Inconsistent, missing data means researchers can't determine what drives Manitoba hospital costs: study

Inconsistent record keeping and missing data made it impossible for a team of researchers to determine what is driving overall hospitals costs in Manitoba.

That is the key finding in a report published Monday by the Manitoba Centre for Health Policy at the University of Manitoba.

The report, titled Variations in resource use and costs of hospital care in Manitoba, concluded that "currently, important pieces of information — such as workloads for some departments and expenditures for others —  are missing. In order to make informed decisions about how to best manage hospitals, we must have access to the requisite data.… Once those elements are in place, we can begin to understand what is driving hospital expenditures in our province."

Dr. Nathan Nickel, the lead author of the report, said that where records existed, each hospital tended to record data on things like departmental expenditures, staffing levels and patient loads in ways that suited their local needs.

The researchers said because different hospitals used different methods of record keeping, it was impossible to zero in on factors system-wide that are driving costs in the province's hospitals.

"We really wanted to be able to give evidence back that would be able to paint a holistic picture of drivers of hospital costs," Nickel told CBC News.

The report, which focused on hospital records from 2009 to 2013, enumerated missing records. Notably, it found:

• Fifty-five per cent of emergency departments failed to report their expenditure data in at least one fiscal year.
• Fifty-six per cent of occupational therapy departments across hospitals did not report their expenditure data in at least one fiscal year.
• Eighty-one per cent of emergency departments in the Prairie Mountain Health Authority did not report financial data in the study period.

Of all health regions in the province, the Winnipeg Regional Health Authority had the greatest number of departments that recorded expenditures but failed to report on workloads, staff levels or patient volume.

Many of the missing activity records were from nursing units, the report found.

Validity of KPMG report not in question: province

Asked whether or not these record-keeping gaps undermine the validity of the system-wide recommendations contained in the closely guarded KPMG report on health reforms, a spokesperson for the province told CBC News that the reports from KPMG and the Centre for Health Policy "are mutually exclusive. They reviewed different time periods and had different parameters."

"The department and health system at large use many databases and other sources of evidence upon which we make policy and planning decisions," said Amy McGuiness, press secretary for the minister of health.

She said that historically, departments were not required to report on workload data but that with the recent establishment of a new provincial health organization called Shared Health Services Manitoba, monitoring of performance outcomes and accountability will be improved.

Staff turnover

Dr. Nickel said that in his discussions with health officials, he learned that part of the problem with data reliability lies with staff turnover in certain regions.

He also says record-keeping training is an issue that should be addressed.

"People go to school for two years to learn how to record health-care data and so they're very, very specialized in that. We don't have a similar type of training process in place for recording these costing data in this system," he said.

"Already, we have great data to inform what's happening at the local hospital level vis-a-vis hospital costs. It would be good now to also have data that allow us to look at things and make comparisons across the province and over time," said Nickel.

WRHA confident of data quality

In an email to CBC News, the Winnipeg Regional Health Authority wrote that last year, the Canadian Institute for Health Information gave the authority's reporting top grades and expressed little concern.

"We continue to strive to improve our collection and reporting processes but are confident the data reported by the WRHA remains valuable and relevant in our reporting to CIHI and as we use it to inform decisions made across the region," said spokesperson Bronwyn Penner Holigroski.

"The quality of data reported by the WRHA is comparable to that shared by other jurisdictions." 

A spokesperson for the Prairie Mountain Health Authority said some of the gaps in their data exist because there is no requirement to report on them.

"Prairie Mountain Health will be doing further analysis of the MCHP report and will work with Manitoba Health, Seniors and Active Living and other organizations to determine data needs going forward.  While workload measurement specific data are not reported, Prairie Mountain Health does review staffing and service activity annually to guide decision-making," said Blaine Kraushaar.