health connections program evaluation report...health connections evaluation report page 3333...

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Health Connections Program

Evaluation Report

Published: February 6, 2009

Evaluation-Information Support February 6, 2009

Information Support and Research

Information Support and Research #104 – 1815 Kirschner Road Kelowna, BC V1Y 4N7 Prepared by: Christine Ronning, GIS Analyst Prepared on: Draft 8 – February 6, 2009 Contact: Christine Ronning, GIS Analyst, Information Support and Research Telephone: (250) 770-3408 E-mail: [email protected] Reviewed by: James Coyle, Leader-Evaluation, Information Support and Research Telephone: (250) 870-4714 E-mail: [email protected]


Acknowledgements This evaluation has involved numerous individuals and organizations’ cooperation, participation and time. We would specifically like to thank:

• Interior Health, Health Connections Executive Sponsors o Diane Goossens – Acting Chief Human Resource Officer o Brent Hobbs – Regional Director, Patient Transportation

• Interior Health, Health Connections Health Service Area Leads o Barb Dante – Home & Community Care Director, Kootenay Boundary o Todd Mastel – Director Business Support, East Kootenay o Genevieve Nice – Manager Acute Care Services, Okanagan o Ed Rende – Manger Transition Projects, Thompson Cariboo Shuswap

• BC Transit Partners o Steve Segal – Custom Program Coordinator o Johann Van Schaik – Transit Planner

• Health Connection Service Operators o Charlene Bonderoff – Salmo Community Resources Society o Jack Keough – Yellowhead Community Services o Shelley Langford – Laker’s Go-Bus Society o Glen Leyden - DSR Holdings Ltd o Lindsay Neison – LDN Transportation o Eileen Oliver-Bauer – Lower Similkameen Community Services Society o John Peck – Farwest, Paratransit o Lynn Pelly – Princeton & District Community Services o Eileen Perkin – South Okanagan Transit Society o Carole Rausch – Kimberley Transportation Committee o Sonya Smith – Olympus Stage Lines o Judy Soroke – Castlegar and District Community Services Society o Don Stach – Grouse Mountain Transportation o Lyndon Switzer - Lyndon Enterprises Ltd o Ralph Vanderheide – Farwest Coach inc, Conventional & Custom o Wayne Wennerstrom – Mile O-Taxi and Charters

• Municipal Partners o Carollyne Evans – District of 100 Mile House o Leslie Groulx – District of Clearwater o Shannon Moskal – Kootenay East Regional Hospital District o Jim Gustafson – Regional District of Central Kootenay o Lee-Ann Crane – Kootenay East Regional Hospital District o Erin Felker – City of Kamloops o Laurie Cordell – City of Kimberley o Tom Clement – Village of Ashcroft o Janette Van Vianen – Town of Osoyoos o Patrick Robbins – Town of Princeton o Alan Chell – City of Revelstoke o John Maclean – Regional District of Kootenay Boundary o Maggie Knox – Regional District of North Okanagan o Brian Carruthers – City of Williams Lake

• Interior Health Facility Schedulers • Doctor and Specialist office staff • NRG Research Group • Gisela Bonnie – Purchasing Coordinator • May-Bo McAllister – Manager, Strategic Information

Health Connections Evaluation Report Page 1111

TABLE OF CONTENTS EXECUTIVE SUMMARY ........................................................................ 2

PROGRAM DESCRIPTION ..................................................................... 6

ELEMENTS OF THE EVALUATION........................................................... 8

EVALUATION METHODOLOGY............................................................... 9

FINDINGS ........................................................................................12

REVIEW OF FINDINGS & INTERPRETATIONS ...........................................36

CONCLUSIONS .................................................................................41

RECOMMENDATIONS .........................................................................42

APPENDIX A: LOGIC MODEL ................................................................45

APPENDIX B: DATA COLLECTION .........................................................46

APPENDIX C: DATA ANALYSIS METHODS ...............................................50

APPENDIX D: DATA DETAILS ...............................................................56

APPENDIX E: IH PARTNER FEEDBACK REPORT .......................................69

APPENDIX F: HEALTH PROFESSIONALS FEEDBACK REPORT.....................74

APPENDIX G: IH SCHEDULER FEEDBACK REPORT ...................................90

APPENDIX H: NRG HEALTH CONNECTIONS SURVEY REPORT.....................94

APPENDIX I: IHA RURAL MEDICAL ACCESS PROGRAM PROPOSAL............ 121

APPENDIX J: GLOSSARY .................................................................. 132

ADDENDUM-JANUARY 13, 2009 .......................................................... 134



Executive Summary

Health Connections Program Background Those living in rural and remote communities experience challenges in accessing transportation to non emergent health care services which are located in larger population centres. The Ministry of Health Services (MoHS) acknowledges this as an issue and provides annual funding to Health Authorities in varying amounts for improving client access to health services. Interior Health Authority (IHA) receives approximately $1 million on an annual basis which is further distributed to our four Health Services Areas (HSAs). This funding allows each HSA the opportunity to customize transportation services for rural medical clients. Please see the Glossary in Appendix J that defines terms used throughout the document. Project Objectives The document “Interior Health Rural Medical Access Program Proposal”, dated November 30 2004, describes Goal 2 below as the key program objective. Initial program evaluation discussion with the IHA Health Connections team identified 2 additional program goals (and related objectives) that are included below. Goal 1: To develop a Health Connections program within the Health Authority that meets transportation needs for rural health clients to use in accessing health services Objective: Increase awareness of the program among target population and health care providers. Goal 2: To improve access to core specialty services for individuals who live in rural communities by enhancing/(creating) transportation systems.1 Objective: To optimize (i.e. the right vehicle, right time, right route) the number of trips/routes from rural communities to Health Service Area referral centres. Goal 3: To make the best possible use of health care dollars Objective: to ensure the cost per rider is affordable, sustainable and equitable across all Health Service Areas of Interior Health. Purpose of Evaluation

• To determine whether the program goals and objectives have been achieved.

• To identify current areas of success and opportunities for improvement within the Health Connections program.

Specific aims are: • To understand if the program is servicing those that it was originally set up for

(medical riders).

• To understand how/if the program has increased access to/from the target population.

• To understand the community and medical staff level of awareness of the transportation programs in various communities across IH and identify opportunities to enhance communications about this service.

1 “Interior Health Rural Medical Access Program Proposal”, November 30 2004



Key findings

1. The Health Connections service is successfully meeting a transportation need for many people who are living in rural areas that have to travel for higher level medical services outside of their home communities. (Goal 2)

2. The original program principles developed to guide the Health Connections program development have been ‘met’ or ‘mostly met’. (All Goals)

3. 25% of all Health Connections clients report they would not have been able to get to their appointment without the service. (Goal 2)

4. Just over 80% of rural communities in Interior Health have transportation service now that the Health Connections service is available. (Goal 2)

5. The number of communities with access to transportation has increased by 127% (from 30 to 68 communities). (Goal 2)

6. About half of local government and transit operator partners (47%) indicate ‘improved access to medical appointments’ has been the most significant change noticed due to program implementation. (Goal 2)

7. Medical ridership has increased from 7,837 to 9,944 over the 2006/07 to 2007/08 time period . At the HSA level, the change varies: (Goal 1)

o East Kootenay (EK) – an increase of 212 from 2,469 to 2,681

o Kootenay Boundary (KB) – an increase of 403 from 2,448 to 2,851

o Okanagan (OK) – a decrease of 77 from 1,466 to 1,389

o Thompson Cariboo Shuswap (TCS) – an increase of 1,569 from 1,454 to 3,023

*It should be noted that TCS routes did not start running until halfway through the 2006/07 fiscal year, resulting in lower medical rides tracked during this year.

8. The proportion of medical rides on Health Connections routes has also increased with 21.7% in 2006/07 and 23.6% in 2007/08. At the HSA level, the change varies: (Goal 1)

o East Kootenay – an increase of 2.1% from 36.5% to 38.6%

o Kootenay Boundary – an increase of 0.5% from 11.7% to 12.2%

o Okanagan – an increase of 2.6% from 25.9% to 28.4%

o Thompson Cariboo Shuswap – an decrease of 8.3% from 52.4% to 44.1%

*It should be noted that TCS routes did not start running until halfway through the 2006/07 fiscal year.

9. Occupancy rates on bus routes are running at about 28% overall; approximately 6% of the overall occupancy is represented by medical rides.2 This suggests that there is an opportunity to increase the number of riders on Health Connections routes, especially those riding to medical appointments. At the HSA level occupancy rates vary: (Goal 1)

o East Kootenay – 30% overall, 12% medical

o Kootenay Boundary – 23% overall, 2% medical

o Okanagan – 28% overall, 5% medical

o Thompson Cariboo Shuswap – 25% overall, 11% medical

2 With exception of the Castlegar to Trail route (35 passengers), all routes are run with 20 passenger buses

Occupancy is only calculated for those routes with set schedules



10. Awareness of the Health Connections brand name and program description are low among Health Connections clients, physician office staff and specialist IH schedulers. (Goal 1)

11. Of surveyed health professionals that were not originally aware of the Health Connections service, 62% are now very likely or somewhat likely to refer patients to use the service now that they are aware. (Goal 1)

12. Almost all health professionals surveyed would be interested in receiving Health Connections information if a marketing campaign were to occur in the near future. (Goal 1)

13. Client satisfaction for those using the Health Connections service is very high; nine in every ten clients feels the overall service provided by Health Connections is ‘excellent’ or ‘good’ and most would be tolerant of a $1 to $2 fare increase for a round trip. Taken together with the limited financial risk of these partnerships and the support from municipal partnerships, the overall sustainability for Health Connections does not appear to be at risk. (Goal 3)



Recommendations

1. Continue to monitor, manage and improve the Health Connections transportation program through utilization of more accurate community and route specific data (see Appendix D).

2. Improve communication between BC Transit, Municipal Partners and Interior Health

by implementing formal communication policies regarding changes to routes or route costing.

3. Promote the Health Connections name and service through consistent advertising in

partnership with BC Transit and a focus on hard copy pamphlets or brochures that details the Health Connection service schedules.

4. Improve Kootenay Boundary ridership data collection and reporting processes.

Completed by BC Transit and Interior Health Kootenay Boundary lead. 5. Review of transport schedules including times and days of travel to ensure routes

are running during times of greatest transportation need and can connect seamlessly to other transportation services. To be completed by Interior Health HSA leads and BC Transit.

6. Explore the creation of routes across Health Services Area boundaries that follow

desired clinical referral patterns and allow Health Connections clients transportation access to specialized medical services that are not available in their HSA.

7. Conduct a more detailed review of Health Connections Transportation Model costs

and services to consider how issues of sustainability and the relative services align with existing and planned patient transportation services currently provided by Interior Health. To be completed collaboratively by HSA leads, Interior Health Business Support and BC Transit.

8. Identify and develop a minimum number of key performance indicators and prepare

regular reports that include analysis and next steps based upon these indicators. Frequency of these reports will need to be determined by the parties involved; quarterly or semi-annually is recommended. To be completed collaboratively by IHA Health Connections team, BC Transit and the Patient Transportation Office.

9. Review the communities currently without Health Connections service listed in

Appendix D while considering the cost and need to provide transportation access for these communities. To be completed by the IHA, Health Connections team.

*The rationale for each recommendation can be found on pages 43-45.



Program Description

Overview People living in rural and remote communities experience challenges in accessing transportation to non emergent health care services which are available in larger population centres. The Ministry of Health Services (MoHS) acknowledges this as a significant issue across BC. As a result, the MOHS, provides annual funding to Health Authorities in varying amounts for improving client access to health services. Interior Health Authority receives $1 million on an annual basis which is further distributed to our four Health Services Areas (HSAs), allowing each area to customize transportation services for rural medical clients. Operations began at Interior Health between 2005 and 2006 titled as Health Connections, and have been implemented through the development of partnerships with BC Transit, community organizations and local and regional government groups. The four HSAs, East Kootenay (EK), Kootenay Boundary (KB), Okanagan (OK) and Thompson Cariboo Shuswap (TCS) have structured delivery of the Health Connections program slightly differently. Below is a table describing the different characteristics of each HSA. Table 1: Health Service Area Characteristics

HSA Geographic Area (Square

Km)

Population (2009)*

Rural Com.

(#)

Density (persons per sq km)

Pre-existing Transportation

East Kootenay

45,085.2 78,780 12 1.7 Only one route between communities pre-existed Health Connections

Kootenay Boundary

28,802.8 79,849 20 2.7 A number of routes pre-existing between communities in this HSA

Okanagan 21,298.6 355,469 5 16.1

Well established transportation already in place, although in danger of funding removal

Thompson Cariboo Shuswap

120,160.0 223,810 15 1.8 Only one route between communities pre-existed Health Connections

*Source: PEOPLE33, BC Stats Ministry of Labour and Citizens’ Services

Due to various existing transit routes, geography and population distribution, programs were custom tailored to each HSA. Some changes have included efforts to increase the frequency of runs on existing public transit routes as well as the addition of individual client pick-up and drop off at specified locations. Table 2 describes the different program structures between HSAs.



Table 2: Health Connections program structure by HSA

HSA # of routes

# of cost sharing routes

Rider Fare (One-way)

Budget Service Type

East Kootenay 4 2 $2.50 $285,714 Custom paratransit

Kootenay Boundary

9 9 $1.50-$3.00 $285,714

A combination of conventional transit, HandyDART and volunteer driver program services

Okanagan 4 3 $2.50-$10.00 $122,858

A combination of HandyDART and volunteer driver program services


11 2 $5.00 $305,714 Custom paratransit

Note: TCS budget was originally $285,714 and OK $142,858, however $20,000 from the Okanagan budget is transferred to TCS each year

Interior Health looked at a number of transportation models and providers during the program development phase. The work done during this phase of the project resulted in the current program structure. Interventions of Interest for Evaluation Funding from the Health Connections program is provided to increase access to transportation for rural medical clients. By assessing the number of new or additional routes we will be able to measure the increase in access for these clients. The implementation of the Health Connections program resulted in those scheduling medical appointments, becoming aware of route days and times to schedule visits accordingly. We will evaluate how this process currently works. Health Connections Program Goals and Objectives Goal 1: To develop a Health Connections program within the Health Authority that meets transportation needs for rural health clients to use in accessing health services Objective: Increase awareness of the program among target population and health care providers. Goal 2: To improve access to core specialty services for individuals who live in rural communities by enhancing/(creating) transportation systems.3 Objective: To optimize (i.e. the right vehicle, right time, right route) the number of trips/routes from rural communities to Health Service Area referral centres. Goal 3: To make the best possible use of health care dollars Objective: to ensure the cost per rider is affordable, sustainable and equitable across all Health Service Areas of Interior Health.




Elements of the Evaluation

Program Principles The rural transportation concept was developed in 2004 by a representative from each BC Health Authority and the Ministry of Health Services. During this process a number of Provincial Principles were developed to guide the program development and implementation in each Health Authority. These principles also guided the creation of the evaluation framework. Discussion and review of the program’s application of these principles are presented in Section E. Evaluation Type This evaluation has formative (process) and summative (outcome) elements and therefore will assess both the processes in place meant to accomplish program goals & objectives and whether they have been met by the program currently in place. Evaluation Scope In Scope: This evaluation will assess the outcomes and impacts related to the changes in transportation services as a result of Health Connections funding up until the evaluation start date of February 2008. Out of Scope: This evaluation will not assess activities and associated outcomes that were previously in place before Health Connections funding was introduced or that are added during the evaluation process; This report will not examine elements of the transit system that are the obvious domain of BC Transit and other governing bodies and not Interior Health (such as elements of the competitive marketplace for transit bodies). Health Connections Target Population Interior Health residents living in rural Local Health Areas as defined by the ‘Interior Health Rural Medical Access Program Proposal’. More specifically all clients living in Local Health Areas other than: Penticton, Summerland, Central Okanagan (Kelowna), Vernon, Enderby, Armstrong-Spallumcheen, Salmon Arm and Kamloops. The target population is further defined as those with limited transportation options in accessing medical services outside their communities due to either financial or health related constraints. In addition the described clients must be using transportation to access health care services that do not require transport by ambulance. More specifically, provincial program principles for the Health Connections program state: “Focus on communities identified by health authorities with the greatest need for access to medical specialty services, consistent with the ‘Standards of Accessibility and Guidelines for Provision of Sustainable Acute Care Services by Health Authorities’” 4 Evaluation Target Audience This evaluation is being completed as part of the original program proposal and agreement with the Ministry of Health Services. As a result, Ministry of Health Services officials will be part of the evaluation target audience. In completing this evaluation our focus will be on the Interior Health Senior Executive Team (SET) and Health Connections Committee audience as they will use the evaluation to help adjust and improve the Health Connections program. Health Connections partners such as BC Transit, volunteer groups and local and regional government groups may also receive a copy of the evaluation report or summary.




Evaluation Methodology

Evaluation Team This evaluation was led by Interior Health employees, James Coyle (Leader, Evaluation) and Christine Ronning (GIS Analyst). The evaluation also directly involved the IHA Health Connections team consisting of Diane Goossens (Past Project Sponsor), Barb Dante (Health Connections Chair and KB HSA lead), Todd Mastel (EK HSA lead), Genevieve Nice (OK HSA lead) and Ed Rende (TCS HSA lead) provided guidance and input throughout the evaluation process. Brent Hobbs (Current Project Sponsor) has recently joined the team and provided guidance and input. The NRG Research team was hired in a consulting role to administer the Client Satisfaction Survey and Health Professional Survey. BC Transit’s Steve Segal provided significant input and clarification regarding data sourced from BC Transit and knowledge on the Health Connections program development. Types of Data Collected

• Ridership data (total and medical) • Budget reports • Route specifics such as time and locations of pick-up and drop-offs; type of services

offered (i.e. HandyDART); distances traveled; funding partnerships; operating partnerships

• Rider and program satisfaction from clients using the service; funding partners; operational partners and health professionals

How Data Was Collected It should be noted that a variety of years of data (2004, 2006, 2006/07, 2007/08) are presented throughout the report. This allows indicators to show past and present service accessibility, recent trends and current program performance. Ridership data (total and medical) – are collected by individual operators and sent to Interior Health HSA leads. All data sources provide route locations (to and from), number of trips and time period information. The majority of Health Connections funded routes are operated by BC Transit, however some community volunteer driver programs also operate transport services. Both have been further depicted below. Budget reports including budgeted and actual expenditures were compiled by individual HSA business consultants and forwarded through the HSA leads to evaluators. Financial data is broken down by cost center; each associated with individual operators. Actual expenditure values are also broken down by operator. This data is pulled from the Interior Health Matman Meditech Module. Route Specifics include things such as route times, drop off and pick up locations, transport service type and rider fare. These details are provided by the HSA leads and BC Transit. Kilometers driven are calculated using Routeview Pro software. Route distances are calculated as based on the distance between locations and does not account for additional driving done in and around destination or departure places. Rider and program satisfaction data was collected through surveys that were developed and completed as part of the evaluation. A number of different groups were identified to obtain feedback from: Health Connections Clients; Program Partners and Health Professionals. *Please note, more details on data collection are found in Appendix B.



Data Limitations Program Wide

• In most cases, medical rides are tracked when clients call in to schedule their trip. However sometimes riders will show up at scheduled stops and board without pre-booking. In this situation, medical rides may not be tracked and are impossible to factor into this report.

• Medical riders are classified differently by various operators across Interior Health. BC Transit does not have a specific definition for what a medical rider should be; therefore any rider traveling for an appointment related to health care (i.e. doctor, dentist, physiotherapist etc.) will be included. Lower Similkameen Community Services Society defines a medical rider as those traveling for specialist appointments.

• There may be other transportation systems in place in communities that have not been accounted for in this evaluation report. For example there is taxi voucher program in place in Oliver where mothers with babies or small children are eligible to apply for vouchers that will allow them to transport themselves and their children as far as Kelowna for medical appointments.

• Data does not break out individual/unique riders in most cases. Therefore the numbers we use in this report refer to trips. One rider may use a service multiple times resulting in multiple trips counted.

• % Occupancy can only be calculated for those routes that have pre-determined schedules (I.e. a set number of trips per week with a defined number of seats/rides available). Therefore occupancy is not calculated for Volunteer Driver Programs or HandyDART bus services.

• The number of Health Connections clients who completed the survey was low. Therefore results at the Health Service Area level may be unreliable and should be interpreted with caution.

• Surveying the ‘potential client group’ may have provided valuable information regarding how to adjust and improve services and marketing strategies to increase medical ridership. However, the logistics of surveying this group are difficult and resource intensive; therefore they fell outside of the scope of this evaluation.

Kootenay Boundary Health Service Area

• Most routes here do not require a trip to be booked; therefore there is no opportunity to track medical trips. A one-day survey was done to get a sense of medical ridership in Kootenay Boundary in April 2008. This survey reported that 10% of rides are associated with medical trips. Of interest, during an additional data collection process we were able to calculate a second medical ridership estimate for Kootenay Boundary and found this value to be similar at just under 10%.

o The number of medical rides in Kootenay Boundary is estimated using the 10% proxy determined in the one-day survey.

• There is no ridership data for Kootenay Boundary in 2006/07, with exception of the Kootenay Lake West route.

• There is no data tracked for the Nakusp/New Denver to Nelson route. Okanagan Health Service Area

• 2007/08 fiscal year ridership data for Vernon is incomplete. HandyDART trips within Enderby and Lumby have not been provided by BC Transit for January-March 2008.

• No medical rides are tracked for Osoyoos data in 2006/07. • Changes in the Okanagan Health Service Area leadership over time for this program

have led to some continuity challenges regarding the OK HSA routes and rationale.



Thompson Cariboo Shuswap Health Service Area • There is no medical ridership data for routes operated by FarWest Coach Lines in TCS

for September and October 2006. • There is no data for Lillooet, Lytton or Revelstoke routes for March 2007. • There is no data for Clearwater March 2008. • The TCS program did not start until September 2006 and therefore only partial year data

for 2006/07 exists. • Budget data for 100 Mile House in 2007/08 was not invoiced and/or tracked accurately.

Data has been adjusted for these errors and reflects planned rather than expenditure values.


Findings

The evaluation questions were informed by the development of a Health Connections Program logic model (See Appendix A). Logic Models are used to identify the goals and objectives of a program while outlining the necessary activities and processes that are needed in order to reach them; in this way it can be used as part of the planning process for new and existing programs. The development of a logic model also allowed the Evaluators to better understand how a program is intended to work, and so is also helpful in creating a comprehensive, relevant and useful evaluation framework. The program principles mentioned in the section below influenced both the creation of the logic model and evaluation elements. Program Principles Tables 1 and 2 describe the program principles as defined by the Province and Interior Health in the document “Interior Health Rural Medical Access Program Proposal”, November 30 2004. The following scale was used to assess if the respective principle has been achieved: • Yes – principle is fully met; Mostly – principle is mostly met; Un-measurable – No way to

measure; No – principle not met; NA – Not applicable. Table 3: Provincial Principles No. Program Principle Principle

Achieved? Explanation

1 Address transportation needs of residents living in rural communities within the Health Authorities and seeking medically insured health services outside their communities from recognized medical specialties. Eligible patients will require a referral by their physician for these health services. This new program is not connected to the Travel Assistance Program (TAP).

