Ontario Renal Network (ORN) Update - CentralEastLHIN/media/sites/ce/Primary...– organ donation, continuum of care, psychosocial support Care Close to Home – patient supports, home

Ontario Renal Network (ORN) Update: Central East LHIN Board

Heather S. Reid (Regional Director, ORN)

Dr. Andrew Steele (Regional Medical Lead, ORN)

September 24th, 2014

Objectives

• Overview ORN - Strategic Priorities/Targets of Ontario Renal Plan (ORP) 1/ORP 2 Development

• ORN Provincial Governance

• Central East LHIN Regional/Local Governance/Chronic Kidney Disease (CKD) Programs

• 2013/14 Key Initiatives/Achievements (Regional/Local Performance: Q4 Results)

• 2014/15 In Progress/Next Steps (Opportunities/linkages LHIN)

• Discussion/Questions?

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3 Lakeridge Health | ORN | June 27, 2014

Overview: ORN

To provide overall leadership and strategic direction to effectively

organize and manage the delivery of renal services in Ontario in a

consistent and coordinated manner

Hemodialysis costs the Ontario health care system about $60,000 per

patient, per year of treatment

Focus is to prevent or delay the need for dialysis, improve quality of

life across all stages of disease

Broaden “appropriate” chronic kidney disease patient care options

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About the Ontario Renal Network

•Established in 2009 by MOHLTC and

Cancer Care Ontario (CCO)

•Provides overall leadership/strategic

direction to effectively organize and manage

the delivery of renal services across Ontario

•ORN does this through:

•Planning CKD services

•Information and Standards

• Using funding to drive improvement

•Public reporting

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People and Patients

• Pre-dialysis Patients - 11,071

• Incident Dialysis Patients - 2,043 in-facility, 500 home

• Prevalent Dialysis Patients (10,349 total)

- In-facility - 7,975 in-facility

- Home - 2,374

• Among those dialyzing at home

- PD - 76%

- HD - 24%

• Health Human Resources: Interdisciplinary care including ~228 Nephrologists

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Characteristics of End Stage Renal Disease

(ESRD) Patients

• Often socioeconomically disadvantaged

• High proportion are aboriginal

• Limited life expectancy

• Major burden of disease (multiple comorbidities)

• Very impaired quality of life

• Many value quality over quantity of life

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Seven Strategic Priorities for Action (ORP 1)

• Accountability to patients

• Early detection and prevention of progression

• Peritoneal and vascular access for dialysis patients

• Independent dialysis

• CKD infrastructure planning

• Research and innovation

• Aligning funding to patient-focused care

(~89% of funding now follows patients)

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Emerging Themes From Environment Scan

(Supporting ORP 2)

Evidence – IT, research partnerships, clinical protocols, innovation forums

Transplantation – organ donation, continuum of care, psychosocial support

Care Close to Home – patient supports, home dialysis, self-management

Governance – leadership, transparent policies, strategic goals

Funding – efficiencies, incentives for quality care

Health Human Resources – network of multidisciplinary providers

Continuum of Care – education, special populations, coordination, end of life

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ORN is a Partnership

•26 Regional CKD Programs

•14 LHINs

•14 Regional Directors

•14 Regional Medical Leads

The work of the ORN is guided by a partnership

between medical

and administrative leadership

ORN

Provincial Leadership Regional Leadership

Provincial office at CCO

•VP ORN

•Provincial Medical Director

•Provincial Medical Leads:

•Early detection/prevention

•Primary care

•Vascular access

•Data and measurement

•Independent dialysis

•CKD Funding

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Renal Health System

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ORN Provincial Structure

CCO

Michael Sherar, CEO

VP, ORN

Rebecca Harvey

Provincial Medical Leads (7)

Regional Medical

Leads (14)

Regional Directors (14)

Provincial Medical Director

Dr. Peter Blake

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Regional Leadership

Central East LHIN Regional Renal

Steering Committee

Work Group TBD (as per Regional

Work Plan)

Work Group TBD (as per Regional

Work Plan)

Co-Chairs

Dr. Andrew Steele,

Regional Medical Lead

Heather Reid,

Regional Director

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Prevalent Patients receiving care in a Central East Regional CKD

