quality and accessibility of portuguese hospital services through 2000 to 2007 course: mestrado...
TRANSCRIPT
Quality and accessibility of Quality and accessibility of Portuguese hospital services Portuguese hospital services
through 2000 to 2007through 2000 to 2007
Course: Mestrado Integrado em Medicina
Subject: Introdução à Medicina I
Class 8
Teacher (adviser) Alberto Freitas
15th December 2008
Structure of the presentation
• Motivations
• Indicators
• Research Question and Aims
• Participants and Methods
• Expected Results
• References
Evaluate the state of Portuguese healthcare
Analyse its evolution through the past eight years (2000-2007)
Compare the activity and quality indicators among the different Portuguese regions.
Motivations of the study
Indicators
Importance• Mechanisms to assess quality and accessibility of hospitals
• Factors for accounting and financial directing
What are quality and activity/productivity indicators?
Indicators
Health care quality indicators
• Measures which contain relevant information concerning services conditions
• Reflect the health status of a population and help monitoring health conditions
Indicators
Activity/Productivity indicators
• Evaluate hospital performance
• Express the relation between applied resources and goals achieved
• Related with public access to healthcare services
Indicators
Indicators
Both quality and activity indicators are susceptible:• Actualization of evaluative parameters• Modification of their relevance in hospital assessment
Indicators are not fixed evaluative parameters!
Indicators Domain
Mortality Quality
Hospitalization time Quality and Activity/Productivity
Postponed surgeries Quality
Ambulatory episodes Activity/Productivity
Ambulatory surgeries Activity/Productivty
Births by Caeserean-section Activity/Productivity
Main diagnostics Quality
Surgical procedures, complications Quality
Indicators
• How have health indicators evolved, in Portugal, during the past 8 years, how is that reflected in the quality and accessibility of healthcare services an in which ways can they be improved?
Research Question and Aims
Research Question
Research Question and Aims
Participants and Methods
Study Participants
Target population:Portuguese continent population
Sampling Methods:No samples were taken from the dataset of
registers from private and public continental hospitals
Participants and Methods
Study Participants
Note: Analysis of only continent private and public hospitals recordsMadeira and the Azores archipelagos use a different system of classification
Inclusion and exclusion criteria: each indicator considers all registers, thus no need for criteria
Participants and Methods
Study Design
Descriptive – Indicators analysis will describe accessibility and quality parameters of hospitalsAnalytical – Less evident, only few relations are established between indicators
Observational – There was no intervention. Data was collected from observation of hospital’s registers
Longitudinal – The study consists of a data follow up through 2000 to 2007
Retrospective – Data was collected from registers in the pastProspective – Via the results obtained a future prospect of the healthcare system will be presented
Participants and Methods
Study Design
Secondary data – Data wasn’t specifically collected for this study
Participants and Methods
Data collection methods
Dataset provided by the Health Care System Central Administration (ACSS) containing all registers of public and private hospitals in the continent, from 2000 to 2007
Microsoft Office Excel:
• Graphics and tables
SPSS • Data filtering
(according to each indicator)
• Statistical calculations and graphics (Planned
Statistical Analysis)
Participants and Methods
Data collection methods
Variable description
Participants and Methods
Diagnosis Related Groups - DRG Classification system for patients admitted to
hospital
• Clinically coherent and homogenous groups• Consumption of resources
Variable description
Participants and Methods
The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
System of codes to diagnoses and procedures associated with hospital utilization
The ICD-9-CM consists of:• tabular list containing a numerical list of disease code numbers;• classification system for surgical, diagnostic, and therapeutic procedures
Participants and Methods
Variable descriptionThe International Classification of Diseases,
Ninth Revision, Clinical Modification (ICD-9-CM)
Participants and Methods
Variable descriptionHospital IDHospital Location – Allows an analysis of the various regions through the hospitals there located.
Both allow a regional analysis according to hospitals location – NUTS
Participants and Methods
Variable descriptionNomenclature of territorial units for statistics (NUTS)
Level II: 7 units, of which 5 in the continent.