Mostly No Health Connections clients are required to obtain physician referrals to use the service. Those traveling for non-medical services are also allowed to use the service if medical clients have not booked spots.

2 Focus on communities identified by health authorities with the greatest need for access to medical specialty services, consistent with the "Standards of Accessibility and Guidelines for Provision of Sustainable Acute Care Services by Health Authorities" published by the British Columbia Ministries of Health Services and Health Planning in February 2002 (revised 2004). The specific target population for the proposed "Rural Medical Access Program" should reference standard 4.3 dealing with "Specialty Services":

“Access to core specially services will be available within four hours travel time for 98% of residents within the region and 95% of the population of each HSDA. Core specialty services include general surgery, anesthesia, psychiatry, internal medicine, obstetrics and gynecology, and

Yes All routes are set up as same day return trips, therefore ensuring that travel is within the stated 4 hour one-way travel time.



pediatrics. Depending on the catchment population and location, specialty services outside major referral centres may include other specialties such as orthopedics, urology, ophthalmology and otolaryngology."

3 Support rural residents who are not well serviced by the current provincial Travel Assistance Program (TAP), and for whom travel and the associated expense represents the greatest financial burden.

Un-measurable

Difficult to assess due to lack of data on those receiving assistance from TAP and Health Connections client profiles.

4 Reflect local community capacity and respect historical informal arrangements and community networks wherever possible.

Yes Achieved through partnering with existing transport providers in each local community.

5 Be available to individuals with a valid BC health insurance card, who are residents of one of the four involved health authorities, traveling to seek medical specialty services in BC The program does not cover out of province travel.

Mostly As mentioned above, anyone can use this service. No Health Connections routes exist to out of Province or out of IHA locations.

6 Be open to all eligible individuals, independent of income, age or medical condition (the need must not be emergency – related). The program will include some mileage restriction (specified by each health authority). Participants will be obligated to pay a "user fee," as the program will not provide a complete subsidy.

Mostly The program has successfully made itself open to all individuals, although not all services can accommodate clients with complex medical conditions. User fees have been implemented for all routes and go directly to operating partners.

7 The program will not provide reimbursement to individual residents. By avoiding an approach that provides direct financial assistance to individuals, there is a potential to mitigate the risk that excessive client demand will drive costs beyond allocated funding.

Yes Condition met under current program.

8 The program will be a "funder of last resort". That is, individuals receiving full travel assistance from other Provincial Government funded programs, e.g. social assistance, workers' compensation, or third party insurance etc., will be ineligible. Individuals who would normally receive full travel assistance from a third-party program, but where the program's expenditures have been exhausted, are eligible for this new rural medical access program.

Un-measurable

Difficult to measure given lack of data on individual Health Connections clients. Not applicable anyways as any individual booking a ride can use the service.

9 Subsidization of BC Ambulance Services (BCAS) ground or air ambulance trips will not be provided.

Yes Condition met under current program.

10 Authorities will promote increased local and regional infrastructure and medical services capacity wherever possible. The intent of the program will be to avoid exporting patients outside each of the involved regions, and potentially

Mostly There is service offered from the communities of Merritt and Revelstoke to Kelowna, which is a violation of the original Program Principles as Merritt and Revelstoke are found in the Thompson Cariboo Shuswap HSA,



repatriate patients. while Kelowna is in the Okanagan. According to program principles, transportation is meant to provide access to medical services within the same HSA as where rural clients live.

11 Potentially include at a later date "provincial or preferred rates" for third party transportation (bus lines, scheduled airlines and other air carriers, and ferries) and accommodation. Health authorities will need to work together to negotiate consistent and equitable arrangements.

NA This is not currently part of the program.

Health authorities may examine, tender and attempt to contract for hotel/hostel arrangements where the hosts coordinate local travel, and provide meals and support.

NA This is not currently part of the program.

Contain a cost containment strategy and a strong evaluative component, in part to ensure continuous quality improvement, as well as to attempt to forecast future demands and service requirements. The program will also be designed to minimize misuse and fraud.

Yes Evaluation currently underway.

Adhere to the principle of fair and open competition and tendering practices.

Yes Contacted local transportation companies during program development and opening posted contract positions.

May provide accommodation subsidy, however this is not obligatory.

NA Not currently part of the program.

Table 4: Interior Health Principles No. Program Principle Principle

Achieved? Explanation

1 As transportation is not within the mandate of the Health Authorities, Interior Health will provide subsidy grants through contractual arrangements to third party providers who will be responsible for the transportation arrangements.

Yes This is how the program is currently set up.

2 The focus will be on providing transportation that supports the 2002 Acute Care Centres Role Review redesign (“Hospitals Within a Hospital System”). Revised 2004.

Yes Transportation is set up to flow from rural to urban areas where higher level medical services are found.

3 The program will support patient non-emergent transportation from rural areas to tertiary and service area hospitals that provide specialist services.

Yes Transportation is set up to flow from rural to urban areas where higher level medical services are found.

4 Where possible, Interior Health will schedule specialist services to align with patients’ use of the rural transportation program.

Yes IH schedulers are aware of the program and book appointments to coordinate with clients Health Connections ride times.

5 Financial assistance for patient accommodation will not be provided, however Interior Health will provide lists of available accommodation with preferred providers.

Yes A list of accommodation options is currently found on the Health Connections page of the Interior Health website.



6 Where applicable, Interior Health will provide subsidy to third party providers through appropriate business practices and contracts.

Yes Currently done within the program.

7 Interior Health will require the third party providers submit semi-annual reports including performance indicators (for example statistical indicators and financial information).

Yes Although initially some reporting issues occurred, current data is forwarded to Interior Health in a timely and consistent manner.

8 Interior Health will utilize an internally agreed upon financial formula to determine allocation need for rural Local Health Areas.

Yes A population based formula determined how the original $1 million budget was split between the 4 HSAs. Each HSA’s annual budget has remained the same since the initial program start up.

Health Connections Transportation Service Types The majority of Health Connections routes are serviced by the Community Bus. These buses carry up to 20 passengers and can accommodate wheel chairs and scooters. The Trail to Castlegar route is serviced by a conventional transit bus with seating for up to 35 passengers and can also accommodate wheelchairs. Volunteer Driver Programs use personal vehicles to transport patients and vary in the ability to accommodate wheelchairs.

Community Bus Conventional Bus



Program Indicators The indicators in this evaluation are defined and grouped by type. Descriptive Indicators Descriptive Indicators are used to help understand the Health Connections region both as a whole and as four different Health Service Areas. These indicators may allow the audience to better interpret the process and outcome indicator results presented. Program Performance / Process Indicators Program Performance (Process) Indicators are related to how the program operates; these will provide information to assess if the program is reaching its’ intended goals. This information is also intended to be used to improve program performance. Outcome Indicators Outcome Indicators determine how well the intended goals and objectives of the program were achieved. The information provided here assesses how effective the program is and what impacts it has made. For further details on how indicator data was collected see Appendix B; for indicator data analysis see Appendix C; for further data details see Appendix D.

Text and charts for indicators 1-4, 8, 17-18, 21-22 are pulled directly from the NRG Research Group Report Health Connection Survey Report, October 24, 2008. (This work by NRG Research was led directly by, and under the supervision of, the Health Connections Program Evaluators.) See Appendix H. Text and charts for indicators 19-20, 25-27 are sourced from the NRG Research Group Report Health Professionals Survey Report. November 25, 2008 and the Information Support & Research Report IH Scheduler Feedback Report. November 25, 2008. See Appendices F and G. Text and charts for indicators 22 and 24 are sourced from the IHA Information Support & Research Report IH Partner Feedback Report, November 8, 2008. See Appendix E.

Descriptive Indicators Health Connections clients are primarily older women; 77% are women and 77% are 55 or older including 29% who are 75 or older. The average age of a Health Connections client is 65. Despite their age, the vast majority of Health Connections clients are able to walk independently and almost one-half own a vehicle. 1. Frequency of Use One third of clients have used Health Connections just once or twice in the past six months, while the same proportion has used it three to six times and seven or more times (see figure 1). On average, Health Connections clients have used the service nine times in the last six months. KB clients are much heavier users, averaging 20 times in the last six months while TCS clients are the least frequent users, averaging five times in the last six months.



Figure 1 - Number of times using the service within the last 6 months

32%

16%

17%

12%

10%

9%

5%

1 - 2 times

3 - 4 times

5 - 6 times

7 - 12 times

13 - 24 times

25+ times

Not sureMean = 8.7*

Min = 1

Note: *2 responses (144 and 100 times) are excluded from the mean calculation, n = 145 Source: Health Connection Survey Report, NRG Research Group: October 24, 2008

2. Health Connections Transportation Alternatives For one quarter of clients, if Health Connections was not available, they claim they would not have been able to get to their appointments as they have no other means. Even among those who have vehicles, 21% claim they would not have been able to get to their appointments. Some reasons for this include not wanting to drive distances or not being capable of driving after their appointment.

Figure 2 - Alternative means for getting to health care facilities

25%

19%

15%

15%

15%

2%

2%

3%

3%

Would not have happened/have no other means

Friend

Family member (spouse, daughter/son, sibling, etc)

Drive myself

Public transport

Taxi

Hitchhiked

Other

Not sure

n = 145 Source: Health Connection Survey Report, NRG Research Group: October 24, 2008

3. Reason for Using the Service Clients in KB and OK are more likely to cite a lack of alternatives (i.e. no car, no other drivers) while those in TCS are more likely to cite not being able to afford to drive as a reason. Clients in both TCS and EK are more likely to claim they don’t drive long distances and they feel Health Connections is reasonably priced (see figure 3).



Figure 3 - Reasons for using Health Connections service*

44%

37%

25%

18%

17%

10%

10%

9%

5%

3%

2%

5%

No one to drive me/no friends/relatives here

Don't have a car

Can't afford to drive

Don't drive long distances

Convenient

Don't like to drive

Resonable price

Like to use public transportation

Can't drive after the appointment

Like the people who use the service

Ride share good for environment

Other

Note: *allows multiple responses, n = 145 Source: Health Connection Survey Report, NRG Research Group: October 24, 2008

4. Health Connections Distance from Pick-up Locations For three in ten clients, they are picked up right outside their home, especially those in OK (79%). However, at the other end of the spectrum, four in ten have to walk more than six blocks to get to their pick-up location. This is the case primarily in TCS (67%). Figure 4 - Travel distance to the Heath Connections pick-up location

30%

5%

11%

13%

41%

Picked up outside my home/building

Less than one street block from home (< 2

minute)

Between 1-2 blocks

Between 3-6 blocks

More than 6 blocks from home

N = 145 Source: Health Connection Survey Report, NRG Research Group: October 24, 2008



5. Distance Traveled (Km) Figure 5 – Estimated Kilometers Traveled on Health Connections Routes (2007/08)

0

50,000

100,000

150,000

200,000

250,000

EK KB* OK* TCS

Health Service Area

Dis

tan

ce (

km

)

HSA IHA

* Indicates underestimated kilometer values due to missing data Notes: Kilometers calculated using Routeview Pro software to determine distance between to and from locations Source: All_IHA Systems for IHA_Q4, BC Transit, 2007/08; Digital Road Atlas, Routeview Pro

Thompson Cariboo Shuswap is geographically the largest of the 4 Health Services Areas and reports the highest number of estimated kilometers traveled during the 2007/08 year. Differences in kilometers traveled values are influenced by both geography (route distance) and frequency (the amount of times a trip is run per week). It is important to note that kilometers shown are based on pre determined routes and trips per week, not actual kilometers traveled on Health Connections routes. Traveled kilometers for the volunteer driver program in the Okanagan, and both HandyDART and volunteer driver programs in Kootenay Boundary, are not included above.

6. Cost per Kilometer Figure 6 - Health Connections Cost per Kilometer by Health Service Area

$0.0

$0.5

$1.0

$1.5

$2.0

$2.5

EK KB* OK* TCS

Health Service Area

Co

st

($)

HSA IHA Average

* Indicates underestimated kilometer values due to missing data Source: All_IHA Systems for IHA_Q4, BC Transit, 2007/08, Digital Road Atlas, Meditech MatMan



East Kootenay reports the highest IH cost per kilometer of the 4 Health Service Areas, followed by Thompson Cariboo Shuswap, Kootenay Boundary and Okanagan. Cost per kilometer values will be influenced by start up costs and bus leasing costs. The EK and KB programs pay for bus leasing as part of the contract, while TCS and OK do not. Most routes in EK and TCS were new routes implemented as part of the Health Connections program while KB and OK routes were mostly enhancement of existing services. As mentioned above, kilometers traveled are not calculated for all Health Connections services. Therefore budget expenditures associated with kilometer attributed routes only are included in HSA total expenditure Figures. 7. Cost per Ride (Health Connections) Figure 7 - Health Connections Cost per medical ride for Health Connections Routes by HSA (2007/08)

$0

$20

$40

$60

$80

$100

$120

EK KB OK TCS

Health Service Area

Co

st

($)

Medical Rides IHA Medical Rides

Source: All_IHA Systems for IHA_Q4, BC Transit, 2007/08; LSCSS, 2007/08; CDCSS, 2007/08; SCRS, 2007/08; Meditech MatMan, 2007/08

Cost per ride is calculated by dividing the total Health Connections expenditure by the number of rides. Figure 7 shows the cost per medical ride in each HSA (based upon IH funding contributions), however if non-medical rides were included, the cost per ride value would be considerably lower. We have chosen to include only medical rides, as this gives an indication of the cost that is paid for access to transportation for rural medical clients. In the 2007/08 fiscal year, East Kootenay and Thompson Cariboo Shuswap reported the highest cost per medical ride, followed by Kootenay Boundary and finally Okanagan. As the number of medical rides increases the cost per ride decreases, therefore EK has the least number of medical rides per spent dollar values, while Ok has the most across the HSAs. As with the cost per kilometer, cost per ride values are influenced by start up and bus leasing costs.



8. Awareness of Program - Clients Figure 8 - Source of awareness of Health Connections service

34%

14%

10%

8%

6%

5%

3%

10%

10%

Friend/Relative/Word of

mouth

Newspaper/newspaper ad

Medical

assistant/receptionist/other

Brochure/Poster

Saw the bus

Doctor

Hospital

Other

Don't recall


One-third of clients first found out about using Health Connections transportation for medical appointments through word of mouth from a friend or relative. The second most common source is newspapers (14%) followed by medical assistants or someone in the doctor’s office (10%). Only five percent of clients first found out about Health Connections from a doctor. Awareness from the doctor or the doctor’s office is fairly consistent across the regions.



Program Performance (Process) Indicators

9. Rural Communities Served

Figure 9 - Proportion of Rural Communities Serviced after Implementation of Health Connections (2007/2008)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

EK KB OK TCS

Health Service Areas

Pro

port

ion (%

)

HSA IHA Average

Note: Rural communities defined by location within a rural Local Health Area as defined in “Interior Health Rural Medical Access Program Proposal”, Nov 30 2004. Rural communities, further filtered by population size (n=> 500) as defined by PEOLE33, BC Stats, Ministry of Labor and Citizens’ Services It should be noted that buses will stop and pick up passengers at any community along the route. For data consistency and comparability throughout the report a community definition was developed and applied to data used in indicators. The majority of rural communities included above are serviced with the implementation of Health Connections. All rural communities are serviced in the OK Health Service Areas, while KB services only 70%. EK services the second highest proportion of rural communities (90%), and TCS the third by servicing just under 90% of rural communities in the HSA. The Boundary area of Kootenay Boundary is not serviced by Health Connections resulting in the lower proportion of rural communities serviced in this Health Service Area. A 2001 BC Transit feasibility study indicated strong support for implementing a tri-city transportation service linking the Trail-Nelson-Castlegar area. This became the Kootenay Boundary HSA priority for Health Connections. 10. Rides per 1,000 Rural Population

Figure 10: Rides per 1,000 population living in rural Local Health Areas, 2007/08

0

50

100

150

200

250

300

350

EK KB OK TCS

Health Service Area

Rid

es p

er 1,0

00 P

op.

Medical Non-Medical

Source: All_IHA Systems for IHA_Q4, BC Transit, 2007/08, PEOPLE 33 by BC Stats Ministry of Labour and Citizens’ Services



KB has the highest rate of rides per 1,000 rural population, followed by OK, EK and finally TCS. OK has the highest rate of medical rides, while EK has the lowest, although rates are similar across the health authority. This indicator shows that rural medical populations are serviced equally across the health authority. It should be noted that KB medical ridership numbers are based on a calculation of 10% of non-medical riders, with exception of Volunteer Driving Programs, as actual medical ridership data is not available. 11. Community Access to Health Connections Transportation Figure 11 - Access to Transportation Service Before (2004) & After (2006) Health Connections

0

5

10

15

20

25

30

35

EK KB OK TCS

Health Service Area

Co

mm

un

itie

s (

#)

2004 2006

2004 IHA 2006 IHA

Source: 2004 values based on information from BC Transit and verified by HSA leads; 2006 values from All_IHA Systems for IHA_Q4, BC Transit, 2007/08 Figure 11 shows that all HSAs, with exception of KB, have increased the number of communities with access to transportation for health care services through the Health Connections program. The TCS has increased access to the largest number of communities at 28. In KB and OK, the number of communities with access may not have increased significantly, however, a number of these communities now have enhanced access due to the Health Connections program (see figure 12). It should be noted that the Okanagan HSA has a large number of communities located in urban LHAs where access to transportation was not targeted. In addition, communities in rural LHAs are located closer to urban centres and transportation systems were established before Health Connections was implemented. One of these transportation routes was in danger of being removed due to financial strain felt by the funding partners. The Health Connections funding in OHSA, ensured this route continued operation; similar situations also surfaced upon review of the routes in KB.



12. Community Health Connections Transportation Service Status Figure 12 - Community Access to Current Health Connection Services (2007/08)

0

5

10

15

20

25

30

35

EK KB OK TCS

Health Service Area

Co

mm

un

itie

s (

#)

New Enhanced Pre-existing

Source: All_IHA Systems for IHA_Q4, BC Transit, 2007/08, service type provided by HSA leads

The majority of serviced communities in the Thompson Cariboo Shuswap and East Kootenay Health Service Areas are serviced by new routes. All communities in Kootenay Boundary were already serviced, although 66% of the communities now have enhanced service. Enhanced service can indicate either an increase in transportation frequency (the service between Trail and Castlegar ran once a day, 5 days a week and now runs 3 times a day, 5 days a week), the addition of another route (Castlegar was serviced by the Trail to Castlegar route, now a route also runs between Castlegar and Nelson) or the addition of another type of service (Enderby had HandyDART service from Enderby to Vernon, now there are HandyDART hours for within community transportation). 13. Number of Communities Served Per Week Figure 13 – Number of Communities Served per week Before (2004) & After (2006) Health Connections

0

10

20

30

40

50

60

70

80

90

EK KB OK TCS

Health Service Area

Com

munitie

s/w

eek (#)

2004 2006

HSA 2004 Average HSA 2006 Average

Source: 2004 values based on information from BC Transit and verified by HSA leads; 2006 values from All_IHA Systems for IHA_Q4, BC Transit, 2007/08



All HSAs increased access to transportation in rural communities with the implementation of the Health Connections Program. Figure 13 shows that KB has the greatest increase in number of communities serviced per week from 29 before Health Connections was implemented to 72 afterwards or an increase of approximately 148%. The largest rate of increase in community’s services per week is found in the East Kootenays with an increase of 2,300%. A map of Health Connections routes showing route frequency per week is found in Appendix D, Figure 3. 14. Change in Proportion of Medical Rides Figure 14 - Proportion of Medical Rides for Health Connections Routes by HSA (2006/07 - 2007/08)

0%

10%

20%

30%

40%

50%

60%

EK KB OK TCS*

Health Service Area

Med

ical R

iders

hip

(%

)

2006/07 2007/08

IHA 2006/07 IHA 2007/08

* TCS only has partial year data for 2006/07 year Source: All_IHA Systems for IHA_Q4, BC Transit, 2007/08; IHA_Ridership_0906_0307_Ver Final, BC Transit, 2006/07; LSCSS, 2006/07-2007/08; CDCSS, 2006/07-2007/08; SCRS, 2006/07-2007/08

The proportion of medical rides has slightly increased from 2006/07 to 2007/08 in all HSAs except for the TCS. As TCS routes were not fully operational until September 2006, 6 months into the 2006/07 fiscal year, only data from September 06 – March 07 is available. Therefore the high proportion of medical ridership in 2006/07 may reflect seasonal differences of medical service need rather than a higher proportion of medical rides in the 2006/07 year. It should be noted that Kootenay Boundary medical rides on all BC Transits routes are estimated. No medical ridership is tracked in KB therefore a value of 10% has been applied to the total number of rides to calculate medical rides. This value is based on a one-day survey done by BC Transit in April of 2008. 2006/07 ridership data is not available in Kootenay Boundary with exception of the Kootenay Lake West route. Therefore values have been estimated using the rate of change between 2006/07 and 2007/08 for the Kootenay Lake West route. A map of Health Connections routes showing proportion of medical rides is found in Appendix D, Figure 2.



15. Change in Total Medical Rides Figure 15 - Change in Medical Rides by HSA (2006/07-2007/08)

0

500

1,000

1,500

2,000

2,500

3,000

3,500

EK KB OK TCS*Health Service Areas

Tri

ps (

#)

2006/07 2007/08IHA 06/07 Average IHA 07/08 Average

* Increase in TCS is influenced by partial year data for 2006/07 year Source: All_IHA Systems for IHA_Q4, BC Transit, 2007/08; IHA_Ridership_0906_0307_Ver Final, BC Transit, 2006/07; LSCSS, 2006/07-2007/08; CDCSS, 2006/07-2007/08; SCRS, 2006/07-2007/08

The number of medical rides increased in all Health Service Areas, with exception of the Okanagan. It is interesting to note that the proportion of medical rides has decreased from 2006/07 to 2007/08 in the TCS, yet the absolute number of medical rides has increased. This indicates that ridership has increased overall, but non medical rides have increased at a greater rate than medical rides. TCS has the largest number of medical rides in 2007/08 and also has the largest increase in medical rides of the 4 HSAs. The large increase is partly due to the TCS program starting 4 months into the 2006/07 fiscal year. A map of Health Connections routes showing proportion of medical rides is found in Appendix D, Figure 1.

16. Route Occupancy Figure 16 - % Occupancy of Health Connections Routes by HSA (2007/08)

0%

20%

40%

60%

80%

100%

EK KB OK TCS

Health Service Area

Occupancy (%

)

Medical Non-Medical IHA Averagel

Note: Occupancy based on total number of rides available, see Appendix C for details Source: All_IHA Systems for IHA_Q4, BC Transit, 2007/08



Occupancy rates are used to describe the proportion of use in direct comparison with the proportion of capacity across each of the route’s buses/vehicles. Figure 16 shows that EK routes are operating at the highest % occupancy, although rates are similar across all Health Service Areas and none above 35%. TCS and EK have the highest proportion of occupancy associated with medical riders and KB the lowest. Route occupancy does change with the number of passengers riding the bus. For example, 1 wheelchair passenger would decrease potential seats to 16 and 2 would decrease it to 12. For this indicator, we have only provided occupancy based on ambulatory passengers. This indicator is only calculated for transportation services that have pre-defined routes, pick up times and seat availability. HandyDART and Volunteer Driver Programs are excluded. 17. Sensitivity to Fare Increase If the cost of the service was $1 to $2 more than what clients pay now, nine in ten continue to say they would be likely to use the service, including eight in ten who are “very” likely. However, if the cost of the service increases by $3 to $5, then the proportion of clients who are likely to use the service in the future drops to 75% and those “very” likely to use the service drops to 50%. Clients in KB appear to be the most price sensitive as their likely usage decreases as price increases. Specifically, KB likely future usage drops from 96% to 76% with a $1-$2 increase, and to 38% with a $3-$5 increase.

