Local Health Integration Network Research Articles

"Whatever Job I'm In, I'm Going to Find a Way to Make a Difference" - A Black Community Leader's Perspective on Engagement and Advocacy.

Camille Orridge is a patient and community-focused healthcare leader who has passionately and tirelessly worked for more than 50 years to address systemic barriers in the healthcare system, creating innovative equitable health solutions for underserved populations. She has founded a number of key initiatives, including Pathways to Education, the Canadian Home Care Association and the Black Coalition for AIDS Prevention (Black CAP) and has served on numerous boards, as a volunteer and in her capacity as the CEO of the Toronto Central Local Health Integration Network. In this oral history narrative, Camille reflects on her extensive 50-year journey as a healthcare advocate, identifying victories but also areas that continue to be barriers for historically marginalized communities, such as Black communities. In so doing, she discusses the complexities that she has encountered while pushing boundaries and reimagining a more equitable healthcare system in Ontario and reveals key historical touchpoints in the health equity and advocacy space.

Breast Cancer Screening Among Females With and Without Schizophrenia

Breast cancer screening with mammography is recommended in Ontario, Canada, for females 50 years or older. Females with schizophrenia are at higher risk of breast cancer, but in Ontario it is currently unknown whether breast cancer screening completion differs between those with vs without schizophrenia and whether primary care payment models are a factor. To compare breast cancer screening completion within 2 years after the 50th birthday among females with and without schizophrenia, and to identify the association between breast cancer screening completion and different primary care payment models. This case-control study analyzed Ontario-wide administrative data on females with and without schizophrenia who turned 50 years of age between January 1, 2010, and December 31, 2019. Those with schizophrenia (cases) were matched 1:10 to those without schizophrenia (controls) on local health integration network, income quintile, rural residence, birth dates, and weighted Aggregated Diagnosis Group score. Data analysis was performed from November 2021 to February 2023. Exposures were schizophrenia and primary care payment models. Outcomes included breast cancer screening completion among cases and controls within 2 years after their 50th birthday and the association with receipt of care from primary care physicians enrolled in different primary care payment models, which were analyzed using logistic regression and reported as odds ratios (ORs) and 95% CIs. The study included 11 631 females with schizophrenia who turned 50 years of age during the study period and a matched cohort of 115 959 females without schizophrenia, for a total of 127 590 patients. Overall, 69.3% of cases and 77.1% of controls had a mammogram within 2 years after their 50th birthday. Cases had lower odds of breast cancer screening completion within 2 years after their 50th birthday (OR, 0.67; 95% CI, 0.64-0.70). Cases who received care from a primary care physician in a fee-for-service (OR, 0.57; 95% CI, 0.53-0.60) or enhanced fee-for-service (OR, 0.79; 95% CI, 0.75-0.82) payment model had lower odds of having a mammogram than cases whose physicians were paid under a Family Health Team model. This case-control study found that, in Ontario, Canada, breast cancer screening completion was lower among females with schizophrenia, and differences from those without schizophrenia may partially be explained by differences in primary care payment models. Widening the availability of team-based primary care for females with schizophrenia may play a role in increased breast cancer screening rates.

Implantable Hearing Devices in Ontario: A Population-Based Study of Access to Care and Access to Devices

Introduction: The prevalence of hearing loss in Canada is high, with many patients requiring implantable hearing devices (IHDs) as treatment for their disease severity. Despite this need, many eligible patients do not pursue these interventions. The objective of this study was to examine rates of IHD based on geographic location to understand locoregional variation in access to care. Study Design: This was a retrospective population-based cohort study. Setting: All hospitals in the Canadian province of Ontario. Methods: Of all patients with IHD between April 1, 1992, and March 31, 2021, cochlear implants (CIs) (4,720) and bone-anchored hearing aids (BAHA) (1,125) cohorts were constructed. Place of residence was categorized based on Local Health Integrated Network (LHIN). Summary statistics for place of surgical institution based on LHIN at first surgery, name of institution of first surgery and “as the crow flies” distance (in km) between place of residence and surgical institution were calculated. Rate of implantations was calculated for LHIN regions based on number of surgeries per 1,000,000 persons/years. Results: Toronto Central, Central, Central East, and Champlain regions had >10% of patients undergoing BAHA and CI. 1,019 (90.6%) and 4,232 (89.7%) of patients receiving BAHA and CI, respectively, resided in urban/suburban regions and 94 patients (8.4%) and 436 (9.2%) resided in rural regions. The median distance between residential location and the institution was 46.4 km (interquartile range [IQR], 18.9–103.6) and 44.7 km (IQR, 15.7–96.9) for BAHA and CI, respectively. From 1992 to 2021, the number of CI and BAHA performed across Ontario increased by 17 folds and 6 folds, respectively. Conclusion: This large comprehensive population study provides longitudinal insight into the access to care of IHD based on geographic factors. Our findings of the present population-based study indicate an overall increase in access to devices with disproportionate access to care based on geographic locations. Further work is needed to characterize barriers to IHD access to align with demands.

