marquis - methods of assessing response to quality improvement strategies marquis: methods of...
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s MARQuIS:Methods of Assessing Response to Quality Improvement Strategies
PRIORITIES WHEN USING CARE ABROAD – PATIENTS’, PROFESSIONALS’, FINANCERS’ views (Groene, Poletti, Vallejo, Suñol, Klazinga, Kutryba)
PATIENT-CENTEREDNESS IN EUROPEAN HOSPITALS (Lombarts, Rupp, Klazinga, Suñol et al)
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MARQuIS:Methods of Assessing Response to Quality Improvement Strategies
2. PRIORITIES WHEN USING CARE ABROAD (PATIENTS, PROFESSIONALS, FINANCERS)
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Objectives
To identify and prioritize issues relevant for patients’ safety and centeredness as defined by patients, health care providers and health care financing bodies.
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s MethodsQualitative, semi-structured interviews addressing the patients pathway (admission issues & diagnosis & treatment, discharge).
Discourse analysis to elect issues and priorities and comparison of grouped themes and contents.
Population studied
Interviewees Countries participating
Patients 40 Italy (23), Spain (17)
Professionals 30Belgium (6), Czech Republic
(7), Ireland (3), Poland (8), Spain (3), Netherlands (3)
Financing bodies
3Belgium (2), The Netherlands
(1)
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s ResultsThemes
1. Differences between countries in administrative arrangements.
2. Communication processes and language barriers.
3. Differences between countries in clinical procedures.
4. Demands on the physical structure and hotel services.
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Results (1/4) Specific quality requirements for administrative arrangements
Administrative requirements in general do not pose problems; difficulties in making arrangements with multiple purchasers.
Professionals and financers considered CBP as more time-consuming and expensive.
Financers would like to selectively contract with providers - professionals think that contracts should be made at health system level.
Where authorization of treatment is required, free movement of patients does not seem to be fully ensured (assessment of eligibility based on clinical/adminstrative criteria).
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Results (2/4) Specific quality requirements for Communication and language barriers
Cross-border patients (CBP) have higher information and communication needs throughout the care process.
Cultural differences with regard to patient and family involvement.
Differences in unit organization and professionals roles confusing.
Lack of information of patients at discharge, differences in discharge policies.
Difficulties in arranging back-transfer.
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s Results (3/4) Specific quality requirements for clinical procedures
Informed consent procedures differ greatly (extent, language, legal issues).
Some differences exist with regard to medical procedures: • transplantations (organs of non-heart beating patients)• rehabilitation • caesarean section on demand.
Quality problems may result from lack of coordination of follow up care, in particular with regard to names and dosage of drugs and discharge information.
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s Results (4/4) Specific quality requirements for physical structure and hotel services
Patients, professionals and financers state that CBP have higher demands on hotel services.
Most common issues/demands: - Timing and scope of meals
- Privacy
- Respect for families or carers’ needs
- Accomodation,
- Purchasable items
There are differences in expectations and cultures between patients from different geographical areas.
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MARQuIS:Methods of Assessing Response to Quality Improvement Strategies
3. PATIENT-CENTEREDNESS IN EUROPEAN HOSPITALS (Lombarts, Rupp, Klazinga, Suñol et al)
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s Objectives
The strategic objective of work package 4 is to describe in a sample of EU member states how hospitals have applied national quality strategies, to what extend they meet the defined requirements of cross-border patient care and what organizational and/or methodological variables are associated with (non-)compliance of requirements.
Further, WP4 is to validate the statistical results provided by WP3 concerning types and quantity of health services used by patients from another European member state.
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s Hospitals in the sample
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s Hospitals in the sample
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s 1. Administrative requirementsPatient rights and service Designated person to support EU patients with administrative procedures
Total (n)
211
131
7
0
30
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yes no na-dk
By country (%)
0
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yes no na-dk
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s 1. Administrative requirements Patient rights and service Procedure with regard to transferring EU patients to home country
Total (n)
98
213
22
0
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yes no na-dk
By country (%)
0
10
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50
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90
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yes no na-dk
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s 2. Information requirements Patient rights and service Information leaflets in other EU languages
Total (n)
105
235
8
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yes no na-dk
By country (%)
0
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yes no na-dk
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s 2. Information requirements Patient rights and serviceCB-care arrangements & support
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yes no na-dk
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s 2. Information requirements Patient rights and service Formalized arrangements with translation service for EU patients
Total (n)
96
246
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yes no na-dk
By country (%)
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yes no na-dk
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s 2. Information requirements Patient rights and serviceAvailability written policies
0306090
120150180210240270300330360
yes no na-dk
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s 3. Clinical requirements Patient safety:designated responsible person for…
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s 3. Clinical requirements Patient safety: available systems …
0306090
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yes no na-dk
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s 4. Physical infrastructurePatient rights and servicePrivacy and facilities
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yes no na-dk
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s Variance overall classification score
min. max.
Belgium (n=24) 2.10 - 3.10
Czech Republic (n=38) 1.50 - 3.00
France (n=65) 1.87 - 3.25
Ireland (n=23) 1.90 - 3.08
The Netherlands (n=8) 2.09 - 2.52
Poland (n=76) 1.86 - 3.45
Spain (n=105) 1.70 - 3.26
UK (n=10) 1.77 - 2.37
Total (n=349) 1.50 - 3.45
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s External pressure and classification score
Total Most mature
Inter-mediate
Least mature
External pressure, 9 items, alpha: 0.68
2.25 (0.79)
n= 310
1.72 (0.64)*
n=75
2.23 (0.71)
n=157
2.79 (0.73)
n=78
* Statistically significant (Student t-test) between the most mature and the least mature
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s Patients’ rights and classification score
Total Most mature Inter-mediate
Least mature
General part 1.13 (0.16)
n=350
1.07 (0.11)***
n=87
1.10 (0.12)
n=172
1.25 (0.2)
n=86
AMI 1.55 (0.4)
n=310
1.46 (0.37)*
n=73
1.56 (0.39)
n=151
1.61 (0.43)
n=81
Appendicitis 1.52 (0.39)
n=307
1.36 (0.32)***
n=75
1.52 (0.38)
n=150
1.66 (0.42)
n=79
Deliveries 1.62 (0.39)
n=272
1.49 (0.34)**
n=64
1.65 (0.39)
n=136
1.67 (0.40)
n=69
* Statistically significant (Student t-test) between the most mature and the least mature are flagged; *p<0.05, **p<0.01, p***<0.001
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Summary First study on cross-border care quality and safety
requirements in a large sample of European hospitals, There are CB-care collaboration, arrangements and
services, although there appears considerable variation, Some quality strategies (such as patient rights) appear
reasonable on paper, Patient safety requirements appear adequate overall, but
wide differences per system, External pressure appears to be associated with the
implementation of quality requirements.
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Acknowledgements
Authors and co-authors.Country Coordinators for their
coordination efforts and support.Hospital coordinators who filled in the
questionnaire: thank you!This project was funded by the European
Commission through its "Scientific Support to Policies" action under the Sixth Framework Programme for Research.