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MARQuIS - Methods of Assessing Response to Quality Improvement Strategies MARQuIS: Methods of Assessing Response to Quality Improvement Strategies PRIORITIES.

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Presentation on theme: "MARQuIS - Methods of Assessing Response to Quality Improvement Strategies MARQuIS: Methods of Assessing Response to Quality Improvement Strategies PRIORITIES."— Presentation transcript:

1 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies MARQuIS: Methods of Assessing Response to Quality Improvement Strategies PRIORITIES WHEN USING CARE ABROAD – PATIENTS, PROFESSIONALS, FINANCERS views (Groene, Poletti, Vallejo, Suñol, Klazinga, Kutryba) PATIENT-CENTEREDNESS IN EUROPEAN HOSPITALS (Lombarts, Rupp, Klazinga, Suñol et al)

2 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies MARQuIS: Methods of Assessing Response to Quality Improvement Strategies 2.PRIORITIES WHEN USING CARE ABROAD (PATIENTS, PROFESSIONALS, FINANCERS)

3 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies Objectives To identify and prioritize issues relevant for patients safety and centeredness as defined by patients, health care providers and health care financing bodies.

4 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies Methods Qualitative, semi-structured interviews addressing the patients pathway (admission issues & diagnosis & treatment, discharge). Discourse analysis to elect issues and priorities and comparison of grouped themes and contents. Population studied IntervieweesCountries participating Patients40Italy (23), Spain (17) Professionals30 Belgium (6), Czech Republic (7), Ireland (3), Poland (8), Spain (3), Netherlands (3) Financing bodies 3 Belgium (2), The Netherlands (1)

5 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies Results Themes 1.Differences between countries in administrative arrangements. 2.Communication processes and language barriers. 3.Differences between countries in clinical procedures. 4.Demands on the physical structure and hotel services.

6 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies Results (1/4) Specific quality requirements for administrative arrangements Administrative requirements in general do not pose problems; difficulties in making arrangements with multiple purchasers. Professionals and financers considered CBP as more time-consuming and expensive. Financers would like to selectively contract with providers - professionals think that contracts should be made at health system level. Where authorization of treatment is required, free movement of patients does not seem to be fully ensured (assessment of eligibility based on clinical/adminstrative criteria).

7 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies Results (2/4) Specific quality requirements for Communication and language barriers Cross-border patients (CBP) have higher information and communication needs throughout the care process. Cultural differences with regard to patient and family involvement. Differences in unit organization and professionals roles confusing. Lack of information of patients at discharge, differences in discharge policies. Difficulties in arranging back-transfer.

8 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies Results (3/4) Specific quality requirements for clinical procedures Informed consent procedures differ greatly (extent, language, legal issues). Some differences exist with regard to medical procedures: transplantations (organs of non-heart beating patients) rehabilitation caesarean section on demand. Quality problems may result from lack of coordination of follow up care, in particular with regard to names and dosage of drugs and discharge information.

9 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies Results (4/4) Specific quality requirements for physical structure and hotel services Patients, professionals and financers state that CBP have higher demands on hotel services. Most common issues/demands: -Timing and scope of meals -Privacy -Respect for families or carers needs -Accomodation, -Purchasable items There are differences in expectations and cultures between patients from different geographical areas.

10 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies MARQuIS: Methods of Assessing Response to Quality Improvement Strategies 3. PATIENT-CENTEREDNESS IN EUROPEAN HOSPITALS (Lombarts, Rupp, Klazinga, Suñol et al)

11 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies Objectives The strategic objective of work package 4 is to describe in a sample of EU member states how hospitals have applied national quality strategies, to what extend they meet the defined requirements of cross-border patient care and what organizational and/or methodological variables are associated with (non-)compliance of requirements. Further, WP4 is to validate the statistical results provided by WP3 concerning types and quantity of health services used by patients from another European member state.

12 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies Hospitals in the sample

13 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies Hospitals in the sample

14 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies 1. Administrative requirements Patient rights and service Designated person to support EU patients with administrative procedures

15 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies 1. Administrative requirements Patient rights and service Procedure with regard to transferring EU patients to home country

16 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies 2. Information requirements Patient rights and service Information leaflets in other EU languages

17 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies 2. Information requirements Patient rights and service CB-care arrangements & support

18 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies 2. Information requirements Patient rights and service Formalized arrangements with translation service for EU patients

19 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies 2. Information requirements Patient rights and service Availability written policies

20 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies 3. Clinical requirements Patient safety: designated responsible person for…

21 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies 3. Clinical requirements Patient safety: available systems …

22 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies 4. Physical infrastructure Patient rights and service Privacy and facilities

23 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies Variance overall classification score min.max. Belgium (n=24)2.10 -3.10 Czech Republic (n=38)1.50 -3.00 France (n=65)1.87 -3.25 Ireland (n=23)1.90 -3.08 The Netherlands (n=8)2.09 -2.52 Poland (n=76)1.86 -3.45 Spain (n=105)1.70 -3.26 UK (n=10)1.77 -2.37 Total (n=349)1.50 -3.45

24 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies External pressure and classification score TotalMost mature Inter- mediate Least mature External pressure, 9 items, alpha: 0.68 2.25 (0.79) n= 310 1.72 (0.64)* n=75 2.23 (0.71) n=157 2.79 (0.73) n=78 * Statistically significant (Student t-test) between the most mature and the least mature

25 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies Patients rights and classification score TotalMost matureInter- mediate Least mature General part1.13 (0.16) n=350 1.07 (0.11)*** n=87 1.10 (0.12) n=172 1.25 (0.2) n=86 AMI1.55 (0.4) n=310 1.46 (0.37)* n=73 1.56 (0.39) n=151 1.61 (0.43) n=81 Appendicitis1.52 (0.39) n=307 1.36 (0.32)*** n=75 1.52 (0.38) n=150 1.66 (0.42) n=79 Deliveries1.62 (0.39) n=272 1.49 (0.34)** n=64 1.65 (0.39) n=136 1.67 (0.40) n=69 * Statistically significant (Student t-test) between the most mature and the least mature are flagged; *p<0.05, **p<0.01, p***<0.001

26 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies Summary First study on cross-border care quality and safety requirements in a large sample of European hospitals, There are CB-care collaboration, arrangements and services, although there appears considerable variation, Some quality strategies (such as patient rights) appear reasonable on paper, Patient safety requirements appear adequate overall, but wide differences per system, External pressure appears to be associated with the implementation of quality requirements.

27 MARQuIS - Methods of Assessing Response to Quality Improvement Strategies Acknowledgements Authors and co-authors. Country Coordinators for their coordination efforts and support. Hospital coordinators who filled in the questionnaire: thank you! This project was funded by the European Commission through its "Scientific Support to Policies" action under the Sixth Framework Programme for Research.


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