN residents to 7,437.7 for North West LHIN residents.

The leading causes of PYLL for Ontario residents in 2011 were ischaemic heart disease, cancer of lung & bronchus, and intentional self‐harm.

For Ontario residents in 2011, ischaemic heart disease was the leading cause of both death and PYLL.


Mortality and Potential Years of Life Lost

Ontario Range in LHINs

Mortality, 2011

Total deaths, 2011 88,967 2,189 – 11,314

% change in total deaths (2007‐2011) 2.3% ‐6.9% ‐ 13.8%

All‐cause mortality rate per 100,000 population 670.8 413.8 ‐ 929.7

% change in all‐cause mortality rate (2007‐2011) ‐1.3% ‐9.4% ‐ 15.6%

% of deaths that were premature (age < 75) 37.2% 33.7% ‐ 44.7%

Top 10 leading causes of death, 2011 (rates per 100,000 population)

Ischaemic heart disease 97.5 50.7 ‐ 149.3

Dementia and Alzheimer disease 52.9 31.3 ‐ 69.3

Cancer of lung & bronchus 49.1 27.5 ‐ 84.5

Cerebrovascular diseases 37.1 25.0 ‐ 50.5

Chronic lower respiratory diseases 28.6 14.7 ‐ 52.4

Cancer of colon, rectum, anus 24.2 12.8 ‐ 32.8

Diabetes 21.6 11.7 ‐ 36.7

Cancer of lymph, blood & related 19.7 9.7 ‐ 26.1

Falls 16.1 8.6 ‐ 21.9

Influenza and pneumonia 15.7 9.8 ‐ 22.7

Potential years of life lost (PYLL), 2011

Total PYLL, 2011 536,071 16,385 – 63,592

% change in PYLL (2007‐2011) ‐3.4% ‐8.1% ‐ 16.2%

PYLL rate per 100,000 population (age < 75) 4,327.0 2,963.9 – 7,437.7

% change in PYLL rate (2007‐2011) ‐6.5% ‐10.5% ‐ 18.3%

Top 10 leading causes of PYLL, 2011 (rates per 100,000 population, age < 75)

Ischaemic heart disease 395.0 200.4 ‐ 655.6

Cancer of lung & bronchus 320.0 180.7 ‐ 626.1

Intentional self‐harm 269.4 166.7 ‐ 782.6

Perinatal conditions 241.1 117.1 ‐ 454.1

Accidental poisoning 164.8 67.0 ‐ 589.2

Transport accidents 147.6 29.6 ‐ 420.8

Cancer of colon, rectum, anus 146.1 89.3 ‐ 204.7

Cancer of breast 143.0 100.5 ‐ 234.2

Cancer of lymph, blood & related 137.3 92.6 ‐ 182.3

Cirrhosis and other liver diseases 131.2 57.3 ‐ 265.1

Note: In the 2011 death file from Statistics Canada, 4% of postal codes for Ontario residents were missing; this is compared to a negligible percentage of missing data since they started using postal codes to assign municipality of residence in 2008. Consequently, all the geographic fields that are derived from postal code or municipality (including LHINs) have a higher percentage of missing data in 2011.

46 28 August 2015



Births and Maternal Outcomes

In FY 2011/12, there were 6,082 births in Erie St. Clair hospitals.

5.3% of women who gave birth in the LHIN were under 20 years of age which was above the provincial average. 15.4% were aged 35 or older when they gave birth which was below the provincial average.

The rate of Caesarean deliveries in the Erie St. Clair LHIN was 25.7% which was below the provincial average of 28.4%.

Erie St Clair LHIN had the highest proportion of hospital births attended by obstetricians (93.1%) and the lowest proportion attended by a family physician (2.2%).

The rate of pre‐term births (less than 37 weeks) was slightly lower than the provincial average.

The percentages of newborns classified as “small for gestational age” and as “large for gestational age” were 8.1% and 10.4%, respectively.

The LHIN had the second lowest rate of infants being exclusively breastfeed at discharge.

Erie St. Clair LHIN residents had the lowest 30‐day obstetric readmission rate (1.1%) in the province.

Births and Maternal Outcomes 2011/12

Indicator Erie St. Clair

LHIN Ontario

Total births in Erie St. Clair LHIN hospitals 6,082 139,386

Distribution of maternal age (%)

< 20 5.3 3.2

≥ 35 15.4 22.0

Rate of Caesarean delivery (%) 25.7 28.4

Distribution of care provider who attended the hospital birth (%)

Obstetrician 93.1 84.7

Family physician 2.2 8.6

Midwife 4.0 5.2

Rate of pre‐term birth (< 37 weeks) (%) 7.2 8.0

% births small for gestational age 8.1 9.4

% births large for gestational age 10.4 10.0

Rate of exclusive breastfeeding at discharge among term live births (%) † 49.5 63.2

30‐day obstetric readmission rate, LHIN of patient (%) 1.1 1.7

† Between 10% and 30% of records and missing information were excluded from calculations in HNHB and Central West LHINs. Individual hospitals in Waterloo Wellington, Toronto Central, Central, Central East, and North East LHIN that did not collect information on breastfeeding at discharge from hospital or had more than 30% of missing records on this variable and were excluded from the denominator used for these calculations.

48 28 August 2015


In 2013 there were 5,983 births in Erie St. Clair LHIN to women who were Ontario residents regardless of birth location (hospital, home, birth centre, other) †.

The rate of women who reported smoking at first prenatal visit was 13.4%. This rate was higher than the Ontario rate (10.8%) and ranked 7th among all LHINs (with the exception of the MH LHIN) ††.


86.6% of the women were nonsmokers in their first prenatal visit, compared to 89.2% for the province and ranked 7th among all LHINs (with the exception of the MH LHIN)††.

The proportion of women who reported smoking at time of admission was 11.8%, it was higher than the Ontario rate (8.4%). The rate has decreased slightly since the first prenatal visit (decrease of ‐1.6 percentage points).

The prevalence of smoking at admission for birth ≥20, 10‐19, and 1‐9 cigarettes per day were 0.5 percent, 3.6 percent, and 7.2 percent, respectively. The prevalence has decreased slightly since the first prenatal visit (decrease of ‐0.2, ‐0.5, and ‐0.8 percentage points, respectively).

88.2% of the women were nonsmokers at time of admission for birth. The rate has increased slightly since at first prenatal visit (increase of 1.6 percentage points).

The women who reported drinking alcohol and using drugs during pregnancy were 1.3% and 2.5%, compared to 1.6% and 2.0% for the province, respectively.


Maternal smoking at first prenatal visit Erie St. Clair LHIN Ontario

All pregnancies with live birth or stillbirth (LHIN of residence) † 5,983 121,792

Number of women who reported smoking >20 cigarettes/day 39 765

% women who reported smoking >20 cigarettes/day 0.7 0.6%

Number of women who reported smoking 10‐20 cigarettes/day 245 4,352

% women who reported smoking 10‐20 cigarettes/day 4.1 3.6%

Number of women who reported smoking <10 cigarettes/day 481 7,288

% women who reported smoking <10 cigarettes/day 8.0 6.0%

Number of women who reported unknown amount of cigarettes smoked/day 36 768

% women who reported unknown amount of cigarettes smoked/day 0.6 0.6%

Number of nonsmokers 5,182 108,619

% nonsmokers 86.6 89.2%






% women who reported smoking 10‐20 cigarettes/day 3.6 2.8


% women who reported smoking <10 cigarettes/day 7.2 4.8


% women who reported unknown amount of cigarettes smoked/day 0.6 0.5


% nonsmokers 88.2 91.6



Number of women who self‐reported consumption of alcoholic beverages 80 2,072

% women who self‐reported consumption of alcoholic beverages 1.3 1.6



Number of women who self‐reported drug or substance use 149 2,610

% women who self‐reported drug or substance use 2.5 2.0

†Records with missing values for any variables required to calculate the denominator were excluded †† The Mississauga Halton LHIN had >30% of records with missing information on maternal smoking at first prenatal visit therefore were excluded from the analysis.

50 28 August 2015

Mortality and Potential Years of Life Lost 5,158 Erie St. Clair LHIN residents died in 2011.

The all‐cause mortality rate was 808.8 per 100,000 population; similar to the LHIN’s rate in 2007. It remains higher than the provincial rate.

The leading causes of death in 2011 were ischaemic heart disease, cancer of lung and bronchus, dementia and Alzheimer disease. The top 10 diseases accounted for 54.3% of total deaths.

Among LHINs, Erie St Clair residents have the highest mortality rate for cirrhosis and other liver diseases, and the second highest rate for cerebrovascular deaths.

29,976 years of potential life were lost by LHIN residents in 2011. This was a 7.7% decrease in PYLL from 2007.

The LHIN’s PYLL rate for 2011 was 5,079.9 per 100,000 population aged less than 75. This rate was higher than the Ontario rate (4,327.0). Since 2007, the PYLL rate decreased by 5.2% for Erie St. Clair LHIN residents.

The leading causes of PYLL in 2011 were ischaemic heart disease, cancer of lung and bronchus, and intentional self‐harm. The PYLL rates for ischaemic heart disease (587.9) and cancer of lung and bronchus (406.9) were both higher than the corresponding Ontario rates (395.0 and 320.0, respectively). The PYLL rate for cirrhosis and other liver diseases for LHIN residents in 2011 was the second highest among all LHINs. The PYLL rates due to accidental poisoning and due to cancer of the colon, rectum, and anus were the third highest for Erie St. Clair residents among all LHINs.

Ischaemic heart disease and cancer of lung and bronchus were the top two leading causes of death and PYLL for Erie St. Clair LHIN residents in 2011.


Mortality and Potential Years of Life Lost, 2011

Erie St. Clair

LHIN Ontario Comment

Mortality

Total deaths, 2011 5,158 88,967

% change in total deaths (2007‐2011) ‐2.3% 2.3%

All‐cause mortality rate per 100,000 population 808.8 670.8

% change in all‐cause mortality rate (2007‐2011) ‐0.2% ‐1.3%

% of deaths that were premature (age < 75) 38.3% 37.2%

Top 10 leading causes of death, (rates per 100,000 population)

Ischaemic heart disease 125.3 97.5

Cancer of lung & bronchus 65.2 49.1

Dementia and Alzheimer disease 53.9 52.9

Cerebrovascular diseases 49.6 37.1 2nd highest in province

Chronic lower respiratory diseases 40.6 28.6

Cancer of colon, rectum, anus 28.5 24.2

Cancer of lymph, blood & related 24.3 19.7

Diabetes 22.0 21.6

Influenza and pneumonia 15.1 15.7

Cirrhosis and other liver diseases 14.9 9.9 Highest in province

Potential years of life lost (PYLL)

Total PYLL, 2011 29,976 536,071

% change in PYLL (2007‐2011) ‐7.7% ‐3.4%

PYLL rate per 100,000 population (age < 75) 5,079.9 4,327.0

% change in PYLL rate (2007‐2011) ‐5.2% ‐6.5%

Top 10 leading causes of PYLL, (rates per 100,000 population, age < 75)



Intentional self‐harm 268.1 269.4

Accidental poisoning 262.5 164.8 3rd highest in province

Cirrhosis and other liver diseases 215.1 131.2 2nd highest in province

Cancer of colon, rectum, anus 194.2 146.1 3rd highest in province


Cancer of breast 156.4 143.0

Transport accidents 138.3 147.6

Congenital malformations, deformations, chromosomal abnormalities

135.5 127.5


52 28 August 2015

2. SOUTH WEST LHIN


In FY 2011/12, there were 9,911 births in South West LHIN hospitals.

4.3% of women who gave birth in the South West LHIN were under 20 years of age and15.0% aged 35 or older (slightly lower than provincial average of 22.0%).

The LHIN had the lowest rate of Caesarean deliveries in the province (23.4%).

Compared to the provincial average, a lower proportion hospital births were attended by obstetricians, and a higher proportion by family physicians or midwives

The South West LHIN had a similar rate of pre‐term (less than 37 weeks) births compared to the province.

8.7% of newborns were classified as “small for gestational age”, while 10.8% of newborns were considered “large for gestational age”. These proportions were similar to the provincial averages.

The rate of exclusive breastfeeding in the South West LHIN was 62.2% which was similar to Ontario’s rate.

The 30‐day obstetric readmission rate for residents of South West LHIN was 1.5%, compared to 1.7% for the province.


Indicator South

West LHIN Ontario

Total births in South West LHIN hospitals 9,911 139,386


< 20 4.3 3.2

≥ 35 15.0 22.0





Midwife 7.2 5.2









In 2013 there were 9,848 births in South West LHIN to women who were Ontario residents regardless of birth location (hospital, home, birth centre, other) †.



85.7% of the women were nonsmokers in their first prenatal visit, compared to 89.2% for the province and ranked 5th among all LHINs (with the exception of the MH LHIN) ††.

The proportion of women who reported smoking at time of admission was 12.0%, it was higher than Ontario rate (8.4%). The rate has decreased since the first prenatal visit (decrease of ‐2.3 percentage points).


88.0% of the women were nonsmokers at time of admission for birth. The rate has increased slightly since at first prenatal visit (increase of 2.3 percentage points).


54 28 August 2015

Maternal smoking at first prenatal visit South West LHIN Ontario



































In 2011, 7,556 South West LHIN residents died. The all‐cause mortality rate for LHIN residents was 794.6 per 100,000 population in 2011; higher than the Ontario rate (670.8). Both the LHIN and provincial rates decreased since 2007 (South West by 3.4% and Ontario by 1.3%).

The leading causes of death for LHIN residents were ischaemic heart disease, dementia and Alzheimer disease, and cancer of lung and bronchus. The top 10 causes accounted for 54.8% of all deaths. The mortality rate for influenza and pneumonia for LHIN residents was the highest among all LHINs.

In 2011, 35.8% of LHIN resident deaths were considered premature (occurred in those younger than age 75 years). This was the second lowest percentage of premature deaths among all LHINs.

42,700 years of potential life were lost in 2011 by LHIN residents. This was a decrease of 7.8% since 2007, more than twice the percent decrease compared to Ontario overall. The PYLL rate per 100,000 population aged less than 75 years for LHIN residents was 4,857.8 in 2011. This was similar to the Ontario rate (4,327.0), and both rates decreased since 2007 (by 8.4% for the South West LHIN and by 6.5% for Ontario residents).

The leading causes of PYLL were ischaemic heart disease, cancer of lung and bronchus, and perinatal conditions.

The PYLL rates for South West LHIN residents for perinatal conditions, congenital malformations, deformations, and chromosomal abnormalities, and lymph cancer were among the highest out of all LHINs.

56 28 August 2015


South

West LHIN Ontario Comment

Mortality

Total deaths, 2011 7,556 88,967









Cerebrovascular diseases 44.1 37.1



Diabetes 24.9 21.6


Influenza and pneumonia 22.7 15.7 Highest in province

Falls 17.7 16.1


Total PYLL, 2011 42,700 536,071

% change in PYLL (2007‐2011) ‐7.8% ‐3.4%






Perinatal conditions 264.5 241.1 3rd highest in

province



219.0 127.5 2nd highest in

province


Cancer of lymph, blood & related 175.7 137.3 2nd highest in

province



Accidental poisoning 131.9 164.8



1. Waterloo Wellington LHIN Births and Maternal Outcomes

In FY 2011/12, there were 7,973 births in Waterloo Wellington LHIN hospitals.

3.1% of women who gave birth were under 20 years of age (similar to the provincial result) and 17.9% were aged 35 or older (lower than the provincial average of 22.0%)

The rate of Caesarean deliveries was the third lowest in the province (25.4%) and below the provincial rate of 28.4%.

81.2% of hospital births were attended by obstetricians, 7.2% by family physicians, and 9.2% by midwives. The Waterloo Wellington LHIN had the second highest proportion of midwife‐attended hospital births in the province, which was almost twice the provincial average (5.2%).

The rate of pre‐term births (less than 37 weeks) was the lowest in the province at 5.7%.

The proportion of newborns classified as “small for gestational age” was 7.7% which was the third lowest in the province while the proportion of newborns classified as “large for gestational age” was similar to the province.

The rate of exclusive breastfeeding (72.9%) was the second highest rate among all LHINs.

The 30‐day obstetric readmission rate for LHIN residents was similar to the provincial rate.


Indicator Waterloo Wellington

LHIN Ontario

Total births in Waterloo Wellington LHIN hospitals 7,973 139,386


< 20 3.1 3.2

≥ 35 17.9 22.0





Midwife 9.2 5.2






† Between 10% and 30% of records and missing information were excluded from calculations in HNHB and Central West

LHINs. Individual hospitals in Waterloo Wellington, Toronto Central, Central, Central East, and North East LHIN that did not

collect information on breastfeeding at discharge from hospital or had more than 30% of missing records on this variable

and were excluded from the denominator used for these calculations.

58 28 August 2015

Maternal smoking, alcohol and drug use during pregnancy among all women who live in Ontario

and who had a live birth or stillbirth (LHIN of maternal residence), 2013/14 (BORN)

In 2013 there were 8,179 births in Waterloo Wellington LHIN to women who were Ontario

residents regardless of birth location (hospital, home, birth centre, other) †.

The rate of women who reported smoking at first prenatal visit was relatively the same as

the provincial (10.7%) and ranked 6th among all LHINs (with the exception of the MH LHIN)

††.

The prevalence of smoking at first prenatal visit ≥20, 10‐19, and 1‐9 cigarettes per day were

0.5 percent, 3.7 percent, and 6.2 percent, respectively.

89.3% of the women were nonsmokers in their first prenatal visit. The rate was relatively

similar to the Ontario rate of 89.2% and ranked 8th among all LHINs (with the exception of

the MH LHIN) ††.

The proportion of women who reported smoking at time of admission was 9.0%, it was

slightly higher than Ontario rate (8.4%). The rate has decreased since the first prenatal visit

(decrease of ‐1.7 percentage points).

The prevalence of smoking at admission for birth ≥20, 10‐19, and 1‐9 cigarettes per day

were 0.4 percent, 2.9 percent, and 5.4 percent, respectively. The prevalence has decreased

slightly since the first prenatal visit (decrease of ‐0.1, ‐0.8, and ‐0.8 percentage points,

respectively).

91.0% of the women were nonsmokers at time of admission for birth. The rate has increased

slightly since the first prenatal visit (increase of 1.7 percentage points).

The women who reported drinking alcohol and using drugs during pregnancy were 1.6% and

1.5%, compared to 1.6% and 2.0% for the province, respectively†††.


Maternal smoking at first prenatal visit Waterloo Wellington LHIN Ontario







% women who reported smoking <10 cigarettes/day 6.2 6.0% Number of women who reported unknown amount of cigarettes smoked/day 25 768












Number of women who reported unknown amount of cigarettes smoked/day

22 627





All pregnancies with live birth or stillbirth (LHIN of residence) ††† 7,573 129,793

Number of women who self‐reported consumption of alcoholic beverages 120

2,072






†Records with missing values for any variables required to calculate the denominator were excluded

†† The Mississauga Halton LHIN had >30% of records with missing information on maternal smoking at first prenatal visit

therefore has been excluded from the analysis.

†††Values with greater than 10% but less than 30% missing data should be interpreted with caution (as indicated in yellow).

60 28 August 2015


4,454 residents of Waterloo Wellington LHIN died in 2011. The all‐cause mortality rate for Waterloo Wellington LHIN residents was 596.6 per 100,000 population in 2011. This rate decreased by 3.1% since 2007.

The leading causes of death in 2011 for Waterloo Wellington LHIN residents were ischaemic heart disease, dementia and Alzheimer disease, and cerebrovascular disease. The top 10 causes accounted for 54.7% of all deaths for LHIN residents in 2011. Most of the cause‐specific rates were lower for Waterloo Wellington LHIN residents than corresponding provincial rates. In particular, the mortality rate for by falls for LHIN residents was the third lowest of all LHINs.

In 2011 37.0% of Waterloo Wellington resident deaths were premature (similar to the Ontario result) resulting in 26,858 years of potential life were lost by LHIN residents.

The PYLL rate was 3,821.7 per 100,000 population aged less than 75 years for LHIN residents. This rate was lower than the Ontario rate in 2011 (4,327.0). Both rates decreased since 2007 (by 4.9% and 6.5%, respectively).

The leading causes of PYLL for Waterloo Wellington LHIN residents were intentional self‐harm, ischaemic heart disease, and cancer of lung and bronchus. The PYLL rates for perinatal conditions, accidental poisoning, and ischaemic heart disease for this LHIN were among the lowest among all LHINs.



Waterloo Wellington


Mortality

Total deaths, 2011 4,454 88,967

% change in total deaths (2007‐2011) 0.0% 2.3%












Diabetes 19.8 21.6


Falls 12.1 16.1 3rd lowest in province


Total PYLL, 2011 26,858 536,071

% change in PYLL (2007‐2011) ‐2.0% ‐3.4%





Ischaemic heart disease 268.9 395.0 3rd lowest in province



Perinatal conditions 138.7 241.1 2nd lowest in province



Cancer of breast 115.7 143.0 3rd lowest in province

Congenital malformations, deformations, chromosomal abnormalities 115.6 127.5

Cirrhosis and other liver diseases 111.7 131.2

Note: In the 2011 death file from Statistics Canada, 4% of postal codes for Ontario residents were missing; this is compared

to a negligible percentage of missing data since they started using postal codes to assign municipality of residence in 2008.

Consequently, all the geographic fields that are derived from postal code or municipality (including LHINs) have a higher

percentage of missing data in 2011.

62 28 August 2015



In FY 2011/12, there were 12,843 hospital births in HNHB LHIN hospitals.

4.3% of women who gave birth were under 20 years of age and 18.2% of women who gave birth were aged 35 or older (lower than the provincial average of 22.0%).

The LHIN’s the rate of Caesarean births (28.8%) was similar to the provincial rate.

82.1% of hospital births were attended by an obstetrician and 7.8% by a family physician. The proportion of births attended by a midwife was higher than the province (7.9% vs 5.2%).

The LHIN’s rate of pre‐term births (less than 37 weeks) was the second highest in the province, although not much higher than the provincial rate (8.0%).

7.5% of newborns were classified as “small for gestational age”; this proportion was lower than the provincial average (9.4%) and was the second lowest proportion among all the LHINs. 12.3% of newborns were classified as “large for gestational age”, which was greater than the provincial average.

The rate of exclusive breastfeeding in the HNHB LHIN was 59.3% which was below the provincial rate.

The 30‐day obstetric readmission rate for residents of HNHB LHIN was the same as the provincial rate (1.7%).


Indicator HNHB LHIN Ontario

Total births in Hamilton Niagara Haldimand Brant LHIN hospitals 12,843 139,386


< 20 4.3 3.2

≥ 35 18.2 22.0





Midwife 7.9 5.2









In 2013 there were 13,260 births in HNHB LHIN to women who were Ontario residents regardless of birth location (hospital, home, birth centre, other) †.



86.0% of the women were nonsmokers in their first prenatal visit, compared to 89.2% for the province and ranked 8th among all LHINs (with the exception of the MH LHIN) ††.

The proportion of women who reported smoking at time of admission was 11.8%, it was higher than Ontario rate (8.4%). The rate has decreased since the first prenatal visit (decrease of‐2.2 percentage points).


88.2% of the women were nonsmokers at time of admission for birth. The rate has increased since the first prenatal visit (increase of 2.2 percentage points).


64 28 August 2015

Maternal smoking at first prenatal visit HNHB LHIN Ontario



































In 2011, there were 11,314 deaths for HNHB LHIN resident.

The all‐cause mortality rate for LHIN residents in 2011 was higher than the provincial rate (809.6 vs 670.8) although both the LHIN and Ontario rates have decreased since 2007.

The leading causes of death for LHIN residents in 2011 were ischaemic heart disease, dementia and Alzheimer disease, and cancer of lung and bronchus. All of the top 10 cause‐specific mortality rates for LHIN residents were higher than the Ontario rates. In particular, the mortality rate from falls was the highest for LHIN residents when compared to other LHINs. The top 10 causes accounted for 55.7% of all deaths in 2011.

36.4% of resident deaths were premature (occurred in those younger than 75 years) resulting in 63,592 years of potential life lost.

The LHIN’s PYLL rate of 4,943.9 per 100,000 population aged less than 75 years was greater than the Ontario rate (4,327.0). Since 2007, the PYLL rate decreased by 8.3% for LHIN residents.

The leading causes of PYLL for HNHB LHIN residents were for ischaemic heart disease, cancer of lung and bronchus, and intentional self‐harm. The PYLL rates for cirrhosis and other liver diseases and for cancer of the lymph and blood system were the third highest among all LHINs.

66 28 August 2015


HNHB LHIN

Ontario Comment

Mortality

Total deaths, 2011 11,314 88,967












Diabetes 29.5 21.6


Falls 21.9 16.1 Highest in province



Total PYLL, 2011 63,592 536,071

% change in PYLL (2007‐2011) ‐7.2% ‐3.4%







Perinatal conditions 225.8 241.1


Cirrhosis and other liver diseases 192.1 131.2 3rd highest in province

Cancer of lymph, blood & related 168.4 137.3 3rd highest in province








There were 8,321 births in Central West LHIN hospitals in FY 2011/12.

2.0% of women who gave birth in the Central West LHIN were under 20 years and 19.4% were 35 years or older. Both proportions were slightly lower than the provincial averages of 3.2% and 22.0%, respectively.

Central West LHIN had the highest rate of Caesarean births in the province (32.3%).

The proportion of births attended by an obstetrician (87.5%) was higher than the provincial average (84.7%), while the proportion of births attended by a family physician (7.5%) was similar to the provincial average (8.6%). 2.8% of births were attended by a midwife; much lower than the Ontario average (5.2%).

In the Central West LHIN, 11.7% of newborns were classified as “small for gestational age” which was the highest proportion in the province. 7.8% of newborns were classified as “large for gestational age”. This proportion was the second lowest among all LHINs.

The rate of exclusive breastfeeding (48.2%) in this LHIN was the lowest in the province.

For residents of Central West LHIN, the rate of 30‐day obstetric readmission rate (2.0%) was one of the highest in the province.


Indicator Central

West LHIN Ontario

Total births in Central West LHIN hospitals 8,321 139,386


< 20 2.0 3.2

≥ 35 19.4 22.0





Midwife 2.8 5.2




Rate of exclusive breastfeeding at discharge among term live births (%)† 48.2 63.2


† Between 10% and 30% of records and missing informa on were excluded from calcula ons in HNHB and Central West LHINs. Individual hospitals in Waterloo Wellington, Toronto Central, Central, Central East, and North East LHIN that did not collect information on breastfeeding at discharge from hospital or had more than 30% of missing records on this variable and were excluded from the denominator used for these calculations.

68 28 August 2015


In 2013 there were 9,406 births in Central West LHIN to women who were Ontario residents regardless of birth location (hospital, home, birth centre, other) †.

Central West LHIN had the third lowest proportion of women who reported smoking at first prenatal visit (5.4%) among all LHINs (with the exception of the MH LHIN) ††.


94.6% of the women were nonsmokers in their first prenatal visit, compared to 89.2% for the province and was the highest (ranked 11th) among all LHINs (with the exception of the MH LHIN) ††.

The proportion of women who reported smoking at time of admission was 3.5%, compared to 8.4% for the province. The rate has decreased since the first prenatal visit (decrease of‐1.9 percentage points).

The prevalence of smoking at admission for birth ≥20, 10‐19, and 1‐9 cigarettes per day were 0.1 percent, 0.9 percent, and 2.1 percent, respectively. The prevalence has decreased since the first prenatal visit (decrease of ‐0.1, ‐0.5, and ‐1.2 percentage points, respectively).




Maternal smoking at first prenatal visit Central West LHIN Ontario

































70 28 August 2015


3,593 Central West LHIN residents died in 2011.

The all‐cause mortality rate for Central West LHIN residents was 413.8 per 100,000 population in 2011. Although this was the lowest all‐cause mortality rate among all LHINs the rate has increased slightly (by 1.9%) since 2007.

The leading causes of death for LHIN residents were ischaemic heart disease, dementia and Alzheimer disease, and cancer of lung and bronchus. The rates for all the top 10 causes of mortality were lower than the Ontario rates and all rates were among the lowest among the LHINs. The top 10 causes of mortality accounted for 51.1% of all Central West LHIN resident deaths in 2011.

44.7% of LHIN resident deaths occurred in those younger than 75 years and are considered premature – this was the largest proportion among all the LHINs. These premature deaths resulted in 29,694 years of potential life were lost.

The LHIN’s PYLL rate was lower than the provincial rate (3,569.3 vs 4,327 per 100,000 population aged less than 75 years). Since 2007, the PYLL rate decreased by 8.9% for Central West LHIN residents.

The leading causes of PYLL for Central West LHIN residents were for perinatal conditions, ischaemic heart disease, and cancer of lung and bronchus. The PYLL rate for perinatal conditions for Central West LHIN residents was the highest among all LHINs. The rates of PYLL for cancer of lung and bronchus and intentional self‐harm for Central West residents were the second lowest among LHINs.



Central

West LHIN Ontario Comment

Mortality

Total deaths, 2011 3,593 88,967



% change in all‐cause mortality rate (2007‐2011) 1.9% ‐1.3%



Ischaemic heart disease 57.0 97.5 2nd lowest in province

Dementia and Alzheimer disease 31.3 52.9 Lowest in province

Cancer of lung & bronchus 27.5 49.1 Lowest in province

Cerebrovascular diseases 25.0 37.1 Lowest in province

Chronic lower respiratory diseases 15.1 28.6 2nd lowest in province

Diabetes 13.2 21.6 3rd lowest in province

Cancer of colon, rectum, anus 12.8 24.2 Lowest in province

Cancer of breast 10.0 14.7 2nd lowest in province

Influenza and pneumonia 9.8 15.7 Lowest in province

Cancer of lymph, blood & related 9.7 19.7 Lowest in province


Total PYLL, 2011 29,694 536,071

% change in PYLL (2007‐2011) 0.3% ‐3.4%




Perinatal conditions 454.1 241.1 Highest in province


Cancer of lung & bronchus 185.1 320.0 2nd lowest in province

Intentional self‐harm 175.1 269.4 2nd lowest in province



139.3 127.5



Cerebrovascular diseases 123.9 100.2 3rd highest in province



72 28 August 2015



There were 12,800 births in Mississauga Halton LHIN hospitals in FY 2011/12.

1.1% of women who gave birth in the Mississauga Halton LHIN were under 20 years of age; this was the lowest proportion among the LHINs and also less than half of the provincial average (3.2%).

27.1% of women who gave birth in the LHIN were aged 35 years or older which was higher than the provincial average and was the third highest proportion in the province.

The rate of Caesarean births in Mississauga Halton LHIN was slightly less than the provincial rate.

Mississauga Halton LHIN had the third highest proportion of obstetrician‐attended hospital births (90.7%) among all LHINs; this proportion was also above the provincial average of 84.7%. Proportions of family physician‐attended births (4.6%) and midwife‐attended births (3.6%) in this LHIN were both the third lowest proportions in the province, lower than the provincial averages (8.6% and 5.2%, respectively).

At 6.5%, the rate of pre‐term births (less than 37 weeks) was below the provincial rate and was the third lowest in the province.

The percentage of newborns classified as “small for gestational age” (11.2%) was the second highest proportion among all LHINs. The percentage of newborns classified as “large for gestational age” (8.3%) was the third lowest proportion among all LHINs.

The rate of exclusive breastfeeding (57.2%) was the third lowest in the province.

The 30‐day obstetric readmission rate for residents of Mississauga Halton LHIN (1.4%) was the second lowest among all LHINs and below the provincial rate (1.7%).


Indicator Mississauga Halton LHIN

Ontario

Total births in Mississauga Halton LHIN hospitals 12,800 139,386


< 20 1.1 3.2

≥ 35 27.1 22.0





Midwife 3.6 5.2









In 2013 there were 7,942 births in Mississauga Halton LHIN to women who were Ontario residents regardless of birth location (hospital, home, birth centre, other) †.

The proportion of women who reported smoking at time of admission was 3.4%, compared to 8.4% for the province.

The prevalence of smoking at admission for birth ≥20, 10‐19, and 1‐9 cigarettes per day were 0.3 percent, 0.7 percent, and 2.2 percent, respectively. The prevalence of smoking at admission was below the provincial rate.

96.6% of the women were nonsmokers at time of admission for birth. The rate was higher than the provincial (91.6%).


74 28 August 2015

Maternal smoking at first prenatal visit Mississauga Halton LHIN Ontario

All pregnancies with live birth or stillbirth (LHIN of residence) †† 7,942 121,792



















24 627















In 2011, 5,194 Mississauga Halton LHIN residents died.

Although the all‐cause mortality rate increased slightly since 2007, the LHIN has the second lowest mortality rate among LHINs.

The leading causes of death for LHIN residents were ischaemic heart disease, dementia and Alzheimer disease, and cancer of lung and bronchus. The rates for all the top 10 causes of mortality were lower than the Ontario rates and many of these were among the lowest rates overall. The top 10 causes of mortality accounted for 51.2% of Mississauga Halton LHIN resident deaths in 2011.

36.6% of all deaths for LHIN residents occurred in those younger than 75 years and were considered premature.

32,452 years of potential life were lost in 2011 by LHIN residents.

The LHIN’s PYLL rate of 2,980.5 per 100,000 population aged less than 75 years was much lower than the provincial rate of 4,327.0, and was the second lowest PYLL rate among all LHINs. Since 2007, the PYLL rate for LHIN residents decreased by 9.0%.

The leading causes of PYLL for Mississauga Halton LHIN residents were for ischaemic heart disease, perinatal conditions, and cancer of lung and bronchus. Most cause‐specific rates were lower than the overall cause‐specific rates for Ontario and many were among the lowest when compared to the other LHINs.

76 28 August 2015



Ontario Comment

Mortality

Total deaths, 2011 5,194 88,967






Ischaemic heart disease 50.7 97.5 Lowest in province

Dementia and Alzheimer disease 39.3 52.9 2nd lowest in province

Cancer of lung & bronchus 31.0 49.1 3rd lowest in province

Cerebrovascular diseases 25.9 37.1 3rd lowest in province

Cancer of colon, rectum, anus 16.2 24.2 2nd lowest in province


Cancer of lymph, blood & related 14.5 19.7 3rd lowest in province

Diabetes 13.7 21.6

Falls 13.5 16.1

Cancer of breast 12.5 14.7 3rd lowest in province


Total PYLL, 2011 32,452 536,071

% change in PYLL (2007‐2011) ‐4.0% ‐3.4%




Ischaemic heart disease 200.4 395.0 Lowest in province


Cancer of lung & bronchus 185.9 320.0 3rd lowest in province

Intentional self‐harm 166.7 269.4 Lowest in province


Cancer of colon, rectum, anus 105.0 146.1 2nd lowest in province


Cancer of lymph, blood & related 100.6 137.3 3rd lowest in province

Cirrhosis and other liver diseases 99.5 131.2 2nd lowest in province


98.6 127.5





There were 20,432 births in Toronto Central LHIN hospitals in FY 2011/12.

Compared with other LHINs, Toronto Central had the lowest proportion of births among women age <20 and the highest proportion of births among women age 35 or older.

The rate of Caesarean births (31.9%) was higher than the corresponding provincial rate (28.4%) and was the second highest among all LHINs.

Nine out of 10 births in the LHIN were attended by an obstetrician.

The rate of pre‐term births in this LHIN was the highest out of all LHINs at 11.5%.

The proportion of births in the LHIN classified as “small for gestational age” (10.6%) was slightly higher than the province average (9.4%) while the proportion of newborns classified as “large for gestational age” (8.4%) was marginally lower than the province average (10.0%).

Toronto Central LHIN had the third highest rate of exclusive breastfeeding (72.1%) out of all LHINs.

The 30‐day obstetric readmission rate (2.0%) for LHIN residents was greater than the rate for the province (1.7%) and was one of the highest in the province.


Indicator Toronto Central LHIN

Ontario

Total births in Toronto Central LHIN hospitals 20,432 139,386


< 20 1.5 3.2

≥ 35 33.4 22.0





Midwife 3.9 5.2







78 28 August 2015


In 2013 there were 12,982 births in Toronto Central LHIN to women who were Ontario residents regardless of birth location (hospital, home, birth centre, other) †.

Toronto Central LHIN had the second lowest proportion of women who reported smoking at first prenatal visit (3.6%) among all LHINs (with the exception of the MH LHIN) ††.




The prevalence of smoking at admission for birth ≥20, 10‐19, and 1‐9 cigarettes per day were 0.1 percent, 0.3 percent, and 1.4 percent, respectively. The prevalence has slightly decreased since the first prenatal visit (decrease of ‐0, ‐0.2, and ‐0.4 percentage points, respectively).


The women who reported drinking alcohol and using drugs during pregnancy were 1.5% and 1.0%, compared to 1.6% and 2.0% for the province, respectively†††.


Maternal smoking at first prenatal visit Toronto Central LHIN Ontario




















133 627









All pregnancies with live birth or stillbirth (LHIN of residence)††† 10,270 130,158



†Records with missing values for any variables required to calculate the denominator were excluded. †† Mississauga Halton LHIN had >30% of records with missing information on maternal smoking at first prenatal visit therefore were excluded from the analysis. †††Values with greater than 10% but less than 30% missing data should be interpreted with cau on (as indicated in yellow).

80 28 August 2015


6,694 Toronto Central LHIN residents died in 2011.

The LHIN’s all‐cause mortality rate has decreased since 2007 and is lower than the provincial rate.

The leading causes of mortality for LHIN residents were ischaemic heart disease, dementia and Alzheimer disease, and cancer of lung and bronchus. All of the top 10 cause‐specific mortality rates for LHIN residents were lower than the Ontario rates. These 10 causes accounted for 49.3% of all deaths for Toronto Central LHIN residents in 2011.

43,313 potential years of life were lost by residents of this LHIN in 2011.

In 2011, 37.3% of all LHIN resident deaths were premature (occurred in those younger than 75 years). This percentage was very similar to the Ontario percentage.

The PYLL rate was 3,914.6 per 100,000 population aged less than 75 years for LHIN residents in 2011. This rate was lower than the Ontario rate of 4,327.0. The rate for Toronto Central LHIN residents decreased by 3.2% between 2007 and 2011, while the Ontario rate decreased by 6.5%.

The leading causes of PYLL for LHIN residents in 2011 were perinatal conditions, ischaemic heart disease, and intentional self‐harm. Most of the top 10 causes of PYLL rates (except perinatal conditions, accidental poisoning, and cancer of the brain and nervous system) were lower than the corresponding provincial cause‐specific rates. The PYLL rate for perinatal conditions for residents of Toronto Central LHIN was the second highest rate among LHINs.




Ontario Comment

Mortality

Total deaths, 2011 6,694 88,967














Falls 13.4 16.1



Total PYLL, 2011 43,313 536,071

% change in PYLL (2007‐2011) 0.7% ‐3.4%



Top 10 leading causes of PYLL, 2011 (rates per 100,000 population, age < 75)

Perinatal conditions 345.7 241.1 2nd highest in

province









Cancer of brain & nervous system 106.8 88.9


82 28 August 2015

8. CENTRAL LHIN


There were almost 18,000 births in Central LHIN hospitals in FY 2011/12.

1.5% of women in the Central LHIN who gave birth were under 20 years of age which was the second lowest proportion in the province.

27.3% of women who gave birth in the LHIN were aged 35 years or older, which was the second highest proportion in the province.

The rate of Caesarean births was 27.9% in the LHIN, similar to the provincial rate.

In the Central LHIN, 91.2% of births were attended by an obstetrician, which was the second largest proportion in the province, while the proportion of births attended by a family physician (3.3%) was the second lowest in the province. Midwives attended 4.7% of births in the LHIN.

The rate of pre‐term births was 6.5% in the LHIN, lower than the provincial rate (8.0%).

10.2% of newborns were classified as “small for gestational age” which was similar to the provincial average of 9.4%. The Central LHIN had the lowest percentage of newborns classified as “large for gestational age” (7.7%) in the province, lower than the provincial average of 10.0%.

The rate of exclusive breastfeeding was 62.0% in the Central LHIN compared to the provincial rate of 63.2%.

The 30‐day obstetric readmission rate (1.7%) for LHIN residents was the same as the provincial rate.


Indicator Central LHIN

Ontario

Total births in Central LHIN hospitals 17,997 139,386


< 20 1.5 3.2

≥ 35 27.3 22.0





Midwife 4.7 5.2









In 2013 there were 16,874 births in Central LHIN to women who were Ontario residents regardless of birth location (hospital, home, birth centre, other) †.

Central LHIN had the lowest proportion of women who reported smoking at first prenatal visit (3.5%) among all LHINs (with the exception of the MH LHIN) ††.



The proportion of women who reported smoking at time of admission was 2.5%, compared to 8.4% for the province and the lowest among all LHINs. The rate has decreased since the first prenatal visit (decrease of‐1.0 percentage points).

The prevalence of smoking at admission for birth ≥20, 10‐19, and 1‐9 cigarettes per day were 0.2 percent, 0.7 percent, and 1.3 percent, respectively. The prevalence has slightly decreased since the first prenatal visit (decrease of ‐0, ‐0.2, and ‐0.7 percentage points, respectively).



84 28 August 2015

Maternal smoking at first prenatal visit Central LHIN Ontario




















63 627












†Records with missing values for any variables required to calculate the denominator were excluded. †† Mississauga Halton LHIN had >30% of records with missing information on maternal smoking at first prenatal visit therefore has been excluded from the analysis.



There were 8,273 Central LHIN resident deaths in 2011. This was an increase from 2007 of 4.7% ‐ double the rate of increase seen for Ontario residents over the same time period.

The all‐cause mortality rate for LHIN residents was 470.4 per 100,000 population. This was lower than the Ontario all‐cause mortality rate in 2011 (670.8). Both rates decreased since 2007.

The leading causes of death for residents of this LHIN in 2011 were ischaemic heart disease, dementia and Alzheimer disease, and cancer of lung and bronchus. The top 10 causes of death accounted for 52.4% of all LHIN resident deaths. All the top 10 specific‐cause mortality rates for residents of this LHIN were lower than the Ontario rates and all top 10 rates were among the lowest of all LHINs.

33.7% of Central LHIN resident deaths in 2011 were considered premature. This percentage was less than that for Ontario residents (37.2%). Central LHIN residents had the lowest percentage of premature deaths of all LHINs.

In 2011, 49,146 years of potential life were lost by residents of Central LHIN, a decrease of 1.7% from 2007. In Ontario overall, the total PYLL decreased by 3.4% between 2007 and 2011.

The PYLL rate for residents of the LHIN was 2,963.9 per 100,000 population aged less than 75 years in 2011. This was the lowest PYLL rate among all LHINs and a decrease of 8.1% since 2007. In contrast, the overall PYLL rate for Ontario residents decreased by 6.5% between 2007 and 2011.

The leading causes of PYLL for LHIN residents were ischaemic heart disease, perinatal conditions, and cancer of lung and bronchus. Many of the top 10 cause‐specific rates of PYLL for LHIN residents were the lowest out of all LHINs or among the lowest.

86 28 August 2015


Central LHIN

Ontario Comment

Mortality

Total deaths, 2011 8,273 88,967






Ischaemic heart disease 66.1 97.5 3rd lowest in province

Dementia and Alzheimer disease 42.7 52.9 3rd lowest in province

Cancer of lung & bronchus 29.6 49.1 2nd lowest in province

Cerebrovascular diseases 25.2 37.1 2nd lowest in province

Cancer of colon, rectum, anus 17.6 24.2 3rd lowest in province

Chronic lower respiratory diseases 15.4 28.6 3rd lowest in province

Cancer of lymph, blood & related 14.0 19.7 2nd lowest in province

Influenza and pneumonia 12.1 15.7 3rd lowest in province

Falls 12.0 16.1 2nd lowest in province

Diabetes 11.7 21.6 Lowest in province


Total PYLL, 2011 49,146 536,071

% change in PYLL (2007‐2011) ‐1.7% ‐3.4%




Ischaemic heart disease 237.3 395.0 2nd lowest in province


Cancer of lung & bronchus 180.7 320.0 Lowest in province

Intentional self‐harm 177.9 269.4 3rd lowest in province

Accidental poisoning 120.3 164.8 3rd lowest in province


Congenital malformations, deformations and chromosomal abnormalities

110.0 127.5

Cancer of breast 100.5 143.0 Lowest in province

Cancer of lymph, blood & related 92.6 137.3 Lowest in province

Cancer of colon, rectum, anus 89.3 146.1 Lowest in province





In FY 2011/12, there were 13,670 births in Central East LHIN hospitals.

3.4% of women who gave birth in the LHIN were under 20 years of age.

18.7% of women who gave birth in the LHIN were aged 35 years or older, which was lower than the provincial average (22.0%).

The rate of Caesarean births in the Central East LHIN was 29.2%, while the provincial rate was 28.4%.

The proportion of births attended by obstetricians (85.4%) or family physicians (9.9%) were similar to the provincial averages (84.7% and 8.6%, respectively).

The rate of pre‐term births (less than 37 weeks) was 7.3%.

In the Central East LHIN, 10.6% of newborns were classified as “small for gestational age” and 9.7% of newborns were classified as “large for gestational age”; these proportions were both similar to the provincial averages.

The rate of exclusive breastfeeding in the Central East LHIN (73.6%) was the highest among all LHINs.

Residents of Central East LHIN had a 30‐day obstetric readmission rate of 1.9%, while the provincial rate was 1.7%.


Indicator Central East

LHIN Ontario

Total births in Central East LHIN hospitals 13,670 139,386


< 20 3.4 3.2

≥ 35 18.7 22.0





Midwife 3.6 5.2







88 28 August 2015


In 2013 there were 14,877 births in Central East LHIN to women who were Ontario residents regardless of birth location (hospital, home, birth centre, other) †.

Central East LHIN had the forth lowest proportion of women who reported smoking at first prenatal visit (9.5%) among all LHINs (with the exception of the MH LHIN) ††.


Over 90% of the women were nonsmokers in their first prenatal visit, compared to 89.2% for the province and was the fourth highest proportions in the province (with the exception of the MH LHIN) ††.


The prevalence of smoking at admission for birth ≥20, 10‐19, and 1‐9 cigarettes per day were 0.5 percent, 2.6 percent, and 4.0 percent, respectively. The prevalence has slightly decreased since the first prenatal visit (decrease of ‐0.2, ‐0.7, and ‐0.9 percentage points, respectively).

The proportion of nonsmokers at time of admission for birth had increased since the first prenatal visit (increase of 0.9 percentage points).



Maternal smoking at first prenatal visit Central East LHIN Ontario




















70 627












†Records with missing values for any variables required to calculate the denominator were excluded. †† Mississauga Halton LHIN had >30% of records with missing information on maternal smoking at first prenatal visit therefore were excluded from the analysis.

90 28 August 2015


There were 9,601 Central East LHIN resident deaths in 2011.

The all‐cause mortality rate for residents of this LHIN was lower than the provincial rate (621.4 versus 670.8 per 100,000).

The leading causes of death for LHIN residents were ischaemic heart disease, cancer of lung and bronchus, and dementia and Alzheimer disease. Most of the rates for the top 10 causes of mortality were lower than the Ontario rates. The top 10 causes of mortality accounted for 53.8% of all resident deaths in the Central East LHIN in 2011.

36.7% of all LHIN resident deaths occurred in those younger than 75 years of age and are considered premature.

55,887 years of potential life were lost in 2011 by residents of Central East LHIN, although this decreased by 7.6% since 2007.

The PYLL rate was 3,883.1 per 100,000 population aged less than 75 years for LHIN residents, which was lower than the PYLL rate for Ontario residents (4,327.0). Since 2007, the PYLL rate decreased by 9.5% for Central East residents.

The leading causes of PYLL by Central East LHIN residents were ischaemic heart disease, cancer of lung and bronchus, and intentional self‐harm. Most cause‐specific rates were lower than the overall cause‐specific rates for Ontario residents. The PYLL rate for breast cancer for LHIN residents was the second lowest among all LHINs.



Central East LHIN

Ontario Comment

Mortality

Total deaths, 2011 9,601 88,967












Diabetes 21.3 21.6


Falls 16.9 16.1



Total PYLL, 2011 55,887 536,071

% change in PYLL (2007‐2011) ‐7.6% ‐3.4%










Congenital malformations, deformations, chromosomal abnormalities 129.6 127.5



Cancer of breast 113.5 143.0 2nd lowest in province


92 28 August 2015

10. SOUTH EAST LHIN


There were 4,140 births in hospitals in the South East LHIN in FY 2011/12.

5.8% of women who gave birth in the LHIN were under 20 years of age which was the third highest proportion in the province.

14.2% of women who gave birth were aged 35 years or older which was the third lowest proportion in the province.

The rate of Caesarean deliveries was similar to the provincial average.

82.9% of hospital births in the South East LHIN were attended by obstetricians, while 12.3% were attended by family physicians, and 3.1% by midwives. The proportion of obstetrician‐attended births was similar to the provincial average while the proportion of births attended by family physicians was higher than the provincial average. The South East LHIN had the second lowest proportion of midwife attended hospital births in the province.

The rate of pre‐term births (8.8%) was the second highest among all LHINs.

In the South East LHIN, 9.1% of newborns were classified as “small for gestational age” which was similar to the provincial average of 9.4%, while the proportion of newborns classified as “large for gestational age” (13.9%) was the second highest in the province.

The rate of exclusive breastfeeding in the South East LHIN (61.1%) was similar to the provincial rate (63.2%).

The 30‐day obstetric readmission rate for LHIN residents was 1.5%, while the provincial rate was 1.7%.


Indicator South East

LHIN Ontario

Total births in South East LHIN hospitals 4,140 139,386


< 20 5.8 3.2

≥ 35 14.2 22.0





Midwife 3.1 5.2









In 2013 there were 4,434 births in South East LHIN to women who were Ontario residents regardless of birth location (hospital, home, birth centre, other) †.

South East LHIN had the third highest proportion of women who reported smoking at first prenatal visit (21.3%) among all LHINs (with the exception of the MH LHIN) ††.


78.7% of the women were nonsmokers in their first prenatal visit, which was lower than the provincial average (89.2%) (with the exception of the MH LHIN) ††.

The proportion of women who reported smoking at time of admission was 18.3%, compared to 8.4% for the province. The rate had decreased since the first prenatal visit (decrease of‐3.0 percentage points).

The prevalence of smoking at admission for birth ≥20, 10‐19, and 1‐9 cigarettes per day were 1.2 percent, 7.7 percent, and 9.3 percent, respectively. The prevalence had decreased since the first prenatal visit (decrease of ‐0.3, ‐3.2, and ‐1.6 percentage points, respectively).


The women who reported drinking alcohol and using drugs during pregnancy were almost twice higher than the provincial rate (2.3% and 3.8% vs. 1.6% and 2.0%, respectively).

94 28 August 2015

Maternal smoking at first prenatal visit South East LHIN Ontario




















9 627















4,440 residents of South East LHIN died in 2011.

The all‐cause mortality rate for South East LHIN residents was 904.4 per 100,000 in 2011. Although this was the third highest all‐cause mortality rate among all LHINs the rate has decreased by 8.0% since 2007.

The leading causes of death for residents of this LHIN were ischaemic heart disease, cancer of lung and bronchus, and dementia and Alzheimer disease. The rates for all the top 10 causes of mortality were greater than the Ontario rates and all of these were among the highest among the LHINs.

The top 10 causes of mortality accounted for 55.7% of all South East LHIN resident deaths in 2011.

37.6% of all resident deaths occurred in those younger than 75 years and are considered premature. Premature deaths accounted for 25,402 years of potential life were lost for LHIN residents in 2011.

The PYLL rate was 5,648.1 per 100,000 population aged less than 75 years for LHIN residents, which was greater than the PYLL rate for Ontario residents (4,327.0). Although the PYLL rate has decreased by 8.8% since 2007, it is the third highest rate among LHINs.

The leading causes of PYLL for LHIN residents were ischaemic heart disease, cancer of lung and bronchus, and intentional self‐harm. Many of the cause‐specific PYLL rates for LHIN residents were among the highest of the LHINs in 2011.

96 28 August 2015


South East LHIN

Ontario Comment

Mortality

Total deaths, 2011 4,440 88,967






Ischaemic heart disease 131.8 97.5 3rd highest in province

Cancer of lung & bronchus 75.6 49.1 2nd highest in province

Dementia and Alzheimer disease 69.3 52.9 Highest in province

Cerebrovascular diseases 50.5 37.1 Highest in province

Chronic lower respiratory diseases 47.7 28.6 3rd highest in province

Diabetes 33.2 21.6 3rd highest in province

Cancer of colon, rectum, anus 32.8 24.2 Highest in province

Cancer of lymph, blood & related 26.1 19.7 Highest in province

Cancer of prostate 18.5 10.6 Highest in province

Influenza and pneumonia 18.3 15.7 3rd highest in province


Total PYLL, 2011 25,402 536,071

% change in PYLL (2007‐2011) ‐8.1% ‐3.4%



Top 10 leading causes of PYLL,(rates per 100,000 population, age < 75)

Ischaemic heart disease 601.4 395.0 3rd highest in province

Cancer of lung & bronchus 512.1 320.0 2nd highest in province

Intentional self‐harm 371.1 269.4 3rd highest in province



229.3 127.5 Highest in province

Cancer of colon, rectum, anus 203.7 146.1 2nd highest in province

Cancer of breast 189.0 143.0 2nd highest in province






11. CHAMPLAIN LHIN


In FY 2011/12, there were 13,546 births in Champlain LHIN hospitals.

2.7% of women who gave birth in the Champlain LHIN were under 20 years, while 22.3% were aged 35 years or older.

The rate of Caesarean births in the Champlain LHIN (28.9%) was similar to the provincial rate.

The percentages of hospital births attended by an obstetrician (82.5%) and by a midwife (5.0%) were similar to the provincial averages (84.7% and 5.2%, respectively), while the percentage of hospital births attended by a family physician (11.1%) was higher than the provincial average (8.6%).

The rate of pre‐term births in the LHIN (8.6%) was similar to the provincial rate (8.0%).

A smaller proportion of newborns was classified as “small for gestational age” (7.9%) compared to the province, while a similar proportion of newborns was classified as “large for gestational age” (11.4%) compared to the province.

The rate of exclusive breast feeding was similar to the province.

The 30‐day obstetric readmission rate for LHIN residents was 1.9%, while the provincial rate was 1.7%.


Indicator Champlain

LHIN Ontario

Total births in Champlain LHIN hospitals 13,546 139,386


< 20 2.7 3.2

≥ 35 22.3 22.0





Midwife 5.0 5.2







98 28 August 2015


In 2013 there were 13,386 births in Champlain LHIN to women who were Ontario residents regardless of birth location (hospital, home, birth centre, other) †.

The proportion of women who reported smoking at first prenatal visit was 9.7%. The proportion was slightly lower than the provincial average (10.8%) and ranked 5th among all LHINs (with the exception of the MH LHIN) ††.


90.3% of the women were nonsmokers in their first prenatal visit, which was slightly higher than the provincial average (89.2%) (with the exception of the MH LHIN) ††.

The proportion of women who reported smoking at time of admission was 7.7%, compared to 8.4% for the province. The rate had decreased since the first prenatal visit (decrease of‐2.0 percentage points).





Maternal smoking at first prenatal visit Champlain LHIN Ontario




















20 627













100 28 August 2015


7,932 residents of Champlain LHIN died in 2011.

The all‐cause mortality rate for LHIN residents was 624.4 per 100,000 in 2011. This was lower than the Ontario all‐cause mortality rate (670.8).

The leading causes of death for LHIN residents in 2011 were ischaemic heart disease, dementia and Alzheimer disease, and cancer of lung and bronchus. The top 10 causes of death accounted for 56.1% of LHIN resident deaths.

37.2% of deaths for LHIN residents were premature, which is the same proportion as seen for Ontario residents overall.

In 2011, 48,465 years of potential life were lost by LHIN residents.

The PYLL rate for LHIN residents was 4,073.6 per 100,000 population aged less than 75 years. This rate declined by 10.5% from 2007. In comparison, the PYLL rate for Ontario residents decreased by 6.5% since 2007.

The leading causes of PYLL for Champlain LHIN residents were ischaemic heart disease, cancer of lung and bronchus and intentional self‐harm. The PYLL rate for transport accidents for LHIN residents was the third highest among the LHINs.

Champlain LHIN residents had the largest percent decrease in both the all‐cause mortality rate and PYLL rate from 2007 to 2011.



Champlain


Mortality

Total deaths, 2011 7,932 88,967













Diabetes 19.4 21.6


Falls 13.5 16.1


Total PYLL, 2011 48,465 536,071

% change in PYLL (2007‐2011) ‐5.7% ‐3.4%








Transport accidents 207.0 147.6 3rd highest in province






118.5 127.5


102 28 August 2015



In FY 2011/12, there were 4,068 births in North Simcoe Muskoka LHIN hospitals.

5.0% of women who gave birth in the LHIN were under 20 years of age. 15.9% were aged 35 or older when they gave birth, which was lower than provincial average.

The rate of Caesarean deliveries (31.3%) was the third highest in the province.

74.6% of hospital births were attended by an obstetrician, which was the third lowest proportion among all LHINs and lower than the provincial average. The proportion of births attended by a family physician (16.7%) was greater than the provincial average and was the third highest in the province.

The rate of pre‐term deliveries (6.9%) was lower than the provincial rate.

Both the percentages of newborns classified as “small for gestational age” (8.0%) and those classified as “large for gestational age” (11.5%) were similar to the province percentages (9.4% and 10%, for “small for gestational age” and “large for gestational age”, respectively).

The rate of exclusive breastfeeding in the LHIN was more than 70%, which was higher than the provincial rate.

The 30‐day obstetric readmission rate (1.8%) for LHIN residents was similar to the provincial rate (1.7%).


Indicator

North Simcoe Muskoka LHIN

Ontario

Total births in North Simcoe Muskoka LHIN hospitals 4,068 139,386


< 20 5.0 3.2

≥ 35 15.9 22.0





Midwife 5.8 5.2









In 2013 there were 3,982 births in North Simcoe Muskoka LHIN to women who were Ontario residents regardless of birth location (hospital, home, birth centre, other) †.

North Simcoe Muskoka LHIN had the highest proportion (ranked 10th) of women who reported smoking at first prenatal visit (17.2%) among all LHINs (with the exception of the MH LHIN) ††.


82.8% of the women were nonsmokers in their first prenatal visit, which was slightly lower than the provincial average (89.2%) (with the exception of the MH LHIN) ††.

The proportion of women who reported smoking at time of admission was 14.7%, compared to 8.4% for the province and the highest (ranked 4th) among all LHINs. The rate has decreased since the first prenatal visit (decrease of‐2.5 percentage points).




104 28 August 2015

Maternal smoking at first prenatal visit North Simcoe Muskoka LHIN

Ontario




















15 627















3,471 North Simcoe Muskoka LHIN residents died in 2011.

The all‐cause mortality rate for LHIN residents has decreased since 2007 but is higher than the provincial rate (763.8 versus 670.8 per 100,000).

The leading causes of death for LHIN residents in 2011 were ischaemic heart disease, dementia and Alzheimer disease, and cancer of lung and bronchus. The top 10 causes of death accounted for 56.4% of all resident deaths of this LHIN. All but one (influenza and pneumonia) of the top 10 specific‐cause mortality rates for LHIN residents were higher than the Ontario rates. The mortality rate for colorectal cancer and dementia and Alzheimer were the third highest for LHIN residents among all LHINs.

38.5% of resident deaths were premature in this LHIN in 2011. This percentage was similar to that for Ontario residents (37.2%).

In 2011, 19,827 years of potential life were lost by LHIN residents.

The 2011 PYLL rate for LHIN residents was 4,714.7 per 100,000 population aged less than 75 years. The PYLL rate decreased by 9.2% since 2007. In contrast, the PYLL rate for Ontario residents decreased by 6.5% since 2007.

The leading causes of PYLL for residents of this LHIN were cancer of lung and bronchus, ischaemic heart disease, and intentional self‐harm. Many of the top 10 cause‐specific PYLL rates for North Simcoe Muskoka residents were greater than the Ontario rates. In particular, the PYLL rates for diabetes and chronic lower respiratory diseases for LHIN residents were the second and third highest in the province, respectively.

106 28 August 2015



Ontario Comment

Mortality

Total deaths, 2011 3,471 88,967







Dementia and Alzheimer disease 64.0 52.9 3rd highest in province




Cancer of colon, rectum, anus 30.8 24.2 3rd highest in province

Diabetes 30.6 21.6





Total PYLL, 2011 19,827 536,071

% change in PYLL (2007‐2011) ‐7.3% ‐3.4%









Diabetes 187.9 104.6 2nd highest in province




Chronic lower respiratory diseases 126.0 78.4 3rd highest in province



13. NORTH EAST LHIN


There were 5,155 births in North East LHIN hospitals in FY 2011/12.

8.3% of women who gave birth in the LHIN were under 20 years of age which was the second highest proportion among all LHINs and was much greater than the provincial average (3.2%).

10.8% of women were aged 35 years or older, which was the lowest proportion among all LHINs and much lower than the provincial average (22.0%).

The rate of Caesarean births (30.0%) was similar to the provincial rate (28.4%).

The proportion of hospital births attended by obstetricians (69.9%) was the second lowest among all LHINs and well below the provincial average of 84.7%. 18.2% of hospital births were attended by family physicians; this proportion was the second highest among all LHINs and was greater than the provincial average of 8.6%.

Among all LHINs, the North East LHIN had the third highest proportion of midwife‐attended hospital births (8.7%).

The rate of pre‐term births in the North East LHIN (7.5%) was similar to the provincial rate.

The proportion of newborns classified as “small for gestational age” (7.9%) was below the provincial average (9.4%); however the proportion of newborns classified as “large for gestational age” (12.7%) was higher than the provincial average (10.0%) and the third highest among all LHINs.

The rate of exclusive breastfeeding in this LHIN (63.9%) was similar to the provincial rate.

For residents of North East LHIN, the 30‐day obstetric readmission rate was 1.5%, compared to the provincial rate of 1.7%.


Indicator North East

LHIN Ontario

Total births in North East LHIN hospitals 5,155 139,386


< 20 8.3 3.2

≥ 35 10.8 22.0





Midwife 8.7 5.2







108 28 August 2015


In 2013 there were 5,353 births in North East LHIN to women who were Ontario residents regardless of birth location (hospital, home, birth centre, other) †.

North East LHIN had the highest proportion (ranked 11th) of women who reported smoking at first prenatal visit (25.6%) among all LHINs (with the exception of the MH LHIN) ††.



The proportion of women who reported smoking at time of admission was 22.6% which was higher than the provincial (8.4%) and the second highest among all LHINs. The rate had decreased since the first prenatal visit (decrease of‐3.0 percentage points).





Maternal smoking at first prenatal visit North East

LHIN Ontario




















47 627













110 28 August 2015


5,304 residents of North East LHIN died in 2011.

The all‐cause mortality rate for LHIN residents was 929.7 per 100,000, much higher than the Ontario all‐cause mortality rate in 2011. This rate was the highest among all the LHINs, and decreased only slightly (0.2%) since 2007.

The leading causes of death in 2011 were ischaemic heart disease, cancer of lung and bronchus, dementia and Alzheimer disease. The top 10 diseases accounted for 55.1% of total resident deaths.

Many of the top 10 cause‐specific mortality rates for residents of North East LHIN in 2011 were the highest rates or among the highest rates of all the LHINs.

42.7% of deaths were considered premature in 2011. This was the second highest percentage of premature deaths among all LHINs.

34,786 years of potential life were lost by residents of North East LHIN in 2011.

