assessment of the portuguese pediatric healthcare services
DESCRIPTION
Assessment of the Portuguese Pediatric Healthcare Services. Adriana Alves de Sá Lemos Pinto Ana Isabel Moreira Ferrão Ana Rita Ribeiro Mieiro Pinto Dias Fátima Daniela Almeida Ribeiro Guadalupe Maria da Silva Costa Marinho Joana Gomes Amorim João Sérgio de Lima Soares Neves - PowerPoint PPT PresentationTRANSCRIPT
Assessment of the Assessment of the Portuguese Pediatric Portuguese Pediatric Healthcare ServicesHealthcare Services
• Adriana Alves de Sá Lemos Pinto• Ana Isabel Moreira Ferrão• Ana Rita Ribeiro Mieiro Pinto Dias• Fátima Daniela Almeida Ribeiro • Guadalupe Maria da Silva Costa Marinho• Joana Gomes Amorim• João Sérgio de Lima Soares Neves• Luís Miguel Fernandes Teles• Mafalda Sofia Ferreira Gonçalves• Pedro Martins Pereira• Sara Daniela Correia Miranda• Sara Margarida Preto Roca
Class 1Prof. Alberto Freitas
Introduction
Background
Justification
Aims
Participants
Methods
Description of the chosen PDIs
Result Analysis
Comparison with SábadoMagazine
Expected results
Flow Chart
References
Introdução à Medicina I 2007/2008
Pediatric Quality Indicators
INTRODUCTIONINTRODUCTION“Quality day care from infancy clearly has positive
effects on children’s intellectual, verbal, phisical and
cognitive development, especially when children would
otherwise experience impoverished and relatively
unstimulating home environments. Care of unknown
quality may have deleterious effects.”
Lamb’s, Michael. Handbook of Child Psychology 1998. 104
www.qualityindicators.ahrq.gov/documentation.htm
• In 1994 the Health Care Cost and Utilization Project were developed at the Agency for Health Care Research and Quality; (1)
• 33 indicators were designed to evaluate quality at hospitals; (1)
BackgroundBackground
(1) AHRQ: Agency for healthcare research and quality [Internet]. USA; Measures of Pediatric Health Care Quality Based on Hospital Administrative Data, The Pediatric Quality Indicators.2007 [about 1 screen] Available from: http://www.qualityindicators.ahrq.gov/downloads/pdi/
SS
BackgroundBackground
• Pediatric Quality Indicators - “Set of measures that focus on children’s health care quality” (1) - were created;
• The population in study is submitted to several requirements;
(1) AHRQ: Agency for healthcare research and quality [Internet]. USA; Measures of Pediatric Health Care Quality Based on Hospital Administrative Data, The Pediatric Quality Indicators.2007 [about 1 screen] Available from: http://www.qualityindicators.ahrq.gov/downloads/pdi/
BackgroundBackground• Provider-level indicators – include cases where a
secondary diagnosis code flags a potentially preventable complication;(1)
• Accidental Puncture or Laceration
• Decubitus Ulcer
• Foreign Body Left During Procedure
• Iatrogenic Pneumothorax in Neonates
• Iatrogenic Pneumothorax in Non-neonates
• Pediatric Heart Surgery Mortality
• Pediatric Heart Surgery Volume (1). AHRQ: Agency for healthcare research and quality [Internet]. USA; Measures of Pediatric Health Care Quality Based on Hospital Administrative Data, The Pediatric Quality Indicators.2007 [about 1 screen] Available from: http://www.qualityindicators.ahrq.gov/downloads/pdi/
• Postoperative Hemorrhage or Hematoma
• Postoperative Respiratory Failure
• Postoperative Sepsis
• Postoperative Wound Dehiscence
• Selected Infections Due to Medical Care
• Transfusion Reaction
• Area-level indicators – cases where a patient’s risk of the complication occurred in a separate hospitalization;(1)
• Asthma Admission Rate
• Diabetes Short-term Complication Rate
• Gastroenteritis Admission Rate
• Perforated Appendix Admission Rate
• Urinary Tract Infection Admission Rate (1). AHRQ: Agency for healthcare research and quality [Internet]. USA; Measures of Pediatric Health Care Quality Based on Hospital Administrative Data, The Pediatric Quality Indicators.2007 [about 1 screen] Available from: http://www.qualityindicators.ahrq.gov/downloads/pdi/
JustificationJustification
This study can be considered important and innovative since pediatric care is significantly different from adult
care:
• Evaluation of hospitals’ conditions focused on the quality of the pediatric services
provided.
