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Six years of hospitalization in Portuguese public hospitals

Faculty of Medicine – University of Porto. Six years of hospitalization in Portuguese public hospitals. An analysis of the major causes of admission. Structure. Faculty of Medicine – University of Porto. Purposes.

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Six years of hospitalization in Portuguese public hospitals

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  1. Faculty of Medicine – University of Porto Six years of hospitalizationin Portuguese public hospitals An analysis of the major causes of admission

  2. Structure Faculty of Medicine – University of Porto

  3. Purposes • The main purpose of this work is to analyse six years of hospitalization in Portuguese public hospitals, describing and emphasizing the major causes of admission. • In this sense, it is essential to compare demographic characteristics of the patients as well to point out hospitalization’s causes and its temporal evolution. Faculty of Medicine – University of Porto

  4. Introduction • Diagnosis Related Groups (DRGs) are a systematic classification of the hospitalized patients in hospitals that attend acute cases (Palmer et al, 1986). • This system was developed in the late 60’s by a multidisciplinary team of Yale University and the main researchers were Robert B. Fetter and John Thompson. Faculty of Medicine – University of Porto

  5. The categories should be consistent in terms of the anatomy, physiopathologic classification and clinical treatment of the patients. On the other hand each group should contain patients with similar patterns in what concerns to the resources consumption. Faculty of Medicine – University of Porto

  6. The main purposes of DRG are: • to evaluate and improve the management, planning and revision of the hospital utilization; • to define the complexity of the hospital profile (case-mix), in terms of consumption of resources during hospitalization; • to finance the previous payment of treatments; • to measure and examine the hospital products (Fetter, 1989). Faculty of Medicine – University of Porto

  7. In Portugal, the DRG system was implemented in 1990. • According to some studies, the DGR payment system seems to have had a positive impact on productivity and technical efficiency of the hospital services in Portugal(Dismuke et al, 1999). Faculty of Medicine – University of Porto

  8. Methods The sample of this study: • - All the hospitalizations that have occurred between 1999 and 2004 in Portuguese public hospitals in a universe of 89 hospitals, located in the continent. • - The data base was provided by the IGIF and incorporates data relating to 34 central hospitals, 36 general district hospitals and 19 district hospitals level 1, amounting a total of 89 hospitals and 25677 beds (DGS, August 2006). Faculty of Medicine – University of Porto

  9. Project methodologies included: • - Research of papers and statistical analysis using SPSS. • - Use of a random sample of the data base (5% of all the data) in which the syntax would be previously designed. • - Selection of the four MDC (Major Diagnosis Categories), according to frequency and clinical relevance. • - After specifying the MDCs, recourse to the DRGs. Faculty of Medicine – University of Porto

  10. Statistical analysis – variables and aims: 1) Demographic characteristics of the patients: age, gender. 2) Hospitalization’s causes and its temporal evolution, defining: • the main diagnosis (recurring either to DRG or MDC); • the type of admission; • the median time of hospitalization; • the discharge destination. 3) Evaluation of hospital’s outcomes, appealing to: • mortality; • number of admissions; • readmission due to the same previous causes or after medical/surgical episode (within a period of 30 days). Faculty of Medicine – University of Porto

  11. Results - Four MDCs were selected according to their frequency and clinical significance. In spite of being frequent, two MDCs (MDC=14 and 15) were eliminated as they weren’t related with the purpose of the study. - Within each MDC, three DRGs were chosen based on the same criteria. Faculty of Medicine – University of Porto

  12. Results:nervous systemdemographic indicators Faculty of Medicine – University of Porto

  13. Results:nervous systemhospitalization profile Faculty of Medicine – University of Porto

  14. Results:nervous systemhospitalization profile Faculty of Medicine – University of Porto

  15. Results: nervous systemhospital outcomes Faculty of Medicine – University of Porto

  16. Results: respiratory systemdemographic indicators Faculty of Medicine – University of Porto

  17. Results:respiratory systemhospitalization profile Faculty of Medicine – University of Porto

  18. Results: respiratory system hospital outcomes Faculty of Medicine – University of Porto

  19. Results: circulatory system demographic indicators Faculty of Medicine – University of Porto

  20. Results: circulatory system hospitalization profile Faculty of Medicine – University of Porto

  21. Results: circulatory system hospitalization profile Mortality in myocardial infarction Faculty of Medicine – University of Porto

  22. Results: circulatory system hospital outcomes Faculty of Medicine – University of Porto

  23. Results: digestive system demographic indicators Faculty of Medicine – University of Porto

  24. Results: digestive system hospitalization profile Faculty of Medicine – University of Porto

  25. District level 1 Central General district Results: digestive system hospital outcomes Faculty of Medicine – University of Porto

  26. Discussion • The major causes of admissions were related to disorders of the digestive, circulatory, respiratory and nervous system, affecting over 80000 people out of a total of over 240000. • Admissions at central hospitals were primarily due to circulatory disorders and at general district and district level 1 hospitals due to disorders of digestive system. Faculty of Medicine – University of Porto