Figure 17 - Likelihood of continued use of the service

91%

78%

50%

4%

12%

25%

2%

3%

9%

2%

2%

3%

1%

1%

5%

Likelihood of

continued use of the

service

Likelihood of


service when the cost

is $1-2 more

Likelihood of


service when the cost

is $3-5 more

Very likely

Somewhat likely

Not very likely

Not at all likely

Not sure




18. Health Connections Client Awareness Just over one in ten clients claim they are aware of a program named Health Connections. Regionally, clients in KB (95%) and OK (100%) are more likely than clients in the other two regions to indicate they have not heard of the Health Connections program. Despite the low awareness of the Health Connections program, once clients were informed of the program, one-third of clients claimed they are aware that the service provider they were using is associated with the Interior Health Authority’s Health Connections program. Awareness of this association in EK (46%) and TCS (37%) is significantly higher than in KB (14%). Figure 18 - Awareness and understanding of the Health Connections Program

11%

34%

89%

66%

Heard about the program

Knew the service provider

is associated with the

program (after being told

about the program) Yes No/Not sure

Description o f the

program*

-A transportation/bus/taxi

service (7%)

-A program/service getting

people (in rural areas) to

healthcare services (6%)

Note: *allows multiple responses, n = 145 Source: Health Connection Survey Report, NRG Research Group: October 24, 2008 19. Physician Office and IH Scheduler Awareness Figure 19 - Awareness of the Health Connections Program

37%

19%

58%

82%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

IH Schedulers

Physician Offices

Yes No

Physician Office n=200; IH Scheduler n = 19 Source: IH Schedulers Feedback Report, Information Support & Research: November 25, 2008



Figure 19 shows that awareness of the Health Connections brand name is low. IH schedulers report a higher level of awareness at 37% in comparison to physician offices with only 19% of those surveyed having heard of the program before. Of interest, only 84% of physician office respondents that were aware of the Health Connections name identified it as a transportation service. 20. Route Consideration Figure 20 –Consideration of Health Connections route times when scheduling out of town appointments

100%

66%

0%

29%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

IH Schedulers

Physician Offices

Yes No


All IH schedulers aware of the Health Connections program take route times and schedules into consideration when scheduling client appointments. In comparison, only 66% of physician office respondents take Health Connections route times and schedules into consideration.



Outcome Indicators

21. Health Connections Client Satisfaction More than nine in ten clients feel the overall service provided by Health Connections is excellent or good. Seven percent rated the service as fair while just one client felt it was poor. Interestingly, all of the fair and poor ratings are from KB. In this particular HSA, one-third rated the service they received from Health Connections as fair while five percent rated it as poor. Figure 21 - Satisfaction with the Health Connections Program and program components

77%

81%

79%

69%

67%

65%

56%

34%

16%

17%

19%

27%

28%

24%

29%

48%

7%

2%

14%

8%

10%

2%

4%

5%

2%

Overall

Friendliness of the driver

Value of the service

Reliability (on-time pick-up before and after)

Convenience of the pick-up/drop-off locations

Ease of booking the ride

Availability when you need it

Comfort of the vehicle

Excellent Good Fair Poor Very poor DK

Note: value labels accounting for less than 2% are not shown in the above Figure, n = 145 Source: Health Connection Survey Report, NRG Research Group: October 24, 2008

22. Municipal Partner Feedback – Most Significant Change 47% of responses noted the most significant change due to the Health Connections Service is the improved access to medical appointments. 20% reported that Relief & Appreciation for the service was the most significant change. Figure 22 – Most Significant Change Noticed Due to Health Connections Program

46.7%

20.0%

13.3%

6.7%

13.3%

Improved access to medical appointment

Relief & Appreciation for the service

Provides more options for transportation

Is a low cost option

None

Notes: Question allows for multiple responses, n = 15 Source: IH Partner Feedback Report, Information Support & Research: November 8, 2008



23. Client Suggested Improvements Many clients felt that the Health Connections service needed no improvement or was fine the way it was (39%) The most common suggestion for improving Health Connections transportation to health care services is to have the busses available on more days (37%). Clients in EK (49%) and TCS (39%) are more likely to mention this suggestion than clients in OK (18%). The next most common reason; more pick-up/drop off times (14%), is cited significantly more by KB clients (48%) than clients in any other region. Similarly, while seven percent of all clients suggested more pick-up/drop off locations, among KB clients, this increases to 24%. Figure 23 - Suggested improvements

39%

37%

14%

10%

7%

6%

1%

7%

Nothing/fine the way it is

Bus available more days

More pick up/drop times

More comfortable bus

More pick up/drop off locations

Promote the service

Less waiting time for bus in destination community

Other

Suggestions*

Note: *allows multiple responses, n = 145 Source: Health Connection Survey Report, NRG Research Group: October 24, 2008



24. Municipal Partner Suggested Improvements No one type of partner response regarding areas for improvement emerged as more significant than another; moreover, the number of responses was a fairly small. Responses regarding more advertising, more service days and better or additional connections between routes were slightly higher than those responses regarding longer service hours, more funding and serving additional communities. Figure 24 – Opportunities for Improvement Within the Current Service

20.0%

20.0%

20.0%

13.3%

13.3%

13.3%

More advertising

More service days

Better or additional connections between routes

Longer service hours

More funding

Service more communities

Note: Question allows for multiple responses, n = 15 Source: IH Partner Feedback Report, Information Support & Research: November 8, 2008

Comments below are from the Partner Feedback survey and are sorted by Health Service Area. They detail specific feedback that may be useful to leads in the respective HSA. East Kootenay

• ‘Medical appointments - many requests for this to expand to Creston - Trail once per week as many of the specialists are there’

• ‘Receptionists at EKRH etc, need to be more aware of the service and more helpful in locating patients when the bus is waiting’

Kootenay Boundary • ‘Add a later afternoon service between Trail, Castlegar & Nelson during the week’

Okanagan • ‘Perhaps an extension of service, or a link to existing services between Penticton and

Kelowna as many Princeton residents must access services only available in Kelowna’ • ‘Better connections between Osoyoos & Kelowna ; better cooperation between different

systems to allow connections between Osoyoos & Kelowna daily Mon-Fri’

Thompson Cariboo Shuswap • ‘A connection in Kamloops for patients travelling to Kelowna's cancer clinic’ • ‘Trying to get 150 Mile on board. Sugar Cane Reserve asked for service but did not

follow up’ • ‘Chase should use another day for transportation as many doctors in Kamloops do not

work Fridays. Perhaps a switch of days from Logan Lake - Merritt runs as usage is lower on the Logan Lake & Merritt run’

• ‘More service during the week from/to Williams Lake, some clinics are not open on Mondays ; a more comfortable bus’



• ‘Some folks have wondered if there would be service from Bella-Coola to Kamloops, using our existing service’

25. Suggested Improvements by Health professionals who Schedule Appointments with Clients As stated in the ‘Health Professionals Survey Report by NRG, “When asked about what improvements could be made to the service, 21 of the 56 physician offices provided a suggestion. The most common suggestion revolved around more frequent service – either run more frequently during the day or run more days during the week. Other suggestions related to increasing awareness of the service by advertising the service or the schedules in newspapers. All comments provided were general in nature with exception of the following comment specific to the Okanagan HSA: ”‘We schedule people to Kelowna and they need a 3-5 hour window to be there. Health Connections doesn’t have it right now because of a lack of times”

Marketing Guidance 26. Willingness to Receive Material Figure 25 –Interest in receiving Health Connections information in future from those aware of the program

100%

86%

0%

14%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

IH Schedulers

Physician Offices

Yes No


All IH schedulers aware of the Health Connections service are interested in receiving information if Interior Health decides to do a marketing campaign in the future; 86% of physician offices would also like to receive material.



Figure 26 –Interest in receiving Health Connections information in future (expressed by those unaware of the program)

90%

96%

10%

4%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

IH Schedulers

Physician Offices

Yes No


The majority of both physician offices and IH schedulers that were unaware of the program would like to receive material during a marketing campaign. 27. Preferred Material to Receive Figure 27 –Information or materials required to assist in using Health Connections buses

0% 10% 20% 30% 40% 50% 60% 70%

Schedules

Brochures

Website

Other

Don’t need anything

IH Schedulers Physician Offices

Physician Office n=56; IH Scheduler n = 7 Sources: IH Schedulers Feedback Report, Information Support & Research: November 25, 2008

Both IH Schedulers and Physician Offices would find paper copy schedules of the Health Connections routes, days and times most useful in helping them to advertise the program and to consider travel times when booking routes. The next most requested item by both groups were brochures.


Additional Health Connections Team Feedback This section details feedback observed from the Health Connections Team over the course of the evaluation. No formal interviews or surveys were administered to this group.

Interior Health Project Sponsor

• Great team to work with who are stewards of the Health Connections Program in their individual HSAs

• Initial issues with timely data to monitor the program

• HSA programs have been developed to be both sustainable and fit the need of respective communities necessitating some trips not being health specific

• Have heard many success stories regarding the program and has been a good partnership with local government organizations

• Future improvements should include a review of access equity, fare equity and cost sharing across Interior Health

Okanagan Health Service Area Lead

• The service is especially important in Princeton where higher level medical services are not available anymore

• The program is operationally run off the side of the desk for each HSA lead and this may be negatively impacting the program

• Communication of program principles during program initiation was poor and therefore route set-up may not have followed these principles as closely as they could have

• Believes partnerships with local volunteer driver programs have been extremely beneficial for Okanagan clients

• Thinks the program would greatly benefit from on-going marketing efforts, but is concerned about budget limitations regarding this initiative

Kootenay Boundary Service Area Lead

• Has finally provided much needed transit between Trail, Castlegar and Nelson

• Believes partnerships with local volunteer driver programs have been

extremely beneficial to clients of the Kootenay Boundary

• Sees a need for increased communication between BC Transit and Interior Health leads

East Kootenay Health Service Area Lead

• Program has been a success in helping people gain greater access to transportation

• The program has promoted positive working relationships with local government groups

Thompson Cariboo Shuswap Health Service Area Lead

• Well received program within the Thompson Cariboo Shuswap as reflected by increasing ridership numbers

• Concerned with the static budget. Operations costs are increasing as is demand for additional routes, the program can not grow on it’s current budgetary constraints

• Values the working relationship with BC Transit

BC Transit Representative

• Ridership data collection was initially laborious to set up and difficult to get data from operators. Process to date is streamlined and is less time consuming

• Have received many reports of good community feedback through the transit operators

• Good working relationship with Interior Health

• Believes the program would benefit from greater visibility in the communities

• HSA leads, transit operators and BC Transit should meet annually to review the program


Review of Findings & Interpretations

The four Health Service Areas (HSAs) covered by the Health Connections Program vary in their size, volume of target population, transportation services offered, partnering organizations, fares charged and cost sharing agreements. A number of indicators presented throughout the report are meant to describe and help understand how these differences may impact results of performance and outcome indicators. Positive Findings The majority of Program Principles have been met, or mostly met, with the implementation of the Health Connections program (see Tables 3&4).

The Health Connections Service is successfully meeting a transportation need for many people who are living in rural areas that have to travel for higher level medical services outside of their home communities. This is supported by Figure 2 that shows 25% of all Health Connections clients would not have been able to get to their appointment without the service; Figure 9 shows just over 80% of rural communities in Interior Health are serviced now that the Health Connections service has been implemented; and Figures 11-13 show the high number of communities with new or enhanced access to transportation and the volume of this access. Client satisfaction results report that nine in every ten clients feels the overall service provided by Health Connections is ‘excellent’ or ‘good’ (see Figure 21) and 91% of clients are ‘very likely’ to use the service again (see Figure 17). When asked what could improve the Health Connections service, over a third of clients responded ‘nothing/fine the way it is’ (see Figure 23). The service is so highly valued among Health Connections clients; most would be tolerant of a $1 to $2 fare increase for a round trip (see Figure 17). 100% of respondents from the IH Schedulers survey are either ‘somewhat likely’ or ‘very likely’ to refer clients to the Health Connections service (see Table 8, Appendix G). The vast majority (96%) of Physician offices surveyed that are ‘not very likely’, ‘somewhat likely’, or ‘very likely’ to refer clients to the Health Connections service, would be interested in receiving information about Health Connections during a marketing campaign (see Figure 4-6, Appendix F). Similarly, 100% of IH Schedulers aware of the program and 95% of those previously unaware of the program would like to receive information (see Figures 25 & 26). Figure 22 highlights that Health Connections local government and transport operator partners agree that the service meets medical appointment needs as 47% of responses state that the most significant change noticed due to Health Connections is ‘Improved access to medical appointments’. Opportunities for Improvement Medical ridership is slightly increasing on Health Connections routes as is the proportion of medical ridership (see Figures 14&15). However, there is further opportunity to increase ridership numbers as shown in Figure 16. At the Health Authority level, Health Connections routes are operating at less than 28% occupancy, with less than 6% represented by medical rides, indicating there is much more capacity available for additional riders, especially those traveling for medical appointments.

Program awareness among clients, physicians, medical office assistants and medical appointment IH schedulers is low (see Figures 18&19). 11% of Health Connections clients are familiar with the Health Connections name and once the service is described to them, only 34% recognize the service. Figure 19 shows 23% of those working in doctor’s offices and 35% of



those scheduling appointments in acute care sites are aware of the Health Connections brand name. Figure 8 shows the highest proportion of Health Connections clients (34%) became aware of the service through word of mouth and secondly by a newspaper ad (14%). Results of the Partner Feedback Survey found that ‘more advertising’ was one of the top three responses for suggested improvements to the current service (Figure 24). When asked what types of materials would be most useful to health professionals, both IH schedulers and physician offices requested hard copy schedules with times, days and routes for the Health Connections service. Of those physician office respondents that were not aware of the service, report only 62% are ‘somewhat likely’ or ‘very likely’ to refer clients to the Health Connections service. Figure 23 shows that of those clients with a suggestion for Health Connections service improvement, more than one third felt having a ‘bus available on more days’ would improve the service. The Partner Survey results in Figure 24 also indicate that ‘more service days’ would improve the service. In addition, Figure 25 shows that health professionals have indicated more service days and times would help to improve the service. Costing indicators are presented in Figures 6 and 7 in the report. Data used to calculate these values is reported in Table 10 of Appendix D. A budget surplus has not been explicitly reported within the document, however in 2007/08, this surplus totaled approximately $170,000 across the Health Authority. KB reported the highest surplus at $73,000, followed by OK at $50,000, EK at $24,000 and finally TCS at $22,000. Below is a summary of the findings for each Health Service Area. Due to a low number of Health Connections clients participating in the client survey, feedback at the HSA level should be interpreted with caution. Results from this report have been underlined. East Kootenay Health Service Area Positive Findings The East Kootenay Health Connections Service is successfully meeting a transportation need for many people who are living in rural areas that have to travel for higher level medical services outside of their home communities. This is supported by the results that 30% of East Kootenay Health Connections clients state they would not have been able to get to their medical appointments without the service. Figure 9 shows just over 90% of rural communities in East Kootenay are serviced now that Health Connections has been implemented, Health Connections has increased the number of communities with transportation service from 1 to 10 (Figure 11) and the number of medical rides has increased from just under 2,500 to almost 2,700 between 2006/07 – 2007/08 (Figure 15). All Health Connections in EK rated the Health Connections service as ‘good’ or ‘excellent’ and 92% of clients are ‘very likely’ to use the service again. Even with a $1-$2 fare increase for a round trip, 72% of EK clients would be ‘very likely’ to use the service again. Although only 14% of EK clients are aware of the Health Connections brand name, 46% recognize the service once it had been described to them. Physician Offices in the East Kootenay region have a high awareness for Health Connections with 44% recognizing the name. Opportunities for Improvement Although East Kootenay routes are operating at a slightly higher occupancy rate than other Health Service Areas at around 30%, this rate indicates there is much more capacity available



for additional riders. Given the occupancy rate for medical rides is just under 12%, there is an enhanced opportunity to increase the number of rides associated with those traveling for medical appointments.

The highest proportion of Health Connections clients (32%) became aware of the service through ‘word of mouth’ and secondly by a ‘newspaper ad’ (24%). Of EK clients with a suggestion for Health Connections service improvement, almost half of clients felt ‘bus available on more days’ would improve the service. Kootenay Boundary Health Service Area Positive Findings The Kootenay Boundary Health Connections Service is successfully meeting a transportation need for many people who are living in rural areas that have to travel for higher level medical services outside of their home communities. This is supported by the results that 24% of Kootenay Boundary Health Connections clients state they would not have been able to get to their medical appointments without the service. Figure 9 shows 70% of rural communities in Kootenay Boundary are serviced now that the Health Connections has been implemented, Health Connections has enhanced access for 10 communities (Figure 12) and the number of total rides has increased from just under 21,000 to just over 23,000 between 2006/07 – 2007/08 (Figure 15). In addition, 86% of clients are ‘very likely’ to use the current service again. Opportunities for Improvement

Ridership data is extremely difficult to track in Kootenay Boundary due to the integration of routes with conventional transit systems. Data is incomplete given that no ridership is reported for the New Denver/Nakusp to Nelson route or for additional HandyDART hours that are part of the Health Connections KB program. 62% of KB Health Connections clients rated the overall service as ‘good’ or ‘excellent’, and if a fare increase of $1-$2 per round trip was implemented only 57% of clients would be ‘very likely’ to use the service again. Kootenay Boundary routes are operating at around 23% occupancy, indicating there is much more capacity available for additional riders, both medical and non-medical. Program awareness is low, with no KB clients having heard of the Health Connections brand name; only 14% recognize the service once it had been described to them.

The highest proportion of KB Health Connections clients (19%) became aware of the service by ‘seeing the bus’ and secondly by ‘word of mouth’ (14%). Of KB clients with a suggestion for Health Connections service improvement, almost half of clients felt ‘more pick up/drop times’ would improve the service. Okanagan Health Service Area Positive Findings The Okanagan Health Connections Service is successfully meeting a transportation need for many people who are living in rural areas that have to travel for higher level medical services



outside of their home communities. This is supported by the results that 25% of Okanagan Health Connections clients state they would not have been able to get to their medical appointments without the service. Figure 9 shows 100% of rural communities in Okanagan are serviced now that Health Connections has been implemented, Health Connections has enhanced access for 8 communities (Figure 12), 89% of clients are ‘very likely’ to use the current service again and all clients using the service rated it as either ‘good’ or ‘excellent’. The service is so highly valued that even with a $1-$2 fare increase per round trip, 79% of clients would still be ‘very likely’ to use the service again. When asked what improvements could be made to the service, 61% responded ‘none/fine the way it is’. Opportunities for Improvement

Total medical rides have decreased from almost 1,500 to just under 1,400 between 2006/07 – 2007/08 (Figure 15). Medical ridership has been consistent or slightly increased in all routes with exception of the HandyDART service within Enderby, Lumby and Armstrong. Okanagan routes are operating at just under 28% occupancy, with just over 5% represented by medical rides, indicating there is much more capacity available for additional riders, especially those traveling for medical appointments. Program awareness is low, with no OK clients having heard of the Health Connections brand name and only 29% recognizing the service once it had been described to them.

The highest proportion of OK Health Connections clients (36%) became aware of the service through ‘word of mouth’ and the second highest proportion (14%) ‘didn’t know’. Of OK clients with a suggestion for Health Connections service improvement, 18% felt the ‘bus available on more days’ would improve the service. Thompson Cariboo Shuswap Health Service Area Positive Findings The Thompson Cariboo Shuswap Health Connections Service is successfully meeting a transportation need for many people who are living in rural areas that have to travel for higher level medical services outside of their home communities. This is supported by the results that 21% of Thompson Cariboo Health Connections clients state they would not have been able to get to their medical appointments without the service. Figure 9 shows 86% of rural communities in Thompson Cariboo are serviced now that Health Connections has been implemented, Health Connections has increased the number of communities with transportation has been implemented, service from 1 to 29 (Figure 11) and medical rides have doubled from just under 1,500 to just over 3,000 between 2006/07-2007/08 (Figure 15). In addition, 93% of clients are ‘very likely’ to use the current service again and 95% of clients using the service rated it as either ‘good’ or ‘excellent’. The service is so highly valued that even with a $1-$2 fare increase per round trip, 88% of clients would still be ‘very likely’ to use the service again. Opportunities for Improvement

Thompson Cariboo routes are operating at just over 25% occupancy, with just over 11% represented by medical rides, indicating there is much more capacity available for additional riders, especially those traveling for medical appointments.



Program awareness is low, with 19% of TCS clients having heard of the Health Connections brand name and only 37% recognizing the service once it had been described to them.

The highest proportion of TCS Health Connections clients (42%) became aware of the service through ‘word of mouth’ and the secondly by seeing a ‘newspaper ad’ (16%). Of TCS clients with a suggestion for Health Connections service improvement, 39% felt ‘bus available on more days’ would improve the service. Unexpected Findings

• In a number of instances, discrepancies have been found between what the HSA leads expected the Health Connections service was providing and what is actually happening operationally.

a. The Nelson to Trail via Salmo route in Kootenay Boundary is not posted on the BC Transit website. Clients are told about the service when they call in to book a ride. This route is a HandyDART service and only runs when there is a need.

b. Health Connections service in the Vernon area does not run from smaller communities to Vernon, but rather within the smaller communities themselves. An existing HandyDART service still runs from Armstrong, Enderby and Lumby to Vernon ensuring higher level medical clients in the communities have service to Vernon.

• Those in social services in communities with Health Connections programs see the service as beneficial to those with low income and limited access to transportation. For populations living in isolated communities it is important for individuals to feel they can leave town and access services in larger centres regardless if this service is medically related. There is strong belief this service is beneficial to the mental health of those with poor access to transportation.

• Cost centres for individual routes in the Okanagan HSA are grouped together, so spending for each route was assigned values matching budgeted numbers.

• The 100 Mile House operator invoiced Interior Health for $11,000 less than the contract amount in 2007/08.



Conclusions

The Health Connections program is a well received and valued service throughout Interior Health that has mostly achieved its program goals and objectives while carrying out key activities required to provide a good service. Although clients’ awareness of the program name and it’s association with Interior Health may be low, they are very thankful, and in some cases dependent, on the service to access higher level medical services outside of their community. The evaluation process has uncovered a number of areas where opportunities for program improvement of performance and monitoring exist. These focus on the opportunity to increase medical ridership and access to transportation for all rural clients within Interior Health. Although out of the scope of this evaluation, a couple of recent events involving the Health Connections program should be noted:

• A road closure between the communities of Penticton and Peachland in the Okanagan Health Service Area, restricted access to high level medical services in Kelowna including the cancer center and a number of specialists. Within a few short days, the Okanagan HSA Health Connections lead and BC Transit were able to put into operation a Health Connections bus that serviced a number of communities south of the road closure to Kelowna 5 days a week. This service normally runs 1 day a week to Kelowna.

