ObjectivesTo assess the utility of publicly reported performance trend results of Canadian hospitals (by hospital size/type and jurisdiction).DesignLongitudinal observational study.Setting489 hospitals in Canada between fiscal years 2012–2013 and 2016–2017.ParticipantsAnalysis focused on indicator results of individual Canadian hospitals.Primary and secondary outcomesEight outcome indicators of hospital performance: in-hospital mortality (2), readmissions (4) and adverse events (2). Performance trend outcomes of improving, weakening or no change over time. Comparators in performance by hospital size/type of above, below or same as average.ResultsAt the national level, between 2012–2013 and 2016–2017, Canadian hospitals largely reduced in-hospital mortality: hospital deaths (hospital standardised mortality ratio) −9%; hospital deaths following major surgery −11.1%. Conversely, readmission to hospital increased nationwide: medical 1.5%; obstetric 5%; patients aged 19 years and younger 4.6% and surgical 3%. In-hospital sepsis declined −7.1%. Approximately 10% of the 489 hospitals in this study had a trend of improving performance over time (n=49) in one or more indicators, and a similar number showed a weakening performance over time (n=52). Roughly half of the hospitals in this study (n=224) had no change in performance over time for at least four out of the eight indicators. No single hospital had an improving or weakening trend in more than two indicators. Teaching and larger-sized hospitals showed a higher ratio of improving performance compared with smaller-sized hospitals.ConclusionsAnalysis of Canadian hospital performance through eight indicators shows improvement of in-hospital mortality and in-hospital sepsis, but rising rates of readmissions. Subdividing the analysis by hospital size/type shows greater instances of improvement in teaching and larger-sized hospitals. There is no clear pattern of a particular province/territory with a significant number of hospitals with improving or weakening trends. The overall assessment of trends of improving and weakening as presented in this study can be used more systematically in monitoring progress.
ObjectivesTo examine the association between hospital deaths (hospital standardised mortality ratio, HSMR), readmission, length of stay (LOS) and eight hospital characteristics.DesignLongitudinal observational study.SettingA total of 119 teaching and large-sized hospitals in Canada between fiscal years 2013–2014 and 2017–2018.ParticipantsAnalysis focused on indicator results and characteristics of individual Canadian hospitals.Primary and secondary outcomesHospital deaths (HSMR); all patients readmitted to hospital; average LOS and a series of eight hospital characteristic summary measures: number of acute care hospital stays; number of acute care beds; number of emergency department visits; average acute care resource intensity weight; total acute care resource intensity weight; hospital occupancy rate; patients admitted through the emergency department (%); patient days in alternate level of care (%).ResultsComparing 2013–2014 to 2017–2018, hospital deaths (HSMR) largely declined, while readmissions increased; 69% of hospitals decreased their hospital deaths (HSMR), while 65% of hospitals increased their readmissions rates. A greater proportion of community-large hospitals (31%, n=14) improved on both hospital deaths (HSMR) and readmission compared to Teaching hospitals (13.9%, n=5). Hospital deaths (HSMR), readmission and LOS largely showed very weak and non-significant correlations. LOS was largely positively and statistically significantly correlated with the suite of eight hospital characteristics. Hospital deaths (HSMR) was largely negatively (not statistically significantly) correlated with the hospital characteristics. Readmission was largely not statistically significantly correlated and showed no clear pattern of correlation (direction) with hospital characteristics.ConclusionsExamining publicly reported hospital performance results can reveal meaningful insights into the association among outcome indicators and hospital characteristics. Good or bad hospital performance in one care domain does not necessarily reflect similar performance in other care domains. Thus, caution is warranted in a narrow use of outcome indicators in the design and operationalisation of hospital performance measurement and governance models (namely pay-for-performance schemes). Analysis such as this can also inform quality improvement strategies and targeted efforts to address domains of care experiencing declining performance over time; further granular subdivision of the analyses, for example, by hospital peer-groups, can reveal notable differences in performance.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.