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The Implications for Measurements of Healthcare The W ay F orward : The Czech C ase

The Implications for Measurements of Healthcare The W ay F orward : The Czech C ase. Petr Tůma 05.03.2009 Prague. Which quality and performance indicators are measured. Performance indicators only - based on IR-DRGs data

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The Implications for Measurements of Healthcare The W ay F orward : The Czech C ase

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  1. The Implications for Measurements of Healthcare The Way Forward: The Czech Case Petr Tůma 05.03.2009 Prague

  2. Which quality and performance indicators are measured • Performance indicators only - based on IR-DRGs data • Quality indicators tested, but not used- based on AHRQ1) Inpatient Mortality Indicators- based on AHRQ ACSC2) Indicators • Quality indicators proposed, but not tested, not used- based on PQRI3) Process Indicators 1) AHRQ = the Agency for Health Care and Research Quality 2) ACSC = Ambulatory Care Sensitive Conditions 3) PQRI = Physician Quality Reporting Initiative

  3. Currently Accessible Internet Sites • South Bohemia Region Hospitals Comparison (Reg-SB)http://www.zebricky.cz/ • Vysočina Region Hospitals Comparison (Reg-VYS)http://www.zdravi-vysociny.cz/cz/Content/HtmlPage.aspx?folderid=27 • National Reference Centre - „Jak se kde léčí“1) (NRC-1)http://www.jaksekdeleci.cz/vitejte.php • National Reference Centre - „BRIX“(NRC-2)http://brix.nrc.cz/BRIX/faces/pages/login.jsp 1) „How the Health Care is Delivered“

  4. CZ Internet Sites Characteristics

  5. How is data collected; How is data processed • Administrative data only • Routine payment claim (Health Insurance Companies bills) • Data is processed by IR-DRG grouper • Measures:- patients number- ALOS- mortality rates- complexity level (severity level)- ...

  6. CZ data & measures characteristics CZ administrative data is • very rich in details • of poor quality (especially ICD-10 coding) • not audited Measures are • not standardised • not labelled with simple language

  7. How are the results published (what is accessible for experts, what is available for general public) • All three sites (Reg-SB; Reg-VYS; NRC-1) are - available for general public - difficult to understand for general public (due to IR-DRG complexity and terminology) • The utility for general public was not tested • The utility for professionals was not evaluated

  8. Key lessons learned • With the exception of an early interest of media, the general reaction both of professionals and general public is silence and indifference • IR-DRG is not suitable basis for measures aimed at general public • Measures often does not demonstrate the difference in performance but the difference of coding routine • The need of data set innovation and a new Procedure Classification System adoption is unconditional

  9. Next steps - expected development and recommendations Suggestions: • Adoption of process quality indicators => Additional data collection=> Clinical guidelines improvement • Larger involvement of clinicians • The utility enhancement for general public via adoption of the AHRQ/ National Quality Forum „Guidelines for Consumer-focused Public Reporting“ www.qualityforum.org • Individual QI indicators grouped into categories rather then „QI composites“

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