Quantifying the escalating impact of paramedic transported emergency department visits for opioid-related conditions in Ontario, Canada: A population-based cohort study.

While overdoses comprise the majority of opioid research, the comprehensive impact of the opioid crisis on emergency departments (EDs) and paramedic services has not been reported. We examined temporal changes in population-adjusted incidence rates of ED visits and paramedic transports due to opioid-related conditions. We conducted a population-based cohort study of all ED visits in the National Ambulatory Care Reporting System from January 1, 2009 to December 31, 2019 in Ontario, Canada. We included all patients with a primary diagnosis naming opioids as the underlying cause for the visit, without any other drugs or substances. We clustered geographic regions using Local Health Integration Network boundaries. Descriptive statistics, incidence rate ratios (IRR) and 95% confidence intervals (CIs) were calculated to analyze population-adjusted temporal changes. Overall, 86,403 ED visits were included in our study. Incidence of opioid-related ED visits increased by 165% in the study timeframe, with paramedic transported patients increasing by 429%. Per 100,000 residents, annual ED visits increased from 40.4 to 97.2, and paramedic transported patients from 12.1 to 67.9. The proportion of opioid-related ED visits transported by paramedics increased from 35.0% to 69.9%. The medical acuity of opioid-related ED visits increased throughout the years (IRR 6.8. 95% CI 5.9-7.7), though the proportion of discharges remained constant (~75%). The largest increases in ED visits and paramedic transports were concentrated to urbanized regions. Opioid-related ED visits and paramedic transports increased substantially between 2009 and 2019. The proportion of ED visits transported by paramedics doubled. Our findings could provide valuable support to health stakeholders in implementing timely strategies aimed at safely reducing opioid-related ED visits. The increased use of paramedics followed by high rates of ED discharge calls for exploration of alternative care models within paramedic systems, such as direct transport to specialized substance abuse centres.

Mitigating Caregiver Distress in South Western Ontario: Perspectives on Role, Community, and Care.

The former South West Local Health Integration Network (SW LHIN) of Ontario, which is in a predominantly rural region, regularly reports the lowest rates of caregiver distress in the province.Caregivers from rural communities regularly face challenges related to the access, applicability, and availability of supports and services, This qualitative case study describes perspectives of caregiving from the region, and explores how role construction and expectations of caregivers might both mitigate distress and influence service support use. Thematic analysis identified five themes: anticipated care, gendered caring, service support assumptions, confidence in community, and the "line in the sand": care decisions for evolving needs. Using the lens of caregiver identity theory, the findings suggest that these caregivers conceptualize identity as an extension of their primary role, to include caregiving obligations and responsibilities. We also noted a steadfast confidence in community and perceived service support assumptions across the region, with no notable rural-urban divide.

Patterns of failure after radiotherapy (RT) in patients with prostate cancer re-staged with 18F-DCFPyL PSMA-PET: A regional cohort analysis.

