TORONTO, ON-Most Ontarians have no way of knowing if their local hospital is one of the best performing in Ontario, or one of the worst.

A new study released today by independent research organization The Fraser Institute compares the performance of Ontario's 136 acute care hospitals. But only 29 of the hospitals agreed to be identified.

Stratford General Hospital is the highest ranked of the hospitals that agreed to be identified, finishing 19th. Stratford has ranked among the top 10 hospitals going back to 2002.

Anonymous Hospital #10 is the highest ranked hospital in Ontario and has been a consistent top performer, ranked first or second since 2002. But its top administrators refused to let the Fraser Institute divulge its name. The eight lowest-ranked hospitals also refused to be identified. These hospitals have consistently been among Ontario's poorest performing hospitals.

"The hospitals that agreed to be identified in this report should be commended. These hospitals are obviously committed to their patients and the public by being accountable and transparent regarding their performance," said Nadeem Esmail, Director of Health System Performance Studies at The Fraser Institute and co-author of the Hospital Report Card: Ontario 2008.

In the Institute's 2006 Hospital Report Card, 43 hospitals agreed to be identified.

"It's unfortunate that even fewer of Ontario's hospitals appear willing to embrace the values of accountability and transparency, something I'm sure most people in Ontario will find unacceptable."

The peer-reviewed Hospital Report Card: Ontario 2008 compares the performance of hospitals based on up to 50 indicators of quality (such as death due to a stroke) and patient safety (such as a foreign body left inside a patient during a procedure). The gold standard methodology was developed by the US Agency for Healthcare Research and Quality (AHRQ) and researchers at Stanford University and employs a risk-adjustment system developed by 3M. This approach is being used in more than a dozen US states, Manitoba, British Columbia and Ontario. The current report card uses 39 indicators calculated for the latest year for which results are available. The indicators are risk-adjusted and are shown for acute-care hospitals in Ontario from 1997 to 2006 (where available), comprising more than 9.5 million completely anonymous patient records.

All of the information in the hospital report card is available either in a series of free PDF documents or in a convenient and interactive way at www.fraserinstitute.org and www.hospitalreportcards.org

The report card is based on data from the Canadian Institute for Health Information's (CIHI) Discharge Abstract Database. This information is derived from patient records provided to CIHI by all hospitals in Ontario.

The Hospital Report Card: Ontario 2008 allows the public to look up a given condition or procedure and compare death rates, volumes of procedures, rates of adverse events, or utilization rates for their hospital to those of other hospitals in Ontario.

A key measure within the report card is the Hospital Mortality Index, which allows the examination of the overall performance of a hospital across nine mortality indicators.

Anonymous Hospital #10, the top-ranked Ontario hospital, scored 91.2 out of 100. Stratford General scored 88.2. St. Thomas-Elgin General Hospital is the second highest named hospital with a score of 84.9, good for 39th place.

Since 2002, the top-ranked hospital has improved its score to 91.2 from 79.6. The most improved hospital, the 12th ranked Anonymous Hospital # 25, improved its score to 89.4 from 68.7 in 2002.

The worst hospital, Anonymous Hospital #18, scored 72.8 out of 100. It was also in the bottom 10 in 2002 with a score of 67.2. Anonymous Hospital #55 has the third lowest score at 79.0 and is notable for showing the smallest improvement from 2002, when it scored 74.7.

Esmail pointed to the measure of deaths from heart attacks (acute myocardial infarction) as a way of comparing hospitals. One hospital in the bottom fifth has an acute myocardial infarction rate nearly three times the rate for one hospital ranked in the top fifth.

"If you have a greater chance of dying from a heart attack in one hospital compared to another, isn't that something you would want to know? As health care consumers, patients have a right to know how their hospital compares to other hospitals. Are they more likely to get an infection? Is there a higher rate of mortality for conditions where mortality is rare?" he said.

The report card also uses the Hospital Mortality Index to rank municipalities (based on where patients live). It found that Maple, Port Perry, and Orangeville had the highest rankings, each with 91. Among the larger municipalities, Ottawa was ranked 20th with a score of 86, Hamilton was 37th with a score of 84, while Toronto was 40th , Windsor 44th, London 45th, Kingston 55th, Sault Ste. Marie 72nd, and Sudbury 80th.

The lowest ranked municipality is Fort Erie at 93rd with a score of 62.2. Other municipalities ranked near the bottom have consistently earned low scores, such as Huntsville, Brockville, Tillsonburg and Port Colborne.

But Esmail cautioned that due to patient mobility, the hospital in the highest or lowest ranked municipality is not necessarily the highest or lowest ranked hospital.

"When it comes to the performance and services offered by most Ontario hospitals, they don't appear to want the public to know how they compare to hospitals nearby or in other communities," he said.

"If we truly want to improve Canada's health care system, administrators in the system must accept the need for measurement and comparison while acknowledging the rights of health care users to know how the system is performing."