Tuesday, April 3, 2012

Best and worst GTA hospitals: Toronto-area lags in patient care, national report says

Half the hospitals in Greater Toronto fare worse than the national average when it comes to keeping patients alive following major surgery, according to a watershed report released Wednesday.

The newly released data, which makes a host of hospital performance measures public for the first time, also shows that 11 of 18 GTA hospitals fall below the national average at preventing inpatients from dying within 30 days of being admitted for a major heart attack.

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The Canadian Institute for Health Information (CIHI) released the landmark data in an innovative online tool that is being called the most advanced of its kind in the world.

It allows patients, physicians and hospital administrators to compare the performance of more than 600 acute-care hospitals across the country.

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The tool provides data on 21 clinical measures, which include readmission and mortality rates after various procedures, as well as nine financial measurements. In most cases, CIHI released four years of results.

Experts say publicly releasing such data forces hospitals to compare their performance against other hospitals and helps administrators focus on specific system improvements to better protect patients.

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Public reporting also provides patients with information about potential risks and problems inside their local hospitals.

Among the hospitals in the GTA, there is wide variation in performance measures with as much as a three-fold variation between some institutions.

ALSO SEE: Hospitals in Ontario spend more on administrative departments than hospitals in other Canadian provinces, report finds

To ensure fair comparison, CIHI assigned hospitals within peer groups based on size. In the GTA, there are five teaching hospitals, which typically see the sickest, more complex patients, and 14 large community hospitals that have more than 8,000 inpatient cases a year. (The Hospital for Sick Children is only included in three clinical measures, all of which involve readmission rates.)

According to a Star analysis of the 2010-2011 data, Lakeridge Health (with sites in Oshawa, Bowmanville and Port Perry) is the worst performing large community hospital in the GTA when compared against national averages in its peer group.

The analysis, which included the 21 clinical indicators, found that Lakeridge scored below the national average 13 times. The second worst performing large community hospital in the GTA is St. Joseph’s Health Centre, which fell below the national average on 12 clinical measures.

Halton Healthcare Services is tied with Mississauga’s Credit Valley Hospital as the best ranked hospital when compared against national averages for the same clinical measurements. Both institutions scored above the national average for 17 of the 21 measures

Michelle DiEmanuele, president of the newly merged Credit Valley Hospital and Trillium Health Centre, said she is delighted with the report, adding that it serves as a validation of the hard work the hospital has done to improve quality and patient experience.

“The CIHI report actually represents for us an indication of how successful we’ve been over the last several years in actually achieving our goals,” she said.

However, overall trends in the CIHI report do not tell the full story. When looking at a specific measure, for example, patients are three times more likely to die five days after major surgery at Halton Healthcare Services (with sites in Oakville, Milton and Georgetown) than at Markham Stouffville Hospital.

Dr. Lorne Martin, chief of staff at Halton, explained that the mortality figure reported for 2010-2011 is somewhat of an anomaly.

“In all cases other than the year that’s being reported, our mortality were well within expected ranges, and, in most cases, at the better level of performance for the GTA hospitals and better than national averages. So, the current year that’s reported is an exception,” he said.

Wide variation is also seen for the clinical measure that looks at an inpatient’s chance of dying within 30 days of being admitted to a hospital for stroke.

Patients admitted to Southlake Regional Health Centre for stroke are more than twice as likely to die within 30 days as patients admitted for the same condition at The Scarborough Hospital.

Among the five teaching hospitals in the GTA, the University Health Network and Sunnybrook Health Sciences Centre score the poorest. The University Health Network scored above national averages on measures of three clinical indicators and Sunnybrook did so for eight.

The University Health Network comprises four hospitals: Princess Margaret, Toronto Western, Toronto General and Toronto Rehab.

Dr. Bob Bell, president of the University Health Network, said it’s very difficult to compare data across hospitals.

“There are a great deal of apples and orange comparison in this data from my review of it,” Bell said. “But it’s certainly something we will use to do internal quality improvement.”

Keith Rose, executive vice president of Sunnybrook, said his hospital, as well as UHN, both have extensive regional province-wide programs, managing some of the sickest patients in hospitals.

“The kind of patients that are managed at Sunnybrook are high risk, severely injured or very sick patients,” said Rose. “It’s pretty hard to standardize for that kind of group of patients because they’re so much more complex than anywhere in the province.”

Jeremy Veillard, vice president of research and analysis at CIHI, said the Institute believes publicly releasing hospital measures “increases accountability and transparency in the system.”

Making the new tool will also help healthcare professionals improve their practice, which in turn helps improve patient care, he said.

In 2007, CIHI released mortality rates at hospitals for the first time. The rate, which is released annually by CIHI for individual hospitals, shows how effective institutions are at avoiding preventable deaths.

In the last five years, most Canadian hospitals have made progress in improving their death rates — with 40 per cent making “substantial progress,” Veillard said. The advances are largely attributed to hospital boards and administrators putting increased focus on system improvements in their institutions that better protect patients.

Overall, the CIHI analysis found, among other things:

• Fewer patients died after major surgery, heart attack and stroke at Canadian hospitals in 2010 than in 2007.

• Fewer patients were readmitted to hospital following heart attack, stroke, and hip and knee surgery in 2010 than in 2007.

• Hospitals across Canada have generally reduced the amount of money they spend on administrative costs. Ontario, however, spends more than any other province on hospital administrative departments, including human resources.

The tool is part of the Canadian Hospital Reporting Project at CIHI.

With files by Jayme Poisson; data analysis by the Star’s Andrew Bailey

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