• 2 new buses have recently been purchased using federal gas tax funding for the

Thompson Cariboo Health Service Area. These buses will enhance the existing service by making the vehicles more accessible for those in wheelchairs or scooters.

In addition to the above examples, BC Transit was awarded an Innovation Award by the Canadian Urban Transit Association (CUTA) in 2006. These are just some examples of how the Health Connections team is continuously working together to improve transportation access for clients in need of medical services away from home.



Recommendations

Recommendations are made below assuming the program/project continues: 1. Continue to monitor, manage and improve the Health Connections transportation

program through collection and utilization of more accurate community and route specific data (see Appendix D).

Rationale:

• Health Connections has created transportation access for 38 rural communities across Interior Health and enhanced access for an additional 20.

• The program is highly valued among both clients and partnering organizations.

• Existing partnerships allow for route flexibility to meet transportation needs for medical clients in a timely manner.

2. Improve communication between BC Transit, Municipal Partners and Interior Health

by implementing formal communication policies regarding changes to routes or route costing.

Rationale:

• Kootenay Boundary would like to have been consulted when invoice costs increased.

• A HandyDART service for Kootenay Boundary outlined in the original Health Connections contract, has no associated data resulting in uncertainty about where/if this service is running.

• The HandyDART service in the Vernon area (Enderby, Armstrong and Lumby) was thought to run between these communities and Vernon by the Okanagan HSA lead, however in reality the service runs within each community.

• The number of times a week certain routes run as understood by the Okanagan HSA lead is different than in reality.

3. Promote the Health Connections name and service through consistent advertising

done in partnership with BC Transit and a focus on hard copy pamphlets or brochures that detail the Health Connections service schedules.

Rationale:

• Awareness level of the Health Connections program among physician offices, specialist IH schedulers and Health Connections clients is low.

• A low number of Health Connections clients found out about the service through their doctor’s offices.

• The last marketing campaign was completed in 2006 when the Health Connections program first started up. Staff may no longer remember the program is in place or new staff may not be aware of the program at all.

• Occupancy rates on existing routes indicate there is capacity to accommodate more riders than are currently using the service.



• The majority of doctor, specialist offices and IH schedulers identify hard copy Health Connections schedules as being the most useful tool to help them share information with clients.

4. Improve Kootenay Boundary ridership data collection and reporting processes.

Completed by BC Transit and Interior Health Kootenay Boundary lead. Rationale:

• There seems to be no data for the Nakusp/New Denver route (there is a summary row titled Nakusp run, but the route specifics in this section outline Trail-Castlegar-Nelson).

• All other HSAs outline their routes in a return trip basis (i.e. Merritt to Kamloops captures all the clients that travel both from Merritt to Kamloops and from Kamloops to Merritt), where KB data is defined in individual legs (i.e. Nelson to Castlegar and then a separate row for Castlegar to Nelson).

• A number of HandyDART hours are paid for which we have no data for and are not sure if it’s in operation.

5. Review of transport schedules including times and days of travel to ensure routes are

running during times of greatest transportation need and can connect seamlessly to other transportation services. To be completed by Interior Health HSA leads and BC Transit.

Rationale:

• Feedback from the partner survey indicated that some services are not open on the days that buses run.

• The top 3 suggestions for improvement to the service from the Health Connections partners included better or additional connections between routes, and more service days.

• The most common response for improving the Health Connections service as indicated by Health Connections clients (37%), is adding buses on additional days. It should be noted that 39% of clients responded the service is fine the way it is.

6. Explore the creation of routes across Health Services Area boundaries that follow desired clinical referral patterns and allow Health Connections clients transportation access to specialized medical services that are not available in their HSA.

Rationale:

• The current program principle advises against routes crossing Health Services Areas, yet Kelowna General Hospital in the Okanagan Health Service Area offers services unavailable elsewhere in the Health Authority.

• A route from Revelstoke to Kelowna already crosses Health Authority boundaries and reports a higher proportion (60%) of medical rides than non-medical.

• Feedback from the partner survey has identified a need for a route between Creston and Trail which will cross over the Kootenay Boundary and Kootenay Boundary Health Service Areas.

7. Conduct a more detailed review of Health Connections Transportation model costs and services to consider issues of sustainability and how the relative services align



with existing and planned IH patient transportation services. Suggest to be completed collaboratively by HSA leads, Interior Health Business Support and BC Transit.

Rationale:

•••• Detailed costing analysis has been considered out of scope for this evaluation.

•••• Patient transportation is currently in a state of change within Interior Health and opportunities to link Health Connections with these other programs may exist.

•••• Cost per medical ride may indicate more cost effective transportation models exist.

•••• A surplus of $170,000 was reported for the Health Connections budget in the 2007/08 fiscal year.

8. Identify and develop a minimum number of key performance indicators and prepare regular reports that include analysis and next steps based upon these indicators. Frequency of these reports will be determined by the parties involved, however quarterly or semi-annual reports seem reasonable. To be completed collaboratively by HSA leads, Interior Health Business Support and BC Transit.

Rationale:

•••• A number of budget inconsistencies were identified during the evaluation process.

•••• Data is available to HSA leads at various times throughout the year and in a number of different formats, making it difficult to review data on a consistent basis.

9. Review the communities currently without Health Connections service listed in

Appendix D, while considering the cost and need to provide transportation access for these communities. To be completed by the IHA, Health Connections team.

Rationale:

• Approximately 20% of the rural communities in Interior Health do not have access to transportation allowing them to travel to non-emergent medical services outside their community

• A surplus budget was reported for the Health Connections budget in the 2007/08 fiscal

year.


Appendix A: Logic Model

OUTCOMES Changes, benefits or impacts as a result of an activity

INPUTS Resources dedicated to or consumed by the program

ACTIVITIES What you do to fulfill your

goals and objectives

OUTPUTS The direct products of the

activities you do Short-term Intermediate Long-term

• $1 million from Ministry of Health Services

• Staff (IH) o SET sponsor o HSA leads o Communications o Contracts

• Staff (Other) o Route IH

schedulers o Medical

appointment IH schedulers

o Bus operators • Transport vehicles

• Develop program principles (2004)

• Define target population (rural, low income etc.)

• Identify transport partners

• Determine routes funded by Health Connections

• Develop contracts with partners

• Develop advertisements (brochures, radio, media releases)

• Organize promotional events

• Adjust medical appointment scheduling to accommodate HC clients

• % of target population using service

• # of partners • # of routes funded

by Health Connections

• # of contracts completed

• # of brochures printed

• # of offices running out of brochures

• # of media advertisements/events

• # of calls about HC/time period

• % of appointments by HC clients

• Increased public awareness of program

• Increased knowledge of program among medical professionals and support staff

• New or additional routes running to and from rural communities

• Program is widely known and used by target population

• Target population appropriately accesses necessary medical care

• Good relationship with partnering organizations

• Program principles are met

• Equitable access to medical services for all IH residents

• Healthier IH population


Appendix B: Data Collection

Data for this evaluation has been collected from a variety of different sources using various methods. This Appendix details the data collection for each indicator presented throughout the main body of the evaluation. In some case multiple indicators may use the same data source; however that source and data collection process will only be listed once below. How Data Was Collected Ridership data (total and medical) – are collected by individual operators and sent to Interior Health HSA leads. All data sources provide route locations (to and from), number of trips and time period information. The majority of Health Connections funded routes are operated by BC Transit, however some community volunteer driver programs also operate transport services. Both have been further depicted below. BC Transit partners:

Most ridership data is collected and aggregated by BC Transit and provided to Interior Health in quarterly updates. Previously data was sent in separate files to individual HSA leads somewhat inconsistently, however 2007/08 ridership data has been more timely and complete. Most routes require clients to book trips, therefore giving IH schedulers the opportunity to ask if the client is traveling for a medical appointment. There is not a specific definition for medical riders as determined by BC Transit, therefore operators must use their discretion in classifying a client as medical or not.

Kootenay Boundary has limited medical ridership data. Funded routes are a combination of volunteer driver programs, para-transit, HandyDART and conventional transit services. The only way to track medical ridership in a conventional transit system, is to have the bus driver ask each individual getting on if they are traveling for a medical appointment, which is not practical. At this time we are unsure why para-transit routes have not reported medical ridership. A one-day survey conducted in May 2008 reports 10% of riders on that day were traveling for medical purposes.

Volunteer Driver Programs:

There are 3 volunteer driver programs partnering with the Health Connections Program. The Lower Similkameen Community Services Society provides data grouped in 3 month periods with rider ‘type’ attributes. Funding for this organization has been directed towards those traveling from the Keremeos area to specialist appointments elsewhere in the Okanagan and therefore these are the only rides included in ridership data. The Castlegar District & Community Services Society provides data by month and provides rides to clients with a broad range of ‘medical’ needs. All client rides tracked by this source are considered medical. The Salmo Community Resources Society provides data by month and provides rides to clients with a broad range of ‘medical’ needs. All client rides tracked by this source are considered medical.

Indicators using ridership data sources: • 7. Cost per Ride (Health Connections)

o Number of rides used as a denominator



• 10. Rides per 1,000 Rural Population o Number of rides used as a numerator

• 14. Change in Proportion of Medical Rides • 15. Change in Total Medical Rides • 16. Route Occupancy

o Number of rides used as a numerator

Budget reports including budgeted and actual expenditures were compiled by individual HSA business consultants and forwarded through the HSA leads to evaluators. Financial data is broken down by cost centre as each are associated with individual operators. Therefore actual expenditure numbers are also broken down by operator. This data is pulled from the Interior Health Matman Meditech Module. Indicators using budget data source:

• 6. Cost per Kilometer o Provide expenditure dollar value for numerator

• 7. Cost per Ride (Health Connections) o Provide expenditure dollar value for numerator

Route Specifics include things such as route times, drop off and pick up locations, transport service type and rider fare. These details are provided by the HSA leads and BC Transit. The document most referenced for this information is titled ‘Health Connections Routes_datesJune 27 07.doc’ Indicators using route specifics source:

• 5. Distance Traveled (Km) o Provided to and from community locations

• 6. Cost per Kilometer o Provided to and from community locations

• 9. Rural Communities Served o Provided to and from communities to determine route and what communities are

located along the way • 11. Community Access to Health Connections Transportation

o Provided to and from community locations • 12. Community Health Connections Transportation Service Status

o Provided to and from community locations • 13. Number of Communities Served Per Week

o Provided to and from community locations • 16. Route Occupancy

o Provides number of times a week route runs and seat capacity Kilometers Driven are calculated using Routeview Pro software. Route distances are calculated as based on the distance between locations and does not account for additional driving done in and around destination or departure places. Indicators using kilometers driven data source:

• 5. Distance Traveled (Km) o Calculated kms between route to and from locations

• 6. Cost per Kilometer o Calculated kms between route to and from locations



Population data is downloaded from the PEOPLE33 Population Projections and Estimates provided by BC Stats. Only population values for rural Local Health Areas have been included and were pulled for 2007 to coincide with the 2007/08 fiscal year ridership data. Indicators using population data source:

• 10. Rides per 1,000 Rural Population

Place data is pulled from Stats Canada 2006 census data and associated populations and place types are used to define a community (> 500). Indicators using place data source:

• 9. Rural Communities Served • 11. Community Access to Health Connections Transportation • 12. Community Health Connections Transportation Service Status • 13. Number of Communities Served Per Week

Rider and program satisfaction was collected by surveys that were developed and completed as part of the evaluation. A number of different groups were identified to obtain feedback from: Health Connections Clients:

As health connections clients are not using a service directly provided by Interior Health we were unable to obtain individual client information for surveying purposes. Therefore client consent and confidentiality agreements were developed and distributed to partnering transportation operators, namely BC Transit, Lower Similkameen Community Services Society, Castlegar & District Community Services Society and Salmo Community Resources Society. Client consent to answer a survey around transportation access was obtained from clients calling in to book rides to medical appointments between June and September 2008. A number of operators did not provide client consent data for the survey and therefore survey numbers are lower than originally targeted. Some Health Connections funded routes do not require clients to book trips and therefore do not have the opportunity to obtain client consent information allowing a telephone survey to be administered. In these cases on board paper consent collection forms were administered so those willing to participate in the survey could be contacted to answer a tele-phone survey at a later date. A third party, NRG Research Group was forwarded the client information and contacted individuals for survey administration. Survey results were then provided to Interior Health in a report format and incorporated into the evaluation document.

Program Partners:

This group includes local government and transportation operators. Interview questions were developed to ask of each Health Connections partner. These responses were aggregated, analyzed and results included in the evaluation document.

Health Professionals/IH schedulers:

This group includes staff working in family physician offices, specialist’s offices and acute care scheduling centres. These people connect with potential Health Connections clients on a daily basis and could be a vital part of program promotion. The list of physicians was obtained from Medical Administration and filtered to contain only rural family physicians in a city with access to a Health Connections service or any specialists that do not schedule appointments in referral centres are also included.



IH acute care IH schedulers have also been targeted in this survey to understand awareness and flexibility in scheduling appointments to accommodate bus schedules. Survey results were then provided to Interior Health in a report format and incorporated into the evaluation document.

Indicators using survey feedback sources: • 1. Frequency of Use • 2. Health Connections Transportation Alternatives • 3. Reason for Using the Service • 4. Health Connections Distance from Pick-up Locations • 8. Program Awareness • 17. Sensitivity to Fare Increase • 18. Health Connections Client Awareness • 19. Physician Office and IH Scheduler Awareness • 20. Route Consideration • 21. Health Connections Client Satisfaction • 22. Partner Feedback – Most Significant Change • 23. Client Suggested Improvements • 24. Partner Suggested Improvements • 25. Suggested Improvements by Health Professionals who Schedule

Appointments with Clients • 26. Willingness to Receive Material • 27. Preferred Material to Receive



Appendix C: Data Analysis Methods

Methods of data analysis used to calculate given indicators are described below. 1. Frequency of Use From Health Connection Survey Report, NRG Research Group: October 24, 2008, pg. 15 “From June to October 10th, 2008, a list of clients using Health Connections services was compiled from clients calling in to schedule their trip and onboard the buses. In the Kootenay Boundary area, another transportation survey was in progress during this time. Therefore, potential Health Connections clients were selected based on their reason for travelling (i.e. medical related). In total, 257 records were provided to NRG for surveying purposes. After removing duplicates and incomplete phone numbers, a total of 234 clients were available for contact. Of these, 152 surveys were completed. However, during the data cleaning process, it was determined that 7 respondents who completed interviews from Kootenay Boundary did not travel for medical reasons and therefore had to be removed from the final data analysis. Based on a population of 227, a final sample of 145 represents a 64% response rate. The final sample distribution by Health Service Area is as follows: Table 3 Sample by HSA

HSA Sample % Distribution

Kootenay Boundary (KB) 21 14

Kootenay Boundary (EK) 37 26

Okanagan (OK) 28 19

Thompson Cariboo Shuswap (TCS) 57 39

Unassigned 2 1

As with all sample surveys, the results are subject to margins of error. For a total sample of 145, the results have a maximum margin of error of +/-8% at the 95% level of confidence. The sub-samples for each HSA are small and therefore need to be viewed with caution. Throughout the report, where there does appear to be some differences in results by HSA, we have made note of such. All interviewing took place between October 3rd and 14th, 2008.” 2. Health Connections Transportation Alternatives See methods noted under 1. Frequency of Use 3. Reasons for Using the Service See methods noted under 1. Frequency of Use 4. Health Connections Distance from Pick-up Locations See methods noted under 1. Frequency of Use



5. Distance Traveled (Km) Kilometers were calculated using Routeview Pro software and the digital road atlas dataset. Distance between route origin and destination locations were calculated. No distance was added to account for time driving within origin or destination places. Kilometers shown are those that should have been traveled as based on the pre-determined routes and number of times per week they are scheduled to run. These are not actual kilometers driven. Volunteer Driver Program and Vernon HandyDART services do not have pre-set routes allowing for the calculation of expected kilometers driven. Therefore they are excluded from this indicator. 6. Cost per Kilometer To calculate the cost per kilometer the following formula is used:

(Budget expenditure/ # of kilometers)

As mentioned above, not all routes have associated kilometer traveled values. Budget expenditures for those routes without kilometers were excluded. HSA totals are the sum of expenditures associated with kilometer attributed routes. Therefore the HSA expenditure values in this indicator will differ from the cost per rider indicator. 7. Cost per Ride As described in the Data Collection section, financial expenditure data is broken down by operator. Linking the number of rides per route to the cost per route, we were able to calculate a cost per ride. It should be noted that administration fees have been included in these ridership costing values on an HSA level. 8. Program Awareness See methods noted under 1. Frequency of Use 9. Rural Communities Served The proportion of rural communities serviced by HSA uses the following formula:

# of rural communities serviced by Health Connections

# of rural communities

Please see the Glossary in Appendix J for the definition of community and rural. 10. Rides per 1,000 Rural Population Rides per 1,000 population are calculated using the following formula

(# of rides/rural population)*1,000

Rural population is defined as all LHAs within Interior Health with exception of Penticton, Summerland, Central Okanagan, Vernon, Enderby/Armstrong, Salmon Arm and Kamloops. 11. Community Access to Health Connections Transportation BC Transit and IH Health Service Area leads were able to provide the Health Connections evaluators with information on which routes existed before the program was implemented. Using this information evaluators were able to perform a count of the communities serviced before and after the Health Connections Program was implemented. To note, this is a count of communities served, not routes. For example a route starting in Revelstoke and ends in



Kamloops stopping at 4 communities on the way, this route services 5 communities. Please see the Glossary in Appendix J for the definition of community. 12. Community Health Connections Transportation Service Status BC Transit and IH Health Service Area leads were able to provide the Health Connections evaluators with information on which routes existed before the program was implemented. Using this information evaluators were able to perform a count of the communities serviced before and after the Health Connections Program was implemented and most importantly for this indicator, by service type. It should be noted that buses will stop and pick up passengers at any community along the route. For data consistency and comparability throughout the report a community definition was developed and applied to data used in indicators. Service types and community definition are defined in the Glossary found in Appendix J. 13. Number of Communities Served Per Week To measure the increase in number of routes and/or rides, quantifying and comparing past and current transportation services was required. To accomplish this, a ‘communities serviced per week’ value was calculated for each route. It was possible to calculate this value for all transportation service types and providers, allowing for the aggregation and comparison of data across HSAs. BC Transit Data:

For example, the Osoyoos to Penticton route stops in Oliver and Okanagan Falls before reaching Penticton: therefore servicing 3 communities. This route runs 3 times a week, resulting in service to 9 communities per week. This method allows for frequency of routes traveled and number of communities served to be accounted for ensuring comparability between routes.

Volunteer Driver Programs:

Three Volunteer Driver Programs (VDP) are funded by the Health Connections Program and provide service to clients on a ‘service needed’ basis. Route destination and departure times and locations are not previously determined; therefore transportation services run only when and where clients express a need. To quantify this service type an average number of communities served per week will be calculated. As each rider comes from a single community, we can extrapolate that 1 ride is the equivalent of servicing 1 community. Given the difference in data collection techniques, these values were calculated differently for VDP5: The Lower Similkameen Community Services Society provides stats in three month periods, so will divide the number of riders by 3 to get a monthly total and then again by 4 to get a weekly total. So for example between April and June 2004, 30 people used the service. This calculates to 10 communities serviced per month and 2.5 or 3 per week. The Castlegar District and Community Services Society provides stats on a monthly basis so values are divided by 4 to calculate a monthly value. In April of 2006, 21 communities were serviced or 5 per week. Salmo Community Resources Society – provides stats on a monthly basis so values are divided by 4 to calculate a monthly value. In April of 2007, 4 communities were serviced or 1 per week. A years worth of data will be used to calculate the average rides per week provided by each VDP before Health Connections was implemented and a years worth of data after

5 No need to account for multiple communities as each ride represents a single community



Health Connections implementation. Vernon HandyDART services:

Health Connections pays for 54 hours of time per month for this service. Medical riders need to call for scheduled pick ups. To get a value of hours per week, divide by 4 to get 12. Given that the trips are all within the 3 communities (Vernon, Enderby, Armstrong) we believe it’s reasonable to estimate the total trip time at 1 hour. 3 communities with a 1 hour trip per day = 3 hours. With an available 12 hours per week, the Health Connections service could serve 3 communities at 1 hour a trip, 4 times a week.

Both BC Transit data and Volunteer Driver Program data can be combined using the communities serviced per week values, therefore providing before and after service availability per Health Service Area. 14. Change in Proportion of Medical Rides This indicator is calculated by dividing the number of medical rides by the total rides per route. In a number of cases data was incomplete and estimates were used to provide more accurate totals. This was done for the following:

• Routes from Merritt, Logan Lake and Chase to Kamloops and Merritt to Kelowna were missing medical ride data for September and October 2006 – averages of the next 5 months were used to estimate medical rides.

• No medical ride data is collected for Kootenay Boundary so 2006/07 and 2007/08 data is multiplied by 10% to estimated medical rides. This 10% is based on the one day survey of the Kootenay West Lake routes that was completed by BC Transit in April 2008. Once the 10% is calculated and tagged as medical rides, this number is then subtracted from the total to assign a number of non-medical rides.

• Routes from Lillooet, Lytton and Revelstoke are missing data for March 2007. Averages from rides as based on the previous 6 months are used to estimate numbers.

• Creston 2007/08 is missing March 2008 data – numbers were estimated by using the average of rides reported for the previous three months

• There is no HandyDART data for Enderby or Lumby for January – March 2008. Averages of previous months in the year are used to estimate rides during this time period.

• No medical ridership data is provided for the Osoyoos 2006/07 route. The total number of visits associated with Osoyoos para-transit in 2006/07 was included and the 10% medical ridership value for 2007/08 applied to the data to determine the number of medical and non-medical riders.

• There is no data for Kootenay Boundary in 2006/07 with exception of the Kootenay Lake West route (Nelson-Castlegar). The growth rate for this route between 2006/07 -2007/08 was applied to all other routes to determine number of rides. The 10% figure applied above to obtain medical rides was also applied.

15. Change in Total Medical Rides Medical ride data is presented in this indicator. See ‘Change in Proportion of Medical Rides’ for methods used to calculate missing data values. 16. Route Occupancy Only those routes with set schedules have been included in this analysis. To calculate occupancy, the actual number of rides is divided by the potential number of rides. To calculate the potential number of rides per year the following formula was used:

2*(# round trips per week) * (Number of seats in the vehicle) * (Number of weeks in a year)



So for example, the Kimberley to Cranbrook route runs 3 times a day, 2 times a week or 6 times a week. As there is 20 seats in each vehicle the number of seats available per week is 240 = 2*(6)*(20). The number of potential seats needs to incorporate 20 seats in both directions, which is why we multiple 6 trips per week by 2. To get the number per year, we multiple by 52 to get 12,840. Therefore, the Kimberley to Cranbrook route has a potential of 12,480 rides per year. Route occupancy does change with the number of passengers riding the bus. For example, 1 wheelchair passenger would decrease potential seats to 16 and 2 would decrease it to 12. For this indicator, we have only provided occupancy based on ambulatory passengers. It should be noted that Kootenay Boundary ridership data is tracked differently than other Health Service Areas. This is due to transit routes meeting in communities and riders potentially having to transfer buses to get to their final destinations. The Nelson to Trail route consists of a bus running from Nelson to Castlegar and then meeting up with another bus running from Castlegar to Trail which are all tracked in each direction. Therefore these routes don’t need to be multiplied by 2 to obtain the number of seats each way. 17. Sensitivity to Fare Increase See methods noted under 1. Frequency of Use 18. Health Connections Awareness See methods noted under 1. Frequency of Use 19. Physician Office and IH Scheduler Awareness From Health Professionals Survey Report, NRG Research Group: November 25, 2008, pg. 4 A list of Interior Health physicians was obtained from the IH Medical Administration group. This list was originally compiled to understand the physician capacity within Interior Health. An attempt to compile a comprehensive list was made, however some physicians may be missing. Addresses listed do not necessarily indicate office location and therefore, grouping by office is not exact. Physician data was filtered as follows:

• Physician must reside in a community with access to a Health Connections transportation service.

