Preventable death rate U.S.higher than Canada

Canada's health care system offers "excellent value for the money" says a British researcher who has studied preventable deaths in 19 industrialized nations.

The study, to be released today in Health Affairs, looks at "amenable mortality", deaths that would not have occurred if effective health care had been available.

Conditions that caused these deaths included bacterial infections, treatable cancers, diabetes, some cardiovascular disease and the complications of common surgical procedures. The study, which looked at figures from 2002-03, updated a similar report based on 1997-98 figures.
Its goal was to compare amenable deaths in the United States with 14 western European nations, plus Canada, Australia, New Zealand and Japan.

The study also tracked whether gaps in these countries had narrowed or widened. The figures were computed according to amenable deaths per 100,000 population under the age of 75.
In the first study, the researchers found that amenable deaths in the U.S. stood at 114.74 per 100,000 population, exceeded only by Ireland, Portugal, Finland and the United Kingdom.

In that time period, Canada's amenable mortality rate was 88.77, the seventh-lowest rate after France, Japan, Spain, Australia, Sweden and Italy.
In the most recent study, Canada's amenable death rate had dropped to 76.83, putting Canada sixth after France, Japan, Australia, Spain and Italy.

Meanwhile, amenable mortality rates in the U.S. have barely budged from 114.74 to 109.65 in 2002-03, taking the U.S. from 15th place to last place among the 19 countries.

"This study shows that Canada's health system has performed very well in its ability to prevent people from dying from treatable conditions," said Martin McKee, a researcher at the London School of Hygiene and Tropical Medicine, and co-author of the study.

"While everyone has to die from something, sometime, in an ideal world, no-one would die from the causes we have looked at, in the age groups we have included."

"Of course, we don't live in an ideal world," said McKee.
"However, the bottom line is that the Canadian health system delivers outcomes that are substantially better than those in its southern neighbour."

"More importantly, outcomes in Canada are improving more quickly than those in the U.S.," he said.
"Given that the U.S health care system is far more expensive, this suggests that Canadians are getting excellent value for money."

The researchers expect there will be further improvements in amenable mortality rates in industrialized countries, but the rate will slow down.

The most significant gains were made in the 1970s and 1980s, when drugs to treat common conditions such as hypertension became widely available, said McKee.
That raises questions about whether the U.S. will be able to narrow the gap between itself and countries with much lower amenable mortality rates, he said.

"Other research shows that many Americans are unable to afford the prescription drugs they need," said McKee.

"So, if some future administration can tackle this then we could see real improvements there." In countries like Canada, he expects the main gains will be less in amenable mortality and more the the quality of life, especially for older people.

Source: Ottawa Citizen

Humber River Regional highest death rate, not Scarborough General

On orders from the provincial health ministry, Humber River Regional Hospital quietly released the worst death rate of any Toronto-area hospital.

On Monday, more than a week after the Canadian Institute for Health Information published a high-profile report containing death rates for hospitals across Canada, Humber broke its silence to report a rate of 136, meaning its in-hospital death rate was 36 points above the national average of 100.

Humber's rate is the second worst in Canada. Only Kitchener's Grand River Hospital fared worse, with a rate of 142.

The release of Humber's data also boosts Scarborough General Hospital to second worst in the GTA; its death rate was 134.

Humber's figures were omitted from the CIHI report because hospital officials insisted data inconsistencies had skewed the numbers. Hospital officials ultimately released the numbers in a brief statement on a media wire service. Calls to three Humber representatives were not returned yesterday.

The disclosure came at the insistence of the provincial government.

On Dec. 4, Health Minister George Smitherman told the Legislature that Humber would release its numbers in one week.

"My office has been in touch with Humber River Regional Hospital. In the interests of transparency, I'm pleased to tell the House that they'll be releasing their data within a week," he said in response to a question from Laura Albanese, MPP for York South-Weston.

"By next year, our government will have passed a regulation that would require all hospitals to report this data, without exemption, to ensure this information continues to drive much-needed improvements in patient safety."

Humber cited a "misunderstanding" in the data related to end-of-life care (palliative and "do not resuscitate" cases) as the reason for its numbers not being publicly released as part of the CIHI press conference Nov. 29.

Mortality rates for 85 large, Canadian, acute-care hospitals and 42 health regions, except Quebec, were released at the news conference for the first time.