The PYLL rate per 100,000 population aged less than 75 years was 6,612.2 for LHIN residents in 2011. Although the LHIN’s PYLL rate has decreased since 2007, it is the second highest among all LHINs.

The leading causes of PYLL in 2011 were ischaemic heart disease, cancer of lung and bronchus, and intentional self‐harm. The PYLL rates for ischaemic heart disease (655.6) and cancer of lung and bronchus (626.1) were both higher than the corresponding Ontario rates (395.0 and 320.0, respectively) and were the highest among all LHINs.

Most of the top 10 cause‐specific PYLL rates were among the highest among all LHINs.

Ischaemic heart disease and cancer of lung and bronchus were the top two leading causes of death and PYLL for North East LHIN residents in 2011.



North East LHIN

Ontario Comment

Mortality

Total deaths, 2011 5,304 88,967






Ischaemic heart disease 137.9 97.5 2nd highest in province

Cancer of lung & bronchus 84.5 49.1 Highest in province


Chronic lower respiratory diseases 52.4 28.6 Highest in province


Diabetes 33.8 21.6 2nd highest in province

Cancer of colon, rectum, anus 31.0 24.2 2nd highest in province

Cancer of lymph, blood & related 25.8 19.7 2nd highest in province

Falls 21.6 16.1 2nd highest in province

Diseases of urinary system 20.3 13.0 Highest in province


Total PYLL, 2011 34,786 536,071

% change in PYLL (2007‐2011) ‐4.2% ‐3.4%




Ischaemic heart disease 655.6 395.0 Highest in province

Cancer of lung & bronchus 626.1 320.0 Highest in province

Intentional self‐harm 411.9 269.4 2nd highest in province

Accidental poisoning 304.7 164.8 2nd highest in province

Transport accidents 290.6 147.6 2nd highest in province


192.7 127.5 3rd highest in province


Chronic lower respiratory diseases 184.8 78.4 Highest in province

Cancer of lymph, blood & related 182.3 137.3 Highest in province

Diabetes 181.7 104.6 3rd highest in province


112 28 August 2015

14. NORTH WEST LHIN


There were just fewer than 2,500 births in North West LHIN hospitals in FY 2011/12.

10.9% of women who gave birth in the LHIN were under 20 years of age; this proportion was the highest among all LHINs. 12.6% of women who gave birth were aged 35 years or older. This was the second lowest proportion among all LHINs.

The rate of Caesarean births in the North West LHIN (24.4%) was lower than the provincial rate.

The North West LHIN was the only LHIN in which the proportion of hospital births attended by family physicians (43.7%) was higher than the proportion of hospital births attended by obstetricians (41.2%). Among all LHINs, the North West LHIN had the lowest proportion of obstetrician‐attended births and also had the highest proportion of family physician‐attended births.

The proportion of midwife‐attended births (12.2%) was the highest among all LHINs and was much greater than the provincial average (5.2%).

The rate of pre‐term deliveries (6.1%) in North West LHIN was the second lowest among all LHINs.

Among all LHINs, the North West LHIN had the lowest percentage of newborns classified as “small for gestational age” (6.8%) and the highest percentage of newborns classified as “large for gestational age” (16.3%).

The rate of exclusive breastfeeding in the North West LHIN (58.0%) was below the provincial rate (63.2%).

Residents of North West LHIN had the highest 30‐day obstetric readmission rate (2.7%) out of all the LHINs.


Indicator North West

LHIN Ontario

Total births in North West LHIN hospitals 2,448 139,386


< 20 10.9 3.2

≥ 35 12.6 22.0





Midwife 12.2 5.2









In 2013 there were 2,490 births in North West LHIN to women who were Ontario residents regardless of birth location (hospital, home, birth centre, other) †.

North East LHIN had the highest proportion of women who reported smoking at first prenatal visit (34.7%) among all LHINs (with the exception of the MH LHIN) ††.



The proportion of women who reported smoking at time of admission was 30.9% which was higher than the provincial (8.4%) and the second highest among all LHINs. The rate had decreased since the first prenatal visit (decrease of‐3.8 percentage points).


69.1% of the women were nonsmokers at time of admission for birth. The rate had increased since the first prenatal visit (increase of 3.8 percentage points).

The proportion of women who reported drinking alcohol and using drugs during pregnancy were the highest in the province (5.3% and 13.4%, compared to 1.6% and 2.0% for the province, respectively).

114 28 August 2015

Maternal smoking at first prenatal visit North West

LHIN Ontario




















8.0 627















2,189 North West LHIN residents died in 2011.

The all‐cause mortality rate for residents of North West LHIN was 923.4 per 100,000 in 2011. This was the second highest all‐cause mortality rate among all LHINs and was an increase of 15.6% in this rate since 2007. In Ontario, the overall all‐cause mortality rate decreased by 1.3% over the same time period.

The leading causes of death for residents of this LHIN were ischaemic heart disease, cancer of lung and bronchus, and dementia and Alzheimer disease. The rates for all the top 10 causes of mortality were greater than the Ontario rates and all but one of these were among the highest across all LHINs. The top 10 causes of mortality accounted for 54.5% of all North West LHIN resident deaths in 2011.

42.3% of all North West LHIN resident deaths occurred in those younger than 75 years, and are considered premature.

16,385 PYLL were lost in 2011 by residents of this LHIN.

The PYLL rate for North West LHIN has increased by 18% since 2007. The rate was much higher than the provincial rate (7,437.7 versus 4,327.0 per 100,000 population aged less than 75 years) and is the highest rate among LHINs.

The leading causes of PYLL by residents of North West LHIN were intentional self‐harm, ischaemic heart disease, and accidental poisoning. Many of the cause‐specific PYLL rates for North West LHIN residents were the highest rates or among the highest rates among all the LHINs.

North West LHIN residents had the largest percent increases among all LHINs from 2007 to 2011 for all‐cause mortality rate, and PYLL rates.

116 28 August 2015


North West LHIN

Ontario Comment

Mortality

Total deaths, 2011 2,189 88,967






Ischaemic heart disease 149.3 97.5 Highest in province

Cancer of lung & bronchus 67.1 49.1 3rd highest in province

Dementia and Alzheimer disease 65.0 52.9 2nd highest in province

Chronic lower respiratory diseases 48.5 28.6 2nd highest in province

Cerebrovascular diseases 45.1 37.1 3rd highest in province

Diabetes 36.7 21.6 Highest in province


Cancer of lymph, blood & related 24.9 19.7 3rd highest in province

Cancer of breast 19.8 14.7 Highest in province

Intentional self‐harm 19.4 8.8 Highest in province


Total PYLL, 2011 16,385 536,071

% change in PYLL (2007‐2011) 16.2% ‐3.4%


% change in PYLL rate (2007‐2011) 18.3% ‐6.5%


Intentional self‐harm 782.6 269.4 Highest in province

Ischaemic heart disease 635.1 395.0 2nd highest in province

Accidental poisoning 589.2 164.8 Highest in province

Cancer of lung & bronchus 475.7 320.0 3rd highest in province

Transport accidents 420.8 147.6 Highest in province

Cirrhosis and other liver diseases 265.1 131.2 Highest in province

Cancer of breast 234.2 143.0 Highest in province

Diabetes 214.3 104.6 Highest in province

Cancer of colon, rectum, anus 204.7 146.1 Highest in province

Mental & behavioural disorders from psychoactive substance use 170.7 34.6 Highest in province


.


General Health, Risk Factors, and Prevention

General health, risk factors, and prevention

Notes: This document and the accompanying workbook contain analyses based on the Canadian Community Health Survey (CCHS). The target population of the CCHS annual survey is Canadians aged 12+. Individuals living on Aboriginal Reserves and on Crown lands, institutional residents, full‐time members of the Canadian Forces and residents of certain remote regions are excluded. Prepared June 2015

118 28 August 2015

ONTARIO General Health

In 2013, 60% of Ontarians said they had very good or excellent health and 71% reported very good or excellent mental health. The proportion of those reporting very good or excellent mental health has declined over the examined time period for most LHINs.

23% of Ontarians reported that most days were ’quite a bit’ or ’extremely’ stressful.

14% of Ontarians reported experiencing moderate or severe pain/discomfort, and 31% reported activity limitations because of long‐term physical or mental health problems.

91% of Ontarians reported having a regular medical doctor, but this ranged from 83% in North West LHIN to 95% in South East LHIN.

Although 31% of people received a flu shot in the year preceding the survey, this percentage has been decreasing over time. In 2005, 42% of people reported getting the flu shot.

Risk Factors

18% of Ontario residents reported daily or occasional smoking in 2013. Smoking rates varied by LHIN from 12% in Central West LHIN to 24% in HNHB LHIN. Smoking rates have been declining over time.

17% of Ontarians reported heavy drinking. Heavy drinking is defined as having consumed 5 or more drinks on an occasion for males or 4 or more drinks for women, at least once a month during the past year.

54% of Ontarians were either overweight or obese and 46% were physically inactive.

61% of Ontario residents did not consume enough fruits and vegetables (i.e., had fewer than 5 servings of fruits or vegetables daily.)

These risk factors contribute to many cancers and chronic conditions including heart disease, stroke, COPD, diabetes, and osteoarthritis.

General health, risk factor prevalence: Ontario (2013)

% of population, age 12+ Ontario Range across

LHINs Trend over

time

Very good or excellent self‐perceived health 60.0 56.9‐61.6 ‐

Very good or excellent self‐perceived mental health 70.9 65.4‐76.3 unfavourable

Days that are ‘quite a bit’ or ‘extremely’ stressful (age 15+) 23.4 18.4‐27.1 ‐

With moderate or severe pain/discomfort 13.5 9.2‐19.0 ‐

With participation/activity limitations sometimes/often 31.3 23.3‐37.5 ‐

Have a regular medical doctor 91.0 82.7‐95.2 ‐

Received flu shot in the past year 31.2 24.2‐40.8 unfavourable

Risk Factors

Are daily or occasional smokers 18.0 12.4‐24.0 favourable

Are heavy drinkers 17.2 12.4‐25.2 ‐

Are overweight or obese (age 18+) 53.5 42.8‐65.2 unfavourable

Are physically inactive 45.6 40.2‐50.6 favourable

Consume < 5 servings of fruits/vegetables daily 60.8 57.1‐65.2 unfavourable

See Appendix Table for all LHINs.



General Health

In 2013, 60% of Erie St. Clair LHIN residents said that they had very good or excellent health and 74% reported very good or excellent mental health.

18% of Erie St. Clair LHIN residents reported that most days were ‘quite a bit’ or ‘extremely’ stressful. This rate was the lowest among all LHINs and was significantly lower than the provincial average (23%).

12% of LHIN residents reported usually experiencing moderate or severe pain/discomfort and 30% experienced activity limitations because of long‐term physical or mental health problems.

90% of Erie St. Clair LHIN residents reported having a regular medical doctor.

34% of LHIN residents received a flu shot in the year preceding the survey, which was slightly higher than the provincial average.

Risk Factors

Compared with Ontario, a significantly higher proportion of Erie St. Clair LHIN residents were overweight or obese.

51% of LHIN residents were physically inactive, which was the 2nd highest rate among all LHINs.

64% of Erie St. Clair LHIN residents consumed fewer than 5 servings of fruits and vegetables daily.

General health, risk factor prevalence: Erie St. Clair LHIN (2013)

% of population, age 12+ Erie St. Clair LHIN

Ontario LHIN Rank (1‐14)

LHIN Trend over time

Very good or excellent self‐perceived health 59.8 60.0 9 ‐

Very good or excellent self‐perceived mental health 73.9 70.9 3 unfavourable

Days that are ‘quite a bit’ or ‘extremely’ stressful (age 15+) 18.4↓ 23.4 1 favourable

With moderate or severe pain/discomfort 11.9 13.5 5 ‐

With participation/activity limitations sometimes/often 29.9 31.3 4 favourable

Have a regular medical doctor 89.7 91.0 10 ‐

Received flu shot in the past year 34.0 31.2 6 ‐

Risk Factors

Are daily or occasional smokers 18.3 18.0 7 favourable

Are heavy drinkers 19.4 17.2 8 favourable

Are overweight or obese (age 18+) 59.8↑ 53.5 10 unfavourable

Are physically inactive 50.6 45.6 13 unfavourable

Consume < 5 servings of fruits/vegetables daily 63.9 60.8 12 ‐

↑ LHIN result is significantly higher than Ontario.↓ LHIN result is significantly lower than Ontario. Ranks: Low ranks (e.g., 1) is ‘better’

120 28 August 2015

2. SOUTH WEST LHIN

General Health

62% of South West LHIN residents said they had very good or excellent health, which was the highest proportion among all the LHINs. 69% of South West LHIN residents reported very good or excellent mental health.

Compared to the province, South West residents were significantly less likely to report their days were stressful. 19% of South West LHIN residents reported that most days were ‘quite a bit’ or ‘extremely’ stressful compared to 23% provincially.

14% of South West LHIN residents reported usually experiencing moderate or severe pain/discomfort, and 34% experienced activity limitations because of long‐term physical or mental health problems.

93% of LHIN residents reported having a regular medical doctor, which was slightly higher than the provincial average.

Compared with the province, a significantly larger proportion of South West LHIN residents received a flu shot in the previous year. Over time, the proportion of residents who received a flu shot has declined.

Risk Factors

Approximately 18% of South West LHIN residents reported being daily or occasional smokers.

South West LHIN had significantly higher proportions of residents who were heavy drinkers (22%) and who were overweight or obese (60%) compared to the province.

Approximately 49% of South West LHIN residents were physically inactive and 60% reported inadequate consumption of fruits and vegetables.

General health, risk factor prevalence: South West LHIN (2013)

% of population, age 12+ South

West LHIN Ontario

LHIN Rank (1‐14)




Days that are ‘quite a bit’ or ‘extremely’ stressful (age 15+) 19.4↓ 23.4 2 ‐

With moderate or severe pain/discomfort 14.1 13.5 7 unfavourable

With participation/activity limitations sometimes/often 33.6 31.3 7 ‐

Have a regular medical doctor 93.1 91.0 5 favourable

Received flu shot in the past year 36.7↑ 31.2 4 unfavourable

Risk Factors

Are daily or occasional smokers 17.9 18.0 6 ‐

Are heavy drinkers 21.5↑ 17.2 10 ‐



Consume < 5 servings of fruits/vegetables daily 60.3 60.8 6 unfavourable




General Health

Approximately 61% of Waterloo Wellington LHIN residents reported very good or excellent health, and 71% reported very good or excellent mental health.

22% of Waterloo Wellington LHIN residents reported that their days were ‘quite a bit’ or ‘extremely’ stressful, similar to the provincial average of 23%.

Approximately 15% of LHIN residents usually experienced moderate or severe pain/discomfort, and 35% experienced activity limitations because of long‐term physical or mental health problems.

93% of Waterloo Wellington LHIN residents reported having a regular medical doctor.

25% of Waterloo Wellington LHIN residents received a flu shot in the past year, which was significantly lower than the provincial average of 31%. Over time, the proportion of residents getting a flu shot has declined.

Risk Factors

Among Waterloo Wellington LHIN residents, the rate of smoking (19%) was similar to the provincial average. Approximately 21% of LHIN residents were heavy drinkers and this proportion was slightly larger than the provincial average.

Compared with the province, Waterloo Wellington LHIN residents had slightly lower rates of overweight/obesity (52%) and physical inactivity (43%).

61% of Waterloo Wellington LHIN residents reported inadequate consumption of fruits and vegetables.

General health, risk factor prevalence: Waterloo Wellington LHIN (2013)

% of population, age 12+ Waterloo Wellington

LHIN Ontario

LHIN Rank (1‐14)




Days that are ‘quite a bit’ or ‘extremely’ stressful (age 15+) 22.5 23.4 6 ‐

With moderate or severe pain/discomfort 14.5 13.5 8 unfavourable

With participation/activity limitations sometimes/often 35.3 31.3 9 unfavourable


Received flu shot in the past year 25.2↓ 31.2 13 unfavourable

Risk Factors


Are heavy drinkers 20.6 17.2 9 ‐

Are overweight or obese (age 18+) 51.7 53.5 5 ‐

Are physically inactive 42.5 45.6 4 favourable



122 28 August 2015


General Health

In 2013, 57% of HNHB LHIN residents reported very good or excellent health and 71% reported very good or excellent mental health.

23% of HNHB LHIN residents reported their days were ‘quite a bit’ or ‘extremely’ stressful, which was similar to the provincial average.

Compared to the province, HNHB LHIN had a significantly higher proportion of residents reporting they usually experience moderate or severe pain/discomfort (17 vs. 14% for Ontario). Approximately 35% of HNHB LHIN residents had activity limitations because of long‐term physical or mental health problems and this proportion was slightly higher than the provincial average (31%).

HNHB LHIN had a significantly higher proportion of residents with a regular medical doctor (94%) relative to Ontario (91%). This rate was the 2nd highest among all the LHINs.

32% of LHIN residents had received a flu shot in the past year. Over time, the proportion of residents getting a flu shot has declined.

Risk Factors

24% of HNHB LHIN residents were daily or occasional smokers, significantly higher than the Ontario average of 18%.

55% of HNHB LHIN residents were overweight or obese and 44% were physically inactive.

62% of HNHB LHIN residents reported inadequate consumption of fruits and vegetables.

General health, risk factor prevalence: HNHB LHIN (2013)

% of population, age 12+ HNHB LHIN



Very good or excellent self‐perceived health 57.1 60.0 13 unfavourable



With moderate or severe pain/discomfort 16.6↑ 13.5 11 unfavourable


Have a regular medical doctor 94.3↑ 91.0 2 ‐

Received flu shot in the past year 32.2 31.2 9 unfavourable

Risk Factors

Are daily or occasional smokers 24.0↑ 18.0 14 ‐








General Health

62% of Central West LHIN residents reported very good or excellent health. Compared with the province, Central West LHIN had a significantly higher proportion of residents (76%) who reported very good or excellent mental health. Among all LHINs, Central West had the 3rd highest proportion of residents reporting very good or excellent health and the highest proportion of reporting very good or excellent mental health.

25% of Central West LHIN residents reported their days were ‘quite a bit’ or ‘extremely’ stressful.

Compared with the province, Central West LHIN had significantly lower proportions of residents reporting pain/discomfort and participation/activity limitations. Approximately 9% of residents reported moderate or severe pain/discomfort, compared to 14% for Ontario. 23% of Central West LHIN residents reported activity limitations because of long‐term physical or mental health problems, compared to 31% provincially.

93% of Central West LHIN residents reported having a regular medical doctor.

Compared with Ontario, a significantly smaller proportion of Central West LHIN residents (26%) received a flu shot in the past year.

Risk Factors

Compared with Ontario, Central West LHIN had a significantly lower proportion of smokers, and this proportion was the lowest among all LHINs. Central West also had the second lowest proportion of heavy drinkers (12%) in the province.

Central West LHIN residents had a significantly higher rate of physical inactivity compared with Ontario overall. Approximately 56% of residents were overweight or obese.

General health, risk factor prevalence: Central West LHIN (2013)

% of population, age 12+ Central West LHIN




Very good or excellent self‐perceived mental health 76.3↑ 70.9 1 favourable


With moderate or severe pain/discomfort 9.2↓ 13.5 1 ‐

With participation/activity limitations sometimes/often 23.3↓ 31.3 1 ‐



Risk Factors

Are daily or occasional smokers 12.4↓ 18.0 1 favourable

Are heavy drinkers 12.4 17.2 2 favourable

Are overweight or obese (age 18+) 56.1 53.5 9 unfavourable

Are physically inactive 53.9↑ 45.6 14 ‐



124 28 August 2015


General Health

59% of Mississauga Halton LHIN residents reported very good or excellent health and 70% reported very good or excellent mental health.

26% of Mississauga Halton LHIN residents reported that most days were ‘quite a bit’ or ‘extremely’ stressful; this was the third highest proportion in the province.

Compared with Ontario, Mississauga Halton LHIN had significantly lower proportions of residents reporting pain/discomfort and activity limitations. Approximately 10% of LHIN residents reported moderate or severe pain/discomfort and 24% experienced activity limitations because of long‐term physical or mental health problems.

93% of Mississauga Halton LHIN residents reported having a regular medical doctor.

Compared with Ontario, a significantly lower proportion of Mississauga Halton LHIN residents had received a flu shot in the past year. Over time, the proportion of residents getting a flu shot has declined.

Risk Factors

Approximately 16% of LHIN residents were daily or occasional smokers, and 17% were heavy drinkers.

53% of Mississauga Halton LHIN residents were overweight or obese and 45% were physically inactive.

59% of Mississauga Halton LHIN residents consumed less than 5 servings of fruits & vegetables daily.

General health, risk factor prevalence: Mississauga Halton LHIN (2013)

% of population, age 12+ Mississauga

Halton

LHIN Ontario

LHIN Rank (1‐14)


Very good or excellent self‐perceived health 59.0 60.0 10 unfavourable







Risk Factors




Are physically inactive 45.4 45.6 8 ‐





General Health

62% of Toronto Central LHIN residents reported very good or excellent health, which was the 2nd highest proportion in the province. 67% of residents also reported very good or excellent mental health.

Almost 27% of Toronto Central LHIN residents reported that most days were ‘quite a bit’ or ‘extremely’ stressful, which was the 2nd highest proportion among all LHINs.

10% of LHIN residents said that they usually experienced moderate or severe pain/discomfort and 31% reported experiencing activity limitations because of long‐term physical or mental health problems.

Compared with Ontario, Toronto Central LHIN had a significantly lower proportion of residents who had a regular medical doctor (86%).

33% of Toronto Central LHIN residents received a flu shot in the past year. Over time, the proportion of residents getting a flu shot has declined.

Risk Factors

Approximately 19% of Toronto Central LHIN residents were daily or occasional smokers. Compared with Ontario, Toronto Central LHIN had a significantly higher proportion of residents who reported heavy drinking (24%).

Toronto Central LHIN had the lowest rate of overweight/obesity among adults in the province (43%), and this rate was significantly lower than the provincial average.

Among all LHINs, Toronto Central LHIN had the lowest proportion (57%) of residents who did not consume enough fruits and vegetables daily.

General health, risk factor prevalence: Toronto Central LHIN (2013)

% of population, age 12+ Toronto Central LHIN







With participation/activity limitations sometimes/often 30.7 31.3 5

Have a regular medical doctor 85.6↓ 91.0 12 ‐


Risk Factors



Are overweight or obese (age 18+) 42.8↓ 53.5 1 ‐




126 28 August 2015

8. CENTRAL LHIN

General Health

60% of Central LHIN residents reported that they had very good or excellent health and 75% reported very good or excellent mental health, which was the 2nd highest in the province.

24% of Central LHIN residents reported that most days were ‘quite a bit’ or ‘extremely’ stressful compared to 23% provincially.

Compared with the province, significantly lower proportions of Central LHIN residents reported pain/discomfort and activity limitations. Approximately 10% of LHIN residents reported that they usually experience moderate or severe pain/discomfort and 25% said they experience activity limitations because of long‐term physical or mental health problems.

92% of Central LHIN residents reported having a regular medical doctor.

28% of Central LHIN residents had received a flu shot in the past year. Over time, the proportion of residents getting a flu shot has declined.

Risk Factors

Central LHIN had among the lowest rates in the province for smoking, heavy drinking, and overweight/obesity. Approximately 15% of residents reported smoking, 9% reported heavy drinking and 51% were overweight or obese. Compared with Ontario, Central LHIN had a significantly lower rate of heavy drinking.

47% of Central LHIN residents were physically inactive.

61% of Central LHIN residents reported inadequate consumption of fruits and vegetables.

General health, risk factor prevalence: Central LHIN (2013)

% of population, age 12+ Central LHIN




Very good or excellent self‐perceived mental health 74.9 70.9 2 ‐






Risk Factors


Are heavy drinkers 9.3↓ 17.2 1 ‐







General Health

58% of Central East LHIN residents reported very good or excellent health and 67% reported very good or excellent mental health.

20% of Central East LHIN residents reported that most days were ‘quite a bit’ or ‘extremely’ stressful compared to 23% provincially.

Compared with Ontario, Central East LHIN had a significantly higher proportion of residents (19%) who reported that they usually experience moderate or severe pain/discomfort. 36% of Central East LHIN residents experienced activity limitations because of long‐term physical or mental health problems.

92% of LHIN residents reported having a regular medical doctor.

29% of LHIN residents had received a flu shot in the past year. Over time, the proportion of residents getting a flu shot has declined.

Risk Factors

Central East LHIN residents had lower rates of smoking, heavy drinking and overweight/obesity relative to the province; however these differences were not statistically significant. Approximately 16% of Central East LHIN residents were daily or occasional smokers, 14% reported heavy drinking and 51% were overweight or obese.

48% of Central East LHIN residents were physically inactive, compared to 46% for Ontario.

65% of residents report inadequate consumption of fruits and vegetables, which was the highest rate among all 14 LHINs.

General health, risk factor prevalence: Central East LHIN (2013)

% of population, age 12+ Central East LHIN

Ontario LHIN Rank(1‐14)





With moderate or severe pain/discomfort 19.0↑ 13.5 14 unfavourable

With participation/activity limitations sometimes/often 36.1 31.3 12 unfavourable



Risk Factors







128 28 August 2015

10. SOUTH EAST LHIN

General Health

61% of South East LHIN residents reported very good or excellent health and 72% reported very good or excellent mental health.

25% of South East LHIN residents reported that most days were ‘quite a bit’ or ‘extremely’ stressful, which was slightly higher than the provincial rate (23%).

16% of South East LHIN residents reported that they usually experience moderate or severe pain/discomfort. Compared with Ontario, South East LHIN had a significantly higher proportion of residents with activity limitations because of long‐term physical or mental health problems.

South East LHIN also had a significantly higher proportion of residents with a regular medical doctor (95%) relative to the province and this rate was the highest among all the LHINs.

Compared with Ontario, a significantly higher proportion of South East LHIN residents (41%) reported that they had received a flu shot in the past year. This was the 2nd highest rate among all LHINs.

Risk Factors

21% of residents in South East LHIN were daily or occasional smokers and 19% were heavy drinkers.

60% of South East LHIN residents were overweight or obese and this rate was significantly higher than the provincial average. 46% of South East LHIN residents were physically inactive. This proportion was similar to the Ontario average.

59% of South East LHIN residents reported inadequate consumption of fruits and vegetables.

General health, risk factor prevalence: South East LHIN (2013)

% of population, age 12+ South East

LHIN Ontario

LHIN Rank (1‐14)




Days that are ‘quite’ a bit or ‘extremely’ stressful (age 15+) 25.0 23.4 11 unfavourable


With participation/activity limitations sometimes/often 37.5↑ 31.3 14 ‐

Have a regular medical doctor 95.2↑ 91.0 1 favourable


Risk Factors






↑ LHIN result is significantly higher than Ontario.

↓ LHIN result is significantly lower than Ontario.

Ranks: Low ranks (e.g., 1) is ‘better’


11. CHAMPLAIN LHIN

General Health

61% of Champlain residents reported very good or excellent health and 70% reported very good or excellent mental health. The proportion of residents reporting very good or excellent mental health declined over the time period examined.

Nearly 25% of Champlain LHIN residents said that most days were ‘quite a bit’ or ‘extremely’ stressful, compared to 23% for Ontario.

13% of Champlain LHIN residents reported that they usually experience moderate or severe pain/discomfort, and 33% experienced activity limitations because of long‐term physical or mental health problems.

87% of Champlain LHIN residents reported having a regular medical doctor, and this proportion was significantly lower than the provincial average of 91%.

35% of LHIN residents had received a flu shot in the past year.

Risk Factors

18% of Champlain LHIN residents were smokers and 18% were heavy drinkers.

Among all LHINs, Champlain LHIN had the 3rd lowest proportion of residents who were overweight or obese (51%).

44% of Champlain LHIN residents were physically inactive.

59% of Champlain LHIN residents reported inadequate consumption of fruits and vegetables, and this proportion declined over the time period examined.

General health, risk factor prevalence: Champlain LHIN (2013)

% of population, age 12+ Champlain

LHIN Ontario

LHIN Rank(1‐14)




Days that are ‘quite a bit’ or ‘extremely‘ stressful (age 15+) 24.9 23.4 10 ‐





Risk Factors







130 28 August 2015


General Health

61% of North Simcoe Muskoka residents reported very good or excellent health and 71% reported very good or excellent mental health. These rates are similar to those for Ontario.

27% of LHIN residents reported that most days were ‘quite a bit’ or ‘extremely’ stressful, which was higher than the provincial average (23%).

17% of North Simcoe Muskoka LHIN residents reported that they usually experience moderate or severe pain/discomfort and 36% experienced activity limitations because of long‐term physical or mental health problems. These rates were elevated relative to those for Ontario.

94% of North Simcoe Muskoka LHIN residents reported having a regular medical doctor.

32% of LHIN residents reported that they had received a flu shot in the past year.

Risk Factors

Approximately 23% of North Simcoe Muskoka LHIN residents were smokers and 22% were heavy drinkers and these proportions were the 3rd highest among all LHINs.

North Simcoe Muskoka LHIN had the 2nd lowest proportion of residents who were physically inactive (42%) among the 14 LHINs. 54% of North Simcoe LHIN residents were overweight or obese, which was comparable to the provincial average.

63% of North Simcoe Muskoka LHIN residents reported inadequate consumption of fruits and vegetables.

General health, risk factor prevalence: North Simcoe Muskoka LHIN (2013)

% of population, age 12+






Days that are ‘quite a bit’ or ‘extremely’ stressful (age 15+) 27.1 23.4 14 unfavourable





Risk Factors








13. NORTH EAST LHIN

General Health

57% of North East LHIN residents reported very good or excellent health, which was the lowest rate among all LHINs. 73% of North East LHIN residents reported very good or excellent mental health.

21% of North East LHIN residents reported that most days were ‘quite a bit’ or ‘extremely’ stressful.

Approximately 19% of North East LHIN residents reported that they usually experience moderate or severe pain/discomfort and 37% experienced activity limitations because of long‐term physical or mental health problems. These rates were significantly higher than the provincial average.

85% of North East LHIN residents reported having a regular medical doctor, which was significantly lower than the provincial average of 91% and was the 2nd lowest proportion among all LHINs.

Compared with Ontario, a significantly higher proportion of North East LHIN residents (37%) had received a flu shot in the past year.

Risk Factors

Compared with the province, North East LHIN had significantly higher proportions of residents who were heavy drinkers (22%) and who were overweight or obese (62%).

Approximately 21% of North East LHIN residents reported smoking, which was slightly higher than the Ontario rate.

43% of North East LHIN residents were physically inactive.

62% of LHIN residents reported inadequate consumption of fruits and vegetables.

General health, risk factor prevalence: North East LHIN (2013)

% of population, age 12+ North East

LHIN Ontario

LHIN Rank(1‐14)





With moderate or severe pain/discomfort 18.6↑ 13.5 13 ‐

With participation/activity limitations sometimes/often 37.4↑ 31.3 13 ‐



Risk Factors



Are overweight or obese (age 18+) 62.0↑ 53.5 13 ‐




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14. NORTH WEST LHIN

General Health

59% of North West LHIN residents reported very good or excellent health. 65% of North West LHIN residents reported very good or excellent mental health, which was the lowest proportion among all LHINs.

Approximately 15% of LHIN residents reported that they usually experience moderate or severe pain/discomfort and 36% experienced activity limitations because of long‐term physical or mental health problems. These rates were higher than most other LHIN areas.

21% of LHIN residents reported that most days were ‘quite a bit’ or ‘extremely’ stressful; the lowest rate among LHINs and significantly lower than the provincial rate (23%).

83% of North West LHIN residents reported having a regular medical doctor. This was the lowest rate among all LHINs and was significantly lower than the provincial average of 91%.

41% of North West LHIN residents reported that they had received a flu shot in the past year, which was significantly higher than the provincial average.

Risk Factors

North West LHIN residents had significantly higher rates of smoking, heavy drinking, and overweight/obesity compared with Ontario and these rates were among the highest across the LHIN areas.

North West LHIN had the lowest prevalence of physical inactivity among all LHINs.

64% of North West LHIN residents reported inadequate consumption of fruits and vegetables.

General health, risk factor prevalence: North West LHIN (2013)

% of population, age 12+ North

West LHIN Ontario

LHIN Rank (1‐14)








Received flu shot in the past year 40.8↑ 31.2 1 favourable

Risk Factors

Are daily or occasional smokers 23.6↑ 18.0 13 ‐






28 August 2015 133

Appendix: Prevalence of risk factors across LHIN areas, 2013, population age 12+

% of the population age 12+ with… 1. ESC 2. SW 3. WW 4. HNHB 5. CW 6. MH 7. TC 8. CEN 9. CE 10. SE 11. CH 12. NSM 13. NE 14. NW ONT

Very good or excellent self-perceived health 59.8 61.6 61.2 57.1 61.6 59.0 61.6 60.0 57.7 61.2 61.2 61.4 56.9 58.8 60.0

Very good or excellent self-perceived mental health 73.9 69.3 70.7 70.8 76.3↑ 69.6 67.4 74.9 66.5 72.4 70.3 71.0 72.5 65.4 70.9

Days that are ‘quite a bit’ or ‘extremely’ stressful (age 15+) 18.4↓ 19.4↓ 22.5 22.8 24.8 25.7 26.5 24.3 19.7 25.0 24.9 27.1 20.8 20.7 23.4

With moderate or severe pain/discomfort 11.9 14.1 14.5 16.6↑ 9.2↓ 9.5↓ 10.3 9.9↓ 19.0↑ 15.6 13.2 16.9 18.6↑ 14.8 13.5

With participation/activity limitations sometimes/often 29.9 33.6 35.3 34.9 23.3↓ 24.1↓ 30.7 24.5↓ 36.1 37.5↑ 32.5 36.1 37.4↑ 35.8 31.3

Have a regular medical doctor 89.7 93.1 93.1 94.3↑ 93.3 92.5 85.6↓ 91.9 92.3 95.2↑ 87.2↓ 93.9 84.5↓ 82.7↓ 91.0

Received flu shot in the past year 34.0 36.7↑ 25.2↓ 32.2 26.0↓ 24.2↓ 32.5 28.4 29.1 40.7↑ 35.1 32.4 36.8↑ 40.8↑ 31.2

Risk Factors

Are daily or occasional smokers 18.3 17.9 18.9 24.0↑ 12.4↓ 15.6 18.9 15.4 15.9 21.02 17.6 22.8 21.3 23.6↑ 18.0

Are heavy drinkers 19.4 21.5↑ 20.6 16.0 12.4 16.9 24.0↑ 9.3↓ 14.1 18.9 18.1 22.2 21.8↑ 25.2↑ 17.2

Are overweight or obese (age 18+) 59.8↑ 59.9↑ 51.7 55.1 56.1 53.0 42.8↓ 50.7 51.4 60.4↑ 51.3 54.4 62.0↑ 65.2↑ 53.5

Are physically inactive 50.6 48.6 42.5 43.8 53.9↑ 45.4 42.3 46.6 48.0 45.7 43.9 41.6 43.1 40.2 45.6

Consume < 5 servings of fruits/vegetables daily 63.9 60.3 60.6 62.0 59.4 58.9 57.1 60.8 65.2 58.5 59.3 62.8 62.3 64.3 60.8

1 Heavy drinking refers to consuming 5 or more drinks on one occasion (4 for women), at least once a month in the past year. † Estimates with high sampling variability (CV between 16.6 -33.3) - must be used with caution. F - Estimates with CVs greater than 33.3% are too unreliable to be published and have been suppressed due to extreme sampling variability. . Missing data Significance testing: LHINs are compared to Ontario (↑ higher; ↓lower)

134 28 August 2015

135 28 August 2015

Chronic Conditions

Chronic Conditions: Prevalence, mortality, hospital separations and hospital days of stay for selected chronic conditions Notes: This document and the accompanying workbook describe the burden of selected chronic conditions. Analysis is based on data from the Canadian Community Health Survey, the Discharge Abstract Database (acute separations and total acute days), and mortality data from Statistics Canada and the Ontario Registrar General. Analysis is provided for: arthritis (arthritis & related conditions‐in the mortality/hospital analysis), asthma, cancer, congestive heart failure (CHF)‐in the mortality/hospital analysis only, chronic obstructive pulmonary disease (COPD), diabetes, hypertension, heart disease (ischemic heart disease (IHD)‐in the mortality/hospital analysis), and stroke. Prepared June 2015

136 28 August 2015

ONTARIO 37% of Ontario residents (aged 12+) had a chronic condition and 15% had multiple conditions.

The selected chronic conditions accounted for approximately 60% of deaths, 22% of acute hospital separations, and 26% of total acute hospital days.

In 2013, the conditions with the highest prevalence rates were high blood pressure, arthritis, asthma, and diabetes.

Cancer, ischaemic heart disease (IHD), stroke, and chronic obstructive pulmonary disease (COPD) had the highest mortality rates in 2010 & 2011. Among the selected conditions, cancer, arthritis, IHD, congestive heart failure (CHF), and COPD had the highest acute care separation rates in 2013/14. Cancer, IHD, CHF, arthritis, and stroke had the highest rates of total acute days.

Although hospitalization trends vary by condition, acute separation rates increased between 2010/11 and 2013/14 for 3 of 8 conditions (for which time trends were available), while total acute inpatient day rates declined for 5 of 8 conditions. The diagnostic criteria for CHF have changed since the 2012 analysis; therefore time trends are not available for this condition.

Although the prevalence of cancer was only 1.9%, these conditions were a leading cause of mortality, acute care separations and hospital days in the province. Cancer accounted for 7% of total acute hospital days in Ontario.

Heart disease, including IHD and CHF, accounted for 7% of all hospital days and 7% of all acute care separations.

Approximately 8% of Ontario residents had asthma and 4% had COPD. These chronic respiratory conditions accounted for approximately 3% of hospital days.

Over time, the prevalence and acute separation rates for asthma declined. Acute separation and mortality rates for COPD have remained relatively stable, while inpatient days have declined.

Although the prevalence of stroke is relatively low, this condition had among the highest rates of mortality and total acute inpatient days.

Many chronic conditions can be prevented or onset can be delayed. Smoking, misuse of alcohol, excess weight, poor diet and physical inactivity are well established modifiable risk factors for many chronic conditions. Over 80% of COPD, for example, is attributable to smoking and 50% of diabetes is attributable to obesity.

137 28 August 2015

Condition Ontario Range across LHINs Trend‡

Prevalence (2013), rate per 100, age 12+

Arthritis (age 14+) 17.3 (11.1 – 24.9) Asthma 7.5 (4.3 – 9.4) DecreasingCancer 1.9 (1.0 – 3.4)Chronic Obstructive Pulmonary Disease (COPD)

(age 35+) 4.3 (2.6 – 6.0)

Diabetes 6.6 (3.9 – 9.7)High blood pressure 18.3 (14.8 – 24.2) IncreasingHeart disease 4.8 (2.4 – 7.3)Suffer from effects of stroke 1.3 (0.9 – 2.3)

Have a chronic condition 37.3 (31.9 – 48.6) Have multiple chronic conditions1 15.0 (9.1 – 20.7)

† ‐ High sampling variability – estimate must be used with caution 1 ‐ Of the selected conditions on this list

Mortality (2010 & 2011), rate per 100,000

Arthritis & related conditions 2.7 (1.7 – 6.5) DecreasingAsthma 0.7 (0.4 – 1.1) IncreasingCancer 200.8 (125.5 – 281.6) Congestive Heart Failure (CHF) 13.2 (8.9 – 18.2) NACOPD 26.8 (12.7 – 50.4) Diabetes 21.6 (12.1 – 36.6) DecreasingHypertension 7.3 (4.1 – 12.4) IncreasingIschemic Heart Disease (IHD) 99.2 (53.7 – 145.9) DecreasingStroke 29.6 (19.6 – 41.6) Decreasing

Acute Inpatient Hospital Separations (2013/14), rate per 100,000

Arthritis & related conditions 367.4 (255.6 – 590.0) IncreasingAsthma 34.5 (25.2 –56.0) DecreasingCancer 424.7 (354.8 – 627.2) CHF 183.8 (136.8 –278.4) NACOPD 182.4 (92.0 – 393.8) Diabetes 99.3 (66.2 – 228.5) IncreasingHypertension 18.5 (10.1 – 33.5) IncreasingIHD 357.2 (251.1 – 734.2) DecreasingStroke 133.7 (102.6 – 205.2)

Total Acute Inpatient Hospital Days (2013/14), rate per 100,000

Arthritis & related conditions 1,541.7 (1,099.4 – 2,694.1) Asthma 98.2 (67.7 – 136.5) Cancer 3,592.2 (2,685.4 – 6,037.8) DecreasingCHF 1,653.6 (1,180.3 – 3,079.2) NACOPD 1,360.3 (649.3 – 3,357.5) DecreasingDiabetes 892.2 (632.7 – 2,124.6) Hypertension 86.5 (44.6 – 198.5) DecreasingIHD 1,863.4 (1,254.9 – 3,616.6) DecreasingStroke 1,474.8 (1,060.8 – 2,469.0) Decreasing

‡Trends refer to comparison of values shown to analysis provided for the 2012 IHSP. For prevalence, 2013 rates were compared to those from 2009‐2010. For mortality, 2010 & 2011 rates were compared to 2006 & 2007. Acute separations and days from 2013/14 were compared to 2010/11.

138 28 August 2015


In 2013, 42% of Erie St. Clair residents (aged 12+) had a chronic condition and 19% had multiple conditions. Compared with Ontario, Erie St. Clair LHIN had a significantly higher proportion of residents with multiple chronic conditions and this proportion increased since 2009‐2010.

Compared with the province, Erie St. Clair LHIN had a significantly higher prevalence rate for arthritis, while rates were comparable for all other conditions. Among all LHINs, Erie St. Clair residents had the third highest prevalence rate of asthma; however this rate was not significantly different than the provincial average.

The selected chronic conditions accounted for 63% of deaths, 24% of acute separations, and 28% of total acute days for Erie St. Clair LHIN residents.

Erie St. Clair LHIN residents had higher mortality rates than the province for cancer, CHF, COPD, diabetes, hypertension, IHD and stroke. The LHIN had higher acute separation and total acute day rates than the province for all conditions except asthma and hypertension.

Although the prevalence of cancer in Erie St. Clair LHIN was only 1.1%, these conditions were a leading cause of mortality, acute care separations and hospital days. Cancer accounted for 8% of all acute days for LHIN residents in 2013/14. Erie St. Clair LHIN had the second highest acute separation rate and the third highest rate of acute inpatient days for cancer in the province.

Approximately 9% of Erie St. Clair LHIN residents had asthma and 5% had COPD. These chronic respiratory conditions accounted for approximately 4% of total acute days for LHIN residents.

Over time, the prevalence, mortality, acute separation and day rates for COPD increased for Erie St. Clair LHIN residents, while rates for IHD have decreased.

Chronic condition prevalence rates per 100 population aged 12+, Erie St. Clair LHIN, 2013

Condition Erie St. Clair

LHIN Ontario Comment Trend‡

Prevalence (2013), rate per 100, aged 12+

Arthritis (age 14+) 20.7↑ 17.3 DecreasingAsthma 8.5 7.5 3rd highest Increasing Cancer 1.1† 1.9 COPD (age 35+) 5.4† 4.3 IncreasingDiabetes 7.6 6.6 High blood pressure 19.4 18.3 Heart disease 5.3† 4.8 Suffer from effects of stroke 2.3† 1.3 Increasing

Have a chronic condition 41.5 37.3 Have multiple chronic conditions1 18.7↑ 15.0 Increasing

↑ ‐ LHIN result is significantly higher than Ontario; ↓ ‐ LHIN result is significantly lower than Ontario † ‐ High sampling variability – estimate must be used with caution 1 ‐ Of the selected conditions on this list

‡ ‐ 2013 rates were compared to those from 2009‐2010.

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Mortality (2010 & 2011), acute separation and total acute day (2013/14) rates, Erie St. Clair LHIN

Mortality rate per

100,000 Hosp separation rate

per 100,000 Hosp days rate per

100,000 Erie St. Clair LHIN Trends†

Condition ESC LHIN

Ontario ESC LHIN Ontario ESC LHIN Ontario Mortality Seps Days

Arthri s‡ 3.2 2.7 473.3 367.4 1,748.1 1,541.7 Decreasing Increasing Decreasing

Asthma 0.5 0.7 25.2 34.5 75.1 98.2 Decreasing Decreasing Increasing

Cancer 244.0 200.8 510.6 424.7 4,253.2 3,592.2 Increasing Decreasing

CHF 17.5 13.2 209.4 183.8 1,743.0 1,653.6 NA NA NA

COPD 37.5 26.8 266.1 182.4 2,032.4 1,360.3 Increasing Increasing Increasing

Diabetes 23.7 21.6 110.5 99.3 1,095.9 892.2 Decreasing

Hypertension 12.4 7.3 18.0 18.5 75.2 86.5 Increasing Decreasing Decreasing

IHD 129.8 99.2 437.6 357.2 2,464.1 1,863.3 Decreasing Decreasing Decreasing

Stroke 39.2 29.6 173.0 133.7 1,929.7 1,474.8 Decreasing Increasing

‡ includes related condi ons †Trends refer to comparison of values shown to analysis provided for the 2012 IHSP. For mortality, 2010 & 2011 rates were compared to 2006 & 2007. Acute separations and days from 2013/14 were compared to 2010/11.

140 28 August 2015

2. SOUTH WEST LHIN

In 2013, 39% of South West LHIN residents (aged 12+) had a chronic condition and 16% had multiple conditions.

The prevalence of most chronic conditions in South West were similar to provincial rates, however the LHIN had a significantly higher rate of arthritis and a significantly lower rate of cancer compared to Ontario. Among all LHINs, South West had the second highest prevalence of asthma; however this rate was not significantly different from the provincial rate. The prevalence of arthritis and asthma has increased for the South West LHIN since 2009‐2010.

The selected chronic conditions accounted for 61% of deaths, 22% of acute separations, and 26% of total acute days for South West LHIN residents.

South West LHIN had higher mortality rates and total acute day rates than the province for all conditions except asthma. Compared with the province, South West LHIN had higher acute separation rates for all chronic conditions except IHD and asthma.

Although the prevalence of cancer in South West LHIN was only 1%, these conditions were a leading cause of mortality, acute care separations and total acute days. Cancer accounted for 7% of total acute days for South West LHIN residents. Although the rate of total acute hospital days for cancer was higher than provincial average, the rate has decreased over time for South West LHIN residents.

Approximately 9% of LHIN residents had asthma and 5% had COPD. These chronic respiratory conditions accounted for approximately 3% of total acute days among South West LHIN residents.

Chronic condition prevalence rates per 100 population aged 12+, South West LHIN, 2013

Condition South West



Arthritis (age 14+) 20.6↑ 17.3 IncreasingAsthma 9.0 7.5 2nd highest IncreasingCancer 1.0†↓ 1.9

COPD, (age 35+) 4.8 4.3 Diabetes 7.0 6.6 Increasing High blood pressure 17.5 18.3 DecreasingHeart disease 4.7 4.8 DecreasingSuffer from effects of stroke F 1.3

Have a chronic condition 39.0 37.3

Have multiple chronic conditions1 15.6 15.0

↑ ‐ LHIN result is significantly higher than Ontario; ↓ ‐ LHIN result is significantly lower than Ontario † ‐ High sampling variability – estimate must be used with caution 1 ‐ Of the selected conditions on this list F ‐ Estimates with CVs greater than 33.3% are too unreliable to be published and have been suppressed due to extreme sampling variability


141 28 August 2015

Mortality (2010 & 2011), acute separation and total acute day (2013/14) rates, South West LHIN

Mortality rate per 100,000

Hosp separation rate per 100,000

Hosp days rate per 100,000

South West LHIN Trends†

Condition SW LHIN

Ontario SW LHIN Ontario SW LHIN Ontario Mortality Seps Days


Asthma 0.5 0.7 27.9 34.5 85.8 98.2 Decreasing Decreasing

Cancer 231.6 200.8 483.2 424.7 4,012.1 3,592.2 Decreasing

CHF 16.8 13.2 215.4 183.8 1,855.2 1,653.6 NA NA NA

COPD 34.8 26.8 220.3 182.4 1,601.7 1,360.3

Diabetes 24.6 21.6 116.7 99.3 1,037.0 892.2 Decreasing Increasing Increasing

Hypertension 8.6 7.3 21.9 18.5 120.4 86.5 Increasing Increasing Increasing


Stroke 35.7 29.6 152.7 133.7 1,515.6 1,474.8 Decreasing


142 28 August 2015


In 2013, 35% of Waterloo Wellington residents (aged 12+) had a chronic condition and 12% had multiple conditions. Waterloo Wellington LHIN had the third lowest rate of residents with multiple chronic conditions among all LHINs.

Waterloo Wellington LHIN had the lowest prevalence of high blood pressure in the province and this rate was significantly lower than the provincial average. Rates for all other conditions were comparable to Ontario rates. Since 2009‐2010, the prevalence of arthritis and heart disease increased and the prevalence of high blood pressure and asthma decreased for Waterloo Wellington LHIN residents.

The selected chronic conditions accounted for 61% of deaths, 20% of acute separations, and 26% of total acute days for Waterloo Wellington LHIN residents.

Mortality rates for all chronic conditions, except stroke, were comparable to or lower than provincial rates. Acute separation rates for Waterloo Wellington LHIN were lower than or comparable to the provincial rates for all conditions except stroke. Waterloo Wellington LHIN had lower total acute day rates than the province for all the selected chronic conditions.

Although the prevalence of cancer in Waterloo Wellington LHIN was only 1.5%, these conditions were a leading cause of mortality, acute separations and total acute days. Cancer accounted for 8% of all acute hospital days for LHIN residents.

Approximately 7% of Waterloo Wellington LHIN residents had asthma and 5% had COPD. These chronic respiratory conditions accounted for approximately 3% of total acute hospital days for Waterloo Wellington LHIN residents.

Chronic condition prevalence rates per 100 population aged 12+, Waterloo Wellington LHIN, 2013

Condition Waterloo Wellington



Arthritis (age 14+) 16.0 17.3 IncreasingAsthma 7.1 7.5 Decreasing Cancer 1.5† 1.9 COPD (age 35+) 4.6† 4.3 IncreasingDiabetes 6.9† 6.6 High blood pressure 14.8↓ 18.3 Lowest DecreasingHeart disease 5.1† 4.8 Increasing Suffer from effects of stroke 0.9† 1.3

Have a chronic condition 34.5 37.3 Have multiple chronic conditions1 12.3 15.0 3rd lowest Decreasing



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Mortality (2010 & 2011), acute separation and total acute day (2013/14) rates, Waterloo Wellington LHIN

Mortality rate per



100,000 Waterloo Wellington LHIN Trends†

Condition WW LHIN

Ontario WW LHIN Ontario WW LHIN Ontario Mortality Seps Days

Arthri s‡ 2.9 2.7 337.4 367.4 1,422.3 1,541.7 Decreasing Increasing

Asthma 0.9 0.7 35.8 34.5 91.6 98.2 Increasing Increasing Increasing

Cancer 185.0 200.8 354.8 424.7 3,109.3 3,592.2 Decreasing Decreasing

CHF 12.2 13.2 150.2 183.8 1,234.3 1,653.6 NA NA NA

COPD 22.8 26.8 160.9 182.4 1,024.5 1,360.3 Increasing Decreasing

Diabetes 21.8 21.6 90.9 99.3 635.7 892.2 Decreasing

Hypertension 4.5 7.3 10.1 18.5 44.6 86.5 Increasing Decreasing

IHD 85.9 99.2 259.3 357.2 1,424.4 1,863.3 Decreasing

Stroke 34.7 29.6 146.9 133.7 1,060.8 1,474.8 Increasing Increasing Decreasing


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4. HAMILTON NIAGARA HALDIMAND BRANT LHIN

In 2013, 39% of HNHB LHIN residents (aged 12+) had a chronic condition and 18% had multiple conditions. HNHB LHIN had a significantly higher proportion of residents with multiple conditions compared to Ontario and this proportion has increased since 2009‐2010.

Compared with the province, HNHB LHIN residents had a significantly higher prevalence of arthritis, with 1 in 5 residents affected. HNHB LHIN also had the highest prevalence of COPD among all LHINs; however this rate was not significantly different from the provincial average.

Since 2009‐2010, the prevalence rates have increased for COPD, diabetes, and high blood pressure in HNHB LHIN.

The selected chronic conditions accounted for 62% of deaths, 23% of acute separations, and 26% of total acute days for HNHB LHIN residents.

Compared with Ontario, HNHB LHIN residents had higher mortality rates for all selected chronic conditions except asthma; the mortality rate for hypertension was comparable to the provincial average. HNHB LHIN also had higher acute separation and total acute day rates than the province for all conditions except asthma.

Although the prevalence of cancer in HNHB LHIN was only 1.5%, these conditions were a leading cause of mortality, acute care separations and total acute hospital days. Cancer accounted for 7% of all acute hospital days for HNHB LHIN residents.

Approximately 8% of HNHB LHIN residents had asthma and 6% had COPD. These chronic respiratory conditions accounted for approximately 3% of total acute days for LHIN residents.

Mortality rates for arthritis increased while rates for IHD decreased for HNHB LHIN residents since 2006 & 2007. Acute separation and day rates for asthma among HNHB LHIN residents have declined since 2010/11.

Chronic condition prevalence rates per 100 population aged 12+, HNHB LHIN, 2013 Condition HNHB LHIN Ontario Comment Trend‡


Arthritis (age 14+) 20.6↑ 17.3 Asthma 8.1 7.5 DecreasingCancer 1.5† 1.9 COPD (age 35+) 6.0 4.3 Highest IncreasingDiabetes 7.8 6.6 Increasing High blood pressure 20.7 18.3 Increasing Heart disease 5.1 4.8 Decreasing Suffer from effects of stroke 1.5† 1.3

Have a chronic condition 39.3 37.3 Have multiple chronic conditions1 18.3↑ 15.0 Increasing



145 28 August 2015

Mortality (2010 & 2011), acute separation and total acute day (2013/14) rates, HNHB LHIN




HNHB LHIN Trends†

Condition HNHB LHIN

Ontario HNHB LHIN

Ontario HNHB LHIN

Ontario Mortality Seps Days

Arthri s‡ 4.0 2.7 439.2 367.4 1,948.0 1,541.7 Increasing Increasing Decreasing

Asthma 0.6 0.7 34.1 34.5 88.3 98.2 Decreasing Decreasing Decreasing

Cancer 243.0 200.8 426.3 424.7 3,852.1 3,592.2

CHF 15.9 13.2 235.7 183.8 2,112.7 1,653.6 NA NA NA

COPD 32.3 26.8 210.4 182.4 1,672.0 1,360.3



IHD 134.3 99.2 415.3 357.2 2,387.4 1,863.3 Decreasing

Stroke 38.0 29.6 158.6 133.7 1,722.0 1,474.8 Decreasing Decreasing


146 28 August 2015


In 2013, Central West LHIN had a significantly lower proportion (32%) of residents (aged 12+) with a chronic condition and this was the third lowest proportion among all LHINs. 12% of Central West LHIN residents had multiple conditions and this was the second lowest proportion among all LHINs. The proportion of Central West LHIN residents with chronic conditions and with multiple conditions has declined since 2009‐2010.

Compared to the province, Central West LHIN had a significantly lower prevalence of arthritis and heart disease. Among all LHINs, Central West LHIN residents had the lowest prevalence of heart disease, the second lowest prevalence of arthritis, and the third lowest prevalence of asthma.

Over time, the prevalence of COPD among Central West LHIN residents increased, while the prevalence rates of arthritis, asthma, high blood pressure, and heart disease declined.

Chronic conditions accounted for 58% of deaths, 19% of acute separations, and 25% of total acute days for Central West LHIN residents.

IHD, CHF, and stroke accounted for 10% of all total acute hospital days and 7% of all acute care separations for Central West LHIN residents.

For most of the selected chronic conditions, Central West LHIN had consistently lower mortality, acute separation, and total acute day rates than Ontario. In comparison to other LHINs, Central West LHIN had the highest rates of acute separations and acute hospital days for asthma. Note that the prevalence data may underestimate the true population prevalence of asthma, since the CCHS is limited to respondents aged 12 and older.

Over time, acute separation and total acute day rates for Central West LHIN residents increased for cancer and diabetes and decreased for asthma and hypertension.

Chronic condition prevalence rates per 100 population aged 12+, Central West LHIN, 2013

Condition Central West



Arthritis (age 14+) 12.9↓ 17.3 2nd lowest DecreasingAsthma 6.5† 7.5 3rd lowest DecreasingCancer F 1.9 COPD (age 35+) 4.4† 4.3 Increasing Diabetes 7.2 6.6 High blood pressure 16.9 18.3 DecreasingHeart disease 2.4†↓ 4.8 Lowest DecreasingSuffer from effects of stroke F 1.3

Have a chronic condition 32.4↓ 37.3 3rd lowest Decreasing Have multiple chronic conditions1 12.1 15.0 2nd lowest Decreasing



147 28 August 2015

Mortality (2010 & 2011), acute separation and total acute day (2013/14) rates, Central West LHIN




Central West LHIN Trends†

Condition CW LHIN

Ontario CW LHIN Ontario CW LHIN Ontario Mortality Seps Days



Cancer 125.5 200.8 363.6 424.7 2,685.4 3,592.2 Increasing Increasing

CHF 10.2 13.2 136.8 183.8 1,180.3 1,653.6 NA NA NA

COPD 13.3 26.8 99.5 182.4 649.3 1,360.3 Increasing Decreasing

Diabetes 13.0 21.6 90.1 99.3 851.4 892.2 Decreasing Increasing Increasing

Hypertension 4.1 7.3 18.4 18.5 81.4 86.5 Increasing Decreasing Decreasing

IHD 58.7 99.2 358.4 357.2 1,646.3 1,863.3 Increasing

Stroke 20.7 29.6 102.6 133.7 1,132.0 1,474.8


148 28 August 2015


In 2013, 39% of Mississauga Halton LHIN residents (aged 12+) had a chronic condition and 15% had multiple conditions. The prevalence of chronic conditions and multiple conditions have increased for Mississauga Halton LHIN residents since 2009‐2010.

The prevalence rates for the selected chronic conditions for Mississauga Halton LHIN residents were comparable to the provincial average. Among all LHINs, Mississauga Halton residents had the third lowest prevalence rates for arthritis and COPD.

The prevalence of arthritis, diabetes, high blood pressure, and heart disease increased for Mississauga Halton LHIN residents since 2009‐2010.

The selected chronic conditions accounted for 59% of deaths, 20% of acute separations, and 26% of total acute days for Mississauga Halton LHIN residents.

Compared with Ontario, Mississauga Halton LHIN had lower mortality, acute separation and total acute day rates for all the selected chronic conditions. Mississauga Halton had among the lowest acute separation and day rates for these conditions among all LHINs.

Since 2010/11, the acute separation and day rates for Mississauga Halton LHIN residents increased for cancer, diabetes, and hypertension and decreased for asthma.

Chronic condition prevalence rates per 100 population aged 12+, Mississauga Halton LHIN, 2013

Condition Mississauga Halton LHIN

Ontario Comment Trend‡


Arthritis (age 14+) 14.0 17.3 3rd lowest IncreasingAsthma 7.7 7.5 Cancer 1.2† 1.9 COPD (age 35+) 2.9† 4.3 3rd lowest DecreasingDiabetes 8.4† 6.6 IncreasingHigh blood pressure 21.7 18.3 Increasing Heart disease 5.6† 4.8 Increasing Suffer from effects of stroke F 1.3

Have a chronic condition 39.3 37.3 IncreasingHave multiple chronic conditions1 15.2 15.0 Increasing



149 28 August 2015

Mortality (2010 & 2011), acute separation and total acute day (2013/14) rates, Mississauga Halton LHIN

Mortality rate per



100,000 MH LHIN Trends†

Condition MH LHIN

Ontario MH LHIN Ontario MH LHIN Ontario Mortality Seps Days



Cancer 146.7 200.8 364.8 424.7 3,198.0 3,592.2 Increasing Increasing

CHF 8.9 13.2 138.7 183.8 1,336.5 1,653.6 NA NA NA

COPD 12.7 26.8 98.7 182.4 784.0 1,360.3 Decreasing

Diabetes 13.6 21.6 66.2 99.3 655.4 892.2 Increasing Increasing


IHD 53.7 99.2 269.1 357.2 1,327.6 1,863.3 Decreasing Increasing Decreasing

Stroke 19.6 29.6 103.5 133.7 1,310.1 1,474.8


150 28 August 2015


In 2013, 32% of Toronto Central LHIN residents (aged 12+) had a chronic condition, and this proportion was the second lowest among all LHINs. 13% of Toronto Central LHIN residents had multiple conditions.

Compared to Ontario, Toronto Central LHIN residents had a significantly lower prevalence of diabetes. Toronto Central LHIN residents had among the lowest prevalence rates for asthma, COPD, and high blood pressure across all LHINs; however these rates were not significantly different from the provincial average.

The prevalence of diabetes and asthma decreased, while the prevalence of high blood pressure increased among Toronto Central LHIN residents since 2009‐2010.

The selected chronic conditions accounted for 56% of all deaths, which was the lowest proportion among all the LHINs. These conditions also accounted for 19% of acute hospital separations, and 25% of all total acute hospital days for Toronto Central LHIN residents.

Toronto Central had slightly higher day rates than the province for stroke, but had comparable or lower rates of mortality, acute separations, and total acute days for all other selected chronic conditions.

Toronto Central LHIN had the lowest rates of IHD acute separations and total acute days within the province.

Over time, mortality rates for arthritis, asthma, diabetes and IHD for Toronto Central LHIN residents have declined. Acute separation and total acute day rates for stroke, IHD and COPD have also declined for LHIN residents compared to 2010/11.

Chronic condition prevalence rates per 100 population aged 12+, Toronto Central LHIN, 2013

Condition Toronto

Central LHIN Ontario Comment Trend‡


Arthritis (age 14+) 15.1 17.3 Asthma 6.4 7.5 2nd lowest DecreasingCancer F 1.9 COPD (age 35+) 2.7† 4.3 2nd lowest Diabetes 3.9†↓ 6.6 Lowest Decreasing High blood pressure 15.4 18.3 3rd lowest Increasing Heart disease 5.0† 4.8 Suffer from effects of stroke F 1.3

Have a chronic condition 32.1↓ 37.3 2nd lowest Have multiple chronic conditions1 13.2 15.0



151 28 August 2015

Mortality (2010 & 2011), acute separation and total acute day (2013/14) rates, Toronto Central LHIN




Toronto Central LHIN Trends†

Condition TC LHIN

Ontario TC LHIN Ontario TC LHIN Ontario Mortality Seps Days


Asthma 0.7 0.7 35.1 34.5 100.4 98.2 Decreasing

Cancer 175.7 200.8 405.4 424.7 3,433.6 3,592.2

CHF 12.1 13.2 175.1 183.8 1,647.4 1,653.6 NA NA NA

COPD 19.3 26.8 126.9 182.4 888.5 1,360.3 Decreasing Decreasing

Diabetes 15.6 21.6 82.7 99.3 800.3 892.2 Decreasing Increasing

Hypertension 7.2 7.3 19.1 18.5 85.3 86.5 Increasing Increasing Decreasing

IHD 84.9 99.2 251.1 357.2 1,254.9 1,863.3 Decreasing Decreasing

Stroke 24.2 29.6 110.1 133.7 1,511.2 1,474.8 Decreasing Decreasing Decreasing


152 28 August 2015

8. CENTRAL LHIN

In 2013, 32% of Central LHIN residents (aged 12+) had a chronic condition and 9% had multiple conditions. These rates were the lowest among all LHINs and were significantly lower than the provincial rates. The prevalence of multiple chronic conditions among Central LHIN residents has declined since 2009‐2010.

