Slide 1

Slide 2 Slide 3 Creation of information systems that allow to grade the management [1] Ribeiro N. Indicadores de Gesto para Administrao Pblica. TOC. 2000 June Slide 4 In a general way measurement units to monitor and evaluate through comparison between different entities are Two main functions EvaluateDescribe [1] Ribeiro N. Indicadores de Gesto para Administrao Pblica. TOC. 2000 June [2] Johantgen M, Elixhauser A, Bali JK, et al. Quality indicators using hospital discharge data: state and national applications. As many as one-fourth of hospital deaths might be preventable [2] Slide 5 Efficiency Efficacy Effectiveness Cost-efficiency Comparability Availability Relevance Consistency Reliability [1] Ribeiro N. Indicadores de Gesto para Administrao Pblica. TOC. 2000 June [3] Correia L F. Indicadores de Desempenho Econmico na Sade [Internet]. 2005 [4] Collopy B T. Clinical indicators in accreditation: an effective stimulus to improve patient care. Slide 6 Purpose Entity being measured Dimension of quality Type of measure Intended audience [5] Eddy D M. Performance measurement: problems and solutions. 1998 Slide 7 Lack of technical means Input/Output measurement difficulties Availability of funding Employees lack of instruction Little dynamism from commissions responsible for executing indicators Inadequacies of information systems [1] Ribeiro N. Indicadores de Gesto para Administrao Pblica. TOC. 2000 June [3] Correia L F. Indicadores de Desempenho Econmico na Sade. 2005 [5] Eddy D M. Performance measurement: problems and solutions. 1998 Slide 8 Facing an inefficient and non productive governmental management of public health systems Construction of evaluation means for the efficiency and effectiveness levels of health systems [1] Ribeiro N. Indicadores de Gesto para Administrao Pblica. TOC. 2000 June Slide 9 Comparative quality reporting Public reporting Pay-for-performance Public reporting Pay-for-performance Comparative quality reporting Slide 10 The financing of Health entities is based on Diagnosis Related Groups (DRGs) Sorting systems for patients in clinically coherent and homogeneous groups in a resource consumption point of view Built from the diagnostic features and patients therapeutic profiles that explain the resource consumption in hospitals Tendency to rationalize the funds distribution process [7] Bentes M, Gonalves M, Urbano J, Tranquada S. A utilizao dos GDHs como instrumento de financiamento hospitalar. Slide 11 We explicitly acknowledge limits of our ability to measure actual quality of care. The literature on quality of care clearly underscores the quality improvement implementation and Hospital Performance difficulty of measuring quality in a valid, reliable fashion. Each approach to assessing quality is subject to criticism, regardless of whether measures derive from discharge abstract databases or from patient chart abstracts. [8] Weiner B J, Alexander J A, Shortell S M, Baker L C, Becker M, Geppert J J. Quality of Care - Quality Improvement Implementation and Hospital Performance on Quality Indicators. Slide 12 Slide 13 Norte Centro Lisboa Alentejo Algarve Regio Autnoma dos Aores Regio Autnoma da Madeira Compare the numbers from 2000 to 2007 Establish a comparison between the different areas of Portugal Evolution of the services quality and efficiency [9] Nomenclatura de Unidades Territoriais para fins estatsticos, Wikipdia, 2008 [10] Parlamento Europeu, Conselho da Unio Europeia. Regulamento (CE) N. 1059/2003 do Parlamento Europeu e do Conselo, relativo instituio de uma Nomenclatura Comum das Unidades Territoriais Estatsticas (NUTS), Jornal Oficial da Unio Europeia. 