hospital performance measures for cardiovascular …
TRANSCRIPT
HOSPITAL PERFORMANCE
MEASURES FOR
CARDIOVASCULAR DISEASES
CARE IN KOREA’S NHI
Sun Min KIM, MD, PhD
Health Insurance Review and Assessment of Korea
Characteristics of Korean National
Health Insurance system
Single unified insurer covering entire population
Private sector dominant providers 92.7 % of hospital beds are owned by private
sector
Mainly fee-for-services payment system even in acute hospital sectors
Adopting electronic data interchange 95.8% of claims are done digitally
Quality assessment and P4P are coded by NHI act
Performance of the CVD in Korea
Uncontrolled Diabetes Hospital
Admission Rate, 2009
Potentially Avoidable Hospital
Admissions in Korea
Source : OECD Reviews of Health Care Quality KOREA Raising Standards
In-hospital Case Fatality Rates within 30 Days after
Admission of Stroke(Ischemic and Hemorrhagic)
Ischemic Stroke Hemorrhagic Stroke
In-hospital Case Fatality Rates within 30
Days after Admission for AMI, 2009
Admission-based Patient-based
“Korean Paradox”
In general, In-hospital fatality rates across the AMI and stroke correlate
In-hospital fatality rates and population based mortality of AMI and stroke correlate
But Koreans High In-hospital fatality rates of AMI, but low stroke
Low population-based mortality rates of AMI, but high stroke
Issues raised in OECD reviews of health care quality 1. Does the high case-fatality rates reflect poor quality
hospital care?
2. Did policies to reduce cardiovascular disease outside the hospital sector are being delivered appropriately?
Effort to Measure the Quality of Care in
Korea
Health Insurance Review and
Assessment service(HIRA)
NHI governing organization founded in
2000
Major functions
Claims Review
Quality Assessment
Standard Development
Drug Management
In situ inspection
Payment arrangement
Domain of Quality Assessment in 2012
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Acute Diseases
Acute myocardial infarction (AMI), Acute Stroke,
Coronary artery bypass graft (CABG), 30-day mortality
of surgery for Colorectal/Gastric/Liver cancer, Volume
indicators for surgical care
Chronic Diseases Diabetes, Hemo-dialysis, Hypertension
Patient Safety Prophylactic antibiotics for surgery
Blood transfusion
Drug Utilization
Antibiotics prescription rate, Injection prescription rate,
Drug cost per prescription, Expensive drug
prescription, Number of drugs per prescription
Long-term Care Long-term care hospital,
Psychiatric disease (Medicaid)
HIRA
NHIC
Provider Consumer
Government
Assessment Results
Information for
Policy Development
Public Report for
Informed Choices
Feedback &
Education
Claims Review
Pay for Performance
12
Utilization of Quality Results
Quality Indicators for the Cardiovascular
Diseases Care
Indicators of Acute Myocardial
Infarction
Indicators
Thrombolytics administration rate within 60 minutes of hospital arrival
Primary PCI rate within 120 minutes of hospital arrival
Aspirin administration rate of hospital arrival
Aspirin prescription rate at discharge
Beta-blocker prescription rate at discharge
In-hospital case fatality rate
30-day case fatality rate after admission
Indicators of Acute Stroke
Indicators
Ischemic and
Hemorrhagic
stroke
Documentation rate of smoking history
Neurological examination rate
Dysphagia examination rate within 2 days
Brain imaging rate within 24 hours
Brain imaging rate within 1 hour
Consideration rate of early rehabilitation (within 3 days)
Ischemic
stroke only
Lipid profile test rate
Consideration rate of IV t-PA initiation
IV t-PA administration rate
Antithrombotics administration rate (within 48 hours)
Antithrombotics prescription rate at discharge
Anticoagulants prescription rate at discharge (atrial fibrillation
patient)
Indicators of Hypertension Care
Measures
Continuity
of care
Rate of patients with sufficient duration of drug prescription
Rate of continued prescription patients
Average days of prescription of anti-hypertensive