The prevalence of arthritis and asthma was also significantly lower in Central LHIN compared to the province. Among all LHINs, Central LHIN residents had among the lowest prevalence rate of arthritis, COPD, and diabetes. The prevalence rates of arthritis, asthma, diabetes, and heart disease have declined since 2009‐2010, while the rates of high blood pressure increased.

The selected chronic conditions accounted for 58% of deaths, 20% of acute separations, and 26% of total acute days for Central LHIN residents.

Compared with Ontario, Central LHIN had comparable or lower mortality, acute separation, and total acute day rates for all selected chronic conditions

Over time, Central LHIN residents’ mortality rates for diabetes, IHD, and stroke decreased while the COPD rate and hypertension rate increased.

Chronic condition prevalence rates per 100 population aged 12+, Central LHIN, 2013

Condition Central LHIN Ontario Comment Trend‡


Arthritis (age 14+) 11.1↓ 17.3 Lowest DecreasingAsthma 4.3†↓ 7.5 Lowest DecreasingCancer F 1.9 COPD (age 35+) 2.6† 4.3 Lowest Diabetes 5.0 6.6 2nd lowest DecreasingHigh blood pressure 17.1 18.3 IncreasingHeart disease 3.8† 4.8 2nd lowest DecreasingSuffer from effects of stroke 1.2† 1.3

Have a chronic condition 31.9↓ 37.3 Lowest Have multiple chronic conditions1 9.1↓ 15.0 Lowest Decreasing



153 28 August 2015

Mortality (2010 & 2011), acute separation and total acute day (2013/14) rates, Central LHIN




Central LHIN Trends†

Condition Central LHIN

Ontario Central LHIN

Ontario Central LHIN



Asthma 0.7 0.7 31.9 34.5 100.0 98.2 Increasing

Cancer 143.8 200.8 403.7 424.7 3,165.5 3,592.2

CHF 10.3 13.2 151.9 183.8 1,355.3 1,653.6 NA NA NA

COPD 14.4 26.8 92.0 182.4 672.0 1,360.3 Increasing Increasing Decreasing

Diabetes 12.1 21.6 66.2 99.3 632.7 892.2 Decreasing Increasing Increasing

Hypertension 5.3 7.3 16.0 18.5 70.3 86.5 Increasing Increasing




154 28 August 2015


In 2013, 40% of Central East residents (aged 12+) had a chronic condition and 17% had multiple conditions. The proportion of Central East LHIN residents with a chronic condition has increased since 2009‐2010.

The prevalence of chronic conditions in Central East was similar to provincial rates in 2013. Among all LHINs, Central East LHIN residents had the 3rd lowest prevalence rates of diabetes and heart disease. Since 2009‐2010, the prevalence rate for arthritis increased, while rates of COPD, diabetes, and heart disease have declined.

The selected chronic conditions accounted for 59% of deaths, 22% of acute separations, and 25% of total acute hospital days for Central East LHIN residents.

Compared with Ontario, Central East LHIN residents had comparable or lower mortality rates for all selected chronic conditions. Central East LHIN had higher acute separation rates than the province for asthma and IHD, and had a higher total acute day rate for asthma.

Although the prevalence of cancer in the LHIN was approximately 3%, these conditions were a leading cause of mortality, acute care separations and total acute hospital days. Cancers accounted for 5% of all hospitalizations and 7% of all total acute hospital days for Central East LHIN residents.

Approximately 8% of LHIN residents had asthma and 4% had COPD. These chronic respiratory conditions accounted for approximately 3% of total acute hospital days among Central East LHIN residents.

Over time, Central East LHIN residents’ mortality and acute separation rates and day rates for hypertension and asthma have increased, while rates for IHD have decreased.

Chronic condition prevalence rates per 100 population aged 12+, Central East LHIN, 2013

Condition Central East



Arthritis (age 14+) 20.4 17.3 IncreasingAsthma 8.3 7.5 Cancer 3.4† 1.9 COPD, (age 35+) 4.1 4.3 DecreasingDiabetes 5.8 6.6 3rd lowest Decreasing High blood pressure 17.9 18.3 Heart disease 4.3 4.8 3rd lowest DecreasingSuffer from effects of stroke 1.0† 1.3

Have a chronic condition 40.1 37.3 IncreasingHave multiple chronic conditions1 16.5 15.0



155 28 August 2015

Mortality (2010 & 2011), acute separation and total acute day (2013/14) rates, Central East LHIN

Mortality rate per



100,000 Central East LHIN Trends†

Condition CE LHIN Ontario CE LHIN Ontario CE LHIN Ontario Mortality Seps Days

Arthritis‡ 2.1 2.7 358.3 367.4 1,424.8 1,541.7 Decreasing Increasing

Asthma 0.9 0.7 41.4 34.5 109.8 98.2 Increasing Increasing Increasing

Cancer 190.3 200.8 402.7 424.7 3,205.7 3,592.2

CHF 11.3 13.2 174.7 183.8 1,447.8 1,653.6 NA NA NA


Diabetes 20.2 21.6 94.6 99.3 819.7 892.2 Decreasing Increasing Decreasing



Stroke 27.3 29.6 127.5 133.7 1,446.8 1,474.8 Decreasing


156 28 August 2015

10. SOUTH EAST LHIN

In 2013, 49% of South East LHIN residents (aged 12+) had a chronic condition and 20% had multiple conditions; these rates were significantly higher than Ontario rates. Among all LHINs, South East LHIN had the highest rate of residents with a chronic condition and the third highest rate with multiple conditions. In addition, both of these rates have increased since 2009‐2010.

Compared with Ontario, South East LHIN residents had significantly higher prevalence rates for arthritis, diabetes, and high blood pressure and these rates. Among all LHINs, South East had among the highest prevalence rates for arthritis, diabetes, high blood pressure, and heart disease. Since 2009‐2010 rates have increased for arthritis, COPD, diabetes, and high blood pressure.

Chronic conditions accounted for 62% of deaths, 25% of acute separations, and 27% of total acute days for South East LHIN residents.

Compared with Ontario, South East LHIN had higher mortality rates and higher acute separation rates for all selected chronic conditions except asthma. South East LHIN also had higher total acute day rates than the province for all conditions.

Although the prevalence of cancer among South East LHIN residents is only 1.9%, these conditions were a leading cause of mortality, and accounted for 7% of all total acute hospital days for LHIN residents.

IHD, CHF, and stroke accounted for 11% of total acute days and 9% of all acute care separations.

Approximately 8% of South East LHIN residents had asthma and 6% had COPD. These chronic respiratory conditions accounted for approximately 3% of hospital days among LHIN residents.

Over time, mortality rates for South East LHIN residents have increased for arthritis, COPD, diabetes, and hypertension, while rates have decreased for asthma, IHD and stroke. Between 2010/11 and 2013/14, South East LHIN residents’ acute separations and day rates increased for diabetes, and decreased for asthma, IHD and COPD.

Chronic condition prevalence rates per 100 population aged 12+, South East LHIN, 2013

Condition South East



Arthritis (age 14+) 24.9↑ 17.3 Highest IncreasingAsthma 8.1 7.5 DecreasingCancer 1.9† 1.9 COPD (age 35+) 5.8† 4.3 2nd highest Increasing Diabetes 9.5↑ 6.6 2nd highest Increasing High blood pressure 22.9↑ 18.3 2nd highest IncreasingHeart disease 6.3 4.8 3rd highest Suffer from effects of stroke 1.8† 1.3

Have a chronic condition 48.6↑ 37.3 Highest IncreasingHave multiple chronic conditions1 20.0↑ 15.0 3rd highest Increasing



157 28 August 2015

Mortality (2010 & 2011), acute separation and total acute day (2013/14) rates, South East LHIN




South East LHIN Trends†

Condition SE LHIN Ontario SE LHIN Ontario SE LHIN Ontario Mortality Seps Days




CHF 16.1 13.2 217.3 183.8 1,663.7 1,653.6 NA NA NA

COPD 50.4 26.8 283.0 182.4 1,886.9 1,360.3 Increasing Decreasing Decreasing

Diabetes 36.0 21.6 121.8 99.3 1,084.7 892.2 Increasing Increasing Increasing

Hypertension 11.0 7.3 19.5 18.5 107.5 86.5 Increasing Decreasing Increasing


Stroke 41.6 29.6 181.7 133.7 1,843.9 1,474.8 Decreasing Increasing Decreasing


158 28 August 2015

11. CHAMPLAIN LHIN

In 2013, 35% of Champlain residents (aged 12+) had a chronic condition and 15% had multiple chronic conditions. The proportion of Champlain LHIN residents with a chronic condition has decreased since 2009‐2010.

The prevalence of most chronic conditions in Champlain LHIN was similar to provincial rates. Champlain LHIN had the highest prevalence of asthma among all LHINs but had the second lowest prevalence of high blood pressure. Prevalence rates of arthritis, asthma, and diabetes among Champlain LHIN residents have decreased since 2009‐2010.

The selected chronic conditions accounted for 61% of deaths, 21% of acute separations, and 26% of total acute days for Champlain LHIN residents.

Compared with Ontario, Champlain LHIN residents had lower or comparable mortality rates for all selected chronic conditions. Champlain LHIN residents also had lower or comparable acute separation rates than Ontario for all conditions except arthritis and COPD. LHIN residents had higher total acute day rates than the province for arthritis, CHF, COPD, and IHD but had lower or comparable rates for all other conditions.

Champlain LHIN had the second lowest rate of acute separations for asthma and hypertension, and the third lowest rate for stroke.

Although the prevalence of cancer among Champlain LHIN residents was only 2.1%, these conditions were a leading cause of mortality, acute separations, and days. Cancers accounted for 7% of all acute hospital days for Champlain LHIN residents.

Approximately 9% of Champlain LHIN residents had asthma and 4% had COPD. These chronic respiratory conditions accounted for approximately 3% of total acute hospital days among LHIN residents.

Over time, mortality rates for Champlain residents decreased for arthritis, IHD, and stroke and increased for hypertension, diabetes, COPD, and asthma. Champlain LHIN residents’ rates of acute separations and total acute days had increased compared to 2010/11 for hypertension and arthritis.

Chronic condition prevalence rates per 100 population aged 12+, Champlain LHIN, 2013

Condition Champlain



Arthritis (age 14+) 16.3 17.3 DecreasingAsthma 9.4 7.5 Highest DecreasingCancer 2.1† 1.9 COPD (age 35+) 4.0† 4.3 Diabetes 5.9 6.6 Decreasing High blood pressure 15.2 18.3 2nd lowest Heart disease 4.6 4.8 IncreasingSuffer from effects of stroke 0.9† 1.3

Have a chronic condition 34.5 37.3 DecreasingHave multiple chronic conditions1 14.8 15.0



159 28 August 2015

Mortality (2010 & 2011), acute separation and total acute day (2013/14) rates, Champlain LHIN




Champlain LHIN Trends†

Condition Champlain

LHIN Ontario

Champlain LHIN

OntarioChamplain

LHIN Ontario Mortality Seps Days

Arthri s‡ 2.4 2.7 397.8 367.4 1,651.6 1,541.7 Decreasing Increasing Increasing

Asthma 0.6 0.7 26.4 34.5 95.9 98.2 Increasing Decreasing

Cancer 200.7 200.8 383.2 424.7 3,501.9 3,592.2 Decreasing Decreasing

CHF 12.1 13.2 170.4 183.8 1,753.7 1,653.6 NA NA NA


Diabetes 19.2 21.6 87.4 99.3 821.2 892.2 Increasing Decreasing



Stroke 26.2 29.6 106.6 133.7 1,249.7 1,474.8 Decreasing Decreasing Decreasing


160 28 August 2015


In 2013, 44% of North Simcoe Muskoka residents (aged 12+) had a chronic condition. This rate was significantly higher than the provincial average and was the second highest rate among all the LHINs. 18% of North Simcoe Muskoka LHIN residents had multiple conditions. The rate of multiple chronic conditions increased for North Simcoe Muskoka LHIN residents compared to 2009‐2010.

The proportion of residents with high blood pressure was significantly higher among North Simcoe Muskoka LHIN residents compared to Ontario. North Simcoe Muskoka LHIN residents had the highest prevalence of high blood pressure in the province and this rate has increased over time.

The selected chronic conditions accounted for 62% of deaths, 24% of acute separations, and 26% of total acute days for North Simcoe Muskoka LHIN residents.

Compared with Ontario, North Simcoe Muskoka LHIN residents had higher mortality rates for cancer, COPD, diabetes, IHD and stroke. North Simcoe Muskoka LHIN residents had higher acute separation rates than the province for arthritis, cancer, COPD, diabetes, IHD, and stroke. LHIN residents also had higher total acute day rates than the province for arthritis, COPD, diabetes and IHD.

Although the prevalence of cancer in North Simcoe Muskoka LHIN was only 2%, these conditions were a leading cause of mortality and accounted for 7% of all acute hospital days for LHIN residents.

IHD, CHF, and stroke accounted for 11% of all total acute days and 9% of all acute care separations.

Among all LHINs, North Simcoe Muskoka LHIN had among the lowest rates of acute separations and total acute days for asthma.

Over time, mortality rates for arthritis, diabetes, hypertension, IHD, and stroke declined for North Simcoe Muskoka LHIN residents. Acute separation and total acute day rates decreased for asthma, COPD, hypertension, and IHD between 2010/11 and 2013/14.

Chronic condition prevalence rates per 100 population aged 12+, North Simcoe Muskoka LHIN, 2013

Condition North Simcoe Muskoka LHIN

Ontario Comment Trend‡


Arthritis (age 14+) 20.0 17.3 Asthma 7.9† 7.5 DecreasingCancer 2.0† 1.9 COPD (age 35+) 4.3† 4.3 DecreasingDiabetes 6.1† 6.6 Increasing High blood pressure 24.2↑ 18.3 Highest Increasing Heart disease 5.7† 4.8 Suffer from effects of stroke F 1.3

Have a chronic condition 43.5↑ 37.3 2nd highest Have multiple chronic conditions1 18.3 15.0 Increasing



161 28 August 2015

Mortality (2010 & 2011), acute separation and total acute day (2013/14) rates, North Simcoe Muskoka LHIN




NSM LHIN Trends†

Condition NSM LHIN

Ontario NSM LHIN Ontario NSM LHIN Ontario Mortality Seps Days


Asthma 1.1 0.7 27.4 34.5 67.7 98.2 Increasing Decreasing Decreasing


CHF 12.6 13.2 188.8 183.8 1,687.8 1,653.6 NA NA NA

COPD 37.7 26.8 248.8 182.4 1,880.2 1,360.3 Decreasing Decreasing

Diabetes 27.1 21.6 123.0 99.3 1,014.7 892.2 Decreasing Increasing

Hypertension 7.5 7.3 18.0 18.5 79.3 86.5 Decreasing Decreasing Decreasing




162 28 August 2015

13. NORTH EAST LHIN

In 2013, 43% of North East LHIN residents (aged 12+) had a chronic condition and 21% had multiple conditions, and these rates were significantly higher than the provincial rates. North East LHIN residents had the highest prevalence of multiple chronic conditions among all LHINs.

Compared with Ontario, North East LHIN residents had significantly higher prevalence rates for arthritis and heart disease. North East LHIN residents had among the highest prevalence rates in the province for heart disease, arthritis, COPD, and diabetes. The prevalence rate for COPD and asthma declined, while the rate of diabetes increased since 2009‐2010.

The selected chronic conditions accounted for 62% of deaths, 25% of acute separations, and 27% of total acute days for North East LHIN residents.

Compared with Ontario, North East LHIN residents had higher mortality rates for all selected chronic conditions except asthma. North East LHIN residents had higher acute separation and day rates than the province for all conditions. North East LHIN residents had among the highest rates of acute care separations and total acute days in the province for all conditions. North East LHIN residents’ acute separation rates were more than twice the provincial average for IHD and COPD and just under twice the provincial average for diabetes and hypertension. The total acute day rate for residents was approximately 2.5 times the provincial average for COPD and nearly twice the provincial rate for IHD and hypertension.

IHD, CHF, and stroke accounted for 10% of all total acute days and 10% of all acute care separations.

Over time, mortality rates for North East LHIN residents decreased for IHD and increased for asthma, COPD, hypertension, and stroke. Compared to 2010/11 total acute day rates decreased for all conditions.

Chronic condition prevalence rates per 100 population aged 12+, North East LHIN, 2013

Condition North East



Arthritis (age 14+) 23.6↑ 17.3 2nd highest Asthma 8.2 7.5 DecreasingCancer 2.8† 1.9 COPD (age 35+) 5.8 4.3 3rd highest DecreasingDiabetes 8.7 6.6 3rd highest IncreasingHigh blood pressure 21.6 18.3 Heart disease 7.3↑ 4.8 Highest Suffer from effects of stroke 1.3† 1.3

Have a chronic condition 43.1↑ 37.3 3rd highest Have multiple chronic conditions1 20.7↑ 15.0 Highest



163 28 August 2015

Mortality (2010 & 2011), acute separation and total acute day (2013/14) rates, North East LHIN




North East LHIN Trends†

Condition NE LHIN

Ontario NE LHIN Ontario NE LHIN Ontario Mortality Seps Days

Arthri s‡ 4.1 2.7 590.0 367.4 2,555.1 1,541.7 Decreasing

Asthma 0.7 0.7 41.8 34.5 127.2 98.2 Increasing Decreasing Decreasing


CHF 18.2 13.2 268.1 183.8 2,531.8 1,653.6 NA NA NA

COPD 48.2 26.8 393.8 182.4 3,357.5 1,360.3 Increasing Increasing Decreasing




Stroke 36.7 29.6 200.0 133.7 2,098.1 1,474.8 Increasing Decreasing


164 28 August 2015

14. NORTH WEST LHIN

In 2013, 43% of North West LHIN residents (aged 12+) had a chronic condition and 20% had multiple conditions and these rates were significantly higher than the provincial average. North West LHIN had among the highest prevalence rates in the province for chronic and multiple conditions; the rate of multiple chronic conditions increased compared to 2009‐2010.

North West LHIN residents had significantly higher prevalence of high blood pressure relative to the province. Among all LHINs, North West LHIN had among the highest prevalence rates for arthritis, diabetes, high blood pressure, and heart disease.

Chronic conditions accounted for 61% of deaths, 22% of acute separations, and 26% of total acute days for North West LHIN residents.

Compared with Ontario, North West LHIN had higher mortality rates for all selected chronic conditions except hypertension. LHIN residents also had higher acute separation rates than the province for all conditions except asthma and had higher total acute day rates than the province for all conditions.

North West LHIN had the highest mortality rate in the province for arthritis and this rate was 2.4 times the provincial average.

North West LHIN had the highest rate of acute separations in the province for CHF, diabetes, and stroke. Acute separation rates for North West LHIN residents were more than twice the provincial average for COPD and diabetes. Similarly the total acute day rates for residents were more than twice the provincial average for COPD, diabetes, and hypertension.

Over time, North West LHIN residents’ mortality rates increased for cancer, COPD, diabetes and decreased for hypertension and stroke. There was a reduction in hospital separation and day rates for IHD in 2013/14 compared to 2010/11.

Chronic condition prevalence rates per 100 population aged 12+, North West LHIN, 2013

Condition North West



Arthritis (age 14+) 21.1 17.3 3rd highest DecreasingAsthma 8.4 7.5 Increasing Cancer F 1.9 COPD (age 35+) 5.6† 4.3 DecreasingDiabetes 9.7 6.6 Highest IncreasingHigh blood pressure 22.6↑ 18.3 3rd highest IncreasingHeart disease 6.5 4.8 2nd highest Suffer from effects of stroke 1.9† 1.3 2nd highest

Have a chronic condition 43.1↑ 37.3 3rd highest Have multiple chronic conditions1 20.1↑ 15.0 2nd highest Increasing



165 28 August 2015

Mortality (2010 & 2011), acute separation and total acute day (2013/14) rates, North West LHIN




North West LHIN Trends†

Condition NW LHIN

Ontario NW LHIN

Ontario NW LHIN


Arthri s‡ 6.5 2.7 514.5 367.4 2,694.1 1,541.7 Increasing

Asthma suppr 0.7 32.6 34.5 104.9 98.2 Decreasing

Cancer 254.4 200.8 478.6 424.7 5,445.8 3,592.2 Increasing

CHF 16.5 13.2 278.4 183.8 3,079.2 1,653.6 NA NA NA

COPD 42.9 26.8 371.1 182.4 3,256.9 1,360.3 Increasing Decreasing Increasing

Diabetes 36.2 21.6 228.5 99.3 2,124.6 892.2 Increasing Increasing

Hypertension 5.4 7.3 30.9 18.5 198.5 86.5 Decreasing Increasing



‡ includes related conditions †Trends refer to comparison of values shown to analysis provided for the 2012 IHSP. For mortality, 2010 & 2011 rates were compared to 2006 & 2007. Acute separations and days from 2013/14 were compared to 2010/11. suppr ‐ The asthma mortality rate was suppressed since the number of deaths was fewer than 5.

166 28 August 2015

167 28 August 2015

Health Care Utilization

Acute Care Utilization

Analysis of Acute Care Utilization

Notes: This document and the accompanying workbook contain analysis on separations, length of stay, and other selected indicators from acute care facilities in Ontario. Analysis is based on data from the Discharge Abstract Database. Prepared June 2015

168 28 August 2015

ONTARIO Acute Care Utilization LHIN of hospital

In 2013/14, there were 1,003,073 acute separations, 5,397,903 acute days, and 6,278,673 total days from acute care units in Ontario hospitals. Toronto Central LHIN hospitals accounted for the largest proportion of these separations (15.6%) and days (15.9% total and 16.7% acute).

In 2013/14, the average total length of stay for Ontario hospitals was 6.3 days and the average acute length of stay was 5.4 days. The average total lengths of stay ranged from 5.1 days in Central West LHIN to 7.4 days in North West LHIN hospitals, while the average acute length of stay ranged from 4.6 days in Central West LHIN to 6.1 days in North West LHIN.

Between 2010/11 and 2013/14, acute separations increased by 4.9% and acute days increased by 3.2%, while total days remained stable. The average lengths of stay have remained relatively stable over the past 4 years.

Alternate level of care (ALC) days are those days where a physician (or designated other) has indicated that a patient occupying an acute care hospital bed does not require the intensity of resource/services provided in acute care. This analysis includes only those cases that have been discharged from care during the fiscal year. In 2013/14, there were 54,149 ALC separations and 880,770 ALC days in Ontario hospitals. There was a 1.0% reduction in ALC separations and a 15.8% reduction in ALC days between 2010/11 and 2013/14.

The average ALC length of stay decreased from 19.1 days in 2010/11 to 16.3 days in 2013/14. Average ALC lengths of stay ranged from 8.4 days in Waterloo Wellington LHIN hospitals to 27.7 days in North East LHIN hospitals in 2013/14.

The % ALC days (ALC days as a percentage of total days) decreased from 16.7% in 2010/11 to 14.0% in 2013/14. In 2013/14, Central West LHIN hospitals had the lowest % ALC days, while North East LHIN hospitals had the highest.

Long‐term care (LTC) (31.8%), home with support (18.3%), chronic care (15.6%) and rehabilitation (11.1%) were the discharge destinations associated with the greatest proportion of total ALC days for Ontario hospitals. The distribution of ALC days by discharge destination varied by LHIN of hospital, which may be related to patterns of care and the availability of particular services.

The Ontario HBAM inpatient grouper (HIG) (similar to CMG+) aggregates acute care separations with similar resource use and clinical characteristics based on most responsible diagnosis and/or principal intervention. The HIG weight is a relative cost value that reflects the resources consumed during each acute care stay. The average HIG weight for Ontario was 1.49 in 2010/11 (based on 2014/15 HIG weights) and increased to 1.50 in 2013/14. Toronto Central LHIN hospitals (1.85) had the highest average HIG weight in 2013/14, while Central West LHIN hospitals (1.18) had the lowest.

The three HIGs accounting for the largest proportion of acute care days for Ontario hospitals in 2013/14 were: 196‐heart failure without coronary angiogram, 138‐viral/unspecified pneumonia, and 810‐palliative care. The leading HIGs vary by LHIN. Some of this variation is due to the types of specialty care provided within LHIN hospitals.

In 2013/14, the HIGs accounting for the largest proportion of ALC days for Ontario hospitals were: 670‐dementia; 811‐general symptom/sign, and 026‐ischemic event of central nervous system; 671‐organic mental disorder; and 809‐awaiting placement. These HIGs were also among the leading causes of ALC days for all LHINs; however the order differed.

169 28 August 2015

LHIN of patient

There were 991,471 acute separations and 6,216,903 total days for Ontario residents in 2013/14. Residents of HNHB, Central East, and Central LHINs had the largest number of acute care separations in the province.

In 2013/14, the acute separation rate for Ontario residents was 73.2 separations/1,000 population but varied substantially by LHIN of patient residence. Rates were lowest for residents of the Mississauga Halton and Central LHINs and highest for residents of the North East and North West LHINs. From 2010/11 to 2013/14, the overall acute separation rate for Ontario residents increased by 2.3%.

The average total length of stay for Ontario residents was 6.3 days while the average acute length of stay was 5.4 days. Residents of North West LHIN had the longest average total (7.5 days) and acute lengths of stay (6.2 days), while residents of Central West LHIN had the shortest (5.2 days and 4.8 days, respectively).

Average ALC lengths of stay ranged from 8.4 days for Waterloo Wellington LHIN residents to 27.0 days for residents of the North East LHIN.

Acute care hospital utilization by LHIN of hospital, 2013/14

LHIN of hospital Acute

separations Total days

Average total LOS

Acute days

Average acute LOS

Average HIG

Weight

Erie St. Clair 45,128 289,545 6.4 233,348 5.2 1.44

South West 86,356 545,744 6.3 487,080 5.6 1.55

Waterloo Wellington 45,465 241,364 5.3 212,227 4.7 1.31

HNHB 114,466 767,655 6.7 651,269 5.7 1.58

Central West 47,532 239,986 5.1 218,668 4.6 1.18

Mississauga Halton 66,747 402,210 6.0 354,656 5.3 1.38

Toronto Central 156,258 995,501 6.4 900,961 5.8 1.85

Central 97,115 533,281 5.5 458,830 4.7 1.34

Central East 89,274 543,363 6.1 455,683 5.1 1.37

South East 38,728 242,391 6.3 210,423 5.4 1.58

Champlain 98,426 670,783 6.8 583,114 5.9 1.58

North Simcoe Muskoka 33,180 204,841 6.2 160,990 4.9 1.31

North East 59,163 414,741 7.0 316,699 5.4 1.42

North West 25,235 187,268 7.4 153,955 6.1 1.41

Ontario hospitals 1,003,073 6,278,673 6.3 5,397,903 5.4 1.50

170 28 August 2015

ALC separations and days by LHIN of hospital, 2013/14

LHIN of hospital ALC

separations ALC days Average ALC LOS

% ALC days (of total days)

Erie St. Clair 3,090 56,197 18.2 19.4

South West 3,561 58,664 16.5 10.7

Waterloo Wellington 3,486 29,137 8.4 12.1

HNHB 8,518 116,386 13.7 15.2

Central West 1,800 21,318 11.8 8.9

Mississauga Halton 2,746 47,554 17.3 11.8

Toronto Central 7,594 94,540 12.5 9.5

Central 5,748 74,451 13.0 14.0

Central East 3,838 87,680 22.9 16.1

South East 1,557 31,968 20.5 13.2

Champlain 4,494 87,669 19.5 13.1

North Simcoe Muskoka 2,309 43,851 19.0 21.4

North East 3,540 98,042 27.7 23.6

North West 1,868 33,313 17.8 17.8

Ontario hospitals 54,149 880,770 16.3 14.0

Proportion of ALC days (of total ALC days) by discharge destination by LHIN of hospital, 2013/14

LHIN of hospital Home without support

Home with

support

Long‐term care

Chronic care Rehabilitation

Another facility† Deceased Total

Erie St. Clair 5.3 12.7 19.8 21.6 10.9 20.9 8.9 100.0

South West 4.1 18.8 45.2 9.1 7.9 3.7 11.2 100.0

Waterloo Wellington 6.2 20.9 22.6 17.9 19.2 5.6 7.7 100.0

HNHB 4.8 23.5 27.6 19.5 9.0 6.0 9.6 100.0

Central West 7.5 21.7 16.6 21.4 23.7 1.4 7.7 100.0

Mississauga Halton 6.4 19.0 30.2 17.6 13.8 1.5 11.5 100.0

Toronto Central 5.2 18.7 22.7 17.9 23.9 3.5 8.1 100.0

Central 4.8 24.9 34.1 11.3 11.4 2.7 10.8 100.0

Central East 5.5 8.6 41.8 23.9 8.4 2.5 9.3 100.0

South East 11.1 10.3 39.2 6.2 9.1 10.0 14.1 100.0

Champlain 10.6 23.0 34.3 9.5 9.3 3.9 9.5 100.0

North Simcoe Muskoka 5.9 19.8 36.3 10.2 5.9 6.2 15.8 100.0

North East 14.2 15.2 29.9 13.1 5.4 6.3 16.0 100.0

North West 7.2 14.7 42.3 16.6 5.6 2.5 11.0 100.0

Ontario hospitals 7.1 18.3 31.8 15.6 11.1 5.4 10.8 100.0

†Includes acute and ambulatory facili es

171 28 August 2015

Acute care days by top 10 HIGs, Ontario hospitals, 2013/14

HBAM Inpatient Grouper (HIGs)

Ontario

Acute Days % of total

(196) Heart Failure without Coronary Angiogram 161,289 3.0

(138) Viral/Unspecified Pneumonia 120,046 2.2

(810) Palliative Care 119,068 2.2

(026) Ischemic Event of Central Nervous System 87,537 1.6

(139b) Chronic Obstructive Pulmonary Disease 83,894 1.6

(321) Unilateral Knee Replacement 78,528 1.5

(487) Lower Urinary Tract Infection 76,410 1.4

(654) Other/Unspecified Sepsis 75,863 1.4

(139a) Chronic Bronchitis 71,748 1.3

(811) General Symptom/Sign 71,218 1.3

All Other CMGs 4,452,302 82.5

Total 5,397,903 100.0

ALC days by top 10 HIGs, Ontario hospitals, 2013/14


Ontario

ALC Days % of total

(670) Dementia 86,278 9.8

(811) General Symptom/Sign 48,580 5.5

(026) Ischemic Event of Central Nervous System 38,423 4.4

(671) Organic Mental Disorder 37,648 4.3

(809) Awaiting Placement 28,613 3.2

(727) Fixation/Repair Hip/Femur 26,583 3.0

(810) Palliative Care 23,326 2.6

(196) Heart Failure without Coronary Angiogram 21,808 2.5

(487) Lower Urinary Tract Infection 19,475 2.2

(806) Convalescence 17,291 2.0

All other HIGs 532,745 60.5

Total 880,770 100.0

172 28 August 2015

Acute care hospital utilization by LHIN of patient, 2013/14

LHIN of patient Acute

separations

Acute separations/

1,000 populationTotal days

Average total LOS

Acute days

Average Acute LOS

Average HIG

weight

Erie St. Clair 52,400 82.1 339,818 6.5 282,276 5.4 1.56

South West 79,878 83.1 496,933 6.2 440,117 5.5 1.50

Waterloo Wellington 50,543 66.3 276,216 5.5 246,600 4.9 1.41

HNHB 115,294 81.2 763,910 6.6 646,766 5.6 1.55

Central West 59,659 67.0 312,536 5.2 288,000 4.8 1.36

Mississauga Halton 70,177 58.9 434,483 6.2 383,448 5.5 1.44

Toronto Central 79,974 65.2 511,441 6.4 437,076 5.5 1.56

Central 108,665 59.8 628,580 5.8 552,409 5.1 1.47

Central East 109,082 69.2 666,726 6.1 572,168 5.3 1.50

South East 41,310 83.8 259,514 6.3 227,374 5.5 1.62

Champlain 90,198 69.7 619,095 6.9 531,835 5.9 1.56

North Simcoe Muskoka 38,582 82.7 235,802 6.1 193,171 5.0 1.49

North East 64,281 113.4 445,517 6.9 346,938 5.4 1.48

North West 26,079 110.4 195,441 7.5 162,156 6.2 1.49

Unknown 5,349 30,891 5.8 26,923 5.0 1.51

Out‐of‐province 11,602 61,770 5.3 60,646 5.2 1.60

Ontario residents† 991,471 73.2 6,216,903 6.3 5,337,257 5.4 1.50

†Excludes out of province residents

173 28 August 2015

ALC separations and days by LHIN of patient, 2013/14

LHIN of patient ALC separations ALC days Average ALC

LOS

Erie St. Clair 3,154 57,542 18.2

South West 3,505 56,816 16.2

Waterloo Wellington 3,520 29,616 8.4

HNHB 8,558 117,144 13.7

Central West 2,027 24,536 12.1

Mississauga Halton 3,070 51,035 16.6

Toronto Central 5,205 74,365 14.3

Central 6,250 76,171 12.2

Central East 4,590 94,558 20.6

South East 1,596 32,140 20.1

Champlain 4,429 87,260 19.7

North Simcoe Muskoka 2,343 42,631 18.2

North East 3,646 98,579 27.0

North West 1,875 33,285 17.8

Unknown 257 3,968 15.4

Out‐of‐province 124 1,124 9.1

Ontario residents† 54,025 879,646 16.3

†Excludes out of province residents

174 28 August 2015

Erie St Clair LHIN

There were 45,218 acute separations, 233,348 acute days, and 289,545 total days from Erie St. Clair LHIN hospitals in 2013/14. Residents from outside the LHIN accounted for 1.1% of the separations from Erie St. Clair LHIN hospitals in 2013/14.

Between 2010/11 and 2013/14, acute days declined by 2.6% while separations and total days increased by 1.2% and 3.0%, respectively. During the same period, there was 4.9% growth in acute separations and 3.2% growth in acute care days for Ontario hospitals overall, while total days remained stable.

In 2013/14 there were 3,090 ALC separations from Erie St. Clair LHIN hospitals with an average ALC length of stay of 18.2 days. Between 2010/11 and 2013/14, Erie St. Clair hospitals had the largest rate of growth in ALC separations (23.5%) and ALC days (35.2%) among all the LHINs. During the same period, there was a 1.0% reduction in ALC separations and 15.8% reduction in ALC days for Ontario hospitals overall.

Chronic care (21.6%), another facility (20.9%), and LTC (19.8%) were the discharge destinations that accounted for the largest proportion of ALC days from Erie St. Clair LHIN hospitals. Among all LHINs, Erie St. Clair had the largest proportion of ALC days that were discharged to another facility, which includes other acute and ambulatory care facilities.

In 2013/14, Erie St. Clair LHIN residents had a higher acute separation rate than the province. There was 2.2% growth in the acute separation rate between 2010/11 and 2013/14, which is comparable to the increase for Ontario residents.

In 2013/14, 16.5% of acute separations by Erie St. Clair LHIN residents were from hospitals outside the LHIN.

The average HIG weight for Erie St. Clair hospitals in 2013/14 (1.44) was lower than the provincial average (1.50). In contrast, the average HIG weight for Erie St. Clair LHIN residents (1.56) was higher than that for Ontario residents (1.50).

In 2013/14, the HIGs 196‐heart failure without coronary angiogram, 654‐other/unspecified sepsis, and 138‐viral/unspecified pneumonia accounted for the largest proportion of acute care days in Erie St. Clair LHIN hospitals. Among all LHINs, Erie St. Clair LHIN hospitals had the largest proportion of acute days for 654‐other/unspecified sepsis and 726‐hip replacement with trauma/complication of treatment. Three of the leading HIGs for Erie St. Clair LHIN hospitals were not among the leading HIGs for Ontario hospitals: 727‐fixation/repair hip/femur, 221‐colostomy/enterostomy, and 726‐hip replacement with trauma/complication of treatment.

175 28 August 2015

Acute care hospital utilization, Erie St. Clair LHIN, 2013/14

Indicator Erie St. Clair LHIN Ontario†

LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital

Acute separations 45,128 1,003,073 1.2

Total days 289,545 6,278,673 3.0

Average total LOS 6.4 6.3

Acute days 233,348 5,397,903 ‐2.6

Average acute LOS 5.2 5.4

Average HIG weight 1.44 1.50

% Inflow acute separations 1.1

ALC separations 3,090 54,149 23.5

ALC days 56,197 880,770 35.2

Average ALC LOS 18.2 16.3

% ALC days (of total days) 19.4 14.0

Proportion of total ALC days by discharge destination:

Home without support 5.3 7.1

Home with support 12.7 18.3

Long‐term care 19.8 31.8

Chronic care 21.6 15.6

Rehabilitation 10.9 11.1

Another facility‡ 20.9 5.4

Deceased 8.9 10.8

LHIN of patient

Acute separations 52,400 991,471 1.4

Acute separations/1,000 population 82.1 73.2 2.2

Total days 339,818 6,216,903 3.1


Acute days 282,276 5,337,257 ‐1.8



% Outflow acute separations 16.5


ALC days 57,542 879,646 36.0


†LHIN of pa ent results for Ontario exclude out‐of‐province residents ‡Includes acute and ambulatory facili es

176 28 August 2015

Acute care days by top 10 HIGs, Erie St. Clair LHIN hospitals, 2013/14


Erie St. Clair LHIN Ontario Comment

# % # %

(196) Heart failure without Coronary Angiogram

7,236 3.1 161,289 3.0

(654) Other/Unspecified Sepsis 5,769 2.5 75,863 1.4 Largest % in province

(138) Viral/Unspecified Pneumonia 5,555 2.4 120,046 2.2 (139b) Chronic Obstructive Pulmonary Disease

5,423 2.3 83,894 1.6

(139a) Chronic Bronchitis 4,887 2.1 71,748 1.3 (026) Ischemic Event of Central Nervous System

4,868 2.1 87,537 1.6

(321) Unilateral Knee Replacement 4,047 1.7 78,528 1.5 (727) Fixation/Repair Hip/Femur 3,835 1.6 70,028 1.3 Not in Ontario top 10

(221) Colostomy/Enterostomy 3,234 1.4 67,339 1.2 Not in Ontario top 10

(726) Hip Replacement with Trauma/ Complication of Treatment

3,231 1.4 41,547 0.8 Largest % in province; not in Ontario top 10

All Other HIGs 185,263 79.4 4,540,084 84.1 Total 233,348 100.0 5,397,903 100.0

177 28 August 2015

South West LHIN

There were 86,356 acute separations, 487,080 acute days, and 545,744 total days from South

West LHIN hospitals in 2013/14. Residents from outside the LHIN accounted for 13.7% of the separations from South West LHIN hospitals.

Acute separations increased by 4.6%, acute days by 5.6%, and total days increased by 4.5% between 2010/11 and 2013/14. During the same period, there was 4.9% growth in acute separations and 3.2% growth in acute care days for Ontario hospitals overall, while total days remained stable.

In 2013/14, there were 3,561 ALC separations from South West LHIN hospitals, with an average length of stay of 16.5 days. Between 2010/11 and 2013/14, ALC separations increased by 2.2% while there was a 3.5% decrease in ALC days. During the same period, there was a 1.0% reduction in ALC separations and 15.8% reduction in ALC days for Ontario hospitals overall. South West LHIN had a lower % ALC days (of total days) compared to the provincial average.

The discharge destinations associated with the largest proportion of ALC days for South West LHIN hospitals were LTC (45.2%), home with support (18.8%), and death (11.2%). Among all LHINs, South West LHIN had the largest proportion of ALC days that were discharged to LTC and the smallest proportion that were discharged home without support.

In 2013/14, South West LHIN residents had a higher acute separation rate than the province. In 2013/14, 6.7% of separations by South West LHIN residents were from hospitals outside the LHIN.

Between 2010/11 and 2013/14, acute care separations, acute and total days and the acute care separation rate increased for LHIN residents, and there was a reduction in ALC days.

The average HIG weight for South West LHIN hospitals in 2013/14 (1.55) was higher than the provincial average (1.50), while the average HIG weight for South West LHIN residents was equal to the average for Ontario residents (1.50).

In 2013/14, the HIGs accounting for the largest proportion of acute days in South West LHIN hospitals were 196‐heart failure without coronary angiogram, 810‐palliative care, and 138‐viral or unspecified pneumonia. The HIGs: 805‐rehabilitation, 806‐convalescence, and 221‐ colostomy/enterostomy appeared in the top 10 for South West LHIN but were not among the leading HIGs for Ontario.

178 28 August 2015

Acute care hospital utilization, South West LHIN, 2013/14

Indicator South West LHIN Ontario†

LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital


Total days 545,744 6,278,673 4.5


Acute days 487,080 5,397,903 5.6





ALC days 58,664 880,770 ‐3.5










Deceased 11.2 10.8

LHIN of patient



Total days 496,933 6,216,903 4.7


Acute days 440,117 5,337,257 6.3





ALC days 56,816 879,646 ‐5.7



179 28 August 2015

Acute care days by top 10 HIGs, South West LHIN hospitals, 2013/14


South West LHIN Ontario Comment

# % # %

(196) Heart Failure without Coronary Angiogram 14,576 3.0 161,289 3.0

(810) Palliative Care 14,238 2.9 119,068 2.2

(138) Viral/Unspecified Pneumonia 11,055 2.3 120,046 2.2

(811) General Symptom/Sign 7,397 1.5 71,218 1.3

(026) Ischemic Event of Central Nervous System 7,146 1.5 87,537 1.6

(805) Rehabilitation 6,934 1.4 48,873 0.9 Not in Ontario top 10

(139b) Chronic Obstructive Pulmonary Disease 6,894 1.4 83,894 1.6

(321) Unilateral Knee Replacement 6,318 1.3 78,528 1.5

(806) Convalescence 6,307 1.3 43,778 0.8 Not in Ontario top 10


All Other HIGs 400,065 82.1 4,516,333 83.7

Total 487,080 100.0 5,397,903 100.0

180 28 August 2015

Waterloo Wellington LHIN

There were 45,465 acute separations, 212,227 acute days, and 241,364 total days from

Waterloo Wellington LHIN hospitals in 2013/14. Residents from outside the LHIN accounted for 7.1% of the acute separations from Waterloo Wellington LHIN hospitals in 2013/14.

Between 2010/11 and 2013/14 acute separations increased by 6.7% and acute days by 5.9%, while total days decreased by 0.3% for Waterloo Wellington LHIN hospitals. During the same period, there was 4.9% growth in acute separations and 3.2% growth in acute care days for Ontario hospitals overall and total days remained stable.

There were 3,486 ALC separations from Waterloo Wellington LHIN hospitals, with an average ALC length of stay of 8.4 days in 2013/14. Between 2010/11 and 2013/14, ALC days decreased by 30.0% for Waterloo Wellington LHIN hospitals, while ALC separations increased by 18.4%. During the same period, there was a 1.0% reduction in ALC separations and 15.8% reduction in ALC days for Ontario hospitals overall.

Waterloo Wellington LHIN hospitals had the 2nd lowest average acute and total lengths of stay and the lowest average ALC length of stay in the province in 2013/14.

The discharge destinations associated with the largest proportions of ALC days for Waterloo Wellington LHIN hospitals were LTC (22.6%), home with support (20.9%) and rehabilitation (19.2%). Among all LHINs Waterloo Wellington LHIN had the smallest proportion of deaths.

The acute separation rate for Waterloo Wellington LHIN residents was lower than the provincial average. The separation rate increased by 4.0% from 2010/11 to 2013/14 compared to 2.3% growth for Ontario residents overall.

16.5% of acute separations for Waterloo Wellington LHIN residents were from hospitals outside the LHIN in 2013/14.

In 2013/14, Waterloo Wellington LHIN residents had the shortest ALC length of stay in the province, which was 7.9 days shorter than the average for Ontario residents.

The average HIG weight for Waterloo Wellington LHIN hospitals in 2013/14 (1.31) was lower than the provincial average (1.50). Similarly, the average HIG weight for Waterloo Wellington LHIN residents (1.41) was lower than that for Ontario residents (1.50).

The HIGs 196‐Heart failure without coronary angiogram, 138‐viral/unspecified pneumonia, and 321‐unilateral knee replacement accounted for the largest proportion of acute care days in Waterloo Wellington LHIN hospitals. Among all LHINs, Waterloo Wellington LHIN hospitals had the largest proportion of acute care days for HIG 321‐unilateral knee replacement and 162‐cardiac valve replacement. The HIGs: 162‐cardiac valve replacement, 727‐fixation/repair hip/femur, and 477‐renal failure were in the top 10 for Waterloo Wellington LHIN but were not among the leading HIGs for Ontario.

181 28 August 2015

Acute care hospital utilization, Waterloo Wellington LHIN, 2013/14

Indicator Waterloo Wellington LHIN Ontario†

LHIN % change

2010/11 ‐ 2013/14

LHIN of hospital


Total days 241,364 6,278,673 ‐0.3


Acute days 212,227 5,397,903 5.9





ALC days 29,137 880,770 ‐30.0










Deceased 7.7 10.8

LHIN of patient



Total days 276,216 6,216,903 1.0


Acute days 246,600 5,337,257 6.6





ALC days 29,616 879,646 ‐29.9



182 28 August 2015

Acute care days by top 10 HIGs, Waterloo Wellington LHIN hospitals, 2013/14


Waterloo Wellington LHIN Ontario Comment

# % # %

(196) Heart Failure without Coronary Angiogram

6,845 3.2 161,289 3.0

(138) Viral/Unspecified Pneumonia

5,424 2.6 120,046 2.2

(321) Unilateral Knee Replacement

4,511 2.1 78,528 1.5 Largest % in province

(026) Ischemic Event of Central Nervous System

3,989 1.9 87,537 1.6

(139b) Chronic Obstructive Pulmonary Disease

3,737 1.8 83,894 1.6

(654) Other/Unspecified Sepsis 3,536 1.7 75,863 1.4

(162) Cardiac Valve Replacement


(727) Fixation/Repair Hip/Femur

3,233 1.5 70,028 1.3 Not in Ontario top 10

(810) Palliative Care 3,155 1.5 119,068 2.2

(477) Renal Failure 3,084 1.5 66,863 1.2 Not in Ontario top 10

All Other HIGs 171,295 80.7 4,488,166 83.1

Total 212,227 100.0 5,397,903 100.0

183 28 August 2015

Hamilton Niagara Haldimand Brant (HNHB) LHIN

There were 114,466 acute separations, 651,269 acute days and 767,655 total days from HNHB

hospitals in 2013/14. Residents from outside the LHIN accounted for 6.4% of the acute separations from HNHB LHIN hospitals.

Between 2010/11 and 2013/14, acute separations from HNHB LHIN hospitals increased by 3.8%, acute days by 6.1%, and total days increased by 2.5%. During the same period, there was 4.9% growth in acute separations and 3.2% growth in acute care days for Ontario hospitals overall, while total days remained stable.

The average ALC length of stay was lower in HNHB LHIN hospitals compared to Ontario in 2013/14. However, the % ALC days (of total days) for HNHB LHIN hospitals was higher than the rate for Ontario.

Between 2010/11 and 2013/14 there was a 1% reduction in ALC separations and a 13.8% reduction in ALC days in HNHB LHIN hospitals. During the same period, there was a 1.0% reduction in ALC separations and 15.8% reduction in ALC days for Ontario hospitals overall.

The discharge destinations associated with the largest proportion of total ALC days for HNHB LHIN hospitals were LTC (27.6%), home with support (23.5%), and chronic care (19.5).

In 2013/14, the acute separation rate for HNHB LHIN residents was higher than the provincial average.

7.1% of separations by HNHB LHIN residents were from hospitals outside the LHIN in 2013/14.

Between 2010/11 and 2013/14, the acute separations, separation rate, total and acute days increased for HNHB LHIN residents, while ALC separations and ALC days declined. The average ALC length of stay was shorter for HNHB LHIN residents compared to Ontario residents.

The average HIG weights for HNHB LHIN hospitals (1.58) and for HNHB LHIN residents (1.55) were higher than the averages for Ontario hospitals (1.50) and Ontario residents (1.50).

1.6% of acute days for HNHB LHIN hospitals were for HIG 221‐colostomy/enterostomy, which was the largest proportion of acute days for this HIG in the province. This HIG as well as 805‐rehabilitation and 727‐fixation/repair of hip/femur were among the top 10 HIGs for HNHB LHIN hospitals but were not in the top 10 HIGs for Ontario.

184 28 August 2015

Acute care hospital utilization, HNHB LHIN, 2013/14

Indicator HNHB LHIN Ontario†

LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital


Total days 767,655 6,278,673 2.5


Acute days 651,269 5,397,903 6.1




ALC separations 8,518 54,149 ‐1.0

ALC days 116,386 880,770 ‐13.8










Deceased 9.6 10.8

LHIN of patient



Total days 763,910 6,216,903 2.2


Acute days 646,766 5,337,257 5.5





ALC days 117,144 879,646 ‐12.7



185 28 August 2015

Acute care days by top 10 HIGs, HNHB LHIN hospitals, 2013/14

HNHB LHIN Ontario Comment

HBAM Inpatient Grouper (HIGs) # % # % (196) Heart Failure without Coronary Angiogram

21,209 3.3 161,289 3.0




12,117 1.9 87,537 1.6


11,268 1.7 83,894 1.6


(221) Colostomy/Enterostomy 10,186 1.6 67,339 1.2 Largest % in province; not in Ontario top 10


(487) Lower Urinary Tract Infection 9,220 1.4 76,410 1.4

(727) Fixation/Repair Hip/Femur 8,767 1.3 70,028 1.3 Not in Ontario top 10

All Other HIGs 529,018 81.2 4,528,096 83.9

Total 651,269 100.0 5,397,903 100.0

186 28 August 2015

Central West LHIN

There were 47,532 acute separations, 218,668 acute days, and 239,986 total days from Central West LHIN hospitals in 2013/14. Residents from outside the LHIN accounted for 16.6% of the separations from Central West LHIN hospitals in 2013/14.

Between 2010/11 and 2013/14, increases were seen in acute separations (15.0%), acute days (13.3%), and total days (12.3%) at Central West LHIN hospitals. During the same period, there was 4.9% growth in acute separations and 3.2% growth in acute care days for Ontario hospitals overall, while total days remained stable.

There were 1,800 ALC separations from Central West LHIN hospitals with an average ALC length of stay of 11.8 days, which was the 2nd shortest length of stay in the province. Central West LHIN hospitals had the lowest % ALC days (of total days) in the province in 2013/14 at 8.9%. Between 2010/11 and 2013/14, ALC separations decreased by 19.0% and ALC days increased by 2.9% for LHIN hospitals. During the same period, there was a 1.0% reduction in ALC separations and 15.8% reduction in ALC days for Ontario hospitals overall.

Central West LHIN hospitals had the shortest average acute and total lengths of stay in the province.

The discharge destinations associated with the largest proportion of total ALC days for Central West LHIN hospitals were rehabilitation (23.7%), home with support (21.7%), and chronic care (21.4%). Among all LHINs, Central West LHIN had the smallest proportions of ALC days that were discharged to LTC, to another facility, and ended in the patient’s death. Central West LHIN also had the 2nd largest proportion of ALC days discharged to rehabilitation.

The acute separation rate for Central West LHIN residents was lower than that for Ontario residents. One third of separations by Central West LHIN residents were from hospitals outside the LHIN in 2013/14.

Acute separations, acute days, and total days increased for Central West LHIN residents between 2010/11 and 2013/14. During this same period, ALC separations and ALC days decreased by 13.6% and 3.1% respectively for LHIN residents.

The average HIG weights for Central West LHIN hospitals (1.18) and for Central West LHIN residents (1.36) were the lowest amongst the LHINs and lower than the provincial average (1.50 for Ontario hospitals and for residents).

Central West LHIN hospitals had the largest proportion of acute days in the province for 175‐percutaneous coronary intervention with MI/shock/arrest/heart failure. This HIG as well as 563a‐vaginal birth with anaesthetic without non‐major obstetric/gynecologic intervention, and 727‐fixation/repair hip/femur were among the top 10 HIGs for Central West LHIN hospitals but were not within the top 10 HIGs for the province.

187 28 August 2015

Acute care hospital utilization, Central West LHIN, 2013/14

Indicator Central West LHIN Ontario†

LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital


Total days 239,986 6,278,673 12.3


Acute days 218,668 5,397,903 13.3





ALC days 21,318 880,770 2.9










Deceased 7.7 10.8

LHIN of patient



Total days 312,536 6,216,903 9.8


Acute days 288,000 5,337,257 11.1





ALC days 24,536 879,646 ‐3.1



188 28 August 2015

Acute care days by top 10 HIGs, Central West LHIN hospitals, 2013/14

Central West LHIN Ontario Comment

HBAM Inpatient Grouper (HIGs) # % # %

(810) Palliative Care 8,621 3.9 119,068 2.2


6,605 3.0 161,289 3.0



(175) Percutaneous Coronary Intervention with MI/Shock/Arrest/Heart Failure



4,052 1.9 87,537 1.6

(563a) Vaginal Birth with Anaesthetic without Non‐Major Obstetric/Gynecologic Intervention





All Other HIGs 171,278 78.3 4,507,311 83.5

Total 218,668 100.0 5,397,903 100.0

189 28 August 2015


There were 66,747 acute separations, 354,656 acute days, and 402,210 total days from

Mississauga Halton LHIN hospitals in 2013/14. Residents from outside the LHIN accounted for 20.1% of the acute separations from Mississauga Halton LHIN hospitals in 2013/14.

Acute separations increased by 4.2%, acute days by 10.0% and total days by 11.6% between 2010/11 and 2013/14. During the same period, there was 4.9% growth in acute separations and 3.2% growth in acute care days for Ontario hospitals overall, while total days remained stable.

There were 2,746 ALC separations from Mississauga Halton LHIN hospitals in 2013/14 with an average length of stay of 17.3 days. The % ALC days (of total days) in Mississauga Halton LHIN hospitals was lower than the provincial average in 2013/14.

Between 2010/11 and 2013/14, ALC separations decreased 8.1% while ALC days increased by 25.2% for Mississauga Halton LHIN hospitals. During the same period, there was a 1.0% reduction in ALC separations and 15.8% reduction in ALC days for Ontario hospitals overall.

The discharge destinations associated with the largest proportion of total ALC days for Mississauga Halton LHIN hospitals were LTC (30.2%), home with support (19.0%), and chronic care (17.6%). Compared with the province, greater proportions of ALC discharges from Mississauga Halton LHIN hospitals went to chronic care and rehabilitation and smaller proportions went to another facility (includes acute and ambulatory care).

Mississauga Halton LHIN residents had the lowest acute separation rate in the province in 2013/14.

24.0% of separations by Mississauga Halton LHIN residents were from hospitals outside the LHIN in 2013/14.

Acute separations, acute separation rate, total and acute care days increased for Mississauga Halton LHIN residents between 2010/11 and 2013/14. Over the same period, ALC days increased while ALC separations declined for Mississauga Halton LHIN residents.

The average HIG weight for Mississauga Halton LHIN hospitals in 2013/14 (1.38) was lower than the provincial average (1.50). The average HIG weight for Mississauga Halton LHIN residents (1.44) was the 3rd lowest in the province.

Mississauga Halton LHIN hospitals had the largest proportion of acute days in the province for 172‐coronary artery bypass graft without coronary angiogram without MI/shock/arrest with/ without pump, and this HIG was not one of the top 10 HIGs for Ontario. Similarly, 563a‐vaginal birth with anaesthetic without non‐major obstetric/ gynecologic intervention and 477‐renal failure were not within the top 10 HIGs for Ontario.

190 28 August 2015

Acute care hospital utilization, Mississauga Halton LHIN, 2013/14

Indicator Mississauga Halton LHIN Ontario†

LHIN % change

2010/11 ‐ 2013/14

LHIN of hospital


Total days 402,210 6,278,673 11.6


Acute days 354,656 5,397,903 10.0





ALC days 47,554 880,770 25.2










Deceased 11.5 10.8

LHIN of patient



Total days 434,483 6,216,903 10.3


Acute days 383,448 5,337,257 9.4





ALC days 51,035 879,646 17.5


†LHIN of pa ent results for Ontario exclude out‐of‐province residents ‡Includes acute and ambulatory facilities

191 28 August 2015

Acute care days by top 10 HIGs, by Mississauga Halton LHIN hospitals, 2013/14

Mississauga Halton LHIN Ontario Comment



11,704 3.3 161,289 3.0

(810) Palliative Care 11,144 3.1 119,068 2.2



7,398 2.1 87,537 1.6


(563a) Vaginal Birth with Anaesthetic without Non‐Major Obstetric/ Gynecologic Intervention





(172) Coronary Artery Bypass Graft without Coronary Angiogram without MI/Shock/Arrest with/without Pump


All Other HIGs 284,788 80.3 4,521,811 83.8

Total 354,656 100.0 5,397,903 100.0

192 28 August 2015


There were 156,258 acute separations, 900,961 acute days, and 995,501 total days from Toronto Central LHIN hospitals in 2013/14. Residents from outside the LHIN accounted for 55.2% of the acute separations from Toronto Central LHIN hospitals in 2013/14. Toronto Central LHIN had the highest inflow rate of all the LHINs.

There were 7,594 ALC separations from Toronto Central LHIN hospitals in 2013/14 with an average ALC length of stay of 12.5 days. Toronto Central LHIN hospitals had the 2nd lowest % ALC days (of total days) in the province.

Acute separations, acute days and total days increased for Toronto Central LHIN hospitals between 2010/11 and 2013/14. During the same period, ALC separations increased by 2.8% and ALC days decreased by 11.8% in Toronto Central LHIN hospitals. For Ontario hospitals there was growth in acute separations (4.9%) acute care days (3.2%) and reduction in ALC separations (1.0%) and ALC days (15.8%), between 2010/11 and 2013/14.

The discharge destinations associated with the largest proportion of total ALC days for Toronto Central LHIN hospitals were rehabilitation (23.9%), LTC (22.7%), and home with support (18.7%). Among all LHINs, Toronto Central LHIN had the largest proportion of ALC days that were discharged to rehabilitation.

Toronto Central LHIN residents had the 3rd lowest acute separation rate in the province in 2013/14 and this rate (65.2) was lower than the provincial average (73.2).

12.5% of separations by Toronto Central LHIN residents were from hospitals outside the LHIN in 2013/14.

Toronto Central LHIN hospitals had the highest average HIG weight in the province in 2013/14 (1.85). The average HIG weight for Toronto Central LHIN residents (1.56) was also larger than the provincial average (1.50).

Toronto Central LHIN hospitals had the largest proportion of acute days in the province for two HIGs: 618a‐bone marrow/stem cell transplant and 638‐chemotherapy/radiotherapy admission for neoplasm. These HIGs as well as 162‐cardiac valve replacement, 221‐colostomy/enterostomy, 563a‐vaginal birth with anaesthetic without non‐major obstetric/gynecologic intervention were among the leading HIGs for Toronto Central LHN hospitals but were not among the top 10 HIGs for Ontario.

193 28 August 2015

Acute care hospital utilization, Toronto Central LHIN, 2013/14

Indicator Toronto Central LHIN Ontario† LHIN % change

2010/11 ‐ 2013/14

LHIN of hospital


Total days 995,501 6,278,673 1.5


Acute days 900,961 5,397,903 3.1





ALC days 94,540 880,770 ‐11.8










Deceased 8.1 10.8

LHIN of patient


Acute separations/1,000 population 65.2 73.2 ‐2.4

Total days 511,441 6,216,903 ‐0.2


Acute days 437,076 5,337,257 0.7





ALC days 74,365 879,646 ‐5.3



194 28 August 2015

Acute care days, top 10 HIGs, by Toronto Central LHIN hospitals, 2013/14

Toronto Central LHIN Ontario Comment



21,022 2.3 161,289 3.0 Smallest % in province

(810) Palliative Care 15,227 1.7 119,068 2.2



(162) Cardiac Valve Replacement


(618a) Bone Marrow/Stem Cell Transplant


(638) Chemotherapy/Radiotherapy Admission for Neoplasm

12,234 1.4 22,256 0.4 Largest % in Ontario; not in Ontario top 10


(321) Unilateral Knee Replacement


(563a) Vaginal Birth with Anaesthetic without Non‐Major Obstetric/ Gynecologic Intervention




All Other HIGs 770,766 85.5 4,614,925

85.5

Total 900,961 100.0 5,397,903

100.0

195 28 August 2015

Central LHIN

There were 97,115 acute separations, 458,830 acute days, and 533,281 total days from Central

LHIN hospitals in 2013/14. Residents from outside the LHIN accounted for 28.5% of the acute separations from Central LHIN hospitals in 2013/14. There were 5,748 ALC separations from Central LHIN hospitals in 2013/14 with an average length of stay of 13.0 days.

While acute separations increased between 2010/11 and 2013/14, acute and total days decreased. During the same period, there was a 1.6% increase in ALC separations, and a 15.3% reduction in ALC days.

Average total, acute, and ALC lengths of stay were lower in Central LHIN hospitals compared to Ontario in 2013/14.

In 2013/14, the largest proportions of total ALC days for Central LHIN hospitals were discharged to LTC (34.1%), home with support (24.9%), and rehabilitation (11.4%). Among all LHINs, Central LHIN hospitals had the largest proportion of ALC days discharged home with support.

Central LHIN residents had the second lowest acute separation rate in the province.

36.1 % of separations by Central LHIN residents were from hospitals outside the LHIN in 2013/14.

The average HIG weight for Central LHIN hospitals (1.34) was lower than the provincial average (1.50) in 2013/14 while the average HIG weight for Central LHIN residents (1.47) was slightly lower than the provincial average (1.50).

Central LHIN hospitals had the largest proportion of acute days in the province for the following HIGs: 228‐complex hernia repair, 563a‐vaginal birth with anaesthetic without non‐major obstetric/gynecologic intervention, and 477‐renal failure. These HIGs as well as 727‐fixation/repair hip/femur were among the top 10 HIGs for Central LHIN hospitals but were not within the top 10 HIGs for the province.

196 28 August 2015

Acute care hospital utilization, Central LHIN, 2013/14

Indicator Central LHIN Ontario†

LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital


Total days 533,281 6,278,673 ‐3.5


Acute days 458,830 5,397,903 ‐1.3





ALC days 74,451 880,770 ‐15.3










Deceased 10.8 10.8

LHIN of patient



Total days 628,580 6,216,903 ‐1.7


Acute days 552,409 5,337,257 0.1





ALC days 76,171 879,646 ‐13.1



197 28 August 2015

Acute care days by top 10 HIGs, Central LHIN hospitals, 2013/14

Central LHIN Ontario Comment


(228) Complex Hernia Repair 22,884 5.0 31,342 0.6 Largest % in province; not in Ontario top 10


14,601 3.2 161,289 3.0

(810) Palliative Care 11,956 2.6 119,068 2.2




8,180 1.8 87,537 1.6

(563a) Vaginal Birth with Anaesthetic without Non‐Major Obstetric/Gynecologic Intervention


(477) Renal Failure 7,704 1.7 66,863 1.2 Largest % in province; not in Ontario top 10



All Other HIGs 350,510 76.4 4,527,885 83.9

Total 458,830 100.0 5,397,903 100.0

198 28 August 2015

Central East LHIN

There were 89,274 acute separations, 455,683 acute days, and 543,363 total days from Central

East LHIN hospitals in 2013/14. Residents from outside the LHIN accounted for 11.4% of the acute separations from Central East LHIN hospitals in 2013/14.