Program (March 31, 2014)

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SubLHIN Geography (used for planning capacity)

• 3 Regional CKD Programs (TSH, LH, PRHC):

• TSH: 57 stations; 3 satellites associated with

TSH: 2 as part of TSH: Corporate Drive, Yee

Hong, 1 separate facility – Bridgepoint;

• LH: 46 stations; no satellites at LH but 2

operating sites – LHO (34) and LHW (12);

• PRHC: 27 stations; 2 satellites associated with

PRHC: 2 separate facilities – Northumberland

Hills Hospital, Ross Memorial Hospital;

• Independent Health Facilities (IHF): Markham,

Ajax Pickering and Peterborough Dialysis

Management Clinics (DMCs)

LHIN

Sub-

LHIN

Code

Name of Sub-LHIN

9 901 North East Cluster

9 902 Durham Cluster

9 903 Scarborough Cluster

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CENTRAL EAST LHIN Regional Renal Steering

Committee (RRSC) Responsibilities

• Approves annual work plan and priorities

• Provides strategic advice on capacity planning, identification of service

gaps, integration opportunities

• Reviews performance data from regional CKD programs and identifies

areas for improvement

• Reviews key issues in the delivery of CKD regional program services and

facilitates collaborative solutions

• Provides strategic advice to ORN initiatives

• Establishes working groups as required

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Key Functions

Regional Renal

Steering Committee

Regional Planning

Stakeholder Engagement

Knowledge Transfer and

Exchange

Performance Management & Reporting

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Key Functions

Regional Planning

• Capacity assessment plans for CKD Regional Programs

• Dialysis equipment planning

• Capital planning

• Transplant services

Stakeholder Engagement

• Input into Ontario Renal Plan 2

• Clinical engagement (primary care tool kit; nephrology/surgery

collaboration, vascular surgery)

• Linking with other networks / groups (Vascular Coalition, Mental Health,

Health Links, palliative care)

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Key Functions

Knowledge Transfer and Exchange (KTE)

• Implementation of CKD annual funding

• Ontario Renal Reporting System (ORRS) data reporting requirements

• Education / training e.g. peritoneal dialysis training with CCAC, LTC;

vascular surgeons/nephrologists

Performance Management and Reporting

• Regular reporting through ORRS

• Qtly performance review and reporting/discussion on program

performance with all CKD Programs

• Qtly performance review with the ORN (VP and Provincial Medical Lead)

with Regional Director and Regional Medical Lead

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2013/14 Key Initiatives/Achievements

PROVINCIAL

• Funding Methodology: QBP’s, Carve-Outs, Capital

• Completion of state of the art database for real-

time reporting of patient-level data: Ontario Renal

Reporting System (ORRS)

• Regional Reviews: Utilizing “draft” new scorecard

• ORN planning day, Regional Medical Leads and

Regional Directors – May 2014

• ORN Planning Day: Body Access/Independent

Dialysis Coordinators – May 2014

• Transition of Independently-Funded Satellite:

TEGH, transition to St. Michael’s from TSH

• Patient and Family Consultations to inform ORP 2

development

REGIONAL/LOCAL

• Expanded Regional Renal Steering Committee

(RRSC)

• Provider Sessions: 3 Regional Sites, with new

Director, Clinical/Quality at ORN

• Opening on new Transition Unit PRHC May 2014

• Discussions/review of Peterborough IHF capacity

• Pre-capital submission completed

TSH/LHIN/ORN

• ORN/PRHC/NHH/RMH: Memorandums of

Understanding

• Expansion at TSH with nocturnal shift

• Opening of newly renovated pre-dialysis clinic

LHW trailer

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2013/14 Key Initiatives/Achievements

(cont’d)

PROVINCIAL

• Organizational Standards (ORN): working groups

e.g. equipment/capital, pre- dialysis, acute kidney

injury, CCAC, LTCH

• Linkages with Primary Care/Early Detection and

Prevention

• Chronic Disease Prevention and

Management/Self-Management – continued focus

provincially and all programs

• PD Assisted Care – funding changes, CCAC,

LTCH

REGIONAL/LOCAL

• Central East LHIN Regional Renal Work Plan

Completed

• Capacity Planning Phase 1 complete:

• forecasted surpluses or shortages are

dependent on the home dialysis rates

achieved and the number of patients who

are medically suitable for satellite care

• Changes to patient travel patterns, home

dialysis utilization, transplant rate, and

dialysis growth rate also will affect the

results of this assessment.

