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Quality and accessibility of Portuguese hospital services through 2000 to 2007 Course: Mestrado Integrado em Medicina Subject: Introdução à Medicina I.

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Presentation on theme: "Quality and accessibility of Portuguese hospital services through 2000 to 2007 Course: Mestrado Integrado em Medicina Subject: Introdução à Medicina I."— Presentation transcript:

1 Quality and accessibility of Portuguese hospital services through 2000 to 2007 Course: Mestrado Integrado em Medicina Subject: Introdução à Medicina I Class 8 Teacher (adviser) Alberto Freitas 15th December 2008

2 Structure of the presentation Motivations Indicators Research Question and Aims Participants and Methods Expected Results References

3 Evaluate the state of Portuguese healthcare Analyse its evolution through the past eight years (2000-2007) Compare the activity and quality indicators among the different Portuguese regions. Motivations of the study

4 Indicators Importance Mechanisms to assess quality and accessibility of hospitals Factors for accounting and financial directing

5 What are quality and activity/productivity indicators? Indicators

6 Health care quality indicators Measures which contain relevant information concerning services conditions Reflect the health status of a population and help monitoring health conditions Indicators

7 Activity/Productivity indicators Evaluate hospital performance Express the relation between applied resources and goals achieved Related with public access to healthcare services Indicators

8 Both quality and activity indicators are susceptible: Actualization of evaluative parameters Modification of their relevance in hospital assessment Indicators are not fixed evaluative parameters!

9 Indicators Domain Mortality Quality Hospitalization time Quality and Activity/Productivity Postponed surgeries Quality Ambulatory episodes Activity/Productivity Ambulatory surgeries Activity/Productivty Births by Caeserean-section Activity/Productivity Main diagnostics Quality Surgical procedures, complications Quality Indicators

10 How have health indicators evolved, in Portugal, during the past 8 years, how is that reflected in the quality and accessibility of healthcare services an in which ways can they be improved? Research Question and Aims Research Question

11 Aims Provide reliable nationwide and regionally comparisons through a time period (2000-2007) Theorize future evolution and prioritize indicators improvements Infer about qualitative and accessibility parameters Research Question and Aims

12 Participants and Methods Study Participants Target population: Portuguese continent population Sampling Methods: No samples were taken from the dataset of registers from private and public continental hospitals

13 Participants and Methods Study Participants Note: Analysis of only continent private and public hospitals records Madeira and the Azores archipelagos use a different system of classification Inclusion and exclusion criteria: each indicator considers all registers, thus no need for criteria

14 Participants and Methods Study Design Descriptive – Indicators analysis will describe accessibility and quality parameters of hospitals Analytical – Less evident, only few relations are established between indicators Observational – There was no intervention. Data was collected from observation of hospitals registers

15 Longitudinal – The study consists of a data follow up through 2000 to 2007 Retrospective – Data was collected from registers in the past Prospective – Via the results obtained a future prospect of the healthcare system will be presented Participants and Methods Study Design

16 Secondary data – Data wasnt specifically collected for this study Participants and Methods Data collection methods Dataset provided by the Health Care System Central Administration (ACSS) containing all registers of public and private hospitals in the continent, from 2000 to 2007

17 Microsoft Office Excel: Graphics and tables SPSS Data filtering (according to each indicator) Statistical calculations and graphics (Planned Statistical Analysis) Participants and Methods Data collection methods

18 Variable description Participants and Methods Diagnosis Related Groups - DRG Classification system for patients admitted to hospital Clinically coherent and homogenous groups Consumption of resources

19 Variable description Participants and Methods The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) System of codes to diagnoses and procedures associated with hospital utilization The ICD-9-CM consists of: tabular list containing a numerical list of disease code numbers; classification system for surgical, diagnostic, and therapeutic procedures

20 Participants and Methods Variable description The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)

21 Participants and Methods Variable description Hospital ID Hospital Location – Allows an analysis of the various regions through the hospitals there located. Both allow a regional analysis according to hospitals location – NUTS

