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Evaluating Portuguese primary healthcare through Prevention Quality Indicators (PQIs)

Evaluating Portuguese primary healthcare through Prevention Quality Indicators (PQIs). Introdução à Medicina II Class 9 Adviser: Alberto Freitas. PQIs Primary Healthcare Ambulatory Care Sensitive Conditions

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Evaluating Portuguese primary healthcare through Prevention Quality Indicators (PQIs)

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  1. Evaluating Portuguese primary healthcare through Prevention Quality Indicators (PQIs) Introdução à Medicina II Class 9 Adviser: Alberto Freitas

  2. PQIs • Primary Healthcare • Ambulatory Care Sensitive Conditions • “avoidable hospitalization rates are a sensitive indicator for assessing quality of primary ambulatory care” (Niti et al. 2003) Prevention starts here. Image source: http://www.parklandhealthcenter.org/phc_content.aspx?id=3778 IntroMedI - class 9 - PQIs

  3. Source: Ansari Z. Laditka JN. Laditka SB. Access to Health Care and Hospitalization for Ambulatory Care Sensitive Conditions. Med Care Res Rev. 2006; 63:719-742 IntroMedI - class 9 - PQIs

  4. AIMS • Assessment of the primary healthcare system quality, in an outpatient setting. • Compare different level 2 NUTS*, trends 2000-2005 • Lay an hypothesis for the likely observed differences. • *except for Azores and Madeira. IntroMedI - class 9 - PQIs

  5. PARTICIPANTS • 6199102 patients’ discharge data from national database (ACSS) • 94 Acute Care Public Hospitals (continent) IntroMedI - class 9 - PQIs

  6. DATA COLLECTION • Data collected from acute care hospital database • Variables of interest present in the database or calculated from others • INE (Instituto Nacional de Estatística) provides populational and other statistical data IntroMedI - class 9 - PQIs

  7. Division in NUTS II IntroMedI - class 9 - PQIs

  8. INCLUSION • Diagnosis according to PQI • EXCLUSION • Age <18 • MDC = 14 or 15 • Transferred from • Related non-evaluative conditions IntroMedI - class 9 - PQIs

  9. INVALID • Address codes missing. non-existent or belonging to the Azores or Madeira. • Absurd age (below 0; over 150) • Undetermined Sex (3) IntroMedI - class 9 - PQIs

  10. STRATIFICATION • NUT II (Norte, Centro, Lisboa, Alentejo, Algarve) • Year (2000-2005) • Gender • Age (0-17; 18-24; 25-34; 35-44; 45-54; 55-64; 65-74; 75+) IntroMedII - class 9 - PQIs

  11. IntroMedII - class 9 - PQIs

  12. RESULTS OVERVIEW IntroMedII - class 9 - PQIs

  13. * * Overall PQI = Sum of all PQIs except for 2 and 9 IntroMedI - class 9 - PQIs

  14. IntroMedI - class 9 - PQIs

  15. IntroMedII - class 9 - PQIs

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  17. IntroMedII - class 9 - PQIs

  18. IntroMedII - class 9 - PQIs

  19. IntroMedII - class 9 - PQIs

  20. Significant Correlations • Overall PQI • Acute PQI • Diabetes PQI No relevant associations found IntroMedII - class 9 - PQIs

  21. Significant Correlations • Life Quality • GIP per Capita • Life Expectancy at Birth • Healthcare Facilities • Number of Health Centers per 100.000 pop. • Medical visits per inhabitant • Number of doctors per 1000 pop. • Education • Literacy Index • Proportion of active population with minimum education (“3º Ciclo”) • Proportion of active population with secondary education or higher • Neonatal • Age of first pregnancy • Neonatal mortality rate IntroMedII - class 9 - PQIs

  22. r= 0.699 r=0,539 r=0,499 p < 0.05 0.35 < r < 0.7 r=0,365 IntroMedII - class 9 - PQIs

  23. r=-0,611 r=-0,399 r=-0,457 p < 0.05 -0.62 < r < -0.38 r=-0,503 IntroMedII - class 9 - PQIs

  24. p < 0.01 r = 0.60 IntroMedII - class 9 - PQIs

  25. r= 0,735 r= 0,7 r= 0,731 p < 0.01 0,631< r <0,735 r= 0,631 IntroMedII - class 9 - PQIs

  26. r= -0,596 r= -0,567 r= -0,761 p < 0.05 -0,761< r <-0,513 r= -0,513 IntroMedII - class 9 - PQIs

  27. p < 0.01 r = 0.71 IntroMedII - class 9 - PQIs

  28. r= -0,675 r= -0,681 p < 0.02 -0,681< r <-0,530 r= -0,530 IntroMedII - class 9 - PQIs

  29. r= -0,647 r= -0,615 r= -0,390 p < 0.05 -0,680< r <-0,390 r= -0,644 r= -0,680 IntroMedII - class 9 - PQIs

  30. p < 0.01 r = 0.37 IntroMedII - class 9 - PQIs

  31. r= 0,472 r= 0,383 r= 0,430 p < 0.05 0,383< r <0,472 IntroMedII - class 9 - PQIs