There were 3,838 ALC separations from Central East LHIN hospitals in 2013/14 with an average ALC length of stay of 22.9 days. Among all LHINs, Central East had the 2nd longest ALC length of stay.

Between 2010/11 and 2013/14, acute separations and acute days increased (7.5% and 4.3%, respectively) while total days remained relatively stable (decreased 0.3%). During this same period, there was a 17.9% reduction in ALC separations and an 18.6% reduction in ALC days for Central East LHIN hospitals.

The largest proportions of ALC days for Central East LHIN hospitals were discharged to LTC (41.8%) and chronic care (23.9%). Among all LHINs, Central East LHIN hospitals had the largest proportion of ALC days discharged to chronic care and the smallest proportion that were discharged home with support.

Residents of Central East LHIN had a lower acute care separation rate than the province. This rate increased 6.6% between 2010/11 and 2013/14.

27.5 % of separations by Central East LHIN residents were from hospitals outside the LHIN in 2013/14.

ALC separations and days for Central East LHIN residents decreased by 16.3% and 19.8%, respectively between 2010/11 and 2013/14.

Central East LHIN residents had the 2nd longest ALC length of stay in the province in 2013/14.

The average HIG weight for Central East LHIN hospitals (1.37) was lower than the provincial average (1.50) in 2013/14, while the average HIG weight for Central East LHIN residents was the same as the provincial average (1.50).

Across all LHINs, Central East LHIN hospitals had the largest proportions of acute days for the following HIGs: 810‐palliative care, 196‐heart failure without coronary angiogram, 026‐ischemic event of central nervous system, and 727‐fixation/repair hip/femur. In addition, 727‐Fixation/repair hip/femur was not among the top 10 HIGs for Ontario hospitals.

199 28 August 2015

Acute care hospital utilization, Central East LHIN, 2013/14

Indicator Central East LHIN Ontario†

LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital


Total days 543,363 6,278,673 ‐0.3


Acute days 455,683 5,397,903 4.3





ALC days 87,680 880,770 ‐18.6










Deceased 9.3 10.8

LHIN of patient



Total days 666,726 6,216,903 0.0


Acute days 572,168 5,337,257 4.3





ALC days 94,558 879,646 ‐19.8



200 28 August 2015

Acute care days by top 10 HIGs, Central East LHIN hospitals, 2013/14

Central East LHIN Ontario Comment


(810) Palliative Care 22,789 5.0 119,068 2.2 Largest % in province







9,600 2.1 83,894 1.6

(727) Fixation/Repair Hip/Femur 7,919 1.7 70,028 1.3 Largest % in province; not in Ontario top 10

(139a) Chronic Bronchitis 7,755 1.7 71,748 1.3




All Other HIGs 346,018 75.9 4,453,492 82.5

Total 455,683 100.0 5,397,903 100.0

201 28 August 2015

South East LHIN

There were 38,728 acute separations, 210,423 acute days, and 242,391 total days from South

East LHIN hospitals in 2013/14. Residents from outside the LHIN accounted for 6.4% of the acute separations from South East LHIN hospitals in 2013/14.

There were 1,557 ALC separations from South East LHIN hospitals in 2013/14 with an average ALC length of stay of 20.5 days. Central East LHIN had the 3rd longest ALC length of stay in the province. In 2013/14, the % ALC days (of total days) was slightly lower in South East LHIN hospitals compared to Ontario.

While acute separations increased for South East LHIN hospitals between 2010/11 and 2013/14, acute and total days declined. During the same period, there was 4.9% growth in acute separations and 3.2% growth in acute care days for Ontario hospitals overall, while total days remained stable. South East LHIN hospitals had the largest reduction in ALC separations in the province (22.6%). There was also an 11.7% reduction in ALC days for South East LHIN hospitals during the period. During the same period, there was a 1.0% reduction in ALC separations and 15.8% reduction in ALC days for Ontario hospitals overall.

The discharge destinations accounting for the largest proportion of ALC days for South East LHIN hospitals were LTC (39.2%), deceased (14.1%), and home without support (11.1%). Among all LHINs, South East LHIN hospitals had the smallest proportion of ALC days discharged to chronic care.

South East LHIN residents had the 3rd highest acute care separation rate (83.8) in the province in 2013/14.

12.3% of separations by South East LHIN residents were from hospitals outside the LHIN in 2013/14.

South East LHIN residents had the 3rd longest ALC length of stay in the province. ALC separations and ALC days declined 24.0% and 15.7% respectively for South East LHIN residents from 2010/11 to 2013/14.

The average HIG weight for South East LHIN hospitals (1.58) was higher than the provincial average (1.50) in 2013/14. Among all LHINs, South East LHIN residents had the highest average HIG weight (1.62) in the province.

South East LHIN hospitals had the largest proportion of acute care days in the province for HIG 805‐rehabilitation in 2013/14. This HIG as well as 727‐fixation/repair hip/femur, and 221‐colostomy/enterostomy were in the top 10 for South East LHIN hospitals but were not among the leading HIGs for the province.

202 28 August 2015

Acute care hospital utilization, South East LHIN, 2013/14

Indicator South East LHIN Ontario†

LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital


Total days 242,391 6,278,673 ‐3.2


Acute days 210,423 5,397,903 ‐1.7





ALC days 31,968 880,770 ‐11.7










Deceased 14.1 10.8

LHIN of patient



Total days 259,514 6,216,903 ‐3.0


Acute days 227,374 5,337,257 ‐0.9





ALC days 32,140 879,646 ‐15.7



203 28 August 2015

Acute care days by top 10 HIGs, South East LHIN hospitals, 2013/14

South East LHIN Ontario Comment



5,769 2.7 161,289 3.0

(805) Rehabilitation 4,412 2.1 48,873 0.9 Largest % in province; not in Ontario top 10


4,400 2.1 83,894 1.6


4,069 1.9 87,537 1.6



(139a) Chronic Bronchitis 3,556 1.7 71,748 1.3




All other HIGs 171,524 81.5 4,532,211 84.0

Total 210,423 100.0 5,397,903 100.0

204 28 August 2015

Champlain LHIN

There were 98,426 acute separations, 583,114 acute days, and 670,783 total days from Champlain LHIN hospitals in 2013/14. Residents from outside the LHIN accounted for 10.7% of the acute separations from Champlain LHIN hospitals in 2013/14.

There were 4,494 ALC separations from Champlain LHIN hospitals in 2013/14 with an average ALC length of stay of 19.5 days.

Separations and acute days from Champlain LHIN hospitals increased between 2010/11 and 2013/14, while total days declined. During the same period, ALC separations increased by 13.2% and ALC days decreased by 22.0%.

Among all LHINs, Champlain LHIN had the 2nd longest acute length of stay and the 3rd longest total length of stay.

The discharge destinations accounting for the largest proportion of ALC days for Champlain LHIN hospitals were LTC (34.3%), home with support (23.0%), and home without support (10.6%).

Champlain LHIN residents had a lower acute care separation rate than the provincial average.

2.6% of separations by Champlain LHIN residents were from hospitals outside the LHIN in 2013/14.

In 2013/14, Champlain LHIN residents had the 2nd longest acute length of stay in the province. The average HIG weights for Champlain LHIN hospitals (1.58) and for Champlain LHIN residents

(1.56) were greater than the Ontario average (1.50) in 2013/14.

In 2013/14, the HIGs accounting for the largest proportion of acute days in Champlain LHIN hospitals were: 196‐heart failure without coronary angiogram, 138‐viral or unspecified pneumonia, 811‐general symptom/sign, and 810‐palliative care. HIGs 162‐cardiac valve replacement, 175‐percutaneous coronary intervention with MI/shock/arrest/heart failure, 221‐ colostomy/enterostomy, and (805) rehabilitation appeared in the top 10 HIGs for Champlain LHIN but were not among the leading HIGs for Ontario.

205 28 August 2015

Acute care hospital utilization, Champlain LHIN, 2013/14

Indicator Champlain LHIN Ontario†

LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital


Total days 670,783 6,278,673 ‐2.4


Acute days 583,114 5,397,903 1.4





ALC days 87,669 880,770 ‐22.0










Deceased 9.5 10.8

LHIN of patient



Total days 619,095 6,216,903 ‐2.8


Acute days 531,835 5,337,257 1.3





ALC days 87,260 879,646 ‐22.0



206 28 August 2015

Acute care days by top 10 HIGs, Champlain LHIN hospitals, 2013/14

Champlain LHIN Ontario Comment



16,545 2.8 161,289 3.0

(138) Viral/Unspecified Pneumonia 12,934 2.2 120,046 2.2 (811) General Symptom/Sign 9,649 1.7 71,218 1.3 (810) Palliative Care 9,448 1.6 119,068 2.2 (139a) Chronic Bronchitis 9,269 1.6 71,748 1.3 (139b) Chronic Obstructive Pulmonary Disease 9,195 1.6 83,894 1.6 (162) Cardiac Valve Replacement 8,496 1.5 46,621 0.9 Not in Ontario top 10

(175) Percutaneous Coronary Intervention with MI/Shock/Arrest/Heart Failure




All other HIGs 483,666 82.9 4,558,128 84.4 Total 583,114 100.0 5,397,903 100.0

207 28 August 2015


There were 33,180 acute separations, 160,990 acute days, and 204,841 total days from North

Simcoe Muskoka LHIN hospitals in 2013/14. Residents from outside the LHIN accounted for 9.8% of the acute separations from North Simcoe Muskoka LHIN hospitals.

There were 2,309 ALC separations from North Simcoe Muskoka LHIN hospitals in 2013/14 with an average ALC length of stay of 19.0 days. The % ALC days (of total days) was greater in North Simcoe Muskoka LHIN hospitals compared to Ontario hospitals in 2013/14 (21.4% and 14.0%, respectively)

Acute separations and total days increased for North Simcoe Muskoka LHIN hospitals between 2010/11 and 2013/14, while acute days decreased. During the same period, ALC separations declined 1.3% while ALC days increased by 13.1%.

The discharge destinations accounting for the largest proportion of ALC days for North Simcoe Muskoka LHIN hospitals were LTC (36.3%), home with support (19.8%) and death (15.8%).

North Simcoe Muskoka LHIN residents had a higher acute care separation rate than the province in 2013/14 (82.7 and 73.2, respectively).

22.4% of acute separations by North Simcoe Muskoka LHIN residents were from hospitals outside the LHIN in 2013/14.

The average HIG weight for North Simcoe Muskoka LHIN hospitals (1.31) was the second lowest in the province in 2013/14, while the average HIG weight for North Simcoe Muskoka LHIN residents (1.49) was comparable to that for Ontario residents (1.50).

Across all LHINs, North Simcoe Muskoka LHIN hospitals had the largest proportions of acute days for 487‐lower urinary tract infection and 139b‐chronic obstructive pulmonary disease. In addition, 477‐renal failure, and 727‐fixation/repair hip/femur were among the top 10 HIGs for North Simcoe Muskoka LHIN hospitals but were not among the leading HIGs for Ontario.

208 28 August 2015

Acute care hospital utilization, North Simcoe Muskoka LHIN, 2013/14

Indicator North Simcoe Muskoka LHIN Ontario†

LHIN % change 2010/11

‐ 2013/14

LHIN of hospital


Total days 204,841 6,278,673 1.4


Acute days 160,990 5,397,903 ‐1.4





ALC days 43,851 880,770 13.1










Deceased 15.8 10.8

LHIN of patient



Total days 235,802 6,216,903 1.1


Acute days 193,171 5,337,257 ‐0.7





ALC days 42,631 879,646 10.3



209 28 August 2015

Acute care days by top 10 HIGs, North Simcoe Muskoka LHIN hospitals, 2013/14

North Simcoe Muskoka LHIN Ontario Comment



5,392 3.3 161,289 3.0

(487) Lower Urinary Tract Infection 4,060 2.5 76,410 1.4 Largest % in province

(139b) Chronic Obstructive Pulmonary Disease 4,021 2.5 83,894 1.6 Largest % in province

(139a) Chronic Bronchitis 3,262 2.0 71,748 1.3 (138) Viral/Unspecified Pneumonia 3,224 2.0 120,046 2.2 (654) Other/Unspecified Sepsis 2,945 1.8 75,863 1.4 (026) Ischemic Event of Central Nervous System

2,761 1.7 87,537 1.6


(810) Palliative Care 2,470 1.5 119,068 2.2 (727) Fixation/Repair Hip/Femur 2,441 1.5 70,028 1.3 Not in Ontario top 10

All other HIGs 127,854 79.4 4,465,157 82.7 Total 160,990 100.0 5,397,903 100.0

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North East LHIN

There were 59,163 acute separations, 316,699 acute days, and 414,741 total days from North East LHIN hospitals in 2013/14. Residents outside the LHIN accounted for 2.7% of the acute separations from North East LHIN hospitals in 2013/14.

In 2013/14 there were 3,540 ALC separations from North East LHIN hospitals and this LHIN had the longest average ALC length of stay in the province at 27.7 days. North East LHIN hospitals also had the largest % ALC days (of total days) in the province at 23.6%.

Between 2010/11 and 2013/14, acute separations decreased slightly (0.3%), while there was a 3.3% reduction in acute days and an 18.1% reduction in total days for North East LHIN hospitals. During the same period, ALC separations decreased by 5.4% and ALC days decreased by 45.2%. Among all LHINs, North East LHIN had the greatest reduction in acute, total and ALC days between 2010/11 and 2013/14.

The discharge destinations accounting for the largest proportion of ALC days for North East LHIN hospitals were LTC (29.9%), deceased (16.0%), and home with support (15.2%). Among all LHINs, North East LHIN hospitals had the largest proportions discharged home without support and deaths and the smallest proportion of ALC days discharged to rehabilitation.

North East LHIN residents had the highest acute separation rate in the province at 113.4.

10.5% of acute separations by North East LHIN residents were from hospitals outside the LHIN in 2013/14.

Between 2010/11 and 2013/14, North East LHIN residents had the greatest reduction in acute (3.9%), total (17.6%) and ALC (45.1%) days among all LHINs in the province. Despite this reduction, North East LHIN residents had the longest average ALC length of stay in the province in 2013/14.

The average HIG weights for North East LHIN hospitals (1.42) and residents (1.48) were less than the provincial average (1.50).

Among all LHINs, North East LHIN hospitals had the largest proportions of acute days for 139a‐chronic bronchitis and 257‐symptom/sign of digestive system. HIGs 257‐symptom/sign of digestive system, 806‐convalescence, and 805‐rehabilitation were among the leading HIGs for North East LHIN hospitals but were not in the top 10 HIGs for Ontario.

211 28 August 2015

Acute care hospital utilization, North East LHIN, 2013/14

Indicator North East LHIN Ontario†

LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital

Acute separations 59,163 1,003,073 ‐0.3

Total days 414,741 6,278,673 ‐18.1


Acute days 316,699 5,397,903 ‐3.3





ALC days 98,042 880,770 ‐45.2










Deceased 16.0 10.8

LHIN of patient

Acute separations 64,281 991,471 ‐0.3


Total days 445,517 6,216,903 ‐17.6


Acute days 346,938 5,337,257 ‐3.9





ALC days 98,579 879,646 ‐45.1



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Acute care days, top 10 HIGs, by North East LHIN hospitals, 2013/14

North East LHIN Ontario Comment



9,362 3.0 161,289 3.0

(139a) Chronic Bronchitis 7,705 2.4 71,748 1.3 Largest % in province

(138) Viral/Unspecified Pneumonia 7,083 2.2 120,046 2.2 (806) Convalescence 6,963 2.2 43,778 0.8 Not in Ontario top 10


6,794 2.1 83,894 1.6

(811) General Symptom/Sign 6,716 2.1 71,218 1.3 (487) Lower Urinary Tract Infection 5,017 1.6 76,410 1.4 (321) Unilateral Knee Replacement 4,969 1.6 78,528 1.5 (805) Rehabilitation 4,839 1.5 48,873 0.9 Not in Ontario top 10

(257) Symptom/Sign of Digestive System


All Other HIGs 252,645 79.8 4,595,268 85.1 Total 316,699 100.0 5,397,903 100.0

213 28 August 2015

North West LHIN

There were 25,235 acute separations, 153,955 acute days, and 187,268 total days from North

West LHIN hospitals in 2013/14. North West LHIN hospitals had the longest acute (6.1 days) and total (7.4 days) lengths of stay in the province. Residents from outside the LHIN accounted for 2.1% of the acute separations from North West LHIN hospitals in 2013/14.

In 2013/14 there were 1,868 ALC separations from North West LHIN hospitals with an average ALC length of stay of 17.8 days, which was longer than the provincial average. The % ALC days (of total days) was greater in North West LHIN hospitals compared to Ontario in 2013/14.

Across all LHINs, North West LHIN hospitals had the greatest reduction in acute care separations (3.7%), from 2010/11 to 2013/14, while acute days and total days increased by 7.1% and 2.1%, respectively. During the same period, there was 4.9% growth in acute separations and 3.2% growth in acute care days for Ontario hospitals overall, while total days remained stable. ALC separations and days declined for North West LHIN hospitals by 13.2% and 16.0% respectively between 2010/11 and 2013/14. For Ontario overall, there was a 1.0% reduction in ALC separations and 15.8% reduction in ALC days

The discharge destinations accounting for the largest proportions of ALC days for North West LHIN hospitals were LTC (42.3%), chronic care (16.6%), and home with support (14.7%). Compared with Ontario, North West LHIN hospitals had larger proportions of ALC days discharged to LTC and smaller proportions discharged home with support, to rehabilitation, and to another facility.

North West LHIN residents had the 2nd highest acute separation rate in the province in 2013/14 at 110.4.

5.2% of acute separations by North West LHIN residents were from hospitals outside the LHIN in 2013/14.

North West LHIN residents had the longest average acute and total lengths of stay in the province in 2013/14.

ALC separations and ALC days declined for North West LHIN residents between 2010/11 and 2013/14.

The average HIG weight for North West LHIN hospitals (1.41) was less than the provincial average (1.50) while the average for North West LHIN residents (1.49) was comparable to that for Ontario residents (1.50).

North West LHIN hospitals had the largest proportions of acute days in the province for the following HIGs: 138‐viral/unspecified pneumonia, 811‐general symptom/sign, and 806‐convalescence. The following HIGs were among the top 10 HIGs for North West LHIN hospitals but were not among the top 10 for Ontario: 806‐convalescence, 805‐rehabilitation, 202‐arrhythmia without coronary angiogram.

214 28 August 2015

Acute care hospital utilization, North West LHIN, 2013/14

Indicator North West LHIN Ontario†

LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital

Acute separations 25,235 1,003,073 ‐3.7

Total days 187,268 6,278,673 2.1


Acute days 153,955 5,397,903 7.1





ALC days 33,313 880,770 ‐16.0










Deceased 11.0 10.8

LHIN of patient

Acute separations 26,079 991,471 ‐3.0


Total days 195,441 6,216,903 2.5


Acute days 162,156 5,337,257 7.2





ALC days 33,285 879,646 ‐15.8



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Acute care days by top 10 HIGs, North West LHIN hospitals, 2013/14

North West LHIN Ontario Comment



4,466 2.9 161,289 3.0



(811) General Symptom/Sign 3,676 2.4 71,218 1.3 Largest % in province;


3,625 2.4 83,894 1.6

(806) Convalescence 3,579 2.3 43,778 0.8 Largest % in province; not in Ontario top 10

(139a) Chronic Bronchitis 2,824 1.8 71,748 1.3 (805) Rehabilitation 2,541 1.7 48,873 0.9 Not in Ontario top 10

(810) Palliative Care 2,260 1.5 119,068 2.2 (026) Ischemic Event of Central Nervous System

2,172 1.4 87,537 1.6

(202) Arrhythmia without Coronary Angiogram


All Other HIGs 122,306 79.4 4,537,622

84.1

Total 153,955 100.0 5,397,903

100.0

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217 28 August 2015

Emergency Department Visits

Analysis of Unscheduled Emergency Department Utilization

Notes: This document and accompanying workbook contain analysis on unscheduled emergency department utilization. Analysis is based on data from the National Ambulatory Care Reporting System.

Prepared June 2015

CTAS levels: The Canadian Triage and Acuity Scale (CTAS), developed by the Canadian Association of Emergency Physicians (CAEP), is used by hospital emergency departments to prioritize patient’s care according to the type and severity of their presenting signs and symptoms. The levels are noted below. More information on triage level guidelines is available at: http://caep.ca/resources/ctas I Resuscitation: Conditions that are threats to life or limb (or imminent risk of deterioration) requiring immediate aggressive interventions. II Emergent: Conditions that are a potential threat to life limb or function, requiring rapid medical intervention or delegated acts. III Urgent: Conditions that could potentially progress to a serious problem requiring emergency intervention. These conditions may be associated with significant discomfort or affecting ability to function at work or activities of daily living. IV Less Urgent (Semi urgent): Conditions that are related to patient age, distress, or potential for deterioration or complications that would benefit from intervention or reassurance within 1‐2 hours. V Non Urgent: Conditions that may be acute but non‐urgent as well as conditions which may be part of a chronic problem with or without evidence of deterioration. The investigation or interventions for some of these illnesses or injuries could be delayed or even referred to other areas of the hospital or health care system.

218 28 August 2015

ONTARIO

This analysis includes unscheduled emergency department (ED) visits to comprehensive emergency departments and hospital‐based urgent care centres as reported to the National Ambulatory Care Reporting System.

There were more than 5.9 million unscheduled ED visits to Ontario hospitals in 2013/14, an increase of 6.1% from 2010/11. Champlain, HNHB, and South West LHIN hospitals had the largest number of ED visits in 2013/14.

The Canadian Triage and Acuity Scale (CTAS) is used by hospital EDs to prioritize patient’s care according to the type and severity of their presenting signs and symptoms. The triage levels consist of a five point scale (level I‐resuscitation, level II‐emergent, level III‐urgent, level IV‐less urgent, level V‐non urgent) that identify the relative urgency of the patient’s need for treatment by a health care provider. The guidelines were developed by the Canadian Association of Emergency Physicians (CAEP) and were originally published in 1999, with revisions in 2004, 2008, and 2013. The revisions have included the addition of modifiers1 and changes to the list of complaints to assist in the objective assignment of acuity levels. As a result, caution must be used when interpreting changes in CTAS levels over time as acuity levels may be influenced by changes to the CTAS guidelines.

In 2013/14, in Ontario hospitals, 36.7% of visits were in CTAS IV & V (less urgent/non urgent), 44.3% were in CTAS III (urgent), and 18.7% of visits were in CTAS I & II (resuscitation/ emergent).

Between 2010/11 and 2013/14, the number of visits in the lower acuity levels declined while those in higher acuity levels increased in Ontario hospitals. The number of visits in CTAS IV & V decreased by 9.0%, while CTAS III visits increased by 14.1% and CTAS I & II visits increased by 27.3%.

The distribution of ED visits by CTAS level differed by LHIN in 2013/14. 52.0% of ED visits to North East LHIN hospitals were in CTAS IV & V compared to 20.3% of visits in Central West LHIN hospitals. Toronto Central LHIN hospitals had the largest proportion of visits in CTAS III (54.3%), while North East LHIN hospitals had the smallest percentage (32.9%). Central West LHIN hospitals had the largest proportion of visits in CTAS I & II (25.9%), while South East LHIN hospitals had the smallest proportion (13.1%).

ED length of stay (EDLOS) refers to the length of time from the earlier of the time of visit triage or registration to either the time the patient left the ED or visit disposition. The 90th percentile refers to the length of time within which 9 out of 10 patients completed their ED visits. In Ontario hospitals in 2013/14, the 90th percentile EDLOS was 8.0 hours, however this varied by LHIN from 6.1 hours in South West LHIN hospitals to 10.4 hours for Toronto Central LHIN. The 90th percentile EDLOS in Ontario hospitals decreased from 2010/11, when it was 8.2 hours.

The leading causes for the ED visits were assigned based on the chapter of the International Statistical Classification of Diseases and Related Health Problems (ICD 10 CA) main problem diagnosis. The leading ICD‐10‐CA chapters for ED visits to Ontario hospitals in 2013/14 were 19‐Injury, poisoning and certain other consequences of external causes (23.1%); 18‐Symptoms,

1 Modifiers were divided into first and second order types; first order modifiers are those that are applicable to a wide number of different complaints (e.g. vital sign modifiers, pain severity); second order modifiers are specific to particular complaints (e.g. low blood sugar, mental health symptoms). Canadian Association of Emergency Physician (CAEP) Update, retrieved from: http://www.cjem‐online.ca/sites/default/files/CJEM_Vol_10,_No_3,_p224.pdf

219 28 August 2015

signs and abnormal clinical and laboratory findings (19.7%); and 10‐Diseases of the respiratory system (10.0%).

In 2013/14, there were 5,809,892 ED visits by Ontario residents, an increase of 5.8% from 2010/11. HNHB, Central East, and Champlain LHIN residents had the largest number of visits in 2013/14.

The distribution of visits by CTAS level varied by LHIN of patient residence, similar to the pattern observed by LHIN of hospital. Residents of the North East LHIN had the largest proportion in CTAS IV & V (51.3%) while Central West residents had the smallest proportion (23.2%). Toronto Central residents had the largest proportion of visits in CTAS III (53.5%) and Central LHIN residents had the largest proportion in CTAS I & II (25.3%).

The provincial ED visit rate (per 1,000 population) was 429.2 in 2013/14 and rates varied by LHIN of patient residence. Mississauga Halton and Central LHINs had the lowest rates (298.2 and 301.2 respectively) and North West and North East LHINs residents had the highest (858.8 and 766.8, respectively). From 2010/11 to 2013/14, the provincial rate increased by 3.3%.

ED visits best treated in alternative primary care settings include visits in CTAS IV & V for those aged 1‐74 years for conditions such as upper respiratory infections (e.g., common cold, sinusitis, tonsillitis, pharyngitis), conjunctivitis, otitis media, and cystitis, which did not result in an inpatient admission. The crude rate of ED visits that could be treated in alternative settings varied greatly by LHIN, ranging from 4.8 for Central West LHIN residents to 52.2 for North East LHIN residents. From 2010/11 to 2013/14 there was a 14.7% reduction in the provincial rate.

Differences in rates may reflect differences in access to other types of primary care services. Unscheduled emergency department visit utilization, LHIN of hospital, 2013/14

LHIN of hospital

Visits‡ % of visits by CTAS level

90th percentile EDLOS (hours) I & II III IV & V

Erie St Clair 300,551 20.5 38.8 40.6 8.1

South West 591,102 13.8 37.8 48.3 6.1

Waterloo Wellington 259,429 17.1 50.0 32.8 7.7

HNHB 650,711 19.2 47.9 32.7 9.1

Central West 244,979 25.9 53.7 20.3 8.9

Mississauga Halton 382,295 21.9 44.0 33.9 8.6

Toronto Central 536,626 24.8 54.3 20.7 10.4

Central 533,138 25.3 46.2 28.5 8.5

Central East 583,227 16.7 46.7 36.5 7.8

South East 293,317 13.1 40.0 46.4 6.6

Champlain 651,322 17.4 44.0 38.4 8.4

North Simcoe Muskoka 253,527 16.2 40.3 43.4 7.1

North East 437,125 13.2 32.9 52.0 6.2

North West 207,882 15.4 40.5 42.7 6.8

Ontario hospitals 5,925,231 18.7 44.3 36.7 8.0 ‡Includes visits with missing/unknown CTAS level

220 28 August 2015

Unscheduled emergency department visits by ICD‐10‐CA chapter, Ontario hospitals, 2013/14 Ontario

Major Ambulatory Cluster (MAC) # %

(19) Injury & Poisoning & Other Consequences of External Causes 1,366,440 23.1

(18) Symptoms, Signs & Abnormal Clinical & Lab. Findings 1,164,429 19.7

(10) Diseases of Respiratory System 589,994 10.0

(13) Diseases of Musculoskeletal System & Connective Tissue 373,092 6.3

(21) Factors Influencing Health Status & Contacts with Health Services 345,595 5.8

(11) Diseases of Digestive System 334,234 5.6

(14) Diseases of Genitourinary System 316,059 5.3

(01) Infectious & Parasitic Diseases 242,597 4.1

(12) Diseases of Skin & Subcutaneous Tissue 234,925 4.0

(05) Mental & Behavioural Disorders 224,509 3.8

(09) Diseases of Circulatory System 207,638 3.5

(08) Diseases of Ear & Mastoid Process 140,614 2.4

(06) Diseases of Nervous System 89,554 1.5

(07) Diseases of Eye & Adnexa 89,386 1.5

(15) Pregnancy, Childbirth & the Puerperium 83,848 1.4

(04) Endocrine, Nutritional & Metabolic Diseases 59,290 1.0

(03) Diseases of Blood & Blood‐Forming Organs & Disorders Involving Immune Mechanism 26,535 0.4

(02) Neoplasms 26,149 0.4

(16) Conditions Originating In Perinatal Period 8,133 0.1

(17) Congenital Malformations, Deformations & Chromosomal Abnormalities 2,210 0.0

Total 5,925,231 100.0

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Unscheduled emergency department visit utilization, LHIN of patient, 2013/14

LHIN of patient

Visits‡ % of visits by CTAS level

ED visits best treated in alternative primary care settings per

1,000§ # Rate per 1,000 I & II III IV & V

Erie St Clair 313,829 491.8 20.1 38.8 41.0 29.3

South West 552,642 574.8 14.2 38.1 47.6 42.5

Waterloo Wellington 277,151 363.5 16.9 49.0 34.0 12.7

HNHB 656,318 462.4 19.1 47.9 32.9 21.7

Central West 285,888 321.0 24.8 52.0 23.2 4.8

Mississauga Halton 355,146 298.2 23.0 45.6 31.2 6.4

Toronto Central 405,865 330.9 22.7 53.5 23.6 6.3

Central 547,103 301.2 25.3 47.4 27.3 5.9

Central East 623,218 395.6 17.7 46.6 35.6 13.9

South East 296,335 600.8 13.3 40.2 46.1 35.2

Champlain 568,884 439.8 18.2 44.9 36.7 20.7

North Simcoe Muskoka 246,066 527.3 16.7 40.8 42.5 30.2

North East 434,776 766.8 13.5 33.4 51.3 52.2

North West 202,965 858.8 15.5 40.6 42.4 45.4

Unknown 43,706 24.6 45.7 28.6

Out‐of‐province 115,339 14.1 37.9 47.9

Ontario residents† 5,809,892 429.2 18.8 44.4 36.4 18.5

‡Includes visits with missing/unknown CTAS level †Excludes out of province residents §Crude rate for residents aged 1‐74 years

222 28 August 2015

Erie St. Clair LHIN

In 2013/14, there were 300,551 ED visits to Erie St. Clair LHIN hospitals and just over 2% of these

visits were by residents from outside the LHIN. Between 2010/11 and 2013/14, there was 1.3% growth in ED visits to Erie St. Clair LHIN hospitals compared to 6.1% growth for Ontario.

Between 2010/11 and 2013/14 in Erie St. Clair LHIN hospitals, the number of visits in the lower acuity levels declined while those in the higher acuity levels increased. Specifically, the number of visits in CTAS IV & V decreased by 5.8%, while visits in CTAS III increased by 1.3% and CTAS I & II increased by 19.7%.

Compared with the province, Erie St. Clair LHIN hospitals had smaller proportions of visits in CTAS III and larger proportions of visits in the other triage levels in 2013/14.

In 2013/14, the 90th percentile EDLOS in Erie St. Clair hospitals (8.1 hours) was similar to that for Ontario hospitals (8.0).

The number of ED visits by Erie St. Clair residents was 313,829 in 2013/14 and 6.2% of these visits occurred in other LHINs. Between 2010/11 and 2013/14, both the number and rate of ED visits for LHIN residents increased.

The ED visit rate for Erie St. Clair residents was higher than the provincial average.

Between 2010/11 and 2013/14 the number of CTAS IV & V visits for Erie St. Clair residents declined, while visits in the higher acuity CTAS levels increased. Compared with Ontario residents, Erie St. Clair LHIN residents had larger proportions of visits in CTAS I &II and CTAS IV & V and a smaller proportion of visits in CTAS III.

The rate of ED visits best treated in alternative primary care settings (aged 1‐74 years) was higher for Erie St. Clair residents compared to Ontario residents. Between 2010/11 and 2013/14 there was an 8.7% reduction in the rate for Erie St. Clair LHIN residents compared to a 14.7% reduction for Ontario residents.

The leading ICD‐10‐CA chapters for ED visits in Erie St. Clair hospitals were injuries and poisonings; symptoms, signs and abnormal clinical findings; respiratory system diseases; factors influencing health status and contact with health services; and digestive system diseases. Among all LHINs, Erie St. Clair hospitals had the largest proportions of ED visits for pregnancy childbirth and the puerperium, and endocrine, nutritional and metabolic diseases.

223 28 August 2015

Unscheduled emergency department visit utilization, Erie St. Clair LHIN, 2013/14

Indicator Erie St. Clair LHIN Ontario†

LHIN % change

2010/11 ‐ 2013/14

LHIN of hospital

Visits‡ 300,551 5,925,231 1.3

# visits by CTAS level

I & II (resuscitation/emergent) 61,535 1,108,343 19.7

III (urgent) 116,720 2,625,170 1.3

IV & V (less urgent/non urgent) 121,992 2,172,564 ‐5.8

% visits by CTAS level‡

I & II (resuscitation/emergent) 20.5 18.7

III (urgent) 38.8 44.3

IV & V (less urgent/non urgent) 40.6 36.7

90th percentile EDLOS (hours) 8.1 8.0

% Inflow visits 2.1

LHIN of patient

Visits‡ 313,829 5,809,892 1.0

ED visit rate/1,000 population 491.8 429.2 1.9



III (urgent) 121,825 2,581,509 1.9


% visits by CTAS level




% Outflow visits 6.2

ED visits best treated in alternative primary care settings /1,000 population age 1‐74, crude

29.3 18.5 ‐8.7

†LHIN of pa ent results for Ontario exclude out‐of‐province residents ‡Includes visits with missing/unknown CTAS level

224 28 August 2015

Unscheduled emergency department visits by ICD‐10‐CA chapter, Erie St. Clair LHIN hospitals, 2013/14

Erie St. Clair LHIN Ontario Comment

ICD‐10‐CA Chapter # % # %

(19) Injury & Poisoning & Other Consequences Of External Causes

60,580 20.2 1,366,440 23.1

(18) Symptoms, Signs & Abnormal Clinical & Lab. Findings

56,736 18.9 1,164,429 19.7

(10) Diseases of Respiratory System 31,073 10.3 589,994 10.0

(21) Factors Influencing Health Status & Contacts with Health Services

23,054 7.7 345,595 5.8

(11) Diseases of Digestive System 18,193 6.1 334,234 5.6

(13) Diseases of Musculoskeletal System & Connective Tissue

17,970 6.0 373,092 6.3

(14) Diseases of Genitourinary System 16,730 5.6 316,059 5.3

(12) Diseases of Skin & Subcutaneous Tissue 12,347 4.1 234,925 4.0

(01) Infectious & Parasitic Diseases 11,713 3.9 242,597 4.1

(09) Diseases of Circulatory System 11,312 3.8 207,638 3.5

(05) Mental & Behavioural Disorders 11,033 3.7 224,509 3.8 (15) Pregnancy, Childbirth & the Puerperium 7,751 2.6 83,848 1.4 Largest % in province

(08) Diseases of Ear & Mastoid Process 7,248 2.4 140,614 2.4 (06) Diseases of Nervous System 4,962 1.7 89,554 1.5 (04) Endocrine, Nutritional & Metabolic Diseases 3,417 1.1 59,290 1.0 Largest % in province

(07) Diseases of Eye & Adnexa 3,404 1.1 89,386 1.5 (03) Diseases of Blood & Blood‐Forming Organs & Disorders Involving Immune Mechanism

1,457 0.5 26,535 0.4

(02) Neoplasms 1,323 0.4 26,149 0.4 (16) Conditions Originating in Perinatal Period 182 0.1 8,133 0.1 (17) Congenital Malformations, Deformations & Chromosomal Abnormalities

66 0.0 2,210 0.0

Total 300,551 100.0 5,925,231 100.0

225 28 August 2015

South West LHIN

In 2013/14, there were 591,102 ED visits to South West LHIN hospitals and 9.7% of these visits were by residents from outside the LHIN. Between 2010/11 and 2013/14, there was a 1.4% reduction in ED visits to South West LHIN hospitals compared to 6.1% growth for Ontario.

Between 2010/11 and 2013/14 in South West LHIN hospitals, the number of visits in the lower acuity levels declined while those in the higher acuity levels increased. Specifically, CTAS IV & V visits decreased by 15.6%, while CTAS III visits increased by 10.6% and CTAS I & II increased by 41.8%.

South West LHIN hospitals had a larger proportion of ED visits in CTAS IV & V compared to Ontario (48.3% and 48.3% and 36.7%, respectively) but had smaller proportions of visits in the other triage levels.

The 90th percentile EDLOS for South West LHIN hospitals (6.1 hours) was the shortest in the province.

There were 552,642 ED visits by South West LHIN residents in 2013/14 and 3.4% of these visits occurred in other LHINs. Both the number and rate of ED visits decreased for LHIN residents between 2010/11 and 2013/14.

South West LHIN residents had the 4th highest visit rate in the province, and this rate was higher than the provincial average.

ED visits decreased for the lower acuity levels (CTAS IV & V) from 2010/11 to 2013/14 while those in the higher acuity levels increased for South West LHIN residents.

In 2013/14, South West LHIN had the 3rd highest rate of ED visits best treated in alternative primary care settings in the province. The rate for South West LHIN residents declined by 17.6% between 2010/11 and 2013/14.

The leading ICD‐10‐CA chapters for ED visits in South West LHIN hospitals were injuries and poisonings; symptoms, signs and abnormal clinical findings; respiratory system diseases; factors influencing health status and contact with health services; and diseases of the musculoskeletal system. Among all LHINs, South West LHIN hospitals had the largest proportion of ED visits for diseases of the respiratory system, and of the ear and mastoid process. South West LHIN hospitals also had the smallest proportion of visits in the province for mental and behavioural disorders and diseases of blood and blood‐forming organs.

226 28 August 2015

Unscheduled emergency department visit utilization, South West LHIN, 2013/14

Indicator South West LHIN Ontario†

LHIN % change

2010/11 ‐ 2013/14

LHIN of hospital

Visits‡ 591,102 5,925,231 ‐1.4



III (urgent) 223,143 2,625,170 10.6







% Inflow visits 9.7

LHIN of patient

Visits‡ 552,642 5,809,892 ‐2.5

ED visit rate/1,000 population 574.8 429.2 ‐3.4



III (urgent) 210,364 2,581,509 9.4








42.5 18.5 ‐17.6


227 28 August 2015

Unscheduled emergency department visits by ICD‐10‐CA chapter, South West LHIN hospitals, 2013/14

South West LHIN Ontario Comment


(19) Injury & Poisoning & Other Consequences of External Causes

134,296 22.7 1,366,440 23.1


98,555 16.7 1,164,429 19.7

(10) Diseases of Respiratory System 74,176 12.5 589,994 10.0 Largest % in province


39,851 6.7 345,595 5.8


38,314 6.5 373,092 6.3





(08) Diseases of Ear & Mastoid Process 20,021 3.4 140,614 2.4 Largest % in province

(09) Diseases of Circulatory System 18,288 3.1 207,638 3.5 (05) Mental & Behavioural Disorders 16,835 2.8 224,509 3.8 Smallest % in province

(07) Diseases of Eye & Adnexa 10,061 1.7 89,386 1.5 (06) Diseases of Nervous System 8,991 1.5 89,554 1.5 (15) Pregnancy, Childbirth & the Puerperium 6,462 1.1 83,848 1.4 (04) Endocrine, Nutritional & Metabolic Diseases 5,483 0.9 59,290 1.0 (02) Neoplasms 1,919 0.3 26,149 0.4 (03) Diseases of Blood & Blood‐Forming Organs & Disorders Involving Immune Mechanism


(16) Conditions Originating in Perinatal Period 651 0.1 8,133 0.1 (17) Congenital Malformations, Deformations & Chromosomal Abnormalities

246 0.0 2,210 0.0

Total 591,102 100.0 5,925,231 100.0

228 28 August 2015


In 2013/14, there were 259,429 ED visits to Waterloo Wellington LHIN hospitals and 5.4% of these visits were by residents from outside the LHIN. Between 2010/11 and 2013/14, there was 3.6% growth in ED visits to Waterloo Wellington LHIN hospitals compared to 6.1% growth for Ontario.

Between 2010/11 and 2013/14 in Waterloo Wellington LHIN hospitals, the number of visits in the lower acuity levels declined while those in the higher acuity levels increased. Specifically, CTAS IV & V visits decreased by 18.8%, while CTAS III visits increased by 15.7% and CTAS I & II increased by 33.0%.

50.0% of ED visits to Waterloo Wellington LHIN hospitals in 2013/14 were CTAS III, which was much higher than the corresponding proportion for Ontario (44.3%). Compared with Ontario, Waterloo Wellington LHIN had smaller proportions of visits in the other triage levels.

The 90th percentile EDLOS for Waterloo Wellington LHIN hospitals was shorter than that for Ontario.

There were 277,151 ED visits by Waterloo Wellington LHIN residents in 2013/14 and 11.4% of these visits occurred in hospitals outside the LHIN. Both the number and rate of ED visits for LHIN residents increased between 2010/11 and 2013/14.

The ED visit rate for Waterloo Wellington LHIN residents was lower than the provincial average.

The number of CTAS I & II visits for Waterloo Wellington LHIN residents increased by 31.2% and CTAS III visits increased by 14.9%, while CTAS IV and V visits declined by 17.6% between 2010/11 and 2013/14.

The rate of ED visits best treated in alternative primary care settings was lower for Waterloo Wellington LHIN residents compared to Ontario residents in 2013/14.

The leading ICD‐10‐CA chapters for ED visits in Waterloo Wellington LHIN hospitals were injuries and poisonings; symptoms, signs and abnormal clinical findings; respiratory system diseases; diseases of the musculoskeletal system; and factors influencing health status and contact with health services. Among all LHINs, Waterloo Wellington LHIN hospitals had the smallest proportion of ED visits for diseases of the musculoskeletal system and for infectious and parasitic diseases.

229 28 August 2015

Unscheduled emergency department visit utilization, Waterloo Wellington LHIN, 2013/14

Indicator Waterloo Wellington LHIN Ontario†

LHIN % change 2010/11

‐ 2013/14

LHIN of hospital

Visits‡ 259,429 5,925,231 3.6



III (urgent) 129,837 2,625,170 15.7







% Inflow visits 5.4

LHIN of patient

Visits‡ 277,151 5,809,892 3.2




III (urgent) 135,729 2,581,509 14.9








12.7 18.5 ‐26.5


230 28 August 2015

Unscheduled emergency department visits by ICD‐10‐CA chapter, Waterloo Wellington LHIN hospitals, 2013/14

Waterloo Wellington LHIN Ontario Comment



63,554 24.5 1,366,440 23.1


56,352 21.7 1,164,429 19.7





14,486 5.6 345,595 5.8



(05) Mental & Behavioural Disorders 10,421 4.0 224,509 3.8

(01) Infectious & Parasitic Diseases 9,295 3.6 242,597 4.1 Smallest % in province


(12) Diseases of Skin & Subcutaneous Tissue 8,947 3.4 234,925 4.0 (08) Diseases of Ear & Mastoid Process 4,800 1.9 140,614 2.4 (15) Pregnancy, Childbirth & the Puerperium 4,504 1.7 83,848 1.4 (06) Diseases of Nervous System 4,070 1.6 89,554 1.5 (07) Diseases of Eye & Adnexa 3,249 1.3 89,386 1.5 (04) Endocrine, Nutritional & Metabolic Diseases

2,533 1.0 59,290 1.0

(03) Diseases of Blood & Blood‐Forming Organs & Disorders Involving Immune Mechanism

1,083 0.4 26,535 0.4

(02) Neoplasms 1,082 0.4 26,149 0.4 (16) Conditions Originating in Perinatal Period

333 0.1 8,133 0.1

(17) Congenital Malformations, Deformations & Chromosomal Abnormalities

59 0.0 2,210 0.0

Total 259,429 100.0 5,925,231 100.0

231 28 August 2015


In 2013/14, there were 650,711 ED visits to HNHB LHIN hospitals and 4.2% of these visits were by residents from outside the LHIN. Between 2010/11 and 2013/14, ED visits to HNHB LHIN hospitals increased by 8.6%, compared to 6.1% growth in visits for Ontario.

From 2010/11 to 2013/14 in HNHB LHIN hospitals, the number of visits in the lower acuity levels declined while those in the higher acuity levels increased. Specifically, the number of visits in CTAS IV & V decreased by 6.8%, while CTAS III visits increased by 13.7% and CTAS I & II visits increased by 29.9%.

47.9% of ED visits in HNHB LHIN hospitals in 2013/14 were in CTAS III. Compared with Ontario, HNHB LHIN hospitals had a larger proportion of visits in CTAS I & II and CTAS III and a smaller proportion of CTAS IV & V visits.

HNHB LHIN hospitals had the second longest 90th percentile EDLOS (9.1 hours) in the province in 2013/14.

There were 656,318 ED visits by HNHB LHIN residents in 2013/14 and 5.0% of these visits occurred in hospitals in other LHINs. Between 2010/11 and 2013/14 there was 8.9% growth in visits and 7.7% growth in the visit rate for HNHB LHIN residents.

The ED visit rate for HNHB LHIN residents was higher than the provincial average.

Between 2010/11 and 2013/14, CTAS I‐III visits increased for HNHB LHIN residents, while CTAS IV & V visits declined.

Compared with Ontario, HNHB LHIN residents had a higher rate of ED visits best treated in alternative primary care settings for those aged 1‐74 years in 2013/14.

The leading ICD‐10‐CA chapters for ED visits in HNHB LHIN hospitals were injuries and poisonings; symptoms, signs and abnormal clinical findings; respiratory system diseases; diseases of the musculoskeletal system; and digestive system diseases. Compared with Ontario hospitals, HNHB LHIN hospitals had larger proportions of visits for injury and poisoning, and smaller proportions of visits for diseases of the musculoskeletal system and for factors influencing health status and contact with health services.

232 28 August 2015

Unscheduled emergency department visit utilization, HNHB LHIN, 2013/14

Indicator HNHB LHIN Ontario†

LHIN % change

2010/11 ‐ 2013/14

LHIN of hospital

Visits‡ 650,711 5,925,231 8.6



III (urgent) 311,752 2,625,170 13.7







% Inflow visits 4.2

LHIN of patient

Visits‡ 656,318 5,809,892 8.9




III (urgent) 314,118 2,581,509 14.2








21.7 18.5 ‐0.5

†LHIN of patient results for Ontario exclude out‐of‐province residents ‡Includes visits with missing/unknown CTAS level

233 28 August 2015

Unscheduled emergency department visits by ICD‐10‐CA chapter, HNHB LHIN hospitals, 2013/14

HNHB LHIN Ontario Comment



157,407 24.2 1,366,440 23.1


126,074 19.4 1,164,429 19.7



37,838 5.8 373,092 6.3




30,380 4.7 345,595 5.8




(05) Mental & Behavioural Disorders 23,136 3.6 224,509 3.8 (08) Diseases of Ear & Mastoid Process 15,795 2.4 140,614 2.4 (07) Diseases of Eye & Adnexa 10,689 1.6 89,386 1.5 (06) Diseases of Nervous System 10,578 1.6 89,554 1.5 (15) Pregnancy, Childbirth & the Puerperium 7,210 1.1 83,848 1.4 (04) Endocrine, Nutritional & Metabolic Diseases 6,881 1.1 59,290 1.0 (03) Diseases of Blood & Blood‐Forming Organs & Disorders Involving Immune Mechanism

2,719 0.4 26,535 0.4


206 0.0 2,210 0.0

Total 650,711 100.0 5,925,231 100.0

234 28 August 2015

Central West LHIN

In 2013/14, there were 244,979 ED visits to hospitals in the Central West LHIN and residents from outside the LHIN accounted for 15.3% of these visits. Between 2010/11 and 2013/14, there was 17.9% growth in ED visits to Central West LHIN hospitals compared to 6.1% growth for Ontario.

From 2010/11 to 2013/14 in Central West LHIN hospitals, the number of visits in the lower acuity levels declined while those in the higher acuity levels increased. Specifically, the number of visits in CTAS IV & V decreased by 16.9%, while CTAS III visits increased by 20.0% and CTAS I & II visits increased by 66.2%.

In 2013/14, Central West hospitals had the largest proportion of CTAS I & II (25.9%) ED visits and the smallest proportion of CTAS IV & V visits (20.3%) in the province.

Central West LHIN hospitals had the 3rd longest 90th percentile EDLOS (8.9 hours) in the province.

There were 285,888 ED visits by Central West LHIN residents in 2013/14 and 27.4% of these visits occurred in hospitals outside the LHIN. ED visits for Central West LHIN residents increased by 15.1% between 2010/11 and 2013/14, while visit rates increased by 6.6%.

In 2013/14 Central West LHIN residents had the 3rd lowest ED visit rate in the province.

Central West LHIN residents had the smallest proportion of CTAS IV & V visits in the province.

In 2013/14, Central West LHIN had the lowest rate of ED visits best treated in alternative primary care settings in the province. There was a 30.4% reduction in this rate for Central West LHIN residents between 2010/11 and 2013/14.

The leading ICD‐10‐CA chapters for ED visits in Central West LHIN hospitals were symptoms, signs and abnormal clinical findings; injuries and poisonings; respiratory system diseases; diseases of the musculoskeletal system; and genitourinary system diseases. Across all LHINs, Central West LHIN hospitals had the largest proportion of visits for symptoms, signs and abnormal clinical and laboratory findings and for conditions originating in the perinatal period. Central West LHIN hospitals also had the lowest proportion of visits for factors influencing health status and contact with health services, diseases of the skin and subcutaneous tissue, diseases of the digestive system, diseases of the ear and mastoid process, diseases of the nervous system, and diseases of the eye and adnexa.

235 28 August 2015

Unscheduled emergency department utilization, Central West LHIN, 2013/14

Indicator Central West LHIN Ontario†

LHIN % change

2010/11 ‐ 2013/14

LHIN of hospital

Visits‡ 244,979 5,925,231 17.9



III (urgent) 131,636 2,625,170 20.0







% Inflow visits 15.3

LHIN of patient

Visits‡ 285,888 5,809,892 15.1




III (urgent) 148,578 2,581,509 17.0








4.8 18.5 ‐30.4


236 28 August 2015

Unscheduled emergency department visits by ICD‐10‐CA chapter, Central West LHIN hospitals, 2013/14

Central West LHIN Ontario Comment



61,057 24.9 1,164,429 19.7 Largest % in province


58,974 24.1 1,366,440 23.1



15,246 6.2 373,092 6.3


(11) Diseases of Digestive System 12,958 5.3 334,234 5.6 Smallest % in province






(12) Diseases of Skin & Subcutaneous Tissue 7,423 3.0 234,925 4.0 Smallest % in province

(15) Pregnancy, Childbirth & the Puerperium 4,550 1.9 83,848 1.4 (08) Diseases of Ear & Mastoid Process 3,929 1.6 140,614 2.4 Smallest % in province

(06) Diseases of Nervous System 3,237 1.3 89,554 1.5 Smallest % in province

(07) Diseases of Eye & Adnexa 2,726 1.1 89,386 1.5 Smallest % in province

(04) Endocrine, Nutritional & Metabolic Diseases 2,653 1.1 59,290 1.0 (03) Diseases of Blood & Blood‐Forming Organs & Disorders Involving Immune Mechanism

1,337 0.5 26,535 0.4

(02) Neoplasms 1,044 0.4 26,149 0.4 (16) Conditions Originating in Perinatal Period 519 0.2 8,133 0.1 Largest % in province


73 0.0 2,210 0.0

Total 244,979 100.0 5,925,231 100.0

237 28 August 2015


In 2013/14, there were 382,295 ED visits to Mississauga Halton LHIN hospitals and 20.8% of these visits were by residents from outside the LHIN. Between 2010/11 and 2013/14, there was 10.9% growth in ED visits to Mississauga Halton LHIN hospitals compared to 6.1% growth for Ontario.

From 2010/11 to 2013/14 in Mississauga Halton LHIN hospitals, the number of visits increased in all triage levels with growth of 10.8% for CTAS IV & V, 10.3% for CTAS III, and 12.0% for CTAS I & II. Mississauga Halton LHIN is one of only two LHINs in Ontario that experienced growth in CTAS IV & V visits. In Ontario hospitals over the same time period, CTAS IV & V visits decreased by 9.0%.

Compared with Ontario, Mississauga Halton LHIN hospitals had a larger proportion of CTAS I & II visits and a smaller proportion of CTAS IV & V visits in 2013/14.

The 90th percentile EDLOS was slightly longer in Mississauga Halton LHIN hospitals (8.6 hours) compared to Ontario hospitals (8.0 hours) in 2013/14.

There were 355,146 ED visits by Mississauga Halton LHIN residents in 2013/14, and 14.8% of these visits occurred in other LHINs. Between 2010/11 and 2013/14, there was 10.1% growth in ED visits, and 7.3% growth in the visit rate for LHIN residents.

Mississauga Halton LHIN residents had the lowest ED visit rate in the province in 2013/14.

In 2013/14, Mississauga Halton LHIN residents had larger proportions of CTAS I ‐ III visits and a smaller proportion of CTAS IV & V visits compared with Ontario residents overall.

Mississauga Halton LHIN residents had a lower rate of ED visits best treated in alternative primary care settings than the province in 2013/14 (6.4 versus 18.5). Between 2010/11 and 2013/14 there was an 8.2% reduction in this rate among Mississauga Halton LHIN residents.

The leading ICD‐10‐CA chapters for ED visits in Mississauga Halton LHIN hospitals were injuries and poisonings; symptoms, signs and abnormal clinical findings; respiratory system diseases; diseases of the musculoskeletal system; and digestive system diseases. Across all LHINs, Mississauga Halton LHIN hospitals had the smallest proportion of visits for endocrine, nutritional and metabolic diseases.

238 28 August 2015

Unscheduled emergency department visit utilization, Mississauga Halton LHIN, 2013/14

Indicator Mississauga Halton LHIN Ontario†

LHIN % change

2010/11 ‐ 2013/14

LHIN of hospital

Visits‡ 382,295 5,925,231 10.9



III (urgent) 168,244 2,625,170 10.3

IV & V (less urgent/non urgent) 129,606 2,172,564 10.8







LHIN of patient

Visits‡ 355,146 5,809,892 10.1




III (urgent) 161,855 2,581,509 10.7








6.4 18.5 ‐8.2


239 28 August 2015

Unscheduled emergency department visits by ICD‐10‐CA chapter, Mississauga Halton LHIN hospitals, 2013/14

Mississauga Halton LHIN Ontario Comment



98,945 25.9 1,366,440 23.1


87,027 22.8 1,164,429 19.7



24,294 6.4 373,092 6.3






13,648 3.6 345,595 5.8

(12) Diseases of Skin & Subcutaneous Tissue

13,137 3.4 234,925 4.0

(05) Mental & Behavioural Disorders 11,516 3.0 224,509 3.8 (15) Pregnancy, Childbirth & the Puerperium

6,719 1.8 83,848 1.4

(07) Diseases of Eye & Adnexa 6,549 1.7 89,386 1.5 (08) Diseases of Ear & Mastoid Process 6,314 1.7 140,614 2.4 (06) Diseases of Nervous System 5,195 1.4 89,554 1.5

(04) Endocrine, Nutritional & Metabolic Diseases


(02) Neoplasms 1,804 0.5 26,149 0.4 (03) Diseases of Blood & Blood‐Forming Organs & Disorders Involving Immune Mechanism

1,788 0.5 26,535 0.4

(16) Conditions Originating in Perinatal Period

637 0.2 8,133 0.1


98 0.0 2,210 0.0

Total 382,295 100.0 5,925,231 100.0

240 28 August 2015


In 2013/14, there were 536,626 ED visits to Toronto Central LHIN hospitals and 36.9% of these visits were by residents from outside the LHIN. Between 2010/11 and 2013/14, there was 9.8% growth in ED visits to Toronto Central LHIN hospitals compared to 6.1% growth for Ontario.

From 2010/11 to 2013/14, the number of visits in the lower acuity levels declined while those in the higher acuity levels increased for Toronto Central LHIN hospitals. CTAS IV & V visits decreased by 18.7%, while CTAS III visits increased by 16.3% and CTAS I & II visits increased by 33.6%.

Toronto Central LHIN hospitals had the largest proportion of CTAS III visits (54.3%) in the province and the 2nd smallest proportion of CTAS IV & V ED visits (20.7%) in 2013/14.

Toronto Central LHIN hospitals had the longest 90th percentile EDLOS in the province in 2013/14 at 10.4 hours.

There were 405,865 ED visits by Toronto Central LHIN residents in 2013/14, and 16.5% of these visits occurred in other LHINs. Between 2010/11 and 2013/14, there was a 7.3% increase in ED visits and a 0.2% increase in visit rates for Toronto Central LHIN residents.

Among all LHINs, Toronto Central LHIN residents had the 4th lowest ED visit rate, with a rate below the provincial average.

Toronto Central LHIN residents had the largest proportion of CTAS III visits (53.5%) and the 2nd smallest proportion of CTAS IV & V visits (23.6%) in the province in 2013/14.

Toronto Central LHIN residents had the 3rd lowest rate of ED visits best treated in alternative primary care settings in the province in 2013/14. Between 2010/11 and 2013/14 there was a 19.2% reduction in the rate for Toronto Central LHIN residents.

The leading ICD‐10‐CA chapters for ED visits in Toronto Central LHIN hospitals were symptoms, signs and abnormal clinical findings; injuries and poisonings; respiratory system diseases; mental health and behavioural disorders; and diseases of the musculoskeletal system. Across all LHINs, Toronto Central LHIN hospitals had the largest proportion of visits for mental health and behavioural disorders; diseases of the circulatory system; diseases of the eye and adnexa; neoplasms; diseases of the blood and blood‐forming organs; and congenital malformations, deformations and chromosomal abnormalities. Toronto Central LHIN hospitals also had the smallest proportion of ED visits in the province for diseases of the respiratory system and diseases of the genitourinary system.

241 28 August 2015

Unscheduled emergency department visit utilization, Toronto Central LHIN, 2013/14

Indicator Toronto Central LHIN Ontario†

LHIN % change

2010/11 ‐ 2013/14

LHIN of hospital

Visits‡ 536,626 5,925,231 9.8



III (urgent) 291,198 2,625,170 16.3








LHIN of patient

Visits‡ 405,865 5,809,892 7.3




III (urgent) 217,031 2,581,509 14.1








6.3 18.5 ‐19.2


242 28 August 2015

Unscheduled emergency department visits by ICD‐10‐CA chapter, Toronto Central LHIN hospitals, 2013/14

Toronto Central LHIN Ontario Comment



121,524 22.6 1,164,429 19.7


114,590 21.4 1,366,440 23.1

(10) Diseases of Respiratory System 39,056 7.3 589,994 10.0 Smallest % in province

(05) Mental & Behavioural Disorders 37,053 6.9 224,509 3.8 Largest % in province


32,368 6.0 373,092 6.3


(14) Diseases of Genitourinary System 25,951 4.8 316,059 5.3 Smallest % in province



22,977 4.3 345,595 5.8

(09) Diseases of Circulatory System 20,483 3.8 207,638 3.5 Largest % in province

(12) Diseases of Skin & Subcutaneous Tissue 18,425 3.4 234,925 4.0 (07) Diseases of Eye & Adnexa 9,978 1.9 89,386 1.5 Largest % in province

(08) Diseases of Ear & Mastoid Process 8,777 1.6 140,614 2.4 (06) Diseases of Nervous System 8,260 1.5 89,554 1.5 (15) Pregnancy, Childbirth & the Puerperium 7,790 1.5 83,848 1.4

(04) Endocrine, Nutritional & Metabolic Diseases

5,496 1.0 59,290 1.0

(02) Neoplasms 3,608 0.7 26,149 0.4 Largest % in province



(16) Conditions Originating in Perinatal Period 1,007 0.2 8,133 0.1 (17) Congenital Malformations, Deformations & Chromosomal Abnormalities

474 0.1 2,210 0.0 Largest % in province

Total 536,626 100.0 5,925,231 100.0

243 28 August 2015

Central LHIN

In 2013/14, there were 533,138 ED visits to Central LHIN hospitals and 21.3% of these visits were by residents from outside the LHIN. Between 2010/11 and 2013/14, there was 16.7% growth in ED visits to Central LHIN hospitals compared to 6.1% growth for Ontario.

From 2010/11 to 2013/14 in Central LHIN hospitals, the number of visits increased in all triage levels with growth of 7.5% for CTAS IV & V, 18.2% for CTAS III, and 26.4% for CTAS I & II. Central LHIN is one of only two LHINs in Ontario that experienced growth in the number of CTAS IV & V visits. Over the same time period, CTAS IV & V visits decreased by 9.0% overall for Ontario hospitals.

In 2013/14, Central LHIN hospitals had the 2nd largest proportion of ED visits in CTAS I & II in the province (25.3%) and the 3rd smallest proportion of CTAS IV & V visits (28.5%).

The 90th percentile EDLOS for Central LHIN hospitals (8.5) in 2013/14 was slightly longer than that for Ontario hospitals (8.0).

There were 547,103 ED visits by Central LHIN residents in 2013/14 and 23.3% of these visits occurred in other LHINs. Between 2010/11 and 2013/14 there was 12.9% growth in ED visits and 9.4% growth in the visit rate for LHIN residents.

Central LHIN residents had the 2nd lowest ED visit rate in the province in 2013/14.

Central LHIN residents had the largest proportion of visits in CTAS I & II in the province (25.3%) in 2013/14 and among the smallest proportions of visits in CTAS IV & V (27.3%).

In 2013/14, the rate of ED visits best treated in alternative primary care settings for Central LHIN residents was the 2nd lowest in Ontario (5.9) and much lower than the rate for Ontario residents (18.5). Between 2010/11 and 2013/14 the rate for Central LHIN residents declined by 10.2%.

The leading ICD‐10‐CA chapters for ED visits in Central LHIN hospitals were injuries and poisonings; symptoms, signs and abnormal clinical findings; respiratory system diseases; diseases of the musculoskeletal system; and digestive system diseases. Across all LHINs, Central LHIN hospitals had the largest proportion of visits for injuries and poisoning.

244 28 August 2015

Unscheduled emergency department visit utilization, Central LHIN, 2013/14

Indicator Central LHIN Ontario†

LHIN % change

2010/11 ‐ 2013/14

LHIN of hospital

Visits‡ 533,138 5,925,231 16.7



III (urgent) 246,065 2,625,170 18.2








LHIN of patient

Visits‡ 547,103 5,809,892 12.9




III (urgent) 259,064 2,581,509 16.0








5.9 18.5 ‐10.2


245 28 August 2015

Unscheduled emergency department visits by ICD‐10‐CA chapter, Central LHIN hospitals, 2013/14

Central LHIN Ontario Comment



139,261 26.1 1,366,440 23.1 Largest % in province


115,567 21.7 1,164,429 19.7



33,102 6.2 373,092 6.3




23,405 4.4 345,595 5.8




(05) Mental & Behavioural Disorders 17,477 3.3 224,509 3.8 (08) Diseases of the Ear & Mastoid Process 9,348 1.8 140,614 2.4 (15) Pregnancy, Childbirth & the Puerperium 8,730 1.6 83,848 1.4 (07) Diseases of the Eye & Adnexa 7,404 1.4 89,386 1.5 (06) Diseases of Nervous System 7,176 1.3 89,554 1.5

(04) Endocrine, Nutritional & Metabolic Diseases 4,980 0.9 59,290 1.0 (03) Diseases of Blood & Blood‐Forming Organs & Disorders Involving Immune Mechanism

2,657 0.5 26,535 0.4


134 0.0 2,210 0.0

Total 533,138 100.0 5,925,231 100.0

246 28 August 2015

Central East LHIN

In 2013/14, there were 583,227 ED visits to Central East LHIN hospitals and 9.4% of these visits were by residents from outside the LHIN. Between 2010/11 and 2013/14, there was 5.2% growth in ED visits for Central East LHIN hospitals compared to 6.1% growth for Ontario.

