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Quality Indicators And Healthcare A First Step To The Evaluation Of A Hospital’s Performance Introdução à Medicina 2008/2009 Ana Cristina Pereira Ana Teresa.

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Presentation on theme: "Quality Indicators And Healthcare A First Step To The Evaluation Of A Hospital’s Performance Introdução à Medicina 2008/2009 Ana Cristina Pereira Ana Teresa."— Presentation transcript:

1 Quality Indicators And Healthcare A First Step To The Evaluation Of A Hospital’s Performance Introdução à Medicina 2008/2009 Ana Cristina Pereira Ana Teresa Carapenha Ana Rita Oliveira André Vinha Catarina Vieira Eduardo Freitas João Rebelo Mariana Oliveira Marli Cruz Nuno Ribeiro Paulo Guedes Victoriano Costa Authors

2 Quality Of Healthcare The indicators are the source of information to evaluate the performance of a hospital. KIRKMAN, Jamie John, BOUAMRA, Omar, Introdução à Medicina - Turma 10

3 Quality Of Healthcare Introdução à Medicina - Turma 10 EDDY, David M., 1998

4 Research Question and Main Aim Introdução à Medicina - Turma 10 How did quality and performance indicators evolve through the years in a central hospital? Our main objective is to calculate these indicators concerning different variables and to have a perspective of the performance of the hospital in case. Used data: episodes in a central hospital, between 1999 and 2008.

5 Specific Aims Introdução à Medicina - Turma 10

6 Methods SPSS (Statistical Package for the Social Sciences) Provider of predictive analytics software and solutions. (*) (*) SPSS: The Predictive Analytics Company:

7 Introdução à Medicina - Turma 10 Methods DRGs ICD-9-CM “ICD-9-CM is the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States.” (**) “A system for classifying patient care by relating common characteristics such as diagnosis, treatment, and age to an expected consumption of hospital resources and length of stay.” (*) (*) MeSh definition (**) Classifications of Diseases and Functioning & Disability: INE “The entity responsible for ensuring the production and dissemination of official statistical information.” (***) (***) Statistics Portugal:

8 Introdução à Medicina - Turma 10 Obtained Results DeceasedAliveTotal Respiratory disorder (except infections, bronchitis and asthma) with major CC (****) Other nervous system disorders (except transient ischemic attack, seizure and headache) with major CC Septicemia with major CC Hepatobiliary and pancreas disorders with major CC Respiratory neoplasms Intracranial hemorrhage Extracorporeal membrane oxygenation or tracheotomy with mechanical ventilation for more than 96 hours or tracheotomy with pdx except face/mouth/neck dx Major stomach, oesophageal, duodenal, small and large bowel procedure with major CC Simple pneumonia and pleurisy with CC (age >17) Circulatory disorders with AMI, expired4360 (****) CC: complications and commorbilities. (HCUP -3 Nationwide Inpatient Sample for 1994: Diagnosis-Related Groups:

9 Introdução à Medicina - Turma 10 Obtained Results Alive (%)Deceased (%)Total (%) Cardiac arrest, unexplained25,0%75,0%100,0% HIV with ventilator or nutritional support42,4%57,6%100,0% Tracheotomy for HIV infection46,2%53,8%100,0% Craniotomy for multiple significant trauma46,5%53,5%100,0% Neonate, birthweight between g, with significant OR procedure, without multiple major problems50,0% 100,0% Pneumocystosis50,0% 100,0% HIV with OR procedure and ventilator or nutritional support52,6%47,4%100,0% Craniotomy for multiple significant trauma with non-traumatic major CC56,4%43,6%100,0% Septicemia with major CC57,1%42,9%100,0% Major skin and breast disorders with major CC62,3%37,7%100,0%