  32. r= -0,288 r= -0,357 p < 0.05 - 0.37 < r < - 0.35 IntroMedII - class 9 - PQIs

  33. p < 0.01 r= 0,64 IntroMedII - class 9 - PQIs

  34. What is missing? IntroMedII - class 9 - PQIs

  35. REFERENCES • Farquhar, M. AHRQ Quality Indicators [slides]. Rockville (MD): Agency for Healthcare Research and Quality; 2005. 20 slides colour. • General Questions about the AHRQ QIs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality; July 2004 [cited 2007 Oct 31]. Available from: http://www.qualityindicators.ahrq.gov/general_faq.htm • Agency for Healthcare Research and Quality. Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions. Version 3.1. Rockville (MD): Agency for Healthcare Research anm,mid Quality; March 2007. • AHRQ Prevention Quality Indicators Overview [Internet]. Rockville (MD): Agency for Healthcare Research and Quality; July 2004 [cited 2007 Oct 31]. Available from: http://www.qualityindicators.ahrq.gov/pqi_overview.htm IntroMedI - class 9 - PQIs

  36. Ansari Z, Laditka JN, Laditka SB. Access to Health Care and Hospitalization for Ambulatory Care Sensitive Conditions. Med Care Res Rev. 2006; 63:719-42 • Billings J, Zeitel L, Lukomnick J, Carey TS, Blank AE, Newman L. Impact of socioeconomic status on hospital use in New York City. Health Aff (Millwood). 1993; 2:162-9. • Starfield B. Primary care and health: a cross-national comparison. JAMA. 1991; 266:2268-71. • Sanderson C, Dixon J. Conditions for which onset or hospital admission is potentially preventable by timely and effective ambulatory care. J Health Serv Res Policy. 2000, 5:222-30. • Kozak LJ, Hall MJ, Owings MF. Trends in Avoidable Hospitalizations, 1980-1998. Health Aff. 2001; 2 (20): 225-32. IntroMedI - class 9 - PQIs

  37. Casanova C, Starfield B. Hospitalizations of children and access to primary care: a cross-national comparison. Int J Health Serv. 1995; 25:283-94. • Ansari Z, Barbetti T, Carson NJ, Auckland MJ, Cicuttini F: The Victorian ambulatory care sensitive conditions study: rural and urban perspectives. Soz Praventivmed. 2003; 48:33-43. • Sheerin I, Allen G, Henare M, Craig K. Avoidable hospitalizations: potential for primary and public health initiatives in Canterbury, New Zealand. N Z Med J. 2003; 119(1236). • Roos LL, Walld R, Uhanova J, Bond R: Physician visits, hospitalizations, and socioeconomic status: ambulatory care sensitive conditions in a Canadian setting. Health Serv Res. 2005, 40:1167-85. • Porter J, Herring J, Lacroix J, Levinton C. Avoidable Admissions and Repeat Admissions: What Do They Tell Us? Healthc Q. 2007, 10:26-28. IntroMedI - class 9 - PQIs

  38. Niti M, Ng TP. Avoidable hospitalization rates in Singapore, 1991-1998: assessing trends and inequities of quality primary care, J Epidemiol Community Health. 2003; 57: 17-22. • Rizza P, Bianco A, Pavia M, Angelillo IF. Preventable hospitalization and access to primary health care in an area of Southern Italy. BMC Health Serv Res. 2007; 7:134. • Sanchez JLA, Vilalta JS, Perepérez SB, Martínez IM. Characteristics of avoidable hospitalization in Spain. Med Clin (Barc). 2004; 122(17):653-8. • Weissman JS, Gatsonis C, Epstein AM. Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. JAMA. 1992; 268:2388-94. • Pappas G, Hadden WC, Kozak LJ, Fisher GF. Potentially Avoidable Hospitalization inequalities in rates between US socioeconomic groups. Am J Public Health. 1997; 87:811-6. IntroMedI - class 9 - PQIs

  39. Booth GL, Hux JE. Relationship Between Avoidable Hospitalizations for Diabetes Mellitus and Income Level. Arch Intern Med. 2003; 163:101-6. • Regulation (EC) No 1059/2003 of the European Parliament and of the Council of 26 May 2003 on the establishment of a common classification of territorial units for statistics (NUTS) (Official Journal L 154, 21/06/2003) • Agency for Healthcare Research and Quality. Prevention Quality Indicators: Technical Specifications. Version 3.2. Rockville (MD): Agency for Healthcare Research and Quality; March 2008. • SPSS for Windows, Rel. 15.0.0 2006. Chicago (IL): SPSS Inc. IntroMedI - class 9 - PQIs

  40. Protocol developed by: Ana Catarina Moura, mimed07028@med.up.pt Ana Margarida Oliveira, mimed07022@med.up.pt Bárbara Mendonça, mimed07248@med.up.pt Cláudia Pereira, mimed07173@med.up.pt Hélio Alves, mimed07223@med.up.pt João Miguel Rego, mimed07261@med.up.pt José Pedro Pinto, mimed07054@med.up.pt Maria Francisca Costa, mimed07093@med.up.pt Maria Guiomar Pinheiro, mimed07095@med.up.pt Nelson Couto, mimed07135@med.up.pt Ricardo Reis, mimed07115@med.up.pt José Alberto Silva Freitas, alberto@med.up.pt IntroMedI - class 9 - PQIs

  41. Thank you for your time IntroMedI - class 9 - PQIs

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