Hospitals Not Meeting Women's Need for InformationMonday, July 26 2010
WOMEN'S HEALTH PERSPECTIVE IN HOSPITAL REPORTS 2005
Hospital Reports 2005 include four reports - Rehabilitation, Emergency Department Care, Acute Care and Complex Continuing Care. The reports are based on 2003/04 data and look at five areas - patient care, patient satisfaction, dealing with change, financial condition and provide a women's health perspective. Participation by hospitals is voluntary. The reports are independently prepared by the Hospital Report Research Collaborative (HRRC) based at the University of Toronto, and the Canadian Institute for Health Information (CIHI) for the Ontario Hospital Association and the Ministry of Health and Long-Term Care. The reports use a balanced scorecard to report on the performance of Ontario hospitals.
Hospital Report 2005: Rehabilitation reports on the performance of 45 out of 54 Ontario hospitals that provide rehabilitation in designated, publicly-funded, adult inpatient rehabilitation beds. The report does not include information on rehabilitation services in acute care, or outpatient or community settings, or home-based care. Results are based on 2003/04 data.
Key women's health findings:
- Overall, women receiving inpatient rehabilitation in Ontario are generally less satisfied than men with the quality of care they receive, particularly with respect to the information they receive in preparation for discharge. Although these differences are small, they are statistically significant.
- More women than men used inpatient rehabilitation care in Ontario. Half of the stroke patients in Ontario's inpatient rehabilitation beds are women, and 70 per cent of orthopedic clients are women.
- Women receiving inpatient rehabilitation care were significantly more likely than men to have shorter lengths of stay (even when adjusted for age and function score at admission), and yet are more likely to live alone after their discharge from inpatient rehabilitation. Considering women's dissatisfaction with the information they receive upon their discharge, it is crucial to develop discharge planning strategies targeted specifically for women.
Hospital Report 2005: Emergency Department Care covers 85 per cent of emergency department visits in hospitals, and includes results for 92 out of 124 hospital corporations with emergency departments. Results are based on 2003/04 data.
Key women's health findings:
- More women than men used the ED in the 20-44 and 65-older age groups, and more women than men in the 20-44 age group were triaged as urgent.
- Women had a higher proportion of ED visits (excluding visits related to child birth) than men for conditions such as disorders of the urinary system, asthma and depression, which might have been prevented or reduced through better access to primary care in the community. This points to a need for timely access to primary care, and women's-health specific or sensitive guidelines for the management of certain conditions. Addressing timely access to care in the community may help address the burden of unnecessary ED visits on health system resources.
- Woman abuse is a serious health-care issue that can result in severe physical and psychological harm for women victims of abuse and their families. Although several EDs in Ontario reported the use of guidelines for the evaluation and management of sexual assault and domestic violence and the provision of emergency oral contraception than in previous years, a considerable portion of EDs still lack protocols regarding sexual assault, domestic violence and emergency contraception (19 per cent, 40 per cent, 59 per cent respectively).
- Women are significantly less satisfied than men on all indicators of patient satisfaction. For patient satisfaction, hospitals score highest on the consideration indicator (patients' assessment of whether they were treated with respect and courtesy) and lowest on the communication indicator (patients' assessment of how well information was communicated to them or their family during their ED stay), highlighting opportunities for many hospitals to improve their communications with patients in the ED.
Hospital Report 2005: Acute Care reports on performance in 98 out of 123 eligible organizations that voluntarily participated in the report. It covers 95 percent of acute care hospitalizations. Results are based on 2003/04 data.
Key women's health findings:
- Women make up 57 per cent of users of inpatient acute care in Ontario.
- Overall, women reported lower satisfaction with the care and services they received in Ontario's acute care hospitals than men. Women were particularly less satisfied with the amount and quality of information they received in preparation for discharge and care at home. These findings should prompt hospitals to review their processes for information sharing and exchange with patients and their families, and for discharge planning. Such processes should meet the unique needs of women who are frequently discharged from acute care to situations in which they live alone, or where they also act as the primary provider of childcare and eldercare.