• Physicians must have an office located outside a referral hospital and does not schedule appointments through the hospital.

In total, 337 records were provided to NRG for surveying purposes. After removing duplicates and the one phone number of our national Do Not Call list, a total of 325 clients were available for contact. Of these, 200 surveys were completed which represents a 62% response rate. The distribution of physician offices in the region as well as the final sample distribution by Health Service Area is as follows: Table 1 Sample by HSA

HAS Population % Actual Dist’n

Sample % Sample Dist’n

Kootenay Boundary (KB) 34 10% 16 8%

East Kootenay (EK) 36 11% 27 14%

Okanagan (OK) 205 61% 128 64%

Thompson Cariboo Shuswap 60 18% 27 14%



(TCS)

Unassigned 2 1% 2 1%

As with all sample surveys the results are subject to margins of error. For a total sample of 200, the results have a maximum margin of error of +/-7% at the 95% level of confidence. However, since there is a finite population in this case and the survey sample represents 59% of the population at large, we are able to apply a Finite Population Correction Factor (FPCF) to the margin of error. For this study, the margin of error for the total sample can be reduced by 0.64. Therefore, the maximum margin of error is reduced to +/-4.4%. The sub-samples for each HSA are small and therefore need to be viewed with caution. Throughout the report, where there does appear to be some differences in results by HSA, we have made note of such.

20. Route Consideration See methods noted under 19. Physician Office and IH Scheduler Awareness 21. Health Connections Client Satisfaction See methods noted under 1. Frequency of Use 22. Partner Feedback, Most Significant Change 33 Local government and transportation operators were identified to provide feedback. Survey’s were mailed to addresses provided by BC Transit. 14 of the 33 partners responded for a response rate of 42%. Feedback was collected between June-July 2008. A number of questions in the survey tended to prompt similar answers indicating questions could have been more clearly worded. With exception of Question 1, all questions were open ended and could have multiple answers. As a result the number of responses may total greater than 14, the total number of respondents. 23. Client Suggested Improvements See methods noted under 1. Frequency of Use 24. Municipal Partner Suggested Improvements See methods noted under 24. Partner Feedback, Most Significant Change 25. Suggested Improvements by Health Professionals who Schedule Appointments with Clients See methods noted under 19. Physician Office and IH Scheduler Awareness 26. Willingness to Receive Material See methods noted under 19. Physician Office and IH Scheduler Awareness 27. Preferred Materials to Receive See methods noted under 19. Physician Office and IH Scheduler Awareness


Appendix D: Data Details

The following Tables contain detailed data that Figures throughout the document are based on. Tables 1 - 4 use classifications codes for the place type and Health Connections Service Status which are defined below: Place Type: Health Connections Service Status CY – City New – New route T- Town E – Enhanced route DM – District Municipality P – Pre-existing route VL – Village N – No service UNP – Unincorporated Place N/A – Services not targeted for this centre Table 1 – East Kootenay Communities Serviced by Health Connections

Community Type 2006

Population Rural LHA?

Health Connections

Service Status (New/E/P/N/NA)

Currently Serviced?

Cranbrook CY 18,267 Y NA Y

Kimberley CY 6,139 Y E Y

Creston T 4,826 Y New Y

Fernie CY 4,217 Y New Y

Golden T 3,811 Y New Y

Sparwood DM 3,618 Y New Y

Invermere DM 3,002 Y New Y

Elkford DM 2,463 Y New Y

Radium Hot Springs VL 735 Y New Y

Canal Flats VL 700 Y New Y

Windermere UNP 1,259 Y New Y

Wynndel part A UNP 575 Y N N Table 2 - Kootenay Boundary Communities Serviced by Health Connections

Community Type 2006


Health Connections


Currently Serviced?

Grand Forks CY 4,036 Y N N

Montrose VL 1,012 Y N N

Christina Lake UNP 986 Y P N

Sion UNP 736 Y N N

Greenwood CY 625 Y N N

Midway VL 621 Y N N

Nelson CY 9,258 Y E Y

Castlegar CY 7,259 Y E Y

Trail CY 7,237 Y E Y

Rossland CY 3,278 Y P Y

Fruitvale VL 1,952 Y P Y

Warfield VL 1,729 Y P Y



Nakusp VL 1,524 Y E Y

Kaslo VL 1,072 Y E Y

Salmo VL 1,007 Y E Y

Harrop/Procter UNP 620 Y E Y

New Denver VL 512 Y E Y

Six Mile UNP 958 Y E Y

Ootischenia UNP 856 Y P Y

Genelle UNP 753 Y E Y

Table 3 - Okanagan Communities Serviced by Health Connections

Community Type 2006


Health Connections


Currently Serviced?

Osoyoos T 4,752 Y P Y

Oliver T 4,370 Y P Y

Princeton T 2,677 Y E Y

Keremeos VL 1,289 Y E Y

Cawston UNP 973 Y E Y

Lake Country DM 9,606 NA N

Coldstream DM 9,471 NA N

Peachland DM 4,883 NA N

Westbank UNP 3,930 NA N

Naramata UNP 1,787 NA N

Ellison UNP 1,510 NA N BX/Silver Star Foothills UNP 1,060 P N

Kelowna CY 106,707 NA Y

Vernon CY 35,944 E Y

Penticton CY 31,909 P Y

Summerland DM 10,828 P Y

Spallumcheen DM 4,960 E Y

Armstrong CY 4,241 E Y

Enderby CY 2,828 E Y

Lumby VL 1,634 E Y

Kaleden UNP 1,289 P Y

Grindrod UNP 1,497 New Y

Lakeview UNP 934 NA N

Cherryville UNP 614 N N

Table 4 – Thompson Cariboo Shuswap Communities Serviced by Health Connections

Community Type 2006


Health Connections


Currently Serviced?

Williams Lake CY 10,744 Y New Y

Revelstoke CY 7,230 Y New Y

Merritt CY 6,998 Y New Y

Clearwater** RDEA 3,897 Y E Y

Lillooet DM 2,324 Y New Y

100 Mile House DM 1,885 Y New Y

Ashcroft VL 1,664 Y New Y



Cache Creek VL 1,037 Y New Y

Clinton VL 578 Y New Y Mile 108 Recreational Ranch UNP 2,488 Y New Y

Lower Nicola UNP 1,047 Y New Y

150 Mile House UNP 893 Y New Y

Dog Creek Road Area UNP 880 Y New Y

Gateway/Buffalo Creek UNP 636 Y N N

Fox Mountain UNP 535 Y N N

Kamloops CY 80,376 NA Y

Salmon Arm CY 16,012 New Y

Sicamous DM 2,676 New Y

Chase VL 2,409 New Y

Logan Lake DM 2,162 New Y

Sorrento UNP 1,360 New Y

Barriere UNP 1,209 Y New Y

Blind Bay UNP 1,149 New Y

Silver Creek UNP 1,038 New Y

Ranchero UNP 971 New Y

Falkland UNP 805 N N

Tappen UNP 773 New Y

Scotch Creek UNP 762 New Y

Sunnybrae UNP 699 New Y

White Lake UNP 623 New Y

Malakwa UNP 619 New Y

Cedar Hill/Glenemma UNP 530 N N

Eagle Bay UNP 528 N N

Notch Hill UNP 515 New Y

Deep Creek UNP 500 New Y

Table 5 - Previously Serviced Health Connections Communities Summary

Communities with transportation after HC

HSA

Communities with

transportation before HC*

New system

Enhanced system

Pre-existing systems with no

HC funding

Total with

service N/A No

Service Total Com.

EK 1 9 1 0 10 1 1 12

KB 14 0 10 4 14 0 6 20

OK 14 1 8 6 15 8 1 24

TCS 1 28 1 0 29 1 5 35

IHA Tot. 30 38 20 10 68 10 13 91

HSA Avg 7 10 5 3 17 3 3 23

Table 6 - Rural Communities with Access

HSA Total Rural

Communities

Communities With

Transport Access

Communities With no

Transport Access

Proportion w/ Access

EK 12 11 1 91.7%

KB 20 14 6 70.0%

OK 5 5 0 100.0%

TCS 15 13 2 86.7%

IHA Total 52 43 9 82.7%


Table 7 - Communities served per Week Before and After Implementation of Health Connections

Before HC After HC Change

From To Trips per week

Communities Served Com/week

Trips per week

Communities Served Com/week % #

Kimberley Cranbrook 1 1 1 6 1 6 100.0% 1

Columbia Valley Cranbrook 2 5 10 NA NA

Elk Valley Cranbrook 2 3 6 NA NA

Creston Cranbrook 2 1 2 NA NA

EK 1 12 10 24 2300.0% 23




Trips per week


Argenta/Meadow Creek Nelson 1 1 1 1 1 1 0.0% 0

Kaslo Nelson 1 1 1 1 1 1 0.0% 0

Nelson Trail 0 2 0 1 6 6 NA 6

Nelson Castlegar 0 1 0 15 1 15 NA 15

Castlegar Trail 10 2 20 15 2 30 50.0% 10

Salmo Nelson 1 1 1 3 1 3 200.0% 2

Nakusp/New Denver Trail/Castlegar 1 2 2 2 2 4 100.0% 2

Castlegar Area Trail Area 4 1 4 11 1 11 175.0% 7

Salmo Area Trail Area 0 1 0 1 1 1 NA 1

KB 29 50 16 72 148.3% 43




Trips per week


Osoyoos Penticton 3 2 6 3 2 6 0.0% 0

Osoyoos Kelowna 1 3 3 1 3 3 0.0% 0

Princeton Penticton 2 4 8 3 4 12 50.0% 4

Keremeos** Med. Communities 1 1 1 2 1 2 100.0% 1

Vernon Vernon 0 0 0 4 3 12 1200.0% 12

OK 18 13 13 35 94.4% 17

** Includes Keremeos, Cawston, Hedley and Ollala






Trips per week


Clearwater Kamloops 1 2 3 1 2 2 33.3% 1

Revelstoke Kamloops 1 11 11 NA NA

Revelstoke Kelowna 1 5 5 NA NA

100 Mile House Williams Lake 3 3 9 NA NA

Lillooet Kamloops 1 2 2 NA NA

Lillooet/Lytton Kamloops 1 3 3 NA NA

Williams Lake Kamloops 1 6 6 NA NA

Chase Kamloops 1 1 1 NA NA

Merritt Kamloops 1 3 3 NA NA

Merritt Kelowna 1 1 1 NA NA

Logan Lake Kamloops 2 1 2 NA NA

TCS 3 14 38 45 1400.0% 42 Cells highlighted in orange do not have set transportation schedules and weekly values have been calculated using methodology as outlined in Appendix C


Table 8 - Occupancy Rates for Health Connections Route (2007/08)

Total Total

From To

Trips per

week Potential

Rides/Year Medical Non-

medical % Medical

% Non-Medical

% Total

Kimberley Cranbrook 6 12480 494 1741 4.3% 15.1% 19.4%

Columbia Valley Cranbrook 2 4160 373 542 9.7% 14.1% 23.8%

Elk Valley Cranbrook 2 4160 427 1228 11.1% 32.0% 43.1%

Creston Cranbrook 2 4160 1387 758 36.1% 19.7% 55.9%

EK 12 5760 2681 4269 11.6% 18.5% 30.2%

Total Total

From To

Trips per

week Potential


medical % Medical

% Non-Medical

% Total

Argenta/Meadow Creek Nelson 1 2,080 77 696 3.7% 33.4% 37.2%

Kaslo Nelson 1 2,080 52 471 2.5% 22.6% 25.1%

Nelson Castlegar 15 15,600 835 7,511 5.4% 48.2% 53.5%

Castlegar Nelson 15 15,600 836 7,525 5.4% 48.2% 53.6%

Castlegar Trail 15 27,300 210 1,894 0.8% 6.9% 7.7%

Trail Castlegar 15 27,300 207 1,865 0.8% 6.8% 7.6%

Salmo Nelson 3 6,240 3 30 0.1% 0.5% 0.5%

KB 65 96,200 2221 19991 2.3% 20.8% 23.1%

Total Total

From To

Trips per

week Potential


medical % Medical

% Non-Medical

% Total

Osoyoos Penticton/Kelowna 4 8320 265 2359 3.2% 28.4% 31.5%

Princeton Penticton 3 6240 476 921 7.6% 14.8% 22.4%

OK 7 14560 741 3280 5.1% 22.5% 27.6%

Total Total

To

Trips per

week Potential


medical % Medical

% Non-Medical

% Total

Clearwater Kamloops 1 2080 388 790 18.7% 38.0% 56.6%

Revelstoke Kamloops 1 2080 276 280 14.4% 14.6% 29.0%

Revelstoke Kelowna 1 2080 412 273 21.5% 14.2% 35.7%

100 Mile House Williams Lake 3 6240 336 570 5.8% 9.9% 15.7%

Lillooet Kamloops 1 2080 341 297 17.8% 15.5% 33.2%

Lillooet/Lytton Kamloops 1 2080 366 379 19.1% 19.7% 38.8%

Williams Lake Kamloops 1 2080 487 261 25.4% 13.6% 39.0%

Chase/Merritt/Logan Lake Kamloops/Kelowna 4 8320 417 980 5.4% 12.8% 18.2%

TCS 13 27040 3023 3830 11.2% 14.2% 25.3%

IHA Total 97 143560 8667 31369 6.0% 21.9% 27.9%


Table 9 - Ridership Data for Health Connections Routes

2006/07 2007/08

From To Medical Non-medical Total % Med Medical Non-medical Total % Med

Kimberley Cranbrook 496 1,501 1,997 24.8% 494 1,741 2,235 22.1%

Columbia Valley Cranbrook 356 866 1,222 29.1% 373 542 915 40.8%

Elk Valley Cranbrook 458 878 1,336 34.3% 427 1,228 1,655 25.8%

Creston Cranbrook 1,159 1,050 2,209 52.5% 1,387* 758* 2,145* 64.7%

Kootenay Boundary 2,469 4,295 6,764 36.5% 2,681 4,269 6,950 38.6%

2006/07 2007/08


Argenta/Meadow Creek Nelson 69* 619* 688* 10.0% 77* 696 773 10.0%

Kaslo Nelson 47* 419* 465* 10.0% 52* 471 523 10.0%

Nelson† Trail 30* 272* 303* 10.0% 34* 306 340 10.0%

Trail† Nelson 26* 230* 256* 10.0% 29* 259 288 9.9%

Nelson Castlegar 835* 7,511 8,346 10.0%

Castlegar Nelson 1,503 13,530 15,033 10.0% 836* 7,525 8,361 10.0%

Castlegar Trail 187* 1,685* 1,873* 10.0% 210* 1,894 2,104 10.0%

Trail Castlegar 184* 1,660* 1,844* 10.0% 207* 1,865 2,072 10.0%

Salmo Nelson 3* 26* 29* 10.0% 3* 30 33 10.0%

Salmo Various 4 0 4* 100.0% 54 0 54 100.0%

Castlegar Various 395 0 395* 100.0% 513 0 513 100.0%

Kootenay Boundary 2,448 18,442 20,890 11.7% 2,851 20,556 23,407 12.2% † This route runs from Nelson to Trail via Salmo

Data for Nakusp/New Denver and HandyDART hours are not reported

2006/07 2007/08


Osoyoos Penticton/Kelowna 207* 1,863* 2,070 10.0% 265 2,359 2,624 10.1%

Princeton Penticton 473 1,349 1,822 26.0% 476 921 1,397 34.1%

Vernon Vernon 732 990 1,722 42.5% 550* 219* 769* 71.5%

Keremeos Various 54 0 54 100.0% 98 0 98 100.0%

Okanagan 1,466 4,202 5,668 25.9% 1,389 3,499 4,888 28.4%



2006/07 2007/08


Clearwater Kamloops 110 146 256 43.0% 388 790 1,178 32.9%

Revelstoke Kamloops 105* 64* 169* 62.1% 276 280 556 49.6%

Revelstoke Kelowna 79* 99* 178* 44.4% 412 273 685 60.1%

100 Mile House Williams Lake 147 198 345 42.6% 336 570 906 37.1%

Lillooet Kamloops 242* 249* 491* 49.3% 341 297 638 53.4%

Lillooet/Lytton Kamloops 224* 184* 408* 54.9% 366 379 745 49.1%

Williams Lake Kamloops 308 66 374 82.4% 487 261 748 65.1%

Chase/Merritt/Logan Lake Kamloops/Kelowna 239* 315* 554* 43.1% 417 980 1,397 29.8% Thompson Cariboo Shuswap 1,454 1,321 2,775 52.4% 3,023 3,830 6,853 44.1%

IHA Total 7837 28260 36097 21.7% 9944 32153 42098 23.6% *Indicates estimates due to data gaps. For further details on how estimates were calculated, see Appendix C

Table 10: Health Connections Expenditures and Cost per Ride (2007/08)

Ridership Cost per Ride

From To Medical Non-medical Total Expenditure Medical Non-medical Total

Kimberley Cranbrook 494 1,741 2,235 $40,000 $81 $23 $18

Columbia Valley Cranbrook 373 542 915 $85,000 $228 $157 $93

Elk Valley Cranbrook 427 1,228 1,655 $72,000 $169 $59 $44

Creston Cranbrook 1,387 758 2,145 $60,000 $43 $79 $28

EK 2,681 4,269 6,950 $262,000 $98 $61 $38


From To Medical Non-medical Total Expenditure Medical Non-medical Total Argenta/Meadow Creek Nelson 77 696 773 NA NA NA

Kaslo Nelson 52 471 523 NA NA NA

Nelson Castlegar 835 7,511 8,346

Castlegar Nelson 836 7,525 8,361

Nelson† Trail 34 306 340 NA NA NA

Trail† Nelson 29 259 288 NA NA NA

Salmo Nelson 3 30 33 NA NA NA

ASLCS Sub-total 1,866 16,797 18,664 $134,900 $72 $8 $7



Castlegar Trail 210 1,894 2,104 NA NA NA

Trail Castlegar 207 1,865 2,072 NA NA NA

Trail Transit Sub-total 418 3,758 4,176 $54,600 $131 $15 $13

Salmo Various 54 0 54 $3,000 $56 NA $56

Castlegar Various 513 0 513 $20,225 $39 NA $39

KB 2,851 20,556 23,407 $212,725 $75 $10 $9 †This route runs from Nelson to Trail via Salmo



Osoyoos Penticton/Kelowna 265 2,359 2,624 $15,000 $57 $6 $6

Princeton Penticton 476 921 1,397 $15,000 $32 $16 $11

Vernon Vernon 550 219 769 $33,800 $61 $154 $44

Keremeos Various 98 0 98 $9,792 $100 NA $100

OK 1,389 3,499 4,888 $73,592 $53 $21 $15



Clearwater Kamloops 388 790 1,178 $26,352 $68 $33 $22

Revelstoke Kamloops 276 280 556 NA NA NA

Revelstoke Kelowna 412 273 685 NA NA NA

Revelstoke Sub-Total 688 553 1,241 $60,000 $87 $108 $48

100 Mile House Williams Lake 336 570 906 $44,500 $66 $39 $25

Lillooet Kamloops 341 297 638 NA NA NA

Lillooet/Lytton Kamloops 366 379 745 NA NA NA

Lillooet Sub-Total 707 676 1,383 $46,848 $66 $69 $34

Williams Lake Kamloops 487 261 748 $30,900 $63 $118 $41 Chase/Merritt/Logan Lake Kamloops/Kelowna 417 980 1,397 $75,000 $180 $77 $54

TCS 3,023 3,830 6,853 $283,880 $94 $74 $41

IHA Total 9,944 32,153 42,098 $829,897 $84 $26 $20


Table 11: Health Connections Kilometers Traveled and Expenditures (2007/08)

From To

Trips per week

Kms per year Expenditure

Cost per Km

Kimberley Cranbrook 6 16,704 $40,000 $2.4

Columbia Valley Cranbrook 2 49,344 $85,000 $1.7

Elk Valley Cranbrook 2 31,680 $72,000 $2.3

Creston Cranbrook 2 20,352 $60,000 $2.9

EK 12 118,080 $257,000 $2.2

From To

Trips per week


Cost per Km

Argenta/Meadow Creek Nelson 1 12,000

Kaslo Nelson 1 7,008

New Denver/Nakusp Trail/Castlegar 2 33,024

52,032 $134,900 $2.6

Nelson Trail 3 20,160

Trail Nelson 3 20,160

Salmo Nelson 3 36,000

76,320 $54,600 $0.7

KB 13 168,384 $189,500 $1.1

From To

Trips per week


Cost per Km

Osoyoos Penticton 3 17,856

Osoyoos Kelowna 3 36,576

Osoyoos Sub Total 54,432 $15,000 $0.3

Princeton Penticton 3 33,120 $15,000 $0.5

Vernon Vernon 14,256* $33,800 $2.4

OK 9 101,808 $63,800 $0.6

From To

Trips per week


Cost per Km

Clearwater Kamloops 1 22,368 $26,352 $1.2

Revelstoke Kamloops 1 20,544

Revelstoke Kelowna 1 20,928

Revelstoke sub total 41,472 $60,000 $1.4

100 Mile House Williams Lake 3 28,224 $22,200 $0.8

Lillooet Kamloops 1 16,416

Lillooet/Lytton Kamloops 1 23,040

Lillooet Sub total 39,456 $46,848 $1.2

Williams Lake Kamloops 1 27,840 $30,900 $1.1 Chase/Merritt/Logan Lake Kamloops/Kelowna 4 113,280 $75,000 $0.7

TCS 13 220,032 $283,880 $1.3

IHA TOTAL 152,076 799,180 $1.3

*Calculated as based on an average of 22km per hour


Figure 1: Health Connections Medical Rides (2007/08)



Figure 2: Health Connections Proportion of Medical Rides (2007/08)


Figure 3: Health Connections Proportion of Medical Rides (2007/08)


Appendix E: IH Partner Feedback Report

*This Report begins on the following page.

Strategic Information Management Information Support & Research

1

Project Title: Health Connections Partner Feedback Survey Reporting Period: June-July 2009 Requestor: Interior Health, Health Connections Committee Purpose/Request: To understand how municipal partners and transit operators view the

Health Connections Program. To obtain feedback from these partners and understand how they best feel the program can be improved.

