The latest update from the Canadian Institute of Health Information reveals that hospital rankings are often subjective and subjective rankings can be biased.
In fact, the CIHI also recently published a study that found that when using the Hospital Compare tool, patients are more likely to be admitted to a hospital with higher rankings than those with lower rankings.
That is because the HospitalCompare tool gives patients an idea of how hospitals perform relative to other Canadian hospitals and, therefore, can bias the rankings.
The CIHI published the study in February 2018, which looked at the rankings of all hospitals across Canada and found that the rankings are most accurate when comparing hospitals to each other.
The data from the study is based on patient hospitalizations over a three-year period and uses a variety of measures to assess the quality of care.
For example, the hospital is judged to have “good patient safety” if the average hospital mortality rate is less than 1 per 100,000.
The results were similar when using patient deaths and hospitalizations as a proxy for quality of the hospital.
Hospitals with high rankings for the number of emergency room visits and hospital admissions per 100 resident-years were found to have lower mortality rates and higher hospital admissions than hospitals with lower scores.
Hospices with high ranking for emergency room stays and hospitalization per 100 hospitalizations were found, however, to have significantly higher mortality rates than those that scored lower.
For instance, in the five-year study period, hospitals with high scores for both emergency room and hospital admission rates had higher mortality and hospital deaths than those ranked lower for those two measures.
The study did not take into account whether the hospital had a “good” or “poor” ranking.
This can be especially important in relation to the rankings because patients with less severe illness and injuries, which tend to attract more patients, may be more likely than those who have more severe illnesses and injuries to seek medical attention.
When hospitals with a high ranking were compared to other hospitals, hospitals that had a high score for either of those measures had a higher rate of emergency admissions and hospital mortality than hospitals that did not have a high hospital score.
The authors of the study found that “the relative contribution of these measures to hospital mortality was not significantly different between hospitals that scored high or low on either measure.”
However, they also found that hospital-based measures were “consistent with differences in outcomes for patients with severe illnesses, hospitalization rates, and hospital stays.”
The study also found no differences in the relative impact of hospital rankings between hospitals with different demographics, but found that there were “significantly lower hospital mortality rates” in patients who were of lower socio-economic status, and higher rates of hospital admissions and emergency room hospitalizations for people in higher socio-economically and minority-based communities.
Hospital rankings are also influenced by patient demographics.
Hospital scores are highly influenced by the age of patients, their ability to pay and the number and severity of their medical conditions, according to the CIHI.
Hospital-based rankings are therefore not a measure of hospital quality and, consequently, are unlikely to reflect patients’ actual experiences of hospital care.
This is a concern because the CIHL also released a report earlier this year which found that while some hospitals are more effective than others in managing patients with pre-existing conditions, patients of all ages and socioeconomic status are more at risk for experiencing delays in accessing care and are more vulnerable to adverse outcomes from complications related to their illness.
Health Canada is responsible for administering the Canadian Hospital Classification System, which measures a number of health care services including quality of life, mortality, emergency department visits, emergency room admission and hospital discharge rates, patient safety, and the quality and accessibility of health facilities.
Health Minister Jane Philpott has made a commitment to improve patient safety and access to health care, and has promised to introduce new measures that are designed to better measure and support patients’ care.