From 2010/11 to 2013/14, the number of visits in the lower acuity levels declined while those in the higher acuity levels increased for Central East LHIN hospitals. CTAS IV & V visits decreased by 6.8%, while CTAS III visits increased by 12.2% and CTAS I & II visits increased by 17.8%.

In 2013/14, CTAS III visits accounted for the largest proportion of ED visits in Central East LHIN hospitals (46.7%), which was higher than the corresponding proportion in this category in Ontario hospitals (44.3%).

Central East LHIN hospitals had a slightly shorter 90th percentile EDLOS (7.8 hours) than the province (8.0 hours) in 2013/14.

There were 623,218 ED visits by Central East LHIN residents in 2013/14 and 15.2% of these visits were from hospitals in other LHINs. Between 2010/11 and 2013/14 there was 8.2% growth in ED visits and 8.4% growth in the visit rate for LHIN residents.

The ED visit rate for Central East LHIN residents was lower than the provincial average in 2013/14.

In 2013/14, Central East LHIN residents had a larger proportion of visits in CTAS III compared to Ontario residents.

The rate of ED visits best treated in alternative primary care settings for Central East LHIN residents was lower than that for Ontario residents in 2013/14.

The leading ICD‐10‐CA chapters for ED visits in Central East LHIN hospitals were injuries and poisonings; symptoms, signs and abnormal clinical findings; respiratory system diseases; diseases of the musculoskeletal system; and digestive system diseases. Across all LHINs, Central East LHIN hospitals had the smallest proportion of visits for congenital malformations, deformations and chromosomal abnormalities.

247 28 August 2015

Unscheduled emergency department visit utilization, Central East LHIN, 2013/14

Indicator Central East LHIN Ontario†

LHIN % change

2010/11 ‐ 2013/14

LHIN of hospital

Visits‡ 583,227 5,925,231 5.2



III (urgent) 272,402 2,625,170 12.2







% Inflow visits 9.4

LHIN of patient

Visits‡ 623,218 5,809,892 8.2




III (urgent) 290,358 2,581,509 13.9








13.9 18.5 ‐10.3


248 28 August 2015

Unscheduled emergency department visits by ICD‐10‐CA chapter, Central East LHIN hospitals, 2013/14

Central East LHIN Ontario Comment



143,961 24.7 1,366,440 23.1


123,994 21.3 1,164,429 19.7



36,307 6.2 373,092 6.3



30,308 5.2 345,595 5.8





(09) Diseases of Circulatory System 20,500 3.5 207,638 3.5 (08) Diseases of Ear & Mastoid Process 11,633 2.0 140,614 2.4 (06) Diseases of Nervous System 8,461 1.5 89,554 1.5 (15) Pregnancy, Childbirth & the Puerperium 8,292 1.4 83,848 1.4 (07) Diseases of Eye & Adnexa 7,985 1.4 89,386 1.5 (04) Endocrine, Nutritional & Metabolic Diseases 6,169 1.1 59,290 1.0 (03) Diseases of Blood & Blood‐Forming Organs & Disorders Involving Immune Mechanism

2,979 0.5 26,535 0.4


123 0.0 2,210 0.0 Smallest % in province

Total 583,227 100.0 5,925,231 100.0

249 28 August 2015

South East LHIN

In 2013/14, there were 293,317 ED visits to South East LHIN hospitals and residents from outside the LHIN accounted for 6.8% of these visits. Between 2010/11 and 2013/14, there was a 1.9% reduction in ED visits for South East LHIN hospitals compared to 6.1% growth for Ontario.

From 2010/11 to 2013/14 in South East LHIN hospitals, the number of visits in the lower acuity levels declined while those in the higher acuity levels increased. Specifically, CTAS IV & V visits decreased by 10.1%, while CTAS III increased by 4.6% and CTAS I & II increased by 12.2%.

In 2013/14, 46.4% of ED visits in South East LHIN hospitals were CTAS IV & V, which was higher than the corresponding proportion for Ontario (36.7%).

South East LHIN hospitals had a shorter 90th percentile EDLOS than the province in 2013/14.

There were 296,335 ED visits by South East LHIN residents in 2013/14 and 7.8% of these visits occurred in other LHINs.

South East LHIN residents had the 3rd highest ED visit rate in the province in 2013/14. Between 2010/11 and 2013/14, both the number and rate of ED visits for LHIN residents decreased.

In 2013/14, South East LHIN residents had a larger proportion of visits in CTAS IV & V compared to Ontario residents and smaller proportions in the other triage levels. South East LHIN residents had the smallest proportion of CTAS I & II in the province.

South East LHIN residents had a higher rate of ED visits best treated in alternative primary care settings per 1,000 population than Ontario residents in 2013/14 (35.2 versus 18.5). Among South East LHIN residents this rate declined 23.0% between 2010/11 and 2013/14.

The leading ICD‐10‐CA chapters for ED visits in South East LHIN hospitals were injuries and poisonings; symptoms, signs and abnormal clinical findings; respiratory system diseases; factors influencing health status and contact with health services; and diseases of the musculoskeletal system. Across all LHINs, South East LHIN hospitals had the largest proportion of visits for diseases of the digestive system.

250 28 August 2015

Unscheduled emergency visit utilization, South East LHIN, 2013/14

Indicator South East LHIN Ontario†

LHIN % change

2010/11 ‐ 2013/14

LHIN of hospital

Visits‡ 293,317 5,925,231 ‐1.9



III (urgent) 117,286 2,625,170 4.6







% Inflow visits 6.8

LHIN of patient

Visits‡ 296,335 5,809,892 ‐1.5

ED visit rate/1,000 population 600.8 429.2 ‐2.3



III (urgent) 119,150 2,581,509 5.2








35.2 18.5 ‐23.0


251 28 August 2015

Unscheduled emergency department visits by ICD‐10‐CA chapter, South East LHIN hospitals, 2013/14

South East LHIN Ontario Comment



70,654 24.1 1,366,440 23.1


49,014 16.7 1,164,429 19.7



18,897 6.4 345,595 5.8


18,225 6.2 373,092 6.3

(11) Diseases of Digestive System 17,828 6.1 334,234 5.6 Largest % in province


(01)Infectious & Parasitic Diseases 12,973 4.4 242,597 4.1



(05) Mental & Behavioural Disorders 9,171 3.1 224,509 3.8 (08) Diseases of Ear & Mastoid Process 8,546 2.9 140,614 2.4 (07) Diseases of Eye & Adnexa 4,523 1.5 89,386 1.5 (06) Diseases of Nervous System 4,442 1.5 89,554 1.5 (15) Pregnancy, Childbirth & the Puerperium 3,305 1.1 83,848 1.4 (04) Endocrine, Nutritional & Metabolic Diseases 3,134 1.1 59,290 1.0 (02) Neoplasms 1,263 0.4 26,149 0.4 (03) Diseases of Blood & Blood‐Forming Organs & Disorders Involving Immune Mechanism

1,030 0.4 26,535 0.4


90 0.0 2,210 0.0

Total 293,317 100.0 5,925,231 100.0

252 28 August 2015

Champlain LHIN

In 2013/14, there were 651,322 ED visits to Champlain LHIN hospitals and 14.8% of these visits were by residents from outside the LHIN. Between 2010/11 and 2013/14 there was 8.0% growth in ED visits for Champlain LHIN hospitals compared to 6.1% growth for Ontario.

From 2010/11 to 2013/14 in Champlain LHIN hospitals, the number of visits in the lower acuity levels declined while those in the higher acuity levels increased. CTAS IV & V visits decreased by 9.4%, while CTAS III increased by 21.8% and CTAS I & II increased by 27.8%.

In 2013/14, CTAS III accounted for the largest proportion (44.0%) of ED visits to Champlain LHIN hospitals, which was comparable to the proportion in Ontario hospitals (44.3%). Champlain LHIN hospitals had a lower proportion of visits in the CTAS levels I & II and a larger proportion of CTAS IV & V visits compared to Ontario.

Champlain LHIN hospitals had a slightly longer 90th percentile EDLOS than the province in 2013/14.

There were 568,884 ED visits by Champlain LHIN residents in 2013/14 and 2.5% of these visits were to hospitals in other LHINs. Between 2010/11 and 2013/14, both the number and rate of ED visits for Champlain LHIN residents increased.

In 2013/14 the ED visit rate for Champlain LHIN residents was higher than the provincial average.

In 2013/14, the proportions of ED visits in all CTAS levels for Champlain LHIN residents were comparable to the proportions for Ontario residents.

The rate of ED visits best treated in alternative primary care settings for Champlain LHIN residents was higher than that for Ontario residents in 2013/14. Between 2010/11 and 2013/14 there was a 21.5% reduction in this rate for Champlain LHIN residents.

The leading ICD‐10‐CA chapters for ED visits in Champlain LHIN hospitals were injuries and poisonings; symptoms, signs and abnormal clinical findings; respiratory system diseases; diseases of the musculoskeletal system; and diseases of the digestive system. Across all LHINs, Champlain LHIN hospitals had the largest proportion of visits for infectious and parasitic diseases and diseases of the nervous system.

253 28 August 2015

Unscheduled emergency department visit utilization, Champlain LHIN, 2013/14

Indicator Champlain LHIN Ontario†

LHIN % change

2010/11 ‐ 2013/14

LHIN of hospital

Visits‡ 651,322 5,925,231 8.0



III (urgent) 286,471 2,625,170 21.8








LHIN of patient

Visits‡ 568,884 5,809,892 5.0




III (urgent) 255,357 2,581,509 20.0








20.7 18.5 ‐21.5


254 28 August 2015

Unscheduled emergency department visits by ICD‐10‐CA chapter, Champlain LHIN hospitals, 2013/14

Champlain LHIN Ontario Comment



141,738 21.8 1,366,440 23.1


117,914 18.1 1,164,429 19.7



42,456 6.5 373,092 6.3



37,176 5.7 345,595 5.8


(01) Infectious & Parasitic Diseases 30,588 4.7 242,597 4.1 Largest % in province



(09) Diseases of Circulatory System 21,596 3.3 207,638 3.5 (08) Diseases of Ear & Mastoid Process 18,836 2.9 140,614 2.4 (06) Diseases of Nervous System 10,893 1.7 89,554 1.5 Largest % in province

(15) Pregnancy, Childbirth & the Puerperium 8,809 1.4 83,848 1.4 (07) Diseases of Eye & Adnexa 8,483 1.3 89,386 1.5 (04) Endocrine, Nutritional & Metabolic Diseases 5,988 0.9 59,290 1.0 (02) Neoplasms 3,315 0.5 26,149 0.4 (03) Diseases of Blood & Blood‐Forming Organs & Disorders Involving Immune Mechanism

2,988 0.5 26,535 0.4

(16) Conditions Originating in Perinatal Period 1,366 0.2 8,133 0.1 (17) Congenital Malformations, Deformations & Chromosomal Abnormalities

378 0.1 2,210 0.0

Total 651,322 100.0 5,925,231 100.0

255 28 August 2015

North Simcoe Muskoka (NSM) LHIN

In 2013/14, there were 253,527 ED visits to North Simcoe Muskoka LHIN hospitals and 12.8% of these visits were by residents of other LHINs. Between 2010/11 and 2013/14, the number of ED visits to North Simcoe Muskoka LHIN hospitals increased 5.8% compared to 6.1% growth for Ontario.

From 2010/11 to 2013/14 in North Simcoe Muskoka LHIN hospitals, the number of visits in the lower acuity levels declined while those in the higher acuity levels increased. Specifically, CTAS IV & V visits decreased by 7.6%, while CTAS III increased by 16.9% and CTAS I & II increased by 25.7%.

CTAS IV & V accounted for the largest proportion of ED visits in North Simcoe Muskoka LHIN hospitals (43.4%), which was higher than the corresponding proportion for Ontario (36.7%). North Simcoe Muskoka LHIN hospitals had a lower proportion of visits in CTAS I‐III compared to Ontario hospitals.

North Simcoe Muskoka LHIN hospitals had a shorter 90th percentile EDLOS than the province in 2013/14.

There were 246,066 ED visits by North Simcoe Muskoka LHIN residents in 2013/14 and 10.2% of these visits occurred in other LHINs. Between 2010/11 and 2013/14, ED visits for North Simcoe Muskoka LHIN residents increased by 7.9%, while the ED visit rate increased by 5.4%.

The ED visit rate for North Simcoe Muskoka LHIN residents was higher than the provincial average in 2013/14.

In 2013/14, North Simcoe Muskoka LHIN residents had a larger proportion of CTAS IV & V visits compared to Ontario residents (42.5% versus 36.4%) and a smaller proportion of CTAS I & II visits (16.7% vs. 18.8%).

The rate of ED visits best treated in alternative primary care settings for North Simcoe Muskoka LHIN residents was higher than that for Ontario residents in 2013/14. Between 2010/11 and 2013/14 this rate declined 8.6% for North Simcoe Muskoka LHIN residents.

The leading ICD‐10‐CA chapters for ED visits in North Simcoe Muskoka LHIN hospitals were injuries and poisonings; symptoms, signs and abnormal clinical findings; respiratory system diseases; diseases of the musculoskeletal system; and diseases of the digestive system. Across all LHINs, North Simcoe Muskoka LHIN hospitals had the largest proportion of visits for diseases of the genitourinary system.

256 28 August 2015

Unscheduled emergency department visit utilization, NSM LHIN, 2013/14

Indicator NSM LHIN Ontario†

LHIN % change

2010/11 ‐ 2013/14

LHIN of hospital

Visits‡ 253,527 5,925,231 5.8



III (urgent) 102,271 2,625,170 16.9








LHIN of patient

Visits‡ 246,066 5,809,892 7.9




III (urgent) 100,457 2,581,509 19.1








30.2 18.5 ‐8.6


257 28 August 2015

Unscheduled emergency department visits by ICD‐10‐CA chapter, North Simcoe Muskoka LHIN hospitals, 2013/14

NSM LHIN Ontario Comment



61,301 24.2 1,366,440 23.1


42,788 16.9 1,164,429 19.7



16,599 6.5 373,092 6.3


(14) Diseases of Genitourinary System 14,590 5.8 316,059 5.3 Largest % in province


13,750 5.4 345,595 5.8




(05) Mental & Behavioural Disorders 8,282 3.3 224,509 3.8 (08) Diseases of Ear & Mastoid Process 6,353 2.5 140,614 2.4 (07) Diseases of Eye & Adnexa 4,239 1.7 89,386 1.5 (06) Diseases of Nervous System 3,858 1.5 89,554 1.5 (15) Pregnancy, Childbirth & the Puerperium 2,893 1.1 83,848 1.4 (04) Endocrine, Nutritional & Metabolic Diseases

2,544 1.0 59,290 1.0


935 0.4 26,535 0.4


271 0.1 8,133 0.1


60 0.0 2,210 0.0

Total 253,527 100.0 5,925,231 100.0

258 28 August 2015

North East LHIN

In 2013/14, there were 437,125 ED visits to North East LHIN hospitals and 4.4% of these visits were by residents from outside the LHIN. Between 2010/11 and 2013/14, ED visits increased by 0.6% in North East LHIN hospitals compared to 6.1% growth for Ontario hospitals.

From 2010/11 to 2013/14 in North East LHIN hospitals, the number of visits in the lower acuity levels declined while those in the higher acuity levels increased. CTAS IV & V visits decreased by 9.2%, while CTAS III visits increased by 15.9% and CTAS I & II increased by 17.0%.

Among all LHINs, North East LHIN hospitals had the largest proportion of CTAS IV & V ED visits (52.0%) and the smallest proportion of CTAS III visits (32.9%) in the province.

North East LHIN hospitals had the 2nd shortest 90th percentile EDLOS in the province in 2013/14.

There were 434,776 ED visits by North East LHIN residents in 2013/14 and 3.9% of these visits were to hospitals in other LHINs.

North East LHIN residents had the 2nd highest ED visit rate in the province in 2013/14.

North East LHIN residents had the largest proportion CTAS IV & V visits and the smallest proportion of CTAS III visits in the province.

The rate of ED visits best treated in alternative primary care settings for North East LHIN residents was the highest in the province at 52.2, almost three times the rate for Ontario residents. Between 2010/11 and 2013/14 there was an 8% reduction in this rate for North East LHIN residents.

The leading ICD‐10‐CA chapters for ED visits in North East LHIN hospitals were injuries and poisonings; symptoms, signs and abnormal clinical findings; respiratory system diseases; factors influencing health status and contact with health services; and diseases of the musculoskeletal system. Across all LHINs, North East LHIN hospitals had the largest proportion of visits for diseases of the musculoskeletal system and the smallest proportion of visits for injury and poisoning.

259 28 August 2015

Unscheduled emergency department visit utilization, North East LHIN, 2013/14

Indicator North East LHIN Ontario†

LHIN % change

2010/11 ‐ 2013/14

LHIN of hospital

Visits‡ 437,125 5,925,231 0.6



III (urgent) 143,937 2,625,170 15.9







% Inflow visits 4.4

LHIN of patient

Visits‡ 434,776 5,809,892 0.7




III (urgent) 145,144 2,581,509 16.0








52.2 18.5 ‐8.0


260 28 August 2015

Unscheduled emergency department visits by ICD‐10‐CA chapter, North East LHIN hospitals, 2013/14

North East LHIN Ontario Comment



80,907 18.5 1,366,440 23.1 Smallest % in province


75,613 17.3 1,164,429 19.7



46,157 10.6 345,595 5.8








(09) Diseases of Circulatory System 14,149 3.2 207,638 3.5 (08) Diseases of Ear & Mastoid Process 13,140 3.0 140,614 2.4 (07) Diseases of Eye & Adnexa 6,928 1.6 89,386 1.5 (06) Diseases of Nervous System 6,484 1.5 89,554 1.5 (15) Pregnancy, Childbirth & the Puerperium 4,897 1.1 83,848 1.4 (04) Endocrine, Nutritional & Metabolic Diseases

4,872 1.1 59,290 1.0


1,562 0.4 26,535 0.4


130 0.0 2,210 0.0

Total 437,125 100.0 5,925,231 100.0

261 28 August 2015

North West LHIN

In 2013/14, there were 207,882 ED visits to North West LHIN hospitals and 3.4% of these visits were by residents from outside the LHIN. North West LHIN was one of only 3 LHINs with a reduction in ED visits between 2010/11 and 2013/14 (0.6%). In contrast, there was 6.1% growth in ED visits for Ontario overall.

From 2010/11 to 2013/14 in North West LHIN hospitals, the number of visits in the lower acuity levels declined while those in the higher acuity levels increased. CTAS IV & V visits decreased by 16.8%, while CTAS III increased by 11.8% and CTAS I & II increased by 28.7%.

In 2013/14, CTAS IV & V accounted for the largest proportion of ED visits to North West LHIN hospitals (42.7%) which was greater than the corresponding proportion for Ontario (36.7%). North West LHIN hospitals also had smaller proportions of visits in CTAS I‐III compared to Ontario hospitals.

North West LHIN hospitals had a shorter 90th percentile EDLOS than the province in 2013/14.

There were 202,965 visits by North West LHIN residents in 2013/14 and 1.1% of these visits occurred in other LHINs. Between 2010/11 and 2013/14, the number of ED visits declined slightly (0.2%) while the rate of ED visits increased (0.9%) for North West LHIN residents.

North West LHIN residents had the highest ED visit rate in the province (858.8) which was twice the rate for Ontario.

The rate of ED visits best treated in alternative primary care settings for North West LHIN residents was the 2nd highest in the province at 45.4, which was more than twice the rate for Ontario residents. Between 2010/11 and 2013/14, there was a 13.7% reduction in this rate for North West LHIN residents.

The leading ICD‐10‐CA chapters for ED visits in North West LHIN hospitals were injuries and poisonings; symptoms, signs and abnormal clinical findings; respiratory system diseases; factors influencing health status and contact with health services; and diseases of the musculoskeletal system. Across all LHINs, North West LHIN hospitals had the largest proportion of visits for factors influencing health status and contact with health services and diseases of the skin and subcutaneous tissue. North West LHIN hospitals also had the smallest proportion of visits in the province for symptoms, signs & abnormal clinical & laboratory findings; diseases of the circulatory system; pregnancy, childbirth & the puerperium; neoplasms; and conditions originating in the perinatal period.

262 28 August 2015

Unscheduled emergency department visit utilization, North West LHIN, 2013/14

Indicator North West LHIN Ontario†

LHIN % change

2010/11 ‐ 2013/14

LHIN of hospital

Visits‡ 207,882 5,925,231 ‐0.6



III (urgent) 84,208 2,625,170 11.8







% Inflow visits 3.4

LHIN of patient

Visits‡ 202,965 5,809,892 ‐0.2




III (urgent) 82,486 2,581,509 12.1








45.4 18.5 ‐13.7


263 28 August 2015

Unscheduled emergency department visits by ICD‐10‐CA chapter, North West LHIN hospitals, 2013/14

North West LHIN Ontario Comment



40,272 19.4 1,366,440 23.1


32,214 15.5 1,164,429 19.7 Smallest % in province





13,800 6.6 373,092 6.3


(12) Diseases of Skin & Subcutaneous Tissue 11,400 5.5 234,925 4.0 Largest % in province




(08) Diseases of Ear & Mastoid Process 5,874 2.8 140,614 2.4 (09) Diseases of Circulatory System 5,682 2.7 207,638 3.5 Smallest % in province

(07) Diseases of Eye & Adnexa 3,168 1.5 89,386 1.5 (06) Diseases of Nervous System 2,947 1.4 89,554 1.5 (04) Endocrine, Nutritional & Metabolic Diseases

2,264 1.1 59,290 1.0

(15) Pregnancy, Childbirth & the Puerperium 1,936 0.9 83,848 1.4 Smallest % in province


706 0.3 26,535 0.4

(02) Neoplasms 658 0.3 26,149 0.4 Smallest % in province


120 0.1 8,133 0.1 Smallest % in province

Congenital Malformations, Deformations & Chromosomal Abnormalities

73 0.0 2,210 0.0

Total 437,125 100.0 5,925,231 100.0

264 28 August 2015

265 28 August 2015

Day Surgery

Analysis of Day Surgery and Cardiac Catheterization Utilization Notes: This document and the accompanying workbook contain analysis on day surgery and cardiac catheterization visits in ambulatory care for 2003/04 to 2013/14. Analysis is based on data from the National Ambulatory Care Reporting System. Prepared June 2015

266 28 August 2015

ONTARIO

Day Surgery and Cardiac Catheterization Visits In 2013/14, there were 1,250,987 visits for day surgery and cardiac catheterization to Ontario

hospitals, with the largest proportions of these visits occurring in Toronto Central, HNHB, Central East, and Central LHIN hospitals.

Between 2010/11 and 2013/14, there was 1.0% growth in visits for Ontario overall; however there was no stable trend in visits across all LHIN areas. South West, Central, Central West and South East LHINs experienced the greatest growth in visits during the period, while Toronto Central, North West, Erie St. Clair, and Mississauga Halton LHINs had the greatest reduction in visits.

There were 1,241,468 day surgery and cardiac catheterization visits for Ontario residents in 2013/14. Residents of North East, South East, and Erie St. Clair LHINs had the highest day surgery visit rates, while Toronto Central, Central West, and Mississauga Halton LHINs had the lowest.

Although there was a slight increase (0.9%) in the number of visits for Ontario residents between 2010/11 and 2013/14, there was a 1.5% reduction in the visit rate. Residents of Toronto Central, Mississauga Halton, and Central West LHINs showed the greatest reduction in the rates, while residents of the South West, South East, and North East LHINs showed the greatest increase in rates over the period.

Day surgery and ambulatory cardiac catheterization visits by LHIN of hospital, 2013/14

LHIN of hospital

Visits % Change 2010/11‐2013/14 # %

Erie St Clair 68,532 5.5 ‐5.2 South West 100,326 8.0 9.9 Waterloo Wellington 63,771 5.1 ‐1.7 HNHB 140,208 11.2 1.7 Central West 51,696 4.1 6.3 Mississauga Halton 81,507 6.5 ‐4.7 Toronto Central 144,359 11.5 ‐6.6 Central 134,471 10.7 6.8 Central East 135,140 10.8 ‐1.0 South East 62,142 5.0 5.9 Champlain 124,497 10.0 4.3 North Simcoe Muskoka 42,135 3.4 0.4 North East 74,908 6.0 3.7 North West 27,295 2.2 ‐5.7 Ontario Hospitals 1,250,987 100.0 1.0

267 28 August 2015

Day surgery and ambulatory cardiac catheterization visits by LHIN of patient residence, 2013/14

LHIN of patient residence

Visits % Change 2010/11‐2013/14

# % Rate/1000 population Visits Rate

Erie St Clair 75,926 6.1 119.0 ‐3.8 ‐3.0South West 93,448 7.5 97.2 9.7 8.7Waterloo Wellington 68,185 5.5 89.4 ‐1.6 ‐3.6HNHB 144,874 11.7 102.1 2.8 1.7Central West 62,187 5.0 69.8 0.8 ‐6.6Mississauga Halton 85,636 6.9 71.9 ‐6.0 ‐8.3Toronto Central 79,485 6.4 64.8 ‐7.0 ‐13.2Central 137,285 11.1 75.6 3.1 ‐0.1Central East 147,126 11.9 93.4 0.0 0.2South East 65,748 5.3 133.3 5.8 5.0Champlain 115,863 9.3 89.6 3.3 ‐0.6North Simcoe Muskoka 50,856 4.1 109.0 1.9 ‐0.5North East 80,554 6.5 142.1 4.1 4.0North West 28,015 2.3 118.5 ‐5.3 ‐4.3Unknown 6,280 0.5 ‐0.7 Out‐of‐province 9,519 0.8 10.9 Ontario residents† 1,241,468 100.0 91.7 0.9 ‐1.5†Excludes out‐ of‐province residents

268 28 August 2015

Erie St Clair LHIN

Day Surgery and Cardiac Catheterization Visits In 2013/14, there were 68,532 day surgery and ambulatory cardiac catheterization visits to Erie

St. Clair LHIN hospitals. Residents from outside the LHIN accounted for 1.1% of the visits in 2013/14.

Between 2010/11 and 2013/14, there was a 5.2% reduction in Erie St. Clair LHIN hospital day surgery and cardiac catheterization visits.

There were 75,926 day surgery and ambulatory cardiac catheterization visits for Erie St. Clair LHIN residents, and 10.7% of these visits occurred in hospitals outside the LHIN. There were reductions in both the number and rate of visits for LHIN residents between 2010/11 and 2013/14.

Erie St. Clair LHIN residents had the 3rd highest visit rate in the province. This rate was higher than the provincial average.

Day surgery and ambulatory cardiac catheterization visits, Erie St. Clair LHIN and Ontario, 2013/14

Indicator Erie St Clair LHIN Ontario† LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital

Visits 68,532 1,250,987 ‐5.2

% Inflow 1.1

LHIN of patient

Visits 75,926 1,241,468 ‐3.8

% Outflow 10.7

Visits per 1000 population 119.0 91.7 ‐3.0

†LHIN of pa ent results for Ontario exclude out‐of‐province residents

269 28 August 2015

South West LHIN

Day Surgery and Cardiac Catheterization Visits In 2013/14, there were 100,326 day surgery and ambulatory cardiac catheterization visits to

South West LHIN hospitals. Residents from outside the LHIN accounted for 14.4% of the visits in 2013/14.

Between 2010/11 and 2013/14, there was a 9.9% increase in visits to South West LHIN hospitals.

There were 93,448 day surgery and ambulatory cardiac catheterization visits for South West LHIN residents, and 8.0% of these visits occurred in hospitals outside the LHIN. Among all LHINs, South West LHIN residents had the largest increase in both the number and rate of visits for LHIN residents between 2010/11 and 2013/14.

South West LHIN residents had a higher visit rate compared with the province. Day surgery and ambulatory cardiac catheterization visits, South West LHIN and Ontario, 2013/14

Indicator South West LHIN Ontario† LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital

Visits 100,326 1,250,987 9.9

% Inflow 14.4

LHIN of patient

Visits 93,448 1,241,468 9.7

% Outflow 8.0

Visits per 1000 population 97.2 91.7 8.7


270 28 August 2015



Waterloo Wellington LHIN hospitals. Residents from outside the LHIN accounted for 8.5% of the visits in 2013/14.

Between 2010/11 and 2013/14, visits to Waterloo Wellington LHIN hospitals declined by 1.7%.

There were 68,185 day surgery and ambulatory cardiac catheterization visits for Waterloo Wellington LHIN residents, and 14.4% of these visits occurred in hospitals outside the LHIN. The number of visits declined by 1.6% between 2010/11 and 2013/14 while the visit rate declined by 3.6%.

The visit rate for Waterloo Wellington LHIN residents was slightly lower than the provincial average.

Day surgery and ambulatory cardiac catheterization visits, Waterloo Wellington LHIN and Ontario, 2013/14

Indicator Waterloo Wellington LHIN

Ontario† LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital

Visits 63,771 1,250,987 ‐1.7

% Inflow 8.5

LHIN of patient

Visits 68,185 1,241,468 ‐1.6

% Outflow 14.4



271 28 August 2015



HNHB LHIN hospitals. Residents from outside the LHIN accounted for 5.7% of the visits in 2013/14.

Between 2010/11 and 2013/14, there was a 1.7% increase in visits to HNHB LHIN hospitals.

There were 144,874 day surgery and ambulatory cardiac catheterization visits for HNHB LHIN residents, and 8.8% of these visits occurred in hospitals outside the LHIN. There was an increase in both the number and rate of visits for LHIN residents over the period.

The visit rate for HNHB LHIN residents was higher than the provincial average.

Day surgery and ambulatory cardiac catheterization visits, HNHB LHIN and Ontario, 2013/14

Indicator HNHB LHIN Ontario† LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital

Visits 140,208 1,250,987 1.7

% Inflow 5.7

LHIN of patient

Visits 144,874 1,241,468 2.8

% Outflow 8.8



272 28 August 2015

Central West LHIN


Central West LHIN hospitals. Residents from outside the LHIN accounted for 25.4% of the visits in 2013/14.

Between 2010/11 and 2013/14, there was 6.3% growth in Central West LHIN hospital day surgery and cardiac catheterization visits.

There were 62,187 day surgery and ambulatory cardiac catheterization visits for Central West LHIN residents, and 38.0% of these visits occurred in hospitals outside the LHIN. The number of visits for Central West LHIN residents increased by 0.8%, while the visit rate declined by 6.6% during the period.

Central West LHIN residents had the 2nd lowest visit rate in the province. This rate was much lower than the provincial average.

Day surgery and ambulatory cardiac catheterization visits, Central West LHIN and Ontario, 2013/14

Indicator Central West LHIN Ontario† LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital

Visits 51,696 1,250,987 6.3

% Inflow 25.4

LHIN of patient

Visits 62,187 1,241,468 0.8

% Outflow 38.0



273 28 August 2015



Mississauga Halton LHIN hospitals. Residents from outside the LHIN accounted for 23.7% of the visits in 2013/14.

Between 2010/11 and 2013/14, there was a 4.7% reduction in Mississauga Halton LHIN hospital day surgery and cardiac catheterization visits.

There were 85,636 day surgery and ambulatory cardiac catheterization visits for Mississauga Halton LHIN residents, and 27.4% of these visits occurred in hospitals outside the LHIN. There was a reduction in both the number and rate of visits for LHIN residents over the period.

Mississauga Halton LHIN residents had the 3rd lowest visit rate in the province. This rate was lower than the provincial average.

Day surgery and ambulatory cardiac catheterization visits, Mississauga Halton LHIN and Ontario, 2013/14



LHIN of hospital

Visits 81,507 1,250,987 ‐4.7

% Inflow 23.7

LHIN of patient

Visits 85,636 1,241,468 ‐6.0

% Outflow 27.4



274 28 August 2015



Toronto Central LHIN hospitals. Residents from outside the LHIN accounted for 57.7% in 2013/14.

Between 2010/11 and 2013/14, there was a 6.6% reduction in the number of day surgery and cardiac catheterization visits to Toronto Central LHIN hospitals.

There were 79,485 day surgery and ambulatory cardiac catheterization visits for Toronto Central LHIN residents, and 23.3% of these visits occurred in hospitals outside the LHIN. Over the period, Toronto Central LHIN residents had the largest reduction in both the number and rate of visits among all LHINs.

Toronto Central LHIN residents had the lowest visit rate in the province. This rate was much lower than the provincial average.

Day surgery and ambulatory cardiac catheterization visits, Toronto Central LHIN and Ontario, 2013/14



LHIN of hospital

Visits 144,359 1,250,987 ‐6.6

% Inflow 57.7

LHIN of patient

Visits 79,485 1,241,468 ‐7.0

% Outflow 23.3



275 28 August 2015

Central LHIN


Central LHIN hospitals. Residents from outside the LHIN accounted for 33.3% of the visits in 2013/14.

Between 2010/11 and 2013/14, visits increased by 6.8% in Central LHIN hospitals.

There were 137,285 day surgery and ambulatory cardiac catheterization visits for Central LHIN residents, and 34.7% of these visits occurred in hospitals outside the LHIN. There was an increase in the number of visits for LHIN residents over the period.

The visit rate for Central LHIN residents was lower than the provincial average. Day surgery and ambulatory cardiac catheterization visits, Central LHIN and Ontario, 2013/14

Indicator Central LHIN Ontario† LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital

Visits 134,471 1,250,987 6.8

% Inflow 33.3

LHIN of patient

Visits 137,285 1,241,468 3.1

% Outflow 34.7



276 28 August 2015

Central East LHIN


Central East LHIN hospitals. Residents from outside the LHIN accounted for 16.2% of the visits in 2013/14.

Between 2010/11 and 2013/14, visits to Central East LHIN hospitals declined by 1.0%.

There were 147,126 day surgery and ambulatory cardiac catheterization visits for Central East LHIN residents, and 23.0% of these visits occurred in hospitals outside the LHIN. From 2010/11 and 2013/14, the number and rate of visits for LHIN residents remained relatively unchanged.

The visit rate for Central East LHIN residents was slightly higher than the provincial average. Day surgery and ambulatory cardiac catheterization visits, Central East LHIN and Ontario, 2013/14

Indicator Central East LHIN Ontario† LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital

Visits 135,140 1,250,987 ‐1.0

% Inflow 16.2

LHIN of patient

Visits 147,126 1,241,468 0.0

% Outflow 23.0



277 28 August 2015

South East LHIN


South East LHIN hospitals. Residents from outside the LHIN accounted for 7.2% of the visits in 2013/14.

Between 2010/11 and 2013/14, there was 5.9% growth in South East LHIN hospital day surgery and cardiac catheterization visits.

There were 65,748 day surgery and ambulatory cardiac catheterization visits for South East LHIN residents, and 12.3% of these visits occurred in hospitals outside the LHIN. There was growth in both the number and rate of visits for LHIN residents over the period.

South East LHIN residents had the 2nd highest visit rate in the province. This rate was much higher than the provincial average.

Day surgery and ambulatory cardiac catheterization visits, South East LHIN and Ontario, 2013/14

Indicator South East LHIN Ontario† LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital

Visits 62,142 1,250,987 5.9

% Inflow 7.2

LHIN of patient

Visits 65,748 1,241,468 5.8

% Outflow 12.3


†LHIN of patient results for Ontario exclude out‐of‐province residents

278 28 August 2015

Champlain LHIN


Champlain LHIN hospitals. Residents from outside the LHIN accounted for 10.3% of the visits in 2013/14.

Between 2010/11 and 2013/14, there was 4.3% growth in Champlain LHIN hospital day surgery and cardiac catheterization visits.

There were 115,863 day surgery and ambulatory cardiac catheterization visits for Champlain LHIN residents, and 3.6% of these visits occurred in hospitals outside the LHIN. There was 3.3% growth in the number of visits but a 0.6% reduction in the rate of visits for LHIN residents over the period.

Champlain LHIN residents had a lower visit rate than the provincial average. Day surgery and ambulatory cardiac catheterization visits, Champlain LHIN and Ontario, 2013/14

Indicator Champlain LHIN Ontario† LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital

Visits 124,497 1,250,987 4.3

% Inflow 10.3

LHIN of patient

Visits 115,863 1,241,468 3.3

% Outflow 3.6



279 28 August 2015



North Simcoe Muskoka LHIN hospitals. Residents from outside the LHIN accounted for 11.2% of the visits in 2013/14.

Between 2010/11 and 2013/14, visits to North Simcoe Muskoka LHIN hospitals increased by 0.4%.

There were 50,856 day surgery and ambulatory cardiac catheterization visits for North Simcoe Muskoka LHIN residents, and 26.4% of these visits occurred in hospitals outside the LHIN. There was growth in the number of visits, but there was a slight decrease in the visit rate for LHIN residents over the period.

The visit rate for North Simcoe Muskoka LHIN residents was higher than the provincial average. Day surgery and ambulatory cardiac catheterization visits, North Simcoe Muskoka LHIN and Ontario, 2013/14

Indicator North Simcoe Muskoka LHIN


LHIN of hospital

Visits 42,135 1,250,987 0.4

% Inflow 11.2

LHIN of patient

Visits 50,856 1,241,468 1.9

% Outflow 26.4



280 28 August 2015

North East LHIN


North East LHIN hospitals. Residents from outside the LHIN accounted for 1.9% of the visits in 2013/14.

The number of visits to North East LHIN hospitals increased by 3.7% between 2010/11 and 2013/14.

There were 80,554 day surgery and ambulatory cardiac catheterization visits for North East LHIN residents, and 8.8% of these visits occurred in hospitals outside the LHIN. There was growth in both the number and rate of visits for LHIN residents over the period.

North East LHIN residents had the highest rate of day surgery and cardiac catheterization visits in the province. This rate was much higher than the provincial average.

Day surgery and ambulatory cardiac catheterization visits, North East LHIN and Ontario, 2013/14

Indicator North East LHIN Ontario† LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital

Visits 74,908 1,250,987 3.7

% Inflow 1.9

LHIN of patient

Visits 80,554 1,241,468 4.1

% Outflow 8.8



281 28 August 2015

North West LHIN

Day Surgery and Cardiac Catheterization Visits In 2013/14 there were 27,295 day surgery and ambulatory cardiac catheterization visits to North

West LHIN hospitals. Residents from outside the LHIN accounted for 0.9% of the visits in 2013/14.

Between 2010/11 and 2013/14, there was a 5.7% reduction in North West LHIN hospital day surgery and cardiac catheterization visits.

There were 28,015 day surgery and ambulatory cardiac catheterization visits for North West LHIN residents, and 3.4% of these visits occurred in hospitals outside the LHIN. Both the number and rate of visits for LHIN residents declined over the period.

North West LHIN residents had the 4th highest visit rate in the province. This rate was higher than the provincial average.

Day surgery and ambulatory cardiac catheterization visits, North West LHIN and Ontario, 2013/14

Indicator North West LHIN Ontario† LHIN % change 2010/11 ‐ 2013/14

LHIN of hospital

Visits 27,295 1,250,987 ‐5.7

% Inflow 0.9

LHIN of patient

Visits 28,015 1,241,468 ‐5.3

% Outflow 3.4



282 28 August 2015

283 28 August 2015

Inpatient Rehab

Analysis of Inpatient Rehabilitation Utilization Notes: This document and the accompanying workbook describe the utilization of adult inpatient rehabilitation units in Ontario. Analysis is based on data from the National Rehabilitation Reporting System. Prepared June 2015

284 28 August 2015

ONTARIO

Adult Inpatient Rehabilitation The National Rehabilitation Reporting System (NRS) includes information on utilization of adult

inpatient units that provide physical and cognitive rehabilitation services. This analysis summarizes admissions recorded in the NRS. There are two rehabilitation institution types in Ontario. Special rehabilitation units provide specialized services for specific patient populations (traumatic brain injury, traumatic spinal cord injury, burns, etc.). These units provide care for the residents of a broader region of the province and therefore, are not located in all LHINs. General rehabilitation units are located in all LHINs and offer multiple types of care with relatively lower treatment complexity than is provided in special rehabilitation units.2

There were 31,131 admissions to Ontario rehabilitation units in 2013/14, 87.4% of these admissions were to general and 12.6% to special units. Toronto Central, Central, and Champlain LHIN hospitals had the largest number of total admissions in the fiscal year.

There was a 4.8% increase in inpatient rehabilitation admissions between 2010/11 and 2013/14. Admissions to general units increased by 3.4%, while admissions to special units increased by 15.3%. General admissions increased in 8 of 14 LHINs, and admissions increased in 7 of the 8 LHINs that provide special rehabilitation. Hospitals in Erie St. Clair, Central West, and North East LHINs showed the largest increase in total admissions, while North Simcoe Muskoka, North West, and Toronto Central LHIN hospitals had the largest decrease in admissions, over the period.

Residents of Erie St. Clair, Central East and Champlain LHINs had the highest rehabilitation admission rates, while residents of Waterloo Wellington, North Simcoe Muskoka, and Central West LHINs had the lowest.

Adult inpatient rehabilitation admissions by LHIN of hospital and institution type, 2013/14

LHIN of hospital

General Special Total % Change 2010/11 to 2013/14

# % # % # %

Erie St. Clair 1,475 5.4 632 16.1 2,107 6.8 57.7 South West 1,759 6.5 302 7.7 2,061 6.6 22.6 Waterloo Wellington 1,007 3.7 0 0.0 1,007 3.2 1.2 HNHB 2,089 7.7 587 15.0 2,676 8.6 1.7Central West 778 2.9 0 0.0 778 2.5 53.8 Mississauga Halton 2,440 9.0 0 0.0 2,440 7.8 0.2 Toronto Central 4,916 18.1 1,511 38.5 6,427 20.6 ‐5.3 Central 4,369 16.1 39 1.0 4,408 14.2 4.0 Central East 2,940 10.8 0 0.0 2,940 9.4 ‐0.3 South East 779 2.9 0 0.0 779 2.5 12.4Champlain 3,212 11.8 413 10.5 3,625 11.6 ‐0.8 North Simcoe Muskoka 473 1.7 0 0.0 473 1.5 ‐19.1 North East 695 2.6 245 6.2 940 3.0 42.6 North West 277 1.0 193 4.9 470 1.5 ‐16.2 Ontario hospitals 27,209 100.0 3,922 100.0 31,131 100.0 4.8

2Ontario Ministry of Health and Long‐Term Care. Utilization of Adult Inpatient Rehabilitation Services in Ontario Hospitals: 2003/04‐2007/08. [Online] Available from: URL http://intra.moh.gov.on.ca/MOHLTC_Intranets/HSIMI/Branches/HealthAnalytics/AnalyticReports.html

285 28 August 2015

Adult inpatient rehabilitation admissions and admissions per 100,000 population (age 18+) by LHIN of patient residence, 2013/14

LHIN of patient

Admissions Admissions/100,000 population age 18+# % % change

2010/11 to 2013/14

Rate % change 2010/11 to 2013/14

Erie St. Clair 2,181 7.0 53.3 428.7 52.8South West 1,990 6.4 20.7 258.9 18.6Waterloo Wellington 1,107 3.6 1.7 184.7 ‐0.7HNHB 2,703 8.7 ‐1.7 236.3 ‐3.7Central West 1,400 4.5 14.2 204.9 4.9Mississauga Halton 2,722 8.8 4.1 292.2 0.4Toronto Central 3,348 10.8 1.0 331.6 ‐6.5Central 4,160 13.4 ‐1.7 287.3 ‐5.5Central East 4,501 14.5 3.3 353.5 2.5South East 866 2.8 5.6 213.1 3.6Champlain 3,485 11.2 0.8 335.0 ‐3.5North Simcoe Muskoka 768 2.5 ‐10.6 203.9 ‐13.7North East 1,072 3.5 13.9 231.3 13.1North West 475 1.5 ‐15.2 253.3 ‐15.0Unknown 215 0.7 ‐12.2 Out‐of‐province 138 ‐20.7 Ontario residents† 30,993 100.0 4.9 285.9 1.5

†Excludes out‐of‐province residents

286 28 August 2015

Erie St. Clair LHIN

Adult Inpatient Rehabilitation In 2013/14, there were 2,107 admissions to inpatient rehabilitation units in Erie St. Clair LHIN

hospitals. Of these, 70.0% were to general and 30.0% to special units. Residents from outside the LHIN accounted for 2.2% of the total rehabilitation admissions to the LHIN’s hospitals.

Between 2010/11 and 2013/14, admissions to general units in Erie St. Clair LHIN hospitals increased by 73.9%, while admissions to special units increased by 29.5%.

In 2013/14, there were 2,181 inpatient rehabilitation admissions for Erie St. Clair LHIN residents, and 5.5% were treated in hospitals outside the LHIN. Among all LHINs, Erie St. Clair residents had the largest increase in both the number and rate of admissions between 2010/11 and 2013/14.

Erie St. Clair LHIN residents had the highest admission rate in the province. This rate was approximately 1.5 times higher than the provincial average.

Adult inpatient rehabilitation admissions, Erie St. Clair LHIN and Ontario, 2013/14

Indicator Erie St. Clair LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital

General admissions 1,475 27,209 73.9

Special admissions 632 3,922 29.5

Total admissions 2,107 31,131 57.7

% Inflow 2.2

LHIN of patient


% Outflow 5.5

Admissions per 100,000 age 18+ 428.7 285.9 52.8


287 28 August 2015

South West LHIN

Adult Inpatient Rehabilitation In 2013/14, there were 2,061 admissions to inpatient rehabilitation units in South West LHIN

hospitals. Of these, 85.3% were to general units and 14.7% to special units. Residents from outside the LHIN accounted for 7.9% of the total rehabilitation admissions to the LHIN’s hospitals.

Between 2010/11 and 2013/14, admissions to South West LHIN hospital general units increased by 24.3% and admissions to special units increased by 13.5%.

In 2013/14, there were 1,990 inpatient rehabilitation admissions for South West LHIN residents, and 4.6% were treated in hospitals outside the LHIN. Both the number and rate of admissions for LHIN residents increased between 2010/11 and 2013/14.

The rehabilitation admission rate for South West LHIN residents was lower than the provincial average.

Adult inpatient rehabilitation admissions, South West LHIN and Ontario, 2013/14

Indicator South West LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital




% Inflow 7.9

LHIN of patient


% Outflow 4.6



288 28 August 2015


Adult Inpatient Rehabilitation In 2013/14, there were 1,007 admissions to inpatient rehabilitation units in Waterloo

Wellington LHIN hospitals and residents from outside the LHIN accounted for 4.1% of those admissions.

Admissions to Waterloo Wellington LHIN hospital rehabilitation units increased by 1.2% between 2010/11 and 2013/14.

In 2013/14, there were 1,107 rehabilitation admissions for Waterloo Wellington LHIN residents, and 12.7% were treated in hospitals outside the LHIN. While the number of admissions increased there was a slight decrease in the admission rate for LHIN residents between 2010/11 and 2013/14.

Waterloo Wellington LHIN residents had the lowest rehabilitation admission rate in the province in 2013/14.

Adult inpatient rehabilitation admissions, Waterloo Wellington LHIN and Ontario, 2013/14


Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital


Special admissions ‐ 3,922


% Inflow 4.1

LHIN of patient


% Outflow 12.7

Admissions per 100,000 age 18+ 184.7 285.9 ‐0.7


289 28 August 2015


Adult Inpatient Rehabilitation In 2013/14, there were 2,676 admissions to inpatient rehabilitation units in HNHB LHIN

hospitals. Of these, 78.1% were to general and 21.9% to special units. Residents from outside the LHIN accounted for 5.9% of the total admissions to the LHIN’s hospitals.

Between 2010/11 and 2013/14, admissions to general units in HNHB LHIN hospitals decreased by 5.0%, while admissions to special units increased by 35.3%.

In 2013/14, there were 2,703 rehabilitation admissions for HNHB LHIN residents, and 6.8% were treated in hospitals outside the LHIN. Both the number and rate of admissions for LHIN residents declined between 2010/11 and 2013/14.

The inpatient rehabilitation admission rate for HNHB LHIN residents was lower than the provincial average.

Adult inpatient rehabilitation admissions, HNHB LHIN and Ontario, 2013/14

Indicator HNHB LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital

General admissions 2,089 27,209 ‐5.0



% Inflow 5.9

LHIN of patient

Total admissions 2,703 30,993 ‐1.7

% Outflow 6.8



290 28 August 2015

Central West LHIN

Adult Inpatient Rehabilitation In 2013/14, there were 778 admissions to inpatient rehabilitation units in Central West LHIN

hospitals and residents from outside the LHIN accounted for 15.3% of these admissions.

Between 2010/11 and 2013/14, admissions to Central West LHIN hospitals increased by 53.8%.

In 2013/14, there were 1,400 rehabilitation admissions for Central West LHIN residents, and 52.9% were treated in hospitals outside the LHIN. Both the number and rate of admissions for LHIN residents increased between 2010/11 and 2013/14.

Central West LHIN residents had the 3rd lowest rehabilitation admission rate in the province. This rate was lower than the provincial average.

Adult inpatient rehabilitation admissions, Central West LHIN and Ontario, 2013/14

Indicator Central West LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital

General admissions 778 27,209 53.8


Total admissions 778 31,131 53.8

% Inflow 15.3

LHIN of patient


% Outflow 52.9



291 28 August 2015


Adult Inpatient Rehabilitation In 2013/14, there were 2,440 admissions to inpatient rehabilitation units in Mississauga Halton

LHIN hospitals and residents from outside the LHIN accounted for 13.4% of these admissions.

There was little change (0.2%) in the number of admissions to Mississauga Halton LHIN hospital rehabilitation units between 2010/11 and 2013/14.

In 2013/14, there were 2,722 inpatient rehabilitation admissions for Mississauga Halton LHIN residents, and 22.4% were treated in hospitals outside the LHIN. While the number of admissions for LHIN residents increased by 4.1% between 2010/11 and 2013/14, there was only a slight change (0.4%) in the admission rate. This indicates that the increase in admissions was approximately equal to the rate of population growth.

The inpatient rehabilitation admission rate for Mississauga Halton LHIN residents was higher than the provincial average.

Adult inpatient rehabilitation admissions, Mississauga Halton LHIN and Ontario, 2013/14



LHIN of hospital




% Inflow 13.4

LHIN of patient Total admissions 2,722 30,993 4.1

% Outflow 22.4

Admissions per 100,000 age 18+ 292.2 285.9 0.4 †LHIN of pa ent results for Ontario exclude out‐of‐province residents

292 28 August 2015


Adult Inpatient Rehabilitation In 2013/14, there were 6,427 admissions to inpatient rehabilitation units in Toronto Central

LHIN hospitals. Of these, 76.5% were to general and 23.5% to special units. Residents from outside the LHIN accounted for 58.3% of the total rehabilitation admissions to the LHIN’s hospitals.

Between 2010/11 and 2013/14, admissions to Toronto Central LHIN hospital general units decreased by 8.8%, while admissions to special units increased by 8.1%.

In 2013/14, there were 3,348 rehabilitation admissions for Toronto Central LHIN residents, and 19.9% were treated in hospitals outside the LHIN. Between 2010/11 and 2013/14, there was a 1.0% increase in admissions and a 6.5% reduction in the admission rate for LHIN residents.

The admission rate for Toronto Central LHIN residents was higher than the provincial average.

Adult inpatient rehabilitation admissions, Toronto Central LHIN and Ontario, 2013/14



LHIN of hospital


Special admissions 1,511 3,922 8.1


% Inflow 58.3

LHIN of patient


% Outflow 19.9



293 28 August 2015

Central LHIN

Adult Inpatient Rehabilitation In 2013/14, there were 4,408 admissions to inpatient rehabilitation units in Central LHIN


Between 2010/11 and 2013/14, admissions to Central LHIN hospital general units increased by 3.9%, while admissions to special units increased by 21.9%.

In 2013/14, there were 4,160 rehabilitation admissions for Central LHIN residents, and 34.4% were treated in hospitals outside the LHIN. Both the number and rate of admissions for LHIN residents declined between 2010/11 and 2013/14.

The admission rate for Central LHIN residents was slightly higher than the provincial average. Adult inpatient rehabilitation admissions, Central LHIN and Ontario, 2013/14

Indicator Central LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital




% Inflow 38.0

LHIN of patient


% Outflow 34.4



294 28 August 2015

Central East LHIN

Adult Inpatient Rehabilitation In 2013/14, there were 2,940 admissions to inpatient rehabilitation units in Central East LHIN

hospitals, and residents from outside the LHIN accounted for 3.7% of these admissions.

Between 2010/11 and 2013/14, admissions to Central East LHIN hospital rehabilitation units remained relatively unchanged.

In 2013/14, there were 4,501 inpatient rehabilitation admissions for Central East LHIN residents, and 37.1% were treated in hospitals outside the LHIN. Both the number and rate of admissions for LHIN residents increased between 2010/11 and 2013/14.

Central East LHIN residents had the 2nd highest admission rate in the province. This rate was higher than the provincial average.

Adult inpatient rehabilitation admissions, Central East LHIN and Ontario, 2013/14

Indicator Central East LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital




% Inflow 3.7

LHIN of patient


% Outflow 37.1



295 28 August 2015

South East LHIN

Adult Inpatient Rehabilitation In 2013/14, there were 779 admissions to inpatient rehabilitation units in South East LHIN

hospitals and residents from outside the LHIN accounted for 5.6% of these admissions.

Admissions to South East LHIN hospitals increased by 12.4% between 2010/11 and 2013/14.

In 2013/14, there were 866 rehabilitation admissions for South East LHIN residents, and 15.1% were treated in hospitals outside the LHIN. Both the number and rate of admissions for LHIN residents increased between 2010/11 and 2013/14.

The inpatient rehabilitation admission rate for South East LHIN residents was lower than the provincial average.

Adult inpatient rehabilitation admissions, South East LHIN and Ontario, 2013/14

Indicator South East LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital




% Inflow 5.6

LHIN of patient


% Outflow 15.1



296 28 August 2015

Champlain LHIN

Adult Inpatient Rehabilitation In 2013/14, there were 3,625 admissions to inpatient rehabilitation units in Champlain LHIN


Between 2010/11 and 2013/14, admissions to Champlain LHIN hospital general units decreased by 2.3%, while admissions to special units increased by 12.5%.

In 2013/14, there were 3,485 rehabilitation admissions for Champlain LHIN residents and 0.8% received treatment in hospitals outside the LHIN. Between 2010/11 and 2013/14, admissions for LHIN residents increased by 0.8%, while the admission rate declined by 3.5%. This indicates that the increase in admissions was less than the rate of population growth.

Champlain LHIN had the 3rd highest inpatient rehabilitation admission rate in the province. Adult inpatient rehabilitation admissions, Champlain LHIN and Ontario, 2013/14

Indicator Champlain LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital




% Inflow 4.6

LHIN of patient


% Outflow 0.8



297 28 August 2015


Adult Inpatient Rehabilitation In 2013/14, there were 473 admissions to inpatient rehabilitation units in North Simcoe

Muskoka LHIN hospitals and residents from outside the LHIN accounted for 4.2% of these admissions.

Admissions to North Simcoe Muskoka LHIN hospital rehabilitation units decreased by 19.1% between 2010/11 and 2013/14.

In 2013/14, there were 768 rehabilitation admissions for North Simcoe Muskoka LHIN residents, and 41.0% were treated in hospitals outside the LHIN. Both the number and rate of admissions for LHIN residents decreased between 2010/11 and 2013/14.

In 2013/14, North Simcoe Muskoka LHIN residents had the 2nd lowest inpatient rehabilitation admission rate in the province. This rate was lower than the provincial average.

Adult inpatient rehabilitation admissions, North Simcoe Muskoka LHIN and Ontario, 2013/14



LHIN of hospital

General admissions 473 27,209 ‐19.1


Total admissions 473 31,131 ‐19.1

% Inflow 4.2

LHIN of patient


% Outflow 41.0



298 28 August 2015

North East LHIN

Adult Inpatient Rehabilitation In 2013/14, there were 940 admissions to inpatient rehabilitation units in North East LHIN


Between 2010/11 and 2013/14, admissions to North East LHIN hospital general units increased by 71.2%, while admissions to special units decreased by 3.2%.

In 2013/14, there were 1,072 rehabilitation admissions for North East LHIN residents, and 13.9% were treated in hospitals outside the LHIN. Both the number and rate of admissions for LHIN residents increased between 2010/11 and 2013/14.

In 2013/14 the rehabilitation admission rate for North East LHIN residents was lower than the provincial average.

Adult inpatient rehabilitation admissions, North East LHIN and Ontario, 2013/14

Indicator North East LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital


Special admissions 245 3,922 ‐3.2


% Inflow 1.8

LHIN of patient


% Outflow 13.9



299 28 August 2015

North West LHIN

Adult Inpatient Rehabilitation In 2013/14, there were 470 admissions to inpatient rehabilitation units in North West LHIN


Between 2010/11 and 2013/14, admissions to North West LHIN hospital general units decreased by 30.1%, while admissions to special units increased by 17.0%.

In 2013/14, there were 475 admissions for North West LHIN residents, and 2.5% received treatment in hospitals outside the LHIN. Both the number and rate of admissions for LHIN residents declined between 2010/11 and 2013/14.

The rehabilitation admission rate for North West LHIN residents was lower than the provincial average.

Adult inpatient rehabilitation admissions, North West LHIN and Ontario, 2013/14

Indicator North West LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital

General admissions 277 27,209 ‐30.1



% Inflow 1.5

LHIN of patient


% Outflow 2.5



300 28 August 2015

301 28 August 2015

Mental Health

Analysis of Mental Health Utilization

Notes: This document and the accompanying workbook describe utilization and wait times for mental health services in Ontario. The analysis is based on data from the National Ambulatory Care Reporting System, the Ontario Mental Health Reporting System (which includes activity in designated adult mental health units), and ConnexOntario Health Services Information.

Prepared June 2015

302 28 August 2015

ONTARIO

Mental Health and Substance Abuse Emergency Department Visits In 2013/14, there were 222,025 unscheduled emergency department (ED) visits for Ontario

residents where the main problem or reason for the visit was a mental health (MH) or substance abuse (SA) condition. There were 279,283 visits in total or 57,258 additional visits with a MH/SA condition in any of the diagnostic fields.

Between 2010/11 and 2013/14, there was 15.9% growth in visits with a MH/SA main problem diagnosis and 16.4% growth in visits with a MH/SA condition in any diagnostic field. There was 13.1% growth in the main problem visit rate and 13.6% growth in the any problem visit rate during the period.

In 2013/14, visits with a MH/SA main problem diagnosis accounted for 3.8% of all unscheduled ED visits for Ontario residents. MH/SA visits accounted for 18.2% of all visits for those with an unknown LHIN of residence. This group includes individuals who could not be assigned to a LHIN based on the recorded postal code for the visit and will include patients who are homeless.

North West and North East LHIN residents had the highest ED visit rates for MH/SA conditions, while residents of Central and Mississauga Halton LHINs had the lowest rates.

Unscheduled emergency department utilization for mental health and substance abuse conditions by LHIN of patient residence, 2013/14

LHIN of patient

Mental Health/Substance Abuse Visits Visit Rate/1,000 population

Main Problem

% of Total ED Visits

Any Problem

% of Total ED Visits

Main Problem

Any Problem

Erie St. Clair 11,198 3.6 14,235 4.5 17.5 22.3South West 16,206 2.9 20,760 3.8 16.9 21.6Waterloo Wellington 10,667 3.8 14,362 5.2 14.0 18.8HNHB 23,342 3.6 29,366 4.5 16.4 20.7Central West 11,257 3.9 13,131 4.6 12.6 14.7Mississauga Halton 12,364 3.5 15,483 4.4 10.4 13.0Toronto Central 24,033 5.9 28,413 7.0 19.6 23.2Central 18,498 3.4 23,255 4.3 10.2 12.8Central East 23,468 3.8 29,245 4.7 14.9 18.6South East 9,305 3.1 12,466 4.2 18.9 25.3Champlain 21,688 3.8 27,634 4.9 16.8 21.4North Simcoe Muskoka 8,294 3.4 10,764 4.4 17.8 23.1North East 14,875 3.4 19,983 4.6 26.2 35.2North West 8,871 4.4 11,415 5.6 37.5 48.3Unknown LHIN 7,959 18.2 8,771 20.1 Out‐of Province 2,484 2.2 3,158 2.7

Ontario Residents† 222,025 3.8 279,283 4.8 16.4 20.6


303 28 August 2015

Utilization of Adult Designated Mental Health Beds In 2013/14, there were 56,636 admissions to and 61,372 active cases who received treatment in

Ontario adult designated MH units. There were 56,629 discharges from these units with an average length of stay of 28.0 days. Toronto Central LHIN hospitals had the largest number of active cases, admissions, discharges and total days, while South East LHIN had the longest average length of stay for discharges.

Between 2010/11 and 2013/14, the number of active cases, admissions, and discharges increased by approximately 5%. However, there was a 5.6% reduction in the total days for discharged patients. There was no stable trend in the average length of stay in Ontario over the last four years; it ranged from 25.9 days in 2012/13 to 31.2 days in 2010/11. Since patients can have an extended stay in designated MH beds, the discharge of a single long‐stay patient can skew the average length of stay values.

The case mix grouping method for OMHRS is the System for the Classification of Inpatient Psychiatry (SCIPP), which aggregates cases into broad diagnostic categories based on assessment information. The SCIPP group identifies the most resource intensive diagnosis among all the patient’s conditions. Mood disorders (30.2%), schizophrenia and psychotic disorders (28.4%), and short stay (25.4%) accounted for the largest proportions of active cases in Ontario adult designated MH units in 2013/14.

The proportion of active cases by SCIPP group varied by LHIN. Some of this variation is due to the locations and types of specialized care provided at the specialty MH hospitals. For example, Waterloo Wellington LHIN hospitals had a much larger proportion of active cases with substance related disorders, which is in part, due to the treatment focus of the Homewood Health Centre. Central West and North West LHINs had the largest proportion of short stay active cases. Central East and Erie St. Clair had the largest proportion of active cases for schizophrenia and psychotic disorders. Waterloo Wellington and South West LHINs had the largest proportion of mood disorder active cases.

