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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 I/II Class 9 Adviser: Alberto Freitas. What are PQIs?. QIs Not definitive measures Use hospital discharge inpatient data Based on readily available data. PQIs

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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 I/II Class 9 Adviser: Alberto Freitas

  2. What are PQIs? IntroMedI - class 9 - PQIs

  3. QIs • Not definitive measures • Use hospital discharge inpatient data • Based on readily available data IntroMedI - class 9 - PQIs

  4. 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. IntroMedI - class 9 - PQIs

  5. 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

  6. When were they first introduced? IntroMedI - class 9 - PQIs

  7. Studies of the kind in other countries • United States (Starfied et al.,1991, Sanderson et al., 2000, Kozak et al., 2001) • Australia (Ansari et al., 2003, 2006) • New Zealand (Sheerin et al., 2006) • Canada (Roos et al., 2005, Porter et al., 2007) • Singapore (Niti & Ng, 2003) • Spain (Sánchez et al., 2004) • Italy (Rizza et al., 2007) IntroMedI - class 9 - PQIs

  8. Source: 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 and Quality; March 2007. IntroMedI - class 9 - PQIs

  9. This kind of studies • evaluate the quality of the healthcare conditions • establish patterns • allow comparison with past and future works inside and outside the sampling area. IntroMedI - class 9 - PQIs

  10. Key-words • Ambulatory Care • Primary Care • Quality of Healthcare • Portugal • Delivery of Healthcare • Prevention Quality Indicators IntroMedI - class 9 - PQIs

  11. Aim IntroMedII - class 9 - PQIs

  12. RESEARCH QUESTION What is the status of the primary health care system in Portugal and how does it compare to past years and among its regions? IntroMedI - class 9 - PQIs

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

  14. ParticipantsandMethods IntroMedII - class 9 - PQIs

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

  16. 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

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

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

  19. IntroMedI - class 9 - PQIs

  20. IntroMedI - class 9 - PQIs

  21. IntroMedI - class 9 - PQIs

  22. Source: 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 and Quality; March 2007. IntroMedI - class 9 - PQIs

  23. 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

  24. 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

  25. IntroMedII - class 9 - PQIs

  26. RESULTS OVERVIEW IntroMedII - class 9 - PQIs

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

  28. IntroMedI - class 9 - PQIs

  29. IntroMedII - class 9 - PQIs

  30. IntroMedII - class 9 - PQIs

  31. IntroMedII - class 9 - PQIs

  32. IntroMedII - class 9 - PQIs

  33. IntroMedII - class 9 - PQIs

  34. Significant Associations • 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 IntroMedII - class 9 - PQIs

  35. Significant Associations • Overall PQI • Acute PQI • Diabetes PQI No significant associations found IntroMedII - class 9 - PQIs

  36. Diabetes short-termcomplication • Doctors (N)r=-0,70 • Nurses (N) r=-0,81 • Lit. Indexr=-0,67 • Lifeexp. r=-0,61 • Med. Visitsr=-0,59 • Health Centres r=0,74 • Hospital Distancer=0,76 IntroMedII - class 9 - PQIs

  37. PerforatedAppendix • Pop. Densityr=-0,96 • Med. Visitsr=-0,76 • Doctors (N) r=-0,53 • LifeExp.r=-0,43 • Lit. Indexr=- 0,40 • Hospital Distancer=0,37 IntroMedII - class 9 - PQIs

  38. NONE • Med. Visits r= 0,71 • Life Exp. r= 0,60 • Sec. Education r= -0,36 • Min. Education r= -0,35 Diabetes Long-termcomplication COPD • Hospital Distance r= -0,53 • Min. Education r= -0,39 Hypertension IntroMedII - class 9 - PQIs

  39. Doctors (N) r= -0,68 • Lit. Index r= -0,68 • Health Centres r= 0,70 • Hospital Distance r= 0,56 • Hospital Distance r= 0,78 • Health Centres r= 0,73 CongestiveHeartFailure Dehydration Lit. Index r= -0,64 Life Exp. r= -0,40 IntroMedII - class 9 - PQIs

  40. Sec. Education r= 0,49 • Min. Education r= 0,52 • GDP r= 0,37 • Life Exp. r= -0,51 • Med. Visits r= -0,51 Bacterial Pneumonia UrinaryTractInfection IntroMedII - class 9 - PQIs

  41. GDP r= 0,54 • Minim. Education r= 0,44 • Sec. Education r =0,42 Hospital Distance r= 0,74 Health Centres r= 0,63 Minim. Education r= 0,33 • Life Exp. r= -0,50 • Lit. Index • r= -0,62 Angina withoutProcedure Lower-extremetyamp. inDiabetics

  42. Uncontrolled Diabetes Med. Visits r= 0,50 AdultAsthma GDP r= 0,50 Min. Education r= 0,47 Sec. Education r =0,46 Lit. Index r= 0,38 Med. Visits r= -0,57 IntroMedII - class 9 - PQIs

  43. LowBirthWeightper 100 neonates GDP r=0,70 Age 1st Pregnancy r=0,64 Mean Fig.6 Mean age of first child vs LBW Linear Regression IntroMedII - class 9 - PQIs

  44. Cost Analysis IntroMedII - class 9 - PQIs

  45. IntroMedII - class 9 - PQIs

  46. Discussion IntroMedII - class 9 - PQIs

  47. Prevention • There are differentlevelsofprevention • Preventingtheonsetofthecondition • Preventingtherampagedevelopmentofsymptoms; i.econtrolingthecondition IntroMedII - class 9 - PQIs

  48. Sources: INE, 2005; Cónim C. População e Desenvolvimento Humano- Uma Perspectiva de Quantificação -1970-1999; Marques JL, Martins JM, Castro EA. Análise input-output rectangular inter-regional - emissões de CO2 em Portugal e o protocolo de Quioto Fig.9 Overall PQI per NUT II IntroMedII - class 9 - PQIs

  49. Self-PerceptionofHealth Source: National Health Survey, 1999 Overall PQI IntroMedII - class 9 - PQIs

  50. PatientProfile • Male • Elderly (75 years old +) • Living in areas not densely populated IntroMedII - class 9 - PQIs

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