- For benign uterine conditions and fibroids, vaginal hysterectomies are generally preferable to abdominal hysterectomies, because they are associated with improved secondary outcomes such as a lower risk of complications, a shorter operative time, and a faster recovery time. However, hospitals continue to perform more abdominal than vaginal hysterectomies, which underscores the need for further work on understanding and addressing the barriers to providing the most appropriate type of hysterectomy or treatment/management option for each patient.
- Equitable and timely access to coronary angiography is important, as it is often the first step in a series of other, more invasive therapeutic procedures including surgery that may be necessary following an acute myocardial infarction (AMI). However, in 2003/04, women admitted to hospital with an AMI continued to have a significantly lower level of access to coronary angiography within the episode of hospital care than men. Women with acute coronary syndrome also had significantly higher readmission rates than men, and this difference increased over two years.
Hospital Report 2005: Complex Continuing Care reports on results for 54 out of 106 eligible organizations (51 per cent), covering 85 per cent of patient days in complex continuing care (CCC). Results are based on 2003/04 data.
Key women's health findings:
- Women represent over half of CCC patients in Ontario.
- For all CCC patients, maintaining mobility is an important determinant of overall functional status, independence and quality of life. A significantly higher proportion of women than men experienced deterioration in their ability to walk or wheel themselves during their CCC stay. This points to a need to examine and manage or address causes of limited mobility and function, such as depression, and musculoskeletal conditions through, for example, women's-health specific or sensitive-guidelines for multi-disciplinary care.
- Pain has important psychosocial implications, as it limits participation in activities and quality of life; for short-stay patients, pain may affect readiness for discharge. Canadian population-based surveys have found that women are more likely to report persistent pain and that the prevalence and intensity of pain increases with age. According to the report, a significantly higher proportion of women than men (both short-stay and chronic patients) in CCC hospitals experienced moderate pain on a daily basis, or horrible/excruciating pain ever (based on health-provider assessment), during their assessment period. Women's-health specific or sensitive processes, including pain assessment, monitoring and management, could contribute significantly to women's health.
- Urinary incontinence is far more common in women (1 in 4 women versus 1 in 10 men) and is a common cause of long-term institutionalization, social isolation and loss of function and quality of life. Women commonly experience a decline in physical functioning and loss of mobility as a result of this condition. Overall, a greater proportion of female chronic care patients experienced a worsening in bladder continence during their stay.
What is the OWHC doing to improve women's health in Ontario?
- The OWHC seeks to hold the government and health service providers accountable to the public for the delivery of gender-sensitive services in an equitable and timely manner. The OWHC promotes the development of the right accountability framework and indicators for women's health care, and encourages or advocates appropriate action in response to the evidence these indicators generate.
- The OWHC is funding an innovative quality improvement project, led by the HRRC, aimed at improving the quality of life for the 70 to 80 per cent of patients in complex continuing care facilities who have urinary incontinence. The project, "IC5: Improving Continence Care in Complex Continuing Care," is the first quality improvement initiative of its kind in Canada focused on complex continuing care and involving multiple hospitals. The IC5 project grew out of the Hospital Report 2003: Complex Continuing Care, which reported variations in protocols, processes and outcomes in the use of continence care and catheters in CCC hospitals. IC5 has helped to stress the importance of best practice continence care in each of the participating hospitals. Improved continence care systems, along with better care processes, is helping to achieve better health outcomes in some participating hospitals.
What is the Hospital Report series?
- The Hospital Report series is funded by the Ontario Hospital Association (OHA) and the Ministry of Health and Long-Term Care, and developed by the Hospital Report Research Collaborative (HRRC) at the University of Toronto and the Canadian Institute for Health Information (CIHI).
- The OWHC first funded the development of women's health indicators in the 2002 Hospital Report. The council also funded the production of Women's Health - An Excerpt of Hospital Report 2002: Acute Care, which looked at Ontario hospitals' responses to the health-care needs of Ontario Women and how this care compares with that provided for men. Adalsteinn D. Brown is the principal investigator for the HRRC and the women's health perspective in the reports. Christina Porcellato of the HRRC was the project manager for the women's health segment of the reports. A group of clinicians and researchers in women's health advised on the selection and definition of women's health indicators in the Hospital Report series.