Adult designated mental health unit utilization by LHIN of hospital, 2013/14

LHIN of hospital

Active cases Admissions Discharges Total Days†

Average LOS

Erie St. Clair 2,886 2,715 2,706 55,712 20.6South West 5,155 4,726 4,709 145,357 30.9Waterloo Wellington 4,794 4,403 4,388 141,996 32.4HNHB 5,708 5,297 5,269 129,292 24.5Central West 2,620 2,525 2,526 27,754 11.0Mississauga Halton 2,942 2,748 2,742 40,413 14.7Toronto Central 9,368 8,655 8,681 295,870 34.1Central 5,127 4,976 4,958 58,841 11.9Central East 5,948 5,273 5,291 180,121 34.0South East 2,538 2,204 2,245 126,933 56.5Champlain 5,820 5,442 5,415 133,900 24.7North Simcoe Muskoka 3,319 2,963 2,967 105,315 35.5North East 3,827 3,505 3,519 104,530 29.7North West 1,320 1,204 1,213 38,465 31.7

Ontario Hospitals 61,372 56,636 56,629 1,584,499 28.0

†Discharged cases only

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Proportion of active cases in adult designated mental health units by LHIN of hospital and SCIPP group, 2013/14

LHIN of hospital

SCIPP Group

Short Stay‡

Schizophrenia & psychotic disorders

Cognitive disorders

Mood disorders

Personality disorders

Substance related disorders

All other disorders†

Erie St. Clair 19.6 33.1 3.9 33.4 1.7 2.6 5.7

South West 23.9 24.7 7.4 33.9 2.0 3.1 4.9

Waterloo Wellington 17.8 15.1 2.8 39.4 2.3 16.5 6.3

HNHB 25.3 27.8 4.6 30.7 3.2 2.8 5.6

Central West 33.9 30.9 1.1 23.4 0.4 1.6 8.7

Mississauga Halton 26.2 31.0 4.9 31.4 1.1 1.8 3.6

Toronto Central 23.0 31.7 3.2 30.4 1.8 6.8 3.1

Central 31.2 30.5 3.7 26.7 2.0 1.7 4.3

Central East 21.7 33.7 5.4 31.3 1.6 1.8 4.4

South East 30.7 27.5 7.9 23.0 3.3 3.0 4.5

Champlain 25.8 30.4 7.6 25.6 2.6 3.8 4.1

North Simcoe Muskoka 29.8 24.4 3.6 29.1 3.3 4.4 5.5

North East 28.2 25.2 3.9 32.9 1.9 2.3 5.6

North West 33.9 27.3 5.4 19.0 3.5 3.2 7.7

Ontario Hospitals 25.4 28.4 4.7 30.2 2.1 4.4 4.9‡Includes inpa ent stays (for any condi on) of less than 72 hours. †Includes ea ng disorders, other disorders, ungroupable and non‐mental health SCIPP groups.

In 2013/14, there were 523.1 active cases in adult designated MH units per 100,000 Ontario residents aged 15 and older. The admission and discharge rates were comparable at 483.2 and 483.4, respectively. Residents of North East and North Simcoe Muskoka LHINs had the highest active case, admission and discharge rates.

Between 2010/11 and 2013/14, the active case, admission and discharge rates increased by approximately 3%.

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Adult designated mental health unit utilization by LHIN of patient, 2013/14

LHIN of patient

Volumes Rates per 100,000 Population Age 15+

Active Cases

Admissions Discharges Total Days Average LOS

Active Cases

Admissions Discharges

Erie St. Clair 2,997 2,798 2,779 63,086 22.7 561.9 524.6 521.1South West 4,975 4,582 4,590 136,810 29.8 618.1 569.3 570.3Waterloo Wellington

3,168 2,926 2,940 82,550 28.1 503.9 465.4 467.6

HNHB 5,924 5,496 5,467 136,244 24.9 495.2 459.4 457.0Central West 2,674 2,517 2,542 52,917 20.8 371.2 349.4 352.9Mississauga Halton

3,284 3,074 3,045 56,323 18.5 334.9 313.5 310.6

Toronto Central 6,611 6,177 6,156 184,172 29.9 630.6 589.2 587.2Central 5,966 5,669 5,672 116,471 20.5 393.4 373.8 374.0Central East 6,196 5,640 5,643 134,166 23.8 465.6 423.8 424.1South East 1,973 1,670 1,752 106,071 60.5 466.0 394.5 413.8Champlain 5,523 5,157 5,118 135,883 26.6 508.1 474.5 470.9North Simcoe Muskoka

2,876 2,621 2,628 83,430 31.8 729.1 664.5 666.3

North East 3,971 3,650 3,655 98,576 27.0 821.1 754.8 755.8North West 1,324 1,206 1,211 39,932 33.0 673.7 613.6 616.2Unknown LHIN 1,882 1,629 1,646 98,093 59.6 Out‐of Province 2,028 1,824 1,785 59,775 33.5

Ontario Residents†

59,344 54,812 54,844 1,524,724 27.8 523.1 483.2 483.4


Wait Time for Community Services Organizations that receive Ontario MOHLTC/LHIN funding to provide MH/SA services must

provide information to ConnexOntario Health Service Information for the Drug & Alcohol Helpline (DAH), Ontario Problem Gambling Helpline (OPGH) and Mental Health Helpline (MHH) registries, including regular reporting of the availability of service. Availability or "wait time" refers to the estimated date of the next available treatment slot, where treatment slot refers to a bed, appointment date, and/or caseload opening. Values shown are the median wait time (in days) for all organizations providing the service, across all reporting periods during the fiscal year. Blank values indicate that the service type is not provided within the LHIN, while those with a wait time of zero had no wait for service.

Support within housing and assertive community treatment (ACT) teams had the longest median wait times among the community MH services, while diversion and court support, early psychosis intervention, and short‐term crisis beds had the shortest wait times for Ontario. There was substantial variation in wait time by LHIN and by service type.

The provision of SA treatment services varies by LHIN area, with more specialized services such as community and residential medical/psychiatric treatment and residential supportive treatment services being provided in less than half of all LHINs. Community and residential medical/psychiatric treatment, support within housing, and residential treatment had the longest median wait times among all the SA treatment services.

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Community treatment is the only problem gambling service that is provided in all LHINs. The median wait time for Ontario was 5 days, with a range of 0 to 20 days by LHIN.

Median wait time (in days) to next available treatment slot for community mental health services by LHIN of service and service type, 2014/15 LHIN of service Abuse Service ACT Team Case

Management Counselling and

Treatment Diversion and Court Support

Erie St. Clair 0 16 0 10 0South West 0 0 3 4 0Waterloo Wellington 0 0 22 28 3HNHB 60 91 0 28 0Central West 0 0 180 30 3Mississauga Halton 120 14 16 0Toronto Central 0 151 7 42 0Central 29 1 17 21 0Central East 7 0 7 9 0South East 4 62 28 28 0Champlain 24 181 7 32 0North Simcoe Muskoka 60 0 7 14 0North East 3 17 0 20 0North West 0 26 6 0 0Ontario 3 32 5 17 0

Median wait time (in days) to next available treatment slot for community mental health services by LHIN of service and service type (continued), 2014/15 LHIN of service Early Psychosis

Intervention Short‐Term Crisis

Support Support within

Housing Vocational/Employment

Erie St. Clair 0 0 14 14South West 0 1 58 65Waterloo Wellington 4 0 456 0HNHB 0 0 32 0Central West 61 0 1095 0Mississauga Halton 7 0 83 25Toronto Central 0 0 7 28Central 4 0 32 0Central East 0 0 365 South East 4 0 93 29Champlain 0 0 0 0North Simcoe Muskoka 0 0 38 North East 0 1 30 0North West 0 0 182 14Ontario 0 0 77 9

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Median wait time (in days) to next available treatment slot for substance abuse treatment services by LHIN of service and service type, 2014/15

LHIN of service Case

Management

Community Day/Evening Treatment

Community Medical/ Psychiatric Treatment

Community Treatment

Community Withdrawal Management

Erie St. Clair 0 0 0 0South West 0 5 7 0Waterloo Wellington 50 0 5 HNHB 54 0 4 1Central West 0 0 2 Mississauga Halton 18 18 1Toronto Central 0 1 2 1Central 0 0 3 2Central East 6 28 7 1South East 0 14 Champlain 21 0 90 21 0North Simcoe Muskoka 14 7 7North East 5 0 12 0North West 0 14 Ontario 14 0 65 9 1

Median wait time (in days) to next available treatment slot for substance abuse treatment services by LHIN of service and service type (continued), 2014/15

LHIN of service

Residential Medical/ Psychiatric Treatment

Residential Supportive Level

1

Residential Supportive Level 2

Residential Treatment

Support within Housing

Erie St. Clair 32 48South West 34 90 14Waterloo Wellington 43 345HNHB 0 42 23 7Central West 344 Mississauga Halton 64 Toronto Central 32 0 57 0Central 29 71Central East 37 280South East 19 21 Champlain 98 11 11 54North Simcoe Muskoka 47 35 29North East 0 0 10 39North West 10 181 59 40Ontario 52 7 15 31 39

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Median wait time (in days) to next available treatment slot for problem gambling treatment services by LHIN of service and service type, 2014/15

LHIN of service Com. Day/Evening

Treatment Community Treatment Public Awareness Residential Treatment

Erie St. Clair 13 1 0 22South West 14Waterloo Wellington 1HNHB 0 10 0Central West 6Mississauga Halton 0 4Toronto Central 0 3 0Central 3Central East 4South East 2 0Champlain 20North Simcoe Muskoka 10North East 1 4North West 57 0 64Ontario 0 5 0 19

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Erie St. Clair LHIN

Mental Health and Substance Abuse Emergency Department Visits In 2013/14, there were 11,198 unscheduled ED visits for Erie St. Clair residents where the main

problem was a MH/SA condition. There were 14,235 visits in total or 3,037 additional visits with a MH/SA condition in any of the diagnostic fields.

Between 2010/11 and 2013/14, there was 8.3% growth in visits with a MH/SA main problem diagnosis and 10.0% growth in visits with a MH/SA condition in any diagnostic field.

The MH/SA ED visit rates for Erie St. Clair LHIN residents were higher than the provincial average. The main problem visit rate increased by 9.2% between 2010/11 and 2013/14.

Visits with a MH/SA main problem diagnosis accounted for 3.6% of all ED visits for Erie St. Clair LHIN residents.

Unscheduled emergency department utilization for mental health and substance abuse conditions, Erie St. Clair LHIN and Ontario residents, 2013/14

Indicator Erie St. Clair LHIN Ontario† % change 2010/11‐2013/14

LHIN of patient

Main problem visits 11,198 222,025 8.3

% of total ED visits 3.6 3.8

Any problem visits 14,235 279,283 10.0


Main problem, visits per 1,000 17.5 16.4 9.2

Any problem, visits per 1,000 22.3 20.6 11.0



adult designated MH units in Erie St. Clair LHIN hospitals. There were 2,706 discharges from these units with a total length of stay of 55,712 days. The average length of stay in Erie St. Clair LHIN MH units was 20.6 days compared to 28.0 days for Ontario. Residents from outside the LHIN accounted for 4.7% of the active cases treated in Erie St. Clair LHIN.

Between 2010/11 and 2013/14, Erie St. Clair LHIN hospitals had the largest increase in active cases, admissions, discharges, and days in the province. The average length of stay increased by 3.7 days over the period.

Mood disorders (33.4%) and schizophrenia and psychotic disorders (33.1%) accounted for the largest proportions of active cases in Erie St. Clair LHIN hospitals in 2013/14. Compared with the provincial average, Erie St. Clair had larger proportions of active cases for schizophrenia and psychotic disorders, mood disorder, and all other disorders, and smaller proportions of active cases for the remaining SCIPP groups.

There were 2,997 active cases, 2,798 admissions and 2,779 discharges for Erie St. Clair LHIN residents from Ontario adult designated MH units. 8.3% of Erie St. Clair LHIN resident active cases received treatment in hospitals outside the LHIN. Compared with the provincial average, Erie St. Clair LHIN residents had higher rates of active cases, admissions, and discharges per 100,000 population age 15+.

Active cases, admissions, discharges, total days and the associated rates increased for Erie St. Clair LHIN residents between 2010/11 and 2013/14.

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Adult designated mental health unit utilization, Erie St. Clair LHIN hospitals and residents, 2013/14

Indicator Erie St. Clair LHIN Ontario† % change 2010/11‐2013/14

LHIN of hospital

Active cases 2,886 61,372 27.5

Admissions 2,715 56,636 26.8

Discharges 2,706 56,629 27.0

Total Days (discharged patients only) 55,712 1,584,499 55.2

Average Length of Stay 20.6 28.0

% Inflow Active Cases 4.7

% of Active Cases by SCIPP Group:

Short Stay 19.6 25.4

Schizophrenia & Psychotic Disorders 33.1 28.4

Cognitive Disorders 3.9 4.7

Mood Disorders 33.4 30.2

Personality Disorders 1.7 2.1

Substance Related Disorders 2.6 4.4

All Other Disorders 5.7 4.9

LHIN of patient

Active cases 2,997 59,344 20.1

Admissions 2,798 54,812 20.8

Discharges 2,779 54,844 20.6

Total Days 63,086 1,524,724 19.7


% Outflow Active Cases 8.3

Active Cases per 100,000 (age 15+) 561.9 523.1 20.1

Admission per 100,000 (age 15+) 524.6 483.2 20.7

Discharges per 100,000 (age 15+) 521.1 483.4 20.5


Wait Time for Community Services ACT teams, support within housing and vocational/employment programs had the longest

median wait times among the community MH services in Erie St. Clair LHIN in 2014/15. With the exception of vocational/employment programs, Erie St. Clair LHN had shorter median wait times than the province for all community MH services in 2013/14 and 2014/15.

Among the SA services provided in Erie St. Clair LHIN, only residential treatment and support within housing had wait times in 2013/14‐2014/15. In 2014/15, the median wait time in the LHIN was 9 days longer than the province for support within housing, while the median wait time for residential treatment was only 1 day longer than the provincial median wait time.

In 2014/15, residential treatment and community day/evening treatment for problem gambling had the longest median wait times for services provided within the Erie St. Clair LHIN. The median wait times for problem gambling residential treatment and community day/evening

311 28 August 2015

treatment were greater than the provincial medians, while the median wait time for community treatment in Erie St. Clair was less than that for Ontario.

Median wait time (in days) to next available treatment slot for community mental health, substance abuse and problem gambling services by service type, Erie St. Clair LHIN service providers, 2013/14‐2014/15

Service Type

Erie St. Clair LHIN Ontario

2013/14 2014/15 2013/14 2014/15 Community Mental Health Services Abuse Service 0 0 3 3

Assertive Community Treatment Team 11 16 41 32

Case Management 0 0 4 5

Counselling and Treatment 7 10 16 17

Diversion and Court Support 0 0 0 0

Early Psychosis Intervention 0 0 0 0

Short‐Term Crisis Support Beds 0 0 0 0

Support Within Housing 27 14 53 77

Vocational/Employment 14 14 3 9

Substance Abuse Services

Case Management 14 14

Centralized/Coordination Access 0 0

Community Day/Evening Treatment 0 0 0 0

Community Medical/Psychiatric Treatment 0 0 55 65

Community Treatment 0 0 11 9

Community Withdrawal Management 0 0 1 1

Residential Medical/Psychiatric Treatment 48 52

Residential Supportive Level 1 17 7


Residential Treatment 34 32 32 31

Support within Housing 51 48 52 39

Problem Gambling Services



Public Awareness 0 0 1 0


312 28 August 2015

South West LHIN

Mental Health and Substance Abuse Emergency Department Visits In 2013/14, there were 16,206 unscheduled ED visits for South West LHIN residents where the

main problem was a MH/SA condition. There were 20,760 visits in total or 4,554 additional visits with a MH/SA condition in any of the diagnostic fields.


The rate of MH/SA ED visits for South West LHIN residents was comparable to the provincial average. The main problem visit rate increased by 6.9% over the period.

Visits with a MH/SA main problem diagnosis accounted for 2.9% of all unscheduled ED visits for South West LHIN residents, compared to 3.8% of ED visits for Ontario residents overall.

Unscheduled emergency department utilization for mental health and substance abuse conditions, South West LHIN and Ontario residents, 2013/14

Indicator South West LHIN Ontario† % change 2010/11‐2013/14

LHIN of patient








Utilization of Adult Designated Mental Health Beds In 2013/14 there were 4,762 admissions to and 5,155 active cases who received treatment in

adult designated MH units in South West LHIN hospitals. There were 4,709 discharges from these units with a total length of stay of 145,357 days. The average length of stay in South West LHIN MH units was 30.9 days, slightly longer than the provincial average of 28.0 days. Residents from outside the LHIN accounted for 10.8% of the active cases treated in South West LHIN.

Active cases and total days declined between 2010/11 to 2013/14, while admissions and discharges increased slightly. Active cases decreased by 1.2% and total days by 35.4%, while the average length of stay decreased by 17.3 days over the period. Admissions increased by 1.6% and discharges by 0.8%.

Mood disorders (33.9%) and schizophrenia and psychotic disorders (24.7%) accounted for the largest proportions of active cases in South West LHIN hospitals in 2013/14. Compared with the provincial average, South West LHIN had larger proportions of active cases with cognitive disorders and mood disorders.

There were 4,975 active cases, 4,582 admissions and 4,590 discharges for South West LHIN residents from Ontario adult designated MH units. 7.6% of South West LHIN resident active cases received treatment in hospitals outside the LHIN. Compared with the provincial average, South West LHIN residents had higher rates of active cases, admissions, and discharges per 100,000.

Active cases, admissions, and discharges, and the associated rates increased for South West LHIN residents between 2010/11 and 2013/14, but there was a 24.0% reduction in total days.

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Adult designated mental health unit utilization, South West LHIN hospitals and residents, 2013/14

Indicator South West LHIN Ontario† % change 2010/11‐2013/14

LHIN of hospital

Active cases 5,155 61,372 ‐1.2

Admissions 4,726 56,636 1.6

Discharges 4,709 56,629 0.8

Total Days (discharged patients only) 145,357 1,584,499 ‐35.4











LHIN of patient

Active cases 4,975 59,344 4.3

Admissions 4,582 54,812 5.6

Discharges 4,590 54,844 6.5

Total Days 136,810 1,524,724 ‐24.0







Wait Time for Community Services

In 2014/15, vocational/employment and support within housing had the longest median wait times among the community MH services provided in South West LHIN. The median wait time for vocational/employment in the South West LHIN was greater than the median for Ontario, while the median wait for all other services was less than or equal to those for the province.

Among the SA services provided in South West LHIN, residential treatment and residential supportive level 1 services had the longest median wait times, which were longer than the median wait times for Ontario. In addition, the median wait time for community day/evening treatment in South West LHIN was longer than that for the province in 2014/15.

In 2014/15, community treatment was the only problem gambling service provided in the South West LHIN and the median wait time for this service was greater than the provincial median.

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Median wait time(in days) to next available treatment slot for community mental health, substance abuse and problem gambling services by service type, South West LHIN service providers, 2013/14‐2014/15

Service Type

South West LHIN Ontario









Vocational/Employment 65 3 9





Community Medical/Psychiatric Treatment 55 65




Residential Supportive Level 1 46 34 17 7





Community Day/Evening Treatment 0 0


Public Awareness 1 0

Residential Treatment 37 19

315 28 August 2015


Mental Health and Substance Abuse Emergency Department Visits In 2013/14, there were 10,667 unscheduled ED visits for Waterloo Wellington residents where

the main problem was a MH/SA condition. There were 14,362 visits in total or 3,695 additional visits with a MH/SA condition in any of the diagnostic fields.


The MH/SA ED visit rates for Waterloo Wellington LHIN residents were lower than the provincial average. The main problem visit rate increased by 10.2% between 2010/11 and 2013/14.

Visits with a MH/SA main problem diagnosis accounted for 3.8% of all ED visits for Waterloo Wellington LHIN residents.

Unscheduled emergency department utilization for mental health and substance abuse conditions, Waterloo Wellington LHIN and Ontario residents, 2013/14


Ontario† % change 2010/11‐2013/14

LHIN of patient









adult designated MH units in Waterloo Wellington LHIN hospitals. There were 4,388 discharges from these units with a total length of stay of 141,996 days. The average length of stay in Waterloo Wellington LHIN MH units was 32.4 days compared to 28.0 days for Ontario. Residents from outside the LHIN accounted for 39.6% of the active cases treated in Waterloo Wellington LHIN.

The number of active cases, admissions, and discharges for Waterloo Wellington LHIN hospitals decreased slightly between 2010/11 to 2013/14, while there was a 15.5% increase in total days.

Mood disorders (39.4%), short stay (17.8%), and substance related disorders (16.5%) accounted for the largest proportions of active cases in Waterloo Wellington LHIN adult MH units in 2013/14. Compared with the provincial average, Waterloo Wellington had larger proportions of active cases for mood disorders, substance related disorders, and ‘all other’ disorders.

There were 3,168 active cases, 2,926 admissions and 2,940 discharges for Waterloo Wellington LHIN residents from Ontario adult designated MH units. Among Waterloo Wellington LHIN resident active cases, 8.6% received treatment in hospitals outside the LHIN. Compared with the provincial average, Waterloo Wellington LHIN residents had lower rates of active cases, admissions, and discharges per 100,000.

Active cases, admissions, discharges, and the associated rates for Waterloo Wellington LHIN residents declined between 2010/11 and 2013/14.

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Adult designated mental health unit utilization, Waterloo Wellington LHIN hospitals and residents, 2013/14


Ontario† % change 2010/11‐2013/14

LHIN of hospital

Active cases 4,794 61,372 ‐1.0

Admissions 4,403 56,636 ‐2.8

Discharges 4,388 56,629 ‐1.6












LHIN of patient

Active cases 3,168 59,344 ‐3.4

Admissions 2,926 54,812 ‐5.6

Discharges 2,940 54,844 ‐4.3

Total Days 82,550 1,524,724 9.4



Active Cases per 100,000 (age 15+) 503.9 523.1 ‐5.6

Admission per 100,000 (age 15+) 465.4 483.2 ‐7.8

Discharges per 100,000 (age 15+) 467.6 483.4 ‐6.5


Wait Time for Community Services In 2013/14 and 2014/15, support within housing, counselling/treatment, and case management

had the longest median wait times among the community MH services provided in Waterloo Wellington LHIN. The median wait times for these services in addition to diversion and court support, and early psychosis treatment were greater than those for Ontario.

Among the SA services provided in Waterloo Wellington LHIN, support within housing, case management, and residential treatment had the longest median wait times in 2014/15. The median wait times for these services were longer than those for the province.

Community treatment was the only problem gambling service type provided within the Waterloo Wellington LHIN and the median wait time for this service was less than the median for the province.

317 28 August 2015

Median wait time (in days) to next available treatment slot for community mental health, substance abuse and problem gambling services by service type, Waterloo Wellington LHIN service providers, 2013/14‐2014/15

Service Type

Waterloo Wellington LHIN Ontario
















Community Withdrawal Management 1 1











318 28 August 2015

Hamilton Niagara Haldimand Brant LHIN

Mental Health and Substance Abuse Emergency Department Visits In 2013/14, there were 23,342 unscheduled ED visits for HNHB residents where the main


Between 2010/11 and 2013/14, there was 17.1% growth in visits with a MH/SA main problem diagnosis.

The MH/SA visit rates for HNHB LHIN residents were comparable to the provincial average and these rates increased between 2010/11 and 2013/14.

Visits with a MH/SA main problem diagnosis accounted for 3.6% of all unscheduled ED visits for HNHB LHIN residents.

Unscheduled emergency department utilization for mental health and substance abuse conditions, HNHB LHIN and Ontario residents, 2013/14

Indicator HNHB LHIN Ontario† % change 2010/11‐2013/14

LHIN of patient









adult designated MH units in HNHB LHIN hospitals. There were 5,269 discharges from these units with a total length of stay of 129,292 days. The average length of stay in HNHB LHIN MH units was 24.5 days compared to 28.0 days for Ontario. Residents from outside the LHIN accounted for 6.6% of the active cases treated in HNHB LHIN.

Active cases, admissions, and discharges for HNHB LHIN hospitals declined, while total days increased between 2010/11 to 2013/14.

Mood disorders (30.7%) and schizophrenia and psychotic disorders (27.8%) and short stay (25.3%) accounted for the largest proportions of active cases in HNHB LHIN hospitals in 2013/14. Compared with the provincial average, HNHB had larger proportions of active cases with personality disorder and ‘all other’ disorders.

There were 5,924 active cases, 5,496 admissions and 5,467 discharges for HNHB LHIN residents from Ontario adult designated MH units. 10.0% of HNHB LHIN resident active cases received treatment in hospitals outside the LHIN. Compared with the provincial average, HNHB LHIN residents had lower rates of active cases, admissions, and discharges per 100,000 population.

Active cases, admissions, discharges, and the associated rates decreased for HNHB LHIN residents between 2010/11 and 2013/14 while total days increased.

319 28 August 2015

Adult designated mental health unit utilization, HNHB LHIN hospitals and residents, 2013/14

Indicator HNHB LHIN Ontario† % change 2010/11‐2013/14

LHIN of hospital

Active cases 5,708 61,372 ‐7.4

Admissions 5,297 56,636 ‐8.5

Discharges 5,269 56,629 ‐8.9












LHIN of patient

Active cases 5,924 59,344 ‐6.6

Admissions 5,496 54,812 ‐7.5

Discharges 5,467 54,844 ‐8.2

Total Days 136,244 1,524,724 4.7







Wait Time for Community Services ACT teams and abuse services had the longest median wait times among the community MH

services provided in HNHB LHIN in 2014/15. The median wait times for HNHB abuse services, ACT teams, and counselling/treatment were greater than the median for Ontario.

Among the SA services provided in HNHB LHIN, case management and residential supportive‐level 2 had the longest median wait times, with median wait times longer than those for the province.

Community day/evening treatment, community treatment, and public awareness were the problem gambling services provided in HNHB LHIN. The median wait time for community treatment was longer than that for the province in 2014/15.

320 28 August 2015

Median wait time (in days) to next available treatment slot for community mental health, substance abuse and problem gambling services by service type, HNHB LHIN service providers, 2013/14‐2014/15

Service Type

HNHB LHIN Ontario



























321 28 August 2015

Central West LHIN

Mental Health and Substance Abuse Emergency Department Visits In 2013/14, there were 11,257 unscheduled ED visits for Central West residents where the main



The MH/SA ED visit rates for Central West LHIN residents were lower than the provincial average. The main problem visit rate increased by 39.4% over the period.

Visits with a MH/SA main problem diagnosis accounted for 3.9% of all ED visits for Central West LHIN residents.

Unscheduled emergency department utilization for mental health and substance abuse conditions, Central West LHIN and Ontario residents, 2013/14

Indicator Central West LHIN Ontario† % change 2010/11‐2013/14

LHIN of patient









adult designated MH units in Central West LHIN hospitals. There were 2,526 discharges from these units with a total length of stay of 27,754 days. The average length of stay in Central West LHIN MH units was 11.0 days compared to 28.0 days for Ontario. Residents from outside the LHIN accounted for 23.2% of the active cases treated in Central West LHIN.

Active cases, admissions, discharges and total days increased for Central West LHIN hospitals between 2010/11 to 2013/14.

Short stay (33.9%) and schizophrenia and psychotic disorders (30.9%) accounted for the largest proportions of active cases in Central West LHIN adult MH units in 2013/14. Central West LHIN hospitals had the largest proportion of short stay active cases in the province. Compared with the provincial average, Central West LHIN hospitals also had larger proportions of active cases for schizophrenia and psychotic disorders and ‘all other’ disorders.

There were 2,674 active cases, 2,517 admissions and 2,542 discharges for Central West LHIN residents from Ontario adult designated MH units. 24.8% of Central West LHIN resident active cases received treatment in hospitals outside the LHIN. Compared with the provincial average, Central West LHIN residents had lower rates of active cases, admissions, discharges and total days per 100,000.

Active cases, admissions, discharges, and the associated rates increased for Central West LHIN residents between 2010/11 and 2013/14.

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Adult designated mental health unit utilization, Central West LHIN hospitals and residents, 2013/14

Indicator Central West LHIN Ontario† % change 2010/11‐2013/14

LHIN of hospital

Active cases 2,620 61,372 23.2

Admissions 2,525 56,636 23.5

Discharges 2,526 56,629 24.1












LHIN of patient

Active cases 2,674 59,344 17.4

Admissions 2,517 54,812 16.2

Discharges 2,542 54,844 18.1

Total Days 52,917 1,524,724 50.1







Wait Time for Community Services In 2013/14 and 2014/15, support within housing and case management had the longest median

wait times among the community MH services provided in Central West LHIN. The median wait times for Central West case management, counselling and treatment, diversion and court support, early psychosis intervention, and support within housing were greater than the medians for Ontario.

Residential treatment had the longest median wait time for the SA services provided in Central West LHIN, which was longer than the median wait time for the province in 2013/14 and 2014/15.

Community treatment for problem gambling programs in Central West LHIN had a median wait time of 6 days in 2014/15, which was comparable to the provincial median wait time.

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Median wait time (in days) to next available treatment slot for community mental health, substance abuse and problem gambling services by service type, Central West LHIN service providers, 2013/14‐2014/15

Service Type

Central West LHIN Ontario








Support Within Housing 1,095 1,095 53 77













Support within Housing 52 39



Community Treatment 6 7 5



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Mental Health and Substance Abuse Emergency Department Visits In 2013/14, there were 12,364 unscheduled ED visits for Mississauga Halton residents where the



Mississauga Halton LHIN residents had the 2nd lowest MH/SA ED visit rates in the province. The main problem visit rate increased by 24.5% over the period, while there was 25.9% growth in the any problem visit rate, between 2010/11 and 2013/14.

Visits with a MH/SA main problem diagnosis accounted for 3.5% of all ED visits for Mississauga Halton LHIN residents.

Unscheduled emergency department utilization for mental health and substance abuse conditions, Mississauga Halton LHIN and Ontario residents, 2013/14


Ontario† % change 2010/11‐2013/14

LHIN of patient









adult designated MH units in Mississauga Halton LHIN hospitals. There were 2,742 discharges from these units with a total length of stay of 40,413 days. The average length of stay in Mississauga Halton LHIN MH units was 14.7 days compared to 28.0 days for Ontario. Residents from outside the LHIN accounted for 17.5% of the active cases treated in Mississauga Halton LHIN.

Active cases, admissions, discharges and days increased for Mississauga Halton LHIN hospitals between 2010/11 to 2013/14.

Mood disorders (31.4%) and schizophrenia and psychotic disorders (31.0%) accounted for the largest proportions of active cases in Mississauga Halton LHIN hospitals in 2013/14. Compared with the provincial average, Mississauga Halton had larger proportions of active cases for schizophrenia and psychotic disorders and mood disorders.

There were 3,284 active cases, 3,074 admissions, and 3,045 discharges for Mississauga Halton LHIN residents from Ontario adult designated MH units. 26.1% of Mississauga Halton LHIN resident active cases received treatment in hospitals outside the LHIN. Mississauga Halton LHIN residents had the lowest active case, admission, and discharge rates per 100,000 in the province.

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While the number of active cases, admissions, discharges, and associated rates for Mississauga Halton LHIN residents increased between 2010/11 and 2013/14, the total days for residents declined.

Adult designated mental health unit utilization, Mississauga Halton LHIN hospitals and residents, 2013/14


Ontario† % change 2010/11‐2013/14

LHIN of hospital

Active cases 2,942 61,372 12.5

Admissions 2,748 56,636 10.4

Discharges 2,742 56,629 11.2












LHIN of patient

Active cases 3,284 59,344 11.4

Admissions 3,074 54,812 11.0

Discharges 3,045 54,844 10.1

Total Days 56,323 1,524,724 ‐1.4







Wait Time for Community Services In 2014/15, ACT teams and support within housing had the longest median wait times among

the community MH services in Mississauga Halton LHIN. The median wait times for Mississauga Halton ACT teams, case management, early psychosis intervention, support within housing and vocational/employment programs were greater than the medians for Ontario. There was a substantial increase in the LHIN’s median wait time for support within housing services between 2013/14 and 2014/15.

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Residential treatment had the longest median wait time among the SA services provided in Mississauga Halton LHIN in 2014/15. The median wait time in the LHIN was longer than that for the province for case management, community treatment, and residential treatment.

For problem gambling services provided in Mississauga Halton LHIN, community treatment had a median wait time of 4 days and this wait time was less than the Ontario median wait time.

Median wait time (in days) to next available treatment slot for community mental health, substance abuse and problem gambling services by service type, Mississauga Halton LHIN service providers, 2013/14‐2014/15

Service Type

Mississauga Halton LHIN Ontario

2013/14 2014/15 2013/14 2014/15 Community Mental Health Services Abuse Service 3 3


























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Mental Health and Substance Abuse Emergency Department Visits In 2013/14, there were 24,033 unscheduled ED visits for Toronto Central residents where the



Toronto Central LHIN residents had the 3rd highest MH/SA ED visit rates in the province. The main problem visit rate increased by 4.0% over the period.

Visits with a MH/SA main problem diagnosis accounted for 5.9% of all ED visits for Toronto Central LHIN residents compared to 3.8% for the province.

Unscheduled emergency department utilization for mental health and substance abuse conditions, Toronto Central LHIN and Ontario residents, 2013/14


Ontario† % change 2010/11‐2013/14

LHIN of patient









adult designated MH units in Toronto Central LHIN hospitals. There were 8,681 discharges from these units with a total length of stay of 295,870 days. The average length of stay in Toronto Central LHIN MH units was 34.1 days compared to 28.0 days for Ontario. Residents from outside the LHIN accounted for 40.0% of the active cases treated in Toronto Central LHIN.

Active cases, admissions, and discharges in Toronto Central LHIN hospitals remained stable between 2010/11 to 2013/14, while total days decreased.

Schizophrenia and psychotic disorders (31.7%) and mood disorders (30.4%) accounted for the largest proportions of active cases in Toronto Central LHIN hospitals in 2013/14. Compared with the provincial average, Toronto Central had larger proportions of schizophrenia and psychotic disorders and substance related disorders and smaller proportions of active cases for the other SCIPP groups, with the exception of mood disorders, which was similar to the province.

There were 6,611 active cases, 6,177 admissions, and 6,156 discharges for Toronto Central LHIN residents from Ontario adult designated MH units. Nearly 15% of Toronto Central LHIN resident active cases received treatment in hospitals outside the LHIN. Compared with the provincial average, Toronto Central LHIN residents had higher rates of active cases, admissions, and discharges per 100,000.

Active cases, admissions, discharges, and the associated rates increased for Toronto Central LHIN residents between 2010/11 and 2013/14, while total days declined.

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Adult designated mental health unit utilization, Toronto Central LHIN hospitals and residents, 2013/14


Ontario† % change 2010/11‐2013/14

LHIN of hospital

Active cases 9,368 61,372 ‐0.1

Admissions 8,655 56,636 0.1

Discharges 8,681 56,629 0.1












LHIN of patient

Active cases 6,611 59,344 10.3

Admissions 6,177 54,812 12.9

Discharges 6,156 54,844 9.3

Total Days 184,172 1,524,724 ‐12.5







Wait Time for Community Services

In 2013/14 and 2014/15, ACT teams had the longest median wait times among the community MH services in Toronto Central LHIN. The median wait times were longer than the provincial medians for ACT teams, case management, counselling and treatment, and vocational/employment, while the wait time for support within housing was much less than the provincial median.

Among the SA services provided in Toronto Central LHIN, residential supportive‐level 1 and residential treatment had the longest median wait times in 2013/14 and 2014/15. The median wait times in the LHIN for these services were longer compared to provincial medians.

The median wait times for the problem gambling services provided in Toronto Central LHIN were less than the provincial medians for the corresponding services. Toronto Central LHIN is one of only three LHINs where residential treatment for problem gambling is provided and is the only LHIN that does not have a wait time for the service.

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Median wait time (in days) to next available treatment slot for community mental health, substance abuse and problem gambling services by service type, Toronto Central LHIN service providers, 2013/14‐2014/15

Service Type

Toronto Central LHIN Ontario












Centralized/Coordination Access 1 0 0















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Central LHIN

Mental Health and Substance Abuse Emergency Department Visits In 2013/14, there were 18,498 unscheduled ED visits for Central residents where the main



Central LHIN residents had the lowest MH/SA ED visit rates in the province. The main problem visit rate increased by 19.0% over the period.

Visits with a MH/SA main problem diagnosis accounted for 3.4% of all ED visits for Central LHIN residents.

Unscheduled emergency department utilization for mental health and substance abuse conditions, Central LHIN and Ontario residents, 2013/14

Indicator Central LHIN Ontario† % change 2010/11‐2013/14

LHIN of patient









adult designated MH units in Central LHIN hospitals. There were 4,958 discharges from these units with a total length of stay of 58,841 days. The average length of stay in Central LHIN MH units was 11.9 days compared to 28.0 days for Ontario. Residents from outside the LHIN accounted for 22.3% of the active cases treated in Central LHIN.

The number of active cases, admissions, discharges, and days from Central LHIN hospitals increased between 2010/11 to 2013/14.

Short stay (31.2%), schizophrenia and psychotic disorders (30.5%), and mood disorders (26.7%) accounted for the largest proportions of active cases in Central LHIN hospitals in 2013/14. Compared with the provincial average, Central had larger proportions of active cases for short stay and schizophrenia and psychotic disorders and smaller proportions for all other SCIPP groups.

There were 5,966 active cases, 5,669 admissions, and 5,672 discharges for Central LHIN residents from Ontario adult designated MH units. 33.2% of Central LHIN resident active cases received treatment in hospitals outside the LHIN. Compared with the provincial average, Central LHIN residents had lower rates of active cases, admissions, discharges and total days per 100,000 population. These rates were the 3rd lowest in the province.

Between 2013/14 the number of active cases, admissions, discharges, days, and associated rates increased for Central LHIN residents.

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Adult designated mental health unit utilization, Central LHIN hospitals and residents, 2013/14

Indicator Central LHIN Ontario† % change 2010/11‐2013/14

LHIN of hospital

Active cases 5,127 61,372 23.2

Admissions 4,976 56,636 24.2

Discharges 4,958 56,629 24.2












LHIN of patient

Active cases 5,966 59,344 20.3

Admissions 5,669 54,812 20.9

Discharges 5,672 54,844 20.6

Total Days 116,471 1,524,724 15.6







Wait Time for Community Services In 2013/14 and 2014/15, support within housing and abuse programs had the longest median

wait times among the community MH services in Central LHIN. The median wait time for abuse programs, case management, counselling and treatment, and early psychosis intervention were greater than the medians for Ontario.

Among the SA services provided in Central LHIN support within housing and residential treatment had the longest median wait times in 2013/14. The median wait time for support within housing was longer than the median wait time for the province. Central LHIN had the 2nd longest median wait time for this service in 2013/14; however there was a substantial reduction in the median wait time in 2014/15.

Community treatment for problem gambling had a median wait time of 3 days, which was less than the provincial median wait time.

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Median wait time (in days) to next available treatment slot for community mental health, substance abuse and problem gambling services by service type, Central LHIN service providers, 2013/14‐2014/15

Service Type

Central LHIN Ontario



























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Central East LHIN

Mental Health and Substance Abuse Emergency Department Visits In 2013/14 there were 23,468 unscheduled ED visits for Central East residents where the main



The MH/SA ED visit rates for Central East LHIN residents were lower than the provincial average. The main problem visit rate increased by 20.4% over the period.

Visits with a MH/SA main problem diagnosis accounted for 3.8% of all ED visits for Central East LHIN residents.

Unscheduled emergency department utilization for mental health and substance abuse conditions, Central East LHIN and Ontario residents, 2013/14

Indicator Central East LHIN Ontario† % change 2010/11‐2013/14

LHIN of patient









adult designated MH units in Central East LHIN hospitals. There were 5,291 discharges from these units with a total length of stay of 180,121 days. The average length of stay in Central East LHIN MH units was 34.0 days compared to 28.0 days for Ontario. Residents from outside the LHIN accounted for 16.7% of the active cases treated in Central East LHIN.

Active cases, admissions, discharges, and total days increased between 2010/11 to 2013/14 for Central East LHIN hospitals.

Schizophrenia and psychotic disorders (33.7%) and mood disorders (31.3%) accounted for the largest proportions of active cases in Central East LHIN hospitals in 2013/14. Compared with the provincial average, Central East had a larger proportion of active cases for schizophrenia and psychotic disorders and mood disorders.

There were 6,196 active cases, 5,640 admissions and 5,643 discharges for Central East LHIN residents from Ontario adult designated MH units. 20.1% of Central East LHIN resident active cases received treatment in hospitals outside the LHIN. Compared with the provincial average, Central East LHIN residents had lower rates of active cases, admissions, and discharges per 100,000 population.

Active cases, admissions, discharges, days, and the associated rates increased for Central East LHIN residents between 2010/11 and 2013/14.

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Adult designated mental health unit utilization, Central East LHIN hospitals and residents, 2013/14

Indicator Central East LHIN Ontario† % change 2010/11‐2013/14

LHIN of hospital

Active cases 5,948 61,372 7.2

Admissions 5,273 56,636 5.7

Discharges 5,291 56,629 7.7












LHIN of patient

Active cases 6,196 59,344 12.5

Admissions 5,640 54,812 10.6

Discharges 5,643 54,844 13.0

Total Days 134,166 1,524,724 12.6







Wait Time for Community Services In 2013/14 and 2014/15, support within housing had the longest median wait times among the

community MH services in Central East LHIN. The median wait times for Central East ACT teams, case management, and support within housing programs were greater than the medians for Ontario.

Among the SA services provided in Central East LHIN, support within housing, residential treatment, and community day/evening treatment had the longest median wait times in 2013/14 and 2014/15. The median wait times in the LHIN for these services were longer than the provincial medians.

Community treatment was the only problem gambling service provided in Central East LHIN and had a reported median wait time of 4 days.

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Median wait time (in days) to next available treatment slot for community mental health, substance abuse and problem gambling services by service type, Central East LHIN service providers, 2013/14‐2014/15

Service Type

Central East LHIN Ontario









Vocational/Employment 3 9








Residential Medical / Psychiatric Treatment 48 52










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South East LHIN

Mental Health and Substance Abuse Emergency Department Visits In 2013/14 there were 9,305 unscheduled ED visits for South East residents where the main



South East LHIN residents had the 4th highest MH/SA ED visit rates in the province. The MH/SA main problem visit rate increased by 15.0% over the period, while there was 16.0% growth in the any problem visit rate.

Visits with a MH/SA main problem diagnosis accounted for 3.1% of all ED visits for South East LHIN residents, which was smaller than the proportion for Ontario.

Unscheduled emergency department utilization for mental health and substance abuse conditions, South East LHIN and Ontario residents, 2013/14

Indicator South East LHIN Ontario† % change 2010/11‐2013/14

LHIN of patient









adult designated MH units in South East LHIN hospitals. There were 2,245 discharges from these units with a total length of stay of 126,933 days. The average length of stay in South East LHIN MH units of 56.5 days was the longest in the province and twice as long as the provincial average of 28.0 days. Residents from outside the LHIN accounted for 33.3% of the active cases treated in South East LHIN.

Active cases, admissions, discharges, and days decreased for South East LHIN hospitals between 2010/11 to 2013/14. The average length of stay varied by fiscal year from 39.8 days in 2012/13 to 89.6 days in 2010/11.

Short stay (30.7%) and schizophrenia and psychotic disorders (27.5%) accounted for the largest proportions of active cases in South East LHIN hospitals in 2013/14. Compared with the provincial average, South East had larger proportions of short stay, cognitive disorder, and personality disorder active cases.

There were 1,973 active cases, 1,670 admissions and 1,752 discharges for South East LHIN residents from Ontario adult designated MH units. 14.2% of South East LHIN resident active cases received treatment in hospitals outside the LHIN. Compared with the provincial average, South East LHIN residents had lower rates of active cases, admissions, and discharges per 100,000 population.

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Active cases, admissions, discharges, total days and the associated rates decreased for South East LHIN residents between 2010/11 and 2013/14.

Adult designated mental health unit utilization, South East LHIN hospitals and residents, 2013/14

Indicator South East LHIN Ontario† % change 2010/11‐2013/14

LHIN of hospital

Active cases 2,538 61,372 ‐4.8

Admissions 2,204 56,636 ‐3.6

Discharges 2,245 56,629 ‐2.6












LHIN of patient

Active cases 1,973 59,344 ‐16.1

Admissions 1,670 54,812 ‐18.7

Discharges 1,752 54,844 ‐16.1

Total Days 106,071 1,524,724 23.7







Wait Time for Community Services In 2013/14 and 2014/15, support within housing and ACT teams had the longest median wait

times among the community MH services in South East LHIN. The median wait times for South East LHIN ACT teams, case management, counselling and treatment, early psychosis intervention, support within housing and vocational/employment programs were greater than the medians for Ontario.

Among the SA services provided in South East LHIN, community treatment, residential supportive level 1, and residential treatment had wait times in 2013/14 and 2014/15. The median wait times in the LHIN for community treatment and residential supportive level 1 were longer than those for the province.

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Community treatment and public awareness were the two problem gambling treatment services provided in South East LHIN and the median wait times for both services were less than or equal to the provincial median wait times in 2014/15.

Median wait time (in days) to next available treatment slot for community mental health, substance abuse and problem gambling services by service type, South East LHIN service providers, 2013/14‐2014/15

Service Type

South East LHIN Ontario



























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Champlain LHIN

Mental Health and Substance Abuse Emergency Department Visits In 2013/14, there were 21,688 unscheduled ED visits for Champlain residents where the main



The main problem MH/SA visit rate for Champlain LHIN residents was slightly higher than the provincial average. The main problem visit rate increased by 6.4% over the period, while there was 13.0% growth in the any problem visit rate.

Visits with a MH/SA main problem diagnosis accounted for 3.8% of all ED visits for Champlain LHIN residents.

Unscheduled emergency department utilization for mental health and substance abuse conditions, Champlain LHIN and Ontario residents, 2013/14

Indicator Champlain LHIN Ontario† % change 2010/11‐2013/14

LHIN of patient









adult designated MH units in Champlain LHIN hospitals. There were 5,415 discharges from these units with a total length of stay of 133,900 days. The average length of stay in Champlain LHIN MH units was 24.7 days compared to 28.0 days for Ontario. Residents from outside the LHIN accounted for 10.3% of the active cases treated in Champlain LHIN.

The number of active cases, admissions, and discharges and total days increased between 2010/11 to 2013/14.

Schizophrenia and psychotic disorders (30.4%), short stay (25.8%), and mood disorders (25.6%) accounted for the largest proportions of active cases in Champlain LHIN adult MH units in 2013/14. Compared with the provincial average, Champlain had larger proportions of active cases with schizophrenia and psychotic disorders and cognitive disorders.

There were 5,523 active cases, 5,157 admissions and 5,118 discharges for Champlain LHIN residents from Ontario adult designated MH units. 5.4% of Champlain LHIN resident active cases received treatment in hospitals outside the LHIN. Compared with the provincial average, Champlain LHIN residents had lower rates of active cases, admissions, and discharges per 100,000 population.

Active cases, admissions, discharges, total days and the associated rates increased for Champlain LHIN residents between 2010/11 and 2013/14.

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Adult designated mental health unit utilization, Champlain LHIN hospitals and residents, 2013/14

Indicator Champlain LHIN Ontario† % change 2010/11‐2013/14

LHIN of hospital

Active cases 5,820 61,372 11.3

Admissions 5,442 56,636 11.4

Discharges 5,415 56,629 11.3












LHIN of patient

Active cases 5,523 59,344 12.7

Admissions 5,157 54,812 12.8

Discharges 5,118 54,844 12.6

Total Days 135,883 1,524,724 13.9







Wait Time for Community Services In 2013/14 and 2014/15, ACT teams and counselling and treatment had the longest median wait

times among the community MH services in Champlain LHIN. The median wait times for abuse programs, ACT teams, case management, and counselling and treatment programs were greater than the median wait times for Ontario.

Among the SA programs provided in Champlain LHIN, residential medical/psychiatric and community residential/psychiatric had the longest median wait times. Champlain was one of the few LHINs where these services were provided. The median wait times in Champlain LHIN were greater than or equal to the provincial medians for all SA services, except community withdrawal management and residential treatment.

Community treatment was the only problem gambling services provided in Champlain LHIN with reported wait times and the median wait time for this service was greater than the provincial median.

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Median wait time (in days) to next available treatment slot for community mental health, substance abuse and problem gambling services by service type, Champlain LHIN service providers, 2013/14‐2014/15

Service Type

Champlain LHIN Ontario












Centralized/Coordination Access 0 0 0 0


Community Medical/Psychiatric Treatment 83 90 55 65



Residential Medical/Psychiatric Treatment 89 98 48 52










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Mental Health and Substance Abuse Emergency Department Visits In 2013/14, there were 8,294 unscheduled ED visits for North Simcoe Muskoka residents where

the main problem was a MH/SA condition. There were 10,764 visits in total or 2,470 additional visits with a MH/SA condition in any of the diagnostic fields.

Between 2010/11 and 2013/14, the number of visits with a MH/SA main problem diagnosis increased by 35.6% and there was 32.4% growth in visits with a MH/SA condition in any diagnostic field.

The main problem MH/SA visit rate for North Simcoe Muskoka LHIN residents was higher than the provincial average. The main problem visit rate increased by 32.4% over the period, while there was 29.3% growth in the any problem visit rate.

Visits with a MH/SA main problem diagnosis accounted for 3.4% of all ED visits for North Simcoe Muskoka LHIN residents.

Unscheduled emergency department utilization for mental health and substance abuse conditions, North Simcoe Muskoka LHIN and Ontario residents, 2013/14


Ontario† % change 2010/11‐2013/14

LHIN of patient









adult designated MH units in North Simcoe Muskoka LHIN hospitals. There were 2,967 discharges from these units with a total length of stay of 105,315 days. The average length of stay in North Simcoe Muskoka LHIN MH units was 35.5 days compared to 28.0 days for Ontario. Residents from outside the LHIN accounted for 23.0% of the active cases treated in North Simcoe Muskoka LHIN. The activity for North Simcoe Muskoka LHIN hospitals includes forensic cases treated at the Oakridge division of Waypoint Mental Health Centre.

Active cases, admissions, and discharges for North Simcoe Muskoka hospitals increased between 2010/11 to 2013/14, while total days decreased by 1.9%.

Short stay (29.8%), mood disorders (29.1%) and schizophrenia and psychotic disorders (24.4%) accounted for the largest proportions of active cases in North Simcoe Muskoka LHIN hospitals in 2013/14. Compared with the provincial average, North Simcoe Muskoka had larger proportions of active cases for short stay, personality disorders, and slightly more for ‘all other’ disorders.

There were 2,876 active cases, 2,621 admissions and 2,628 discharges for North Simcoe Muskoka LHIN residents from Ontario adult designated MH units. 11.1% of North Simcoe Muskoka LHIN residents’ active cases received treatment in hospitals outside the LHIN. North Simcoe Muskoka LHIN residents had the 2nd highest rates of active cases, admissions, and discharges per 100,000 population in the province.

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Active cases, admissions, discharges, and the associated rates increased for North Simcoe Muskoka LHIN residents between 2010/11 and 2013/14, while total days declined.

Adult designated mental health unit utilization, North Simcoe Muskoka LHIN hospitals and residents, 2013/14


Ontario† % change 2010/11‐2013/14

LHIN of hospital

Active cases 3,319 61,372 8.0

Admissions 2,963 56,636 7.8

Discharges 2,967 56,629 8.5












LHIN of patient

Active cases 2,876 59,344 10.0

Admissions 2,621 54,812 11.0

Discharges 2,628 54,844 10.3

Total Days 83,430 1,524,724 ‐7.9







Wait Time for Community Services In 2014/15, abuse services and support within housing had the longest median wait times

among the community MH services provided in North Simcoe Muskoka LHIN. The median wait times for North Simcoe Muskoka abuse and case management programs were greater than the medians for Ontario.

Among the SA services provided in North Simcoe Muskoka LHIN, residential medical/psychiatric and residential treatment had the longest median wait times in 2014/15. The median wait time in North Simcoe Muskoka LHIN for residential treatment was longer than that for the province.

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The median wait time for community treatment for problem gambling in North Simcoe Muskoka LHIN was 10 days, which was longer than the provincial median wait time in 2014/15.

Median wait time (in days) to next available treatment slot for community mental health, substance abuse and problem gambling services by service type, North Simcoe Muskoka LHIN service providers, 2013/14‐2014/15

Service Type

North Simcoe Muskoka LHIN Ontario









Vocational/Employment 3 9








Residential Medical/Psychiatric Treatment 47 47 48 52










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North East LHIN

Mental Health and Substance Abuse Emergency Department Visits In 2013/14, there were 14,875 unscheduled ED visits for North East residents where the main


Between 2010/11 and 2013/14, the number of visits with a MH/SA main problem diagnosis remained stable and there was 1.7% growth in visits with a MH/SA condition in any diagnostic field.

North East LHIN residents had the 2nd highest MH/SA ED visit rates in the province. Between 2010/11 and 2013/14, the any problem visit rate increased by 1.6% over the period.

Visits with a MH/SA main problem diagnosis accounted for 3.4% of all ED visits for North East LHIN residents.

Unscheduled emergency department utilization for mental health and substance abuse conditions, North East LHIN and Ontario residents, 2013/14

Indicator North East LHIN Ontario† % change 2010/11‐2013/14

LHIN of patient









adult designated MH units in North East LHIN hospitals. There were 3,519 discharges from these units with a total length of stay of 104,530 days. The average length of stay in North East LHIN MH units was 29.7 days compared to 28.0 days for Ontario. Residents from outside the LHIN accounted for 5.4% of the active cases treated in North East LHIN.

Active cases, admissions, and discharges for North East LHIN hospitals increased between 2010/11 to 2013/14, while total days declined.

Mood disorders (32.9%), short stay (28.2%), and schizophrenia and psychotic disorders (25.2%) accounted for the largest proportions of active cases in North East LHIN hospitals in 2013/14. Compared with the provincial average, North East had larger proportions of active cases for short stay, mood disorders, and ‘all other’ disorders, and smaller proportions for all other SCIPP groups.

There were 3,971 active cases, 3,650 admissions and 3,655 discharges for North East LHIN residents from Ontario adult designated MH units in 2013/14. Approximately 9% of North East LHIN resident active cases received treatment in hospitals outside the LHIN. North East LHIN residents had the highest rates of active cases, admissions, and discharges per 100,000 population in the province.

Active cases, admissions, discharges, and the associated rates increased for North East LHIN residents between 2010/11 and 2013/14, while total days declined.

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Adult designated mental health unit utilization, North East LHIN hospitals and residents, 2013/14

Indicator North East LHIN Ontario† % change 2010/11‐2013/14

LHIN of hospital

Active cases 3,827 61,372 11.5

Admissions 3,505 56,636 12.1

Discharges 3,519 56,629 11.5












LHIN of patient

Active cases 3,971 59,344 11.7

Admissions 3,650 54,812 11.8

Discharges 3,655 54,844 11.1

Total Days 98,576 1,524,724 ‐16.3







Wait Time for Community Services In 2014/15, support within housing and counselling and treatment had the longest median wait

times among the community MH services in North East LHIN. The median wait times for counselling and treatment and short term crisis support beds in North East LHIN were greater than the median wait times for Ontario.

Among the SA services provided in North East LHIN, support within housing and community treatment had the longest median wait times in 2014/15. The median wait time for community treatment in the LHIN was longer than the median wait time for the province, while wait times for all other services were less than or equal to the provincial medians.

Community treatment and public awareness were the problem gambling treatment services provided in North East LHIN in 2014/15. In North East LHIN the median wait time for the public

347 28 August 2015

awareness program was greater than the provincial median, while the median wait time for community treatment was less than the provincial median wait time.

Median wait time (in days) to next available treatment slot for community mental health, substance abuse and problem gambling services by service type, North East LHIN service providers, 2013/14‐2014/15

Service Type

North East LHIN Ontario



























348 28 August 2015

North West LHIN

Mental Health and Substance Abuse Emergency Department Visits In 2013/14, there were 8,871 unscheduled ED visits for North West residents where the main



North West LHIN residents had the highest MH/SA ED visit rates in the province. The main problem visit rate increased by 8.3% over the period, while there was 5.4% growth in the any problem visit rate.

Visits with a MH/SA main problem diagnosis accounted for 4.4% of all ED visits for North West LHIN residents, which is higher than the proportion for Ontario.

Unscheduled emergency department utilization for mental health and substance abuse conditions, North West LHIN and Ontario residents, 2013/14

Indicator North West LHIN Ontario† % change 2010/11‐2013/14

LHIN of patient








Utilization of Adult Designated Mental Health Beds

In 2013/14, there were 1,204 admissions to and 1,320 active cases who received treatment in adult designated MH units in North West LHIN hospitals. There were 1,213 discharges from these units with a total length of stay of 38,465 days. The average length of stay in North West LHIN MH units was 31.7 days compared to 28.0 days for Ontario. Residents from other LHINs accounted for 4.2% of the active cases treated in North West LHIN.

Active cases, admissions, discharges, and days declined for North West LHIN hospitals between 2010/11 to 2013/14.

Short stay (33.9%) and schizophrenia and psychotic disorders (27.3%) accounted for the largest proportions of active cases in North West LHIN adult MH units in 2013/14. Compared with the provincial average, North West had larger proportions of active cases for short stay, cognitive disorders, personality disorders, and ‘all other’ disorders.

There were 1,324 active cases, 1,206 admissions and 1,211 discharges for North West LHIN residents from Ontario adult designated MH units. 4.5% of North West LHIN resident active cases received treatment in hospitals outside the LHIN. North West LHIN residents had the 3rd highest rates of active cases, admissions, and discharges per 100,000 population in the province and these rates were higher than the provincial average.

Active cases, admissions, discharges, total days and the associated rates declined for North West LHIN residents between 2010/11 and 2013/14.

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Adult designated mental health unit utilization, North West LHIN hospitals and residents, 2013/14

Indicator North West LHIN Ontario† % change 2010/11‐2013/14

LHIN of hospital

Active cases 1,320 61,372 ‐19.6

Admissions 1,204 56,636 ‐20.5

Discharges 1,213 56,629 ‐19.2












LHIN of patient

Active cases 1,324 59,344 ‐16.9

Admissions 1,206 54,812 ‐17.8

Discharges 1,211 54,844 ‐16.7

Total Days 39,932 1,524,724 ‐6.0







Wait Time for Community Services In 2013/14 and 2014/15, support within housing and ACT Teams had the longest median wait

times among the community MH services in North West LHIN. The median wait times in North West LHIN for support within housing and vocational/employment programs were longer than the medians for Ontario.

Among the SA services provided in North West LHIN, residential supportive level 2 and residential treatment had the longest median wait times. In 2014/15, the median wait times for all SA services in North West LHIN were longer than the provincial medians.

Community day/evening treatment and residential treatment were the only problem gambling services in North West LHIN with wait times in 2014/15 and the median wait times for these services were greater than the provincial medians. Residential treatment for problem gambling is provided in only three LHINs in the province, and North West LHIN had the longest median wait time for this service.

350 28 August 2015

Median wait time (in days) to next available treatment slot for community mental health, substance abuse and problem gambling services by service type, North West LHIN service providers, 2013/14‐2014/15

Service Type

North West LHIN Ontario



























351 28 August 2015

Complex Continuing Care

Analysis of Complex Continuing Care Utilization Notes: This document and accompanying workbook contain analysis of complex continuing care utilization (2001/02‐2013/14), based on data reported to the Continuing Care Reporting System‐CCC (CCRS‐CCC). Prepared June 2015

352 28 August 2015

ONTARIO

Complex Continuing Care Complex continuing care (CCC) is the provision of continuing, medically complex, and specialized

services in a hospital setting for individuals of any age who have long‐term illnesses or disabilities and who require skilled, multidisciplinary, technology based care that is not available in the patient’s home or in LTC homes. Patients often remain in CCC for an extended period of time.

Active cases are those that received one or more day of treatment in a CCC unit during the fiscal year. Discharges are those that occurred in 2013/14 and will include episodes admitted in previous fiscal years. The total days and average length of stay refer only to episodes that were discharged in 2013/14.

There were 29,502 active cases, 23,986 admissions and 24,050 discharges from Ontario hospital CCC units in 2013/14. Toronto Central and Hamilton Niagara Haldimand Brant (HNHB) LHIN hospitals had the largest number of active cases, admissions and discharges in 2013/14. The average length of stay in Ontario CCC units was 78.7 days. There was substantial variation in the length of stay by LHIN with a range from 31.8 days in Central LHIN to 145.5 days in Champlain LHIN hospitals. Since patients may remain in CCC for an extended period, the discharge of a single long‐stay patient can have a significant impact on the average length of stay.

Between 2010/11 and 2013/14, there was growth in active cases (2.8%), admissions (5.1%), and discharges (4.9%) and an 8.0% reduction in the total days for Ontario CCC units. However there was no stable trend across LHIN areas. HNHB and North Simcoe Muskoka LHIN hospitals had the greatest growth in active cases, while Central West and North West had the greatest reduction over the period. The average length of stay in Ontario CCC units declined from 89.8 days in 2010/11 to 78.7 days in 2013/14.

North West, HNHB and Toronto Central LHIN residents had the highest CCC active case rates, while residents of Central West, Champlain, and Mississauga Halton LHINs had the lowest. The active case rate for Central West LHIN was substantially lower than the rates for other LHINs, approximately one‐third of the provincial rate.

The average length of stay ranged from 54.3 days for HNHB LHIN residents to 147.4 days for Champlain LHIN residents.

353 28 August 2015

Complex continuing care utilization by LHIN of hospital, 2013/14

LHIN of hospital Active Cases Admissions Discharges

Total Days†

Average CCC LOS†

Erie St. Clair 1,548 1,257 1,284 134,561 104.8

South West 1,969 1,618 1,660 117,383 70.7

Waterloo Wellington 1,352 1,119 1,095 73,787 67.4

HNHB 5,477 4,675 4,634 249,653 53.9

Central West 259 213 228 12,815 56.2

Mississauga Halton 1,516 1,244 1,277 113,928 89.2

Toronto Central 7,542 5,926 5,910 603,917 102.2

Central 1,410 1,300 1,299 41,357 31.8

Central East 1,964 1,687 1,693 92,244 54.5

South East 1,424 1,133 1,155 63,435 54.9

Champlain 1,936 1,387 1,390 202,200 145.5

North Simcoe Muskoka 843 725 734 38,866 53.0

North East 1,180 837 847 87,341 103.1

North West 1,082 865 844 61,736 73.2

Ontario hospitals 29,502 23,986 24,050 1,893,223 78.7

†Discharged cases only.

Complex continuing care utilization by LHIN of patient, 2013/14

LHIN of patient Active Cases

Active Cases/1,000 Population Admissions Discharges

Total Days†

Average CCC LOS†

Erie St. Clair 1,552 243.2 1,258 1,290 137,662 106.7

South West 1,962 204.1 1,613 1,660 116,257 70.0

Waterloo Wellington 1,354 177.6 1,121 1,099 66,819 60.8

HNHB 5,451 384.0 4,652 4,601 249,615 54.3

Central West 678 76.1 567 560 33,206 59.3

Mississauga Halton 1,683 141.3 1,349 1,392 133,981 96.3

Toronto Central 3,848 313.7 3,017 3,034 327,864 108.1

Central 3,076 169.4 2,594 2,579 182,860 70.9

Central East 3,237 205.5 2,779 2,754 160,286 58.2

South East 1,427 289.3 1,138 1,152 64,563 56.0

Champlain 1,815 140.3 1,297 1,302 191,945 147.4

North Simcoe Muskoka 668 143.1 555 571 34,325 60.1

North East 1,205 212.5 858 867 91,085 105.1

North West 1,079 456.6 863 844 59,857 70.9

Unknown 232 175 175 20,040 114.5

Out‐of‐province 235 150 170 22,858 134.5

Ontario residentsǂ 29,267 216.2 23,836 23,880 1,870,365 78.3

†Discharged cases only ǂExcludes out‐of‐province residents

354 28 August 2015

Erie St. Clair LHIN

Complex Continuing Care In 2013/14, there were 1,548 CCC active cases treated in Erie St. Clair LHIN hospitals. Residents

from outside the LHIN accounted for 1.7% of these active cases. In 2013/14, there were 1,257 admissions and 1,284 discharges from Erie St. Clair LHIN hospital CCC units. Erie St. Clair LHIN hospitals had the 2nd longest CCC average length of stay in the province in 2013/14.

