Value, 2007

The Fraser Institute

May 2007

The Fraser Institute in Canada has issued a hospital report card and interactive Web site assessing 50 measures of patient safety and quality of care for every acute care hospital in Ontario. The report uses AHRQ's Patient Safety Indicators (PSIs) and Quality Indicators (QIs) as the basis for its methodology.

According to Mark Mullins, PhD, Executive Director of The Fraser Institute, "Our goal with the hospital report card and Web site is to contribute to the improvement of hospital care by providing information about the quality of hospital care directly to patients and the public. This will help people make more informed choices about their health care and improve hospital performance through greater accountability."

When The Fraser Institute was originally investigating methods of creating a report card, several factors came into play. Not only was it important to look at financials and patient satisfaction, but Fraser desired patient outcomes and a system that could be replicated publicly.

"What AHRQ had to offer was ideal. It was replicable, it had public access, and it relied on administrative data. It was, and still is, the gold standard of hospital measurement systems," Mullins says.

Both Fraser's report card and Web site include information for all 136 acute care hospitals in Ontario from 1997 to 2005, comprising more than 8.5 million patient records. Forty-three hospitals agreed to have their institutions identified by name; other hospitals are shown anonymously in the report by number. "This assessment constitutes the most comprehensive measurement of acute care hospital performance and accountability in Canada available to date," Mullins notes.

Using AHRQ PSIs and QIs, the report is based on anonymous patient-level data purchased from the Canadian Institute for Health Information (CIHI). These data are used to produce various CIHI reports and indicators, including annual reports on the performance of the Canadian health care system.

The Fraser report's 50 measures include death rates, adverse events, volumes, and usage rates in three categories: hospital procedures, medical conditions, and indicators related to childbirth. In addition to hospital performance, the report also calculates the 50 indicators for the 138 municipalities in Ontario based on patient location.

Founded in 1974, The Fraser Institute is an independent research and educational organization based in Canada, with offices in Vancouver, Calgary, and Toronto. Its mission is to measure, study, and communicate the impact of competitive markets and government intervention on the welfare of individuals. The Report Card's interactive Web site can be found at http://www.hospitalreportcards.ca.

Impact Case Study Identifier: CDOM 07-08
AHRQ Product: Healthcare Cost & Utilization Project—Quality Indicators (HCUP-QIs)
Topic(s): Patient Safety, Quality
Scope: Canada

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