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ANALYSIS OF THE PORTUGUESE PUBLIC HOSPITAL’S PERFORMANCE THROUGH QUALITY AND MANAGEMENT INDICATORS

ANALYSIS OF THE PORTUGUESE PUBLIC HOSPITAL’S PERFORMANCE THROUGH QUALITY AND MANAGEMENT INDICATORS. Introdução à Medicina 2008/2009 Turma 18. Alexandre Almendra Ana Cunha António Miranda Cristina Costa Gabriela Gonçalves Joana Esteves João Pedro P. Barreto Luísa Costa Mariana Carvalho

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ANALYSIS OF THE PORTUGUESE PUBLIC HOSPITAL’S PERFORMANCE THROUGH QUALITY AND MANAGEMENT INDICATORS

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  1. ANALYSIS OF THE PORTUGUESE PUBLIC HOSPITAL’S PERFORMANCE THROUGH QUALITY AND MANAGEMENT INDICATORS Introdução à Medicina 2008/2009 Turma 18

  2. Alexandre Almendra Ana Cunha António Miranda Cristina Costa Gabriela Gonçalves Joana Esteves João Pedro P. Barreto Luísa Costa Mariana Carvalho Mónica Garrido Pedro Canão Pedro Valente Rita Costa Sara Braga Tiago Magalhães Advisor: Alberto Freitas

  3. 1. INTRODUCTION

  4. INTRODUCTION InternationalQuality Project largestinternational data setofqualityindicators

  5. 2. INDICATORS

  6. INDICATORS • Tools that allow us to assess the condition in a simple, understandable, and comparable way[4] Tools that allow us to assess the condition in a simple, understandable, and comparable way[4] Used by health institutions: Used by health institutions: • Fundamental for management evaluation, efficiency and health effectiveness • Evaluate the economical performance and hospitalar productivity ( outcome patients,newborns ) • Evaluate healthcare quality • Fundamental for management evaluation, efficiency and health effectiveness • Evaluate the economical performance and hospitalar productivity • Evaluate healthcare quality ( patients,newborns ) outcome • [4] Correia L F. Indicadores de Desempenho Económico na Saúde. 2005

  7. E X A M P L E [18]Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2006. Grupos de Diagnósticos Homogéneos. 2006.

  8. E X A M P L E [18]Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2006. Grupos de Diagnósticos Homogéneos. 2006.

  9. INDICATORS Tools that allow us to assess the condition in a simple, understandable, and comparable way[4] • Tools that allow us to assess the condition in a simple, understandable, and comparable way[4] Used by health institutions: Used by health institutions: • Fundamental for management evaluation, efficiency and health effectiveness • Evaluate the economical performance and hospitalar productivity ( outcome patients,newborns ) • Evaluate healthcare quality • Fundamental for management evaluation, efficiency and health effectiveness • Evaluate the economical performance and hospitalar productivity ( outcome patients,newborns ) • Evaluate healthcare quality (Discharged patients,Exceptional admission episodes,Surgical admission time, Complication-free long-term admissions, Readmissions, Newborns, Vaginal Delivery, Unspecified surgical procedures, Medical DRG’s complications ) (Discharged patients,Exceptional admission episodes,Surgical admission time, Complication-free long-term admissions, Readmissions, Newborns, Vaginal Delivery, Unspecified surgical procedures, Medical DRG’s complications ) • [4] Correia L F. Indicadores de Desempenho Económico na Saúde. 2005

  10. Readmissions • Misdiagnosis • Incomplete treatment • Complications E X A M P L E

  11. VaginalDelivery E X A M P L E Percentage of C -sections within the total number of deliveries (in Portugal) [18] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2006. Grupos de Diagnósticos Homogéneos. 2006. [22] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2003. Grupos de Diagnósticos Homogéneos. 2005 Mar. [23] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2004. Grupos de Diagnósticos Homogéneos. 2005 Sep. [24] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2005. Grupos de Diagnósticos Homogéneos. 2006 Aug.

  12. The financing of Health entities is based on Diagnosis Related Groups (DRGs) • System to classify hospital cases into one of approximately 500 groups • expected to have similar hospital resource us

  13. INDICATORS Developedby: • ACS - Alto comissariado da Saude • ACHS - Australian Council on Healthcare Standards • ACSS - Administração Central do Sistema de Saúde • AHRQ - Agency for Healthcare Research and Quality • ACS – Alto comissariado da Saude • AHQR – Agency for HealthcareResearchandQuality • ACHS - Australian Council on Healthcare Standards • ACSS – Administração Central do Sistema de Saúde

  14. INDICATORS • Relevance • Objectivity • Sensibility • Precision • Availability • Cost-efficiency • Reliability [3] Ribeiro N. Indicadores de Gestão para Administração Pública. TOC. 2000 June

