Updated November 2014
Providing care at home or close to home continues to be an important health-care priority in Ontario. Increasing transparency and accountability for publicly funded services is also critical.
Community Care Access Centres (CCACs) are serving more patients year-over-year while focusing on providing better care and value for Ontario's patients and families. In addition to increasing access to services, CCACs are working collectively to enhance patient care and experience and to continuously improve the quality and consistency of home and community care across the province.
Caring for those who need support the most
CCACs are caring for more and more people with multiple chronic and complex health issues – the number of patients with higher needs has increased by 73 per cent over the last five years.8
Helping patients stay in their homes longer
Personal Support Workers (PSWs) play a vital role in helping people do the things they can no longer do on their own and to continue living in their own homes as long as possible. Year-over-year, CCACs are providing more personal support services to people in communities across Ontario.
Listening to what matters most to patients
CCACs regularly seek feedback from patients and their families to help inform ongoing quality improvement efforts. This feedback reveals how patients rate CCAC services and where services can improve. Ninety-two per cent of patients reported a positive experience with the care they received from their CCAC.9, 10
Patients also identified areas for improvement, including the need to improve the care and support they receive when moving from one part of the health-care system to another, such as from hospital to their homes. This is an area where CCACs are working to improve. They have partnered with hospitals and the Ontario Hospital Association to develop a guide that supports shared planning and improved patient transitions from hospitals to the community. In addition, all CCACs will be using a common protocol as of December 2014 to support patients who move between CCACs to make sure that these transitions happen smoothly.
Sharing information
about quality
On April 1, 2014, CCACs began publicly posting their annual Quality Improvement Plans (QIPs) online. The QIP is one tool to help CCACs define and share their organization's quality improvement priorities. All CCACs report on a core set of quality-based indicators that support the Ontario government's health priorities. QIPs include measures and targets for improving patient safety, access and patient experience. CCACs use these measures to guide their ongoing efforts to improve the care patients receive.
Keeping patients safe and at home
Improving safety for patients at home is a priority for CCACs. Tracking patients' visits to hospital emergency departments, particularly when these visits could be prevented, is an important measure of CCACs' efforts to support better safety at home. Since 2010/2011, CCACs have reduced unplanned emergency department visits within the first 30 days of discharge from hospital by 17 per cent.11
Patients with unstable, chronic health conditions, who have been recently hospitalized, are more likely to need to return to hospital. Since CCACs serve more patients who have high health-care needs, the chances of these patients having to return to hospital for care increases. To minimize returns to hospital, patients with chronic and complex health issues need immediate access to in-home care upon discharge from hospital. CCAC Rapid Response Nurses are now caring for patients within the first 24 hours after they are discharged home from the hospital; these nurses also ensure patients visit their family physician within the first seven days following discharge.
Tracking safety risks in the home is an important part of improving patient care. Experience shows that patients cared for at home who have higher care needs and more complex health issues also have greater safety risks. Year-over-year, for the last five years, patients have reported a higher rate of falls. The graph shows that CCACs are caring for patients with more complex health-care issues at home; these patients are more likely to experience a fall. When the rate of falls is adjusted to reflect the increasing medical complexity of patients, the rate of falls is relatively stable. Understanding and tracking information about patient safety is helping CCACs identify initiatives to reduce falls and to improve patient safety overall.
Providing the right place of care
By caring for more patients with high-care needs at home, CCACs are ensuring people can stay in their homes longer, which helps free up long-term care beds for those who need them the most.
CCACs are supporting more patients at home while they wait to be transferred to more appropriate care settings. As a result, 36 per cent more patients are going home from hospital with support, and 48 per cent fewer patients are going to long-term care homes than just five years ago.12
Providing care to patients who need it most – first
Access to care is an important measure of home care quality. When assessing patient-care needs CCAC Care Coordinators must prioritize people whose care needs are urgent. With a specific emphasis on reducing wait times for patients with the greatest needs, the Ministry of Health and Long-Term Care has implemented a new five-day wait time target for all nursing visits and personal support visits. The objective is to ensure that home care visits for patients with high needs begin as soon as possible, and in not more than five days following the patient's discharge from hospital.
Meeting Emerging Needs:
Streamlining access to physiotherapy services & promoting healthy aging
In April 2013, the Ministry of Health and Long-Term Care announced a new strategy to streamline access to physiotherapy services, making CCACs the single point of access for in-home physiotherapy services. This ensures that Ontarians have access to an integrated, coordinated range of rehabilitation, falls prevention, and exercise services based on their needs and goals.