22 Participants and Methods Variable description Nomenclature of territorial units for statistics (NUTS) Level II: 7 units, of which 5 in the continent. North Centre Alentejo Algarve Lisbon Azores Madeira Level III: 30 units, of which 28 in the continent Level I: 3 units, of which 1 is the continent

23 Participants and Methods Variable description Gender – Division into two groups of analysis: men and women Age – Stratification based on age Birth Weight – Obstetrics services Days of hospital stay – Hospitalization Time Discharge date – Year division of each indicator essential to evaluate the evolution of indicators

24 Participants and Methods Planned statistical analysis SPSS for Windows All Indicators: Frequencies Percentages Hospitalization Time: Means Percentiles Median SPSS for Windows and Microsoft Office Excel Graphics Tables

25 Participants and Methods Examples of applied Methods Amb. Ep.Tot.Ep.Amb.% 2000733195723,75 2001959200044,79 20021206202775,95 20031503210667,13 20041827212958,58 20051840212828,65 Evolution of the ratio between number of ambulatory procedures and total number of procedures, from 2000 to 2005

26 Participants and Methods Examples of applied Methods

27 Participants and Methods Examples of applied Methods V3000 = Single lb in hospital w/o cs 650 = Normal delivery 43401 = Cere thrombosis w/ inrct V3001 = single lb in hospital w cs 486= Pneumonia, organism unspecified 55090 = Inguinal hernia, without mention of obstruction or gangrene V581= Encounter for chemotherapy and immunotherapy for neoplastic conditions 36610= Senile cataract, unspecified 4280 = Congestive heart failure, unspecified 4549 = Asymptomatic varicose veins Main diagnostic Freque ncy Perc enta ge Valid Percent age Cumulative Percentage 454911120,9 81 4340111250,9 81,9 428011470,9 82,8 33661013471,1 83,9 V58114521,2 85,1 5509016251,3 86,4 48621821,8 88,1 V300131432,5 90,7 65034102,8 93,5 V300080866,5 100

28 Examples of applied Methods Participants and Methods DRG- 14 DRG- 39 DRG- 89 DRG- 127 DRG- 162 DRG- 359 DRG- 371 DRG- 373 DRG- 390 DRG- 391 20003,19%0,71%2,42%1,70%0,64%1,13%2,04%3,03%0,87%3,35% 20012,98%0,60%2,40%1,72%0,51%1,12%2,76%2,51%0,78%2,90% 20023,67%0,62%2,49%1,64%0,55%1,08%1,83%2,73%0,79%3,03% 20033,29%0,45%2,47%1,75%0,50%1,04%1,64%2,56%0,94%2,85% 20043,36%0,44%3,12%1,86%0,47%0,94%1,77%2,75%0,75%2,87% 20053,36%0,49%3,93%1,80%0,39%0,77%1,68%2,26%0,82%2,76% Hospitalization Time – Percentage of hospitalization time of the 10 most frequent indicators in overall hospitalization time from 2000 to 2005

29 Ambulatory Episodes and Ambulatory Surgeries – Number of ambulatory episodes tends to rise but its still low Hospitalization time – Tendency of diminishing hospitalization episodes and the mean of time of stay Mortality – Greater mortality in rural regions; elderly group likely to have a greater incidence Expected Results Main Expectations – Indicators

30 Expected Results Quality and Accessibility to Portuguese hospitals are expected to improve during the years in analysis. Likelihood of disparity between rural and urban regions: rural regions present worst indicators values. Main Expectations

31 Expected Results Limitations Results from 2% of the ACSS dataset Articles and other information concerning indicators Expected Results Full ACSS dataset may present results that differ: Sample is very small Sample offers no coverage off all years (only 2000 to 2005)

32 Expected Results Limitations Hospital quality and accessibility also depends on: Population lifestyle Financing and logistical support Thus indicators may not reflect the truth about the healthcare system

33 Increase of knowledge and understanding of the Portuguese health system: – Quality characteristics – Accessibility characteristics Expected Results Future implications

