Patients across Ontario should expect to receive excellent care from our health system. And it usually delivers. But in too many instances, the quality of care people receive can vary depending on where they live.
For example, people with a diagnosis of heavy menstrual bleeding living in the northeast are more than ten times as likely to receive a hysterectomy as people living in Toronto. Similarly, people hospitalized with a hip fracture have a likelihood of dying within 30 days of admission that varies from 3% to 16% across the 50 highest volume hospitals in the province.
Some variation in care is always to be expected because of differences in patients’ underlying health conditions or in their treatment preferences. However, wide unwarranted regional variations in practices and outcomes are often a symptom of a system that lacks focus. Several decades ago, renowned health services researcher Dr. John E. Wennberg and colleagues at the Dartmouth Institute of Health Policy and Clinical Practice in the US determined that such regional variations point to a lack of “evidence-based standards of practice”.
Improving the quality of health care involves many factors.
Probably the most commonly discussed enabler of quality is data and the associated issues about quantity, type, accuracy, etc. The role of standards and guidelines are also often referenced. And let’s not forget patient and public partnering as a critical element in quality improvement.
One element that has not had as much attention is the role of leadership. From local quality improvement (QI) efforts to broad system efforts, leadership is a key element needed to enable and sustain quality improvement. To this end QI training programs like IDEAS includes leadership as a component of the curriculum and in the United States, the Institute of Health Care Improvement has a CEO leadership alliance focused on health care.
On Friday, March 9, 1:30 pm ET, join Health Quality Ontario CEO Dr. Joshua Tepper, and VP of Evidence Development and Standards Dr. Irfan Dhalla, for a tweet chat to discuss the opioid crisis and pain management.
Earlier this week, Health Quality Ontario released a quality standard on diabetic foot ulcers.
Diabetic foot ulcers are a significant health problem. An estimated 1 in 10 people in Ontario have diabetes and up to 25% of these individuals will develop a foot ulcer during their lifetime. Sometimes these ulcers eventually lead to amputation of the foot or lower leg. Diabetic ulcers can also cause pain and limit mobility.
Variations in care received by Ontario residents, based on where they live or certain demographic factors, can indicate a lack of quality in a health care system.
The recent report prepared for Health Quality Ontario titled Quality Matters: Realizing Excellent Care for All acknowledges the existence of unwarranted variations in care and the negative impact they can have on patients. This was also a key theme in last year’s Measuring Up report from Health Quality Ontario which noted that, while Ontario was generally doing a good job of providing care to all who needed it, “unacceptable variation” still existed by geography and population groups.