2003 May 26. Slide 14 Slide 15 Excluded episodes (ambulatory episodes): Planned admission Release date equals admission date Patients do not change hospitals Patients do not leave against medical advice nor die % Inpatient episode85,4 Ambulatory episode14,6 Database with inpatient episodes from 87 Portuguese public Hospitals between 2000 and 2007 Slide 16 Male 44,4 Female 55,6 1719,8 18 - 245,4 25 - 3412,6 35 - 449,3 45 - 549,3 55 - 6410,8 65 - 7414,2 7518,2 Alentejo4,9 Algarve3,7 Centro26,0 Lisboa26,5 Norte33,8 200012,1 200112,2 200212,4 200312,7 200412,6 200513,0 200612,5 200712,5 Total admissions: 7.768.467 Slide 17 Discharged patients Newborns Discharged patients Exceptional admission episodes Surgical admission time Complication-free long-term admissions Readmissions Short-term inappropriate admissions Newborns Vaginal Delivery Unspecified surgical procedures Medical DRGs complications Exceptional admission episodes Surgical admission time Complication-free long-term admissions Readmissions Short-term inappropriate admissions Vaginal Delivery Unspecified surgical procedures Medical DRGs complications Slide 18 o HOSP_ID o EPIS_ID o SEXO o BIRTH_WGT o HOSP_FROM o HOSP_TO o ADM_TIP o DSP o SAIDLAST o RESIDE o DDX1 o DDX2-DDX20 o SRG1-SRG20 o ENT1 o HOSP_ID o EPIS_ID o SEXO o BIRTH_WGT o HOSP_FROM o HOSP_TO o ADM_TIP o DSP o SAIDLAST o RESIDE o DDX1 o DDX2-DDX20 o SRG1-SRG20 o ENT1 o TOTDIAS o DRG o MDC o AGE o HOSP_DIST o HOSP_RESIDE o TOTDIAS o DRG o MDC o AGE o HOSP_DIST o HOSP_RESIDE ICD-9-CM code Portaria nr110-A/2007, January the 23rd of 2007attachments II e III [11] Ministrio da Sade. Dirio da Repblica [Internet]. 2007 January 23. Portaria n. 110-A/2007 - 1. Srie - N.16 [12] Ministrio da Sade. I Srie-A. Dirio da Repblica. 2002 Nov 5. [13] Newborn (infant) (liveborn) [Internet], ICD9 chrisendres Slide 19 Beginning Creation of the variable of the lowest limit for each DRG Creation of the variable of the highest limit for each DRG Time < lowest limit YesNo Short-term episode Time > highest limit End YesNo Long-term excepcional episode Normal episode DRG Portaria nr110-A/2007 TOTDIAS DRG Portaria nr110-A/2007 [10] Ministrio da Sade. Dirio da Repblica [Internet]. 2007 January 23. Portaria n. 110-A/2007 - 1. Srie - N.16 Slide 20 a) Comparison between years b) Comparison between regions c) Hyphothesis of other studies Slide 21 20002001200220032004200520062007 Exceptional admission episodes Short-term episode19,219,419,719,8 20,319,719,8 Long-term exceptional episode2,392,111,921,681,611,541,521,49 Readmissions4,985,315,485,475,635,655,705,59 Newborns problems1,041,081,15 1,081,061,041,02 Short-term inappropriate admissions Surgical DRG 4,414,685,095,736,156,056,406,32 Medical DRG1,701,361,331,170,970,950,901,55 Vaginal DeliveryWith complications23,624,126,025,424,425,626,327,6 Unspecified surgical procedures0,830,770,740,760,750,710,690,74 Medical DRGs complications 1) 15,817,318,418,317,719,619,420,2 Variation of overall indicators from 2000 to 2007 (percentages) 1) Data from 1% sample 20002001200220032004200520062007 Readmissions4,985,315,485,475,635,655,705,59 Newborns problems1,041,081,15 1,081,061,041,02 Short-term inappropriate admissions Surgical DRG 4,414,685,095,736,156,056,406,32 Medical DRG1,701,361,331,170,970,950,901,55 Vaginal DeliveryWith complications23,624,126,025,424,425,626,327,6 Unspecified surgical procedures0,830,770,740,760,750,710,690,74 Medical DRGs complications 1) 15,817,318,418,317,719,619,420,2 Variation of overall indicators from 2000 to 2007 (percentages) 1) Data from 1% sample Short-term episode 0,6% Long-term exceptional episode 1% Long-term exceptional episode 1% REASONS: Financing system encourage length of stay reduction Reduce number of beds [5] Shortage of personnel [5] Reduction in admissions caused by bed shortage [5] Both relatives and patients may gain a great deal of pleasure [14] REASONS: Financing system encourage length of stay reduction Reduce number of beds [5] Shortage of personnel [5] Reduction in admissions caused by bed shortage [5] Both relatives and patients may gain a great deal of pleasure [14] [5] Eddy D M. Performance measurement: problems and solutions. 