45 Background: In Ontario, PSMA-PET is available to patients with prostate cancer who experience biochemical failure after definitive primary RT (pRT) or salvage/adjuvant RT (sRT) through a provincial registry study (PREP protocol). Here we review patterns of PSMA-PET-detected failure after primary (pRT) or salvage/adjuvant RT (sRT) radiotherapy (RT) in cohorts of PREP-registry patients from the Local Health Integration Network (LHIN) 4 region. Methods: With ethics approval, we retrospectively analyzed patients imaged with PSMA-PET in Hamilton, Ontario, Canada, after biochemical failure, following pRT or sRT. Demographic, clinical and treatment parameters as well as PSMA-PET results were collected. Results: Between April 2019 and December 2021, 104 pRT and 91 sRT patients were imaged with 18F-DCFPyL PSMA-PET. Median PSA (ng/mL) before PSMA-PET for the two groups was 5.0 (IQR:3.1-8.9) and 1.3 (IQR:0.6-3.4). The percentages of Prostate or Prostatic bed RT alone (Pr-RT) and Pr + pelvic Lymph Node RT (Pr+LN-RT) RT treatments, were Pr-RT:76% vs Pr+LN-RT:24% for the pRT group and Pr-RT:49.4% vs Pr+LN-RT:50.6% for the sRT group, respectively. Rates of PSMA-PET detected local, pelvic lymph node and distant recurrence are shown. In the pRT group, increasing D’Amico risk category (low to high risk) was associated with lower risk for local and increased risk for pelvic and distant metastasis. Pelvic RT was associated with reduce risk for local recurrence in the pRT but not in the sRT group. Conclusions: In this cohort of patients PSMA-PET detected a considerable risk for local recurrence in patient treated with pRT. A high number of patients are detected with pelvic-only disease recurrence, but pelvic RT seems to be associated with reduction in this risk only in the pRT population. Studies with PSMA-PET at baseline, before pRT or sRT, may help discern better patients that would benefit from pelvic RT and systemic therapy.[Table: see text]

Trends in the Rates of Extended-Spectrum-β-Lactamase-Producing Enterobacterales Isolated from Urine Cultures during the COVID-19 Pandemic in Ontario, Canada.

Worldwide, extended-spectrum β-lactamase (ESBL) rates are increasing at an alarming level with increasing rates of health care exposures, international travel, and antibiotic usage. In this study, we investigated whether enhanced social isolation, travel restrictions, and the reduced use of antibiotics in Ontario, Canada during coronavirus disease 2019 (COVID-19) pandemic had an impact on ESBL rates in urine cultures collected from the community and long-term-care (LTC) facilities across the province. Data from a total of 8.6 million urine cultures performed at LifeLabs Ontario from 2016 to 2021 were utilized for analysis. ESBL-producing Escherichia coli (ESBL Escherichia coli) and ESBL Klebsiella pneumoniae were identified using standard operating procedures. Data trends were estimated by interrupted time series (ITS) regression analysis. Among 2.3 million positive urine cultures, 48.9% and 7.2% grew E. coli and K. pneumoniae, of which 5.8% and 3.3% produced ESBLs, respectively. While the overall rate of ESBL isolation was higher in the pandemic period than in the prepandemic period, by ITS regression analysis of the monthly rates of ESBL isolation, decreasing trends were noted for ESBL E. coli in both the community and LTC facilities and for ESBL K. pneumoniae in the community. The ESBL K. pneumoniae rates in LTC facilities continued to increase throughout the COVID-19 period. By subgroup analysis for different genders, age groups, and local health integration network (LHIN) units, similar trends were seen in most cases (P < 0.05), except for a few densely populated LHINs where rate changes were not statistically significant. IMPORTANCE Community-onset urinary tract infections (UTIs) caused by ESBL-producing Enterobacterales, particularly E. coli and K. pneumoniae, are a major public health concern. In this study, we assessed the impact of COVID-19 on ESBL rates in urine cultures in Ontario, Canada. Our results show the recent epidemiology of ESBL-producing Enterobacterales in urine cultures from both the community and LTC facilities in Ontario, Canada, and the impact of COVID-19 restrictions on ESBL trends for the entire province as well as different subgroups of the population based on demographic and geographic characteristics. Our results may have important public health implications in the context of the gradual easing of COVID-19 restrictions.

