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Hospital Report Card: Ontario 2009

Type: Research Studies
Date Published: March 12, 2009
Research Topics:
Hospital Report Cards

The Fraser Institute's Hospital Report Card: Ontario 2009 is constructed to help patients choose the best hospital for their inpatient care by providing them with information on the performance of acute-care hospitals in Ontario.

We set out to create a hospital report card that is easy to understand and accessible by the public, where individuals are able to look up a given condition or procedure and compare death rates, volumes of procedures, rates of adverse events, and utilization rates for their hospital to those of other hospitals in Ontario. This is accomplished by using state-of-the-art indicators developed by the US Agency for Healthcare Research and Quality (AHRQ) in conjunction with Stanford University that have been shown to reflect quality of care inside hospitals. These indicators are presently in use in more than a dozen US states, including several of the more populous ones, New York, Texas, Florida, and California.

We are using the Canadian Institute for Health Information's (CIHI) Discharge Abstract Database (DAD) as our primary information source. This information is derived from patient records provided to the CIHI by all hospitals in Ontario. Demographic, administrative, and clinical data are extracted from the Discharge Abstract Database for inpatient hospital stays from all acute-care hospitals in Ontario. Since more specialized hospitals may treat more high-risk patients and some patients arrive at hospitals sicker than others, it is important to risk-adjust the indicators for patients with the same condition but a different health status. The international standard for risk adjustment, the 3M™ APR™ DRG Classification System, is employed to risk-adjust the data. The Fraser Institute spent two years developing the methods, databases, and computer programs required to adapt the measures to Canadian circumstances. This work has been internally and externally peer-reviewed (Mullins, Menaker, and Esmail, 2006) and is supported by an extensive body of research based on the AHRQ approach.

Of Ontario's 136 acute-care hospitals, 17, representing 5% of inpatient records in Ontario in the latest year, granted us authorization to identify them by name in this report. This represents a significant drop from the first report, in which we were authorized to identify 43 hospitals, representing 41% of inpatient records in Ontario in 2004/05. We applaud those hospitals who voluntarily agreed to be identified in the Hospital Report Card: Ontario 2009. These hospitals should be commended for their efforts to empower patients with information regarding the health care they receive and for their ongoing commitment to quality improvement through accountability and transparency.

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