10 Introdução à Medicina - Turma 10 Obtained Results DeceasedAliveTotal Respiratory disorder (except infections, bronchitis and asthma) with major CC Other nervous system disorders (except transient ischemic attack, seizure and headache) with major CC Septicemia with major CC Hepatobiliary and pancreas disorders with major CC Respiratory neoplasms Intracranial hemorrhage Extracorporeal membrane oxygenation or tracheotomy with mechanical ventilation for more than 96 hours or tracheotomy with pdx except face/mouth/neck dx Major stomach, oesophageal, duodenal, small and large bowel procedure with major CC Simple pneumonia and pleurisy with CC (age >17) Circulatory disorders with AMI, expired4360 Alive (%)Deceased (%)Total (%) Cardiac arrest, unexplained25,0%75,0%100,0% HIV with ventilator or nutritional support42,4%57,6%100,0% Tracheotomy for HIV infection46,2%53,8%100,0% Craniotomy for multiple significant trauma46,5%53,5%100,0% Neonate, birthweight between g, with significant OR procedure, without multiple major problems 50,0% 100,0% Pneumocystosis50,0% 100,0% HIV with OR procedure and ventilator or nutritional support52,6%47,4%100,0% Craniotomy for multiple significant trauma with non-traumatic major CC56,4%43,6%100,0% Septicemia with major CC57,1%42,9%100,0% Major skin and breast disorders with major CC62,3%37,7%100,0%

11 Introdução à Medicina - Turma 10 Obtained Results

12 Introdução à Medicina - Turma 10 Obtained Results

13 Introdução à Medicina - Turma 10 Obtained Results

14 Introdução à Medicina - Turma 10 Obtained Results Statistics Portugal:

15 Introdução à Medicina - Turma 10 Obtained Results

16 Introdução à Medicina - Turma 10 Obtained Results

17 Introdução à Medicina - Turma 10 Obtained Results

18 Introdução à Medicina - Turma 10

19 References REINHARDT, Uwe E.: Quality in consumer-driven health systems. International Journal for Health Care. 1998; 10(5) BENTES, Margarida; BERARDO, Ana; MATIAS, Alberto: XVII Congresso da União Europeia de Gestores Hospitalares HSIEH, Mei-o; KAGLE, Jill Doner: Understanding patient satisfaction and dissatisfaction with health care. Health Soc Work Nov;16(4): GARDNER, Karen L.; SIBTHORPE, Beverly; LONGSTAFF, Duncan: National quality and performance system for divisions of general practice: early reflections on a system under development EDDY, David M.: Performance measurements: problems and solutions in Health Affairs. Vol.17. 4, GERAEDTS, Max; SCHWARTZE, David; MOLZAHN, Tanja: Hospital quality reports in Germany: patient and physician opinion of the reported quality indicators. BMC Health Serv Res.; 2007 Sep 28; BENTES, Margarida; GONÇALVES, Maria da Luz; TRANQUADA, Suzete; URBANO, João: A utilização dos DGH’s como instrumento de financiamento hospitalar. Gestão Hospital, National Library of Medicine. Available from: BRIZ, Teodoro; DIAS, Carlos Matias; FREITAS, Mário: Indicadores de saúde: uma visão de Saúde Pública, com interesse em Medicina Geral e Familiar. Revista Portuguesa Clínica Geral 2007;23: RIBEIRO, Nuno. Administração pública. TOC. 2000/08 DIMICK, Justin B.; WELCH, H. Gilbert; BIRKMEYER, John D.: Surgical mortality as an indicator of hospital quality: the problem with small sample size. JAMA Aug 18;292(7): ENDAHL, Lars A.; UTZON, Jan: Will publication of quality indicators in the health service improve the quality? International experiences and Danish perspectives. Ugeskr Laeger Sep 16;164(38): National report on health sector performance indicators Canberra: Australian Institute of Health and Welfare; 2004.

