Need for Comprehensive Canadian Strategy Role of the Provincial Governments

1. NAMD Need for Comprehensive Canadian Strategy Role of the Provincial Governments Obesity in Canada: Prevention to Treatment1st Annual CABPS Conference in Conjunction with OBN & CMAS Mississauga, Ontario June 8, 2012

2. Overview

3. Other Aspects

4. Policy and Delivery Roadmap

5. Program Cycle

6. Framework Evidence-based Framework Bariatric Services Strategy Ontario Health Technology Assessment Committee HealthTUGO Key Recommendations Provincial Program Team Approach Centres of Excellence Role for Primary Care Registry Telemedicine Expert Consultations Literature Other Jurisdictions

7. Program Design Centres of Excellence (CofE) Ontario Bariatric Network Clinical Standards Best Practices Registry Wait Time Management Central Referral Portal Patient Outcomes Tracking Research Regional Assessment & Treatment Centres (RATC) Education & Outreach Telemedicine

8. Allocate Resources Out-of-Country and In-Province Surgeries Out-of-Country and In-Province Surgeries 2002 – 2011

9. CONTEXT Behind the numbers

10. Allocate ResourcesBariatric Services Strategy Announcement in July 2008$75 M as part of Ontario Diabetes Strategy Comprehensive Bariatric Strategy to build capacity in Ontario to: • improve patient outcomes; • increase patient safety; and • reduce the demand for increasing number of referrals for out-of-country (OOC) bariatric procedures.

11. Standards & Performance Measures Ontario Bariatric Network in Action Topic-focused Working Groups • Teleconferences • Trouble-shooting • Quick sharing of innovations Assessment Telemedicine Registry Implementation Surgery Selection Pre-op Testing Mental Health 11 11

12. 3-months1st Assessment to Surgery Date Y Y High-Level Bariatric Referral Process Physician Faxes Referral Form to the Bariatric Registry 9-month Surgery Goal (1-year Max) SURGERY Occurs Referral Data is sent to BCOE/RATC based on LHIN designation Confirmation Letter: Surgery Date is sent to Patient & Referring Physician BCOE/RATC receives Referral Data Information SURGERY Date Booked Orientation Session: within 3-weeks of Referral received at the centre, patient & referring physician receives info about the next Orientation Session Subsequent Assessments Booked 3 month Goal Y Patient Shows Package Received: Patient has 4-weeks to respond to the BCOE/RATC for their Orientation Date. 3-month Goal • Composition of Team differs between Centres. • May include: • Dietitian • Social Worker • Patient Education • Psychologist/Psychiatrist • Internist/Endocrinologist 1st Assessment is booked (if patient agreeable) Confirmation Letter: 1st Assessment Appt sent to Patient & Referring Physician Patient Shows Confirmation Letter: Orientation Date is sent to Patient & Referring Physician Patient Responds First Assessment Occurs Orientation Session Occurs

13. Wait Time Paradox

14. Toronto Collaborative Centres of Excellence Hamilton Centre of Excellence Ontario Bariatric Network Registry HSC PRATC Thunder Bay Regional Assessment & Treatment Centre Ottawa Centre of Excellence Guelph Centre of Excellence Kingston Regional Assessment & Treatment Centre Windsor Regional Assessment & Treatment Centre Sudbury Regional Assessment & Treatment Centre Funded Programs CHEO PRATC

15. Implementation

16. Implementation & AdjustmentsExamples of Innovations & Best Practices

17. Performance & Accountability Ontario Bariatric Registry

18. Bariatric Registry • Baseline→6-mos→1-yr→2-yr→3-yr→5-yr Regular Site & Provincial Report Cards

19. Lessons

20. www.ontariobariatricnetwork.ca