2004/05 - 2006/07 Service Plan -- Ministry of Health Services

Goal 1: High Quality Patient Care

Objective 1: Provide care at the appropriate level in the appropriate setting by shifting the mix of acute/institutional care to more home/community care.

Objective 2: Provide tailored care for key segments of the population to better address their specific health care needs and improve their quality of life.

Objective 3: Keep people as healthy as possible by preventing disease, illness and disability and slowing the progression of chronic illness to minimize suffering and reduce care costs in the future.

Objective 4: Manage within the available budget while meeting the priority needs of the population.

Priority Strategy 1: Hospital Admissions Prevention through Increased Community Care Options: Prevent unnecessary hospitalizations by providing patients with better access to family physicians, specialists and other providers and services in the community.

PS — Performance Measure 1: Rates of admission for conditions that could be managed outside hospital (conditions classified as "may not require hospitalization").

This rate helps identify opportunities to more efficiently manage resources by focusing expensive, specialized hospital care on those who truly need it, and treating less acute cases in a more cost-effective, appropriate manner.

Baseline 02/03: 5.2% of admissions could be managed outside hospital

Target 03/04: 5% decrease over prior year

Target 04/05: 5% decrease over prior year

Target 05/06: 5% decrease over prior year

Target 06/07: 3% decrease over prior year

PS — Performance Measure 2: NurseLine use rates.

BC NurseLine is a health resource available 24/7 that allows British Columbians to help themselves with expert advice. The number of calls BC NurseLine receives helps gauge whether British Columbians are accessing health resources that will reduce the demand on hospitals and physicians.

Baseline 02/03: 172,934 calls; 1,423 calls transferred from physicians' offices

Target 03/04: 35% increase over baseline 02/03; 100% increase in calls transferred from physicians' offices over baseline 02/03

Target 04/05: 60% increase over baseline 02/03; 150% increase in calls transferred from physicians' offices over baseline 02/03

Target 05/06: 80% increase over baseline 02/03; 175% increase in calls transferred from physicians' offices over baseline 02/03

Target 06/07: 100% increase over baseline 02/03; 200% increase in calls transferred from physicians' offices over baseline 02/03

Priority Strategy 2: Post-Acute (hospital care) Alternatives: Provide appropriate community health support to enable timely discharge of patients from hospital once the need for acute medical care has ended.

PS — Performance Measure 3: Percentage of days spent by patients in hospitals after the need for hospital care ended, measured by alternate level of care days (ALC days) as a percentage of total hospital inpatient days.

Patients remain in hospital acute care beds longer than necessary for various reasons, including lack of room in a residential facility or lack of community services to support discharge from hospital. This ties up expensive critical care resources and creates a backlog for patients needing acute care. When ALC days drop, that means the system is organized better to treat patients in the right setting — acute beds for acute needs, and residential or community care for patients whose acute need has passed.

Baseline 02/03: 13.4% of inpatient days are ALC

Target 03/04: 5% decrease over prior year

Target 04/05: 5% decrease over prior year

Target 05/06: 3% decrease over prior year

Target 06/07: 3% decrease over prior year

Priority Strategy 3: Effective Management of Acute Care Services in Hospitals: Plan for and manage the demand on emergency health services and surgical and procedural services.

PS — Performance Measure 5: Waiting times for key services: Radiotherapy and Chemotherapy.

Monitoring cancer wait times helps ensure patients' cancers are treated as early as possible to achieve the best possible outcomes.

a. Radiotherapy:

Baseline 02/03: 88% within 4 weeks

Target 03/04: 90% within 4 weeks

Target 04/05: Maintain at 90% begin treatment within 4 weeks

Target 05/06: Maintain at 90% begin treatment within 4 weeks

Target 06/07: Maintain at 90% begin treatment within 4 weeks

b. Chemotherapy:

Baseline 02/03: Over 90% within 2 weeks

Target 03/04: 90% within 2 weeks

Target 04/05: Maintain at 90% begin treatment within 2 weeks

Target 05/06: Maintain at 90% begin treatment within 2 weeks

Target 06/07: Maintain at 90% begin treatment within 2 weeks

PS — Performance Measure 6: Emergency Room Use performance measure.