20 References RAVAUD, P., GIRAUDEAU, Bruno; ROUX, P.M., DURIEUX, P.: Are mortality indicators acceptable indicators for the quality of health care?. Presse Med Oct 2;28(29): BROOKS, Robert; BROWN, Steven L.; CHUKMAITOV, Askar S.; MENACHEMI, Nir; SAUNDERS, Charles; TANG, Anqi: Is there a relationship between physician and facility volumes of ambulatory procedures and patient outcomes? J Ambul Care Manage Oct-Dec;31(4): MERRILL, Douglas: Management of outcomes in the ambulatory surgery center: the role of standard work and evidence-based medicine. Curr Opin Anaesthesiol Dec;21(6): MOORE, Dan H.; SAWAYA, George F.; HOPKINS, Linda M.; NOAH, M.S.; LAROS, Russell K.; ESAKOFF, T.: Outcomes associated with cesarean section versus vaginal breech delivery at a university hospital. J Perinatol Mar;27(3): Epub 2006 Oct 12. URIEL, Zanon. Qualidade da assistência médico-hospitalar: conceito e avaliação de indicadores Jul-Set RAS. Vol. 2, Nº 8. Available from: SPSS: The Predictive Analytics Company. Available from: MURPHY, Mark E.; NOETSCHER, Cheryl M.: Reducing hospital inpatient lengths of stay. J Nurs Care Qual Nov;Spec No: MIRZA, Fadi G.; WYLIE, Blair J.: Cesarean delivery in the developing world. Clin Perinatol Sep;35(3):571-82, xii. SHEARER, E.L.: Cesarean section: medical benefits and costs. Soc Sci Med Nov;37(10): LEITE, Sofia. População presente e população residente segundo o sexo e idades através dos censos. Available from: THOMAS, J. William; GUIRE, Kenneth E.; HORVAT, Gary G.: Is patient length of stay related to quality of care? Hosp Health Serv Adm Winter;42(4): JIMÉNEZ, Rosa; LÓPEZ, Libia; DOMINGUEZ, Daniel; FARIÑAS, Humberto: Difference between observed and predicted length of stay as an indicator of inpatient care inefficiency. Int J Qual Health Care Oct;11(5): Introdução à Medicina - Turma 10

21 References MARCH, S.; SWART, E.; ROBRA, B.: Patient satisfaction with outpatient/short stay operations in a practice clinic. Gesundheitswesen Jun;68(6): COYLE, T.T.; HELFRICK, J.F.; GONZALEZ, M.L.; ANDRESEN, R.V., PERROTT, D.H.: Office-based ambulatory anesthesia: Factors that influence patient satisfaction or dissatisfaction with deep sedation/general anesthesia. J Oral Maxillofac Surg Feb;63(2): GICHANGI, P.; APERS, L.; TEMMERMAN, M: Rate of caesarean section as a process indicator of safe motherhood programmes: the case of Kenya. J Health Popul Nutr Jun;19(2):52-8. Inpatient quality indicators overview. Available from: COPNELL, Beverley; HAGGER, Virginia; WILSON, Sally G.; EVANS, Susan M.; SPRIVULIS, Peter C.; CAMERON, Peter A.: Measuring the quality of hospital care: an inventory of indicators. Intern Med J Mar 23. HEIJINK, Richard; KOOLMAN, Xander; PIETER, Daniel; VAN DER VEEN, André; JARMAN, Brian; WESTERT, Gert: Measuring and explaining mortality in Dutch hospitals; the hospital standardized mortality rate between 2003 and BMC Health Serv Res Apr 3;8:73. CAMERON, P.A.; GABBE, B.J.; MCNEIL, J.J.: The importance of quality of survival as an outcome measure for an integrated trauma system. Injury Dec;37(12): Epub 2006 Nov 7. JAIPAUL, C.K.; ROSENTHAL, G.E.: Do hospitals with lower mortality have higher patient satisfaction? A regional analysis of patients with medical diagnoses. Am J Med Qual Mar-Apr;18(2): KAVANAGH, Patricia L.; ADAMS, William G.; WANG, C. Jason: Quality indicators and quality assessment in child health. Arch Dis Child Mar 22. BAARS, Irma J.; EVERS, Silvia M.; ARNTZ, Arnoud; VAN MERODE, Godefridus: Performance measurement in mental health care: present situation and future possibilities. Int J Health Plann Manage Feb 11. HCUP-3 Nationwide Inpatient Sample for 1994: Diagnosis-Related Groups. Available from: Introdução à Medicina - Turma 10


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