Data Notes & Limitations: A number of questions in the survey tended to prompt similar answers indicating questions could have been more clearly worded. With exception of Question 1, all questions were open ended and could have multiple answers. As a result the number of responses may total greater than 14, the total number of respondents. Question 2 “What have been the most frequent types of requests you've had in the past 6 months regarding the HC service?” seemed to prompt answers related to the type of medical appointment clients were traveling for (i.e. dentist). As almost half of the respondents replied this way, Question 2 results have been excluded from this report. Other responses to this question are reflected in Question 6 and therefore feedback has not been lost by excluding this question. Findings & Analysis: 14 of 33 partners, or 42%, responded to the survey. Of these responses, 5 came from Thompson Cariboo Shuswap, 3 from the Okanagan, and 2 from both Kootenay Boundary and East Kootenay. 2 additional surveys were received that were unable to be linked to a Health Service Area. Of the 14 surveys returned, 13 represented partners that had been with the program more than a year. This allows us to be confident responses reflect issues that have come up over the past 3 years. Most Significant Change 2 partners did not identify a most significant change. Of the 13 responses received, 7 felt that improved access to medical appointments is the most significant change. 3 responses noted ‘relief’ and ‘appreciation’ for the service, while 2 noted transportation options and 1 response felt that low cost was the most significant change


2

Figure 1 – Most Significant Change Noticed Due to Health Connections Program

7

3

2

1

2

Improved access to medical appointment

Relief & Appreciation for the service

Provides more options for transportation

Is a low cost option

None

Unexpected Outcomes Almost half of the partners did not identify any unexpected outcomes in regards to the implementation of the Health Connections program. Of those that did, most were surprised at the number and/or frequency of riders. Continued client appreciation, the potential for overnight stays and a schedule change to accommodate doctor’s hours were also noted as unexpected outcomes. Figure 2 – Unexpected Outcomes Noticed Due to Health Connections Program

5

1

1

1

6

Surprised at the number/frequency of riders

Schedule change to due to doc's hours

Potential for overnight stay

Continued client appreciate

No/none


3

Most Positive Aspect 3 of 13 responses felt the most positive aspect of the Health Connections Service is the access to medical services provided that would otherwise not be available. 3 of 13 responses felt that affordable cost was the most positive aspect and 2 of 13 felt that the availability of the service to a diverse clientele was the most positive. Figure 3 – The Most Positive Aspect of the Health Connections Service

4

3

2

1

1

1

1

Access to medical services otherwise unavailable

Affordable Cost

Available to all ages and client types

Partnerships

Names a specific route

Medical facilitiy flexibility in scheduling for bus times

Consistent service

Opportunity for Improvement No one type of partner response regarding areas for improvement were identified. Responses regarding more advertising, more service days and better or additional connections between routes were slightly higher than those responses regarding longer service hours, more funding and serving additional communities. Figure 4 – Opportunities for Improvement Within the Current Service

3

3

3

2

2

2

More advertising

More service days

Better or additional connections between routes

Longer service hours

More funding

Service more communities


4

Other Comments 3 partners had no additional comments. 8 responses provided comments that reflected on the usefulness of the service and well appreciated it is. 2 commented on route specifics; 1 wondered about service from Bella Coola to Kamlops, the other mentioned a specific dialysis client need from 100 Mile House to Williams Lake. Of interest, one comment stated: “asking people what is the purpose of their trip is invasive and often unappreciated". Figure 5 – Other Comments

8

2

2

1

3

Useful, need service/ clients are grateful

Increase mileage causes stress on repairs

Route specific requests

Asking about reason for ride is invasive

none

Straight from the Source Comments below are sorted by Health Service Area and detail specific feedback that may be useful to leads in the given HSA. East Kootenay

• Medical appointments - many requests for this to expand to Creston - Trail once per week as many of the specialists are there

• Receptionists at EKRH etc, need to be more aware of the service and more helpful in locating patients when the bus is waiting

Kootenay Boundary

• Add a later afternoon service between Trail, Castlegar & Nelson during the week

Okanagan

• Prehaps an extension of service, or a link to existing services between Penticton and Kelowna as many Princeton residents must access services only available in Kelowna

• Better connections between Osoyoos & Kelowna ; better cooperation between different systems to allow connections between Osyoos & Kelowna daily Mon-Fri


• A connection in Kamloops for patients travelling to Kelowna's cancer clinic

• Trying to get 150 Mile on board. Sugar Cane Reserve asked for service but did not follow up


5

• Chase chould use another day for transportation as many doctors in Kamloops do not work Fridays. Perhaps a switch of days from Logan Lake - Merritt runs as usage is lower on the Logan Lake & Merritt run

• More service during the week from/to Williams Lake, some clinics are not open on Mondays ; a more comfortable bus

• Some folks have wondered if there would be service from Bella-Coola to Kamloops, using our existing service

Data Source: Partner Survey Report Author: Christine Ronning, GIS Analyst Date Prepared: November 8, 2008


Appendix F: Health Professionals Feedback Report


Health Professionals Survey Report Prepared by:

NRG Research Group Lorraine Macdonald Vice President 604-676-3993 [email protected]

www.nrgresearchgroup.com

November 24, 2008

Health Professionals Survey Report Page | i

REF # 290-08-1320

TABLE OF CONTENTS

EXECUTIVE SUMMARY AND RECOMMENDATIONS ............................................................................................................2

PROGRAM OVERVIEW AND SURVEY OBJECTIVES............................................................................................................3

SURVEY METHODOLOGY AND RESPONSE RATES ............................................................................................................4

SURVEY RESULTS .........................................................................................................................................................6

AWARENESS OF HEALTH CONNECTIONS .......................................................................................................... 6

USAGE OF HEALTH CONNECTIONS ................................................................................................................. 7

FUTURE USAGE OF HEALTH CONNECTIONS .................................................................................................... 10

PROFILE OF PHYSICIAN OFFICES ................................................................................................................. 12

APPENDIX-SURVEY INSTRUMENT .................................................................................................................................13

Health Professionals Survey Report Page | 2

REF # 290-08-1320

Executive Summary and Recommendations

Awareness of the Health Connections name and service is not particularly high among those who schedule patients for out of town medical appointments. However, among those who are aware, two-thirds do take Health Connections route times into consideration when they are making these appointments. Furthermore, among those who are not aware of the Health Connections service, now that they are aware of it, 62% indicate they are either very or somewhat likely to refer patients to use this service. Therefore, it is not surprising that almost all of these schedulers would like to receive program information about Health Connections if it is being distributed.

The information that would be most effective in promoting usage of the service is a paper copy of the bus schedules, as well as brochures that describe the service.

Therefore, in terms of active marketing efforts, there is clearly an opportunity for Interior Health to promote the service as it is offered now to physicians in the region as many are interested in knowing more about the service. Additionally, if materials can be distributed in a timely manner, Health Connections will be relatively top of mind, thus received more positively. This (creating awareness) should be Interior Health’s current primary focus.

For future consideration, Interior Health can examine frequency of service as this was the most common suggestion for improvement made by those who currently refer patients to the system.

A

Health Connections Survey Report Page | 3

REF # 290-08-1320

Program Overview and Survey Objectives

People living in rural and remote communities often experience challenges in accessing transportation to non emergent health care services which are available in larger population centres. Recognizing this as a significant issue across BC, The Ministry of Health (MOH) provides annual funding to Health Authorities in varying amounts for improving client access to health services. As one of six health authorities in British Columbia, Interior Health Authority receives $1 million on an annual basis and distributes it to its four Health Services Areas (HSAs), allowing each area to customize transportation services for rural medical clients. Beginning between 2005 and 2006, the Health Connections Transportation Program is a program offered by Interior Health in partnership with BC Transit, local municipalities, and local transportation operators. The four HSAs, East Kootenay (EK), Kootenay Boundary (KB), Okanagan (OK) and Thompson Cariboo Shuswap (TCS) have offered their own combination of transportation options based on available resources and community needs. To determine the effectiveness of the program, Interior Health Authority has commissioned NRG Research Group to conduct a satisfaction survey with clients who use the transportation service program. Additionally, a survey with Health professionals was completed. The objectives of this survey are:

� To measure awareness of the name “Health Connections” and of the transportation service available to patients in rural areas.

� To determine how many physicians take the Health Connections schedule into consideration when booking out of town appointments.

� To determine how many patients are using Health Connections and how often.

� To gather the type of information that physicians need in order to increase ease of using Health Connections.

� To elicit suggestions for improving the service.

The results of the survey are presented in this report. Detailed computer tables which break out the results of each question by key variables are presented separately.

B


REF # 290-08-1320

Survey Methodology and Response Rates

A list of Interior Health physicians was obtained from the IH Medical Administration group. This list was originally compiled to understand the physician capacity within Interior Health. An attempt to compile a comprehensive list was made, however some physicians may be missing. Addresses listed do not necessarily indicate office location and therefore, grouping by office not exact. Physicians were categorized into two groups; those who refer patients and those who receive patients. Referring physicians are typically located in rural areas and sending patients to a specialist in a major city while receiving physicians are typically the specialist in the major centre. Physician data was filtered as follows:

• Physician must reside in a community with access to a Health Connections transportation service.

• Physicians must have an office located outside a referral hospital and does not schedule appointments through the hospital.

In total, 337 records were provided to NRG for surveying purposes. After removing duplicates and the one phone number of our national Do Not Call list, a total of 325 clients were available for contact. Of these, 200 surveys were completed which represents a 62% response rate. The final sample distribution by Health Service Area is as follows: Table 1 Sample by HSA


Kootenay Boundary (KB) 16 8%

East Kootenay (EK) 27 14%

Okanagan (OK) 128 64%

Thompson Cariboo Shuswap (TCS) 27 14%

Unassigned 2 1%

As with all sample surveys, the results are subject to margins of error. For a total sample of 200, the results have a maximum margin of error of +/-7% at the 95% level of confidence. The sub-samples for each HSA are small and therefore need to be viewed with caution. Throughout the report, where there does appear to be some differences in results by HSA, we have made note of such. All interviewing took place between November 3rd and 14th, 2008.

C


REF # 290-08-1320

Survey Results

Awareness of Health Connections

Awareness of the program name Health Connections among physician offices sits at just under two in ten while awareness of the transportation program itself, once described, is slightly higher at just under three in ten.

Interestingly, just 84% of those who said they were aware of a program called Health Connections are aware that it is a transportation service to help people living in rural areas travel to health care services in urban centres. Therefore, 16% of those who have heard of Health Connections do not associate it with a transportation service.

Physician offices in the East Kootenay region have higher name awareness than all other regions (44% vs. 15%). As well as having higher name awareness, the East Kootenay region also has a greater awareness of the transportation service (63% vs. 23%).

Figure 4-1 Awareness of the Health Connections Program

Base = 200

D


REF # 290-08-1320

Usage of Health Connections

Among those physician offices that are aware of Health Connections, two-thirds indicate they do take Health Connections route times into consideration when they are scheduling out of town appointments.

However, the proportion of patients using Health Connections to travel for out of town appointments does not appear to be high. Only 4% of physician offices that are aware of Health Connections estimate that one-half or more of their patients are using Health Connections to get to out of town medical appointments. Twenty-seven percent estimate that about one-quarter of their patients are using Health Connections while the largest proportion, 36%, say just a few of their patients use Health Connections.

The one thing that two-thirds of physician offices say would help them and their patients coordinate the scheduling of appointments and using Health Connections buses is to have paper copies of the bus schedules. Three in ten mentioned having brochures that describe the service while two in ten indicate they do not need any further information or materials; that they have everything they need.

Figure 4-2 Consideration of the Health Connections route times when scheduling out of town appointments

Base: respondents who are aware of the program (n=56)


REF # 290-08-1320

Figure 4-3 Proportion of patients using Health Connections to travel for out of town appointments

Base: respondents who are aware of the program (n=56)

Figure 4-4 Information or materials required to assist in using Health Connection buses*

Note: *allows multiple responses Base: respondents who are aware of the program (n=56)


REF # 290-08-1320

When asked about what improvements could be made to the service, 21 of the 56 physician offices provided a suggestion. The most common suggestion revolved around more frequent service – either run more frequently during the day or run more days during the week. Other suggestions related to increasing awareness of the service by advertising the service or the schedules in newspapers. A complete of listing of the verbatim comments is provided below.

Verbatim Comments

• More runs, more days.

• Some people struggle with time of buses; there should be more bus services for more days or stay for a longer period of time, like 6-7 hours instead of 4-5 hours, so that more patients can benefit from the service.

• Buses should be available for more days in a week.

• The frequency of buses per week needs to increase.

• The problem is that the bus service in the morning hours is not enough; sometimes patients who need to travel to hospital for surgery may have to re-arrange the time, especially after the daylight savings time change recently.

• We schedule people to Kelowna and they need a 3-5 hour window to be there. Health connection doesn't have it right now because a lack of times.

• More available to people to find out the information.

• Publish the schedules in the newspapers.

• More buses would be helpful.

• To have buses run more than 1 day a week.

• More days.

• Improve the roads.

• Later in the day the bus time is inconvenient for patients in the afternoon. They need to increase the bus service in the afternoon so that more patients can benefit from the program.

• Just keeping it available.

• Local advertising and local reminders that the service is available.

• More choice, more days of buses, multiple runs.

• We need more bus services to more locations like Nelson, etc.

• Some pamphlets will be useful.

• More info about the services would be great.

• More advertising so that more patients know the service and use the service.

• Just letting us know.


REF # 290-08-1320

Future Usage of Health Connections

Among those physician offices that are currently aware of Health Connections, the vast majority indicate they would like to receive information about Health Connections if Interior Health decides to do a marketing campaign in the future.

Figure 4-5 Interest in receiving Health Connections information in future

Base: respondents who are aware of the program, n=56


REF # 290-08-1320

Among those not currently aware of Health Connections, 62% indicate they are either very or somewhat likely to refer patients to use this service now that they are aware of it. Including the 13% who said they are not very likely to refer patients to Health Connections, among this group, an overwhelming 96% are interested in receiving program information about Health Connections.

Figure 4-6 Future use of Health Connections among those not aware of the program

Base: respondents who are unaware of the program, n=144


REF # 290-08-1320

Profile of Physician Offices

About one-half of the physician offices have one person doing all the scheduling for out of town health appointments while one-quarter have two people taking care of scheduling. Similarly, just over one-half of “schedulers” are scheduling for one doctor while 20% are doing the scheduling for 2 doctors.

Those who are “receiving” patients are more likely to be the sole scheduler (61% vs. 31% among non-receivers) and to be doing so for one doctor (64% vs. 35% among non-receivers).

Table 4-1 Profile of Physician Offices

Base 200

HSA

East Kootenay (EK) 14%

Kootenay Boundary (KB) 8%

Okanagan (OK) 64%

Thompson Cariboo Shuswap (TCS) 14%

Number of people in office involved in scheduling out of town health appointment referrals

1 48%

2 25%

3 16%

4 7%

5 or more 8%

Number of doctors scheduled for

1 52%

2 20%

3 11%

4 6%

5 or more 10%

Don’t know 2%

Receivers

Yes 56%

No 44%


REF # 290-08-1320

Appendix-Survey Instrument

Interior Health Authority

Health Professionals Survey October 31, 2008

Import Specialty, HSA & Community, Receiving (Y/N) Hello, my name is _______ and I’m calling from NRG Research Group on behalf of the Interior Health Authority who are conducting an evaluation of the transportation needs of people in rural areas travelling to health care services in urban centres. To help us determine who we should be speaking to, can you please tell me how many people in your office are involved in scheduling out of town health appointment referrals? ____ people

If 1 person: Could I please speak with that person? If 2 or more, ask: Can I please speak to the person who is either in charge of scheduling or does the most scheduling?

If same person: The survey is very short; just 5-8 questions depending on your answers. Would you be able to help us out now?

If new R: Hello, my name is _______ and I’m calling from NRG Research Group on behalf of the Interior Health Authority who are conducting an evaluation of the transportation needs of people in rural areas travelling to health care services in urban centres. I understand you are the person who would I should be speaking to about this. The survey is very short; just 7-8 questions depending on your answers. Would you be able to help us out now? If R is not available now, get name and direct number, if applicable, and schedule callback time. Note: If R would like to validate the authenticity of this service, they can contact James Coyle of the Interior Health Authority. His phone number is 250-870-4714. 1. First, have you heard of a program called “Health Connections”?

1. Yes 2. No 3. Not sure/Ref

2. Health Connections is a partnership between Interior Health, BC Transit and local not-for-profit

societies. This program helps people living in rural areas travel to health care services in urban centres. Are you aware of this service?

1. Yes, aware >> Go to Q4 2. No, not aware/DK

E


REF # 290-08-1320

3. Now that I have described the program to you, how likely are you to refer patients to use this service when they need to travel for out of town medical appointments? Would you say you are…read list

1. Very likely >> Go to Q8.2

2. Somewhat likely >> Go to Q8.2 3. Not very likely; or >> Go to Q8.2 4. Not at all likely >> Go to Q9 5. Don’t know (do not read) >> Go to Q9

4. Do you take Health Connections route times into consideration when you or your office is

involved in the scheduling of out of town appointments for clients? 1. Yes 2. No 5. What proportion of your patients who are travelling for out of town appointments are using

Health Connections? Would you say…read 1. All or almost all 2. Most 3. About half 4. About a quarter 5. A few; or

6. None 7. Don’t know (Do not read) 6. What types of information or materials do you require to make it easier for you and your patients

when coordinating the scheduling of appointments and using Health Connections buses? Probe for specifics. Do not read list. Accept up to 4 replies.

1. Brochures describing service 2. Paper copies of bus schedules (routes, depart times, trip duration) 3. Website of bus schedules 4. Other (specify) ___________________________ 96. Nothing, have everything we need Only ask Q7 if aware of HC (yes in Q2) 7. Do you have any suggestions for improving the service? Probe Record verbatim 95. Other (specify) _____________________ 96. No, it’s fine the way it is


REF # 290-08-1320

8.1 Lastly, if the Health Connections program does a marketing campaign in the near future, would you like Interior Health to send you copies of information that you could share with your patients?

1. Yes >> Go to Q8.3 2. No >> Go to Q9 8.2 If program information is distributed by Interior Health in the near future, would you be interested

in receiving some information about the Health Connections program? 1. Yes 2. No >> Go to Q9 8.3 I just need to confirm that they have your correct address on file?

(DP Note: insert address from sample file) Interviewers: Confirm each field. If not correct, record correct info. Address 1: Address 2: Community Postal Code:

9. Lastly, for how many doctors do you do patient scheduling for out of town appointments? ___ doctors Those are all the questions I have. NRG and the IHA would like to thank you for your time and

input today. Good bye.


Appendix G: IH Scheduler Feedback Report



1

Project Title: Health Connections IH Scheduler Feedback Survey Reporting Period: November 2008 Requestor: Interior Health, Health Connections Committee Purpose/Request: To understand the Health Connections program awareness among IH

Schedulers and find out if they schedule take into consideration route times when scheduling appointments for out of town clients. To obtain feedback from these partners and understand how they best feel the program can be improved.

Data Notes & Limitations: None to date. Findings & Analysis: 19 of 39 scheduling departments contacted, or 49%, responded to the survey. Of these responses, 5 came from Thompson Cariboo Shuswap, 8 from the Okanagan, 2 from Kootenay Boundary and 3 from East Kootenay. 1 additional survey was received that was unable to be linked to a Health Service Area. Program Awareness Program awareness among IH Schedulers is low, with only 37% of those surveyed having heard of the program. Table 1 – Awareness of the Health Connections Program (n=19) Response Type Count Proportion

Yes 7 37%

No 11 58%

Not Sure 1 5%

Total 19 100%

Table 2 – Aware Health Connections is a Transportation Program (n=19) Response Type Count Proportion

Yes 9 47%

No 10 53%

Total 19 100%


2

Route Consideration Of the 9 respondents aware of the Health Connections program, all took the service times into consideration when scheduling appointments for clients using the service. Table 3 – Consideration of the Health Connections route times when scheduling out of town appointments (n=9) Response Type Count Proportion

Yes 9 100%

No 0 0%

Total 9 100%


The estimated proportion of clients traveling from out of town for appointments using the Health Connections service is also low. The majority of respondents believe only ‘a few’ clients traveling from out of town use the Health Connections service. This may indicate low program awareness among the potential client population. Table 4 – Proportion of patients using Health Connections to travel for out of town appointments (n=9) Response Type Count Proportion

Almost all 0 0%

Most 0 0%

About half 0 0% About a quarter 2 22%

A few 6 67%

None 0 0%

Don't know 1 11%

Total 9 100%

Preferred Material to Receive 6 of the 9 respondents provided suggestions for the most useful material to receive and 1 gave two answers for a total of 7 responses. The majority of responses requested hard copy schedules outlining the days and times Health Connections routes run. Table 5 – Information or materials required to assist in using Health Connections buses (n=7)

Response Type Count Proportion

Brochures Available 2 29% Schedules with exact days/times 4 57%

Website 1 14%

Total 7 100%

Service Improvements

• For bus drivers to be more flexible (when appointments running late) • More times/days for buses to run

• Doctors to include on patient requisition forms that they are travelling on a Health Connections bus


3

Future Usage of Health Connections All of those aware of the Health Connections service would like to receive information if a marketing campaign is to take place. Table 6 –Interest in receiving Health Connections information in future by those aware of the program (n=9) Response Type Count Proportion

Yes 9 100%

No 0 0%

Total 9 100%

With exception of one respondent, all respondents (90%) that did not know about the Health Connections program before the survey would like to receive information about the program during a marketing campaign. Table 7 –Interest in receiving Health Connections information in future by those unaware of the program (n=10) Response Type Count Proportion

Yes 9 90%

No 1 10%

Total 10 100%

Patient Referral Of those clients that did not know about the Health Connections program before this survey, all respondents are ‘very likely’ or ‘somewhat likely’ to refer clients to the service. Table 8 –Future use of Health Connections among those not aware of the program (n=10) Response Type Count Proportion

Very Likely 5 50% Somewhat likely 5 50%

Not very likely 0 0%

Not at all likely 0 0%

Don't know 0 0%

Total 10 100%

Data Source: IH Scheduler Survey Report Author: Christine Ronning, GIS Analyst Date Prepared: November 25, 2008, Update December 2, 2008


Appendix H: NRG Health Connections Survey Report


Health Connections Survey Report Prepared by:

NRG Research Group Lorraine Macdonald Vice President 604-676-3993 [email protected]

www.nrgresearchgroup.com

October 24, 2008

Health Connections Survey Report Page | i

Draft: Oct 20, 2008

TABLE OF CONTENTS

EXECUTIVE SUMMARY AND RECOMMENDATIONS ............................................................................................................1

PROGRAM OVERVIEW AND SURVEY OBJECTIVES............................................................................................................4

SURVEY METHODOLOGY AND RESPONSE RATES ............................................................................................................5

SURVEY RESULTS .........................................................................................................................................................6

PROFILE: WHO IS USING HEALTH CONNECTIONS SERVICE? ................................................................................... 6

AWARENESS OF HEALTH CONNECTIONS .......................................................................................................... 8

USAGE OF HEALTH CONNECTIONS ................................................................................................................. 9

SOURCE OF AWARENESS .......................................................................................................................... 10

REASONS FOR USING HEALTH CONNECTIONS ................................................................................................. 11

MAIN PURPOSE OF LAST TRIP USING HEALTH CONNECTIONS ............................................................................... 12

ALTERNATIVES TO USING HEALTH CONNECTIONS ............................................................................................. 13

SERVICE DELIVERY ................................................................................................................................. 14

DISTANCE TO PICK-UP LOCATION ................................................................................................................ 15

SUGGESTIONS FOR IMPROVEMENT............................................................................................................... 16

COST OF SERVICE .................................................................................................................................. 17

LIKELIHOOD OF USING HEALTH CONNECTIONS IN FUTURE ................................................................................... 18

APPENDIX-SURVEY INSTRUMENT .................................................................................................................................19


Draft: Oct 20, 2008

Executive Summary and Recommendations

Profile of Users

Health Connections clients are skewed three to one women with an average age of 65. One-half of clients live on their own while one-third live with one other person. Despite their years, most continue to live independently as almost six in ten live in a house while two in ten live in an apartment. Furthermore, the vast majority are able to walk independently without assistance. Health Connections clients are established in their communities as they have lived there for over 20 years, on average.