A province-wide project involving the ministry and all six health authorities has been launched to improve access to and effectiveness of emergency health services in hospitals. A set of guidelines, best practices and performance measures for the management of emergency rooms will be developed.

Target 03/04: Provincial Emergency Services Project initial recommendations implemented by health authorities

Target 04/05: Develop indicators of performance for emergency room services

Target 05/06: TBD

Target 06/07: TBD

Priority Strategy 4: Alternatives to Institutional Care: Help elderly and disabled individuals avoid institutionalization and remain as independent as possible in their own homes and communities by increasing the range of supportive housing environments and community care options, while reserving residential institutions for patients with the most complex care needs.

PS — Performance Measure 4: Percentage of clients with high care needs living in their own home rather than a facility.

This indicator tracks the number of seniors and people with disabilities who have high care needs and receive home support or adult day care services to allow them to remain more independent and live in their own home. This improves quality of life and also results in more efficient use of critical care resources.

Baseline 02/03: 44.6% of high care clients live in their own home rather than a facility

Target 03/04: 2% increase over prior year

Target 04/05: 5% increase over prior year

Target 05/06: TBD, based on access policy and new assessment tool

Target 06/07: TBD, based on access policy and new assessment tool

Priority Strategy 5: Build the Foundation for Integrated Care Networks:

a. Connect physicians and other health care professionals to diagnostic services, hospitals, and each other.

b. Provide a continuum of services in each health authority for mental health and addictions patients that better integrates primary, secondary, community and tertiary care and is integrated with the larger care networks.

PS — Performance Measure 7: Improved continuity of care measured by the proportion of persons (aged 15 to 64) hospitalized for a mental health diagnosis who receive community or physician follow-up within 30 days of discharge.

A high rate of community or physician follow-up reduces the chances that a mental health client will suffer a relapse and have to be readmitted to hospital.

Baseline 02/03: 72.3% of discharged mental health patients get follow-up in 30 days

Target 03/04: Increase over prior year

Target 04/05: Increase over prior year

Target 05/06: Increase over prior year

Target 06/07: Increase over prior year

PS — Performance Measure 8: Improved availability of community services measured by: Percentage of days spent by mental health patients (aged 15 to 64) in hospital after the need for hospital care ends.

This measure is the same as the previous ALC measure (PS – PM3), but focuses on people who are hospitalized for a mental health diagnosis.

Baseline 02/03: 3.1% of mental health inpatient days are ALC

Target 03/04: 2% reduction over prior year

Target 04/05: 2% reduction over prior year

Target 05/06: TBD, based on new assessment tool

Target 06/07: TBD, based on new assessment tool

PS — Performance Measure 9: Proportion of mental health services (community, physician and acute care) received by mental health clients (aged 15 to 64) that are obtained in their own health authority.

This measure indicates the extent to which mental health clients can be treated in their own communities or regional health authorities. This reduces travel and distance burden on patients and their families. A longer term (5–7 years) target of 87% has been set for this measure.

Baseline 02/03: 84.5% of mental health services are obtained in each client's health authority

Target 03/04: Increase over prior year towards long-term target of 87%

Target 04/05: Increase over prior year towards long-term target of 87%

Target 05/06: Increase over prior year towards long-term target of 87%

Target 06/07: Increase over prior year towards long term target of 87%

Goal 1: High Quality Patient Care

Objective 1: Provide care at the appropriate level in the appropriate setting by shifting the mix of acute/institutional care to more home/community care.

Objective 2: Provide tailored care for key segments of the population to better address their specific health care needs and improve their quality of life.

Objective 4: Manage within the available budget while meeting the priority needs of the population.

