Appropriateness, effectiveness and safety of care delivered in Canadian hospitals: a longitudinal assessment on the utility of publicly reported performance trend data between 2012–2013 and 2016–2017

Abstract

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.

Hospital performance evaluation indicators: a scoping review

“…The clinical wards consisted of 8 wards, namely, emergency departments (EDs) [ 16 , 39 , 56 , 57 , 69 , 70 , 89 ], surgery departments [ 58 , 62 , 63 , 91 , 102 ], intensive care units (ICUs) [ 47 , 64 , 65 ], operating rooms (ORs) [ 38 , 88 , 108 ], surgical intensive care units (SICUs) [ 111 ], obstetrics and gynecology department [ 59 ], neonatal intensive care units (NICUs) [ 74 , 103 ] and quality of care [ 18 , 31 , 40 , 50 , 72 , 92 , 95 , 112 ] indicators. The paramedical departments consisted of 3 departments, pharmacy [ 60 , 76 , 98 ], laboratory and blood bank [ 37 , 42 , 43 , 49 ], and outpatient assessment [ 86 ] indicators.…”

Associations between hospital deaths (HSMR), readmission and length of stay (LOS): a longitudinal assessment of performance results and facility characteristics of teaching and large-sized hospitals in Canada between 2013–2014 and 2017–2018

“…These clear trends of overall decreasing hospital deaths and rising readmissions have been confirmed in our previous analysis. 21 …”

“…Our earlier research 21 established that, over time, Canadian hospitals have largely improved on in-hospital mortality; readmission rates have been trending upward; and that good or bad performance in one domain of care does not automatically reflect the same performance in other domains. What this present study aimed to add is whether a hospital’s improvement or weakening performance over time, in either hospital deaths (HSMR) or readmission, had a positive or negative association on the other; our results showed that 42% of hospitals, the largest proportion across the possible outcomes, in fact decreased hospital deaths (HSMR) while increasing readmission rates.…”