Meeting Community Needs Through Integrated Care Donna Kearney

Meeting Community Needs Through Integrated Care Donna Kearney, BSc. N, RN(EC), MHST Rosseau Nursing Station Nurse Practitioner - Manager Compassion Accountability Rights and Responsibilities Excellence

Rural Indicators of Health “Geography is an Indicator of Health” Roy Romanow 2002 Advanced Age Seasonal & Low Income Minimal Education Few Employment & Social Opportunities Few Support Services High Dependency Compassion Accountability Rights and Responsibilities Excellence

Age Demographics Ontario 2006 District of Parry Sound 2006 Compassion Accountability Rights and Responsibilities Excellence

Rural versus Urban Parry Sound Town of Parry Sound 2006 Rural Parry Sound 2006 Compassion Accountability Rights and Responsibilities Excellence

Primary Care Providers by Region By Postal Code Number of Primary Care FP/NP’s 2006 Census Pop. change since 2001 census Town of Parry Sound 15 FP’s 1 NP @ FHT 5818 Down 5% Georgian Bay Township 1 part-time NP@ Moose Deer Point 2340 Up 17. 5% Seguin Township 1 NP@ Rosseau 4276 Up 15. 6% Whitestone 1 NP @ Whitestone 1030 Up 20. 8% Archipelago 1 NP@ Pointe au Baril 576 Up 14. 1% Unorganized Central West 1 NP@ Britt 1212 Up 10. 3% Unorganized Central East 1 NP@ Argyle 1212 Up 10. 3% Mc. Dougall 0 2704 Up 3. 7% Compassion Accountability Rights and Responsibilities Excellence

Nursing Stations: An Extension of the Hospital Nursing Stations Compassion Accountability Rights and Responsibilities Excellence

Nursing Stations - Model Buildings, Donations, In-kind NP Station Funding, Grants Operations Compassion Accountability Rights and Responsibilities Excellence

Scope of Practice RN NP MD Specialist Diagnosis and Treatment Allied Health Care Providers Compassion Accountability Rights and Responsibilities Excellence

Research: Purpose 1) To evaluate a model of primary health care delivery appropriate for rural populations. 2) To determine the scope and collaborative nature of NP practice in a rural nursing station setting. Compassion Accountability Rights and Responsibilities Excellence

Research: Purpose 3) To define the level of importance of hospital affiliation in reducing cost of care. 4) To show the impact on ER usage, hospital admissions, and wait times for primary health care. Compassion Accountability Rights and Responsibilities Excellence

Research: Process • 12 month data collection period (March 1, 2009 – February 28, 2010) • Used electronic reporting tool developed for the project to improve consistency and accuracy by all 6 nursing stations • Used hospital statistics for ER usage & acuity, admission, and re-admission rates Compassion Accountability Rights and Responsibilities Excellence

Research: Variables • Moose Deer Point nursing station decreased services from 5 days to 2 days per week due to lack of patients. • H 1 N 1 Pandemic • NP vacation time, education time, and sick leaves not replaced consistently • One station dropped out of the study Compassion Accountability Rights and Responsibilities Excellence

Research Findings: Demographics 120% 100% SENIOR 80% 60% ADULT 40% CHILD 20% 0% RNS MDP ANS WNS PAB BNS Totals: 48% Adults (16 -64), 44% Seniors (65+), 8% Children (0 -15) Compassion Accountability Rights and Responsibilities Excellence

Patients Without a Family Doctor 40% 35% 30% 25% 20% 15% 10% 5% 0% RNS MDP ANS WNS PAB BNS Compassion Accountability Rights and Responsibilities Excellence

New Patients 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% RNS MDP ANS WNS PAB BNS Compassion Accountability Rights and Responsibilities Excellence

Type of Care Provided: Nursing Stations 20% 33% Preventative 22% 25% Curative Diagnostic Supportive Compassion Accountability Rights and Responsibilities Excellence

Referral Rates from Nursing Stations 29% FP Specialist 43% Allied Health Total Referral Rate = 11%, Consult Rate = 19% Compassion Accountability Rights and Responsibilities Excellence

Patient Volumes: Nursing Stations 600 Patient Volumes 500 400 RNS ANS 300 WNS PAB 200 BNS 100 0 Mar-09 May July Sept Nov Jan-10 Compassion Accountability Rights and Responsibilities Excellence

Patient Volumes: ER/Nursing Stations 3000 Patient Volumes 2500 2000 Total Stations 1500 Total Emerg 1000 500 0 Mar-09 May July Sept Nov Jan-10 Compassion Accountability Rights and Responsibilities Excellence

