The Fraser Institute

The Fraser Institute

March 12, 2009 06:00 ET

The Fraser Institute: Ontario Hospital Administrators Refuse to Identify Best and Worst Performing Hospitals

TORONTO, ONTARIO--(Marketwire - March 12, 2009) - The majority of hospitals in Ontario refuse to be identified in a report measuring the quality and safety of hospital care, leaving Ontario taxpayers and patients with no way of knowing if their local hospital is one of the best in the province, or one of the worst.

The Fraser Institute today released the Hospital Report Card: Ontario 2009, a peer-reviewed and risk-adjusted study that compares the performance of Ontario's 136 acute care hospitals. Only 17 hospitals agreed to be named in this year's report, a significant drop from the first report card for Ontario in 2006 when 43 hospitals agreed to be identified.

"By refusing to be identified, Ontario hospital administrators are hiding vital information from Ontario taxpayers and patients about the quality of tax-funded health care provided in their community," said Nadeem Esmail, director of health system performance studies at the Fraser Institute and co-author of the Hospital Report Card: Ontario 2009.

"While the hospitals that agreed to be identified in this report should be applauded for their commitment to patients and the public by being accountable and transparent regarding their performance, administrators who refuse to be identified are ducking accountability and hiding behind a wall of silence."

The hospital report card can be downloaded as free PDFs at or viewed in an interactive way at

The peer-reviewed Hospital Report Card: Ontario 2009 compares the performance of hospitals on up to 50 separate indicators of quality (such as death due to a stroke) and patient safety (such as a foreign body left inside a patient during a procedure). The methodology was developed by the US Agency for Healthcare Research and Quality (AHRQ) and researchers at Stanford University and employs a risk-adjustment system developed by 3M. The AHRQ methodology is used in more than a dozen U.S. states as well as British Columbia and Ontario. The current report card provides 39 indicators of inpatient quality and patient safety calculated for the latest year for which results are available as well as a Hospital Mortality Index that shows overall performance across nine indicators of mortality. The indicators are shown for acute-care hospitals in Ontario from 1997/98 to 2006/07 (where available), comprising more than 10.5 million completely anonymous patient records.

Since specialized hospitals may treat more high-risk patients and some patients arrive at hospitals sicker than others, the indicators in the Fraser Institute's hospital report card are risk-adjusted to account for differences in health status among patients.

The report card is based on data from the Canadian Institute for Health Information's (CIHI) Discharge Abstract Database. This information is derived from patient records provided to CIHI by all Ontario hospitals.

The Hospital Report Card: Ontario 2009 allows the public to look up a given condition or procedure and compare death rates, volumes of procedures, rates of adverse events, or utilization rates among Ontario's hospitals.

"If you have a greater chance of dying from a heart attack in one hospital compared to another, or if there was a greater chance of having a foreign object left inside of you following surgery, isn't that something you would want to know? Patients have a right to know how their hospital compares to other hospitals," Esmail said.

The Hospital Report Card: Ontario 2009 found that:

- The top hospital on the Hospital Mortality Index (HMI) in Ontario is Anonymous Hospital 211 with a score of 91.1 out of 100 in 2006/07. It was not among the top 10 in 2005/06;

- Anonymous Hospital 10 was ranked first on the HMI in 2005/06 and ranks seventh in 2006/07;

- Anonymous Hospital 31 is the lowest-ranked hospital in 2006/07 with a score of 78.3. It saw a deterioration in its score between 2005/06 and 2006/07 and was ranked 45th out of 50 in 2005/06;

- Anonymous Hospital 40 experienced the biggest improvement in its HMI from 2005/06 among hospitals for which an HMI could be calculated in both years. It went from 49th of 50 in 2005/06 to 45th of 57 in 2006/07;

- Hanover and District Hospital at 35th is the highest ranked identified hospital on the HMI with a score of 86.0. A score for 2005/06 is unavailable; and

- Bluewater Health-Sarnia site is the lowest-ranked participating hospital, ranked 56th of 57 with a score of 79.9. A score for 2005/06 is unavailable.

The report card also provides information on the various indicators of inpatient quality and patient safety for municipalities (based on where patients lived).

Looking at the Hospital Mortality Index, Caledon had the highest ranking, at 93.1. Innisfil is second at 90.0 followed by Essex at 89.5. Among the larger municipalities, Thunder Bay is ranked fourth at 88.9; Brampton is sixth at 88.6; Hamilton is 12th at 86.8; Ottawa 22nd at 85.2; Toronto 28th at 84.7; North York 32nd at 84.5; Mississauga 35th at 84.1; Sudbury 44th at 83.1; Windsor 48th at 82.8; Kingston 64th at 80.9; and Kitchener 68th at 80.4.

The lowest ranked municipality is Kirkland Lake at 58.6, followed by Meaford at 62.0, and Napanee at 66.6.

However, Esmail cautioned that since patients move between municipalities, a municipality's ranking does not equate to the ranking of its hospital. This means the highest or lowest performing municipality is not necessarily home to the best or worst performing hospital.

The Fraser Institute is an independent research and educational organization with locations across North America and partnerships in more than 70 countries. Its mission is to measure, study, and communicate the impact of competitive markets and government intervention on the welfare of individuals. To protect the Institute's independence, it does not accept grants from governments or contracts for research. Visit

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