Usage and Awareness

One-third of clients have used Health Connections just once or twice in the last six months, while another one-third have used it three to six times and the other one-third have used it more than six times in six months. For three in ten clients, their most recent trip was within the past two weeks. Not unexpected, the majority of clients last used Health Connections to get to an appointment with a specialist or at the hospital. Regardless of usage, awareness of the Health Connections program is not very high; just one in ten are aware that the program is a service that gets people to health care services or a transportation/bus/taxi service. However, once the program is explained to clients, one-third claim they are aware that the service provider they were using is associated with the Interior Health Authority’s Health Connections program. One in three clients first found out about using their service provider for medical appointments through word of mouth from a friend or relative. The second most common source is newspapers (14%) followed by medical assistants or someone in the doctor’s office (10%). Only five percent of clients first found out about the service from a doctor.

A


Draft: Oct 20, 2008

Reasons For Using

Just over one-half of clients do not own a vehicle, so the most common reason for using Health Connections is a lack of alternatives; either they don’t own a vehicle and/or there is no one else to drive them. However, even for those who do own a vehicle, some indicate they can’t afford to drive, they don’t like to drive long distances, they don’t like to drive at all or more specifically, they cannot drive after their appointment. Almost two in ten use Health Connections because it’s convenient while one in ten say it’s reasonably priced and nine percent like to use public transportation. The most common alternative to using Health Connections if it were not available is to ask a friend or family member to drive them, to drive themselves or take public transit. However, one-quarter of clients claim they would not have been able to get to their appointments as they have no other means.

Service Delivery

Overall, clients seem to be very satisfied with the Health Connections service they received overall, and on specific attributes including:

� friendliness of the driver

� value of the service

� reliability of the service

� convenience of the pick-up/drop-off locations

� availability of the ride when needed

� comfort of the vehicle

On all fronts, more than eight in ten clients gave excellent or good ratings. Given the high satisfaction with the service received, it is not surprising that four in ten clients say no improvements to the service are necessary. Among those who did make suggestions, the most common suggestion for improving transportation to health care services is to have busses available on more days, as mentioned by 37% of clients. The next most common reason is to have more pick-up/drop off times, but this was cited by only 14% of clients. Although 41% of clients have to walk more than six blocks to get to their pick up spot, only 7% suggested more pick-up/drop-off locations.


Draft: Oct 20, 2008

Future Usage

As clients are highly satisfied with the Health Connections service, it is not unexpected that 95% of clients say they would likely use the Health Connections transportation service in the future if the need arises. A $1-$2 increase in fees appears to be tolerable, as 90% would still be likely to use the service with the higher cost. However, a $3-$5 increase is less tolerable as future likelihood to use drops to 75%, which is perhaps understandable given that 62% of clients currently pay $4 or more for a one-way trip. In summary, many clients are dependent on the Health Connections program to get them to their medical appointments, regardless of whether or not they own a vehicle. These are primarily elderly women who are living independently in a house or apartment, on their own or with one other person. They may or may not have relatives close by whom they can call on occasionally for a ride or friends who are able to drive them. While most are highly satisfied with the services received to-date, a little more flexibility in terms of days the service is offered, times and pick-up/drop-off locations would improve service for some. With the high level of overall satisfaction and specifically with the value of the service, most would tolerate a $1 to $2 increase in costs, but a $3 to $5 increase would create a barrier to use for some. Lastly, Interior Health Authority should be putting some resources into promoting the program as only 11% are aware of the “Health Connections” name and one-third of clients found out about the service through word of mouth. Given the role of doctors in the process, (i.e. the need to travel to an urban medical facility starts with a doctor’s referral), they present a real opportunity for creating and increasing awareness of the program. IHA should consider using doctor’s offices as a means of communicating to potential clients. This could be in the form of posters, brochures or direct communication from doctors and their staff to their patients.


Draft: Oct 20, 2008

Program Overview and Survey Objectives

People living in rural and remote communities often experience challenges in accessing transportation to non emergent health care services which are available in larger population centres. Recognizing this as a significant issue across BC, The Ministry of Health (MOH) provides annual funding to Health Authorities in varying amounts for improving client access to health services. As one of six health authorities in British Columbia, Interior Health Authority receives $1 million on an annual basis and distributes it to its four Health Services Areas (HSAs), allowing each area to customize transportation services for rural medical clients. Beginning between 2005 and 2006, the Health Connections Transportation Program is a program offered by Interior Health in partnership with BC Transit, local municipalities, and local transportation operators. The four HSAs, East Kootenay (EK), Kootenay Boundary (KB), Okanagan (OK) and Thompson Cariboo Shuswap (TCS) have offered their own combination of transportation options based on available resources and community needs. To determine the effectiveness of the program, Interior Health Authority has commissioned NRG Research Group to conduct a satisfaction survey with clients who use the transportation service program. The objectives of this survey are to determine who uses the service, why they use the service, and how it could be improved. Topic areas for surveying could include any or all of the following:

� Profile users demographically (i.e., gender, age, city of residence, years in the community, living arrangements, vehicle ownership, relatives living nearby, etc.).

� Determine reasons for using the service and frequency of usage (i.e., no vehicle, cannot drive, don’t like distance or winter driving, no friend/relative to drive, etc.).

� Evaluate the benefits and drawback of the service including the value placed on the service by clients.

� Determine whether or not the service is meeting clients’ needs (i.e., availability of transportation when needed, ease of scheduling/booking, value, etc.).

� To determine what improvements should be made to the service.

The results of the survey are presented in this report. Detailed computer tables which break out the results of each question by key variables are presented separately.

B


Draft: Oct 20, 2008

Survey Methodology and Response Rates

From June to October 10th, 2008, a list of clients using Health Connections services was compiled from clients calling in to schedule their trip and onboard the buses. In the Kootenay Boundary area, another transportation survey was in progress during this time. Therefore, potential Health Connections clients were selected based on their reason for travelling (i.e. medical related). In total, 257 records were provided to NRG for surveying purposes. After removing duplicates and incomplete phone numbers, a total of 234 clients were available for contact. Of these, 152 surveys were completed. However, during the data cleaning process, it was determined that 7 respondents who completed interviews from Kootenay Boundary did not travel for medical reasons and therefore had to be removed from the final data analysis. Based on a population of 227, a final sample of 145 represents a 64% response rate. The final sample distribution by Health Service Area is as follows: Table 3 Sample by HSA


Kootenay Boundary (KB) 21 14

East Kootenay (EK) 37 26

Okanagan (OK) 28 19

Thompson Cariboo Shuswap (TCS) 57 39

Unassigned 2 1

As with all sample surveys, the results are subject to margins of error. For a total sample of 145, the results have a maximum margin of error of +/-8% at the 95% level of confidence. The sub-samples for each HSA are small and therefore need to be viewed with caution. Throughout the report, where there does appear to be some differences in results by HSA, we have made note of such. All interviewing took place between October 3rd and 14th, 2008.

C


Draft: Oct 20, 2008

Survey Results

Profile: Who is using Health Connections Service?

Health Connections clients are primarily older women; 77% are women and 77% are 55 or older including 29% who are 75 or older. The average age of a Health Connections client is 65. Despite their age, the vast majority of Health Connections clients are able to walk independently and almost one-half own a vehicle. Just over one-half of clients live on their own while one-third live with one other person. Almost six in ten live in a house while 18% live in an apartment/condominium. KB clients are most likely to live on their own (76%) and in apartments (38%). On average, Health Connections clients have lived in their community for 22 years and 35% have relatives that live nearby whom they could call on occasionally for rides.

Table 4 Key demographic characteristics of service users By HSA

Total (n=145) EK (n=37)* KB (n=21)* OK (n=28)* TCS (n=57)

Gender

Male 23% 19% 19% 29% 23%

Female 77% 81% 81% 71% 77%

Age

<45 9% 8% 19% 4% 9%

45-54 13% 19% 19% 0% 12%

55-64 25% 16% 19% 29% 30%

65-74 23% 22% 5% 18% 33%

75+ 29% 35% 38% 46% 14%

No response 1% 0% 0% 4% 2%

Household size

1 52% 43% 76% 57% 49%

2 33% 35% 5% 32% 40%

3 11% 16% 14% 7% 9%

4 1% 0% 5% 0% 2%

6 1% 5% 0% 0% 0%

No response 1% 0% 0% 4% 0%

D


Draft: Oct 20, 2008

Total (n=145) EK (n=37)* KB (n=21)* OK (n=28)* TCS (n=57)

A family member living nearby to drive you to health-care facilities

Yes 35% 46% 33% 21% 35%

No 65% 54% 67% 79% 65%

Number of years living in the community

<5 21% 19% 24% 18% 23%

5 – 9 11% 19% 5% 14% 7%

10 – 19 25% 11% 29% 32% 28%

20 – 25 8% 14% 5% 0% 9%

26 – 29 3% 0% 5% 4% 5%

30 – 39 13% 16% 14% 11% 12%

40+ 19% 22% 19% 21% 16%

Average # of years 22 23 24 21 21

Housing type

A house 58% 59% 52% 43% 67%

An apartment 17% 19% 38% 7% 12%

Mobile Home (including motor homes & trailers)

14% 5% 0% 29% 16%

Care/seniors home 4% 11% 5% 0% 2%

A townhouse or duplex 3% 3% 5% 7% 2%

Condo 1% 3% 0% 4% 0%

Other 2% 0% 0% 7% 2%

No response 1% 0% 0% 4% 0%

Walking ability

Walk independently 86% 86% 67% 79% 95%

Use a cane 12% 14% 19% 4% 12%

Use a walker 8% 3% 14% 18% 4%

Wheelchair 1% 5% 0% 0% 0%

Scooter 3% 3% 5% 11% 0%

Other 1% 0% 5% 0% 0%

Ownership of a car

Yes 47% 54% 24% 32% 60%

No 53% 46% 76% 68% 40%

Note: *interpret with caution, given the small sample size


Draft: Oct 20, 2008

Awareness of Health Connections

Just over one in ten clients claim they are aware of a program named Health Connections. Furthermore, they are able to describe this program as a service that gets people to health care services or a transportation/bus/taxi service. Regionally, clients in KB (95%) and OK (100%) are more likely than clients in the other two regions to indicate they have not heard of the Health Connections program. Despite the low awareness of the Health Connections program, once clients were informed of the program, one-third of clients claimed they are aware that the service provider they were using is associated with the Interior Health Authority’s Health Connections program. Awareness of this association in EK (46%) and TCS (37%) is significantly higher than in KB (14%). Among the 11% of clients who indicated they are aware of Health Connections (without being read the description), three-quarters are also aware that the service provider they were using is associated with Health Connections. However, among those were not initially aware of Health Connections, once they were told about the program, 28% claimed they are aware that the service provider they were using is associated with Health Connections.

Figure 4-1 Awareness and understanding of the Health Connections Program

Note: *allows multiple responses


Draft: Oct 20, 2008


One-third of clients had last used Health Connections within two weeks of participating in the survey. Reflecting the sample collection for this study, 71% of KB clients had used the service within the last two weeks. For almost one-quarter of clients, they last used the service 3 months ago or longer. OK clients (43%) are more likely to have last used the service in this timeframe. One third of clients have used Health Connections just once or twice in the past six months, while the same proportion has used it three to six times and seven or more times. On average, Health Connections clients have used the service nine times in the last six months. KB clients are much heavier users, averaging 20 times in the last six months while TCS clients are the least frequent users, averaging five times in the last six months.

Figure 4-2 Usage of the Health Connections Program

Figure 4-2.1 Most recent use of the service

Figure 4-2.2 Number of times using the service within the last 6 months


Draft: Oct 20, 2008

Note: *2 responses (144 and 100 times) are excluded from the mean calculation.

Source of Awareness

One-third of clients first found out about using their service provider for medical appointments through word of mouth from a friend or relative. The second most common source is newspapers (14%) followed by medical assistants or someone in the doctor’s office (10%). Only five percent of clients first found out about Health Connections from a doctor. Awareness from the doctor or the doctor’s office is fairly consistent across the regions.

Figure 4-3 Source of awareness of Health Connections service


Draft: Oct 20, 2008

Reasons for Using Health Connections

The most common reason for using Health Connections is a lack of alternatives; no one available to drive me (44%) or don’t have a car (37%). Other reasons that clients cited include they can’t afford to drive (25%), they don’t drive long distances (18%) or the simply don’t like to drive at all (10%). Almost two in ten use Health Connections because it’s convenient while one in ten say it’s reasonably priced and nine percent like to use public transportation. Clients in KB and OK are more likely to cite a lack of alternatives (i.e. no car, no other drivers) while those in TCS are more likely to cite not being able to afford to drive as a reason. Clients in both TCS and EK are more likely to claim they don’t drive long distances and they feel Health Connections is reasonably priced. In terms of being reasonably priced, there is no difference in this perception between those who paid less than $4 for their trip versus those who paid $4 or more.

Figure 4-4 Reasons for using Health Connections service*



Draft: Oct 20, 2008

Main Purpose of Last Trip Using Health Connections

Not unexpected, just over six in ten clients last used Health Connections to get to an appointment with a specialist while three in ten had an appointment at the hospital. All other reasons cited for using the service were mentioned by no more than five percent of clients.

Figure 4-5 Main purpose of last trip using Health Connections service*



Draft: Oct 20, 2008

Alternatives to Using Health Connections

The most common alternative to using Health Connections if it were not available is to ask a friend to drive them (19%), followed by asking a family member, driving themselves or taking public transit, each of these mentioned by 15% of clients. Among those who own vehicles, only three in ten say they would have driven themselves. For one quarter of clients, if Health Connections was not available, they claim they would not have been able to get to their appointments as they have no other means. Even among those who have vehicles, 21% claim they would not have been able to get to their appointments. Some reasons for this include not wanting to drive distances or not being capable of driving after their appointment.

Figure 4-6 Alternative means for getting to health care facilities


Draft: Oct 20, 2008

Service Delivery

More than nine in ten clients feel the overall service provided by Health Connections is excellent or good. Seven percent rated the service as fair while just one client felt it was poor. Interestingly, all of the fair and poor ratings are from KB. In this particular HSA, one-third rated the service they received from Health Connections as fair while five percent rated it as poor. Reflecting high overall satisfaction, all attributes measured are rated as excellent or good by at least eight in ten clients. The two attributes that top the list are “friendliness of the driver” and “value of the service”. For both attributes, 98% of clients gave ratings of excellent or good with the vast majority of those being excellent ratings (~80%). Over nine in ten clients gave excellent or good ratings to the “reliability of the service” and the “convenience of the pick-up/drop-off locations”. Again, the vast majority of these positive scores are excellent ratings (~70%). Almost nine in ten give “ease of booking the ride” an excellent or good score with 65% of these being excellent ratings. By HSA, TCS clients are a little more likely to give “good” ratings rather than “excellent” ratings compared to EK and OK. A high proportion (38%) of KB clients could not provide a rating for this attribute. The two lowest rated attributes are “availability of the ride when needed” and “comfort of the vehicle”. Nonetheless, excellent and good ratings are still received from eight in ten clients. Comfort of the vehicle is the only attribute with fewer excellent ratings (34%) than good ratings (48%). Generally speaking, KB clients are less satisfied with most aspects of service delivery as they are more likely to give fair, poor or very poor ratings on the various attributes measured and overall.

Figure 4-7 Satisfaction with the Health Connections Program and program components


Draft: Oct 20, 2008

Note: value labels accounting for less than 2% are not shown in the above figure.

Distance to Pick-up Location

For three in ten clients, they are picked up right outside their home, especially those in OK (79%). However, at the other end of the spectrum, four in ten have to walk more than six blocks to get to their pick-up location. This is the case primarily in TCS (67%).

Figure 4-8 Travel distance to the Heath Connections pick-up location


Draft: Oct 20, 2008

Suggestions for Improvement

The most common suggestion for improving Health Connections transportation to health care services is to have the busses available on more days (37%). Clients in EK (49%) and TCS (39%) are more likely to mention this suggestion than clients in OK (18%). The next most common reason; more pick-up/drop off times (14%), is cited significantly more by KB clients (48%) than clients in any other region. Similarly, while seven percent of all clients suggested more pick-up/drop off locations, among KB clients, this increases to 24%.

One in ten recommended more comfortable busses and six percent suggested the service needed more promotion. Almost four in ten clients say nothing is required, the service is fine the way it is. OK clients are more likely to make this comment (61%).

Figure 4-9 Suggested improvements



Draft: Oct 20, 2008

Cost of Service

One-third of clients paid less than $4 for a one way trip to use Health Connections while one-half paid between $4 and $5.99 and 12% paid $6 or more. The vast majority of clients are aware of the (correct) price they paid for using Health Connections. Overall, only five percent of clients recalled the cost of their trip incorrectly. These clients claimed they paid $4 or more for their trip whereas the actual cost was $2. Therefore, while they may have a perception they are paying more than they are, they may also have reported the cost of their return trip.

Figure 4-10 Cost of last-trip


Draft: Oct 20, 2008

Likelihood of Using Health Connections in Future

Nine in ten clients claim they are very likely to use the Health Connections transportation service in the future if the need arises. Another four percent are somewhat likely while only four percent say they are unlikely to use it again in the future. If the cost of the service was $1 to $2 more than what clients pay now, nine in ten continue to say they would be likely to use the service, including eight in ten who are “very” likely. However, if the cost of the service increases by $3 to $5, then the proportion of clients who are likely to use the service in the future drops to 75% and those “very” likely to use the service drops to 50%. Clients in KB appear to be the most price sensitive as their likely usage decreases as price increases. Specifically, KB likely future usage drops from 96% to 76% with a $1-$2 increase, and to 38% with a $3-$5 increase.

Figure 4-11 Likelihood of continued use of the service


Draft: Oct 20, 2008

Appendix-Survey Instrument

Interior Health Authority—Health Connections Survey

September 30, 2008

[Import List Source, HSA & Community] Hello, could I please speak with _______? Hello, my name is _____ and I’m calling from NRG Research Group on behalf of the Interior Health Authority. Our records show that you used [insert service provider used] sometime in the past 6 months to get to a medical appointment from (insert start point) to (insert destination). When you scheduled your trip, you were asked about participating in a survey that would help us to understand how the service was that you received and how to improve it. Note: If R would like to validate the authenticity of this service, they can contact James Coyle of the Interior Health Authority. His phone number is 250-870-4714. a. Do you recall taking a trip with [insert service provider used] to get to a medical appointment?

1. Yes 2. No/DK >> thank and terminate

b. Do you have about 10 minutes now to answer a few questions that will help us improve these

transportation services?

1. Yes >> Go to Q1 2. No >> Ask: Is there a more convenient time for us to call back?

If yes, schedule callback date/time: _______________ If no, thank and terminate

1. First, have you heard of a program called Health Connections?

1. Yes 2. No >> Go to Q3 3. Not sure/Ref >> Go to Q3

2. Can you briefly describe what you believe the Health Connections program is? Do not read.

Can be multiple response. 1. A program/service that gets people (in rural areas) to health care services

2. A transportation/bus/taxi service

E


Draft: Oct 20, 2008

3. That’s the service I used 4. Other (specify) __________________ 5. Don’t know/Just heard of the name

3.1 To let you know, Health Connections is a program that helps people living in rural areas travel to

health care services. [insert service provider used] is associated with the Health Connections program. Did you know that [insert service provider used] is associated with the Interior Health Authority’s Health Connections program?

1. Yes, aware 2. No, not aware/DK 3.2 When was the last time you used [insert service provider used] to get to a health care

service? Read list only if necessary 1. Within the last 2 weeks 2. 2 weeks to less than a month ago 3. A month to <3 months ago 4. 3 months or more 5. Can’t remember – Do not read 4. How many times in total have you used [insert service provider used] to get to and from a

medical appointment in the last 6 months? Please count each one-way trip as one trip? IF UNSURE, SAY An estimate is fine.

Record absolute: ______ Range: 1-998; 999. Don’t know

5. How did you first find out about the [insert service provider used]’s service for medical

appointments? Do not read. One response only.

1. Friend/relative/word of mouth 2. Doctor 3. Medical assistant/receptionist/other person in doctor’s office 4. Radio 5. Brochure/poster 6. Hospital 7. Newspaper/newspaper ad 9. Saw the bus

8. Other (please specify)____________________________ In the next few questions, I will refer to the ‘Health Connections service.’ This term refers to the transportation service provided by [insert service provider used] to get to and from medical appointments.


Draft: Oct 20, 2008

6. Why did you use the Health Connections service to get to your medical service appointment? Do not read. Probe. Can be multiple response.

1. Don’t have a car/don’t/can’t drive/no license 2. Can’t afford to drive 3. Don’t like to drive 4. Don’t drive long distances 5. No one else to drive me /Have to/don’t have any other options 6. Ride share good for environment 7. Like to use public transportation 8. Like the people who use the service 9. Enjoy the scenery on the route 10. Other (please specify)____________________________

If CODE 1 NOT mentioned in Q6, ask: 7. Do you own a car? 1. Yes 2. No 8. What was the main purpose of the last trip you took using the Health Connections service? Do not read. Can be multiple response.

1. Appointment at hospital 2. Appointment with specialist/doctor 3. Visiting a loved one/friend 4. Both for medical and social reasons 5. Other (specify) _____________

9. If [insert service provider used]’s Health Connections service was not available, how would

you have gotten to your destination instead? IF NECESSARY: What would the most likely method have been? Do not read list

1. Family member (spouse, daughter/son, sibling, etc) 2. Friend 3. Taxi 4. Drive self 5. Public transport 6. Hitchhiked 7. I would not have been able to go/have no other means 8. Other (specify) ________________ 9. Don’t know


Draft: Oct 20, 2008

10. Now thinking about the whole process of using Health Connections from the time you booked your transportation to when they picked you up to take you to where you needed to go and then to get you back. Overall, how would you rate the service provided by Health Connections? Would you say it was excellent, good, fair, poor or very poor?