TORONTO, Oct. 27 /CNW/ - Women report lower satisfaction overall with the care and services they received in Ontario's hospitals in 2003/04 than men, according to three of the four Hospital Reports 2005 recently released by the Ontario Hospital Association and the Ministry of Health and Long-Term Care. The Ontario Women's Health Council (OWHC) funded the integration of women's health indicators into the Hospital Reports 2005.
Women were most dissatisfied with the quality and amount of information they received in preparation for discharge, according to the Rehabilitation, Emergency Department Care and Acute Care reports. The OWHC strongly believes that the underlying causes of women's dissatisfaction must be explored and addressed immediately. According to the findings of three of the four Hospital Reports 2005 (Rehabilitation, Emergency Department Care and Acute Care), women are more dissatisfied than men on all indicators of patient satisfaction, particularly with respect to the quality and amount of information they receive about their condition, treatment and health-care management at home. Although these differences are small, they are consistent throughout the 2005 Rehabilitation, Emergency Department Care and Acute Care reports, across various sectors, and in previous reports. The Complex Continuing Care 2005 results, however, showed no significant difference in the satisfaction rates of women and men. Hospital Reports 2005 are independently developed by the Hospital Report Research Collaborative (HRRC) based at the University of Toronto and the Canadian Institute for Health Information.
"Women are the majority users of the health-care system in Ontario, and come into contact with hospitals at several times in their lives," said Jane Pepino, chair of the OWHC. "By understanding why they report lower levels of satisfaction in their care, we get that much closer to improving the health of Ontario's women, and improving the overall satisfaction of Ontarians with the hospital sector. Further breakdown of data - such as analysis by gender, ethnicity, education and socioeconomic status - will help us understand how care and the perception of care differ for sub-populations of women."
Some hospitals are already using information from previous Hospital Reports to make positive changes in the provision of care to women. St. Joseph's Health Centre in Toronto, for example, has been identifying opportunities to improve patient satisfaction. It has also disseminated aggregate women's health findings so clinicians can understand the results and find opportunities for change and improvement. In order to complement hospital-based initiatives in quality improvement, however, the OWHC believes more work must be done to find out why care differs for men and women, and how this can be remedied.
"Although some hospitals have attempted to increase awareness of the patient satisfaction issue, and to improve results, more work is needed to explore why women report greater dissatisfaction. It is clear that some hospitals are still not meeting women's needs for information about their condition and treatment, or how they can manage their care at home," said Dr. Donna Stewart, a member of the OWHC. "Considering this government's transformation agenda and the current shortage of family doctors, providing women with the tools they need for self-care should be a priority."
The Emergency Department Care report also identified that more women visited the emergency department (ED) for conditions such as asthma and depression. These ED visits, which continue to add to the burden on Ontario's health system resources, might have been prevented or reduced with timely access to primary care in the community. Women with asthma were more likely than men to return to the ED within 24 to 72 hours of their initial visit, reinforcing the need to pay attention to sex- and gender-specific issues in patient management.
"These reports provide one of the most comprehensive analyses of women's experiences with hospital care anywhere in the world," said Adalsteinn Brown, Principal Researcher, HRRC. "Perhaps more importantly, they also provide a foundation for mainstreaming women's health issues into standard quality improvement programs."
The Hospital Reports are used to inform quality improvement initiatives. For example, based on the findings of the Hospital Report 2003: Complex Continuing Care, the OWHC is funding a multi-hospital quality improvement initiative, called IC5 ("Improving Continence Care in Complex Continuing Care"). IC5 looks specifically at urinary incontinence (UI). UI is far more common in women (1 in 4 women versus 1 in 10 men) and is a common cause of long-term institutionalization, social isolation and loss of function and quality of life. Women commonly experience a decline in physical functioning and loss of mobility as a result of this condition.
All four Hospital Reports 2005 as well as previous reports are available at
The Ontario Women's Health Council was established by the Minister of Health and Long-Term Care in 1998. It provides the minister with expert advice on women's health and acts as an advocate for change in the health-care system. Council members have a wide range of expertise in fields such as research, public and community health, and corporate and consumer issues as they relate to women.