Governance in the transformational journey toward integrated healthcare: The case of Ontario

Ontario, the most populous province and the main driver of economic growth in Canada, has been plagued by rising healthcare costs and declining health quality. Firmly believing that care integration is integral to health quality and efficiency of the healthcare system, the Ontario government has embarked on its journey of healthcare system transformation. The case, by taking a snapshot of its transition from the Local Health Integration Network (LHIN) model to the Ontario Health Team model, offers insights into the governance of the LHIN model as well as the initiative of integrating a myriad of healthcare information systems to support care integration. After 12 years’ controversial operation of LHINs, the government dissolved the organization and announced its plan to switch to the Ontario Health Team model. Under the new model, Ontario Health Teams would be responsible for providing a full and coordinated spectrum of care for patients, especially those with complex care needs. Would this round of transformation and emphatic focus on digital health lead Ontario one step closer to integrated care that Ontarians have been chasing for so long?

Empowering Patient Self-Management: A Community Paramedicine Model of Care in Ontario

Community Paramedicine Remote Patient Monitoring (CPRPM) was launched in Ontario in April 2015 to address high health system usage in vulnerable patients living with chronic disease. CPRPM expands on the home visit model of community paramedicine (CP) to bridge gaps in patient care and address inefficiencies in resource utilization. At patient and systems levels, CPRPM aims to promote patient self-management of chronic diseases. Several reports driving the development of the Ontario Seniors Strategy, which include key recommendations for expanding CP programs, provided the impetus for government to deliver on their electoral platform promise to increase health care spending. The Local Health System Integration Act, 2006 gave Local Health Integration Networks the authority to make home and community care services accessible to Ontario residents, including the supplies and equipment required by patients and their caregivers to support their care at home. Outcome measures of CPRPM point to positive benefits for encouraging patient self-management of chronic diseases and reducing health system strain, with a return on investment of 542%. The variety of options for patient interaction and ability to lessen health system burden makes CPRPM a desirable model of care.

Resilience amongst Ontario registered practical nurses in long-term care homes during COVID-19: A grounded theory study.

This study aimed to understand how the personal and professional resilience of Registered Practical Nurses working in long-term care (LTC) homes in Ontario were impacted during the Coronavirus 2019 pandemic. Registered Practical Nurses are primary regulated healthcare providers that have worked in Ontario LTC homes during the COVID-19 pandemic. As frontline workers, they have experienced increased stress secondary to lockdowns, changing Ministry of Health recommendations, social isolation and limited resources. LTC homes experienced almost a third of all COVID-19-related deaths in Ontario. Understanding registered practical nurses' (RPNs) resilience in this context is vital in developing the programs and supports necessary to help nurses become and stay resilient in LTC and across a range of settings. Purposive sampling was used to recruit 40 Registered Practical Nurses working in LTC homes across Ontario for interviews. Charmaz's Grounded theory guided in-depth one-on-one interviews and analyses completed between April to September 2021. Registered Practical Nurse participants represented 15 (37.5%) private, and 25 (62.5%) public LTC homes across Ontario Local Health Integration Networks. Findings informed two distinct perspectives on resilience, one where nurses were able to maintain resilience and another where they were not. Sustaining and fraying resilience, presented as bimodal processes, was observed in four themes: 'Dynamic Role of the Nurse', 'Preserving Self', 'Banding Together' and 'Sense of Leadership Support'. Resilience was largely drawn from themselves as individuals. Resources to support self-care and work-life balance are needed. Additionally, workplace supports to build capacity for team-based care practices, collegial support in problem-solving and opportunities for 'connecting' with LTC nursing colleagues would be beneficial. Our findings suggest a role for professional development resources in the workplace that could help rebuild this workforce and support RPNs in providing quality care for older adults living in LTC. Our research team included two members of the Registered Practical Nurses Association of Ontario, and these team members contributed to the discussion and design of the study methodology, recruitment, analysis and interpretation. Further, RPNs working in long-term care during the COVID-19 pandemic were the participants in this study and, therefore, contributed to the data. They did not contribute to data analysis or interpretation.

Access to orthopedic specialist service in Ontario via eConsult.