Mobility is essential to quality of life for seniors and the elderly living independently. To promote healthy aging, an increasing number of exercise and falls prevention classes are being offered across the province and CCACs are helping patients to access these classes.
Additional details on these changes can be found at:
http://news.ontario.ca/mohltc/en/2013/04/more-seniors-to-benefit-from-physiotherapy-and-exercise.html
Supporting some of Ontario's most vulnerable patient populations
CCACs are directly delivering front-line care through three new nursing initiatives developed by the Ministry of Health and Long-Term Care to address specific patient needs:
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Rapid Response Nurses – These nurses reduce re-hospitalization and avoidable emergency department visits by improving the quality of transitions from acute care to home care for high-risk and medically complex children, seniors and frail adults.
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Mental Health and Addictions Nurses (MHAN) – These nurses help educators learn how to recognize students with mental health and addiction issues and provide nursing support to them within the school setting. The program has demonstrated early wins by improving students' experiences with moving through the mental health system, decreasing hospital admission rates and increasing school attendance.
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Hospice Palliative Care Nurse Practitioners – These nurses support people to die in their place of choice. The nurses work collaboratively with patients, families and other care providers in acute, hospice and primary care settings to reduce hospitalization and avoidable emergency department visits for patients receiving hospice palliative care, to enhance quality of care by combining therapies to comfort and support patients and their families, and to better manage pain and symptoms.
As of April 1, 2014, CCACs are tracking the impact of these new nursing initiatives by monitoring unnecessary emergency department visits and hospital readmissions, care quality and patient safety. CCACs are also assessing the impact of Rapid Response Nurses by measuring whether connections to primary care are made within seven days of hospital discharge, and if there is a change in the percentage of patients who take their prescribed medications as directed.
Progress in meeting goals to improve patient care
CCACs are making progress towards achieving the quality improvement goals set out in the
2012-2013 Quality Report (PDF). Some of their results are featured below.
Working with primary care in Ontario's Health Links
CCACs have invested in changes to their common electronic health record to enable the capacity to register all patients of active Health Links, effective June 2014. This ensures more timely communication between the CCACs and primary care, and early identification of patients who need a physician or primary care.
Building capacity to care for those in the greatest need
CCACs are measuring the impact of CCAC direct care nurses on patient outcomes.
Meeting and exceeding the wait time target for patients receiving nursing care and patients with complex care needs receiving personal support
CCACs are now reporting on the number of patients receiving care within the new five-day wait time target.
Learn more about our progress »
English Quality Improvement Update in PDF
French Quality Improvement Update in PDF
Footnotes:
1 Ministry of Health and Long-Term Care Health Data Branch Web Portal, Individuals Served In-Home Health Care (Table 3).
2 OACCAC Home Care Database, count of active patients age > 65.
3 Ministry of Health and Long-Term Care Health Data Branch Web Portal, Individuals Served – Publicly Funded Schools and Private/Home Schools (Table 3).
4 Ministry of Health and Long-Term Care Health Data Branch Web Portal, Table 24a End of Life (EOL).
5 Long-Term Care Home System Report (March 31, 2014), Ministry of Health and Long-Term Care Health Data Branch, Health System Information Management & Investment Division (includes new placements and transfers between long-term care homes).
6 OACCAC Home Care Database, analysis undertaken June 2013.
7 Ministry of Health and Long-Term Care, Monthly Health Care Connect Reports (April 1, 2013 and March 31, 2014).
8 OACCAC utilization report: Average Monthly Active Complex and Chronic referral per cent change from FY2009/2010 to 2013/2014.
9 CCAC Client Experience Evaluation Survey Aggregate Provincial Report Annual Results – National Research Corporation, August 2014.
10The Overall Experience Rating provides information about the experience of home care patients with their CCAC and the service providers who provided their care. The percentages above reflect the per cent of responses that were "Good", "Very Good", or "Excellent" on a five point scale (consisting of "Poor", "Fair", "Good", "Very Good" and "Excellent"). Positive responses, those above "Fair", are combined to report the positive total percentage.
11Ministry of Health and Long-Term Care reporting to support Quality Improvement Plans.
12 Access to Care – ALC Trending Report, Access to Care Informatics, Cancer Care Ontario 2013-2014.