North
Centre
Alentejo
Algarve
Lisbon
Azores
MadeiraLevel III: 30 units, of which 28 in the continent
Level I: 3 units, of which 1 is the continent
Participants and Methods
Variable description
Gender – Division into two groups of analysis: men and women
Age – Stratification based on age
Birth Weight – Obstetrics services
Days of hospital stay – Hospitalization Time
Discharge date – Year division of each indicator essential to evaluate the evolution of indicators
Participants and Methods
Planned statistical analysisSPSS for Windows
All Indicators:• Frequencies • Percentages
Hospitalization Time:• Means
• Percentiles• Median
SPSS for Windows and Microsoft Office Excel
GraphicsTables
Participants and Methods
Examples of applied Methods
Amb. Ep. Tot.Ep. Amb.%2000 733 19572 3,752001 959 20004 4,792002 1206 20277 5,952003 1503 21066 7,132004 1827 21295 8,582005 1840 21282 8,65
Evolution of the ratio between number of ambulatory procedures and total number of
procedures, from 2000 to 2005
Participants and Methods
Examples of applied Methods
62 274831
11331722
1002
0
500
1000
1500
2000
frequency
<18 18-44 45-64 65-74 75-84 85+
age
Mortality by age group
27542270
5024
0100020003000400050006000
frequency
male female total
gender
Mortality by gender
Surgery
15%
85%
Ambulatory Surgeries
Surgeries whichrequirehospitalization
Participants and Methods
Examples of applied Methods
•V3000 = Single lb in hospital w/o cs•650 = Normal delivery
• 43401 = Cere thrombosis w/ inrct •V3001 = single lb in hospital w cs
•486= Pneumonia, organism unspecified •55090 = Inguinal hernia, without mention of obstruction or gangrene
•V581= Encounter for chemotherapy and immunotherapy for neoplastic conditions•36610= Senile cataract, unspecified
•4280 = Congestive heart failure, unspecified•4549 = Asymptomatic varicose veins
Main diagnostic
Frequency
Percentage
Valid Percent
age Cumulative Percentage
4549 1112 0,9 0,9 81
43401 1125 0,9 0,9 81,9
4280 1147 0,9 0,9 82,8
336610 1347 1,1 1,1 83,9
V581 1452 1,2 1,2 85,1
55090 1625 1,3 1,3 86,4
486 2182 1,8 1,8 88,1
V3001 3143 2,5 2,5 90,7
650 3410 2,8 2,8 93,5
V3000 8086 6,5 6,5 100
Examples of applied Methods
Participants and Methods
DRG-14
DRG-39
DRG-89
DRG-127
DRG-162
DRG-359
DRG-371
DRG-373
DRG-390
DRG-391
2000 3,19% 0,71% 2,42% 1,70% 0,64% 1,13% 2,04% 3,03% 0,87% 3,35%
2001 2,98% 0,60% 2,40% 1,72% 0,51% 1,12% 2,76% 2,51% 0,78% 2,90%
2002 3,67% 0,62% 2,49% 1,64% 0,55% 1,08% 1,83% 2,73% 0,79% 3,03%
2003 3,29% 0,45% 2,47% 1,75% 0,50% 1,04% 1,64% 2,56% 0,94% 2,85%
2004 3,36% 0,44% 3,12% 1,86% 0,47% 0,94% 1,77% 2,75% 0,75% 2,87%
2005 3,36% 0,49% 3,93% 1,80% 0,39% 0,77% 1,68% 2,26% 0,82% 2,76%
Hospitalization Time – Percentage of hospitalization time of the 10 most frequent indicators in overall hospitalization time from 2000 to 2005
Ambulatory Episodes and Ambulatory Surgeries – Number of ambulatory episodes tends to rise but its still low
Hospitalization time – Tendency of diminishing hospitalization episodes and the mean of time of stay
Mortality – Greater mortality in rural regions; elderly group likely to have a greater incidence
Expected Results
Main Expectations – Indicators
Expected Results
• Quality and Accessibility to Portuguese hospitals are expected to improve during the years in analysis.
• Likelihood of disparity between rural and urban regions: rural regions present worst indicators values.
Main Expectations
Expected Results
LimitationsResults from 2% of the ACSS dataset
Articles and other information concerning indicators
Expected Results
Full ACSS dataset may present results that differ:• Sample is very small• Sample offers no coverage off all years (only 2000 to 2005)
Expected Results
Limitations
Hospital quality and accessibility also depends on:• Population lifestyle• Financing and logistical support
Thus indicators may not reflect the truth about the healthcare system
• Increase of knowledge and understanding of the Portuguese health system:– Quality characteristics– Accessibility characteristics
Expected Results
Future implications
• Suggestions of improvements according to the results obtained
– Healthcare services impact• Improved resources management
– Economic impact• Target financing to needed medical areas
– Social impact• Improvement of quality of life
Expected Results
Future implications
• Portugal• Public and private hospitals• Quality indicators• Organization and administration
KeywordsKeywords
1. Freeman T. Using performance indicators to improve health care quality in the public sector: a review of the literature. Health Services Management Reseach. 2002 May;15(2):126-37.