  15. INDICATORS • Problems associated: • Probabilistic natured problems • Inadequacies of information systems • Inadequacies of information systems • Variety of measurers and measures • Variety of measurers and measures • Complexity of health plans • Complexity of health plans • Availability of funding[6] • Probabilistic natured problems • Availability of funding[6] • Confusion factors and problems with robustness, sensitivity and specificity[7]. • [6] Eddy D M. Performance measurement: problems and solutions. 1998 • [7] Freeman T, Using performance indicators to improve health care quality in the public sector: a review of the literature. 2002

  16. The challenge of every health system is to find ways to apply management and quality indicators adequately, seeking to promote significant improvements in health[9]. [9] Thomson R G, Lally J. Performance management at the crossroads in the NHS: don't go into the red 2000

  17. 3. RESEARCH QUESTION

  18. RESEARCH QUESTION HOW CAN INDICATORS BE USED TO EVALUATE THE QUALITY OF HEALTHCARE PROVIDED TO IN-PATIENTS IN NATIONAL HOSPITALS? WHAT INFORMATION DO THEY PROVIDE ON SPECIFIC ASPECTS: ON PORTUGUESE HEALTH SERVICES PERFORMANCE?

  19. 4. OBJECTIVES

  20. OBJECTIVES Compare the numbers of the last years Evolutionoftheservices’ qualityandefficiency Establish a comparison between the different areas of Portugal

  21. OBJECTIVES • Suggest some possible causes that might have led to the obtained results

  22. TARGET POPULATION: • SOFTWARE: SPSS • Portuguese public Hospitals’ database between 2000 and 2007 DGH DDX TOTAL ADMISSION TIME HOSPITALS LOCATIONS Portuguese population

  23. 5. VARIATIONS IN INDICATORS

  24. VARIATIONS IN INDICATORS • Evolution through the years 2007 2000

  25. VARIATIONS IN INDICATORS • Regional(NUTS II) Statisticalregionsinwhichterritoryisdivided (7 regions, in Portugal) • Lisboa • Alentejo • Norte • Norte • Centro • Alentejo • Algarve • Centro • Lisboa • Algarve • Região Autónoma dos Açores • Região Autónoma dos Açores • Região Autónoma da Madeira [25] Nomenclatura de Unidades Territoriais para fins estatísticos , Wikipédia, 2008 [26] Parlamento Europeu, Conselho da União Europeia. Regulamento (CE) N.º 1059/2003 do Parlamento Europeu e do Conselo, relativo à instituição de uma Nomenclatura Comum das Unidades Territoriais Estatísticas (NUTS), Jornal Oficial da União Europeia. 2003 May 26.

  26. 6. EXPECTED RESULTS

  27. EXPECTED RESULTS

  28. EXPECTED RESULTS

  29. EXPECTED RESULTS

  30. “Economicalscienceisthestudyofthewaypeopleandsocietychoose, withorwithoutusingmoney,themanagementoflimitedproductiveresourcesinalternativeaplications, sotheycanprducegoodsandspreadthem for consumption, nowadaysorinthefuture”

