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B.C. plans to create hospital scorecard

VANCOUVER – The province of British Columbia is planning to launch a health report card as a response to an annual ranking of its hospitals by the Fraser Institute, according to a report in the Vancouver Sun.

“If you’re going to do it, do it right,” said B.C. Health Minister George Abbott, criticizing the Fraser Institute for using methods that he says produce misleading results. “I don’t want to see any hospital tagged with the label of being lower quality or less safe because there’s been inappropriate methodological use of data,” he added.

Abbott said B.C. is in discussions with the Canadian Institute for Health Information about an independent report card similar to one conducted each year in Ontario. He said his ministry commissioned a study last year to determine a better approach than the one taken by the Fraser Institute, adding he hopes that work can be used to generate a new report card by next year.

The Fraser Institute’s latest hospital report card is expected soon, and Abbott said he has approved release of enough information so the report card can identify hospitals by name.

Last February, the Fraser Institute issued its first B.C. Hospital Report Card to rank nearly 100 acute-care facilities in the province. But the government and health authorities refused to divulge the names of hospitals checked for 39 quality indicators, like foreign objects left inside patients after surgery, meaning hospitals were only identified by a number only.

Nadeem Esmail, senior health policy analyst at the Fraser Institute, defended the Insitute’s methodology. “We are very confident in our methodology,” said Esmail, adding the process used is “an internationally validated methodology.”

Esmail also questioned whether the government is in the best position to decide how information is used. “It’s not the government’s place to determine what measurements are valid and what measurements are not,” he said.

“It’s their role to be accountable to the public and so the data should be out there and it should be up to the public to decide.”

In an interview with the Sun, Abbott said his main concerns about the Fraser Institute’s methodology is that it does not account for elements like palliative care units and the demographics surrounding a hospital when looking at mortality rates.

He said this can make good hospitals look bad because they are willing to take on more challenging cases, or because they have a disproportionate number of elderly patients.

In the independent study commissioned last year by the government, the authors took a measured approach to the Fraser Institute report card’s methods, but still identified some clear problems.

“The Fraser Institute report makes inflated claims about what can be concluded from Hospital standardized mortality ratios and adverse-event indicators by ignoring or glossing over serious methodological controversies,” read a copy of the report provided to The Sun.

“Through a combination of too much and too little information, the report makes it easy for the reader to potentially draw inaccurate conclusions, and difficult to draw sound ones.”

The study was conducted by researchers at the Winnipeg Regional Health Authority, led by Dr. Brian Postl, and compared the Fraser Institute model to the methods in the Hospital Report Research Collaborative’s Ontario Hospital Report.

In its conclusion, the report recommends B.C. follow the Ontario model instead of the methods used by the Fraser Institute.

On Wednesday, New Democratic Party health critic Adrian Dix said he does not oppose the idea of a new report card, but said he thinks it is not enough. “I’ve considered the Ontario model quite a bit and I don’t mind it, but I think it only tells half the story,” he said.

“We have lots of reports in healthcare that evoke the problem and that lay out the problem in specific terms,” he added. “You need a process that not only identifies problems, but that aggressively and system-wide drives solutions. That’s what we haven’t seen.”