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Patient safety indicators

Patient Safety. A national priority for the Spanish Health System. Patient safety indicators. Yolanda Agra Varela. MD; Ph.D Sennior Adviser National Quality Agency. Ministry of Health Dublin 29 June 2006. PATIENT SAFETY: A PRIORITY FOR THE SPANISH NHS. STRATEGY Nº 8:

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Patient safety indicators

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  1. Patient Safety. A national priority for the Spanish Health System Patient safety indicators Yolanda Agra Varela. MD; Ph.D Sennior Adviser National Quality Agency. Ministry of Health Dublin 29 June 2006

  2. PATIENT SAFETY: A PRIORITY FOR THE SPANISH NHS • STRATEGY Nº 8: • To improve patient safety in the NHS • To improve awareness and culture • To develop an information system on PS • To perform best practices in all Health Regions

  3. AWARENESS AND CULTURE INFORMATION -Communication campaign -National Conference: ENEAS -International Conference: November 2006 PROFESSIONAL PERCEPTION Validated questionnaire “Hospital Survey on Patient Safety Culture” TRAINING -Basic training in all Regions -Risk Management Tool Kit: on-line -Training for managers and directors -Advanced Qualification on PS -Medication and safety -Material for University training RESEARCH -Sponsoring National RP -Review Group on PS (agreement with Iberoamerican Cochrane Collaboration)

  4. INTERNATIONAL ADVERSE EVENTS INCIDENCE STUDIES Incidence of Patients with AE SPAIN 2005 14.179 14.700 14.179 1.014 1.097 3.745 6.579 30.121 5.624

  5. INFORMATION SYSTEMS • ADVERSE EVENTS • Comparative Analysis of the International Information Systems of AE • Design a notification system of Adverse Events for the NHS, taking into consideration legal aspects • INDICATORS • Agreement on national indicators on PS (AHRQ, OCDE)

  6. TO IMPROVE BEST PRACTICES IN ALL REGIONS • To improve patient identification • To implement PS Units • To prevent nosocomial infections • To promote good practices in clinical settings to prevent: • -Anaesthesia-Related Complications • -Hip Fractures in Surgical Patients • -Pressure ulcers in Hospital Patients • -Pulmonary Thromboembolism (PTE) and Deep Venous Thrombosis (DVT) in Surgical Patients • -Infection in Surgical Wounds • -Wrong-Site Surgery • -Medication Errors and • -Ensure Last Wishes of patients

  7. NATIONAL HEALTH SYSTEM

  8. PUBLIC FUNDED CENTRES IN-PATIENT HEALTH CARE - 2005 779 HOSPITALS 326 (42%) 574 Acute Care Hospitals 92 Mental Health Hospitals 113 Long-Term Care Centres 256 (40 %) 103,736 (66%) 157,926 BEDS 65% 69,000 Physicians 103,000 Nurses 85% 4Beds per 1,000 inhabitants

  9. MINIMUM BASIC DATA SET Mandatory Administrative data Hospital Discharge records (ICD9-CM) Data Base Quarterly (MBDS) Hospital activity + Health Region Data Base validation Regional Data Base National Data Base

  10. SURGERY-RELATED COMPLICATIONS

  11. OBSTETRIC-RELATED COMPLICATIONS

  12. OTHER MEDICAL CARE COMPLICATIONS

  13. ADVANTAGES OF MBDS • Agreement at National level for a Minimum Basic Data Set • Common standards for codification at national level (ICD-9-CM) • Resources exists in the Hospitals (clinical documentation units) • High Coverage: Almost 100% discharges are codified in public Hospitals and >25% in private (depending on the Region) • High qualification of the experts in codification in public hospitals • Exhaustive codification: adverse events could be detected through MBDS • Useful for identifying problems for further analysis

  14. Clinical records: incomplete diagnosis information (comorbidity and elderly patients) Discharge records are the usual source of codification (not all diagnoses and procedures are included e.g.surgery discharges) Private acute care Hospitals (60%) not included in the MBDS Variability in codification related with qualification and DRG,s use of the data for reimbursement Second diagnosis: Prehospitalization vs in-patient complication Variability among Regions LIMITATIONS OF THE DATA

  15. CONSEQUENCES • Differences in the quality of codifications among Hospitals • Lower rates of complications in comparison with specific studies: Underreporting • Unknown variability among Regions • National Specific software in development : delay in data reporting • Oriented to assess cost and not quality of care

  16. ACTIONS FOR IMPROVEMENT • To increase the number of private Hospitals with codification • To improve professional awareness (managers and clinicians) • Feed-back : Give to them to improve the quality of care, not as punishment • To improve expert skills in codification in all Hospitals • Systematic quality control for clinical records and MBDS • Review all clinical records (not only discharge records) should be a requirement to perform the MBDS • For a real picture we would need: review other data bases and clinical records and develop specific adhoc audits and studies

  17. The challenge: Comparing these Indicators among the OECD countries

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