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Introdução à Medicina II 2008/09 Turma 18

Introdução à Medicina II 2008/09 Turma 18. Alexandre Almendra Ana Cunha António Miranda Cristina Costa Gabriela Gonçalves Joana Esteves João Pedro Barreto Luísa Costa Mariana Carvalho Mónica Garrido Pedro Canão Pedro Valente Rita Costa Sara Braga Tiago Magalhães. INTRODUCTION.

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Introdução à Medicina II 2008/09 Turma 18

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  1. Introdução à Medicina II 2008/09 Turma 18

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

  3. INTRODUCTION

  4. INTRODUCTION • Need to evaluate management • Control the costs • Fulfill new requirements • Greater demandings Creation of information systems that allow to grade the management INDICATORS [3] Ribeiro N. Indicadores de Gestão para Administração Pública. TOC. 2000 June

  5. INTRODUCTION INDICATORS In a general way… Two main functions …are… Evaluate Describe …“measurement units” to monitor and evaluate through comparison between different entities [3] Ribeiro N. Indicadores de Gestão para Administração Pública. TOC. 2000 June

  6. INTRODUCTION INDICATORS • Efficiency • Efficacy • Effectiveness • Cost-efficiency • Comparability • Availability • Relevance • Consistency • Reliability [3] Ribeiro N. Indicadores de Gestão para Administração Pública. TOC. 2000 June [4] Correia L F. Indicadores de Desempenho Económico na Saúde [Internet]. 2005

  7. INTRODUCTION PROBLEMS ASSOCIATED • Lack of technical means • Input/Output measurement difficulties • Availability of funding • Employee’s lack of instruction • Little dynamism from commissions responsible for executing indicators • Inadequacies of information systems [3] Ribeiro N. Indicadores de Gestão para Administração Pública. TOC. 2000 June [4] Correia L F. Indicadores de Desempenho Económico na Saúde [Internet]. 2005

  8. INTRODUCTION Facing an inefficient and non productive governmental management of public health systems Construction of evaluation means for the efficiency and effectiveness levels of health systems HEALTH INDICATORS [3] Ribeiro N. Indicadores de Gestão para Administração Pública. TOC. 2000 June

  9. INTRODUCTION • Comparative quality reporting • Public reporting • Pay-for-performance • Public reporting • Pay-for-performance • Comparative quality reporting

  10. INTRODUCTION Tendency to rationalize the funds’ distribution process • [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.

  11. 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?

  12. OBJECTIVES Evolutionoftheservices’ qualityandefficiency Compare the numbers from 2000 to 2007 Establish a comparison between the different areas of Portugal • Norte • Centro • Norte • Centro • Lisboa • Lisboa • Alentejo • Alentejo • Algarve • 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.

  13. WHICH METHODS AND RESOURCES ARE WE GOING TO USE IN ORDER TO REACH OUR GOALS ?

  14. METHODS AND RESOURCES Database with inpatient episodes from 87 Portuguese public Hospitals between 2000 and 2007 Excluded episodes (ambulatory episodes): • Planned admission • Release date equals admission date • Patients do not change hospitals • Patients do not leave against medical advice nor die

  15. METHODS AND RESOURCES Main characteristics of inpatient database Total admissions: 7.768.467

  16. METHODS AND RESOURCES Original variables • HOSP_ID • EPIS_ID • SEXO • DDX1-DDX20 • SRG1-SRG20 • DSP • BIRTH_WGT • ADM_TIP • HOSP_FROM • HOSP_TO • TOTDIAS • SAIDLAST • DRG • MDC • RESIDE • ENT1 • HOSP_RESIDE • DISTANCIA

  17. METHODS AND RESOURCES indicators HEALTH CARE QUALITY ACTIVITY/PRODUCTION Which variables did we use to calculate these indicators? Common variables: cod_conc; nuts3; nuts2; ambulatorio; ano_de_alta; ICD-9-CM code, Portaria nr110-A/2007,January the 23rd of 2007 and attachments II e III

  18. RESULTS RESUltS a) Compare the numbers from 2000 to 2007 b) Establish a comparison between the different areas of Portugal

  19. RESULTS a) COMPARISON BETWEEN YEARS 1)Calculated from a 1 % sample

  20. RESULTS b) COMPARISON BETWEEN NUTS II 1)Calculated from a 1 % sample

  21. [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] Collopy B 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] Kondro W. The joys of quality indicators. Canadian Medical Association Journal. 2008 January 15; 178(2): 142-143. • [12] Shojania K G, Forster A J. Hospital mortality: when failure is not a good measure of success. Canadian Medical Association Journal. 2008 July 15; 179(2): 153-157. • [13] 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/. • [14] Geraedts M, 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] McGlynn E 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. References

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  23. THANK YOU FOR YOUR ATTENTION

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