Background:Increasing strain on public health resources in Canada, in particular with respect to accessing specialist care, necessitates the exploration of alternative models of care. The aim of this study was to assess the efficacy of electronic consultation (eConsult) in providing orthopedic surgery specialist service to patients in the Champlain Local Health Integration Network (LHIN) of Ontario.Methods:This was a cross-sectional review of all 564 Champlain LHIN orthopedic surgery referral requests received via the Champlain Building Access to Specialist service through the eConsult (BASE) system in 2017. Primary outcome measures were impact on primary care provider (PCP) referral pattern and time to receive orthopedic consultation.Results:eConsult prevented unnecessary in-person consultation 64% of the time, while PCP referral decisions were modified 51% of the time. Of all eConsults, 94% were rated as valuable to PCPs in their practice and 97% of eConsults resulted in actionable advice. eConsults took an average of 14.5 minutes of specialist time to complete, and the mean time from referral to response was 3.7 days.Conclusion:The eConsult system spares unnecessary consultation to orthopedic surgery; catches important referrals that would have otherwise been missed; saves time for patients, PCPs and orthopedic surgeons; and improves efficiency in a socialized health care system.

Time to treatment of esophageal cancer in Ontario: A population-level cross-sectional study

ObjectiveTimely cancer treatment improves survival and anxiety for some sites. Patients with esophageal cancer require specific workup before treatment, which can prolong the time from diagnosis to treatment (treatment interval [TI]). The geographical variation of this interval remains uninvestigated in patients with esophageal cancer. MethodsThis retrospective population-level study conducted in Ontario used linked administrative health care databases. Patients treated for esophageal cancer between 2013 and 2018 were included. The TI was time from diagnosis to treatment. Patients were assigned a geographical Local Health Integration Network on the basis of postal code. Covariates included patient, disease, and diagnosing physician characteristics. Quantile regression modeled TI length at the 50th and 90th percentile and identified associated factors. ResultsOf 7509 patients, 78% were male and most were aged between 60 and 69 years. The 50th and 90th percentile TI was 36 (interquartile range, 22-55) and 77 days, respectively. The difference between the Local Health Integration Network with the longest and shortest TI at the 50th and 90th percentile was 18 and 25 days, respectively. Older age (P < .0001), greater comorbidity (P = .0005), greater material deprivation (P = .001), rurality (P = .03), histology (P = .02), and treatment group (P < .0001) were associated with a longer median TI. Older age (P = .03), greater comorbidity (P = .003), greater material deprivation (P = .005), rurality (P = .04), and treatment group (P < .0001) were associated with a longer 90th percentile TI. ConclusionsGeographic variability of time to treatment exists across Ontario. Investigation of facility-level differences is warranted. Patient and disease factors are associated with longer wait times. These results might inform future health care policy and resource allocation.

Increased demand for paramedic transports to the emergency department in Ontario, Canada: a population-level descriptive study from 2010 to 2019

PurposeWe examined changes in annual paramedic transport incidence over the ten years prior to COVID-19 in comparison to increases in population growth and emergency department (ED) visitation by walk-in.MethodsWe conducted a population-level cohort study using the National Ambulatory Care Reporting System from January 1, 2010 to December 31, 2019 in Ontario, Canada. We included all patients triaged in the ED who arrived by either paramedic transport or walk-in. We clustered geographical regions using the Local Health Integration Network boundaries. Descriptive statistics, rate ratios (RR), and 95% confidence intervals were calculated to explore population-adjusted changes in transport volumes.ResultsOverall incidence of paramedic transports increased by 38.3% (n = 264,134), exceeding population growth fourfold (9.4%) and walk-in ED visitation threefold (13.4%). Population-adjusted transport rates increased by 26.2% (rate ratio 1.26, 95% CI 1.26–1.27) compared to 3.4% for ED visit by walk-in (rate ratio 1.03, 95% CI 1.03–1.04). Patient and visit characteristics remained consistent (age, gender, triage acuity, number of comorbidities, ED disposition, 30-day repeat ED visits) across the years of study. The majority of transports in 2019 had non-emergent triage scores (60.0%) and were discharged home directly from the ED (63.7%). The largest users were persons aged 65 or greater (43.7%). The majority of transports occurred in urbanized regions, though rural and northern regions experienced similar paramedic transport growth rates.ConclusionThere was a substantial increase in the demand for paramedic transportation. Growth in paramedic demand outpaced population growth markedly and may continue to surge alongside population aging. Increases in the rate of paramedic transports per population were not bound to urbanized regions, but were province-wide. Our findings indicate a mounting need to develop innovative solutions to meet the increased demand on paramedic services and to implement long-term strategies across provincial paramedic systems.