JustificationJustification
• Spread the results of our PDI’s studies
• Choose the best pediatric services
JustificationJustification
• Appeal to hospital’s attention in what
concerns to their position in the ranking
• Improve services’ quality
AimsAims• Evaluate and compare the quality of Pediatric
services in Portugal.– Considering: Location; economical groups and
evolution among several years
• Compare our results with other studies that have already been done: Sábado Magazine and USA Pediatric Quality Indicators.
Tipe of studyTipe of study
• Retrospective
• Analytic study
• Longitudinal
• Observational
ParticipantsParticipants
1. Target population
Our study will focus on all impatient pediatric episodes of Portuguese Hospitals, based on administrative and clinical data, from 2000 to 2005.
But…
Who is included in pediatric care?
– People aged under 18 years;
– Not in Major Diagnostic Category 14 (Pregnancy, Childbirth & the Puerperium);
– Not in adult Diagnostic Related Groups. (1)
(1). AHRQ: Agency for healthcare research and quality [Internet]. USA; Measures of Pediatric Health Care Quality Based on Hospital Administrative Data, The Pediatric Quality Indicators.2007 [about 1 screen] Available from: http://www.qualityindicators.ahrq.gov/downloads/pdi/
MethodsMethods
• The Accidental Puncture or Laceration indicator is intended to flag cases of complications that arise due to technical difficulties in medical care, specifically those involving an accidental puncture or laceration. (2)
Example – Example – Accidental Puncture or Accidental Puncture or Laceration (PDI1)Laceration (PDI1)
(2). U.S. department of health and human services; AHRQ Quality Indicators Pediatric Quality Measures Clearinghouse [internet], USAgovernment; 2007, March; Available from http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?doc_id=10696
a) Open SPSS data base and apply the general inclusion and exclusion criteria
b) Calculate the numerator
Discharges among cases meeting the inclusion and exclusion rules for the denominator with ICD-9-CM code denoting accidental cut, puncture, perforation, or hemorrhage during medical care in any secondary diagnosis field. (3)
(3). McDonald, K., Measures of Pediatric Health Care Quality Based on Hospital Administrative Data: The Pediatric Quality Indicators, 2006 February 20. 32
1. Apply the specific inclusion and exclusion criteria of the numerator of the chosen PDI
• ICD-9-CM Accidental Puncture or LacerationAccidental Puncture or Laceration Codes
Obtained numerator: 997
c) Calculate the denominator
1. Apply the general inclusion and exclusion criteria of PDI’s
2. Apply the specific inclusion and exclusion criteria of the denominator of the chosen PDI
Included cases:
• All medical and surgical discharges under age 18 defined by specific
DRGs - Diagnostic Related Groups, using ICD-9-CM codes available in
Appendix B (Surgical Discharge DRGs) and E (Medical Discharge
DRGs).
Excluded cases:
•with ICD-9-CM code denoting technical difficulty (e.g., accidental cut, puncture, perforation, or laceration) in the principal diagnosis field;•MDC 14 (pregnancy, childbirth, and puerperium);•normal newborn (DRG 391);•Newborns with birth weight less than 500 grams, available in Appendix G: Low Birth Weight Categories.
Obtained denominator: 784820
d) Divide the numerator by the denominator to obtain the final result.
Final result: (779/ 784820) = 1,245 per 1000
Comparative Result from AHRQ (4) : 0,871 per 1000
(4). U.S. department of health and human services; AHRQ Quality Indicators Pediatric Quality Indicators Comparative Data for Provider Indicators [internet], USAgovernment; 2007, March; Available from: http://www.qualityindicators.ahrq.gov/downloads/pdi/pdi_provider_comparative_v31.pdf
Chosen PDI’sChosen PDI’s
Quality IndicatorQuality Indicator DescriptionDescription
Accidental Accidental Puncture or Puncture or LacerationLaceration
Cases of technical difficulty per 1,000 eligible discharges (population
at risk). Accidental cut, puncture, perforation or hemorrhage during
medical care.