Priority Strategy 6: Better Care for People with Extensive Care Needs: Provide integrated care and targeted services for patients who have extensive health care needs to more effectively manage their contact with health care services.
PS — Performance Measure 10: Percentage of days spent by highest needs patients in hospitals after the need for hospital care ended, measured by alternate level of care days (ALC days) as a percentage of total hospital inpatient days for these patients. This measure is the same as the ALC measure (PS – PM3), but focuses on the health system's highest needs patients. For these patients, ALC days are up to twice the average compared to the entire population. When ALC days drop that means patients have more community care options. Baseline 02/03: 21.8% of highest needs inpatient days are ALC Target 03/04: 5% decrease over prior year Target 04/05: 5% decrease over prior year Target 05/06: 3% decrease over prior year Target 06/07: 3% decrease over prior year
Priority Strategy 7: Better Care for People with Chronic Conditions: Increase the emphasis on the effective management of chronic diseases (e.g., diabetes) to prevent or slow disease progression.
PS — Performance Measure 11: Adherence to clinical best practices for managing chronic diseases measured by percentage of full-service family physicians claiming payment for treating patients according to evidence-based guidelines. Tracking the number of physicians employing evidence-based guidelines indicates whether patients are receiving effective treatment for chronic diseases. Baseline 02/03: No program in place Target 03/04: 30% Target 04/05: 40% Target 05/06: 45% Target 06/07: 50% PS — Performance Measure 12: Use by physicians of appropriate drug therapies to slow or stop the progression of chronic diseases. For 04/05 we will report on congestive heart failure (CHF): percentage of patients suffering from CHF who are prescribed a) ACE inhibitors; b) Beta blockers. Ace inhibitor and Beta blocker drugs are recognized for their importance in treating patients suffering from congestive heart failure. Targets have been set in consultation with the Chronic Disease Collaborative. Baseline 02/03: a) 45%; b) 17% Target 03/04: a) 55%; b) 25% Target 04/05: a) 65%; b) 45% Target 05/06: a) 75%; b) 60% Target 06/07: a) 85%; b) 65%
Priority Strategy 8: Better Care for the Dying: Expand palliative care services to provide dying people with greater choice and access to services.
PS — Performance Measure 13: Percentage of patients in B.C. accessing the home-based PharmaCare Palliative Plan in the 12 months prior to death. Surveys suggest that as death nears, most people would prefer to stay in a familiar environment. PharmaCare Plan P offers coverage for drugs and medical equipment to palliative patients who choose to stay at home. Measuring the number of claims filed under Plan P will signal the rate at which British Columbians are receiving palliative services at home. Baseline 02/03: 12.5% Target 03/04: 13% Target 04/05: 15% Target 05/06: 16% Target 06/07: 17%
Priority Strategy 9: Improve the Health Status of Aboriginal Peoples: Support initiatives to improve Aboriginal health through the formalized participation of Aboriginal people in the planning and delivery of health care.
PS — Performance Measure 14: Improved health status for Aboriginal peoples measured by: a) infant mortality and b) life expectancy. As a group, Aboriginal peoples have a level of health below that of the general population. Aboriginal infant mortality and Aboriginal life expectancy are two important measures of Aboriginal health. Baseline 2002: 4.8 Status Indian (SI) infant deaths per 1,000; SI life expectancy of 73.9 years Target 2003: a) Improvement in SI infant mortality; b) Improvement in SI life expectancy Target 2004: a) No statistically significant difference in infant mortality rates between SI and other residents of B.C.; b) 1999–2003 SI life expectancy of 74.2 years Target 2005: a) No statistically significant difference in infant mortality rates between SI and other residents of B.C.; b) 2000–2004 SI life expectancy of 74.8 years Target 2006: a) No statistically significant difference in infant mortality rates between SI and other residents of B.C.; b) 2001–2005 SI life expectancy of 75.3 years