There were reductions in the number of active cases (7.7%), admissions (8.2%), and discharges (8.4%) for Erie St. Clair LHIN hospital CCC units between 2010/11 and 2013/14, while there was a 19.0% increase in total days. During the period, there was substantial variation in the average length of stay in CCC from 69.9 days in 2011/12 to 104.8 days in 2013/14.

In 2013/14 there were 1,552 CCC active cases for Erie St. Clair LHIN residents, and 1.9% of these cases were treated in hospitals outside the LHIN. There were reductions in the number and rate of active cases, admissions, and discharges, while total days increased between 2010/11 and 2013/14.

The active case rate for Erie St. Clair LHIN residents was higher than the provincial average. Utilization of complex continuing care, Erie St. Clair LHIN and Ontario, 2013/14

Indicator Erie St. Clair LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital

Active cases 1,548 29,502 ‐7.7

% Inflow 1.7

Admissions 1,257 23,986 ‐8.2

Discharges 1,284 24,050 ‐8.4

Total days‡ 134,561 1,893,223 19.0

Average LOS‡ 104.8 78.7

LHIN of patient

Active cases 1,552 29,267 ‐7.9

% Outflow 1.9

Active cases per 100,000 population 243.2 216.2 ‐7.1

Admissions 1,258 23,836 ‐8.6

Discharges 1,290 23,880 ‐8.1

Total days‡ 137,662 1,870,365 22.6


†LHIN of pa ent results for Ontario exclude out‐of‐province residents ‡Discharged cases only.

355 28 August 2015

South West LHIN

Complex Continuing Care In 2013/14, there were 1,969 CCC active cases treated in South West LHIN hospitals. Residents

from outside the LHIN accounted for 4.0% of these active cases. In 2013/14 there were 1,618 admissions and 1,660 discharges from South West LHIN hospital CCC units. The average CCC length of stay (70.7 days) for South West LHIN hospitals was less than the provincial average.

There were reductions in active cases, admissions, discharges, and total days for South West LHIN hospital CCC units between 2010/11 and 2013/14.

In 2013/14 there were 1,962 CCC active cases for South West LHIN residents and 3.7% of these cases were treated in hospitals outside the LHIN. There were reductions in the number and rate of active cases, admissions, discharges, and total days between 2010/11 and 2013/14.

The CCC active case rate for South West LHIN residents was lower than the provincial rate. Utilization of complex continuing care, South West LHIN and Ontario, 2013/14

Indicator South West LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital

Active cases 1,969 29,502 ‐12.7

% Inflow 4.0

Admissions 1,618 23,986 ‐11.6

Discharges 1,660 24,050 ‐10.3

Total days‡ 117,383 1,893,223 ‐12.5


LHIN of patient

Active cases 1,962 29,267 ‐12.3

% Outflow 3.7


Admissions 1,613 23,836 ‐11.5

Discharges 1,660 23,880 ‐9.6

Total days‡ 116,257 1,870,365 ‐11.2



356 28 August 2015


Complex Continuing Care In 2013/14, there were 1,352 CCC active cases treated in Waterloo Wellington LHIN hospitals

and residents from outside the LHIN accounted for 5.1% of these active cases. There were 1,119 admissions and 1,095 discharges from Waterloo Wellington LHIN hospitals in 2013/14. The average CCC length of stay (67.4 days) for Waterloo Wellington LHIN hospitals was less than the provincial average in 2013/14.

Between 2010/11 and 2013/14, active cases, admissions, discharges, and total days declined for Waterloo Wellington LHIN hospitals.

In 2013/14, there were 1,354 CCC active cases for Waterloo Wellington LHIN residents, and 5.2% were treated in hospitals outside the LHIN. Between 2010/11 and 2013/14, there were reductions in the number and rate of active cases, admissions, discharges, and total days in CCC for LHIN residents.

The active case rate for Waterloo Wellington LHIN residents was lower than the provincial rate.

Utilization of complex continuing care, Waterloo Wellington LHIN and Ontario, 2013/14



LHIN of hospital

Active cases 1,352 29,502 ‐7.7

% Inflow 5.1

Admissions 1,119 23,986 ‐6.5

Discharges 1,095 24,050 ‐11.3

Total days‡ 73,787 1,893,223 ‐14.7


LHIN of patient

Active cases 1,354 29,267 ‐7.7

% Outflow 5.2


Admissions 1,121 23,836 ‐6.9

Discharges 1,099 23,880 ‐11.7

Total days‡ 66,819 1,870,365 ‐16.0



357 28 August 2015

Hamilton Niagara Haldimand Brant LHIN

Complex Continuing Care In 2013/14, there were 5,477 CCC active cases treated in HNHB LHIN hospitals. Residents from

outside the LHIN accounted for 2.2% of these active cases. There were 4,675 admissions and 4,634 discharges from HNHB LHIN hospital CCC units in 2013/14. HNHB had the 3rd shortest CCC average length of stay in the province in 2013/14.

Between 2010/11 and 2013/14, there were increases in active cases, admissions, and discharges for HNHB LHIN hospitals, while there was a reduction in total days.

In 2013/14, there were 5,451 CCC active cases for HNHB LHIN residents, and 1.7% of these cases were treated in hospitals outside the LHIN. There was substantial growth in the number and rate of active cases, admissions and discharges for LHIN residents over the period, while there was a 9.3% reduction in total days between 2010/11 and 2013/14.

HNHB LHIN residents had the 2nd highest CCC active case rate in the province. This rate was higher than the provincial average.

Utilization of complex continuing care, HNHB LHIN and Ontario, 2013/14

Indicator HNHB LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital

Active cases 5,477 29,502 19.0

% Inflow 2.2

Admissions 4,675 23,986 25.6

Discharges 4,634 24,050 23.1

Total days‡ 249,653 1,893,223 ‐15.5


LHIN of patient

Active cases 5,451 29,267 19.4

% Outflow 1.7

Active cases per 100,000 population 384.0 216.2 18.1

Admissions 4,652 23,836 25.9

Discharges 4,601 23,880 23.3

Total days‡ 249,615 1,870,365 ‐9.3



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Central West LHIN

Complex Continuing Care In 2013/14, there were 259 CCC active cases treated in Central West LHIN hospitals and

residents from outside the LHIN accounted for 18.9% of these cases. There were 213 admissions and 228 discharges from LHIN hospitals in 2013/14 with an average length of stay of 56.2 days.

There were substantial reductions in active cases (68.6%), admissions (70.7%), discharges (68.7%) and total days (59.0%) from Central West LHIN hospitals between 2010/11 and 2013/14.

In 2013/14, there were 678 CCC active cases for Central West LHIN residents and 69.0% were treated in hospitals outside the LHIN. There were reductions in the number and rate of CCC active cases, admissions and discharges for LHIN residents over the period; however the reduction was to a lesser extent than occurred for Central West LHIN hospitals.

Central West LHIN residents had the lowest CCC active case rate in the province and this rate was approximately one‐third the provincial rate.

Utilization of complex continuing care, Central West LHIN and Ontario, 2013/14

Indicator Central West LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital

Active cases 259 29,502 ‐68.6

% Inflow 18.9

Admissions 213 23,986 ‐70.7

Discharges 228 24,050 ‐68.7

Total days‡ 12,815 1,893,223 ‐59.0


LHIN of patient

Active cases 678 29,267 ‐29.0

% Outflow 69.0


Admissions 567 23,836 ‐28.3

Discharges 560 23,880 ‐29.6

Total days‡ 33,206 1,870,365 ‐31.2



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Complex Continuing Care In 2013/14, there were 1,516 CCC active cases treated in Mississauga Halton LHIN hospitals and

residents from outside the LHIN accounted for 10.4% of these active cases. There were 1,244 admissions to CCC and 1,277 discharges in 2013/14 for Mississauga Halton LHIN hospitals. The average length of stay (89.2 days) was longer than the provincial average in 2013/14.

CCC active cases, admissions, discharges, and total days declined for Mississauga Halton LHIN hospitals between 2010/11 and 2013/14.

In 2013/14, there were 1,683 CCC active cases for Mississauga Halton LHIN residents, and 19.3% were treated in hospitals outside the LHIN. There were reductions in the number and rate of active cases, admissions, and total days, while the number of discharges remained relatively stable for Mississauga Halton residents over the period. The average length of stay for Mississauga Halton LHIN residents varied over the period from 86.3 days in 2012/13 to 118.1 days in 2010/11.

Mississauga Halton LHIN residents’ CCC active case rate was the 3rd lowest in the province, lower than the provincial average.

Utilization of complex continuing care, Mississauga Halton LHIN and Ontario, 2013/14



LHIN of hospital

Active cases 1,516 29,502 ‐6.7

% Inflow 10.4

Admissions 1,244 23,986 ‐5.7

Discharges 1,277 24,050 ‐3.4

Total days‡ 113,928 1,893,223 ‐10.3


LHIN of patient

Active cases 1,683 29,267 ‐2.4

% Outflow 19.3


Admissions 1,349 23,836 ‐2.0

Discharges 1,392 23,880 0.7

Total days‡ 133,981 1,870,365 ‐17.9



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Complex Continuing Care Toronto Central LHIN hospitals had the largest number of CCC active cases in the province in

2013/14 and residents of other LHINs accounted for 49.8% of these active cases. In 2013/14 there were 5,926 admissions to these Toronto Central LHIN CCC units and 5,910 discharges.

Active cases, admissions and discharges for Toronto Central LHIN hospitals increased between 2010/11 and 2013/14, while there was an 11.6% reduction in total days. During the period the average length of stay declined from 130.1 days in.2010/11 to 102.2 days in 2013/14.

In 2010/11 there were 3,848 CCC active cases for Toronto Central LHIN residents, and 1.6% were treated in hospitals outside the LHIN. There was substantial growth in the number and rate of CCC active cases, admissions and discharges for LHIN residents over the period.

Toronto Central LHIN residents had the 3rd highest CCC active case rate and the 2nd longest average length of stay in the province.

Utilization of complex continuing care, Toronto Central LHIN and Ontario, 2013/14



LHIN of hospital

Active cases 7,542 29,502 8.3

% Inflow 49.8

Admissions 5,926 23,986 13.3

Discharges 5,910 24,050 12.5

Total days‡ 603,917 1,893,223 ‐11.6


LHIN of patient

Active cases 3,848 29,267 12.1

% Outflow 1.6


Admissions 3,017 23,836 16.2

Discharges 3,034 23,880 14.8

Total days‡ 327,864 1,870,365 ‐1.7



361 28 August 2015

Central LHIN

Complex Continuing Care In 2013/14 there were 1,410 CCC active cases treated in Central LHIN hospitals. Residents from

outside the LHIN accounted for 5.1% of these active cases. There were 1,300 CCC admissions and 1,299 discharges for Central LHIN hospitals in 2013/14.

There was growth in the active cases, admissions, discharges and total length of stay for Central LHIN hospitals, between 2010/11 and 2013/14.

In 2010/11, there were 3,076 CCC active cases for Central LHIN residents, and 56.5% were treated in hospitals outside the LHIN. Between 2010/11 and 2013/14, active cases, admissions and discharges increased, while the active case rate and total days declined for Central LHIN residents.

The CCC active case rate for Central LHIN residents was lower than the provincial average. Utilization of complex continuing care, Central LHIN and Ontario, 2013/14

Indicator Central LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital

Active cases 1,410 29,502 9.0

% Inflow 5.1

Admissions 1,300 23,986 10.3

Discharges 1,299 24,050 8.5

Total days‡ 41,357 1,893,223 8.1


LHIN of patient

Active cases 3,076 29,267 1.4

% Outflow 56.5


Admissions 2,594 23,836 4.4

Discharges 2,579 23,880 4.7

Total days‡ 182,860 1,870,365 ‐14.2



362 28 August 2015

Central East LHIN

Complex Continuing Care In 2013/14 there were 1,964 CCC active cases treated in Central East LHIN hospitals. Residents

from outside the LHIN accounted for 4.2% of these active cases. There were 1,687 CCC admissions and 1,693 discharges from Central East LHIN hospitals in 2013/14. In 2013/14, the average CCC length of stay in Central East LHIN hospitals (54.5 days) was less than the provincial average (78.7 days).

Between 2010/11 and 2013/14, active cases, admissions, discharges and total days increased for Central East LHIN hospitals.

In 2013/14, there were 3,237 CCC active cases for Central East LHIN residents, and 41.9% were treated in hospitals outside the LHIN. Between 2010/11 and 2013/14, the number and rate of active cases, admissions and discharges increased, while the total days for CCC declined for LHIN residents.

The CCC active case rate for Central East LHIN residents was lower than the provincial rate. Central East LHIN residents also had the 3rd shortest CCC average length of stay in the province.

Utilization of complex continuing care, Central East LHIN and Ontario, 2013/14

Indicator Central East LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital

Active cases 1,964 29,502 13.7

% Inflow 4.2

Admissions 1,687 23,986 16.0

Discharges 1,693 24,050 17.3

Total days‡ 92,244 1,893,223 2.0


LHIN of patient

Active cases 3,237 29,267 12.4

% Outflow 41.9


Admissions 2,779 23,836 17.9

Discharges 2,754 23,880 16.7

Total days‡ 160,286 1,870,365 ‐11.1



363 28 August 2015

South East LHIN

Complex Continuing Care In 2013/14, there were 1,424 CCC active cases treated in South East LHIN hospitals and residents

from outside the LHIN accounted for 2.1% of these active cases. There were 1,133 admissions and 1,155 discharges from South East LHIN hospitals in 2013/14. In 2013/14, the average length of stay in South East LHIN hospitals (54.9 days) was shorter than the provincial average (78.7).

Between 2010/11 and 2013/14, CCC active cases, admissions, discharges and total days declined for South East LHIN hospitals.

In 2013/14, there were 1,427 CCC active cases for South East LHIN residents, and 2.3% were treated in hospitals outside the LHIN. The number and rate of active cases, admissions, discharges, and total days declined between 2010/11 and 2013/14 for LHIN residents.

The active case rate for South East LHIN residents was higher than the provincial average. South East LHIN residents had the 2nd shortest CCC average length of stay in the province.

Utilization of complex continuing care, South East LHIN and Ontario, 2013/14

Indicator South East LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital

Active cases 1,424 29,502 ‐7.4

% Inflow 2.1

Admissions 1,133 23,986 ‐10.5

Discharges 1,155 24,050 ‐6.4

Total days‡ 63,435 1,893,223 ‐5.2


LHIN of patient

Active cases 1,427 29,267 ‐7.8

% Outflow 2.3


Admissions 1,138 23,836 ‐10.5

Discharges 1,152 23,880 ‐6.9

Total days‡ 64,563 1,870,365 ‐4.7



364 28 August 2015

Champlain LHIN

Complex Continuing Care In 2013/14, there were 1,936 CCC active cases treated in Champlain LHIN hospitals and

residents from outside the LHIN accounted for 7.1% of these active cases. There were 1,387 CCC admissions and 1,390 discharges from Champlain LHIN hospitals in 2013/14. Champlain LHIN hospitals had the longest CCC average length of stay in the province in 2013/14.

Between 2010/11 and 2013/14, CCC active cases, admissions and discharges increased for Champlain LHIN hospitals, while total days declined.

There were 1,815 CCC active cases for Champlain LHIN residents in 2013/14, and 0.9% were treated in hospitals outside the LHIN. Between 2010/11 and 2013/14, there was growth in the number and rate of CCC active cases, admissions, discharges and total days for LHIN residents.

Champlain LHIN residents had the 2nd lowest CCC active case rate in the province, but had the longest average length of stay (almost twice that of the provincial average).

Utilization of complex continuing care, Champlain LHIN and Ontario, 2013/14

Indicator Champlain LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital

Active cases 1,936 29,502 14.1

% Inflow 7.1

Admissions 1,387 23,986 17.7

Discharges 1,390 24,050 22.5

Total days‡ 202,200 1,893,223 ‐1.1


LHIN of patient

Active cases 1,815 29,267 15.6

% Outflow 0.9


Admissions 1,297 23,836 19.2

Discharges 1,302 23,880 23.4

Total days‡ 191,945 1,870,365 3.0



365 28 August 2015


Complex Continuing Care In 2013/14, there were 843 CCC active cases treated in North Simcoe Muskoka LHIN hospitals

and residents from outside the LHIN accounted for 29.2% of these active cases. There were 725 CCC admissions and 734 discharges from North Simcoe Muskoka LHIN hospitals in 2013/14. In 2013/14, North Simcoe Muskoka LHIN had the 2nd shortest average CCC length of stay in the province.

Between 2010/11 and 2013/14, CCC active cases, admissions, discharges, and total length of stay increased for North Simcoe Muskoka LHIN hospitals.

In 2013/14, there were 668 CCC active cases for North Simcoe Muskoka LHIN residents, and 10.6% were treated in hospitals outside the LHIN. There was a reduction in the number and rate of active cases, admissions, discharges and total days for LHIN residents over the period.

North Simcoe Muskoka LHIN residents had the 3rd lowest active case rate in the province and this rate was lower than the provincial average. North Simcoe Muskoka LHIN residents also had a shorter average length of stay than the province in 2013/14.

Utilization of complex continuing care, North Simcoe Muskoka LHIN and Ontario, 2013/14



LHIN of hospital

Active cases 843 29,502 16.4

% Inflow 29.2

Admissions 725 23,986 22.3

Discharges 734 24,050 22.3

Total days‡ 38,866 1,893,223 2.8


LHIN of patient

Active cases 668 29,267 ‐10.6

% Outflow 10.6


Admissions 555 23,836 ‐8.0

Discharges 571 23,880 ‐7.0

Total days‡ 34,325 1,870,365 ‐14.6



366 28 August 2015

North East LHIN

Complex Continuing Care In 2013/14, there were 1,180 CCC active cases treated in North East LHIN hospitals and

residents from outside the LHIN accounted for 1.5% of these active cases. There were 837 CCC admissions and 847 discharges for North East LHIN hospitals in 2013/14. The average CCC length of stay in North East LHIN hospitals was longer than the provincial average.

Between 2010/11 and 2013/14, active cases (15.6%), admissions (18.4%), discharges (20.1%) and total days (23.6%) increased for North East LHIN hospitals.

In 2013/14, there were 1,205 CCC active cases for North East LHIN residents, and nearly 3.6% were treated in hospitals outside the LHIN. Between 2010/11 and 2013/14, there was growth in both the number and rate of CCC active cases, admissions, discharges and total days for North East LHIN residents.

The CCC active case rate for North East LHIN residents was lower than the provincial average. Compared with Ontario residents, North East LHIN residents had a longer CCC average length of stay.

Utilization of complex continuing care, North East LHIN and Ontario, 2013/14

Indicator North East LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital

Active cases 1,180 29,502 15.6

% Inflow 1.5

Admissions 837 23,986 18.4

Discharges 847 24,050 20.1

Total days‡ 87,341 1,893,223 23.6


LHIN of patient

Active cases 1,205 29,267 13.9

% Outflow 3.6


Admissions 858 23,836 16.6

Discharges 867 23,880 18.8

Total days‡ 91,085 1,870,365 23.3



367 28 August 2015

North West LHIN

Complex Continuing Care In 2013/14, there were 1,082 CCC active cases treated in North West LHIN hospitals and

residents from outside the LHIN accounted for 0.9% of these active cases. There were 865 CCC admissions and 844 discharges from North West LHIN in 2013/14. The average CCC length of stay in North West LHIN hospitals was less than the provincial average.

There was a substantial reduction in CCC active cases, admissions, discharges and total days between 2010/11 and 2013/14.

In 2013/14, there were 1,079 CCC active cases for North West LHIN residents, and 0.6% of residents were treated in hospitals within the LHIN. There was a substantial reduction in the number and rate of active cases, admissions discharges, and total days for LHIN residents over the period.

North West LHIN residents had the highest CCC active case rate in the province. This rate was 2.1 times higher than the provincial rate. The average length of stay for North West LHIN residents was shorter than the provincial average.

Utilization of complex continuing care, North West LHIN and Ontario, 2013/14

Indicator North West LHIN Ontario† LHIN % change 2010/11‐2013/14

LHIN of hospital

Active cases 1,082 29,502 ‐15.5

% Inflow 0.9

Admissions 865 23,986 ‐17.2

Discharges 844 24,050 ‐19.7

Total days‡ 61,736 1,893,223 ‐20.9


LHIN of patient

Active cases 1,079 29,267 ‐15.0

% Outflow 0.6


Admissions 863 23,836 ‐16.5

Discharges 844 23,880 ‐19.1

Total days‡ 59,857 1,870,365 ‐22.8



368 28 August 2015

369 28 August 2015

Home Care

Home Care Utilization

Notes: This document and the accompanying workbook describe utilization of Homecare services in Ontario. Analysis is based on data from the Home Care Database. Prepared June 2015

370 28 August 2015

ONTARIO Home care service Active Home Care Clients

In Ontario, Community Care Access Centres (CCACs) are responsible for the management of a range of health care services, including placements to long‐term care homes, case management, and the provision of home care services. Home care services include in‐home professional services (e.g. nursing, physiotherapy), in‐home personal support and homemaking, and school health services for children. It is important to note that not all CCACs offer/capture the same services in the same manner; therefore some differences between LHINs may be due to data collection or the types of services that they provide. In August 2013, the ministry instituted physiotherapy reform which included an expansion of in‐home physiotherapy for up to 60,000 more seniors and people with mobility issues. As part of this initiative, CCACs were asked to clear current physiotherapy waitlists in order to manage the substantial influx of new physiotherapy clients post‐August 1, 2013. As a result, this will affect the physiotherapy numbers and rates in 2013/14.

Active home care clients are those that received one or more home care service during the fiscal year.

In 2013/14, there were 624,355 active home care clients in Ontario. HNHB and Central East had the largest number of active clients while North West and North Simcoe Muskoka LHINs had the smallest.

In 2013/14, there were 45.8 active home care clients per 1,000 population for Ontario overall. South East and North East LHINs had the highest rate of active clients, while Mississauga Halton and Central LHINs had the lowest rates in the province.

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Number of active home care clients and rate per 1,000 population by LHIN, 2013/14

LHIN

Number of Active Clients Crude Rate of Active Clients per 1,000 Population

# % % change 2010/11‐ 2013/14

# % change 2010/11‐2013/14

Erie St Clair 37,043 5.9 6.3 57.6 6.5

South West 54,870 8.8 12.7 56.6 11.1

Waterloo Wellington 36,630 5.9 14.7 47.2 10.7

HNHB 79,188 12.7 13.9 55.1 11.5

Central West 31,011 5.0 14.5 36.2 10.1

Mississauga Halton 40,932 6.6 12.9 33.5 7.2

Toronto Central 48,759 7.8 ‐40.5 42.4 ‐40.8

Central 66,414 10.6 20.9 35.5 13.7

Central East 71,099 11.4 16.1 42.9 10.7

South East 30,679 4.9 18.6 62.2 17.8

Champlain 56,893 9.1 16.0 44.3 12.7

North Simcoe Muskoka 22,806 3.7 17.7 48.4 14.0

North East 34,148 5.5 9.0 60.6 9.9

North West 13,883 2.2 16.5 58.0 16.3

Ontario 624,355 100.0 6.9 45.8 3.7

CCAC Services by Type

As noted, services may not be offered by all CCACs. For example, psychology visits occurred in only two LHINs, respiratory visits in four LHINs, and ‘other’ visits in 11 of the 14 LHINs in 2013/14. Since these services are not consistently available in all LHINs, provincial rates for these services will be misleading. Therefore values for psychology, respiratory and ‘other’ are not shown; however these services are included within the ‘All Visits’ totals.

In 2013/14, there were just over 9.9 million home care visits, which represented 729.7 visits per 1,000 population. The number of visits ranged from 256,031 in the North West LHIN to 1,335,574 in the HNHB LHIN, while the visit rates ranged from 452.6 in the Central West LHIN to 1,197.3 per 1,000 population in the North East LHIN.

Nursing and case management accounted for the largest number of visits. However not all LHINs report case management services in the same manner; therefore differences between LHINs may be due to differences in data collection. In 2013/14, the nursing visit rate for Ontario was 474.8 visits per 1,000 population. The nursing visit rate ranged from 292.0 in the Central West LHIN to 768.3 in the North West LHIN.

In 2013/14 there were nearly 29 million home care service hours in Ontario, or 2,126.5 service hours per 1,000 population. The service hour rates ranged from 1,420.2 in the Mississauga Halton LHIN to 3,064.8 in the Hamilton Niagara Haldimand Brant LHIN in 2013/14. Personal support work and homemaking accounted for 93.4% of all home care service hours in 2013/14.

Between 2010/11 and 2013/14 there was a 16.2% increase in home care visits and a 29.6% increase in home care service hours for Ontario. The services with the largest increase in visits/hours over the period were physiotherapy (68.9%), personal support work and homemaking (30.6%), nursing shift (17.4%), and occupational therapy (16.9%).

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Summary of CCAC Services‡ by Type in Ontario, 2013/14

Visits/Hours Crude Rate/1,000 population

Services by Type # % change

2010/11‐2013/14Rate

% change 2010/11‐2013/14

Range in LHINs

Service Visits

All Visits† 9,947,405 16.2 729.7 12.6 452.6 ‐ 1,197.3

Nursing Visit 6,472,107 13.5 474.8 10.0 292.0 ‐ 768.3

Physiotherapy 721,032 68.9 52.9 63.7 34.6 ‐ 75.7

Occupational Therapy 553,173 16.9 40.6 13.3 23.6 ‐ 72.6

Social Work 51,182 ‐1.2 3.8 ‐4.2 0.8 ‐ 9.8

Nutrition and Dietetic 47,667 5.3 3.5 2.1 1.4 ‐ 7.4

Speech Language Therapy 265,082 13.0 19.4 9.5 9.1 ‐ 49.1

Case Management 1,799,132 10.9 132.0 7.5 61.3 ‐ 392.6

Service Hours

All Hours 28,989,316 29.6 2,126.5 25.6 1,420.2 ‐ 3,064.8

Nursing Shift 1,899,307 17.4 139.3 13.9 21.1 ‐ 275.1

Personal Support Work and Homemaking

27,090,009 30.6 1,987.2 26.7 1,329.4 ‐ 2,926.4

‡Not all CCACs offer the same services or report services in the same manner. For example, case management visits may not be reported consistently across LHINs. †Includes visits for respiratory, psychology, and ‘other’ service types (not shown), which are not consistently reported/available in all LHINs.

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Erie St Clair LHIN

Active Home Care Clients

In 2013/14, there were 37,043 active home care clients in the Erie St Clair LHIN.

Erie St. Clair LHIN had a higher rate of active clients than Ontario in 2013/14.

Between 2010/11 and 2013/14, there was a 6.3% increase in active home care clients and a 6.5% increase in the active client rate for Erie St. Clair LHIN.


In Erie St. Clair LHIN, there were 611,914 home care visits and 1,294,526 service hours in 2013/14.

Between 2010/11 and 2013/14 there was a 6.8% increase in all visits and a 13.4% increase in all homecare hours in Erie St. Clair LHIN. During this period, the service types with the largest increase in visits/hours were physiotherapy (26.8%), social work (21.7%), and nursing shift (32.9%).

Erie St. Clair LHIN had a higher rate of home care service visits but a lower rate of service hours than the province in 2013/14.

Erie St. Clair LHIN had higher visit rates than the province for nursing, occupational therapy, speech language therapy, and case management in 2013/14.

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Home Care Clients and Services in the Erie St Clair LHIN, 2013/14

Indicator Erie St Clair LHIN Ontario LHIN % change 2010/11‐

2013/14

Active Clients 37,043 624,355 6.3

Active Clients/1,000 Population 57.6 45.8 6.5

Number of Visits

All Visits† 611,914 9,947,405 6.8

Nursing Visit 430,741 6,472,107 6.1

Physiotherapy 30,546 721,032 26.8

Occupational Therapy 29,337 553,173 2.0

Social Work 2,766 51,182 21.7

Nutrition and Dietetic 1,813 47,667 ‐15.9

Speech Language Therapy 15,373 265,082 2.9

Case Management 98,563 1,799,132 4.0

Number of Hours

All Hours 1,294,526 28,989,316 13.4

Nursing Shift 90,131 1,899,307 32.9


1,204,395 27,090,009 12.2

Service Visits/1,000 Population

All Visits† 951.9 729.7 6.9

Nursing Visit 670.1 474.8 6.2

Physiotherapy 47.5 52.9 27.0

Occupational Therapy 45.6 40.6 2.1

Social Work 4.3 3.8 21.9

Nutrition and Dietetic 2.8 3.5 ‐15.9

Speech Language Therapy 23.9 19.4 3.0

Case Management 153.3 132.0 4.1

Service Hours/1,000 Population

All Hours 2,013.8 2,126.5 13.5

Nursing Shift 140.2 139.3 33.2


1,873.6 1,987.2 12.4

†Includes visits for respiratory, psychology, and ‘other’ service types (not shown), which are not consistently reported/available in all LHINs.

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South West LHIN


In 2013/14, there were 54,870 active home care clients in the South West LHIN.

South West LHIN had a higher rate of active home care clients than the province in 2013/14.

Between 2010/11 and 2013/14 there was a 12.7% increase in active home care clients in the LHIN and an 11.1% increase in the active client rate.


In South West LHIN, there were 886,952 home care visits and 2,116,371 home care service hours in 2013/14.

Between 2010/11 and 2013/14 there was a 13.6% increase in all home care visits and a 40.7% increase in all home care hours in South West LHIN. During this period the service types with the largest increase in visits/hours were physiotherapy (56.5%), nursing shift (40.9%), personal support work and homemaking (40.6%), and social work (31.2%).

In 2013/14 South West LHIN had higher rates of home care visits (914.6) and service hours (2,182.3) than the province.

South West LHIN had the highest rates of social work visits, nutrition and dietetic visits and nursing shift hours, and the 2nd highest rate of physiotherapy visits in the province in 2013/14. Compared with the province, South West LHIN had higher rates for all home care services except personal support work and homemaking.

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Home Care Clients and Services in the South West LHIN, 2013/14

Indicator South West LHIN Ontario LHIN % change 2010/11‐

2013/14

Active Clients 54,870 624,355 12.7


Number of Visits

All Visits† 886,952 9,947,405 13.6

Nursing Visit 564,773 6,472,107 17.9

Physiotherapy 70,157 721,032 56.5


Social Work 9,484 51,182 31.2

Nutrition and Dietetic 7,132 47,667 29.5


Case Management 163,650 1,799,132 ‐12.5

Number of Hours

All Hours 2,116,371 28,989,316 40.7

Nursing Shift 266,824 1,899,307 40.9


1,849,547 27,090,009 40.6


All Visits† 914.6 729.7 11.6





Nutrition and Dietetic 7.4 3.5 27.2


Case Management 168.7 132.0 ‐14.1


All Hours 2,182.3 2,126.5 38.1



1,907.2 1,987.2 38.7


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Waterloo Wellington LHIN Active Home Care Clients

In 2013/14, there were 36,630 active home care clients in the Waterloo Wellington LHIN.

Waterloo Wellington LHIN had a higher rate of active clients than the province in 2013/14.

Between 2010/11 and 2013/14, the number of home care clients in the LHIN increased by 14.7%, while the active client rate increased by 10.7%.


In Waterloo Wellington LHIN, there were 521,524 home care visits and 1,457,452 service hours in 2013/14.

Between 2010/11 and 2013/14, there was a 3.0% increase in all home care visits and a 30.1% increase in all service hours in Waterloo Wellington LHIN. During this period, the service types with the largest increases in visits/hours were personal support work and homemaking (30.4%), nursing shift (25.7%), and physiotherapy (12.6%), while there was a 19.8% reduction in case management visits.

Waterloo Wellington LHIN had lower rates of home care visits (672.6) and hours (1,879.6) than the province in 2013/14.

Compared with Ontario, Waterloo Wellington LHIN had higher visit rates for occupational therapy, social work and nutrition/dietetic and had lower rates for nursing, speech language therapy, case management, and personal support and homemaking in 2013/14.

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Home Care Clients and Services in the Waterloo Wellington LHIN, 2013/14

Indicator Waterloo Wellington

LHINOntario

LHIN % change 2010/11‐2013/14

Active Clients 36,630 624,355 14.7


Number of Visits

All Visits† 521,524 9,947,405 3.0

Nursing Visit 340,313 6,472,107 8.9

Physiotherapy 40,032 721,032 12.6


Social Work 5,362 51,182 2.5



Case Management 79,398 1,799,132 ‐19.8

Number of Hours

All Hours 1,457,452 28,989,316 30.1

Nursing Shift 107,855 1,899,307 25.7


1,349,597 27,090,009 30.4


All Visits† 672.6 729.7 ‐0.7




Social Work 6.9 3.8 ‐1.3


Speech Language Therapy 17.1 19.4 ‐3.5



All Hours 1,879.6 2,126.5 25.3



1,740.5 1,987.2 25.9


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In 2013/14, HNHB LHIN had the largest number of active home care clients (79,188) in the province.

Compared to Ontario, HNHB LHIN had a higher rate of active clients in 2013/14.

Between 2010/11 and 2013/14, the number of home care clients in the LHIN increased by 13.9% and the active client rate increased by 11.5%.


HNHB LHIN had the largest number of home care visits (1,335,574) and service hours (4,403,997) among all the LHINs in 2013/14.

Between 2010/11 and 2013/14, there was a 26.1% increase in home care visits and a 36.8% increase in service hours in HNHB LHIN. During this period, the service types with the largest increases in visits/hours were case management (52.5%), personal support and homemaking (39.0%), and physiotherapy (30.2%).

HNHB LHIN had higher rates of home care service visits (929.4) and hours (3,064.8) than the province in 2013/14. HNHB had the highest rate of home care hours in the province.

Compared with the province, HNHB LHIN had higher rates for nursing, physiotherapy, occupational therapy, nutrition and dietetic, case management, nursing shift and personal support and homemaking in 2013/14. Among all LHINs, HNHB LHIN had the 2nd highest rate of personal support and homemaking hours in 2013/14.

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Home Care Clients and Services in the HNHB LHIN, 2013/14

Indicator HNHB LHIN Ontario LHIN % change 2010/11‐

2013/14

Active Clients 79,188 624,355 13.9


Number of Visits

All Visits† 1,335,574 9,947,405 26.1

Nursing Visit 933,201 6,472,107 21.4

Physiotherapy 91,252 721,032 30.2


Social Work 4,478 51,182 5.4



Case Management 205,118 1,799,132 52.5

Number of Hours

All Hours 4,403,997 28,989,316 36.8

Nursing Shift 264,959 1,899,307 9.8


4,139,038 27,090,009 39.0


All Visits† 929.4 729.7 23.2









All Hours 3,064.8 2,126.5 33.7



2,880.4 1,987.2 36.1


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Central West LHIN


In 2013/14, there were 31,011 active home care clients in the Central West LHIN.

Central West had the 3rd lowest active client rate in the province in 2013/14, with 36.2 active clients per 1,000 population.

Between 2010/11 and 2013/14, the number of home care clients in the LHIN increased by 14.5% and the active client rate increased by 10.1%.


In Central West LHIN, there were 387,932 home care visits and 1,313,831 home care service hours in 2013/14.

Between 2010/11 and 2013/14, there was a 15.4% increase in all visits and a 50.9% increase in all homecare hours in Central West LHIN. During this period, the service types with the largest increase in visits/hours were nursing shift (80.8%), personal support and homemaking (48.8%), and physiotherapy (47.2%).

Central West had the lowest rate of homecare visits and the 2nd lowest rate of home care service hours in the province in 2013/14.

Central West LHIN had the lowest visit rates in the province for nursing and case management. Compared with the province, Central West LHIN had a higher rate of speech language therapy visits in 2013/14.

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Home Care Clients and Services in the Central West LHIN, 2013/14

Indicator Central West LHIN Ontario LHIN % change 2010/11‐

2013/14

Active Clients 31,011 624,355 14.5


Number of Visits

All Visits† 387,932 9,947,405 15.4

Nursing Visit 250,286 6,472,107 23.7

Physiotherapy 36,743 721,032 47.2

Occupational Therapy 20,441 553,173 ‐10.4

Social Work 1,448 51,182 ‐38.4


Speech Language Therapy 19,715 265,082 ‐9.4

Case Management 52,513 1,799,132 ‐12.4

Number of Hours

All Hours 1,313,831 28,989,316 50.9

Nursing Shift 99,130 1,899,307 80.8


1,214,702 27,090,009 48.8


All Visits† 452.6 729.7 11.1



Occupational Therapy 23.9 40.6 ‐13.7






All Hours 1,532.9 2,126.5 45.2



1,417.3 1,987.2 43.1


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In 2013/14, there were 40,932 active home care clients in the Mississauga Halton LHIN.

Mississauga Halton LHIN had the lowest rate of active home care clients (33.5) in the province.

Between 2010/11 and 2013/14 the number of home care clients in the LHIN increased by 12.9% and the active client rate increased by 7.2%.


In the Mississauga Halton LHIN, there were 591,745 home care visits and 1,734,047 service hours in 2013/14.

Between 2010/11 and 2013/14, there was a 14.5% increase in all home care visits and a 3.8% increase in service hours in Mississauga Halton LHIN. During this period, the service types with the largest increase in visits/hours were physiotherapy (47.9%), speech language therapy (22.5%), and nutrition and dietetic (17.3%).

Mississauga Halton had the lowest rate of home care service hours and the second lowest rate of home care service visits (484.7) in the province in 2013/14.

Among all LHINs, Mississauga Halton LHIN had the lowest rates of physiotherapy, occupational therapy, and personal support work and homemaking, in 2013/14. The LHIN also had the 2nd lowest visit rates for nursing, nutrition and dietetic, and speech language therapy in the province in 2013/14.

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Home Care Clients and Services in the Mississauga Halton LHIN, 2013/14

Indicator Mississauga Halton

LHIN Ontario

LHIN % change 2010/11‐2013/14

Active Clients 40,932 624,355 12.9


Number of Visits

All Visits† 591,745 9,947,405 14.5

Nursing Visit 406,549 6,472,107 13.2

Physiotherapy 42,287 721,032 47.9

Occupational Therapy 28,772 553,173 ‐8.7

Social Work 1,443 51,182 10.2



Case Management 97,702 1,799,132 16.4

Number of Hours

All Hours 1,734,047 28,989,316 3.8

Nursing Shift 110,895 1,899,307 8.5


1,623,152 27,090,009 3.5


All Visits† 484.7 729.7 8.9



Occupational Therapy 23.6 40.6 ‐13.2






All Hours 1,420.2 2,126.5 ‐1.3



1,329.4 1,987.2 ‐1.8


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In 2013/14, there were 48,759 active home care clients in Toronto Central LHIN.

Toronto Central LHIN had the 4th lowest rate of active home care clients (42.4) in the province.

Among all LHINs, Toronto Central was the only LHIN that had a reduction in active home care clients (40.5%) and the active client rate (40.8%) between 2010/11 and 2013/14. In contrast, there was a 6.9% increase in the number of active clients and a 3.7% increase in the rate for Ontario overall.


In the Toronto Central LHIN, there were 907,399 home care visits and 3,135,555 service hours in 2013/14.

Between 2010/11 and 2013/14, there was a 19.1% increase in all home care visits and a 19.4% increase in service hours in Toronto Central LHIN. During this period, the service types with the largest increase in visits/hours were case management (147.7%), physiotherapy (119.2%), and speech language therapy (57.6%).

Compared with Ontario, Toronto Central LHIN had higher rates of home care service visits and hours, in 2013/14. Although Toronto Central LHIN had the 4th lowest rates of active home care clients in the province, the LHIN had the 3rd highest rate of service hours (2,725.8) in the province, in 2013/14.

Toronto Central LHIN had higher rates of nursing and speech language therapy visits than the province in 2013/14.

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Home Care Clients and Services in the Toronto Central LHIN, 2013/14

Indicator Toronto Central LHIN Ontario LHIN % change 2010/11‐

2013/14

Active Clients 48,759 624,355 ‐40.5

Active Clients/1,000 Population 42.4 45.8 ‐40.8

Number of Visits

All Visits† 907,399 9,947,405 19.1

Nursing Visit 631,956 6,472,107 3.9

Physiotherapy 50,235 721,032 119.2


Social Work 2,695 51,182 ‐39.8



Case Management 143,456 1,799,132 147.7

Number of Hours

All Hours 3,135,555 28,989,316 19.4

Nursing Shift 148,091 1,899,307 1.0


2,987,464 27,090,009 20.5


All Visits† 788.8 729.7 18.6









All Hours 2,725.8 2,126.5 18.9



2,597.1 1,987.2 19.9


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Central LHIN


In 2013/14, there were 66,414 active home care clients in Central LHIN.

Central LHIN had the 2nd lowest rate of active home care clients (35.5) in the province.

Between 2010/11 and 2013/14, there was a 20.9% increase in the number of active home care clients and a 13.7% increase in the active client rate for Central LHIN.


In Central LHIN, there were 1,076,927 home care visits and 3,270,682 service hours in 2013/14.

Between 2010/11 and 2013/14, there was a 30.2% increase in all home care visits and a 40.6% increase in service hours in Central LHIN. During this period, the service types with the largest increase in visits/hours were physiotherapy (189.2%), speech language therapy (43.9%), and personal support work and homemaking (41.5%).

Central LHIN had the 3rd lowest rates of home care visits and service hours in the province in 2013/14.

Compared with Ontario, Central LHIN had lower rates of visits/hours for all home care service types, with the exception of speech language therapy visits and nursing shift hours, and had the lowest rate of social work visits in the province in 2013/14.

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Home Care Clients and Services in the Central LHIN, 2013/14

Indicator Central LHIN Ontario LHIN % change 2010/11‐

2013/14

Active Clients 66,414 624,355 20.9


Number of Visits

All Visits† 1,076,927 9,947,405 30.2

Nursing Visit 724,056 6,472,107 26.0

Physiotherapy 89,577 721,032 189.2


Social Work 1,450 51,182 ‐54.4



Case Management 146,899 1,799,132 5.6

Number of Hours

All Hours 3,270,682 28,989,316 40.6

Nursing Shift 275,497 1,899,307 32.0


2,995,185 27,090,009 41.5


All Visits† 575.6 729.7 22.4









All Hours 1,748.1 2,126.5 32.2



1,600.8 1,987.2 33.0


389 28 August 2015

Central East LHIN


In 2013/14, there were 71,099 active home care clients in Central East LHIN.

Central East LHIN had a lower rate of active home care clients (42.9) than the province.

Between 2010/11 and 2013/14, there was a 16.1% increase in active home care clients and a 10.7% increase in the active client rate for Central East LHIN.


In the Central East LHIN, there were 1,016,662 home care visits and 3,000,474 service hours in 2013/14.

Between 2010/11 and 2013/14, there was a 19.5% increase in all home care visits and a 30.7% increase in service hours in Central East LHIN. During the period, the service types with the largest increase in visits/hours were physiotherapy (169.1%), case management (34.0%), and personal support work and homemaking (31.9%).

Central East LHIN had the 4th lowest rates of home care visits and service hours in the province in 2013/14 and these rates were less than the provincial average.

Central East LHIN had higher visit rates for physiotherapy, occupational therapy, and case management than Ontario in 2013/14. The LHIN had the lowest rates in the province for speech language therapy and nutrition and dietetic visits.

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Home Care Clients and Services in the Central East LHIN, 2013/14

Indicator Central East LHIN Ontario LHIN % change 2010/11‐

2013/14

Active Clients 71,099 624,355 16.1


Number of Visits

All Visits† 1,016,662 9,947,405 19.5

Nursing Visit 587,791 6,472,107 4.0

Physiotherapy 102,197 721,032 169.1


Social Work 4,118 51,182 ‐8.9



Case Management 227,470 1,799,132 34.0

Number of Hours

All Hours 3,000,474 28,989,316 30.7

Nursing Shift 224,205 1,899,307 18.2


2,776,268 27,090,009 31.9


All Visits† 613.2 729.7 13.8

Nursing Visit 354.5 474.8 ‐1.0








All Hours 1,809.7 2,126.5 24.5



1,674.5 1,987.2 25.7


391 28 August 2015

South East LHIN


In 2013/14, there were 30,679 active home care clients in South East LHIN.

South East LHIN had the highest rate of active home care clients (62.2) in the province.

Between 2010/11 and 2013/14, there was an 18.6% increase in active home care clients and a 17.8% increase in the active client rate for South East LHIN.


In the South East LHIN, there were 473,569 home care visits and 1,492,358 service hours in 2013/14.

Between 2010/11 and 2013/14, there was a 22.0% increase in all home care visits and a 30.5% increase in all service hours in South East LHIN. During the period, the service types with the largest increase in visits/hours were case management (69.5%), physiotherapy (35.6%), and occupational therapy (32.3%).

South East LHIN had the 2nd highest rate of home care service hours and the 3rd highest rate of home care visits in the province in 2013/14.

South East LHIN had the highest rates in the province for occupational therapy visits and personal support work and homemaking hours in 2013/14. With the exception of nursing shift hours, South East LHIN had higher rates than the province for all other home care service types.

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Home Care Clients and Services in the South East LHIN, 2013/14

Indicator South East LHIN Ontario LHIN % change 2010/11‐

2013/14

Active Clients 30,679 624,355 18.6


Number of Visits

All Visits† 473,569 9,947,405 22.0

Nursing Visit 307,564 6,472,107 12.8

Physiotherapy 30,922 721,032 35.6


Social Work 4,565 51,182 ‐8.9



Case Management 80,798 1,799,132 69.5

Number of Hours

All Hours 1,492,358 28,989,316 30.5

Nursing Shift 48,606 1,899,307 31.3


1,443,751 27,090,009 30.5


All Visits† 959.9 729.7 21.0









All Hours 3,025.0 2,126.5 29.4



2,926.4 1,987.2 29.6


393 28 August 2015

Champlain LHIN


In 2013/14, there were 56,893 active home care clients in Champlain LHIN.

Compared with Ontario, Champlain LHIN had a similar rate of active home care clients.

Between 2010/11 and 2013/14, there was a 16.0% increase in active home care clients and a 12.7% increase in the active client rate for Champlain LHIN.


In the Champlain LHIN, there were 844,277 home care visits and 2,649,844 home care service hours in 2013/14.

Between 2010/11 and 2013/14 there was a 15.2% increase in all home care visits and a 33.3% increase in all service hours in Champlain LHIN. During the period, the service types with the largest increase in visit/hours were physiotherapy (83.4%), personal support work and homemaking (36.8%), and case management (27.3%).

Champlain LHIN had lower rates of home care visits and service hours than the province in 2013/14.

Compared with Ontario, Champlain LHIN had higher visit rates for occupational therapy and case management, but had lower rates for all other home care service types in 2013/14.

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Home Care Clients and Services in the Champlain LHIN, 2013/14

Indicator Champlain LHIN Ontario LHIN % change 2010/11‐

2013/14

Active Clients 56,893 624,355 16.0


Number of Visits

All Visits† 844,277 9,947,405 15.2

Nursing Visit 504,431 6,472,107 6.6

Physiotherapy 60,027 721,032 83.4


Social Work 4,326 51,182 15.5



Case Management 184,443 1,799,132 27.3

Number of Hours

All Hours 2,649,844 28,989,316 33.3

Nursing Shift 175,140 1,899,307 ‐1.8


2,474,705 27,090,009 36.8


All Visits† 658.1 729.7 11.7









All Hours 2,065.6 2,126.5 29.4

Nursing Shift 136.5 139.3 ‐4.6


1,929.1 1,987.2 32.9


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North Simcoe Muskoka (NSM) LHIN


In 2013/14, there were 22,806 active home care clients in NSM LHIN.

Compared with Ontario, NSM LHIN had a higher rate of active home care clients.

Between 2010/11 and 2013/14, there was a 17.7% increase in active home care clients and a 14.0% increase in the active client rate for NSM LHIN.


In the NSM LHIN, there were 362,676 home care visits and 1,145,839 home care service hours in 2013/14.

Between 2010/11 and 2013/14, there was a 9.9% increase in all home care visits and a 29.9% increase in all service hours in NSM LHIN. During the period, the service types with the largest increase in visits/hours were physiotherapy (37.5%), personal support work and homemaking (37.0%), and occupational therapy (15.0%). There was a reduction in visits/hours, during the period, for social work, nutrition and dietetic, speech language therapy, and nursing shifts.

NSM LHIN had higher rates of home care visits and service hours than the province in 2013/14.

Compared with Ontario, NSM LHIN had higher rates for nursing, nutrition and dietetic, case management, and personal support work and homemaking in 2013/14.

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Home Care Clients and Services in the North Simcoe Muskoka LHIN, 2013/14

Indicator North Simcoe Muskoka

LHIN Ontario

LHIN % change 2010/11‐2013/14

Active Clients 22,806 624,355 17.7


Number of Visits

All Visits† 362,676 9,947,405 9.9

Nursing Visit 242,801 6,472,107 11.9

Physiotherapy 21,055 721,032 37.5


Social Work 1,928 51,182 ‐28.1



Case Management 69,368 1,799,132 0.3

Number of Hours

All Hours 1,145,839 28,989,316 29.9

Nursing Shift 53,662 1,899,307 ‐36.6


1,092,177 27,090,009 37.0


All Visits† 769.5 729.7 6.2









All Hours 2,431.0 2,126.5 25.6

Nursing Shift 113.8 139.3 ‐38.6


2,317.2 1,987.2 32.7


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North East LHIN


In 2013/14, there were 34,148 active home care clients in North East LHIN.

North East LHIN had the 2nd highest rate of active home care clients in the province in 2013/14.

Between 2010/11 and 2013/14, there was a 9.0% increase in active home care clients and a 9.9% increase in the active client rate for North East LHIN.


In North East LHIN, there were 674,223 home care visits and 1,377,467 home care service hours in 2013/14.

Between 2010/11 and 2013/14, there was a 6.2% reduction in all home care visits and a 24.6% increase in all service hours in North East LHIN. During the period, the service types with the largest increase in visits/hours were physiotherapy (66.3%), nutrition and dietetic (28.7%), and personal support work and homemaking (25.0%). There was a reduction in visits for speech language therapy and case management during the period.

In 2013/14, North East LHIN had the highest rate of home care visits in the province. Rates for visits and hours were higher than the rates for the province.

North East LHIN had the highest rates in the province for physiotherapy and case management and the 2nd highest rate of social work visits in 2013/14. Compared with Ontario, North East LHIN had higher rates for all home care services except speech language therapy visits and nursing shift hours.

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Home Care Clients and Services in the North East LHIN, 2013/14

Indicator North East LHIN Ontario LHIN % change 2010/11‐

2013/14

Active Clients 34,148 624,355 9.0


Number of Visits

All Visits† 674,223 9,947,405 ‐6.2

Nursing Visit 363,642 6,472,107 8.9

Physiotherapy 42,627 721,032 66.3


Social Work 5,342 51,182 19.2



Case Management 221,089 1,799,132 ‐29.9

Number of Hours

All Hours 1,377,467 28,989,316 24.6

Nursing Shift 29,246 1,899,307 9.1


1,348,221 27,090,009 25.0


All Visits† 1,197.3 729.7 ‐5.7









All Hours 2,446.2 2,126.5 25.3



2,394.3 1,987.2 26.0


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North West LHIN


In 2013/14, there were 13,883 active home care clients in North West LHIN.

North West LHIN had the 3rd highest rate of active home care clients in the province in 2013/14.

Between 2010/11 and 2013/14, there was a 16.5% increase in active home care clients and a 16.3% increase in the active client rate for North West LHIN.


In North West LHIN, there were 256,031 home care visits and 596,872 home care service hours in 2013/14.

Between 2010/11 and 2013/14, there was a 41.3% increase in all home care visits and a 27.5% increase in all service hours in North West LHIN. During the period, the service types with the largest increase in visits/hours were social work (69.7%), nutrition and dietetic (61.1%), and case management (49.1%).

In 2013/14 North West LHIN had the 2nd highest rate of home care visits and the 4th highest rate of home care service hours in the province. Both rates were higher than the provincial rates.

North West LHIN had the highest rates in the province for nursing, and speech language therapy visits. Compared with Ontario, North West LHIN had higher rates for all home care services except nutrition and dietetic visits and nursing shift hours.

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Home Care Clients and Services in the North West LHIN, 2013/14

Indicator North West LHIN Ontario LHIN % change 2010/11‐

2013/14

Active Clients 13,883 624,355 16.5


Number of Visits

All Visits† 256,031 9,947,405 41.3

Nursing Visit 184,003 6,472,107 43.0

Physiotherapy 13,375 721,032 28.7


Social Work 1,777 51,182 69.7

Nutrition and Dietetic 501 47,667 61.1


Case Management 28,665 1,799,132 49.1

Number of Hours

All Hours 596,872 28,989,316 27.5

Nursing Shift 5,065 1,899,307 18.3


591,807 27,090,009 27.6


All Visits† 1,069.0 729.7 40.9









All Hours 2,492.1 2,126.5 27.1



2,471.0 1,987.2 27.4


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Long Term Care

Long‐Term Care: Supply, demand, and time to placement Notes: This document and the accompanying workbook provide analysis of Long‐Term Care (LTC) Home bed supply, demand, residents, waitlists and time to placement. Analysis is based on data from the Long‐ Term Care System Reports (Health Data Branch), Client Profile Database (CPro) and the Occupancy Monitoring Database (OCCM). Prepared June 2015

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ONTARIO LTC supply is the number of long‐term care (LTC) home beds occupied or available for occupancy

(adjusted for bed openings and closings) including long stay, short stay (respite and convalescent

care), and interim beds as of March 31, 2014.

The LTC waitlist is the total number of clients on the waiting list for a long stay bed during the fiscal

year, excluding those who were already occupying a permanent or interim bed and awaiting a

transfer.

LTC demand includes LTC residents plus clients on the wait list.

The Time to Placement (TTP) is the median number of days from application to placement for those

clients placed in a long‐stay bed in the fiscal year. These values exclude clients who were

transferred from another LTC home.

In 2013/14, the LTC Home bed supply rate (per 1,000 population age 75+) ranged from 62 in

Mississauga Halton LHIN to 105 in North East LHIN.

The LTC resident rate was 79.7 for Ontario overall and ranged from 60.9 in Mississauga Halton LHIN

to 100.0 in North East LHIN. The LTC waitlist rate ranged from 10.3 in Central West to 37.7 in

Central East LHIN. The LTC demand rate ranged from 81.2 in Mississauga Halton to 132.8 in North

West LHIN.

The LHINs with greater supply of LTC home beds did not necessarily have lower waitlists. For

example, Champlain and Erie St. Clair LHINs had similar LTC bed supply rates, but had very different

waitlist rates (12.4 for Erie St. Clair and 24.7 for Champlain).

The median TTP ranged from 58 days in North East LHIN to 199 days in Toronto Central LHIN.

The supply of LTC Home beds was not necessarily related to the median TTP. Waterloo Wellington

and Central East LHINs had similar supply rates, but the median TTP in Waterloo Wellington was 79

days, whereas in Central East LHIN it was 138 days.

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LTC supply, residents, waitlist and demand rates per 1,000 population, age 75+ and median TTP, 2013/14

LTC supply, residents, waitlist and demand

per 1,000 population age 75+

Median TTP (days)

LHIN LTC Supply LTC Residents LTC beds waitlist

LTC demand

Erie St. Clair 87.6 83.9 12.4 96.4 99

South West 97.4 94.6 16.8 111.3 60

Waterloo Wellington 81.4 79.3 19.6 98.9 79

HNHB 88.6 86.3 15.3 101.6 81

Central West 81.3 79.0 10.3 89.3 74

Mississauga Halton 62.3 60.9 20.2 81.2 189

Toronto Central 73.1 71.3 24.2 95.5 199

Central 62.9 60.3 23.9 84.2 157

Central East 82.9 80.2 37.7 118.0 138

South East 92.2 90.0 17.7 107.7 84

Champlain 87.5 84.0 24.7 108.7 111

North Simcoe Muskoka 82.3 78.1 32.4 110.5 152

North East 104.6 100.0 25.0 124.9 58

North West 99.1 95.8 37.0 132.8 169

Ontario 82.6 79.7 22.7 102.4 108

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In 2013/14, the LTC bed supply rate (per 1,000 population age 75+) in Erie St. Clair LHIN was slightly higher than the provincial average.

The LTC resident rate for Erie St. Clair was slightly higher than the provincial average. The waitlist rate for LTC beds in Erie St. Clair LHIN was the 2nd lowest in the province. This rate was slightly more than half the provincial rate. The LTC demand rate in Erie St. Clair was lower than the provincial average.

The overall median TTP in Erie St. Clair LHIN was 99 days, less than the provincial median of 108 days. The overall median TTP increased from 54 days in 2011/12 to 99 days in 2013/14, an increase of 83%.

The median TTP was considerably lower for clients from acute care (56 days) than for clients from the community (107 days).

LTC supply, residents, waitlist and demand (number and rate per 1,000 population, age 75+) and median TTP, Erie St. Clair LHIN, 2013/14

Erie St. Clair LHIN Ontario Comments†

# Rate‡ # Rate‡

LTC bed supply

Long stay beds, including interim 4,308 77,014

Short stay respite & convalescent care beds 49 1,037

Total beds in operation 4,357 87.6 78,051 82.6

LTC residents 4,177 83.9 75,489 79.7

LTC beds waitlist 619 12.4 21,547 22.7 2nd lowest

LTC demand (residents + waitlist) 4,796 96.4 97,036 102.4

Median time to LTC placement (in days)

Overall 99 108

From acute care only 56 69

From community 107 116

‡Rate per 1,000 popula on age 75+ †Ranking in the province, compared to other LHINs.

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2. SOUTH WEST LHIN

The LTC bed supply rate (per 1,000 population age 75+) in South West LHIN was the 3rd highest in the province, as was the rate of LTC residents. Both rates were higher than those for the province.

The waitlist rate for South West LHIN was lower than the provincial average, while the LTC demand rate was higher than the Ontario rate.

South West LHIN had among the lowest median TTPs in the province in 2013/14. The overall median TTP for South West LHIN was 60 days, which was 48 days less than the provincial median.

In 2013/14 South West LHIN had the lowest median TTP in the province for clients from acute care (34 days); this was half the median TTP for clients from the community (68 days).

LTC supply, residents, waitlist and demand (number and rate per 1,000 population, age 75+) and median TTP, South West LHIN, 2013/14

South West LHIN Ontario Comments†

# Rate‡ # Rate‡

LTC Bed Supply



Total beds in operation 7,420 97.4 78,051 82.6 3rd highest

LTC residents 7,200 94.6 75,489 79.7 3rd highest

LTC beds waitlist 1,279 16.8 21,547 22.7



Overall 60 108 2nd lowest

From Acute Care only 34 69 Lowest

From Community 68 116 2nd lowest


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In 2013/14, the LTC bed supply rate (per 1,000 population age 75+) for Waterloo Wellington LHIN was similar to the provincial average.

While the LTC resident rate for Waterloo Wellington LHIN was comparable to that for the province the waitlist rate was slightly lower than the Ontario rate. The LTC demand rate in Waterloo Wellington LHIN, which includes residents and waitlist, was lower than the provincial average.

The overall median TTP for Waterloo Wellington LHIN was lower than the provincial median (79 days versus 108 provincially). Among all the LHINs, Waterloo Wellington LHIN had the 2nd lowest median TTP from acute care.

The median TTP for Waterloo Wellington LHIN was considerably lower for clients from acute care (45 days) versus those from the community (82 days).

LTC supply, residents, waitlist and demand (number and rate per 1,000 population, age 75+) and median TTP, Waterloo Wellington LHIN, 2013/14


Ontario Comments†

# Rate‡ # Rate‡

LTC Bed Supply




LTC residents 3,879 79.3 75,489 79.7

LTC beds waitlist 961 19.6 21,547 22.7



Overall 79 108

From Acute Care only 45 69 2nd lowest

From Community 82 116


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4. HAMILTON NIAGARA HALDIMAND BRANT LHIN

The supply rate (per 1,000 population age 75+) of LTC home beds in HNHB LHIN was slightly higher than the provincial rate in 2013/14.

HNHB LHIN had the 3rd lowest LTC waitlist rate among all LHINs. However the LTC resident rate for HNHB was higher than the provincial rate. The LTC demand rate in HNHB LHIN, which includes residents and waitlist, was similar to the provincial average.

The overall median TTP for HNHB LHIN was lower the provincial median by nearly one month. The overall median TTP increased by 14% between 2011/12 and 2013/14, to 81 days.

The median TTP for HNHB LHIN was similar for clients from acute care and from the community. Compared with Ontario, HNHB LHIN had longer median TTP for clients from acute care, but had shorter median TTP for clients from the community.

LTC supply, residents, waitlist and demand (number and rate per 1,000 population, age 75+) and median TTP, HNHB LHIN, 2013/14

HNHB LHIN Ontario Comments†

# Rate‡ # Rate‡

LTC Bed Supply




LTC residents 10,207 86.3 75,489 79.7

LTC beds waitlist 1,815 15.3 21,547 22.7 3rd lowest


Median time to LTC Placement (in days)

Overall 81 108

From Acute Care only 86 69



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The LTC bed supply rate (per 1,000 population age 75+) in the Central West LHIN was similar to that of the province in 2013/14.

The rate of LTC residents in Central West LHIN was nearly identical to the provincial rate. Central West LHIN had the lowest waitlist rate and the 3rd lowest demand rate among all LHINs. The waitlist rate was less than half that of the Ontario rate.

Central West LHIN had among the lowest median TTPs in the province. The overall median TTP for Central West LHIN was more than 30 days lower than the provincial median. While the overall median TTP was also relatively low compared to other LHINs, the rate increased by nearly 40% between 2011/12 to 2013/14.

LTC supply, residents, waitlist and demand (number and rate per 1,000 population, age 75+) and median TTP, Central West LHIN, 2013/14

Central West LHIN Ontario Comments†

# Rate‡ # Rate‡

LTC Bed Supply




LTC residents 3,247 79.0 75,489 79.7

LTC beds waitlist 423 10.3 21,547 22.7 Lowest

LTC demand (residents + waitlist) 3,670 89.3 97,036 102.4 3rd lowest


Overall 74 108 3rd lowest

From Acute Care only 50 69 3rd lowest

From Community 76 116 3rd lowest


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In 2013/14, the Mississauga Halton LHIN had the lowest LTC bed supply rate (per 1,000 population age 75+) among all LHINs in the province.

Mississauga Halton LHIN had the 2nd lowest LTC resident rate and the lowest LTC demand rate in the province. The waitlist rate for Mississauga Halton LHIN was slightly lower than the provincial average.

Mississauga Halton LHIN had among the highest median TTP in the province, overall and for clients from acute and community settings. The overall TTP for Mississauga Halton LHIN was 81 days longer than the provincial median.

The overall median time to LTC placement increased by over 50% between 2011/12 and 2013/14. LTC supply, residents, waitlist and demand (number and rate per 1,000 population, age 75+) and median TTP, Mississauga Halton LHIN, 2013/14


Ontario Comments†

# Rate‡ # Rate‡

LTC Bed Supply



Total beds in operation 4,163 62.3 78,051 82.6 Lowest

LTC residents 4,073 60.9 75,489 79.7 2nd lowest


LTC demand (residents + waitlist) 5,426 81.2 97,036 102.4 Lowest


Overall 189 108 2nd highest

From Acute Care only 197 69 Highest

From Community 189 116 2nd highest


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The LTC bed supply rate (per 1,000 population age 75+) in the Toronto Central LHIN was the 3rd lowest in the province, and decreased slightly from 2011/12 to 2013/14.