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Central East LHIN – ORN Q4 Review LH Summary Strategy ORN Target Previous

Performance Current Performance

Accountability to Patients: Patients receiving care in their modality/location of choice

80% 88.2%

Early Detection: % decrease in patients that initiated dialysis as a sub-optimal start

48% decrease

Data under review at ORN

% decrease in patients that initiated dialysis as a crash start

40% decrease Data under review at ORN

Peritoneal and Vascular Access: % decrease in prevalent patients with catheter

51.7% (2% annual decrease)

70% 65.7%

Independent Dialysis: Proportion of patients that started independent dialysis within 6 months of initiation

40% 43% 54.2%

Proportion of prevalent patients on ID

20% 31.8% 30.5%

Infrastructure Planning: Proportion of Facility Based Dialysis Patients who travel more than 60 minutes

5% 3% 4.5%

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Central East LHIN – ORN Q4 Review TSH Summary Strategy ORN Target Previous


Accountability to Patients: Patients receiving care in their modality/location of choice

80% 68.8% (Current capacity issues negatively affecting)







67% 63.6%


40% 37% 36.2%


20% 30.5%


5% 0.8% 0.8%

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Central East LHIN – ORN Q4 Review PRHC Summary Strategy ORN Target Previous


Accountability to Patients: Patients receiving care in their modality and location of choice

80% 100% (3 patients)







53% 65.9%

(Through attrition, loss of patients with fistulas)


40% 11% 28.6% (New transition unit, increasing rates)


20% 18.1%


5% 21.5% 26.2% (This remains a concern and is a focus for the region and ORN)

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2014/15 Initiatives: In Progress/Next Steps

PROVINCIAL

• Develop a measurement framework and tools

associated with patient and family-centred care

(provincially-led)

• Patient Engagement Strategies (survey to CKD

programs, minimum standards to be defined)

• Engaging patients and families in the development,

planning and evaluation of ORN initiatives,

including the Ontario Renal Plan 2

• Draft ORP 2 in December 2014

• Wait times information system, data collection for

review of Vascular Access surgery (arteriovenous

surgery)

• Finalization of ORN scorecard for regional reviews,

monitoring and performance

REGIONAL/LOCAL

• Implementation of action items identified in

Regional Work Plan

• Sharing of data/results in quarterly reviews (ORN

scorecard)

• Opportunities for shared planning, synergies, as

per Vascular Lead member of RRSC, CCAC rep

and membership of CKD Directors on this

committee

• Sharing of expertise, education and knowledge

transfer

• Opportunities for shared infrastructure e.g. OTN

• Continued collaboration with DMC partners in the

provision of hemodialysis services

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2014/15 Initiatives: In Progress/Next Steps (cont’d)

PROVINCIAL

• Education/modality choice to CKD patients (survey

to CKD programs, minimum standards to be

defined)

• Primary Care Engagement/Primary care toolkit

• Central East still to complete second phase of

capacity planning – updated data coming from CCO

• Preparation for surveys and palliative/end of life

framework

• Emergency preparedness work under development

from CCO

• Research and innovation focus

REGIONAL/LOCAL

• Avoiding early start on dialysis; Facilitation

of transplant pathways for potential

recipients and donors; Palliative care for

those choosing to refuse or withdraw from

dialysis; Patient and Family Advisory

Councils

• Phase 2 functional planning with TSH

• Review of travel time and issues to support

Peterborough region and patient access

• Continued new research opportunities

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Discussion……

Questions???

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Documents

Ontario Renal Network (ORN) Update - CentralEastLHIN/media/sites/ce/Primary...– organ donation, continuum of care, psychosocial support Care Close to Home – patient supports, home