Sunday 25 August 2019

Eilish O'Regan: 'Mortality rates are not the full story, but they can't be ignored'


Stock photo: PA
Stock photo: PA
Eilish O'Regan

Eilish O'Regan

Hospitals baulk at the term "league table" when it comes to revealing their statistics on patient death rates from major illnesses. It is seen as too crude a report card to explain the differences in outcomes for heart attack and stroke patients.

But neither can these statistics be dismissed or too easily explained away.

This is still just the third year of what some doctors and health managers see as something of a "name and shame report" on individual Irish hospitals' performance.

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Today's report from the National Healthcare Quality Reporting System allows us to go beyond a national headline figure for deaths from big killers like heart attack and stroke.

We learn today that death rates for both conditions for patients within 30 days of admission to hospital continue to significantly vary across the capital and the country.

Ireland has been lagging behind the UK in publishing individual hospital statistics on mortality rates.

And the figures still only show us what the patient death rates from heart attack and stroke within 30 days of admission to a hospital was.

We still don't know, for instance, about rates from other illnesses, such as cancer.

So how should we interpret today's report?

A multitude of factors can influence these death rate figures - including how soon the patient made it past the hospital threshold.

How quickly did the patient seek medical help? What sort of pre-hospital care did they get? What was their overall state of health?

What kind of expertise was available to treat them in the hospital? Are some hospitals transferring the worst cases?

If this report is to realise its true value, it merits the HSE and each hospital to do more investigation.

Benchmarking is a way of discovering strengths and weaknesses in different hospitals.

All hospitals can improve outcomes for patients, but they must carry out self-analysis.

Are there issues with expertise among medical and other staff? What kind of treatment processes are in place - are they following best practice? Have they access to good diagnostics? Is a regular internal audit of performance carried out?

Elsewhere, there is cause for cautious optimism as cancer survival rates improve, although there are also regional variations in the case of breast cancer - it is lower in the west of Ireland.

Tracking patterns over time allows for weaknesses to be addressed.

There are also other areas of concern, such as the rise in the number of patients being admitted to hospital for diabetes.

This is a worrying trend and clearly linked to our lifestyles, arising from lack of exercise, excess weight and obesity.

The more of this detailed information we have, the better.

It is puts an onus not just on the health service, but also on us as individuals to do some self-questioning.

Irish Independent

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