1998 [14] Thomson R, Taber S, Lally J, Kazandjan V. UK Quality Indicator Project (UK QIP) and the UK independent health care sector: a new development. Slide 22 20002001200220032004200520062007 Exceptional admission episodes Short-term episode19,219,419,719,8 20,319,719,8 Long-term exceptional episode2,392,111,921,681,611,541,521,49 Newborns problems1,041,081,15 1,081,061,041,02 Short-term inappropriate admissions Surgical DRG 4,414,685,095,736,156,056,406,32 Medical DRG1,701,361,331,170,970,950,901,55 Vaginal DeliveryWith complications23,624,126,025,424,425,626,327,6 Unspecified surgical procedures0,830,770,740,760,750,710,690,74 Medical DRGs complications 1) 15,817,318,418,317,719,619,420,2 Variation of overall indicators from 2000 to 2007 (percentages) 1)Data from 1% sample 20002001200220032004200520062007 Exceptional admission episodes Short-term episode19,219,419,719,8 20,319,719,8 Long-term exceptional episode2,392,111,921,681,611,541,521,49 Readmissions4,985,315,485,475,635,655,705,59 Newborns problems1,041,081,15 1,081,061,041,02 Short-term inappropriate admissions Surgical DRG 4,414,685,095,736,156,056,406,32 Medical DRG1,701,361,331,170,970,950,901,55 Vaginal DeliveryWith complications23,624,126,025,424,425,626,327,6 Unspecified surgical procedures0,830,770,740,760,750,710,690,74 Medical DRGs complications 1) 15,817,318,418,317,719,619,420,2 Variation of overall indicators from 2000 to 2007 (percentages) 1) Data from 1% sample General readmission rate of 5,5% Matches the 5-29% set as reference in other articles [15-17] [15] Tierney A J, Worth A. Review: Readmission of elderly patients to hospital. [16] Victir C R, Vetter N J. The early readmission of the elderly to hospital. [17] Thomas J W, Holloway J J. Investigating early readmission as an indicator for quality of care studies.. Slide 23 20002001200220032004200520062007 Exceptional admission episodes Short-term episode19,219,419,719,8 20,319,719,8 Long-term exceptional episode2,392,111,921,681,611,541,521,49 Readmissions4,985,315,485,475,635,655,705,59 Newborns problems1,041,081,15 1,081,061,041,02 Short-term inappropriate admissions Surgical DRG 4,414,685,095,736,156,056,406,32 Medical DRG1,701,361,331,170,970,950,901,55 Vaginal DeliveryWith complications23,624,126,025,424,425,626,327,6 Unspecified surgical procedures0,830,770,740,760,750,710,690,74 Medical DRGs complications 1) 15,817,318,418,317,719,619,420,2 Variation of overall indicators from 2000 to 2007 (percentages) 1) Data from 1% sample 20002001200220032004200520062007 Exceptional admission episodes Short-term episode19,219,419,719,8 20,319,719,8 Long-term exceptional episode2,392,111,921,681,611,541,521,49 Readmissions4,985,315,485,475,635,655,705,59 Newborns problems1,041,081,15 1,081,061,041,02 Short-term inappropriate admissions Surgical DRG 4,414,685,095,736,156,056,406,32 Medical DRG1,701,361,331,170,970,950,901,55 Vaginal DeliveryWith complications23,624,126,025,424,425,626,327,6 Unspecified surgical procedures0,830,770,740,760,750,710,690,74 Medical DRGs complications 1) 15,817,318,418,317,719,619,420,2 Variation of overall indicators from 2000 to 2007 (percentages) 1) Data from 1% sample Slide 24 Respiratory distress syndrome is the most common cause of respiratory failure and mortality [18] The incidence and severity of RDS can be reduced by measures like maternal antenatal steroid treatment [19] [18] Fidanovski D, Milev V, Saikovski A, Hristovski A, Sofiianova A, Koiic L, Kimovska M. Mortality risk factors in premature infants with respiratory distress syndrome treated by mechanical ventilation. [19] Harms K, Herting E, Kron M, Schill M, Schiffmann H.Importance of pre- and perinatal risk factors in respiratory distress syndrome of premature infants. A logical regression analysis of 1100 cases. Slide 25 However this increase is also related to the tremendous strides made by neonatologists and the resulting increased willingness of obstetricians to deliver preterm babies from hostile intrauterine environments [26]. [20] Steer P. The epidemiology of preterm labour. [21] Goldenberg R L, Culhane J F, Iams J D, Romero R. Epidemiology and causes of preterm birth. [22] Martius J A, Steck T, Oehler M J, Wukf K H. Risk factors associated with preterm (