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Province fares poorly on stroke survival

Health Minister Erin Selby: 'concerning'

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Health Minister Erin Selby: 'concerning' (MELISSA TAIT / WINNIPEG FREE PRESS FILES)

A new report comparing the health performance of individual Canadian provinces with about three dozen countries is shining light on some troubling shortcomings in Manitoba.

The study, released Thursday by the Canadian Institute for Health Information (CIHI), found the death rate in Manitoba after a patient is admitted to hospital for stroke compares unfavourably with the vast majority of OECD countries.

Only five countries, including Mexico and Turkey, had worse performances than Manitoba's, while Canada as a whole ranked 20th among the 34-member countries of the Organization for Economic Co-operation and Development.

Percentage of patients age 45 and older who die in hospital within 30 days of being admitted with a primary diagnosis of stroke:

  • Mexico 19.6%
  • Slovenia 12.8%
  • Turkey 11.8%
  • Chile 11.6%
  • Slovak Republic 11.0%
  • Manitoba 10.9%
  • Canada 9.7%
  • OECD average 8.5%
  • United Sates 4.3%

-- source: Canadian Institute for Health Information

The finding has led to renewed calls within the province for the creation of a dedicated stroke unit in Winnipeg. Manitoba is the only province in Canada without such a unit, according to the Heart and Stroke Foundation of Manitoba.

Meanwhile, Manitoba had a worse record than any OECD country when it came to surgical teams leaving sponges and other foreign objects inside patients. Canada, as a whole, had the third-poorest performance among the 20 nations that reported such occurrences. Manitoba's record, however, at 11.8 mishaps per 100,000 surgeries, was worse than that of any nation in the survey. New Zealand had the next highest ratio at 10.6 per 100,000, while the Canadian average was 8.6 per 100,000.

The CIHI report, Quality of care: How the provinces fare internationally, is the first of its kind in Canada. It allows medical professionals and government officials to compare how their province stands up against dozens of countries in 19 categories.

Manitoba -- and Canada as a whole -- fared well in such areas as influenza vaccination, breast cancer survival and 30-day survival rates after being hospitalized for heart attack. Both also performed well, in comparison to OECD nations, in providing care that avoided hospital admissions for asthma and diabetes.

And with respect to cervical cancer screening rates, only the United States had a better record than Manitoba in getting women checked.

Jackie Zalnasky, vice-president of health promotion and research with the Heart and Stroke Foundation of Manitoba, said the report's results are a cause for concern. The foundation has been calling for improved stroke care for a decade.

She said according to research, creation of a specialized stroke unit can reduce the likelihood of death and disability from stroke by as much as 30 per cent. Even tiny Prince Edward Island has such a unit, she said.

Conservative health critic Myrna Driedger tabled a resolution in the Manitoba legislature nearly two years ago calling for the creation of a specialized stroke unit. The motion failed to win government support.

"I don't know why the government is dragging their heels on something like that," she said. She called the study results "alarming."

Health Minister Erin Selby said the government is "looking into" establishing a specialized unit, but she made no commitment. She noted Manitoba's health system has performed well in studies that compare initial response times for stroke patients. The province has also made great strides in reducing the number of strokes that occur, she said.

Selby said she found the fact the province ranked so poorly when it came to surgical teams leaving foreign objects inside patients "concerning."

"I certainly want to hear more about what we can be doing better on that, for sure," she said, noting surgical teams are supposed to use checklists to account for their instruments.

Katerina Gapanenko, manager of health system research at CIHI, said sponges make up the largest percentage of foreign objects left behind in surgeries. She said these incidents tend to occur in extreme trauma cases involving multiple surgical teams. She also noted the overall Manitoba incident numbers are relatively small and one or two fewer incidents would have affected the province's ranking. Still, she said, the result was a cause for concern.

Gapanenko said Manitoba -- and Canada -- may have a poorer ranking with regards to 30-day survival rates for stroke because of differences in hospital admission policies among countries. In some nations, hospitals will admit patients for relatively minor strokes, which would make their numbers look better. That's not always the case here, she said.

Meanwhile, CIHI said in its report it was struck by the high number of Canadian (and Manitoba) mothers -- about three per cent -- who are injured by tears during childbirth. The number excludes caesarian sections or instances where forceps are used and is among the highest within the OECD.

Gapanenko said the result may be partly explained by the fact Canada now has a lower rate of C-sections than other countries.

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