  31. References [1] Entidade Reguladora da Saúde. Relatório da Actividade Reguladora de 2007 [Internet]. Porto: 2008 August [accessed 2008 October 30]. Available from http://www.ers.pt/actividades/relatorio-de-actividades/Relatorio%20Actividade%20 Reguladora%202007.pdf/ view [2] Ministério da Saúde. Diário da República [Internet]. 2007 January 23 [accessed 2008 October 30]. Portaria n.º 110-A/2007 – 1.ª Série – N.º16. Available from http://dre.pt/pdf1sdip/2007/01/01601/00020124.PDF [3] Ribeiro N. Indicadores de Gestão para Administração Pública. TOC. 2000 June [accessed 2008 October 27]; N.º3. Available from www.netautarquia.pt /noticias/Confer Forum.htm. [4] Correia L F. Indicadores de Desempenho Económico na Saúde [Internet]. 2005 December [accessed 2008 October 27]. Available from http://www.iqs.pt/pdf/ Dezembro-2005/13-16-20.pdf. [5] Bentes M, Gonçalves M, Urbano J, Tranquada S. A utilização dos GDHs como instrumento de financiamento hospitalar. RevistaGestãoHospitalar. 1996 December-1997 January;33: 33-43. [6] Eddy D M. Performance measurement: problems and solutions. PubMed [Internet]. 1998 July-August [accessed 2008 October 27]; 17(4):7-25. Available from http://www.ncbi.nlm.nih.gov/pubmed/9691542?ordinalpos=8&itool= EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum. [7] Freeman T, Using performance indicators to improve health care quality in the public sector: a review of the literature. PubMed [Internet]. 2002 May [accessed 2008 October 27]; 15(2):126-37. Available from http://www.ncbi.nlm.nih.gov/ pubmed/12028801. [8] CollopyB T. Clinical indicators in accreditation: an effective stimulus to improve patient care. PubMed [Internet]. 2000 June [accessed 2008 October 27]; 12(3):211-6. Available from http://www.ncbi.nlm.nih.gov/pubmed/10894192?ordinalpos=4&itool=EntrezSystem2. PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum. [9] Thomson R G, Lally J. Performance management at the crossroads in the NHS: don't go into the red. PubMed Central [Internet]. 2000 [accessed 2008 October 27]; 9: 201-202. Available from http://www.pubmedcentral.nih.gov/picrender.fcgi?artid =1743551&blobtype=pdf. [10] Agency for Healthcare Research and Quality (AHRQ). AHRQ Summary Statement on Comparative Hospital Public Reporting [Internet]. United States of America: Health and Human Services. [accessed 2008 October 27]. Available from: http://www.qualityindicators.ahrq.gov/news/AHRQSummaryStatement. pdf. [11] KondroW. The joys of quality indicators. Canadian Medical Association Journal. 2008 January 15; 178(2): 142–143. Shojania K G, Forster A J. Hospital mortality: when failure is not a good measure of success. CanadianMedicalAssociationJournal. 2008 July 15; 179(2): 153-157 [12] Machado M C S. O Plano Nacional da Saúde 2004-2010 [Internet]. Portugal (PT): Alto Comissariado da Saúde. [accessed 2008 October 27]. Available from http://www.acs.min-saude.pt/pns/pt/. [13] GeraedtsM, Schwartze D, Molzahn T. Hospital quality reports in Germany: patien and physician opinion of the reported quality indicators. Canadian Medical Association Journal. 2007 September 28; 7: 157. [15] Galvin R S. Are performance measures relevant?. Health Affairs. 1998 July-August; 29–31. [16] McGlynnE A. Selecting common measures of quality and system performance. Medical Care. 2003 January; 41(1 Suppl):I39-47. [17] Thomson R, Taber S, Lally J, Kazandjian V. UK Quality Indicator Project (UK QIP) and the UK independent health care sector: a new development. International Journal for Quality in Health Care. 2004 April; 16 Suppl:i51-i56.

  32. References [18] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2006. Grupos de Diagnósticos Homogéneos. 2006. [19] J Thomas, S Paranjothy Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit. National Sentinel Caesarean Section Audit Report. RCOG Press; 2001. [20] FaúndesA, Pádua K S, Osis M J D, Cecatti J G, Sousa M H. Brazilian women and physicians' viewpointson their preferred route of delivery. Revista de SaúdePública. 2004; 38(4):488-94 [21] ReynoldsA, Ayres-de-Campos D, Costa M A, Santos C, Campos I, Montenegro N, Influenceofthreeorganisationalmeasuresonthecesarean, Acta Médica Portuguesa. 2004; 17:193-198. [22] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2003. Grupos de Diagnósticos Homogéneos. 2005 Mar. [23] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2004. Grupos de Diagnósticos Homogéneos. 2005 Sep. [24] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2005. Grupos de Diagnósticos Homogéneos. 2006 Aug. [25] Nomenclatura de Unidades Territoriais para fins estatísticos [Internet], Wikipédia, 2008 Dec 13 [accessed 2008 Dec 16]. Availablefrom: http://pt.wikipedia.org/wiki/NUTS [26] Parlamento Europeu, Conselho da União Europeia. Regulamento (CE) N.º 1059/2003 do Parlamento Europeu e do Conselo, relativo à instituição de uma Nomenclatura Comum das Unidades Territoriais Estatísticas (NUTS), Jornal Oficial da União Europeia. 2003 May 26. [27] SPSS for Windows, Rel. 16.0.0 2007. Chicago (IL): SPSS Inc. [28] Pereira A C, Pinto A T, Parry G, Vieira P, Azevedo L F, Martins C, Vieira A, Desenhos de estudos [Internet]. Universidade do Porto, Serviço de Bioestatística e Informática Médica [accessed 2008 Dec 16]. Availablefrom: http://stat2.med.up.pt/cursop/main.php3?capitulo=desenhos_estudo& numero=1&titulo=Desenhos+de+estudo [29] Alto Comissariado da Saúde - Ministério da Saúde. Indicadores e Metas do PNS [Internet]. 2008 [accessed 2008 Dec 10]. Available from: http://195.22.11.132/websig/acsv2/gui/index.php?par=acs&lang=PRT# [30] Lista de distritos portugueses ordenados por população [Internet]. [updated 2008 Nov 14; accessed 2008 Dec 14]. Available from: http://pt.wikipedia.org/wiki/Distritos_portugueses_ordenados _por_ popula%C3%A7%C3%A3o [31] Sistema Nacional de Saúde. Indicadores de Desempenho 2004 – 2006 [Internet]. [acessed 2008 Dec 14]. Available from: http://www.portugal.gov.pt/NR/rdonlyres/A03A04DB-7EE1-43D6-8B69-2FE9118D43D9/0/Indicadores_SNS_2006.pdf.

  33. Thank you for your time

  34. THE END

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