Translation policy in health care settings in Ontario

Abstract In a world of increasing globalisation, governments, including Canada, face ongoing challenges in their efforts to integrate immigrant languages and to communicate with their users in public service settings. By exploring the translation policy in health care settings in Ontario, Canada, this research investigates how immigrant language barriers in health care access are addressed there, and probes into ideologies around the issue of immigrant language integration. Ontarian translation policy in health care settings is pragmatic yet cautious and laissez-faire. It indicates inclusiveness to accommodate immigrants; but it also reveals considerable tensions and hesitations. The belief that translation is a necessary measure to secure immigrants’ equal health care rights has been largely overridden at the regional and institutional level in Ontario, hindering further planning and more effective provision. The inadequate value designated to translation in terms of immigrant integration by government authorities, the ambiguous and ambivalent stances of Toronto Central Local Health Integration Network and some hospitals on translation provision against budgetary concern and the expectation for linguistic homogeneity all play roles in determining the flexibility and fluctuation of translation policy in health care settings in Ontario.

Assessing the contribution of immigrants to Canada’s nursing and health care support occupations: a multi-scalar analysis

BackgroundThe World Health Organization adopted the Global Strategy on Human Resources for Health Workforce 2030 in May 2016. It sets specific milestones for improving health workforce planning in member countries, such as developing a health workforce registry by 2020 and ensuring workforce self-sufficiency by halving dependency on foreign-trained health professionals. Canada falls short in achieving these milestones due to the absence of such a registry and a poor understanding of immigrants in the health workforce, particularly nursing and healthcare support occupations. This paper provides a multiscale (Canada, Ontario, and Ontario’s Local Health Integration Networks) overview of immigrant participation in nursing and health care support occupations, discusses associated enumeration challenges, and the implications for health workforce planning focusing on immigrants.MethodsDescriptive data analysis was performed on Canadian Institute for Health Information dataset for 2010 to 2020, and 2016 Canadian Census and other relevant data sources.ResultsThe distribution of nurses in Canada, Ontario, and Ontario’s Local Health Integration Networks reveal a growth in Nurse Practitioners and Registered/Licensed Practical Nurses, and contraction in the share of Registered Nurses. Immigrant entry into the profession was primarily through the practical nurse cadre. Mid-sized communities registered the highest growth in the share of internationally educated nurses. Data also pointed towards the underutilization of immigrants in regulated nursing and health occupations.ConclusionImmigrants comprise an important share of Canada’s nursing and health care support workforce. Immigrant pathways for entering nursing occupations are complex and difficult to accurately enumerate. This paper recommends the creation of an integrated health workforce dataset, including information about immigrant health workers, for both effective national workforce planning and for assessing Canada’s role in global health workforce distribution and utilization.

Meta-analysis of multi-jurisdictional health administrative data from distributed networks approximated individual-level multivariable regression

Background and ObjectivesCompare meta-analysis in a distributed network to individual-level analysis for assessment of time trends of health services utilization with health administrative data. MethodsWe used administrative data from Ontario, Canada to analyze temporal trends in pediatric inflammatory bowel disease health services use. Beta coefficients were obtained using negative binomial, logistic, and Cox proportional hazards regression models. We replicated the individual-level analyses in each Ontario Local Health Integration Network (LHIN), then meta-analyzed aggregate trends using both fixed and random effects meta-analysis. We compared the pooled estimates of effect with individual-level analysis. ResultsBeta coefficients, summary effect estimates, and 95% confidence intervals (CIs) from the meta-analysis of data from distributed networks were not different than those from individual-level data, regardless of meta-analytic approach used. For example, the 5-year odds ratio of colectomy in ulcerative colitis using individual-level analysis was 0.978 (95% CI 0.950 to 1.007) compared to distributed network fixed effects meta-analysis: 0.982 (95% CI 0.950 to 1.015), and random effects meta-analysis: 0.982 (95% CI 0.950 to 1.015). ConclusionMeta-analysis of multi-jurisdictional estimates were similar to estimates obtained from individual-level analysis. This method is a valid alternative for analysis of multi-jurisdictional data when individual-level data cannot be shared.