Toronto Central LHIN had the 3rd lowest LTC resident rate among all LHINs. The waitlist rate for the LHIN was slightly higher than the provincial average, while the LTC demand rate was lower.

Toronto Central LHIN had the highest median TTP in the province overall and for clients from the community. The overall median TTP for Toronto Central LHIN was 91 days longer than the provincial median. The median TTP for Toronto Central LHIN clients from the community was 4 times the median TTP for clients from acute care.

The overall median TTP increased by more than 50% between 2011/12 and 2013/14. LTC supply, residents, waitlist and demand (number and rate per 1,000 population, age 75+) and median TTP, Toronto Central LHIN, 2013/14

Toronto Central LHIN Ontario Comments†

# Rate‡ # Rate‡

LTC Bed Supply



Total beds in operation 5,878 73.1 78,051 82.6 3rd lowest

LTC residents 5,735 71.3 75,489 79.7 3rd lowest




Overall 199 108 Highest


From Community 243 116 Highest


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8. CENTRAL LHIN

In 2013/14, the LTC bed supply (per 1,000 population age 75+) in Central LHIN was the 2nd lowest in the province.

Central LHIN had the lowest rate of LTC residents and the 2nd lowest LTC demand rate among all LHINs. The waitlist rate was similar to the provincial average.

The median TTP overall, for acute clients, and community clients for Central LHIN were higher than their respective provincial medians. The median TTP overall for Central LHIN was 49 days longer than the Ontario median.

The overall median TTP increased by almost 50% from 2011/12, while the median TTP for community placements remained stable.

LTC supply, residents, waitlist and demand (number and rate per 1,000 population, age 75+) and median TTP, Central LHIN, 2013/14

Central LHIN Ontario Comments†

# Rate‡ # Rate‡

LTC Bed Supply



Total beds in operation 7,247 62.9 78,051 82.6 2nd lowest

LTC residents 6,941 60.3 75,489 79.7 Lowest


LTC demand (residents + waitlist) 9,693 84.2 97,036 102.4 2nd lowest


Overall 157 108

From Acute Care only 130 69 2nd highest



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In 2013/14, the LTC bed supply (per 1,000 population age 75+) was 82.9, nearly identical to the provincial rate.

Although the LTC resident rate was comparable to the provincial average, Central East LHIN had the highest waitlist and the third highest LTC demand rate in the province.

The overall median TTP for Central East LHIN (138 days) was higher than the provincial median (108 days). The median TTP for clients from acute care and from community were also higher than the provincial medians. The median TTP was considerably lower for clients from acute care than for those from the community.

LTC supply, residents, waitlist and demand (number and rate per 1,000 population, age 75+) and median TTP, Central East LHIN, 2013/14

Central East LHIN Ontario Comments†

# Rate‡ # Rate‡

LTC Bed Supply




LTC residents 9,395 80.2 75,489 79.7

LTC beds waitlist 4,418 37.7 21,547 22.7 Highest

LTC demand (residents + waitlist) 13,813 118.0 97,036 102.4 3rd highest


Overall 138 108




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10. SOUTH EAST LHIN

The LTC bed supply rate (per 1,000 population, age 75+) in the South East LHIN was higher than the provincial rate.

Compared with the province, South East LHIN had a lower waitlist rate but had higher rates for LTC residents and LTC demand.

Relative to Ontario, South East LHIN had lower median TTP overall and for clients from both acute and community settings. The median TTP overall for South East LHIN was 24 days shorter than the provincial median.

LTC supply, residents, waitlist and demand (number and rate per 1,000 population, age 75+) and median TTP, South East LHIN, 2013/14

South East LHIN Ontario Comments†

# Rate‡ # Rate‡

LTC Bed Supply




LTC residents 3,954 90.0 75,489 79.7

LTC beds waitlist 777 17.7 21,547 22.7



Overall 84 108




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11. CHAMPLAIN LHIN

The LTC bed supply rate (per 1,000 population age 75+) for Champlain LHIN was higher than the provincial average.

Compared with Ontario, Champlain LHIN had higher rates of LTC residents, waitlist and LTC demand in 2013/14.

In the Champlain LHIN, the overall median TTP to LTC was 111 days in 2013/14, which was similar to the provincial median. The median TTP was considerably lower for clients from acute care than for those from the community.

The overall median TTP decreased by almost 30% between 2011/12 and 2013/14. LTC supply, residents, waitlist and demand (number and rate per 1,000 population, age 75+) and median TTP, Champlain LHIN, 2013/14

Champlain LHIN Ontario Comments†

# Rate‡ # Rate‡

LTC Bed Supply




LTC residents 7,296 84.0 75,489 79.7




Overall 111 108




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The LTC bed supply rate (per 1,000 population, age 75+) in the North Simcoe Muskoka LHIN was similar to the rate for Ontario overall.

While the LTC resident rate was comparable to the Ontario rate, North Simcoe Muskoka LHIN had higher waitlist and LTC demand rates than the province.

The median overall TTP for North Simcoe Muskoka LHIN (152 days) was much longer than the provincial median (108 days). Among all LHINs, North Simcoe Muskoka LHIN had the 3rd highest median TTP for clients from acute care, 55 days longer than the provincial median.

The median overall TTP increased by over 30% between 2011/12 and 2013/14, to 152 days.

LTC supply, residents, waitlist and demand (number and rate per 1,000 population, age 75+) and median TTP, North Simcoe Muskoka LHIN, 2013/14


Ontario Comments†

# Rate‡ # Rate‡

LTC Bed Supply




LTC residents 2,942 78.1 75,489 79.7

LTC beds waitlist 1,222 32.4 21,547 22.7 3rd highest



Overall 152 108

From Acute Care only 124 69 3rd highest



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13. NORTH EAST LHIN

North East LHIN had the highest LTC bed supply rate (per 1,000 population age 75+) among all the LHINs.

North East LHIN also had the highest rate of LTC residents and the 2nd highest LTC demand rate among all LHINs. The waitlist rate for the LHIN was slightly higher than the provincial average.

Among all LHINs, North East LHIN had the lowest median TTP overall and for clients from the community. The overall median TTP for North East LHIN was 50 days shorter than the provincial median. The median TTPs for acute and community were relatively similar for North East LHIN.

LTC supply, residents, waitlist and demand (number and rate per 1,000 population, age 75+) and median TTP, North East LHIN, 2013/14

North East LHIN Ontario Comments†

# Rate‡ # Rate‡

LTC Bed Supply



Total beds in operation 5,004 104.6 78,051 82.6 Highest

LTC residents 4,783 100.0 75,489 79.7 Highest


LTC demand (residents + waitlist) 5,978 124.9 97,036 102.4 2nd highest


Overall 58 108 Lowest


From Community 50 116 Lowest


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14. NORTH WEST LHIN

In 2013/14, the North West LHIN had the 2nd highest LTC bed supply rate (per 1,000 population age 75+) among the LHINs.

North West LHIN had among the highest LTC resident, waitlist, and LTC demand rates across all LHINs.

The median TTP for North West LHIN was the 3rd highest among the LHINs, for overall TTC and for clients from the community. The TTP overall and for acute and community were higher than the provincial medians. The median TTP for clients from the community was considerably longer than that for acute care.

There was a slight decrease in the median TTP between 2011/12 and 2013/14. LTC supply, residents, waitlist and demand (number and rate per 1,000 population, age 75+) and median TTP, North West LHIN, 2013/14

North West LHIN Ontario Comments†

# Rate‡ # Rate‡

LTC Bed Supply



Total beds in operation 1,717 99.1 78,051 82.6 2nd highest

LTC residents 1,660 95.8 75,489 79.7 2nd highest

LTC beds waitlist 641 37.0 21,547 22.7 2nd highest

LTC demand (residents + waitlist) 2,301 132.8 97,036 102.4 Highest


Overall 169 108 3rd highest


From Community 187 116 3nd highest

‡Rate per 1,000 population age 75+ †Ranking in the province, compared to other LHINs.

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419 28 August 2015

Primary Care

Primary Care: Selected indicators from the Health Care Experience Survey Follow‐up with a primary care physician following acute hospital discharge

Primary care enrolment

Notes: This document and the accompanying workbook contain analysis of selected indicators from the Health Care Experience Survey; percentage of patients who saw a primary care physician within seven days of acute discharge from hospital for selected conditions (based on 25 Case Mix Groups (CMGs)), derived from data from the Discharge Abstract Database (DAD), Claims History Database (CHDB), and Corporate Provider Database (CPDB); and primary care enrolment, obtained from the Primary Health Care Status Report, derived from the Client Agency Program Enrolment (CAPE) and CPDB. Prepared June 2015

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ONTARIO Access to, and satisfaction with, primary care

Timely and appropriate access to primary health care is a key part of the Ministry’s Action Plan for Health Care. Specifically, goals include ease of access and faster access to primary care, with more patients receiving same day or next day appointments.

In 2014, 94.0% of Ontarians aged 16 years and older had a primary care provider (referred to as the attachment rate). The attachment rate ranged from 87.3% in the North West LHIN to 97.3% in the South East LHIN.

As well, 44.3% of Ontarians aged 16 and older were able to see a primary care provider on the same day or next day when they were sick; this ranged from 28.4% in the North West LHIN to 57.0% in Central West LHIN.

Access to after‐hours care is another important component of primary care in Ontario. In 2014, 38.1% of Ontarians aged 16 and older were aware that their provider offers an after‐hours clinic. In addition, 52.4% had difficulty accessing after‐hours care without going to an emergency department; this was lowest for the Mississauga Halton LHIN at 45.3% and highest for the North West LHIN at 73.0%.

The majority of Ontarians aged 16 and older who were attached reported that their primary care provider always or often gives them the opportunity to ask questions (85.3%); similarly, most reported that their provider always or often spends enough time with them (82.5%).

Primary care physician follow‐up

Physician visits within seven days of discharge from an acute hospital stay can help to integrate patient care, and prevent avoidable hospital readmissions.

In 2013/14, almost 36% of Ontario patients who had an acute hospital discharge (for selected conditions based on 25 Case Mix Groups (CMGs)) saw a primary care physician (GP/FP or pediatrician) within seven days of their discharge. This ranged from 24.6% for North West LHIN patients to 46.3% for Central West LHIN patients.

The percent of Ontario patients who saw a primary care physician within seven days of discharge was 41.2% for congestive heart failure (CHF) discharges and 34.3% for chronic obstructive pulmonary disease (COPD) discharges. The proportion of patients who saw a primary care provider for CHF discharges was consistently higher than the proportion who saw a primary care provider for COPD discharges across all the LHINs.


Patient enrolment models (PEMs) are primary care physician payment models that involve comprehensive care‐based group practice and patient rostering (i.e., enrolment with a particular primary care provider group).

Over 10.4 million Ontarians were enrolled with a PEM as of May 2015.

Of those enrolled in PEMs, 62% were enrolled with a Family Health Organization (FHO), almost 30% with a Family Health Group (FHG) and 3.8% in Comprehensive Care Models (CCMs).

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Primary care access and satisfaction, adults (aged 16 and older), by LHIN of residence, January 2014‐December 2014

LHIN of residence

Access to, and satisfaction with, primary care

% patient attachment

% same/next day access when sick

% aware of after‐hours clinic offered by provider

% with difficulty accessing after‐

hours care without going to ED

% whose provider allows opportunity for

questions

% whose provider spends enough time with them

Erie St. Clair 96.0% 42.5% 35.5% 61.9% 84.8% 82.2%

South West 94.8% 41.3% 42.5% 56.9% 87.6% 81.7%

Waterloo Wellington 96.5% 42.6% 50.9% 54.1% 86.7% 83.6%

HNHB 95.7% 48.7% 49.6% 48.3% 88.3% 84.5%

Central West 93.8% 57.0% 32.2% 46.8% 76.8% 74.5%

Mississauga Halton 94.5% 47.6% 36.9% 45.3% 80.9% 80.7%

Toronto Central 91.8% 49.3% 34.5% 49.4% 89.3% 85.0%

Central 94.2% 48.1% 30.0% 48.6% 84.6% 82.8%

Central East 93.7% 39.0% 37.1% 49.5% 83.0% 81.5%

South East 97.3% 39.5% 41.9% 59.6% 91.8% 86.9%

Champlain 92.5% 44.0% 37.8% 56.4% 87.4% 83.5%

North Simcoe Muskoka

96.5% 29.4% 34.8% 61.1% 87.1% 81.7%

North East 88.3% 31.9% 34.6% 61.1% 84.0% 85.5%

North West 87.3% 28.4% 38.7% 73.0% 82.1% 80.4%

Ontario 94.0% 44.3% 38.1% 52.4% 85.3% 82.5%

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Percentage of patients who saw a primary care physician within seven days of acute discharge from

hospital for selected conditions based on 25 Case Mix Groups, by LHIN of patient, 2013/14

LHIN of patient

Primary care physician follow‐up within 7 days of discharge Total number of discharges for all conditions (based on 25

CMGs)

% with visits in 7 days

Discharges for CHF patients


Discharges for COPD patients


Erie St. Clair 2,689 35.0% 308 37.7% 435 34.3%

South West 3,580 30.6% 490 34.7% 499 29.6%

Waterloo Wellington

2,275 34.8% 287 38.1% 332 33.9%

HNHB 6,090 36.7% 807 39.5% 856 37.6%

Central West 3,198 46.3% 375 52.4% 299 44.4%

Mississauga Halton 3,937 43.0% 495 49.4% 373 41.9%

Toronto Central 3,865 38.6% 622 47.3% 443 38.2%

Central 5,515 42.4% 787 47.8% 544 43.2%

Central East 5,057 37.1% 658 40.3% 705 32.5%

South East 2,112 34.9% 278 43.7% 373 34.0%

Champlain 3,710 32.0% 511 37.9% 650 30.5%

North Simcoe Muskoka

1,865 33.3% 209 37.1% 302 31.5%

North East 2,715 27.2% 312 34.1% 547 30.3%

North West 1,030 24.6% 110 30.1% 172 25.0%

Ontario 47,941 35.9% 6,293 41.2% 6,570 34.3%

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Number of Ontarians enrolled in Patient Enrolment Models (PEMs) by LHIN of Provider and Group Type*, as of May 2015

LHIN of provider Total # enrolled

Patients enrolled, by Primary Care Models

CCM CSA FHG FHN FHO RNPGA Other

# % # % # % # % # % # % # %

Erie St. Clair 473,920 21,377 4.5% 12,302 2.6% 128,788 27.2% 10,671 2.3% 300,782 63.5% ‐ 0.0% ‐ 0.0%

South West 745,139 25,168 3.4% 13,863 1.9% 102,423 13.7% 43,258 5.8% 560,427 75.2% ‐ 0.0% ‐ 0.0%

Waterloo Wellington 585,108 6,501 1.1% 11,030 1.9% 5,228 0.9% ‐ 0.0% 562,349 96.1% ‐ 0.0% ‐ 0.0%

HNHB 1,121,586 35,888 3.2% 6,998 0.6% 280,170 25.0% 45,796 4.1% 752,597 67.1% ‐ 0.0% 137 0.0%

Central West 684,005 17,556 2.6% ‐ 0.0% 419,973 61.4% ‐ 0.0% 246,476 36.0% ‐ 0.0% ‐ 0.0%

Mississauga Halton 920,583 42,014 4.6% ‐ 0.0% 409,941 44.5% ‐ 0.0% 467,451 50.8% ‐ 0.0% 1,177 0.1%

Toronto Central 1,009,659 52,258 5.2% ‐ 0.0% 284,932 28.2% ‐ 0.0% 652,658 64.6% ‐ 0.0% 19,811 2.0%

Central 1,298,732 72,964 5.6% 7,164 0.6% 666,177 51.3% ‐ 0.0% 552,297 42.5% ‐ 0.0% 130 0.0%

Central East 1,321,965 53,335 4.0% 2,295 0.2% 450,868 34.1% ‐ 0.0% 815,467 61.7% ‐ 0.0% ‐ 0.0%

South East 400,406 18,182 4.5% 10,222 2.6% 37,828 9.4% 20,101 5.0% 313,935 78.4% ‐ 0.0% 138 0.0%

Champlain 973,635 30,791 3.2% 17,126 1.8% 236,045 24.2% ‐ 0.0% 689,673 70.8% ‐ 0.0% ‐ 0.0%

N Simcoe Muskoka 344,779 1,906 0.6% ‐ 0.0% 13,471 3.9% 36,784 10.7% 292,618 84.9% ‐ 0.0% ‐ 0.0%

North East 408,989 10,012 2.4% 1,626 0.4% 40,987 10.0% 48,807 11.9% 201,479 49.3% 42,483 10.4% 63,595 15.5%

North West 166,010 5,811 3.5% ‐ 0.0% 51,595 31.1% 17,218 10.4% 65,069 39.2% 23,546 14.2% 2,771 1.7%

Ontario 10,454,516 393,763 3.8% 82,626 0.8% 3,128,426 29.9% 222,635 2.1% 6,473,278 61.9% 66,029 0.6% 87,759 0.8%

*see next table for description of group types

28 August 2015 424

Primary Care Models CCM Comprehensive Care Models are solo‐practitioners who enrol patients but are paid primarily on a fee‐

for‐service basis

CSA Community Sponsored Agreement Models where physicians are paid largely by salary and part of a FHT.

FHG Family Health Group Models where physicians are paid Fee‐for‐Service plus incentives.

FHN Family Health Network

FHO Family Health Organization

RNPGA Rural and Northern Physician Group Agreement

Other Includes groups with alternate payment type agreements for primary care services to a specific patient type such as HIV or palliative, or primary care in a specific location such as Sault Ste Marie or Moose Factory.

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In 2014, 96.0% of adults (aged 16 and older) in Erie St. Clair had a primary care provider.

42.5% of adults in the Erie St. Clair LHIN were able to see a primary care provider on the same day or next day when they were sick.

35.5% of adults reported that they were aware that their provider offered an after‐hours clinic. In addition, 61.9% of adults had difficulty accessing after‐hours care without going to an emergency department; this was the second highest proportion in the province.

As in the province, the majority of adults in Erie St. Clair who were attached reported that their primary care provider always or often gives them the opportunity to ask questions (84.8%); similarly, most reported that their provider always or often spends enough time with them (82.2%).


In 2013/14, 35.0% of patients in the Erie St. Clair who had an acute hospital discharge (for selected conditions based on 25 CMGs) saw a primary care physician within seven days of their discharge.

The percent of LHIN patients who saw a primary care physician was 37.7% for CHF discharges, lower than the proportion for the province.


Close to 474,000 Ontarians were enrolled with a PEM located in the Erie St. Clair LHIN as of May 2015.

Of those enrolled with PEMs located in the LHIN, the majority (63.5%) were enrolled in a FHO.

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2. SOUTH WEST LHIN


In 2014, 94.8% of South West adults (aged 16 and older) had a primary care provider.

41.3% of South West LHIN adults were able to see a primary care provider on the same day or next day if they were sick.

42.5% of South West LHIN adults were aware that their provider offers an after‐hours clinic; this was the third highest proportion in the province. In addition, 56.9% of LHIN adults had difficulty accessing after‐hours care without going to an emergency department.

87.6% of adults who were attached reported that their primary care provider always or often gives them the opportunity to ask questions and 81.7% reported that their provider always or often spends enough time with them.


In 2013/14, 30.6% of patients in the South West LHIN who had an acute hospital discharge (for selected conditions based on 25 CMGs) saw a primary care physician within seven days of their discharge; this was the third lowest proportion in the province.

The percent of LHIN patients who saw a primary care physician was 34.7% for CHF discharges which was the third lowest proportion in Ontario, while the percent was 29.6% for COPD discharges which was the second lowest proportion in Ontario.


Over 745,100 Ontarians were enrolled with a PEM located in the South West LHIN as of May 2015.

Of those enrolled with PEMs located in the LHIN, the majority (75.2%) were enrolled in a FHO.

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In 2014, 96.5% of Waterloo Wellington adults (aged 16 and older) had a primary care provider – this was the second highest attachment rate among the LHINs.

42.6% of adults in the Waterloo Wellington LHIN were able to see a primary care provider on the same day or next day when they were sick.

While 50.9% of Waterloo Wellington LHIN adults were aware that their provider offers an after‐hours clinic (the highest proportion in the province), 54.1% had difficulty accessing after‐hours care without going to an emergency department.

86.7% of adults who were attached reported that their primary care provider always or often gives them the opportunity to ask questions, and 83.6% reported that their provider always or often spends enough time with them.


In 2013/14, 34.8% of patients in Waterloo Wellington who had an acute hospital discharge (for selected conditions based on 25 CMGs) saw a primary care physician within 7 days of their discharge.

The percent of LHIN patients who saw a primary care physician was 38.1% for CHF discharges, lower than the proportion for the province.


Over 585,000 Ontarians were enrolled with a PEM located in the Waterloo Wellington LHIN as of May 2015.

Of those enrolled with PEMs located in the LHIN, almost all (96.1%) were enrolled in a FHO.

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In 2014, 95.7% of HNHB adults (aged 16 years and older) had a primary care provider.

48.7% of adults in the HNHB LHIN were able to see a primary care provider on the same day or next day when they were sick; this was the third highest proportion in the province.

While almost half of HNHB LHIN adults were aware that their provider offers an after‐hours clinic (the second highest proportion in the province), 48.3% had difficulty accessing after‐hours care without going to an emergency department (the third lowest proportion in the province).

88.3% of HNHB adults who were attached reported that their primary care provider always or often gives them the opportunity to ask questions (the third highest proportion in the province), and 84.5% reported that their provider always or often spends enough time with them.


In 2013/14, 36.7% of patients in the HNHB LHIN who had an acute hospital discharge (for selected conditions based on 25 CMGs) saw a primary care physician within seven days of their discharge.

The percent of LHIN patients who saw a primary care physician for COPD discharges was 37.6%, higher than the proportion for Ontario.


Over 1,121,500 Ontarians were enrolled with a PEM located in the HNHB LHIN as of May 2015.

Of those enrolled with PEMs located in the LHIN, 67.1% were enrolled in a FHO and 25.0% with a FHG.

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In 2014, 93.8% of Central West adults (aged 16 years and older) had a primary care provider.

57.0% of adults in the Central West LHIN were able to see a primary care provider on the same day or next day when they were sick. This was the highest proportion in the province.

Only 32.2% of adults were aware that their provider offers an after‐hours clinic (the second lowest proportion in the province); as well, 46.8% had difficulty accessing after‐hours care without going to an emergency department (also second lowest proportion in Ontario).

The proportions of attached adults in the Central West LHIN who reported that their primary care provider always or often gives them the opportunity to ask questions (76.8%), and that their provider always or often spends enough time with them (74.5%) were the lowest in the province.


In 2013/14, 46.3% of patients in the Central West LHIN who had an acute hospital discharge (for selected conditions based on 25 CMGs) saw a primary care physician within seven days of their discharge; this was the highest proportion in the province.

The percent of LHIN patients who saw a primary care physician was 52.4% for CHF discharges and 44.4% for COPD discharges; these were the also highest proportions in the province.


Over 684,000 Ontarians were enrolled with a PEM located in the Central West LHIN as of May 2015.

Of those enrolled with PEMs located in the LHIN, 61.4% were enrolled in a FHG, while 36.0% were enrolled in a FHO.

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In 2014, 94.5% of Mississauga Halton adults (aged 16 years and older) had a primary care provider.

47.6% of adults in the Mississauga Halton LHIN were able to see a primary care provider on the same day or next day when they were sick.

36.9% of LHIN adults were aware that their provider offers an after‐hours clinic. In addition, 45.3% of adults had difficulty accessing after‐hours care without going to an emergency department, which was the lowest proportion in the province.

80.9% of adults in the LHIN who were attached reported that their primary care provider always or often gives them the opportunity to ask questions which was the second lowest proportion in the province. 80.7% reported that their provider always or often spends enough time with them (the third lowest proportion in the province).


In 2013/14, 43.0% of patients in the Mississauga Halton LHIN who had an acute hospital discharge (for selected conditions based on 25 CMGs) saw a primary care physician within seven days of their discharge; this was the second highest proportion in Ontario.

The percent of LHIN patients who saw a primary care physician was 49.4% for CHF discharges which was the second highest proportion in Ontario, while the percent was 41.9% for COPD discharges, which was the third highest proportion in the province.


Over 920,500 Ontarians were enrolled with a PEM located in the Mississauga Halton LHIN as of May 2015.

Of those enrolled in PEMs located in the LHIN, 50.8% were enrolled in a FHO and 44.5% were enrolled in a FHG.

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In 2014, 91.8% of Toronto Central adults (aged 16 years and older) had a primary care provider. This was the third lowest proportion in the province.

49.3% of adults in the Toronto Central LHIN were able to see a primary care provider on the same day or next day when they were sick; this was the second highest proportion among the LHINs.

Just over a third of LHIN adults were aware that their provider offers after‐hours clinic (the third lowest proportion in the province); 49.4% had difficulty accessing after‐hours care without going to an emergency department.

89.3% of adults in the LHIN who were attached reported that their primary care provider always or often gives them the opportunity to ask questions which was the second highest proportion in Ontario, while 85.0% reported that their provider always or often spends enough time with them which was the third highest proportion in the province.


In 2013/14, 38.6% of patients in Toronto Central who had an acute hospital discharge (for selected conditions based on 25 CMGs) saw a primary care physician within seven days of their discharge; this was higher than the proportion for Ontario.

The percent of LHIN patients who saw a primary care physician was 47.3% for CHF discharges and 38.2% for COPD discharges; these proportions were also higher than the Ontario proportions.


1,009,659 Ontarians were enrolled with a PEM located in the Toronto Central LHIN as of May 2015.

Of those enrolled in PEMs located in the LHIN, 64.6% were enrolled in a FHO.

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8. CENTRAL LHIN


In 2014, 94.2% of Central adults (aged 16 years and older) had a primary care provider.

48.1% of adults in the Central LHIN were able to see a primary care provider on the same day or next day when they were sick. This was higher than the proportion for the province.

Only 30% of LHIN adults were aware that their provider offers an after‐hours clinic; this was the lowest proportion among the LHINs. As well, 48.6% had difficulty accessing after‐hours care without going to an emergency department.

Close to 85% of adults in the LHIN who were attached reported that their primary care provider always or often gives them the opportunity to ask questions, and 82.8% reported that their provider always or often spends enough time with them.


In 2013/14, 42.4% of patients in Central LHIN who had an acute hospital discharge (for selected conditions based on 25 CMGs) saw a primary care physician within seven days of their discharge; this was the third highest proportion in the province.

The percent of LHIN patients who saw a primary care physician was 47.8% for CHF discharges which was also the third highest proportion in the province, while the percent was 43.2% for COPD discharges which was the second highest proportion in the province.


Almost 1.3 million Ontarians were enrolled with a PEM located in the Central LHIN as of May 2015.

Of those enrolled in PEMs located in the LHIN, 51.3% were enrolled in a FHG and another 42.5% were enrolled in a FHO.

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In 2014, 93.7% of Central East adults (aged 16 years and older) had a primary care provider.

39.0% of adults in the Central East LHIN were able to see a primary care provider on the same day or next day when they were sick; this was lower than the proportion for Ontario.

37.1% of Central East LHIN adults were aware that their provider offers an after‐hours clinic, and almost half had difficulty accessing after‐hours care without going to an emergency department.

83.0% of adults in the LHIN who were attached reported that their primary care provider always or often gives them the opportunity to ask questions, and 81.5% reported that their provider always or often spends enough time with them.


In 2013/14, 37.1% of patients in Central East LHIN who had an acute hospital discharge (for selected conditions based on 25 CMGs) saw a primary care physician within seven days of their discharge.

The percent of LHIN patients who saw a primary care physician was 40.3% for CHF discharges and 32.5% for COPD discharges.


1,321,965 Ontarians were enrolled with a PEM located in the Central East LHIN as of May 2015.

Of those enrolled in PEMs located in the LHIN, 61.7% were enrolled in a FHO and 34.1% were enrolled in a FHG.

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10. SOUTH EAST LHIN


In 2014, 97.3% of South East adults (aged 16 years and older) had a primary care provider, the highest attachment rate among the LHINs.

Close to 40% of adults in the South East LHIN were able to see a primary care provider on the same day or next day. This was lower than the percent for the province overall.

Almost 42% of LHIN adults were aware that their provider offers an after‐hours clinic, and almost 60% had difficulty accessing after‐hours care without going to an emergency department.

Over 90% of LHIN adults who were attached reported that their primary care provider always or often gives them the opportunity to ask questions, which was the highest proportion among the LHINs. 86.9% also reported that their provider always or often spends enough time with them, which again was the highest proportion in Ontario.


In 2013/14, 34.9% of patients in the South East LHIN who had an acute hospital discharge (for selected conditions based on 25 CMGs) saw a primary care physician within seven days of their discharge.

The percent of LHIN patients seen by a primary care physician was 43.7% for CHF discharges and 34.0% for COPD discharges.


Just over 400,000 Ontarians were enrolled with a PEM located in the South East LHIN as of May 2015.

Of those enrolled in PEMs located in the LHIN, the majority (78.4%) were enrolled in a FHO.

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11. CHAMPLAIN LHIN


In 2014, 92.5% of Champlain adults (aged 16 years and older) had a primary care provider.

44.0% of adults in the Champlain LHIN were able to see a primary care provider on the same day or next day when they were sick.

37.8% of LHIN adults were aware that their provider offers an after‐hours clinic, and 56.4% had difficulty accessing after‐hours care without going to an emergency department.



In 2013/14, 32.0% of patients in the Champlain LHIN who had an acute hospital discharge (for selected conditions based on 25 CMGs) saw a primary care physician within seven days of their discharge; this was lower than the proportion for the province.

The percent of LHIN patients seen by a primary care physician was 37.9% for CHF discharges and 30.5% for COPD discharges; both proportions were lower than the corresponding proportions for the province.


Over 973,000 Ontarians were enrolled with a PEM located in the Champlain LHIN as of May 2015.

Of those enrolled in PEMs located in the LHIN, the majority (70.8%) were enrolled in a FHO.

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In 2014, 96.5% of North Simcoe Muskoka adults (aged 16 years and older) had a primary care provider; this was the third highest attachment rate among the LHINs.

Close to 30% of adults in the North Simcoe Muskoka LHIN were able to see a primary care provider on the same day or next day when they were sick. This was the second lowest proportion among the LHINs.

34.8% of LHIN adults were aware that their provider offers an after‐hours clinic. In addition, 61.1% had difficulty accessing after‐hours care without going to an emergency department; this was the third highest proportion in the province.



In 2013/14, 33.3% of patients in the North Simcoe Muskoka LHIN who had an acute hospital discharge (for selected conditions based on 25 CMGs) saw a primary care physician within seven days of their discharge.

The percent of LHIN patients who saw a primary care physician was 37.1% for CHF discharges and 31.5% for COPD discharges, both of which were lower than the corresponding proportions for Ontario.


Over 344,000 Ontarians were enrolled with a PEM located in the North Simcoe Muskoka LHIN as of May 2015.

Of those enrolled in PEMs located in the LHIN, almost 85% were enrolled in a FHO and 10.7% in a Family Health Network (FHN).

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13. NORTH EAST LHIN


In 2014, 88.3% of North East adults (aged 16 and older) had a primary care provider, which was the second lowest attachment rate among the LHINs.

Only 31.9% of adults in the North East LHIN were able to see a primary care provider on the same day or next day when they were sick; this was the third lowest proportion in the province.

34.6% of LHIN adults were aware that their provider offers an after‐hours clinic. In addition, 61.1% had difficulty accessing after‐hours care without going to an emergency department, which was the third highest proportion in Ontario.

84.0% of adults in the LHIN who were attached reported that their primary care provider always or often gives them the opportunity to ask questions, and 85.5% reported that their provider always or often spends enough time with them (the second highest proportion among the LHINs).


In 2013/14, only 27.2% of patients in North East LHIN who had an acute hospital discharge (for selected conditions based on 25 CMG) saw a primary care physician within seven days of their discharge; this was the second lowest proportion among the LHINs.

The percent of LHIN patients seen by a primary care physician was 34.1% for CHF discharges, which was the second lowest proportion in the province and 30.3% for COPD discharges, which was the third lowest proportion in Ontario.


Over 408,000 Ontarians were enrolled with a PEM located in the North East LHIN as of May 2015.

Of those enrolled in PEMs located in the LHIN, 49.3% were enrolled in a FHO, 11.9% in a FHN, 10.4% in a Rural and Northern Physician Group Agreement (RNPGA) model, and 10.0% in a Family Health Group (FHG).

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14. NORTH WEST LHIN


In 2014, 87.3% of North West adults (aged 16 years and older) had a primary care provider, which was the lowest attachment rate among the LHINs.

Only 28.4% of adults in the North West LHIN were able to see a primary care provider on the same day or next day when they were sick. This was the lowest proportion in the province.

38.7% of LHIN adults were aware that their provider offers an after‐hours clinic. 73.0% of LHIN adults had difficulty accessing after‐hours care without going to an emergency department, which was the highest proportion among the LHINs.

82.1% of adults in the LHIN who were attached reported that their primary care provider always or often gives them the opportunity to ask questions (the third lowest proportion in the province), and 80.4% reported that their provider always or often spends enough time with them (the second lowest proportion in Ontario).


In 2013/14, 24.6% of patients in North West LHIN who had an acute hospital discharge (for selected conditions based on 25 CMGs) saw a primary care physician with seven day of their discharge; this was the lowest proportion among the LHINs.

The percent of LHIN patients who saw a primary care physician was 30.1% for CHF discharges and 25.0% for COPD discharges; these were also the lowest proportions in the province.


About 166,000 Ontarians were enrolled with a PEM located in the North West LHIN as of May 2015.

Of those enrolled in PEMs located in the LHIN, 39.2% were enrolled in a FHO, 31.1% in a FHG, 14.2% in a RNPGA, and 10.4% in a FHN.

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Health Human Resources

Human Resources Notes: This document and the accompanying workbook contain data extracted from existing published reports (Physician in Ontario Report and Health Professions Database 2011 Stat Book) or data query tool (College of Nurses of Ontario (CNO)). Only members in their respective regulatory college verified as actively practicing in Ontario are included. College members who hold educational certificates (i.e. are registered as students or interns) are excluded. LHIN classification is based on practice location. Counts and rates in this report refer to health professionals in active practice, defined as follows: Physicians are those licensed to practice and practicing in Ontario for a significant portion of the calendar year. Nurses employed in Ontario in full‐time, part‐time, and casual positions. Employment information is collected on all of a member's nursing employers. Health Professionals are those who held active registration with their Regulatory College and are able to practice in full or in any one capacity (clinical, research, teaching, sales, health promotion, etc.). The numbers in this report need to be interpreted with caution. The counts are not full time equivalents (FTEs), therefore a professional who works part‐time is counted the same way as one who works full‐time. This is especially true for physicians in the older age categories, as older physicians may reduce their medical practice activities. Nursing employment information is provided by the CNO. There was a change in the data collection method in 2011 to include information from all the members’ employers. Prior to 2011, employment information was only collected from the member's primary nursing employer. Therefore comparison to employment information reported prior to 2011 is not possible. Finally, the rates shown are counts of the number of providers practicing in each LHIN divided by the LHIN’s population and do not take into consideration that LHIN residents may receive care from providers in other LHINs. Prepared June 2015

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ONTARIO Physicians

From 2010 to 2013, the total number of physicians (family physicians and specialists) in Ontario increased from 24,875 in 2010 to 27,125 in 2013, an increase of 9.0%. Over the same time period, the Ontario population grew at a slower rate (2.5%).

The rate of total physicians (per 100,000 population) increased from 188.3 in 2010 to 200.2 in 2013.

There was a moderate increase in the number of family physicians (8.7%) between 2010 (11,628) and 2013 (12,635). Across LHINs, rates of family physicians ranged from 67.7 in Central West LHIN to 135.0 in Toronto Central LHIN in 2013.

There was a 9.4% increase in the number of specialists between 2010 (13,247) and 2013 (14,490). Across LHINs, rates of specialists ranged from 51.3 in Central West LHIN to 299.8 in Toronto Central LHIN in 2013.

The majority of family physicians in Ontario were between the ages of 30 and 64 (84.3%), with just over 13.7% age 65 and over.

Nurses

The total number of nurses in Ontario increased from 147,510 in 2011 to 161,022 in 2014, an increase of 9.2%. The rate of nurses increased from 1,112.1 in 2011 to 1,177.2 in 2014.

There was a 4.4% increase in the number of registered nurses (RNs) between 2011 (107,625) and 2014 (112,411). The rate of RNs ranged from 408.5 in Central West LHIN to 1,582.8 in Toronto Central LHIN in 2014.

A large increase in the number of registered practical nurses (RPNs) was observed (21.1%) between 2011 (37,775) and 2014 (45,742). Across LHINs, rates in 2014 ranged from 164.0 in Central West LHIN to 605.8 in North West LHIN.

The number of nurse practitioners (NPs) increased by 36.0% between 2011 (2,110) and 2014 (2,869). Across LHINs, rates in 2014 ranged from 6.3 in Central West LHIN to 61.4 in North West LHIN.

Regulated health professionals

Between 2008 and 2011 there was 38% growth in the number of midwives, a 27% increase pharmacists, 22% increase in optometrists, and 17% growth in opticians and occupational therapists.

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Physicians, nurses, and regulated health professionals in Ontario

# Professionals Rate per 100,000 population

Ontario % change Ontario Range across

LHINs

PHYSICIANS IN ONTARIO, 2013 2010‐2013

Family physicians 12,635 8.7% 93.2 67.7 ‐ 135.0Specialists 14,490 9.4% 106.9 51.3 ‐ 299.8Total physicians 27,125 9.0% 200.2 119.0 ‐ 434.8

NURSES IN ONTARIO, 2014 2011‐2014

Registered Nurses (RNs in general class) 112,411 4.4% 821.8 408.5 ‐ 1,582.8Registered Practical Nurses (RPNs) 45,742 21.1% 334.4 164.0 ‐ 605.8Nurse Practitioners (NPs = RNs in extended class) 2,869 36.0% 21.0 6.3 ‐ 61.4Total Nurses 161,022 9.2% 1,177.2 578.8 ‐ 1,997.0

SELECTED HEALTH PROFESSIONS, 2011 2008‐2011

Midwife Occupational Therapist Optician Optometrist Pharmacist†

555 37.7% 4.2 0.5 ‐ 7.5

4,949 16.5% 37.3 14.6 ‐ 67.9

2,467 16.6% 18.6 6.3 ‐ 22.2

1,910 21.6% 14.4 9.9 ‐ 24.4

12,891 26.8% 97.2 57.9 ‐ 133.4

†In 2011, the number of pharmacists assigned to ‘unknown LHIN’ was substantially higher than in previous years. As such, caution should be

taken when interpreting results.

442 28 August 2015


Physicians

The total number of physicians in Erie St. Clair LHIN increased by 9.0% from 847 in 2010 to 923 in 2013. Over the same time period, there was a slight drop in Erie St. Clair population (‐1.0%).

The rate of total physicians (per 100,000 population) in Erie St. Clair increased from 131.6 in 2010 to 144.7 in 2013.

The rate of family physicians and specialists in Erie St. Clair LHIN were lower than the province in 2013.

Close to 18% of family physicians were age 65 and over, which is higher than the proportion for Ontario overall.

Nurses

From 2011 to 2014, the total number of nurses in Erie St. Clair increased by 11.0% reaching a total of 7,892.

Between 2011 and 2014 the number of RNs increased by 4%, RPNs increased by 26%, and nurse practitioners increased by 44%.

Compared to the province, Erie St. Clair had slightly lower rates of RNs, and higher rates of RPNs and NPs in 2014.


In 2011, Erie St. Clair had slightly higher rates of optometrists than the province, but lower rates in the other regulated health professions.

The largest increase in the number of providers was seen for midwives, with an increase between 2008 and 2011 of 60.0%

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Physicians, nurses, and regulated health professionals: Erie St. Clair LHIN # Professionals Rate per 100,000 population

Erie St. Clair

LHIN LHIN % change

Erie St. Clair LHIN

Ontario

Family and Specialist Physicians, 2013 2010‐2013

Family physicians 466 8.1% 73.0 93.2

Specialists 457 9.9% 71.6 106.9

Total physicians 923 9.0% 144.7 200.2

Family Physicians, 2013, by age group % of total physicians

Age <30 7 1.5% 2.0%

Age 30‐64 377 80.9% 84.3%

Age >65 82 17.6% 13.7%

Age >75 10 2.1% 1.9%

Nurses, 2014 2011‐2014

Registered Nurses (RNs) 5,148 3.8% 808.1 821.8

Registered Practical Nurses (RPNs) 2,568 26.4% 403.1 334.4

Nurse Practitioners (NPs) 176 44.3% 27.6 21.0

Total Nurses 7,892 11.0% 1,238.8 1,177.2

Selected professions, 2011 2008‐2011

Midwife 16 60.0% 2.5 4.2

Occupational Therapist 150 11.1% 23.5 37.3

Optician 61 ‐7.6% 9.6 18.6

Optometrist 99 4.2% 15.5 14.4

Pharmacist 517 15.1% 81.1 97.2 Notes: In 2011, the number of pharmacists assigned to ‘unknown LHIN’ was substantially higher than in previous years. As such, caution should

be taken when interpreting results.

444 28 August 2015

2. SOUTH WEST LHIN

Physicians

From 2010 to 2013, the total number of physicians in South West LHIN increased by 8.7% reaching a total of 2,039. Over the same time period, the South West population grew at a much slower rate (0.5%).

The total physician rate (per 100,000 population) in South West increased from 196.9 in 2010 to 212.1 in 2013.

The family physician rate in South West was similar to the province in 2013, but the LHIN had a higher rate of specialists.

Among all LHINs, South West LHIN had the third highest proportion of family physicians who were under the age of 30.

Nurses

From 2011 to 2014, the total number of nurses in South West increased by 3.4%, to a total of 13,924.

Compared to the province, South West had higher rates for all nursing types.

Although the number of RNs remained stable between 2011 and 2014, there was a 28% increase in NPs and 12% increase in RPNs in South West LHIN.


In 2011, South West had lower rates of opticians and pharmacists than the province, but higher rates of other regulated health professions.

Between 2008 and 2011 there were reductions in the number of midwives and opticians in South West LHIN.

445 28 August 2015

Physicians, nurses, and regulated health professionals: South West LHIN # Professionals Rate per 100,000 population

South West

LHIN LHIN % change

South West LHIN Ontario



Specialists 1,147 7.6% 119.3 106.9

Total physicians 2,039 8.7% 212.1 200.2


Age <30 22 2.5% 2.0%

Age 30‐64 752 84.3% 84.3%

Age >65 118 13.2% 13.7%

Age >75 12 1.3% 1.9%

Nurses, 2014 2011‐2014

Registered Nurses (RNs) 9,808 0.1% 1,014.9 821.8



Total Nurses 13,924 3.4% 1,440.8 1,177.2


Midwife 49 ‐5.8% 5.2 4.2


Optician 92 ‐11.5% 9.7 18.6

Optometrist 156 11.4% 16.4 14.4



446 28 August 2015


Physicians

From 2010 to 2013, the total number of physicians in Waterloo Wellington LHIN increased by 8.6% to a total of 1,169. Over the same time period, the Waterloo Wellington population grew by only 1.9%.

The total rate of physicians (per 100,000 population) increased from 144.0 physicians in 2010 to 153.3 in 2013.

The rate of both family physicians and specialists per population in Waterloo Wellington was lower than the province in 2013.

88% of family physicians in the Waterloo Wellington LHIN were between the ages of 30 and 64, while 10% were aged 65 or older.

Nurses

From 2011 to 2014, the total number of nurses in Waterloo Wellington increased by 11.9% reaching a total of 7,865.

Compared to the province, Waterloo Wellington had similar RPNs and NPs rates per 100,000 population in 2014, but much lower rates of RNs.

The number of NPs in Waterloo Wellington increased by 38% and RPNs by 21% between 2011 and 2014.


In 2011, Waterloo Wellington LHIN had higher rates of midwives and optometrists than the province, but lower rates of the other regulated health professions.

Between 2008 and 2011 the number of midwives practicing in Waterloo Wellington LHIN increased by 37% and optometrists by 21%.

447 28 August 2015

Physicians, nurses, and regulated health professionals: Waterloo Wellington LHIN # Professionals Rate per 100,000 population

Waterloo

Wellington LHIN LHIN % change


Ontario



Specialists 505 8.8% 66.2 106.9



Age <30 13 2.0% 2.0%

Age 30‐64 584 88.0% 84.3%

Age >65 67 10.1% 13.7%

Age >75 6 0.9% 1.9%

Nurses, 2014 2011‐2014




Total Nurses 7,865 11.9% 1,020.8 1,177.2


Midwife 56 36.6% 7.5 4.2


Optician 89 1.1% 11.9 18.6

Optometrist 182 21.3% 24.4 14.4



448 28 August 2015


Physicians

From 2010 to 2013, the total number of physicians in HNHB LHIN increased by 9.0% reaching a total of 2,809. Over the same time period, the HNHB population grew at a much slower rate (0.9%).

The rate of physicians (per 100,000 population) in the LHIN increased from 183.5 in 2010 to 197.9 in 2013.

The family physician rate in HNHB was slightly lower than the province in 2013, while the rate of specialists was slightly higher.

Almost 15% of family physicians in the HNHB LHIN were aged 65 and over, slightly more than that for the province.

Nurses

From 2011 to 2014, the total number of nurses in HNHB increased by 8.9%, and the rate per 100,000 increased from 1,176.6 to 1,253.9.

Compared to the province, HNHB LHIN had similar rates for all nursing types in 2014.

The number of RPNs in HNHB increased by 22% from 2011 to 2014, while NPs increased by 17%.


In 2011, HNHB LHIN had lower rates of opticians and pharmacists than the province, but had similar rates for all other reported health professions.

Between 2008 and 2011, the number of midwives increased by 37% and optometrists increased by 26%; however there was an 11% reduction in the number of opticians in HNHB LHIN.

Physicians, nurses, and regulated health professionals: HNHB LHIN # Professionals Rate per 100,000 population

HNHB LHIN LHIN % change

HNHB LHIN Ontario


Family physicians 1,195 8.0% 84.2 93.2

Specialists 1,614 9.7% 113.7 106.9



Age <30 25 2.1% 2.0%

Age 30‐64 996 83.3% 84.3%

Age >65 174 14.6% 13.7%

Age >75 19 1.6% 1.9%

Nurses, 2014 2011‐2014




Total Nurses 17,910 8.9% 1,253.9 1,177.2


Midwife 63 37.0% 4.5 4.2


Optician 154 ‐11.0% 11.0 18.6

Optometrist 198 26.1% 14.2 14.4

Pharmacist 1,163 12.8% 83.2 97.2 Notes: In 2011, the number of pharmacists assigned to ‘unknown LHIN’ was substantially higher than in previous years. As such, caution should be taken when interpreting results.

449 28 August 2015


Physicians

From 2010 to 2013, the total number of physicians in Central West LHIN increased by 11.1%, compared to 8.1% growth in the total population over the same period.

The total physician rate (per 100,000 population) increased slightly, from 115.7 in 2010 to 119.0 in 2013.

The rates of family physicians and specialists were much lower in the Central West LHIN than in the province overall.

3.2% of family physicians in the Central West LHIN were under the age of 30, which was the highest proportion among the LHINs.

Nurses

From 2011 to 2014, the total number of nurses in Central West increased by 14.8%. There was a 63% increase in NPs over the period...

Compared to the province, Central West had much lower rates for all nursing types in 2014. Regulated health professionals

In 2011, Central West had much lower rates per population for all health professionals and these rates were among the lowest among all LHINs.

Between 2008 and 2011 there were increases in the number of health professional of all types except opticians.

Physicians, nurses, and regulated health professionals: Central West LHIN # Professionals Rate per 100,000 population

Central West

LHIN LHIN % change

Central West LHIN

Ontario



Specialists 457 13.1% 51.3 106.9



Age <30 19 3.2% 2.0%

Age 30‐64 508 84.2% 84.3%

Age >65 76 12.6% 13.7%

Age >75 11 1.8% 1.9%

Nurses, 2014 2011‐2014




Total Nurses 5,245 14.8% 578.8 1,177.2


Midwife 4 300.0% 0.5 4.2


Optician 108 0.9% 12.4 18.6

Optometrist 86 26.5% 9.9 14.4



450 28 August 2015


Physicians

From 2010 to 2013, the total number of physicians in the Mississauga Halton LHIN increased by 17.9%, while the total population only increased by 2.7%.

The physician rate (per 100,000 population) increased from 138.6 in 2010 to 159.3 in 2013, but remained lower than the rate for Ontario.

The rate for both family physicians and specialists was lower than that for Ontario overall.

86% of Mississauga Halton LHIN family physicians were age 30‐64. Nurses

From 2011 to 2014, the total number of nurses in Mississauga Halton increased by 16.7%. The largest increases were seen for NPs (45.7%) and RPNs (38.8%).

Compared to the province, Mississauga Halton had much lower rates of RNs, RPNs and NPs in 2014. Regulated health professionals

In 2011, Mississauga Halton had lower rates for all health professionals, compared to Ontario.

Between 2008 and 2011 there was a 15% reduction in opticians and an 8% reduction in midwives practicing in Mississauga Halton LHIN, while the number of occupational therapists and pharmacists increased.

Physicians, nurses, and regulated health professionals: Mississauga Halton LHIN # Professionals Rate per 100,000 population


LHIN % change


Ontario



Specialists 864 20.7% 72.5 106.9



Age <30 17 1.6% 2.0%

Age 30‐64 889 86.1% 84.3%

Age >65 127 12.3% 13.7%

Age >75 19 1.8% 1.9%

Nurses, 2014 2011‐2014




Total Nurses 10,378 16.7% 857.5 1,177.2


Midwife 24 ‐7.7% 2.1 4.2


Optician 188 ‐15.3% 16.4 18.6

Optometrist 140 14.8% 12.2 14.4



451 28 August 2015


Physicians

From 2010 to 2013, the total number of physicians in Toronto Central LHIN increased by 4.9%, while there was a 7.1% increase in the total population during the same period.

The rate of physicians (per 100,000 population) declined from 444.0 in 2010 to 434.8 in 2013.

The rate of family physicians and specialists in Toronto Central was higher than the province in 2013.

The Toronto Central LHIN had the highest proportion of family physicians aged 65 and over (18.5%). Approximately 3% of Toronto Central LHIN family physicians were aged 75 and over in 2013.

Nurses

From 2011 to 2014, the total number of nurses in Toronto Central increased by 9.4%. The largest increase was seen for NPs (40.4%) and RPNs (23.8%).

Compared to the province, Toronto Central also had much higher rates of RNs and NPs. Regulated health professionals

In 2011, Toronto Central had higher rates for all regulated health professions than the province except opticians.

Between 2008 and 2011, Toronto Central LHIN experienced growth in the number of health professionals of all types except opticians.

Physicians, nurses, and regulated health professionals: Toronto Central LHIN # Professionals Rate per 100,000 population

Toronto Central

LHIN LHIN % change


Ontario



Specialists 3,677 5.4% 299.8 106.9



Age <30 45 2.7% 2.0%

Age 30‐64 1,304 78.7% 84.3%

Age >65 307 18.5% 13.7%

Age >75 53 3.2% 1.9%

Nurses, 2014 2011‐2014




Total Nurses 24,877 9.4% 1,997.0 1,177.2


Midwife 68 7.9% 5.7 4.2


Optician 252 ‐8.4% 21.2 18.6

Optometrist 180 34.3% 15.1 14.4

Pharmacist 1,587 11.4% 133.4 97.2 Notes: In 2011, the number of pharmacists assigned to ‘unknown LHIN’ was substantially higher than in previous years. As such, caution should


452 28 August 2015

8. CENTRAL LHIN

Physicians

From 2010 to 2013, the total number of physicians in Central LHIN increased by 12.2%, while the total population grew by only 3.2% over the same time period. In 2013, there were 3,007 physicians in the Central LHIN.

The total rate of physicians (per 100,000 population) in 2013 was 165.6, an increase from 152.3 in 2010.

Central LHIN had lower rates of family physicians and specialists than the province in 2013.

Although the majority of family physicians in Central LHIN were between the ages of 30 and 64, the LHIN had slightly larger proportions of physicians who were aged 65 and older, compared to Ontario overall.

Nurses

From 2011 to 2014, the total number of nurses in the Central LHIN increased by 11.6%, to 13,944. The largest increase was seen for NPs (43.9%) and RPNs (27.1%).

Central LHIN had lower rates than the province for all nursing types in 2014. Regulated health professionals

In 2011, Central LHIN had lower rates of midwives and pharmacists than the province.

There was a 50% increase in the number of midwives in the Central LHIN between 2008 and 2011, while the number of opticians declined by 2.5%.

Physicians, nurses, and regulated health professionals: Central LHIN # Professionals Rate per 100,000 population

Central LHIN LHIN % change

Central LHIN Ontario



Specialists 1,419 14.1% 78.1 106.9



Age <30 25 1.6% 2.0%

Age 30‐64 1,329 83.7% 84.3%

Age >65 234 14.7% 13.7%

Age >75 40 2.5% 1.9%

Nurses, 2014 2011‐2014




Total Nurses 13,944 11.6% 755.6 1,177.2


Midwife 42 50.0% 2.4 4.2


Optician 391 ‐2.5% 22.2 18.6

Optometrist 257 27.2% 14.6 14.4



453 28 August 2015


Physicians

From 2010 to 2013, the total number of physicians in Central East LHIN increased by 8.4%, to a total of 2,217. Over the same time period, the population declined by 0.3%.

The rate (per 100,000 population) of total physicians in Central East LHIN was substantially lower than the province in 2013 (140.7 compared to 200.2).

Central East LHIN had a larger proportion of family physicians aged 65 and older compared to Ontario.

Nurses

From 2011 to 2014, the total number of nurses in Central East increased by 8.2%, to 14,081. There was a 51% increase in NPs and a 19% increase in RPNs during this period.

Compared to the province, Central East had lower rates for all nursing types in 2013. Regulated health professionals

Central East LHIN had lower rates for all health professions than the province in 2013.

Between 2008 and 2011, the number of midwives increased by 38%, while the numbers of optometrists and occupational therapists increased by 23%.

Physicians, nurses, and regulated health professionals: Central East LHIN # Professionals Rate per 100,000 population

Central East

LHIN LHIN % change

Central East LHIN

Ontario



Specialists 1,043 10.6% 66.2 106.9



Age <30 14 1.2% 2.0%

Age 30‐64 984 83.8% 84.3%

Age >65 176 15.0% 13.7%

Age >75 21 1.8% 1.9%

Nurses, 2014 2011‐2014




Total Nurses 14,081 8.2% 886.0 1,177.2


Midwife 44 37.5% 2.8 4.2


Optician 228 ‐11.6% 14.8 18.6

Optometrist 172 22.9% 11.1 14.4



454 28 August 2015

10. SOUTH EAST LHIN

Physicians

From 2010 to 2013, the total number of physicians in South East LHIN increased by 6.2%, while the total population only grew by 0.6%.

South East LHIN had higher rates (per 100,000 population) for family physicians and specialists than the province in 2013.

The rate of total physicians increased from 217.5 in 2010 to 229.1 in 2013.

The age distribution of family physicians in the South East LHIN was similar to the province, with the majority (84.1%) being age 30‐64.

Nurses

From 2011 to 2014, the total number of nurses in the South East LHIN increased by 8.7%, to 7,812. This was similar to the overall increase in Ontario, of 9.2%.

Compared to the province, South East also had much higher rates for all nursing types in 2014.

Over the period there was a 31% increase in the number of NPs and a 15% increase in RPNs in the LHIN.


South East LHIN had lower rates of midwives, opticians, and pharmacists relative to Ontario.

There were increases in the number of midwives, occupational therapists, optometrists and pharmacists practicing in the LHIN between 2008 and 2011.

Physicians, nurses, and regulated health professionals: South East LHIN # Professionals Rate per 100,000 population

South East LHIN LHIN % change

South East LHIN Ontario



Specialists 597 8.9% 121.0 106.9



Age <30 9 1.7% 2.0%

Age 30‐64 448 84.1% 84.3%

Age >65 76 14.3% 13.7%

Age >75 13 2.4% 1.9%

Nurses, 2014 2011‐2014




Total Nurses 7,812 8.7% 1,579.1 1,177.2


Midwife 16 23.1% 3.3 4.2


Optician 52 ‐8.8% 10.6 18.6

Optometrist 65 20.4% 13.2 14.4



455 28 August 2015

11. CHAMPLAIN LHIN

Physicians

From 2010 to 2013, the total number of physicians in Champlain LHIN increased by 9.5%, more than twice the rate of growth for the total population (3.8%).

Champlain LHIN had lower rates than the province (per 100,000 population) for family physicians and specialists in 2013.

The rate of total physicians increased from 244.6 in 2010 to 257.8 in 2013.

The age distribution of family physicians in the Champlain LHIN was slightly younger than in the province, with only 10.5% being aged 65 and over.

Nurses

From 2011 to 2014, the total number of nurses in Champlain increased by 5.1% reaching a total of 16,878 from 11,961, while rate of nurses increased from 1,263.8 to 1,292.1.

Compared to the province, Champlain had higher rates of RNs and RPNs in 2014, but had a similar rate of NPs.


In 2011, Champlain had lower rates of opticians, optometrists, and pharmacists, but similar rates for the other regulated health professions.

There were increases in the number of midwives, occupational therapists, optometrists, and pharmacists practicing in Champlain LHIN between 2008 and 2011.

Physicians, nurses, and regulated health professionals: Champlain LHIN # Professionals Rate per 100,000 population

Champlain LHIN LHIN % change

Champlain LHIN Ontario



Specialists 1,792 8.1% 138.5 106.9



Age <30 35 2.3% 2.0%

Age 30‐64 1,346 87.2% 84.3%

Age >65 162 10.5% 13.7%

Age >75 22 1.4% 1.9%

Nurses, 2014 2011‐2014




Total Nurses 16,878 5.1% 1,292.1 1,177.2


Midwife 43 22.9% 3.4 4.2


Optician 169 0.6% 13.3 18.6

Optometrist 172 27.4% 13.5 14.4



456 28 August 2015


Physicians

From 2010 to 2013, the total number of physicians in North Simcoe Muskoka LHIN increased by 10.9%, while the population only grew by 2.2%.

The total physician rate (per 100,000 population) in North Simcoe Muskoka increased from 144.6 to 156.7 from 2010 to 2013.

North Simcoe Muskoka LHIN had a lower rate of specialists relative to Ontario, but had a similar rate of family physicians.

The North Simcoe Muskoka LHIN had a relatively lower proportion of family physicians aged 65 and over compared to Ontario.

Nurses

From 2011 to 2014, the total number of nurses in North Simcoe Muskoka increased by 10.8%. The largest increases were seen for NPs (50.6%) and RPNs (23.7%).

Compared to the province, North Simcoe Muskoka had higher rates of RPNs and NPs, but lower rates of RNs per 100,000 population in 2014.


In 2011, North Simcoe Muskoka had lower rates of opticians, occupational therapists, optometrists, and pharmacists than the province.

Between 2008 and 2011, the number of occupational therapists, optometrists, and pharmacists practicing in North Simcoe Muskoka LHIN increased.

Physicians, nurses, and regulated health professionals: North Simcoe Muskoka LHIN # Professionals Rate per 100,000 population


LHIN % change


Ontario



Specialists 307 12.9% 65.8 106.9



Age <30 7 1.7% 2.0%

Age 30‐64 374 88.2% 84.3%

Age >65 43 10.1% 13.7%

Age >75 4 0.9% 1.9%

Nurses, 2014 2011‐2014




Total Nurses 5,869 10.8% 1,245.8 1,177.2


Midwife 17 ‐10.5% 3.7 4.2


Optician 78 ‐10.3% 17.2 18.6

Optometrist 53 12.8% 11.7 14.4



457 28 August 2015

13. NORTH EAST LHIN

Physicians

From 2010 to 2013, the total number of physicians in the North East LHIN increased by 8.3%, while the total population declined by 0.1%.

The rate (per 100,000 population) of specialists was lower in North East LHIN than in Ontario overall, while the LHIN had higher rates of family physicians.

The rate of physicians increased from 161.7 in 2010 to 175.0 in 2013.

The age distribution of family physicians in the North East LHIN was similar to the province, with the majority (85.9%) being between the ages of 30 and 64.

Nurses

From 2011 to 2014, the total number of nurses in North East increased by 7.6%, to a total of 9,422. The largest increase was for NPs (33.3%).

Compared to the province, North East had substantially higher rates of RNs, RPNs, and NPs in 2014. Regulated health professionals

In 2011, North East had lower rates of occupational therapists, opticians, and pharmacists than the province, and slightly higher rates of optometrists.

Between 2008 and 2011, the number of occupational therapists, optometrists, and pharmacists practicing in North East LHIN increased.

Physicians, nurses, and regulated health professionals: North East LHIN # Professionals Rate per 100,000 population

North East LHIN LHIN % change

North East LHIN Ontario



Specialists 416 10.1% 73.4 106.9



Age <30 7 1.2% 2.0%

Age 30‐64 495 85.9% 84.3%

Age >65 74 12.8% 13.7%

Age >75 7 1.2% 1.9%

Nurses, 2014 2011‐2014




Total Nurses 9,422 7.6% 1,665.9 1,177.2


Midwife 25 0.0% 4.4 4.2


Optician 61 ‐9.0% 10.7 18.6

Optometrist 96 10.3% 16.8 14.4



458 28 August 2015

14. NORTH WEST LHIN

Physicians

Between 2010 and 2013, there was a 9.3% increase in the total number of physicians in the North West LHIN, while there was a 1.2% decrease in the total population of the LHIN during this period.

North West LHIN had a higher rate of family physicians and a lower rate of specialists than the province in 2013.

The rate of physicians increased from 185.1 in 2010 to 204.4 in 2013.

The North West LHIN had the lowest proportion of family physicians who were aged 65 and over, with a rate less than half that of the province overall (6.6% compared to 13.7%).

Nurses

From 2011 to 2014, the total number of nurses in North West increased by 5.3%, to a total of 4,475.

Rates per 100,000 population for all nursing types in the LHIN were substantially higher than in Ontario overall. The rate of NPs for North West LHIN was triple the rate for Ontario.


In 2011, North West had lower rates of opticians, optometrists and pharmacists practicing in the LHIN compared to Ontario.

Between 2008 and 2011, the number of midwives, occupational therapists, optometrists, and pharmacists practicing in North West LHIN increased.

Physicians, nurses, and regulated health professionals: North West LHIN # Professionals Rate per 100,000 population

North West

LHIN LHIN % change

North West LHIN

Ontario



Specialists 195 10.2% 82.5 106.9



Age <30 6 2.1% 2.0%

Age 30‐64 263 91.3% 84.3%

Age >65 19 6.6% 13.7%

Age >75 1 0.3% 1.9%

Nurses, 2014 2011‐2014




Total Nurses 4,475 5.3% 1,895.6 1,177.2


Midwife 14 16.7% 5.9 4.2


Optician 15 ‐21.1% 6.3 18.6

Optometrist 28 7.7% 11.8 14.4



460 28 August 2015

Documents

2016-2019 Environmental Scan