Foreign Body left Foreign Body left during procedure during procedure
Number of patients with a foreign body unintentionally left in during a
procedure per 1,000 eligible admissions (population at risk). This
indicator is intended to track injuries occurring during a procedure,
specifically accidental cut, puncture, perforation, or laceration.
These procedures may be prevented through proper technique
during procedures.
Chosen PDI’sChosen PDI’s
Selected Selected infection due to infection due to
medical caremedical care
Number of patients with specific infection codes per 1,000 eligible
admissions. This indicator is intended to capture infections that are
due to medical care, but are limited to those easily captured using
administrative data. This indicator likely captures mostly line and
other vascular access related infections. High quality care is likely to
reduce the risk for this complication.
Gastroenteritis Gastroenteritis admission admission
raterate
Number of patients admitted for gastroenteritis per 100,000
population. This indicator is intended to identify hospitalizations for
gastroenteritis, where gastroenteritis is identified as the principal
reason for hospitalization. Timely and effective care for
gastroenteritis, such as oral rehydration therapy, may reduce the
need for hospitalization.
Chosen PDI’sChosen PDI’s
Pediatric heart Pediatric heart surgery volumesurgery volume
Number of patients undergoing surgery for congenital heart disease.
Discharges with a procedure codes for surgical intervention for
congenital heart disease or non-specific heart surgery with a
diagnosis code of congenital heart disease in any field.
Results
Results were divided in:
• Discharge Data: evaluation and comparison of the PDI’s along the years, from 2000 to 2005
• Tipe A: analysis by economic groups:
• 1
• 2
• 3
• 4
• Tipe C: analysis by administrative division
• 1 – Central Hospital
• 2 – District Hospital
• 3 – Distric Hospital of level 1
• Hospital reside : study includes the analysis of the variable “Hospital ID”, which means the values of Pediatric Quality Indicators were calculated to each Hospital and compared.
Decrease of tecnology, complexity and specialisation
PDPDI 1 - Accidental Puncture or I 1 - Accidental Puncture or LacerationLaceration
2,287
0,452 0,4598
0
0,5
1
1,5
2
2,5
3
1 2 3
Per
100
0
Type C
PDI 1= 997 / 784820 = 1,245 per 1000
Rate per 1000 (AHRQ)= 0,871
PDI 3 - PDI 3 - Foreign Body left during Foreign Body left during
procedureprocedure
PDI 3 = 34 / 784810 = 0,043322588 per 1000
Rate per 1000 (AHRQ)= 0,034
0,054
0,068
0,045
0,03
0,03
0,032
0
0,01
0,02
0,03
0,04
0,05
0,06
0,07
0,08
2000 2001 2002 2003 2004 2005
Pe
r 1
00
0
Discharge Date
0,068
0,0240,030
0
0,01
0,02
0,03
0,04
0,05
0,06
0,07
0,08
1 2 3
Pe
r 1
00
0
Type C
0,04
0,071
0,03 0,032
0
0,01
0,02
0,03
0,04
0,05
0,06
0,07
0,08
1 2 3 4
Pe
r 1
00
0
Type A
PDI 7 - Pediatric Heart PDI 7 - Pediatric Heart Surgery VolumeSurgery Volume
PDI 7 - Pediatric Heart PDI 7 - Pediatric Heart Surgery VolumeSurgery Volume
49
66
30
10
20
30
40
50
60
70
80
1 2 4
Nu
mb
er o
f cas
es
Type A
PDI 7 frequency = 118
PDI 12 - Selected infection due to PDI 12 - Selected infection due to medical caremedical care
0,019
0,082
0,124
0,19
0,1
0,227
0
0,05
0,1
0,15
0,2
0,25
2000 2001 2002 2003 2004 2005
Per
100
0
Discharge Date
0,109
0,135
0
0,02
0,04
0,06
0,08
0,1
0,12
0,14
0,16
1 2
Per
100
0
Type C
0,1240,160
0,115
00,020,040,060,08
0,10,120,140,160,18
1 2 4
Per
100
0
Type A
Central Hospitals
0
1
2
3
4
5
6
7
8
2 6 24 54 88
‰
Rate per 1000 (AHRQ)= 2.677
PDI 12 = 69 / 569861 = 0,12 per 1000
PDI 16 - Gastroenteritis PDI 16 - Gastroenteritis admission rate admission rate
PDI 16 frequency = 38469
5. Compare our PDIs results with the ones obtained in other studies
There are studies that evaluate the Quality of Pediatric Services based
on Pediatric Quality Indicators
Investigation published by Sábado Investigation published by Sábado MagazineMagazine
• Ranking of the best pediatric services in Pediatric Health care (5)
1st Hospital Amadora-Sintra
2nd Hospital de Leiria
3rd Centro Hospitalar da Cova da Beira
4th Hospital de Castelo Branco
5th Hospital de Braga
(5). Sábado, 2007, December, Supl 188: 8-18.