Visits Average visits to medical care institutions
Prescription
Rate of overlapping prescription (identical components)
Rate of prescriptions of 4-or-more component anti-hypertensives
Rate of parallel administration of diuretics (in the absence of co-morbiditi
es, i.e. cardio/cerebrovascular diseases)
Rate of prescriptions of not-recommended parallel therapies (in the abse
nce of co-morbidities, i.e. cardio/cerebrovascular diseases)
Tests
Rate of blood test on initial patients
Rate of general urine test on initial patients
Rate of ECG on initial patients
Indicators of Diabetes Care
Measures
Continuity
of care
Share of patients who visit once or more per quarter
Rate of prescription days
Prescription
Rate of overlapping prescriptions (identical components)
Rate of prescriptions of 4-or-more component anti-diabetics
Medication cost per administration day
Tests
Rate of HbA1c tests
Rate of lipid tests
Rate of microalbuminuria tests
Rate of fundus examination
Data Sources of Quality Assessment
Data Warehouse consisted of
Claims review data
Health Care Organizations’ Profile Data
Drug Utilization Review Data
Clinical data from HQDAS(Hospital Quality
Data Acquisition System)
Death data from MOPAS(Ministry of Public
Administration and Security)
Information Flow for Quality
Assessment
Hospit
al
profile
EHR
system
Health care
Organization Profile
EDI system for
claims review
Fee setting
Claims Review Data
Warehous
e Quality Data
Acquisition System Quality
Assessment
Death
Certification
System
Providers HIRA
Ministry of Public
Administration and Security
Patient
Care Claims Review Sending
Claims
Review data
Sending PIN
Filling the
HQDAS Sending
Quality Data
Generating DWs
Sampling of
Cases
Confirming
Cases and Data
Refining Sending PIN
Sending
Death
Information
Calculating
Quality
Indicators
including 30 Day
Mortality
HOSPITA
LS HIRA
MOPAS
Process of Calculating AMI 30
Day Case Fatality PIN, diagnosis,
date on admission
and discharge,
profile of care
provided, etc
Public Report of Quality Results
Risk Adjustment for AMI fatality
Adjusted Mortality = Expected Mortality
Observed Mortality X Average Mortality
Age, Gender, Killip class, Time From symptom onset to arrival to
emergence room, Usage of Ambulance, BMI, Serum Creatinine,
Baseline Blood Pressure, Pulse, Ejection Fraction, Left main
Disease, The Number Of Affected Blood Vessels, Patients Condition
On Arrival To Hospital & Symptoms And Sign Of Heart Disease,
Findings From Cardiogram Within 48 Hours Of Arrival To Hospital,
History Of Stroke
Risk Factors
Pay for Performances for
Cardiovascular Diseases
HIRA Value Incentive Program
(HIRA-VIP)
2000 Legislation of NHI Act including P4P
2004 National Assembly and Board of Audit and Inspection - Requested HIRA to implement P4P
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HIRA Value Incentive Program
(HIRA-VIP)
Organizations : Tertiary hospitals
Disease and procedure : Acute myocardial infarction, Caesarian section
Period : Jul 2007 ~ Dec 2010 (3 ½ years)
AMI
- Increase of prevalence
- Increase of population mortality
- Clinical knowledge of indicators
- World-wide experience of P4P
C-sec
- High C-sec rate, twice of WHO
recommendation(5~15%)
- High variance among hospitals
- Limited effect of public report of
C-sec rate
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Scheme of HIRA-VIP 26
Changes of AMI Quality Score
5Grade
5Grade
5Grade 4Grade
4Grade
4Grade 3Grade
3Grade 3Grade 2Grade 2Grade 2Grade
1Grade 1Grade 1Grade
50.0
60.0
70.0
80.0
90.0
100.0
Year 1 Year 2 Year 3
(CQS)
59.08
64.71
Average
score
1.55
increased
Average
score
3.73
increased
Penalty
threshold
86.66
88.04
Pay for Performances for
Hypertension and Diabetes
Purpose
To increase the income of the primary care
practitioners who cares chronic diseases in
high performance
Design
5 % incentives will be paid
To the primary care practitioners with high
performance score in hypertension and
diabetes care
Thank you very much!