Open letter - Hospital Mortality Rates and You: We're all in this together!
MONTREAL, Feb. 1, 2013 /CNW Telbec/ - Several of you will have seen the recently published hospital mortality tables for Canada, including Québec (Actualité médicale, December 20th, 2012). The Pontiac's referral hospital, Gatineau, was reported to have a rate of 133 - the Canadian average being 100 - and 18 out of the 20 Quebec hospitals in the table had rates of 74-85. I initially found this preposterous and questioned our quality of care on the Québec side of the Ottawa valley, more specifically in the Pontiac where I work.
In fact, however, the contribution of a health care system is in TENTH place on the list of health care determinants, and in terms of quality of care, the best and worst hospitals in the developed world only differ by up to 5% as far as mortality is concerned. Not to mention the fact the university centres generally have the lowest rates, since they tend to be more technical centres - as patients no longer need highly specialized types of care, they are generally transferred to more peripheral hospitals.
Here are the health care determinants, in order:
- income level and social status
- social support networks
- education and literacy
- employment and working conditions
- social environments
- physical environments
- health habits and personal capacity to adapt
- early childhood development
- biological and genetic heritage
- health care services
In fact, once a person has come into our office or our hospital, the other 9 factors have already determined how their health condition will evolve, and our care has less impact than the 9 preceding factors. No wonder the Canadian Medical Association is prioritizing this discussion as its theme for 2012-2013!
By February, we should receive our local figures for the Pontiac. However, whether our rates are higher or lower than our urban centre, it will only be a sign of our relative poverty in the leading determinants of health. Other factors to take into account are accessibility to palliative care, the fact that healthier, richer citizens of Gatineau can afford to pay extra fees and obtain their health care in Ottawa, and the fact that citizens of some neighbourhoods in the city of Gatineau die on the average 6 years younger than those in other neighbourhoods. Of course, there are many other factors. In the Pontiac, we are well aware of the impact of the decline of the forestry industry on the health of our patients. It's a good thing the social support network in some areas is alive and kicking - in the end, the importance of social support is far greater than what we can possibly do within the health system!
Interestingly, only Great Britain and Canada are involved with hospital mortality reporting - one is well-advised against assuming that hospitals and physicians are the cause.
In any case, I wish us all a very low mortality rate. In the meantime,
let's all encourage each other to contribute in any way we can to a
Ruth Vander Stelt, md
President, Québec Medical Association
SOURCE: QUEBEC MEDICAL ASSOCIATIONFor further information:
Québec Medical Association