New tool allows hospital performance comparisons

Canadians can now compare how hospitals across the country are doing on measures like deaths after major surgery and readmissions after hip replacements.

4 ways information could help people

Canadians can now compare how hospitals across the country are doing on measures like deaths after major surgery, readmissions after hip replacements, as well as financial performance.

The Canadian Institute for Health Information unveiled its hospital reporting tool on Wednesday to increase accountability and transparency for 600 acute-care hospitals across the country.

"You could imagine as a patient you could be facing going into hospital for a hip or a knee replacement," said Kira Leeb, director of health system performance with the institute.

Hospitals in the tool are grouped by size to facilitate comparisons. (Paul Chiasson/Canadian Press)

"You could look at the tool and say questions around 'What is the readmission rate for my hip or my knee replacement?' What that allows you to do is look at the rate, be able to see what it is for the hospital and then simply ask your orthopedic surgeon, 'What are the factors that affect readmission rates and how can I avoid being readmitted?'"

The tool displays a map of Canada where people can see how hospitals compare with the national average on these clinical indicators of quality care such as:

  • 28-day readmissions after heart attack and stroke.
  • 30-day mortality rates in hospital after stroke.
  • Readmission 90 days after hip replacement.
  • 30-day readmission rates for obstetric and surgical patients.
  • Obstetric trauma.
  • Caesarean section rates.

Hospitals can use these "performance allocation" indicators to see where they can improve and start learning from each other, the group said.

The results show that performance is moving in the right direction with substantial variation across facilities.

Hospitals are grouped by size so teaching hospitals, large, medium and small community hospitals are compared against their peers for the clinical indicators.

CIHI hospital reporting

The map allows people to hover over hospitals in a given area. Users can then click on a facility's snap shot to see how it compares to the national averages for mortality and readmission rates —  a possible sign of problems with treatment or care.

For large community hospitals for example, mortality rates within five days of major surgery varied eight-fold from 2.2 per 1,000 to 16.5 per 1,000.

Small hospitals performed worse for 30-day readmissions overall and for medical readmissions compared with the other sizes of hospitals and the national average.

Forcing improvements

While patients could try to use the tool to shop around, studies show most go to the closest hospital, said Jeremy Veillard, vice-president of research and analysis at the institute.

Cher Richards wishes she'd been able to search the site before she ended up having colon surgery in a neighbourhood hospital in Toronto where she believes she was discharged too soon.

"I was in the system so I really couldn't change my mind," said Richards. "Now knowing more, I would choose a different hospital."

Health advocate Natalie Mehra of the Ontario Health Coalition said  a low ranking could also force a hospital to change.

"The information could embarrass a hospital and force them to actually improve their standings in whatever areas they're doing poorly," Mehra said.

For example, administrative costs also varied from a high of 5.9 per cent in Ontario to 3.5 per cent in Alberta.

CIHI's information tells people about adverse events and harms from hospitalization in vague terms, said Dr. Michael Graven, director of medical informatics at Dalhousie University in Halifax. He has designed similar health information systems in the U.S. and Belize.

"I will predict, having been down this road many times and been in charge of it a few times, is that its impact will be minimal in spite of the cost and really heroic effort on the part of the folks at CIHI," Graven said.

Structural flaws and old data hamper the project's usefulness, he said.

The interactive website does not yet include rates of C. difficile and other hospital-acquired infections.

With files from CBC's Pauline Dakin and Kelly Crowe