What the Hospital Report Card: British Columbia 2009 Means to You

Last week, the Fraser Institute released its second Hospital Report Card (http://www.hospitalreportcards.ca/ ), with glaring improvements in that this year’s report actually includes the names of hospital facilities. The Fraser Institute battled with the Province and CIHI under the Freedom of Information Act to achieve this, and it should be noted that this is a Canadian first in the disclosure of hospital-related outcomes data.

“This is the first time this level of transparency and accountability in the hospital sector has been available to citizens of any province in Canada. Indeed, British Columbia can now be considered a leading in providing transparency and accountability with respect to publicly funded care being delivered in the province’s hospitals.” – Fraser Institute Report, Hospital Report Card: British Columbia 2009.

The Report uses a peer-reviewed methodology largely based upon an American model for outcomes measurement. Comprising 2.5 million records, the Report assesses 39 quality and safety indicators across 95 public hospitals in BC over a six year period. The results have been risk adjusted for the fact that tertiary hospitals tend to manage higher acuity (sicker) patients, and perform more complex procedures.

The Report Card is searchable by facility, municipality, indicator, and mortality rates. There are many interesting observations to be made, amongst them:

• Tertiary hospitals are not the only ones with good healthcare. In fact, Fraser Health’s Eagle Ridge Hospital ranked number one in the Hospital Mortality Index (the higher the ranking, the better), and Vernon Jubilee Hospital ranked third. Lion’s Gate was second, and Vancouver General fourth. Surprisingly though, hospitals with a wide range of services and specialties, such as Surrey Memorial Hospital, ranked 21 out of 26.
  
• The risk adjusted post-operative infection rate for elective procedures in public hospitals varies greatly and speaks to issues in individual facilities. Across the province, the infection rate is 6.2 per thousand (0.0062%). Ten hospitals in BC ranked higher, with the hospital in Quesnel ranking last with a risk adjusted infection rate of over 30 cases per thousand.
  
• Some hospitals are in need of serious review. Death in low mortality diagnostic related groups (DRG) occurs across the province at 1.4 cases per thousand. This indicates that the death rate among patients that are considered unlikely to die in the hospital. Four hospitals in 2006/7 reported rates over 8.4 per thousand, and one, McBride and District Hospital, reports 41.7 deaths per thousand (it should be noted that this is a smaller hospital and the data may be projected over 1000 patients and easily impacted by just a few cases). 39 hospitals scored 100, and had no deaths in low mortality DRGs.
  
• Not all hospitals use the same techniques. 82.18% of gallbladders in BC were removed using a laparoscopic technique, which as a minimally invasive procedure, results in shorter recovery, pain and complications. 42 hospitals in BC perform gallbladder surgery (normally done by a general surgeon), however if you lived in Prince George, Squamish, or Fort St. John, you were nearly half as likely to have your gallbladder removed using this technique.

While this Report is produced in a very user friendly manner, it has a few shortcomings. Firstly, the list of procedures measured is both short (only five) and somewhat of an odd selection. Two of the procedures listed (esophageal resection and pancreatic resection surgery), are so uncommon that under 100 total procedures are performed across the province each year. How can we measure a hospital’s performance using this indicator when some hospital performed just 9 in the year? The other shortcoming – and this is no reflection upon the Fraser Institute - is that BC patients lack portability in their healthcare options. While technically their insurance is portable, it is a challenge to have a Prince George GP refer you to a Victoria General surgeon for your specific procedure, never mind a logistical nightmare of consults, pre-operative, surgical and post-operative appointments.

I’d also like to see more information on volumes of procedures. If I actually had the opportunity to decide where to receive my care, the volume of procedures/treatments performed for my given medical need would certainly help me to determine where to receive care. Practice makes perfect.

The Fraser Institute claims that this report was designed to assist British Columbia patients in making informed decisions about their care. Beyond that, though, this Report provides a first look for Health Authorities and the Ministry of Health, at meaningful, methodical, risk adjusted data. It gives the hospitals and health authorities something to work with in terms of measuring outcomes, not just throughput. It gives the public something tangible against which to hold these public bodies accountable.

The Report Card may not be everything to everyone, but it is a giant leap for British Columbians in terms of the measurement of health system performance.