Patient Acuity: ER/Nursing Stations ER Triage Score (7% Unknown) Percent 1 - Resuscitation . 02% Nursing Station Acuity Percent 1 – Life Threatening 0% 2 - Emergent 5% 2 - Emergent 3 - Urgent 27% 3 - Urgent 2% 4 – Semi-Urgent 53% 4 - Complicated 21% 5 – Non-Urgent 7% 5 – Episodic/Chronic 77% 22, 126 Total Patients seen in Nursing Stations 19, 240 Total Patients seen in the ER . 09% Triage/Acuity Level 4 & 5: 60% in ER 98% in Nursing Stations Compassion Accountability Rights and Responsibilities Excellence

ER Usage by Postal Code and Age Region by Postal Code # 2006 NP’s/ Census MD’s Adult (16 -64) Senior (65+) Town of Parry Sound 1 NP 15 MD’s 5818 11, 069 190% 1435 (13%) 6829 (62%) 2805 (25%) Georgian Bay 1 P/T NP 2340 1097 6% 146 (13%) 699 (64%) 252 (23%) Seguin 1 NP 4276 2746 64% 455 (17%) 1644 (60%) 647 (23%) Whitestone 1 NP 1030 739 72% 52 (7%) 422 (57%) 265 (36%) Archipelago 1 NP 576 222 38% 22 (10%) 149 (67%) 51 (23%) Central West 1 NP 1212 482 40% 61 (13%) 248 (51%) 173 (36%) Central East 1 NP 1212 0 0 0 2704 6024 223% 411 (7%) 5033 (84%) 580 (9%) Mc. Dougall ER Visits % Pop using ER Child (0 -15) Compassion Accountability Rights and Responsibilities Excellence

Hospital Admissions/Re-Admissions Region by Postal Code Hospital Admissions 65+ years % Population Re-Admissions Within 30 Days % Re-Admits Town of Parry Sound 484 8. 3% 19 3. 9% Georgian Bay (MDP) 42 1. 8% 4 9. 5% Seguin (Rosseau) 77 1. 8% 0 0 Whitestone (Whitestone) 42 4% 3 7% Archipelago (PAB) 11 1. 9% 0 0 Central West (Britt) 32 2. 6% 0 0 Central East (Argyle) 0 0 Mc. Dougall 81 3% 5 6% Compassion Accountability Rights and Responsibilities Excellence

Cost Analysis 6 Nursing Stations Budget: WPSHC Emergency Room 1. 3 million total Staff: 1 NP, 1 Admin Hours: 5 days (7. 5 hours) Patient Volume: 19, 240 Acuity Rates: 98% level 4 & 5 Cost per Patient Visit: $70 Budget: Staff: 3. 3 million total 1 MD, 4+ RN’s, 1 Admin Hours: 7 days (24 hours) Patient Volume: Acuity Rates: 22, 126 60% level 4 & 5 33% level 1, 2, 3 Cost per Patient Visit: starts at $152 Cost Analysis information is not available for FHT’s or NP Led Clinics to date, therefore comparisons are not possible. Compassion Accountability Rights and Responsibilities Excellence

Conclusions • Reduced: • • • Wait times for primary care Visits to the ER Hospitalizations for chronic illness • Increased • • Access to health care for rural seniors Opportunities to ‘Age in Place’ Monitoring for compliance with treatments and health outcomes Collaboration with all health care providers Opportunities for health teaching and illness prevention Continuity of care and advocacy Understanding of patients living conditions and support system Compassion Accountability Rights and Responsibilities Excellence

Recommendations: Local Level • Create permanent NP positions in the ER at WPSHC. • Provide after hours primary care services to residents in the Town of Parry Sound. • Relief funding is needed to replace NP’s at the nursing stations during absences. • Increase operating budgets of nursing stations to allow hiring of additional staff (RPN’s, NP’s), and to provide mentorship opportunities to prepare new NP’s to work full scope in rural nursing stations. Compassion Accountability Rights and Responsibilities Excellence

Recommendations: Provincial/National • Change FP title to ‘Primary Care Specialist’ to promote top-of-scope functioning of all health care providers. • Implement this model of primary care delivery in rural areas throughout Canada for a collaborative, sustainable, and accessible method of entering the health care system. Compassion Accountability Rights and Responsibilities Excellence

Questions – Thank you! Donna Kearney, BSc. N, RN(EC), MHST West Parry Sound Health Centre dkearney@wpshc. com Compassion Accountability Rights and Responsibilities Excellence