Quality indicators for health care providers in Hungary Éva Belicza, Semmelweiss University ( Budapest ) Miklós Fehér, Hungarian Medical Chamber (Budapest )

121.chapter of the health care act deals with quality system of health care providers, it differentiates two quality systems, such as internal and external ones. It also says the introduction of internal quality system is mandatory for every health care institution. Act on health care

The tools and methods of internal quality system are set by a guideline of the Ministry of Health. In this guideline the quality indicators are defined as follows: a quantitative index of events occurring in the course of health provision, which can be used for measuring and evaluating the quality of health provision, the health status of the population and the system of providing health care.

In Hungary two working group were established for designing quality indicators, one in the National Health Insurance Fond another one in the Ministry of Health. There are two main differences between this two working groups. The number of indicators and the sources of data. The ministry group set up more indicators and collected the data from more sources, while the insurance group collected the data from database required by reimbursement system (DRG) only

The indicator groups of ministry: - general - surgery - nosocomic infections and antibiotic treatment - paediatry - oncology - intensive treatment - cardiology - geriatry - human policy

The general indicators: - turn-over of patients per bed - rate of changing admission diagnosis - mortality rate - rate of re-admissions - average length of stay - rate of discrepancy between the clinical and pathological diagnosis - rate of autopsy

Surgical indicators: - rate of surgical interventions - rate of reoperations - rate of endoscopic operations - rate of very specific ( index ) operations - mortality rate in the first 24 hours - rate of non operated patient in the surgical wards

Nosocomic infections and antibiotic treatment: Nosocomic infections and antibiotic treatment: - rate of relevant antibiotic treatments - rate of haemo-culture examinations - rate of nosocomial infections - rate of nosocomic pneumonias in connection with artificial respiration - rate of sepsis in connection with intravascular catheterisation - rate of hospital wound infections - rate of antibiotic prophylaxis - rate of intravenous catheterisations - rate of antibiotic prophylaxis minutes prior operation - rate of antiseptic shavings

: Pediatrics : - frequency of Caesarean section - infant mortality rate - new-born mortality rate - premature birth rate - perinatal death rate - rate of developmental anomalies Oncology: - rate of histological examinations of given type of tumours - rate of tumours detected by screening - death rate of patients with given type of tumours - five years survival rate of patients with given type of tumour

Intensive therapy: - rate of artificial breathing - rate of primarily successful reanimations - rate of artificial feedings - rate of operated patients needed treatment in ICU

Cardiology: Cardiology: - rate of AMI patients with thrombolytic treatment - death rate of AMI patients in the first 24 hours - overall death rate of AMI patients - rate of AMI patients with PTCA Geriatrics: - death rate of admitted geriatric patients within one month - emergence rate of bed shores for bedridden patients - emergence rate of incontinence for geriatric patient in different age groups

Human policy: - rate of licensed health workers - turn-over of personnel

Those are quite numerous indicators, measuring the quality on different levels, such as level of ward, level of individual institutions, and level of group of institutions, on national level and on international level as well. The institutions were grouped according their owner (universities, state, capital, county and town self-governments) and according their geographical localisation.

The NHIF working group has elaborated far less quality indicator yet, in four groups: - AMI, - rehabilitation wards, - Caesarean section rate - autopsy rate.

- death rate in different time-intervals, - rate of different interventions (thrombolysis, PTCA, stent, by-pass) As far as possible risk adjustment was performed. AMI indicators

16 30-day mortality rate of AMI cases , Hungary

17 30-day mortality rate of AMI cases aggregated according to the number (more or less than 50) of cases cared in a hospital (first provider) in a given year

18 30-day mortality rate of AMI cases according to the types of hospitals (first provider),

- death rates in the ward and in the hospital - transmission rate of patients - rehabilitation personell rate Rehabilitation wards indicators

- great debate on question of publicity, how to publish and whether to publish at all - it came to an end by a compromise; the indicators were published on the web unanimously using code-numbers established for this single purpose only. Publication (publish or not to publish?)

Main statements on applying and publishing indicators* ● Indicators itself are not suitable for qualifying purposes ● Application of standards are not avoidable ● Methodology of risk adjustment is not unambiguous ● Outcome results after discharge are not known ● Indicators have to be given over for providers instead of publish it openly *Objective judgement of hospital care;dream or reality. É.Belicza, E.Takács

● Thank you for your attention!