  27. Time of hospitalization - higher in respiratory disorders and lower in digestive disorders. • Readmissions - more frequent in respiratory disorders. • Mortality - higher in respiratory disorders. • Discharge destination - Hospital of NHS: respiratory disorders. - Departure against doctor report: circulatory disorders • Gender - Men: digestive/circulatory/respiratory disorders - Women: nervous disorders • Age- <= 1 and >=60: respiratory disorders - 2 to 17 and 18 to 59: digestive disorders Faculty of Medicine – University of Porto

  28. Faculty of Medicine – University of Porto

  29. Limitations of the study: • DRG system is used to previous payment to hospitals, leading frequently to an inadequate remuneration and therefore promoting the rejection of the most severe patients. • Difficulty in analysing the complexity of the different cases and in deciding which diagnosis suits better a particular patient. • Some indicators are built from the information of hospital data bases which is strongly dependent on the accuracy and rigour that each hospital dedicates to the retrieve and codification of its clinical information. Faculty of Medicine – University of Porto

  30. Limitations of the study: • The variable time of hospitalization can be misleading as some systems consider 1 day the period of time between 0-48h while others consider 1 day the period of time between 0-24h. • The data base didn’t have the identification of the episodes nor the patients and so it was impossible to ensure that readmission occurred due to the same previous causes or after a medical/surgical episode. • The utilization of type C classification of hospitals made our results easier to analyse but in counterpart had implied a reducing view of hospital reality. Faculty of Medicine – University of Porto

  31. Limitations of the study: • The unit of analysis was the hospitalization and so we could not infer anything about the patient profile. • As we analysed only six years of hospitalization we could not conclude anything relatively to the temporal evolution of the disorders. • As we focused only in 4 MDCs and 12 DRGs, this research study can not be seen as an exhaustive dissertation about the causes of admission. • As the private hospitals and those located in Azores and Madeira were excluded it was not possible to extrapolate our results to that population. Faculty of Medicine – University of Porto

  32. Final consideration: • Hospitals across Europe have been changing considerably with more people being admitted but staying for shorter periods. In spite of being centres of health care, they also fulfil essential roles in teaching, research and cooperation with local communities. • Therefore, it is primordial to adapt the structures of each care unit to the population it serves, basing this approach on a long-term program of sustained and stable investment. • This study reported the major causes of admission in Portuguese public hospitals for six years and accomplished relevant results that may help in the restructuring of Portuguese health systems. Given the originality of this study, it is important to analyse the problem under other perspectives in order to build a robust model of Portuguese reality. Faculty of Medicine – University of Porto

  33. Acknowledgements • Altamiro da Costa Pereira, PhD, Professor FMUP • Armando Teixeira-Pinto, PhD, Professor FMUP Faculty of Medicine – University of Porto

  34. 2006/2007 Class 8 Adriana Lages Ana Isabel Rodrigues Ana Rita Matos Carla Maia Diana Leite Ezequiel Silva Hugo Sêco Joana Simões Jorge Silva Márcia Leite Marta Teixeira Raquel Oliveira Sara Machado

  35. References: [1] AVERILL, R.F. The design and development of the Diagnosis Related Groups. In: Health Systems International. Diagnosis Related Groups; second revision definitions manual. New Haven, Conn, 1985. [2] DISMUKE, C.E.; SENA, V. Has DRG payment influenced the technical efficiency and productivity of diagnostic technologies in Portuguese public hospitals? An empirical analysis using parametric and non-parametric methods. Health Care Manag. Sci. 1999 May;2(2):107-16. [3] FETTER, R.B.; FREEMAN, J.L.; AVERILL, R.F.; THOMPSON, J .D. Case-mix definition by Diagnosis Related Groups. Med. Care, 18:1-53, Feb. 1980. [4] FETTER, R.B. Concepts of case-mix management. In Roger-France, F.H.; Moor, G. de; Hofdijk, J.; Jenkins, L., org. Diagnosis Related Groups in Europe. Ghent, Bélgica, Goff BVBA, 1989. p. 134-42. [5] FREEMAN, J.L. DRG refinement project. In: International Conference on the Management and Financing of Hospital Services, 2nd, Sydney, 1988. Proceedings. Sydney, 1988. p. 128-33. [6] PALMER, G.R.; FREEMAN, J.L.; FETTER, R.B.; MADOR, M. International comparisons of hospital usage: a study of nine countries, based on DRGs. New Haven, Health Systems Management Group. Yale School of Organization and Management, 1989. [7] URBANO, J. & BENTES, M. Definição da produção do hospital: os Grupos de Diagnósticos Homogéneos. Rev. port. Saúde públ., Lisboa, 8 (1): 49-60, 1990. [8] VERAS, C.T.; NORONHA, M.F.; MARTINS, M.S.; BRAGA NETO, F.C.; LEITE, I.C.; SILVER, L. Avaliação de métodos alternativos para racionalização e análise de qualidade nos serviços de saúde. Rio de Janeiro, Escola Nacional de Saúde Pública, FIOCRUZ, 1990. Faculty of Medicine – University of Porto

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