Dear Sir:
The article “Docs refute death claims” (The Terrace Standard, July 27) incorrectly reports mortality rates from the Fraser Institute’s Hospital Report Card: British Columbia 2011, leading to misleading and inaccurate claims about the findings and validity of the institute’s report regarding Mills Memorial Hospital.
The report card includes two measures of mortality for heart attacks: an observed rate (what actually happened) and a risk-adjusted rate that mathematically revises the observed rate to what it would have been if the hospital were treating patients of average risk.
Put differently, the risk-adjusted rate accounts for the reality that some hospitals see more high-risk patients and that some patients arrive at hospital sicker than others.
For 2008-2009, the report card finds an observed mortality rate from heart attacks at Mills Memorial Hospital of 42.86 per cent, not 100 per cent.
This is an increase from 36.84 per cent in 2007-2008 and 27.27 per cent in 2006-2007. In other words, the claim that all Mills Memorial patients died is plainly incorrect.
The 100 per cent mortality rate in question is the risk-adjusted mortality rate for 2008-2009. The risk-adjusted mortality rate was 59.18 per cent in 2007-2008 and 46.87 per cent in 2006-2007.
We note in our report that readers should interpret information for smaller hospitals with caution, as the smaller number of patients they see may lead to artificially low or high values for indicators in any given year.
It is also important to look at the statistical significance of that result in the given year and to examine the hospital’s performance over several years.
Critically, the indicator results show Mills Memorial Hospital experienced a mortality rate from heart attacks that is significantly above the provincial average from 2006-2007 through 2008-2009, which should warrant further investigation by the hospital.
The Hospital Report Card: British Columbia 2011 is a peer-reviewed, unbiased, valid, and accurate measurement of various indicators of BC hospital performance. It is based on more than 3,000,000 anonymous patient records and uses state-of-the-art indicators developed by the U.S. Agency for Healthcare Research and Quality in conjunction with Stanford University that have been shown to reflect quality of care inside hospitals.
In addition, indicators in the report are risk-adjusted to account for differences in health status among patients using the international standard for risk adjustment from 3M.
Our methodology is presented in detail in a 42-page document on our website. In addition to this high level of transparency, we are happy to discuss in detail our methodology or findings with hospital, health authority, or government representatives.
Readers of The Terrace Standard can judge the value of the hospital report card for themselves. And that’s by examining the interactive database at http://www.hospitalreportcards.ca/bc.
Nadeem Esmail,
The Fraser Institute,
Calgary, Alberta
Editor’s note: Nadeem Esmail is a Fraser Institute senior fellow and co-author of the Hospital Report Card: British Columbia 2011.