The performance of health systems and hospitals in Canada Studies on outcomes measurement

Scrutiny on the performance of health systems and hospitals in Canada has increased in recent years. Progress has been made away from more rudimentary measures of resources and output performance towards more meaningful measures of outcomes. However, health system and hospital performance outcome measures have inherent limitations and deficiencies to accurately and adequately reflect their contribution towards the realization of health in populations and patients.
This dissertation is composed of five research questions and resultant studies on outcomes-based measurement in the Canadian health system and hospital contexts. The specific research questions of this thesis are:
1. What is outcomes measurement and its state of use in Canada?
2. How are health system and hospital performance indicators evaluated and prioritized?
3. What is the validity and impact of the palliative care code on the Hospital Standardised Mortality Ratio (HSMR) indicator?
4. What are the performance trends on hospital outcome indicators?
5. What is the degree of association between hospital performance outcome indicators?
The findings of this dissertation pose additional areas of research necessary to better understand and utilize health outcome measures. This dissertation also raises important policy considerations both in terms of gaps in practice for optimizing and introducing health outcome measures, but also for critical review of existing policies and governance models that rely on and involve select outcome measures.