1. Excellent 2. Good 3. Fair 4. Poor 5. Very poor 11. Now I’m going to ask you about specific aspects of using the Health Connections service. For

each one, please tell me if you felt that aspect of the service was excellent, good, fair, poor or very poor. Randomize

Exc Gd Fr Pr VP DK 1. Ease of booking the ride 1 2 3 4 5 6 2. Availability of the ride when you needed it 1 2 3 4 5 6 3. Reliability in terms of picking you up on time before and after your appointment 1 2 3 4 5 6 4. Convenience of the pick-up/drop-off locations 5. Value of the service 1 2 3 4 5 6 6. Friendliness of the driver 1 2 3 4 5 6 7. Comfort of the vehicle 1 2 3 4 5 6 12. Is there anything about the Health Connections service that you would change to improve

transportation to health care services for you? Probe Do not read Can be multiple response.

1. More pick up/drop off locations 2. More pick up/drop times 3. Bus available more days 4. Less waiting time for bus in destination community 5. Other (please specify)____________ 6. Nothing/fine the way it is 7. Don’t know

13. How likely are to you to use the Health Connections transportation service in the future if the

need arises? Would you be... read 1. Very likely 2. Somewhat likely 3. Not very likely; or >> Go to D1 4. Not at all likely >> Go to D1 5. Don’t know – Do not read


Draft: Oct 20, 2008

14. Can you tell me how much you paid for a one-way trip the last time you used the Health Connections transportation service?

1. $1.00 - $1.99 2. $2.00 - $3.99 3. $4.00 - $5.99 4. $6.00 or more 5. free 6. don’t know 15. And if the cost of this service was between one and two dollars more than you pay now, how

likely would you be to use the Health Connections transportation service in the future? Would you be... read

1. Very likely 2. Somewhat likely 3. Not very likely; or >> Go to D1 4. Not at all likely >> Go to D1 5. Don’t know – Do not read 16. And if the cost of this service was between 3 and 5 dollars more than you pay now, how likely

would you be to use the Health Connections transportation service in the future? Would you be... read

1. Very likely 2. Somewhat likely 3. Not very likely; or 4. Not at all likely 5. Don’t know – Do not read D1 Lastly, I have just a few more questions to will help us understand who is using the Health

Connections transportation service. Indicate gender: 1. Male 2. Female D2. In what year were you born? 19 __ __ D3. Which of the following best describes your walking ability? Read list. Can be multiple

response.

1. Walk independently 2. Use a cane 3. Use a walker 4. Wheelchair 5. Scooter 6. Other (specify) _________________________

7. refused


Draft: Oct 20, 2008

D4. How many years have you lived in your current community? Record absolute: ______ Range: 1-998; 999. Don’t know/Refused

D5. Including yourself, how many people, in total, live in your household?

Record absolute: ______ Range: 1-8; 9. Don’t know/refused D6. And do you currently live in... read codes 1-4 1. A house 2. A townhouse or duplex 3. An apartment 4. other? (specify) ________________ 5. Care/seniors home – Do not read 6. refused D7. How far do you have to travel to get to the pickup location of the Health Connections driver

service? If necessary, PROBE and READ: “Typically” Read list as necessary until R picks response

1. Not at all / Picked up outside my home/building 2. Less than one street block from your home (less than 2 minutes) 3. Between 1-2 blocks 4. Between 3-6 blocks 5. More than 6 blocks from your home 6. Don’t know D8. And lastly, do you have relatives or other family members that live nearby whom you could call

occasionally to get you to some of your appointments? 1. Yes 2. No Those are all the questions I have. NRG and the IHA would like to thank you for your time and input today. Good bye.


Appendix I: IHA Rural Medical Access Program Proposal


NOVEMBER 30, 2004

PROPOSAL TO THE MINISTRY OF HEALTH SERVICES RURAL MEDICAL ACCESS PROGRAM

Table of Contents

Page

SECTION 1: PROPOSAL

1. Introduction 2 2. Alignment with Interior Health Strategic Direction 2 3. Provincial Principles for the Rural Medical Access

Program 2

4. Interior Health Principles 4 5. Program Administration 5 6. Funding Allocation by HSA 5 7. Program Outline 6 8. Interior Health Steering Committee Responsibilities 8 9. Potential Risks 8 10. Indicative Implementation Plan 9 11. Conclusion

9

SECTION 2

Appendix A: Thompson Cariboo Shuswap HSA Study

SECTION 3

Appendix B: Kootenay Boundary HSA Feasibility Study for the Tri-Cities

SECTION 4

Appendix C: East Kootenay HSA – Elk Valley Feasibility Study

SECTION 5

Appendix D: East Kootenay HSA – Columbia Valley Feasibility Study.

November30, 2004 Interior Health - Rural Medical Access Program Page 1 of 10

PROPOSED RURAL MEDICAL ACCESS PROGRAM 1. INTRODUCTION

The Ministry of Health Services will be providing $1 million annualized funding to Interior Health to fund a Rural Medical Access Program. The intent of this program is to improve access to core specialty services for individuals who live in rural communities by enhancing transportation systems. The funds are to be used for non-ambulance transportation purposes. Four Health Authorities have been instructed to work collaboratively regarding development of the proposals to ensure consistency in the application of the principles, while recognizing the specific needs of each health authority. The subject of this proposal, the Rural Medical Access Program, is not part of the BC Travel Assistance Program (TAP). The BC TAP, underway since 1993, is a partnership program coordinated by the Ministry of Health Services and transportation partners who agree to waive or discount regular fees such as ferry costs, air ambulance subsidies, airfares, and rail subsidies. The Ministry of Health Services does not provide direct financial assistance with travel costs within the TAP. 2. ALIGNMENT WITH INTERIOR HEALTH STRATEGIC DIRECTION Although transportation is not a mandate of the Health Authorities, this program would align with Interior Health Strategic Objective #3 “Hospitals Within a Hospital System”:

To create an integrated network of hospital care that respects Provincial access standards and has the diagnostic capabilities, clinical support and appropriate staff resources required to manage trauma needs and provide quality care in a timely manner.

In addition, the 2002 Acute Care Review of Roles contains the following principles:

• For the wellbeing of patients who require core medical services, patients should be treated locally within their Health Services Area

• An effective patient transportation system within Interior Health is deemed

critical for the delivery of acute care services. 3. PROVINCIAL PRINCIPLES FOR THE RURAL MEDICAL ACCESS PROGRAM Consensus was reached by a provincial ad hoc working group to support the following provincial principles. This group included representation from each of the four Health Authorities together with the Ministry of Health Services. These provincial principles are:

1. Address transportation needs of residents living in rural communities within the Health Authorities and seeking medically insured health services outside their communities from recognized medical specialties. Eligible patients will require a referral by their physician for these health services. This new program is not connected to the Travel Assistance Program (TAP).


2. Focus on communities identified by health authorities with the greatest need for access to medical specialty services, consistent with the "Standards of Accessibility and Guidelines for Provision of Sustainable Acute Care Services by Health Authorities" published by the British Columbia Ministries of Health Services and Health Planning in February 2002. The specific target population for the proposed "Rural Medical Access Program" should reference standard 4.3 dealing with "Specialty Services": “Access to core specially services will be available within four hours travel time for 98% of residents within the region and 95% of the population of each HSDA. Core specialty services include general surgery, anesthesia, psychiatry, internal medicine, obstetrics and gynecology, and pediatrics. Depending on the catchment population and location, specialty services outside major referral centres may include other specialties such as orthopedics, urology, ophthalmology and otolaryngology."

3. Support rural residents who are not well serviced by the current provincial Travel

Assistance Program (TAP), and for whom travel and the associated expense represents the greatest financial burden.

4. Reflect local community capacity and respect historical informal arrangements

and community networks wherever possible.

5. Be available to individuals with a valid BC health insurance card, who are residents of one of the four involved health authorities, traveling to seek medical specially services in BC The program does not cover out of province travel.

6. Be open to all eligible individuals, independent of income, age or medical

condition (the need must not be emergency – related). The program will include some mileage restriction (specified by each health authority). Participants will be obligated to pay a "user fee," as the program will not provide a complete subsidy.

7. The program will not provide reimbursement to individual residents. By avoiding

an approach that provides direct financial assistance to individuals, there is a potential to mitigate the risk that excessive client demand will drive costs beyond allocated funding.

8. The program will be a "funder of last resort". That is, individuals receiving full

travel assistance from other Provincial Government funded programs, e.g. social assistance, workers' compensation, or third party insurance etc., will be ineligible. Individuals who would normally receive full travel assistance from a third-party program, but where the program's expenditures have been exhausted, are eligible for this new rural medical access program.

9. Subsidization of BC Ambulance Services (BCAS) ground or air ambulance trips

will not be provided.

10. Authorities will promote increased local and regional infrastructure and medical services capacity wherever possible. The intent of the program will be to avoid exporting patients outside each of the involved regions, and potentially repatriate patients.


11. Potentially include at a later date "provincial or preferred rates" for third party transportation (bus lines, scheduled airlines and other air carriers, and ferries) and accommodation. Health authorities will need to work together to negotiate consistent and equitable arrangements.

12. Health authorities may examine, tender and attempt to contract for hotel/hostel

arrangements where the hosts coordinate local travel, and provide meals and support.

13. Contain a cost containment strategy and a strong evaluative component, in part

to ensure continuous quality improvement, as well as to attempt to forecast future demands and service requirements. The program will also be designed to minimize misuse and fraud.

14. Adhere to the principle of fair and open competition and tendering practices.

15. May provide accommodation subsidy, however this is not obligatory.

4. INTERIOR HEALTH PRINCIPLES FOR THE RURAL MEDICAL ACCESS

PROGRAM The following additional principles were developed to support the Interior Health program:

1. As transportation is not within the mandate of the Health Authorities, Interior Health will provide subsidy grants through contractual arrangements to third party providers who will be responsible for the transportation arrangements.

2. The focus will be on providing transportation that supports the 2002 Acute Care

Centres Role Review redesign (“Hospitals Within a Hospital System”). 3. The program will support patient non-emergent transportation from rural areas to

tertiary and service area hospitals that provide specialist services.

4. Where possible, Interior Health will schedule specialist services to align with patients’ use of the rural transportation program.

5. Financial assistance for patient accommodation will not be provided, however

Interior Health will provide lists of available accommodation with preferred providers

6. Where applicable, Interior Health will provide subsidy to third party providers

through appropriate business practices and contracts.

7. Interior Health will require the third party providers submit semi-annual reports including performance indicators (for example statistical indicators and financial information).

8. Interior Health will utilize an internally agreed upon financial formula to determine

allocation need for rural Local Health Areas.


5. PROGRAM ADMINISTRATION From the $1 million funding allocation for Interior Health, the Ministry of Health Services has informed the Health Authorities that 5% can be used for administration; this equates to $50,000 annually for Interior Health. This 5% may be exceeded on a one-time basis only in the start up of the program. INTERIOR HEALTH plans to expend more than 5% of the total allocation in January-March 2005, for the purposes of setting up the program, including allocating funds for communication expertise and support. For practicality, the program will be coordinated at a Health Services Area level. This decentralized model is also supported by the Northern Health Authority because of similar issues relating to rural geography, coordinator travel, and the importance of maintaining relationships with transportation providers. A portion of a position within each Health Services Area will be assigned responsibility for the Rural Medical Access Program. These four representatives will also participate, together with additional representatives, on an Interior Health Steering Committee to assist with developing and monitoring the program. The HSA Coordinators have been identified in three of the four HSAs and include the following: Community Development Director, Manager, Quality Improvement and Community Capacity Development Manager. 6. FUNDING ALLOCATION BY HSA Population Based excluding “Urban” Local Health Areas The methodology for fund allocation is population based, but does exclude Local Health Areas (LHAs) that are deemed “urban”, and these are:

Penticton, Summerland, Central Okanagan, Vernon, Enderby/Armstrong Salmon Arm and Kamloops,

The remaining non-urban populations (using P.E.O.P.L.E 29 projections for 2004) have cumulative populations for the HSAs indicated below. In using these non-urban populations, the proportional annual allocation will be:

HSA Non-Urban Population Funding Allocation Thompson Cariboo Shuswap 78,808 $285,714 Kootenay Boundary 79,933 $285,714 East Kootenay 79,951 $285,714 Okanagan 35,363 $142,858 Total 274,055 $1,000,000


7. PROGRAM OUTLINE The approach agreed by Interior Health is to work with the existing service providers many of whom have been actively involved in discussions regarding transportation issues, including the feasibility studies. It is essential that this program build upon the foundation work and relationships with community organizations that have been developed overt time. Thompson Cariboo Shuswap From May to August 2004, Thompson Cariboo Shuswap (TCS) Health Services Area (HSA) assessed the lack of affordable, timely, personalized and friendly transportation for seniors, disabled and lower-income people. This study considered socio-economic indicators relating to transportation to medical services, work, school, and social activities. This study provided an inventory of existing services in TCS in four categories: facility bus, transit bus, HandyDART, and Private (taxi or Band van). The study provided examples of “tried but failed” programs, and success stories. Volunteer drivers are already heavily committed in the TCS HSA and it is not possible to add additional expectations on the volunteer population. The study proposes a short-term pilot project in Merritt in conjunction with BC Transit and other stakeholders. It also proposes a long-term solution involving BC Transit and various stakeholders. The funding allocation of $285,714 (less 5% i.e. $14,285 for administrative overhead) would be allocated in conjunction with information contained in the “Community Capacity Building Transportation” study, and will build upon existing community capacity. This study is attached as Appendix A. Oversight regarding allocation and evaluation will be assigned to the Thompson Cariboo Shuswap Leadership Team, with one member of the team accountable for the HSA Rural Medical Access Program. Okanagan The Okanagan HSA will be providing funding subsidies to third party providers such as BC Transit, current transit operators and existing local transportation groups. There are currently local transportation groups operating in Princeton, Keremeos, and Oliver/Osoyoos. Feasibility studies within the South Okanagan are currently being conducted by BC Transit, the outcome of which will be used to assist in the determination of the specific program details. The funding allocation of $142,858 (less 5% i.e. $7,142 for administrative overhead) will be allocated to these third party providers through contractual agreements, and these providers will provide transportation to improve non-emergency transportation access to health services in Penticton, Vernon and Kelowna. Oversight regarding allocation and evaluation will be assigned to the HSA Okanagan Leadership Team, with one member accountable for the Rural Medical Access Program.


Kootenay Boundary The Kootenay Boundary Transportation Group, with representation from Interior Health, has met to discuss improved non-emergency access to health services. A current proposal is under development relating to the “tri-cities” of Nelson, Castlegar, and Trail. In addition, a report was prepared in February 2001 for BC Transit, Nelson, Castlegar, Trail Inter-City Transit Research – Transportation Needs and Concept Testing by McItyre and Mustel Research Limited. This report considers community support, travel patterns, etc. and has been attached as Appendix B. Kootenay Boundary has a Community Development Director who works with the community to improve transportation, and this work meshes with the proposed Rural Medical Access Program. This Manager will assume overall liaison responsibilities for the new program, across INTERIOR HEALTH. Within Kootenay Boundary, liaison is underway with the Regional Districts, Volunteer Driver Programs and local Transit Operators. Local Transit Operators include Trail Transit Service, Arrow and Slocan Lakes Community Services Society, and City of Nelson. Similar to the Thompson Cariboo Shuswap, Kootenay Boundary HSA has considerable experience with “tried but failed” programs, plus also have success stories. The funding allocation of $285,714 (less 5% i.e. $14,285 for administrative overhead) will be allocated through contractual agreements to third party providers who will provide the transportation. Oversight regarding allocation and evaluation will be assigned to the Kootenay Boundary Leadership Team, with one member accountable for the HSA Rural Medical Access Program. East Kootenay In the East Kootenay, two transit studies have been conducted by BC Transit. The study was of the Elk Valley Transit Feasibility Study was conducted in May 2002, and the Transit Feasibility Study for the Columbia Valley was conducted in April 2002. These have been included as Appendix C and Appendix D respectfully. The East Kootenay will be continuing its work with the Regional Districts, and plans to utilize BC Transit to improve patient access to health services. The funding allocation of $285,714 (less 5% i.e. $14,285 for administrative overhead) will be allocated through contractual agreements to third party providers who will provide the transportation. Oversight regarding allocation and evaluation will be assigned to the East Kootenay Leadership Team, with one member accountable for the HSA Rural Medical Access Program.


Other Options Considered: Several options have been considered but disregarded for reasons of practical application. Interior Health will not be:

• Including accommodation because this was not considered greatest need, • Air transportation because all communities are accessible by ground travel, and

ground travel was established as the priority, and • Allocation of funds on a “needs basis” because the HSAs are responsible for the

allocation of their funds on a needs basis. 8. INTERIOR HEALTH STEERING COMMITTEE RESPONSIBILITIES Further considerations for the Interior Health Rural Medical Access Program Steering Committee are to:

Ensure liaison with the Service Area and Tertiary hospitals to coordinate transportation of rural patients with hospital schedules, for specialist clinics and diagnostic services, and coordination with specialist office visits. The hospitals are located in Kamloops, Trail, Cranbrook, Penticton, Vernon and Kelowna,

Prepare contracts and evaluations with agreed upon consistent performance

measures for the third party providers,

Develop and implement a Communication Strategy.

Develop and maintain accommodation listings of preferred providers within each HSA.

9. POTENTIAL RISKS Potential risks to this program include:

Potential Risk Mitigation Strategy i. The program will be sensitive in a political manner

Effective communication strategy

ii. The program may require additional funding to be sustainable

Priority should be based on greatest need, and compliance with provincial principles.

iii. Potentially, there may be few supporters in the community

Effective communication strategy and work with community partners.

iv. There may be unmet expectations that may result in complaints about inequity relating to program implementation across BC, and within Health Authorities.

Effective communication strategy and work with community partners.

v. There may be complaints about the basis on which the allocations to and within the health authorities are made.

Effective communication strategy.


vi. The potential for "perverse financial incentives." Unless

there is significant management involvement, family practitioners may choose to refer patients to specialists in Vancouver, potentially overlooking resources in a regional HSA centre.

Monitoring and evaluation processes to be transparent and comprehensive. Mechanisms to be established through the Interior Health Steering Committee for decision-making and problem identification and resolution.

vii. Ensuring value for money. Establish comprehensive evaluation with performance indicators and actions to remedy poor performance.

10. IMPLEMENTATION PLAN The following Indicative Implementation Plan has been developed to meet the required timelines for this new program:

Target Date

Activity Responsibility

November 30, 2004

Submission of proposal to the Ministry Executive Liaison Officer, Interior Health

December 2004

Proposals reviewed and approved Ministry of Health Services

December 2004

Identification of remaining HSA Coordinator (3 have already been identified)

Chief Operating Officers

December 2004 Interior Health Steering Committee to be established: draft Terms of Reference, membership, evaluation criteria, processes for liaison with hospitals etc. Revision and refinement of Implementation Plan. Consider options and agree on user fee.

COOs and Executive Liaison Officer

December 2004 onwards

HSA Coordinators develop detailed plans for their respective HSA programs.

HSA Coordinators

December 2004 Develop Communication Strategy Steering Committee, Interior Health Communications and Communications: Ministry of Health.

January 2005 Announcements in each community re the program.

Minister of Health Services

January – March 2005 Program implemented in specified communities (Thompson Shuswap Cariboo and Kootenay Boundary to be implemented first)

Coordinators in conjunction with community partners.

January – March 2005 Detailed planning for those HSAs without feasibility studies to be continued; programs agreed and implementation commenced.


April 2005 onwards. Program implemented in remaining communities.




Monthly (or quarterly) Monitoring of the program to ensure

consistency and compliance with principles, and most effective use of resources.

Interior Health Steering Committee

Winter 2005 Commence evaluation of the program to recommend adjustments as required to funding or service delivery for the new fiscal year.

Interior Health Steering Committee

11. CONCLUSION The purpose of the Interior Health Rural Medical Access Program is to improve transportation access to health care services for individuals who live in rural communities. The focus on the program is to provide funding subsidies based on contractual arrangements with appropriate performance evaluation. There will be accountability to one person within each HSA, and oversight will be by the HSA Leadership Team. An Interior Health Steering Committee will provide coordination and standardization of the program across Interior Health as appropriate. Prepared November 30, 2004


Appendix J: Glossary Community – An incorporated or unincorporated place as defined by BC Stats with a

population of 500 or greater.as of 2006 Custom Transit – Transit that generally runs in city centres and caters to ambulatory

passengers HandyDART – These services are offered where conventional transit already exists

and therefore clients unable to use regular transit are target customers (elderly, disabled)

Health Professional – A health professional in this document refers to an IH scheduler or

someone working in a physician office IH Scheduler – An Interior Health staff member working in a referral centre and

schedules medical appointments for clients traveling in from out of town. In this case IH schedulers working at EKRH, KBRH, KLGH, PRH, KGH, VJH or RIH

Paratransit – A HandyDART bus that runs where conventional transit does not exist

and services both regular and higher need clients, with priority given to higher need clients

Physician Office - In this document a GP office in a rural community where Health

Connections offers service or a specialist office in a referral centre Program Principles - Program principles were set up by a province wide group with

representatives from each Health Authority and the Ministry of Health Services. These principles were developed to guide the program development and many are suggestive in nature

Rural – Any Local Health Area or community that falls within a Local Health

Area in Interior Health with exception of Vernon, Enderby, Armstrong-Spallumcheen, Penticton, Summerland, Central Okanagan, Kamloops and Salmon Arm.

Serviced Community – A community where a Health Connections bus will stop to pick up

clients. Many smaller communities are located a number of kilometers away from the highway or Health Connections route. In these cases, clients will need to arrange transportation to a location where a Health Connections bus will stop; therefore these communities are not considered serviced.

Transportation Service Status - Defines the status of transportation services before and after

Health Connections service implementation

None (N) - No transportation services exist here to our knowledge



New Route (New) - No transportation services existed here before the Health Connections route was implemented

Enhanced Route (E) - Services existed here before the Health Connections route

was implemented but was either less frequent or structured differently.

Pre-existing (P) - Services existed here before the Health Connections route

was implemented and therefore Health Connections dollars did not need to be allocated here

Not Applicable (N/A) - This community falls within an Urban Local Health Areas,

therefore transportation services are not meant to be targeted here. In cases where communities are serviced anyways, a classification of New, E or P will be assigned



Addendum-January 13, 2009

A draft version of the evaluation report was presented to a number of senior management on January 13, 2009. Those present include: o Murray Ramsden, Chief Executive Officer o Chris Mazurkewich, Corporate Chief Operating Officer o Diane Goossens, Acting Chief Human Resources Officer o Kelly Murphy, Corporate Director – Medical Administration o Colleen McEwan, Executive Liaison Officer o Brent Hobbs, Regional Director – Patient Transportation Services o Colin Williamson, Patient Transportation Consultant o James Coyle, Leader – Evaluation o Christine Ronning, GIS Analyst Discussion and determined next steps are summarized below: Discussion

• The cost per ride indicator prompted significant discussion regarding the prospects of a more cost effective transportation model than the current Health Connections program.

• An increase in the use of telehealth technology may result in less need for the program in future and therefore lower ridership.

• There was discussion about the importance for the funding to address the target population for health riders; especially those clients that have no other transport options.

• Working relationships and community use of this service needs to be a consideration when examining program model changes.

Next Steps

• It was determined that some of the data in the original report would be bettered rendered in a mapping format. The Evaluators agreed to prepare maps and insert into the Final version of the Evaluation Report.

• Circulate the Evaluation Report to BC Transit, Ministry of Health Services and Program and Municipal Partners for review and comment; there is interest from IH to get input from our partners regarding how to best fulfill the report recommendations.

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