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Original research
Appropriateness, effectiveness and safety of care delivered in Canadian hospitals: a longitudinal assessment on the utility of publicly reported performance trend data between 2012–2013 and 2016–2017
  1. Omid Fekri,
  2. Edgar Manukyan,
  3. Niek Klazinga
  1. Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Omid Fekri; o.fekri{at}


Objectives To assess the utility of publicly reported performance trend results of Canadian hospitals (by hospital size/type and jurisdiction).

Design Longitudinal observational study.

Setting 489 hospitals in Canada between fiscal years 2012–2013 and 2016–2017.

Participants Analysis focused on indicator results of individual Canadian hospitals.

Primary and secondary outcomes Eight outcome indicators of hospital performance: in-hospital mortality (2), readmissions (4) and adverse events (2). Performance trend outcomes of improving, weakening or no change over time. Comparators in performance by hospital size/type of above, below or same as average.

Results At the national level, between 2012–2013 and 2016–2017, Canadian hospitals largely reduced in-hospital mortality: hospital deaths (hospital standardised mortality ratio) −9%; hospital deaths following major surgery −11.1%. Conversely, readmission to hospital increased nationwide: medical 1.5%; obstetric 5%; patients aged 19 years and younger 4.6% and surgical 3%. In-hospital sepsis declined −7.1%. Approximately 10% of the 489 hospitals in this study had a trend of improving performance over time (n=49) in one or more indicators, and a similar number showed a weakening performance over time (n=52). Roughly half of the hospitals in this study (n=224) had no change in performance over time for at least four out of the eight indicators. No single hospital had an improving or weakening trend in more than two indicators. Teaching and larger-sized hospitals showed a higher ratio of improving performance compared with smaller-sized hospitals.

Conclusions Analysis of Canadian hospital performance through eight indicators shows improvement of in-hospital mortality and in-hospital sepsis, but rising rates of readmissions. Subdividing the analysis by hospital size/type shows greater instances of improvement in teaching and larger-sized hospitals. There is no clear pattern of a particular province/territory with a significant number of hospitals with improving or weakening trends. The overall assessment of trends of improving and weakening as presented in this study can be used more systematically in monitoring progress.

  • audit
  • quality in health care
  • organisation of health services
  • health policy
  • clinical governance

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  • Contributors OF initially conceived of the study, reviewed the literature, performed data analysis, interpreted results and drafted the manuscript. EM assisted in the design of the study, performed and validated data analysis, interpreted results and reviewed the manuscript. NK assisted with the design of the study, interpreted results and assisted in the drafting of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Canadian hospital performance data are published by CIHI via their Your Health System online tool (

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