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This week the CBC has been running a series called Rate My Hospital which will end with the fifth estate program this Friday evening. Their work includes a Rate My Hospital website where individuals can look up the CBC's rating, and enter their opinion about an individual hospital. They have also conducted a voluntary survey of nurses across the country and asked all hospitals for data in a CEO survey. I thought I would send you my thoughts about this work as our hospitals have been judged by the CBC as an average C, according to the CBC's methodology.
I have no difficulty with releasing data about our performance, filling out their survey, or talking to CBC or any media outlet about the work we do here. I do have some difficulty in the way the CBC has chosen to report on the data because the data sets made available to them simply do not account for the differences between the case mixes in hospitals.
An example: they've looked at readmissions and mortality following heart attack or stroke. We know that the Peter Munk Cardiac Centre and the Neurovascular Unit in the Krembil Neuroscience Centre look after the sickest heart and stroke patients - other hospitals transfer heart attack and stroke patients to us when the degree of complexity is recognized. There is no standardization that accounts for the complexity seen in these sub-specialized areas of the hospital. It is therefore not surprising that the hospital looking after the sickest patients in this grouping would have a higher risk of poor outcomes when compared to a hospital that only treats lower acuity patients.
When we received the original data from CIHI that the CBC uses in this "rating" we asked the Peter Munk Cardiac Centre to review their outcomes and report to Senior Management and the Board Quality Committee. As expected, most of the mortality observed was in patients transferred here in very dire situations that unfortunately could not be salvaged. At UHN we use data from a program like Transplant or Princess Margaret Cancer Centre to compare ourselves with programs around the world which have similar volumes and case mix. The same is true in all of our programs and when we don't measure up, we work on it. We also participate in a number of surveys including the Canadian Institute for Health Information's (CIHI) Canadian Hospitals Reporting Program (CHRP) which, as I understand it, is the data that the CBC has used to provide ratings, with the advice of a panel of experts. I think it is unfortunate that the CBC has chosen to use this data to create a rating system, when CIHI itself states that the data cannot be used to compare one hospital to another. CIHI has emphasized that CHRP should be used by a hospital to evaluate quality improvement on a year to year basis. The CBC is using the data to compare hospitals that have entirely different patient populations.
I think the CBC's efforts will prompt discussion about our system and that's a good thing. In my opinion, their efforts at interpreting data leave a lot to be desired because one size definitely does not fit all when dealing with case complexity.