Regional Variation in Pregnancy Outcomes amongst Women in Inflammatory Bowel Disease: A Population-Based Cohort Study.

Background Women with inflammatory bowel disease (IBD) are at risk of certain pregnancy outcomes such as preterm delivery, infants small for gestational age (SGA), and Cesarean delivery. Whether regional variation in these outcomes exists remains unknown. We aimed to assess the geographical variation in these pregnancy outcomes in women with IBD. Methods All pregnancies in women with and without IBD (2002-2013) were identified using Ontario health administrative datasets. Geographical variation in preterm delivery, infants SGA, and Cesarean delivery was assessed using age-adjusted odds ratios (aOR) with 95% confidence intervals (CI) comparing women with and without IBD, stratified by Ontario's 14 health-service regions, known as Local Health Integration Networks (LHINs). Results 1621 women with IBD (2466 pregnancies) and 855,425 women without IBD (1,280,493 pregnancies) were included. Women with IBD were more likely to have preterm delivery (aOR 1.56, 95% CI, 1.35–1.79), infants SGA (aOR 1.52, 95% CI, 1.23–1.88), and Cesarean section (aOR 1.34, 95% CI, 1.22–1.49). Significant geographical variation in these outcomes was detected, with the highest rates observed in the most northern rural areas (aOR for preterm delivery 2.78 (95% CI, 1.03–7.46), aOR for SGA 5.66 (95% CI, 1.67–19.14), and aOR for Cesarean delivery 2.48 (95% CI, 1.11–5.55)). There were no differences in these outcomes in women with and without IBD in more central urban LHINs. Conclusion Significant regional variation was detected in rates of adverse pregnancy outcomes and Cesarean delivery in women with IBD. Further study is required to determine specific reasons for this variation.

Ontario wait times for delayed surgical treatment of traumatic peripheral nerve injury.

Background:To better understand the occurrence and operative treatment of peripheral nerve injury (PNI) and the potential need for additional resources, it is essential to define the frequency and distribution of peripheral nerve procedures being performed. The objective of this study was to evaluate Ontario’s wait times for delayed surgical treatment of traumatic PNI.Methods:We retrieved data on wait times for peripheral nerve surgery from the Ontario Ministry of Health and Long-Term Care Wait Time Information System. We reviewed the wait times for delayed surgical treatment of traumatic PNI among adult patients (age ≥ 18 yr) from April 2009 to March 2018. Data collected included total cases, mean and median wait times, and demographic characteristics.Results:Over the study period, 7313 delayed traumatic PNI operations were reported, with variability in the case volume distribution across Local Health Integration Networks (LHINs). The highest volume of procedures (2788) was performed in the Toronto Central LHIN, and the lowest volume (< 6) in the Waterloo Wellington and North Simcoe Muskoka LHINs. The population incidence of traumatic PNI requiring surgery was 5.1/10 000. The mean and median wait times from surgical decision to surgical repair were 45 and 27 days, respectively. Both the longest and shortest wait times occurred in LHINs with low case volumes. The provincial target wait time was met in 93% of cases, but women waited significantly longer than men (p < 0.001).Conclusion:The provincial distribution of traumatic PNI surgery was variable, and the highest volumes were in the LHINs with large populations. The provincial wait time strategy for traumatic PNI surgery is effective, but women waited longer than men. Precise reporting from all hospitals is necessary to accurately capture and understand the delivery of care after traumatic PNI.