Methods used in the article published by Sábado magazine(6)
Our methods
Target population
• Patients hospitalized in Portugal Continental Public Hospitals
• Patients hospitalized in Portugal Continental Public Hospitals with:
- Age under 18 years
- Not in adult diagnosis related group
- Not in major diagnosis category (pregnancy, childbirth and puerperium)
Software
• Disease Staging • SPSS
Data base
• Direcção-Geral de Saúde
• ACSS (Administração Central do Sistema de Saúde)
Methods used in the Methods used in the investigationinvestigation
Methods used in the article published by Sábado magazine(6)
Our methods
Range of study•2003-2005 •2000-2005
Variables
•Mortality •Complications•Readmissions•General Performance
•Hospital’s ID•Primary diagnosis•Secondary diagnosis•Diagnosis and surgical procedure •Diagnosis Related Group (DRG)
Methods used in the Methods used in the investigationinvestigation
Methods used in Sábado Methods used in Sábado MagazineMagazine
Methods used in the article published by Sábado magazine(6)
Our methods
Variables
•Birth Weight•Length of stay at the hospital•Age (in years)•Major diagnosis category•Residence area•Kind of hospital•Hospitals (division per economic groups)•Administrative division •Hospital localization
Expected ResultsExpected Results
• Differences between results of litoral and inner country PDIs, being the litoral services the most developed.
• Evolution of the PDIs from 2000 to 2005.
• Similarites and differences between our results and the ones obtained by other studies.
Research on the theme AHRQ
Calculate one quality indicator of each type(with SPSS)
Research on the theme on pubmed
Useful for our work
articles obtained
Read title and abstract (2 reviewers)
NoYes Exclude articleObtain full article
Analysis of the information obtained
Calculate the quality indicators
End
Article
First protocol
Second protocol
Data analysis in AHRQ software
Compare results between different
hospitals
Compare results between various
regions of the country
Analise the resultsFinal presentation
Analyse the next article
Analyse the first article
Are there more articles
No
Yes
Yes
Full papers obtained
Compare results between different
hospitals
Manual Creation of the sintax
Third protocol and presentaion
ReferencesReferences1. AHRQ: Agency for healthcare research and quality [Internet]. USA; Measures of Pediatric Health Care Quality
Based on Hospital Administrative Data, The Pediatric Quality Indicators.2007 [about 1 screen] Available from: http://www.qualityindicators.ahrq.gov/downloads/pdi/
2. IBIS-PH: Utah’s Indicator-Based Information System for Public Health [Internet]. Salt Lake City: Center for Health Data Utah Department of Health; Indicators Profile - Complete Indicator Profile of Ambulatory Care Sensitive Conditions: Asthma Hospital Discharges Among Children; November 2004. [about 9 screens]; Available from: http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=citmed.section.59530
3. McDonald, K., Measures of Pediatric Health Care Quality Based on Hospital Administrative Data: The Pediatric Quality Indicators, 2006 February 20. 32
4. U.S. department of health and human services; AHRQ Quality Indicators Pediatric Quality Indicators Comparative Data for Provider Indicators [internet], USAgovernment; 2007, March; Available from: http://www.qualityindicators.ahrq.gov/downloads/pdi/pdi_provider_comparative_v31.pdf,
5. Sábado, 2007, December, 188[suppl]: 8-18.
6. Costa C, Lopes S. Avaliação do Desempenho dos Hospitais Públicos em Portugal Continental – 2005. ENSP, 2007 (www.ensp.unl.pt).