April 4, 2012—A new resource at www.cihi.ca that looks at clinical and financial performance in acute care hospitals shows that hospitals saw fewer deaths after major surgery, heart attack and stroke; fewer readmissions after heart attack, stroke, and hip and knee surgery; and fewer cases of in-hospital hip fracture in 2010 than in 2007.
This resource, a part of the Canadian Hospital Reporting Project at the Canadian Institute for Health Information (CIHI), provides a series of 21 clinical indicators (with risk-adjusted rates) and 9 financial indicators that allows hospitals to compare their performance against those of their peers and to learn from
"This information fills an important gap in health system information," says John Wright, President and CEO, CIHI. "We are now able to report on aspects of both clinical and financial performance across all provinces and territories for more than 600 acute care hospitals in Canada."
While the results show that performance in Canada's hospitals is moving in the right direction for many of the measures, there are substantial variations across hospitals.
"When hospitals are grouped according to their peers," says Jeremy Veillard, Vice President, Research and Analysis, CIHI, "we see a wide range of results in performance." For example, in 2010–2011 among large community hospitals, mortality rates within five days of major surgery varied from 2.2 per 1,000 to 16.5 per 1,000, an eight-fold variation.
Hospitals were assigned to peer groups so that large hospitals can be compared with large, and small ones with small. This enables meaningful peer comparisons for quality improvement. However, measures of performance on selected clinical indicators across all hospitals show that there are hospitals from each of the peer groups that performed in the top 25th percentile for indicators such as mortality following acute myocardial infarction, mortality following major surgery and readmission after hip replacement.
"The fact that CIHI has been able to include small hospitals is very important," says Cecile Hunt, CEO of Prince Albert Parkland Health Region in Saskatchewan. "Almost 60% of hospitals in Canada are smaller facilities, and up until now there has been minimal information available to them about how they are performing in relation to their peers."
Results for financial indicators show that facilities across Canada have generally reduced their administrative costs as a percentage of their total costs since 2007. Administrative costs were calculated regionally for all provinces and at the hospital level for Quebec and Ontario. In Quebec and Ontario, administrative costs tended to decrease as hospital bed numbers increased. For regionally based provinces and territories, administrative costs tended to be lowest in the western provinces and highest in the territories, likely due to the smaller sizes of hospitals in the north as well as their remoteness.
"Whether people use the information to look at hospital care or administration, CIHI's new web-based resource helps facilities across the country better understand their performance in comparison with their peers," says Veillard. "Through comparison they are able to learn from each other. This has the potential to move the system as a whole toward even more transparency and accountability—and more importantly, to provide even better, more cost-efficient care to all Canadians."
i Please note that, for operational reasons, three of the nine financial indicators will become available at a later date.
Established in 1994, CIHI is an independent, not-for-profit corporation that provides essential information on Canada's health system and the health of Canadians. Funded by federal, provincial and territorial governments, CIHI is guided by a Board of Directors made up of health leaders across the country. Our vision is to improve Canada's health system and the well-being of Canadians by being a leading source of unbiased, credible and comparable information that will enable health leaders to make better-informed decisions.