34 Suggestions of improvements according to the results obtained – Healthcare services impact Improved resources management – Economic impact Target financing to needed medical areas – Social impact Improvement of quality of life Expected Results Future implications

35 Portugal Public and private hospitals Quality indicators Organization and administration Keywords

36 1.Freeman T. Using performance indicators to improve health care quality in the public sector: a review of the literature. Health Services Management Reseach. 2002 May;15(2):126-37. 2.Olímpio J, Nogueira V, Bittar. Produtividade em hospitais de acordo com alguns indicadores hospitalares. Revista de Saúde Pública. 1996 February;30(1). 3.Barros PP, Sena C. Quanto maior melhor? Redimensionamento e economias de escala em três hospitais portugueses. 1998 November. 4.Travassos C, Carvalho de Noronha J, Martins M. Mortalidade hospitalar como indicador de qualidade: uma revisão. Ciência & Saúde Coletiva.1999;4(2):367-381. 5.Grenier-Sennelier C, Corriol C, Daucourt V, Michel P, Minvielle E. Développement dindicateurs de qualité au sein des établissements de santé: le project COMPAQH. Revue d'Epidémiologie et de Santé Publique. 2005 September;53: 130. 6. Mahapatra P, Berman P. Using hospital activity indicators to evaluate performance in Andhra pradesh, India. The International Journal of Health Planning and Management. 2006 September;9(2):199-211 References

37 7.MEDSTATWEB. Serviço de Bioestatística e Informática Médica. Faculdade de Medicina da Universidade do Porto [cited 2008 December 15]. Available from: Informatica médica [Internet]. [cited 2008 December 15]. Available from: GDhs em Portugal#Os GDHs em Portugal Centers for Disease Control and Prevention [Internet]. [cited 2008 December 15]. Available from: Diário da República [Internet]. [cited 2008 December 15]. Available from: [Internet]. [cited 2008 December 15]. Available from: http://eur- 12. Rangrez RA, Tabish SA, Bukhari IA, Deva SW, Pandit NA, Wani RA, Department of Hospital Administration, Sher-I-Kashmir, In Institute of Medical Sciences, Srinagar. Role of Ambulatory Care in a Teaching Hospital. JK-Practitioner. 2005; 12(1):48-50

38 References 13. Birkmeyer JD, Siewers AE, Finlayson EVA, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE. Hospital Volume and Surgical Mortality in the United States. The New England Journal of Medicine. 2002 April 11; 346(15):1128-1137. 14. Nawal LM, Bhat DK, Gandhi SR, Nguyen C, Weidenbacher-Hoper VL, Lipsky MS. A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States. International journal for quality in health care. 2007 June ;19(3):141-9. 15. Lynnus Peng, Assistant Clinical Professor. Outpatient Surgery Page [Internet]. University of California at Irvine, Department of Anesthesiology, St Jude Medical Center; [updated 200 November 1; cited 2008 December 15]. Available from: 16. Tracy KJ, Craig EH, Scott DG. Ambulatory Surgery: Next-Generation Strategies for Physicians and Hospitals. Healthcare Financial Management. 2000 January. 17. Jarrett P, Ogg TW. The British Association of Day Surgery: the early years. The Journal of One-Day Surgery;14(3):62-63.

39 18. Dimick JB, Welch HG, Birkmeyer JD. Surgical Mortality as an Indicator of Hospital Quality. JAMA. 2004 August 18; 292(7) References

40 Ana Cláudia Matos Ribeiro Ana Rita Pereira Eluetério Silva Carolina Sobrinho Ribeiro Diogo Costa Branco Diogo do Fundo Raposo Ivo Pedro Costa Gomes João Filipe Pedrosa Bernardes joaofbernardes@hotmail,com José Vitor Reis Lopes Gonçalves Oscar Ricardo Cerqueira Ramos Maria Leonor Taboas Simões Natália Sofia de Sousa Silva Pedro Miguel Aparício Chorão Sofia Maia Teixeira Tânia Sofia Gomes Esteves Developped by:

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