CHARACTERIZING REGIONAL VARIABILITY IN HEALTH RESOURCE UTILIZATION DURING THE DIAGNOSTIC PHASE OF LUNG CANCER ACROSS ONTARIO: A POPULATION-BASED ANALYSIS

TOPIC: Lung Cancer TYPE: Original Investigations PURPOSE: Lung cancer (LC) is the leading cause of cancer-related mortality among Canadians. Significant differences in LC relative survival exist within Ontario (ON), though the reasons for this require further elucidation. We aimed to characterize regional variability in LC care through assessment of health resource utilization (HRU) across ON health regions by Local Health Integration Networks (LHIN) to assess variability in access and equity of care and evaluate the impact of HRU on LC outcomes. METHODS: A retrospective population-based cohort study was conducted with ICES, an administrative database in ON, from January 2007 - December 2017. Patients with newly diagnosed LC were identified from the ON Cancer Registry, including if LC was the cause of death. Data were collected from 90 days prior to LC diagnosis until first LC treatment or up to 120 days after diagnosis if no treatment was received, and included: number of staging tests, biopsies, emergency department (ED) visits and admissions. Through OHIP billing codes, specialty appointments with internal medicine, pulmonology, thoracic surgery (TS), medical oncology, radiation oncology, and palliative care were identified. Descriptive data and unpaired t-tests are reported; a multivariate analysis is in progress. RESULTS: LC patients (n=70,749) in ON underwent a mean of 3.20 staging investigations, which varied by LHIN (range 2.52 to 3.61) and by stage (Stage I mean 2.97+/- 1.75 vs Stage IV mean 3.42+/- 1.88, p<0.001). Patients with stage I disease underwent more biopsies compared to stage IV disease (mean all patients = 1.47, stage I = 1.86+/-1.17, stage IV = 1.34+/-1.08, p<0.001), with variability across LHINs (range mean of all patients 1.25 to 1.61). ED visits were more common for patients with stage IV disease compared to stage I (Stage I = 0.92+/-1.56 visits vs Stage IV 1.68+/-1.67 visits, p<0.001), but hospital admissions occurred more frequently in stage I disease (stage I = 0.94+/-0.79 admissions vs stage IV = 0.91+/-0.87 admissions, p=0.001). The number of specialist visits prior to first LC treatment varied between LHIN from an average of 2.9 to 4.9 visits per patient, with patients in some remote areas seeing fewer specialists than in urban regions. There was significant variability in types of specialist visits between LHINs, with mean pulmonology visits ranging from 0.08 to 1.00 per patient and mean TS visits ranging from 0.21 to 1.62. Only 19.9% of LC patients received smoking cessation counselling ranging from 15.1% - 22.4% across LHINs. CONCLUSIONS: HRU varies by disease stage and by LHIN across ON. Further evaluation of regional differences between may explain the variation in LC survival outcomes. CLINICAL IMPLICATIONS: The knowledge gained from this project has the potential to identify disparities in care that may contribute to the variability in LC outcomes across ON and identify target areas for improvement in LC care. DISCLOSURES: no disclosure on file for Micheal Brundage; No relevant relationships by Genevieve Digby, source=Web Response No relevant relationships by Elizabeth Eisenhauer, source=Web Response Advisory Committee Member relationship with AstraZeneca Precision Program Please note: 2017 - present Added 05/14/2021 by M. Diane Lougheed, source=Web Response, value=Honoraria Research relationship with Astra Zeneca Inc Please note: 2018-present Added 05/14/2021 by M. Diane Lougheed, source=Web Response, value=Grant/Research Support Research relationship with GlaxoSmithKlein Please note: 2018-present Added 05/14/2021 by M. Diane Lougheed, source=Web Response, value=Grant/Research Support Speaker/Speaker's Bureau relationship with Canadian Thoracic Society Please note: 2019 Added 05/14/2021 by M. Diane Lougheed, source=Web Response, value=Honoraria Research relationship with Government of Ontario Please note: 2019-present Added 05/14/2021 by M. Diane Lougheed, source=Web Response, value=Grant/Research Support No relevant relationships by Monica Mullin, source=Web Response No relevant relationships by Chris Parker, source=Web Response No relevant relationships by Marlo Whitehead, source=Web Response

THE IMPACT OF TELEHOMECARE ON HEART FAILURE PATIENTS, NURSES, AND INFORMAL CAREGIVERS: A LONGITUDINAL COHORT STUDY

THE IMPACT OF TELEHOMECARE ON HEART FAILURE PATIENTS, NURSES, AND INFORMAL CAREGIVERS: A LONGITUDINAL COHORT STUDY