Publicly Accountable Hospitals: Where Open Data Can Save Lives

[Jennifer Bell]

I've been meaning to write a post on open health care data for ages.
Personally, I think the issue could be *the* political key for getting
the message of open data through to Canadian voters.

I have to double check that the Frasier Institute is still restricted
from releasing hospital names, as was the case about 18 months ago.

http://www.marketwire.com/press-release/Fraser-Institute-British-Columbias-Best-Performing-Hospitals-Found-Port-Moody-Vancouver-994199.htm

Personally, living the last ~6 months in Californai, I found the
californiahospitalcompare.com very useful when choosing where to have
a baby -- and I would have liked to have the central line infection
info from Consumer Reports Health site a bit sooner, as I found out
after my c-section that my hospital wasn't doing so great on that.

The draft post: -------------------------->

Benchmarking hospital performance is a powerful driver for change. Not
all health care facilities perform equally; even in this day, there
can be large variability between centers due to differences in
practice philosophy, or lack of rigour in adopting simple practices
like regular hand-washing or pre and post operation check-lists.

In the US, the site California Hospital Compare, by the LeapFrog
group, allows the public to compare local hospitals on a number of
indicators.

For instance, here you can see that there is a surprising difference
in mortality for heart bypass surgery from the best San Diego hospital
to the worst. A patient is 5.3x more likely to die at the worst
facility (UC San Diego Hillcrest, with a current mortality rate of
6.15% vs. Scripps Green, with a current rate of 1.14%):

http://www.calhospitalcompare.org/comparison.aspx?c=2&h=190&h=254

The US organization Consumer Reports has seized this opportunity to
provide value for their subscribers by opening a health care
information division. Consumer Reports is tapping into data from the
LeapFrog Group, and have started to compile their own statistics –
such as deaths from ‘central line infections’, infections contracted
through a catheter. Because U.S. hospitals are profit driven, the
threat of losing customers through poor performance provides extra
incentive for ensuring that all possible measures for patient safety
are being followed.

http://www.consumerreports.org/health/home.htm

Who protects Canadian health consumers? Who is our Consumer Reports?
Since our public health care system is publicly funded, you would
think that provincial or federal governments would step up to provide
the same role for Canadians. It currently does not. The non-profit
Frasier Institute, recognizing this gap, has compiled a list of
Canadian hospital performance metrics so that hospital staff can see
how they are performing on average. However, Canadian hospitals have
only released their data to the Frasier Institute on the condition
that they not be named, for fear that patients will go elsewhere.

Not only is this is a profound disservice to Canadian citizens (who
are already paying for these institutions), but the hospitals fears
may be unfounded *if hospitals embrace a policy of open-ness*.

In the book ‘Better’, Atul Gawande describes what happened when the
Cystic Fybrosis Foundation announced the goal of publishing
performance indicators publicly for the first time in 2004.
Cincinatti’s Children’s Hospital faced a crisis: their children’s
Cystic Fybrosis facility was poorly ranked. They feared that once
this became publicly known, their parents of their patients would
understandably take their children elsewhere.

After a series of internal meetings, hospital staff decided on a
strategy of open-ness. They admitted their poor rankings pre-
emptively, and outlined a plan for doing better – which included the
participation of the community.

Not a single patient left the program. Instead, parents joined
committees, along with the unit’s staff, to investigate what practices
at top performing hospitals could be adopted in Cincinatti.
Improving the performance of the CF unit became not just a problem for
the doctors at the clinic, but for the newly informed patients and
community at large.

Publishing performance statistics gives health care consumers not only
the opportunity to make a more informed choice on where to receive
care, but to take action to improve the quality of care in their
region. When information is shared, hospital donors can give money to
enable specific improvements, and communities can organize to push for
changes. In this way, citizens can bypass inefficient mechanisms of
government health care control, and work with health providers
directly to achieve better outcomes in their community.

The current lack of public accountability in hospital performance
could be costing Canadian lives.