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News @ a Glance Pulse the Joys of Quality Indicators

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News @ a Glance Pulse the Joys of Quality Indicators News News @ a glance federal fiscal framework for public in- Canada. Further details are available at: vestments in health research” and new www.aucc.ca. Med school review: The Association of mechanisms for commercializing re- Faculties of Medicine of Canada has search findings. The report, which also Give a day: Upwards of $400 000 “and launched a 2-year exercise to review all surveys current metrics for ascertaining counting” was donated during the facets of medical education, including the return-on-investment in health re- 2007 Give a Day to World AIDS cam- whether laxer entry requirements, short- search, is available at www.acaho.org. paign, which challenged doctors, other ened training periods and lower tuition professionals and all Canadians to con- fees would help to resolve the nation’s Bite-size: It’s $10 in Los Angeles and $2 tribute income earned on World AIDS projected shortage of physicians. in Toronto. That’s Starbucks or Tim Day (Dec. 1) to organizations that have Among options to be analyzed include Horton’s. Taking a lead from a Califor- programs aimed at fighting the pan- allowing students to enter medical nia medical centre that offers doctors demic in Africa. Launched in 2004 by school without having obtained an un- $10 Starbucks certificates if they wash Markham Stouffville Hospital physi- dergraduate degree and shaving a year their hands, Toronto’s University cian Jane Philpott, the campaign raised off basic medical training, which would Health Network will handout $2 over $500 000 in 2006. Details are allow students to graduate in 3 years, as Timmy’s certificates to doctors, nurses available at www.giveaday.ca. — opposed to 4. The latter was among and other staff at its Princess Margaret, Wayne Kondro, CMAJ measures recently urged by CMAJ’s edi- Toronto General and Toronto Western torial team (CMAJ 2008: 178(1]11). hospitals who are spotted complying DOI:10.1503/cmaj.071796 with basic Network hand-hygiene pol- Rx for change: The Canadian Agency for icy aimed at reducing nosocomial Drugs and Technologies in Health and methicillin-resistant Staphylococcus the Cochrane Effective Practice and Or- aureus infection rates. Pulse ganisation of Care group have launched a publicly accessible electronic database The joys of quality indicators on the relative merits of evidence-based interventions like academic detailing, s a general rule of thumb, if therapeutics letters and e-detailing. It’s you’d like better odds of surviv- aimed at providing health care policy- A ing a visit to a Canadian hospi- makers, health professionals and con- tal, hope that you are hospitalized in sumers with information about the ef- New Brunswick, Saskatchewan, Alberta fectiveness of strategies or programs to or British Columbia. promote optimal drug prescribing. The Photos.com Hope also that it’s the Moncton, database is available at www.cadth.ca. Calgary Foothills, Saint John Regional, Laurels: University of Toronto and Calgary Peter Lougheed or Regina Gen- Child-size: The World Health Organi- McLaughlin–Rotman Centre for Global eral hospitals, or in a pinch, the Saska- zation has unveiled a “make medicines Health senior scientist and bioethicist toon Royal University, Hamilton Mc- child size” campaign aimed at the de- Peter Singer has been awarded the Master or Vancouver General (Box 1). velopment of antibiotics, pain medica- Michael Smith Prize from the Canadian Conversely, hope your hospital isn’t tions and other drugs in dosage forms Institutes of Health Research. The prize, in Newfoundland and Labrador, Mani- that are tailored to children’s bodies complete with $500 000 contribution to- toba or Ontario, and, in particular, that and metabolic needs. The agency also ward his research program, is awarded it isn’t the Kitchener Grand River, St. released a list of 206 medicines that annually to Canada’s “Health Researcher Catharines Niagara or pretty much any they deem safe for children’s use. The of the Year.” Singer proposes to use the hospital in Scarborough. WHO projects that roughly 6 million money in furtherance of efforts to help However fair or valid, such are the children under the age of 5 die annually African researchers develop and com- conclusions that will inevitably be from treatable conditions and could be mercialize products that address health drawn by Canadians accessing the saved with “readily available, safe, ef- problems on their continent. newly minted hospital standardized fective and affordable” medicines. mortality ratio report from the Cana- Hiring spree: Canada’s 92 universities dian Institute for Health Information Triple B: The development of a strategic and university colleges will have to hire (CIHI). framework for health research is among as many as 35 600 new faculty by 2016 The quality