"The coding discrepancies were serious enough that to release the (data) presented in the preliminary report would be misleading," the hospital said in a statement.

It said they "embrace the concept that patients deserve transparency and accountability from public institutions" and that the latest numbers show they are "producing significant improvement" in data quality.

However, CIHI told the Star yesterday Humber's rate of 136 is the same as in its original calculations.

The non-profit CIHI uses the hospital standardized mortality ratio, which looks at 65 illnesses that account for 80 per cent of in-hospital deaths, to prepare its report. Anything below 100 is better than average, anything above is worse.

The figures exclude patients in palliative care.

All the numbers crunched by CIHI were sent to the hospitals in early autumn so they could be checked, said CIHI's Christina Lawand.

Grand River officials also say their ranking is misleading. "As a consequence of incorrectly filed data sent to CIHI, over 32 percent of the mortalities included in the Grand River Hospital's ranking should not have been counted because they were in fact palliative care patients being provided end-of-life comfort, not curative, care," said Nancy Hewat, Grand River's executive director of foundation and public affairs.

In Toronto, the University Health Network had the best overall rate, 87, for its three-hospital system. The now-closed Peel Memorial Hospital also had a low rate, 81.

For years, Canadian hospital administrators have known the death rates inside their hospitals but they were never publicized. The disclosure followed a year-long Toronto Star investigation into medical secrecy that examined the lack of information available to patients. As part of the series, the Star urged the public reporting of death rates.

Humber was created in 1997 by the merger of Humber Memorial, Northwestern General and York-Finch General Hospital. It sees about 365,000 outpatients each year and has 100,000 emergency visits, according to its website.

Smitherman told the Legislature his government sees transparency as something that is "powerful and beneficial to our patients."

He also announced that by the beginning of April it will require all hospitals involved in Ontario's Wait Time Strategy to report infection rates in three areas.

And, by the end of July, it will introduce a regulation requiring all provincial hospitals to inform patients about medical errors.
The Star

Editor's opinion:

"I was kind of expecting this when Humber River General was reported to be the only hospital that hadn't submitted the numbers yet (read related article).

That to me, was really suspicious!"

Related article:

Scarborough General Hospital highest death rate in the GTA

Deathly virus starts like an innocent cold

By Guy Derla

Last Tuesday, my eye fell on an article in the Washington Post who reported that an apparently common cold virus (adenovirus) has mutated into a killer strain quite unexpectedly.

In the State Oregon in the U.S. it recently caused a death rate as high as 23%!

The American government run Centers for Disease Control and Prevention, the CDC, has been tracking the virus over the past year and has recorded outbreaks in Oregon, Texas, Washington State and New York.
The virus, first discovered in 1955 in The Netherlands as the adenovirus 14, has recently mutated into a more severe virulent form.

The Frightening thing about this virus is that it's so strong that it can kill strong, young and otherwise healthy people, rather than the usual "at risk" populations of the very young and the very old. There's no way to know if this virus will spark an epidemic, or whether it will die down and disappear for momentarily.

Those who have survived the virus, say that it came on like a usual cold.
But then, instead of getting better at the usual 4-7 day point, their symptoms got worse and turned into high fevers, coughs, and difficult breathing.
Some people have even required mechanical ventilation in Intensive Care to help them breathe.

Could this be, like the in my earlier post mentioned acinetobacter baumannii, next avian flu (bird flu) or SARS -like outbreak and turn into a real pandemic? Will it come our way?

It makes you think when you have a stuffy nose next time!

Source: RevolutionHealth

Scarborough General Hospital highest death rate in the GTA

"Health care experts say the numbers will force medical officials to examine their practices and improve patient care".

Scarborough General Hospital has the highest rate of deaths in the Toronto area – and the third highest in Canada – according to a watershed report that made hospital death rates public last week.
It's the first time in history that a report of this kind this has been done.

The hospital with the lowest rate of deaths in the GTA is the University Health Network, which includes Princess Margaret, Toronto General and Toronto Western Hospitals.

The Canadian Institute for Health Information (CIHI) released mortality rates for 85 large Canadian acute care hospitals and 42 health regions in every province but Quebec, where they don't collect the same data. Health care experts say the figures, which show how effective hospitals are at avoiding preventable deaths, will force medical officials to examine their practices and improve patient care.

