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BC health authorities don't want you to know which hospital is best or worst, improving or declining

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Release Date: February 25, 2008

VANCOUVER, BC-The best hospital in British Columbia has been a top performer since 2001. The worst hospital in the province has seen its performance decline during the past six years.

But the Fraser Institute can't tell you the names of either hospital.

Information measuring and ranking all 95 of BC's acute-care hospitals is contained in the first ever Hospital Report Card: British Columbia 2008, released today by independent research organization the Fraser Institute.

But BC's regional health authorities have refused to identify any of the 95 hospitals.

"If I want to book a hotel, I can go on the internet and get all kinds of information about the facilities and services, pictures of my room, and even ratings and comments from experts and other customers. But when it comes to the performance and services offered by BC hospitals, a cone of silence descends," said Nadeem Esmail, Director of Health System Performance Studies at The Fraser Institute and co-author of the Hospital Report Card: British Columbia 2008 .

"By failing to allow their performances to be measured and reported, BC's health authorities are refusing to commit to accountability and transparency, something I'm sure most British Columbians will find unacceptable."

The peer-reviewed study uses 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 British Columbia.

The Hospital Report Card: British Columbia 2008 consists of 39 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) developed by the US Agency for Healthcare Research and Quality (AHRQ). The indicators are risk-adjusted and are shown for all acute-care hospitals in British Columbia from 2001 to 2006, comprising almost two million completely anonymous patient records.

All of the information in the hospital report card is laid out in 13 separate documents.

The Hospital Report Card: British Columbia 2008 allows the public 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 BC.

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.

BC's top ranked hospital scored 83.5 out of 100 while the worst hospital scored 68.8 out of 100. Over the time frame examined, the most improved hospital increased its score to 81.5 from 75.9 while one hospital with the sharpest decline dropped to 74.9 from 82.1.

 "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? Is there a greater chance of a foreign object being left in a patient during surgery?" Esmail said.

He pointed to the measure of deaths from heart attacks (acute myocardial infarction) as a way of comparing hospitals. One low-ranked hospital has an acute myocardial infarction rate more than four times the rate for the best rated hospital.

"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?" he said. "It would seem that the hospitals and health authorities would prefer that you didn't have that knowledge."

The report card also uses the Hospital Mortality Index to rank municipalities (based on patient location information). It found that Nelson and Port Moody had the highest ranking at 78.6 and 77.5, although there was insufficient data prior to 2004. Penticton was the third highest ranking municipality with a score of 76.7.

The lowest ranked municipality is Salmon Arm at 57.1 followed by Maple Ridge with 58.8 then Abbotsford at 59.4.

"Due to patient mobility, you can't automatically assume that the hospital in the highest ranked municipality is also the highest ranked hospital," Esmail cautioned.

Later this year, the Fraser Institute will release its second Ontario Hospital Report Card in which 29 hospitals agreed to be identified. In 2006 when the Institute released the first Ontario Hospital Report Card, 43 hospitals agreed to be identified. The purpose of the hospital report card is to encourage improved quality of care by identifying disparities in performance between different hospitals.

 "It's unfortunate that BC's health authorities are allowing hospitals to hide behind a wall of anonymity," Esmail said.

"If we are going to seriously work towards improving Canada's health care system, health care workers and bureaucrats must accept the need for measurement and comparison while acknowledging the rights of health care users to know how the system is performing."



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