Health Research, Indicators and Evaluation Elder Health Think Tank 19 November 2008 Dr. Vasanthi Srinivasan Director, Health System Planning and Research Branch, Ministry of Health and Long-Term Care

Overview: 1.Health System Planning and Research Branch investments 2.Ministry elder health research questions 3.Elder health system enhancement 4.The need for program evaluation 5.Aging at Home Strategy indicators 6.A conceptual framework 7.Assessing productivity and return on investment 8.What would be success for the Aging at Home Strategy? 2

HSPRB invests in home care and aging research. 3 Ministry research investments in seniors and aging include: Home Care Research and Knowledge Exchange Chair Seniors Health Research Transfer Network and its Research Collaboration Institute for Clinical and Evaluative Sciences (ICES) Toronto Rehabilitation Institute (TRI) Arthritis Community Research and evaluation Unit (ACREU) Community Health Research Unit (CHRU) Career Scientists The Health System Planning and Research Branch funds diverse streams of health services research across the continuum of care, including elder health. The ministry’s research agenda includes seniors and aging as a priority. We also supports networks that take on a collaborative approach to performing research and building capacity through partnership and synergies within and between, the private and public community, and the government: Health System Performance Research Network Ontario Research Collaborative (ORC) MOHLTC has been working with the Canadian Policy Research Networks (CPRN) and other researchers to develop white papers to better understand the unique needs of seniors.

HSPRB directs aging at home/senior research questions/initiatives to ministry-funded centres/units to inform policy making. Looking at Alternate Levels of Care (ALC) wait times What is the extent and nature of dietary violations in Ontario LTC homes? What factors are considered by an applicant in choosing a long-term care home, e.g., proximity to services; care needs; type of service provider? What alternatives to long-term care homes can be developed for seniors who can no longer live at home? What are the differences in the types of client served and the types of care provided in long-term care homes and supportive housing. How much overlap is there? What impact is the consolidation of the LTC home sector into larger and more cashflow oriented business models having on the quality of care. Can we project the demographic and socioeconomic factors to predict preferences for preferred services including “Private” or “Semi-Private” accommodation in LTC homes? Will economic factors also affect individuals’ preferences for receiving additional care in their home or retirement homes if they can afford it? Can we project the cost of meeting consumer service preferences? 4

MOHLTC has been working with the Canadian Policy Research Networks (CPRN) to understand the unique needs of seniors. Because elder care encompasses such a high proportion of service utilization, integrated health and social care can improve outcomes and increase client satisfaction as well as providing cost savings or cost-effectiveness. Based on a systematic review of the literature, key elements for integrated seniors care could include: umbrella organizational structures to guide integration of strategic, managerial and service delivery levels; encourage and support effective joint/collaborative working; ensure efficient operations; and maintain overall accountability for service, quality and cost outcomes. multidisciplinary case management for effective evaluation and planning of client needs, providing a single entry point into the health care system, and packaging and coordinating services. organized provider networks joined together by standardized procedures, service agreements, joint training, shared information systems and common ownership of resources to enhance access to services, provide seamless care and maintain quality. financial incentives to promote prevention, rehabilitation and the downward substitution of services, as well as to enable service integration and efficiency. Source: “Frameworks of Integrated Care for the Elderly: A Systematic Review” Retrieved May 17, 2008 from 5

Evaluating health care strategies, programs and initiatives is vital for ongoing development and improvement. Research indicators need to be a part of evaluating provincial and national strategies for a sustainable health care system. Information is vital for good decision making and health care delivery; program evaluation of the LHIN aging at home projects and programs is key. In order to determine what we are doing right/ what is working, we need to collect data by on key indicators. Indicators must be validated and contextualized for their reliability in measuring quality, e.g. a nursing home may have more falls than another one, but that number is not indicative of poor service nor indicate the number of frail individuals at that home. 6

Identifying the indicators to evaluate the Aging at Home Strategy is still at an early stage. Some examples of the outcomes we want to measure and indicators for measuring them: Financial / Fiscal Health Indicators can include: expenditures Organizational Capacity Indicators can include: budget, learning, etc. High Quality Health Services Indicators can include: volume/usage, wait times, discharge, etc. Client Perspective Indicators can be sought through surveys to assess satisfaction, etc. System Perspective Indicators can include: ALC, ED visits, ED wait times, LTC placement, etc. 7

Aging Population Health Care Costs Identify elder health issues Review current elder health initiatives and services Evaluate Outcomes Design program evaluation and identify indicators and monitor throughout the program’s implementation Design strategies / initiatives (e.g. Aging at Home and its LHIN programs/projects Examples of MOHLTC Funded work on elder care indicators: Health System Performance Research Network -Measure system effectiveness and quality; use CCAC administrative data and client assessment data (RAI-HC) John Hirdes – Home Care Chair -interRAI, validation and contextualization of RUGIII/Home Care algorithm Aging at Home Initiatives - Potential indicators include: ED visits, alternate level of care days There are many conceptual frameworks for looking at the impact of elder care: 8

Assessing productivity and return on investment of a program also adds value and helps to prioritize during decision making. Knowledge Production Research Impact Leveraging and Capacity Building Knowledge Dissemination & Brokering Product & Policy Development Success is interdependent “People and Potential” Project-Specific Funding Institute Funding Researcher Network Initiatives Health Technology Assessment and Clinical Innovation Tools Portfolio Operations/ Governance Categories 1.Implement analytical tools/ processes to ensure excellence 2.Invest in infrastructure, support and personnel that show ROI. 3.Ensure investments identify and address system priorities. 4.Improve the coordination of research to promote the sustainability of investments 5.Ensure use and uptake of evidence- based findings from funded research Objectives Identification of Emerging Needs Improved Health Outcomes Increased System Sustainability Source : 5 High-Level Themes used to evaluate productivity of Stakeholders (in diamond): Adapted from, Buxton, M. and Hanney, S. (1996). “How can payback from health services research be assessed?” Journal of Health Services Research and Policy, 1: 35–43. 9

Quantifying success for the Aging at Home Strategy? * MacAdam, A. (2007). Equitable Access to Health Care for Ontario’s Ethnocultural Minority Seniors **Source: Statistics Canada, Census, In order to measure success we need to: Identify the questions we want answered Identify possible performance indicators Identify what existing and new data will be needed What does success look like? Seniors can easily access the services required to meet their needs – seniors and their caregivers are satisfied that they are receiving the right care and that their needs are being met Fewer seniors require hospitalization or emergency services - their needs are being met without recourse to these services Fewer seniors require admission to long-term care homes and waiting time to placement is reduced – alternative residential settings are available to those with lesser needs

Contact Information Dr. Vasanthi Srinivasan Director, Health System Planning and Research Health System Strategy Division, MOHLTC 80 Grosvenor Street, 8 th Floor, Toronto (416)