For years, Canadian hospital administrators have known what death rates were inside their hospitals, but unlike the United States and the United Kingdom, they were never made public.

The only hospital in the Greater Toronto Area that CIHI did not release figures for was the Humber River Regional Hospital.

"For this report we got our preliminary results back and when we saw them we said: Hold on, we've got some concerns here," said Gerrard Power, a hospital spokesperson.

"It's important all hospitals report the information so they can figure out the problems and fix them," said Dr. Alan Hudson, head of Ontario's wait time strategy.

"This is an absolutely crucial day for the province of Ontario. It is a major step," said Hudson, a neurosurgeon. "The whole process should be transparent. Taxpayers deserve nothing less."

The long-awaited disclosure follows a year-long Toronto Star investigation into medical secrecy that raised questions about a lack of public reporting in Canada. As part of the investigative series Medical Secrets, the Star urged CIHI to reveal hospital names with reportable data.

The provincial government has mandated that the 1st of April 2008 all Ontario hospitals report adverse events and death rates for certain procedures on their websites along with wait time information.

The CIHI study compares the actual number of deaths in hospital with the average Canadian experience. The numerical result is called the hospital standardized mortality ratio (HSMR). A score above 100 means a hospital is above the national average while a score below that figure reflects a lower mortality rate.

The University Health Network scored an 87, or 13 points below the national average of 100. For years, the UHN has reported patient safety data on its website, from hospital-borne infection rates to wait times.

The UHN has also brought in rapid response care teams, which have helped to bring down death rates at its hospitals. These are groups of intensive care doctors and nurses that can quickly respond to a patient experiencing anything from a cardiac arrest to a drastic drop in blood pressure.

Bell has been a vocal supporter of publicizing death rates. "The data reflects the comparative experience of patients in your hospital related to other hospitals," he explained. "This gives hospital caregivers and managers a concrete goal they can set objectives with and they can use to initiate quality improvements."

Many experts believe public reporting allows hospitals to compare patient outcome records, see where they rank on important indicators and spot trends that could lead to changes that better protect public safety. Public reporting also provides patients with access to information about potential risks and problems inside their local hospitals before they seek treatment.

The Scarborough Hospital's General site scored 134, while the Grace site scored 110. The hospital has suffered from management turmoil, as well as allegations of lax oversight of physicians.

Dr. Steven Jackson, chief of medical staff at the hospital, said management is committed to lowering the numbers and beating the national average. "Everyone is buying into this," he said. "Quality is where we are going."

The figures released last week are viewed as a key indicator of patient safety levels in hospitals, an area of growing interest for medical experts. Between 9,250 and 23,750 Canadian adults experience a "preventable" adverse event in hospital and later die, according to a 2004 CIHI study. Over the past three years – the period covered by the new data – more than 254,000 patients died in Canadian hospitals outside Quebec.

"Releasing these numbers across Canada is a big step forward," said Hilary Short, president of the Ontario Hospital Association, representing all hospitals in the province. "It's hard the first time you release a report like this," she said. "But once you start reporting publicly it really accelerates ... and it forces improvement."

Now, for the numbers:

Canada's best and worst

The following hospitals had mortality ratios (excluding palliative care) ranking at the top and bottom of the list of 85 larger, acute care hospitals in 42 health regions across Canada (excluding Quebec), according to the CIHI survey of hospital deaths.

Top Five

1. The Moncton Hospital - Moncton, N.B.: 56

2. Foothills Medical Centre - Calgary, Alta.: 61

3. Regina General Hospital - Regina, Sask.: 71

4. Peter Lougheed Centre - Calgary, Alta.: 73

5. Saint John Regional Hospital - Saint John, N.B.: 74

Bottom Five

1. Grand River Hospital - K.W. Health Centre, Kitchener, Ont: 142

2. Niagara Health System - St. Catharines General Site, St. Catharines, Ont.: 135

3. The Scarborough Hospital - General Site, Toronto, Ont.: 134

4. Burnaby Hospital - Burnaby, B.C.: 125

5. Red Deer Regional Hospital Centre - Red Deer, Alta.: 125

The Moncton Hospital, N.B. - "lowest death rate in Canada"

The Star