2. Olímpio J, Nogueira V, Bittar. Produtividade em hospitais de acordo com alguns indicadores hospitalares. Revista de Saúde Pública. 1996 February;30(1) .
3. Barros PP, Sena C. Quanto maior melhor? Redimensionamento e economias de escala em três hospitais portugueses. 1998 November.
4. Travassos C, Carvalho de Noronha J, Martins M. Mortalidade hospitalar como indicador de qualidade: uma revisão. Ciência & Saúde Coletiva.1999;4(2):367-381.
5. Grenier-Sennelier C, Corriol C, Daucourt V, Michel P, Minvielle E. Développement d’indicateurs de qualité au sein des établissements de santé: le project COMPAQH. Revue d'Epidémiologie et de Santé Publique. 2005 September;53: 130.
6. Mahapatra P , Berman P. Using hospital activity indicators to evaluate performance in Andhra pradesh, India. The International Journal of Health Planning and Management. 2006 September;9(2):199-211
References
References
7. MEDSTATWEB. Serviço de Bioestatística e Informática Médica. Faculdade de Medicina da Universidade do Porto [cited 2008 December 15]. Available from: http://stat2.med.up.pt/cursop/index.html
8. Mimwiki.med.up.pt: Informatica médica [Internet]. [cited 2008 December 15]. Available from: http://mimwiki.med.up.pt/index.php/Os GDhs em Portugal#Os GDHs em Portugal
9. Cdc.gov: Centers for Disease Control and Prevention [Internet]. [cited 2008 December 15]. Available from: http://www.cdc.gov/nhcs/about/otheract/icd9/abticd9.htm
10. Dgeep.mts.gov.pt: Diário da República [Internet]. [cited 2008 December 15]. Available from: http://www.dgeep.mtss.gov.pt/apresentacao/legislacaopdfs/dl244_02.pdf
11. Eur-lex.europa.eu. [Internet]. [cited 2008 December 15]. Available from: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2007:039:0001:01:PT:HTML
12. Rangrez RA, Tabish SA, Bukhari IA, Deva SW, Pandit NA, Wani RA, Department of Hospital Administration, Sher-I-Kashmir, In Institute of Medical Sciences, Srinagar. Role of Ambulatory Care in a Teaching Hospital. JK-Practitioner. 2005; 12(1):48-50
References
13. Birkmeyer JD, Siewers AE, Finlayson EVA, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE. Hospital Volume and Surgical Mortality in the United States. The New England Journal of Medicine. 2002 April 11; 346(15):1128-1137.
14. Nawal LM, Bhat DK, Gandhi SR, Nguyen C, Weidenbacher-Hoper VL, Lipsky MS. A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States. International journal for quality in health care. 2007 June ;19(3):141-9.
15. Lynnus Peng, Assistant Clinical Professor. Outpatient Surgery Page [Internet]. University of California at Irvine, Department of Anesthesiology, St Jude Medical Center; [updated 200 November 1; cited 2008 December 15]. Available from: http://www.emedicinehealth.com/outpatient_surgery/page2_em.htm
16. Tracy KJ, Craig EH, Scott DG. Ambulatory Surgery: Next-Generation Strategies for Physicians and Hospitals. Healthcare Financial Management. 2000 January.
17. Jarrett P, Ogg TW. The British Association of Day Surgery: the early years. The Journal of One-Day Surgery;14(3):62-63.
18. Dimick JB, Welch HG, Birkmeyer JD. Surgical Mortality as an Indicator of Hospital Quality.
JAMA. 2004 August 18; 292(7)
References
Ana Cláudia Matos Ribeiro [email protected]
Ana Rita Pereira Eluetério Silva [email protected]
Carolina Sobrinho Ribeiro [email protected]
Diogo Costa Branco [email protected]
Diogo do Fundo Raposo [email protected]
Ivo Pedro Costa Gomes [email protected]
João Filipe Pedrosa Bernardes joaofbernardes@hotmail,com
José Vitor Reis Lopes Gonçalves [email protected]
Oscar Ricardo Cerqueira Ramos [email protected]
Maria Leonor Taboas Simões [email protected]
Natália Sofia de Sousa Silva [email protected]
Pedro Miguel Aparício Chorão [email protected]
Sofia Maia Teixeira [email protected]
Tânia Sofia Gomes Esteves [email protected]
Developped by: