Fraser Institute’s Hospital report card a controversal measuring tool

Health organizations say Fraser Institute's Hospital Report Card can be misleading.

The Fraser Institute’s recent  Hospital Report Card is a controversial document among health care organizations.


“It’s pretty much impossible for the average British Columbian to use the information in a useful way,” said Mike Old, a spokesman for the Hospital Employees’ Union.


He said it could be hard for people to make “heads or tails” of the information, categories such as risk adjustment, and what it means and how it will affect them.


The document, released this month, compares the death, infection and other rates for procedures among 95 acute care hospitals in the province. There are 41 indicators overall. The report data is from more than 3 million anonymous patient records from the Canadian Institute for Health Information’s discharge abstract database. However, unlike previous years the report no longer has overall mortality index ranking all hospitals against each other in one index.


Stephen May, a spokesman for the Ministry of Health, said in an e-mail that the report is an important document that allows for transparency but it has strengths and weaknesses.


“We have a number of concerns with the Fraser Institute’s methodology – concerns shared by other jurisdictions in Canada,” he said. “These report cards are evolving tools that must be interpreted with caution. It is more important to compare hospital performance over time than to compare hospitals against each other.


“Ranking hospitals against each other can be volatile and misleading, as hospitals serve different patients with different needs, requiring different procedures.”


He said some hospitals may handle more complex procedures or have a larger volume while others may perform very little, which could lead more expert facilities ranked lower.


May’s sentiments are shared by the Vancouver Island Health Authority. In a statement to the News Bulletin VIHA said that the rankings can shift dramatically from year to year particularly in smaller hospitals based on a few more deaths that might not have been preventable.


The Nanaimo Regional General hospital received a rating on par with most B.C. institutions for most procedures. However for the past several years it has performed worse than the B.C. average on congestive heart failure mortality rates and acute stroke mortality rates. Since 2006-07 NRGH has received a worse than average in congestive heart failure. In acute stroke it received a worse than average mortality rate from 2001-05. It returned to the provincial average for a couple of years and then dipped again from 2007-09.


However, NRGH has been excelling at laparoscopic cholecystectomy, invasive gall bladder removal, and has performed better than average from 2001-09.


Old said realistically a person living in Nanaimo can’t go to a hospital in Kitimat or Nelson for a procedure if it has a better ranking. People are treated in their community and need to demand that their health care providers are kept accountable for the services they offer.


“Nanaimo Regional General Hospital has had its problems but at the end of the day there are thousands of people that receive good quality service every month,” said Old.


Old said people who have concerns should speak to their physicians about their local health care service.


Nadeem Esmail, a Fraser Institute senior fellow and co-author of the report, said the report is a valuable tool to compare trends over time in a hospital and hold health care institutions accountable.


Esmail said a hospital that consistently performs worse than the provincial average should be asked questions and ones that perform significantly better should be used as examples of excellence for other institutions to learn from.


The Hospital Report Card is available at www.hospitalreportcards.ca.


reporter3@nanaimobulletin.com