indicator is essentially a 10 “calls to action” identified as national to address retirements and enrolment measure of the number of “observed” priorities in a report from the Associa- growth, which is projected to rise na- to “expected” deaths within a hospital tion of Canadian Academic Healthcare tionally by between 70 000 and 150 000 or health region for diseases or condi- Organizations entitled From Bench to full-time students over the next decade, tions that account for 80% of in-patient Bedside to Business. Others include de- according a new study by the Associa- mortality in Canada, after adjusting for velopment of a “sustainable, multi-year tion of Universities and Colleges of such factors as age, sex, diagnoses, 142 CMAJ • January 15, 2008 • 178(2) News length of stay, admission status, co- search and Analysis, Jennifer Zellmer. in Canada are a function of adverse morbidities and whether a patient was As well, because of variations in events and a significant portion of transferred from another institution. how hospitals report and handle pallia- those are occurring in hospitals. “It’s In Canada, some 65 diagnosis groups tive care patients, mortality ratios were hard to attribute anything to anything, cause 80% of in-hospital deaths, led by generated in 2 categories: excluding but it’s such a macro number, I assume acute myocardial infarction, heart fail- and including palliative care patients. that within those deaths are many that ure, pneumonia, chronic obstructive pul- The mortality measure was developed are the product of adverse events.” monary disease, septicemia, malignant in Great Britain as a predictor for varia- Hassen had earlier told reporters that neoplasm of bronchus or lung, stroke, tions in mortality rates among hospitals the ratios were strictly a measure of pre- cerebral infarction, respiratory failure and it was concluded the biggest factors ventable deaths, with 100 being “the av- and hip fracture. In that context, hospital were emergency admissions, number of erage number of people dying from ad- standardized mortality ratios are thus doctors per bed and number of general verse events.” But Zellmer says they unique to a nation, in large measure be- practitioners per capita in the hospital’s should not be directly viewed as a cause they reflect local diagnosis groups. locality. When used in the United States, measure of preventable death as the Gun shot wounds, for example, do not factors accounting for variations in- links between mortality and process or make the cut in Canada but are a leading cluded the payer (e.g., Medicare), hospi- quality of care have not been conclu- cause of death in the United States. tal admission rates and the number of sively established. “The notion of pre- In turn, the findings generate an discharges to nursing homes or other ventable is not black and white.” “odds ratio” of dying in hospital, or an health care facilities. The report indicates that in the first estimated increase in risk for various In Canada, though, CIHI and health year of calculations, there were 37 acute predictors. Each additional year of age, care administrators say the ratio should care hospitals across the country with for example, adds a 5% risk of dying. An be viewed as a “driver” of change or ratios under 100. By 2006/07, that had emergency, rather than a planned, ad- progress through time, rather than as a grown to 48. In 2004/05, there was a mission, increases the odds by 160%. measure of hospital performance. hospital (Grand River) with a staggering Men have a 9% higher chance of dying. “The key here is to focus on your 158 ratio. That has since declined to 136. Patients transferred from another acute trend over time, not compare yourself to From that perspective, a high hospi- care facility: 35%. Patients with 2 comor- others,” Zellmer says, adding that such tal standardized mortality ratio should bidities on the Charlson index: 95%. comparisons aren’t valid because of such be viewed as “kind of red flag or an in- With 3: 244%. As for length of stay, rela- factors as differences in the way hospi- dicator” that a hospital needs to move tive to a 3–9-day stay, someone hospital- tals chart and code deaths or things like with programs or measures to improve ized 1 day has a 270% increased risk of under- or over-coding of comorbidities. patient safety, says Sharon Sholzberg- dying. It’s 80% for 2 days, 1% for 10–15, The Canadian version has been under Grey, president of the Canadian 17% for 16–21 and 53% for more than 21. development for over 3 years and the Healthcare Association (formerly CIHI reported hospital mortality ra- process has already had a beneficial ef- known as the Canadian Hospital Asso- tios only for health regions that had at fect, as the national ratio dropped 5.6% ciation). least 2500 qualifying deaths between from 2004/05 to 2006/07, said Institute Ontario Hospital Association Presi- April 2004 and March 2007.
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