SINAS

1. SINAS The National System of Health Quality Assessment Álvaro Moreira da Silva Board of Direction ERS Porto, 08 May 2014

2. Outline • Framework for assessing global quality • SINAS@Hospitais (Hospitals) • SINAS@Saúde.Oral (Dental Care)

3. Legal framework ERS have a legal obligation to develop an evaluation system, which aims to assess health care providers in terms of global quality of services The National System of Health Quality Assessment SINAS • Inform patients on quality of health care services • Encourage continuous improvement in the quality of health care services

4. SINAS: Assessment model • Rating System • Voluntary collaboration of health care providers • Data are collected in different formats, which result in the classification of each establishment • ERS conducts audits of randomly selected establishments, in order to validate the information submitted

5. Global Quality Assessment • Quality in health care: • No consensus on a closed form definition • Conceptualizations of quality depend on how broad is the model of care considered (e.g, just medical care or nursing care included?) • Health care services includes more than just health care • Multidimensional approach needed

6. SINAS framework • Modularity of the SINAS project: • Type of health care provider (“SINAS modules”) • Quality dimensions SINAS@Hospitais SINAS@Saúde.Oral Clinical Excellence Patient Safety Comfort of facilities Patient Focus Patient Satisfaction Registration and licensing Organization and Procedures Patient Safety Comfort of Facilities Patient Satisfaction

7. Methodologies • Specificities • Quality dimensions being assessed are type-of-provider-specific • Methodologies for quality assessment are dimension-specific • Technical coherence (same methodologies for similar indicators) • Methodologies for performance measurement • Methodologies for producing ratings

8. Assessment scheme: stars and ratings 1st level of assessment: awarding stars provider complies with all required quality standards ↓ Access to RATING compliance with all required quality standards could not be confirmed ↓ No access to RATING provider did not collaborate with the assessment ↓ No access to RATING

9. Assessment scheme: stars and ratings 2nd level of assessment: awarding ratings quality level III provider with above average performance quality level II provider with average performance quality level I provider with be low average performance insufficient sample sample size was insufficient for statistical inference unreliable data inconsistencies in data were detected starting assessement not assessed area data not supplied

10. Schedule of assessmentsand public disclosure • Frequency: twice a year • Communication channel: dedicated website www.websinas.com Public disclosure of star and rating coded results • Provider-specific reports • With detailed results of performance on each indicator • Transparency: all methodological aspects of the assessments fully described in the website

11. SINAS implementation • SINAS modules currently implemented SINAS@Hospitais • Assessment of hospitals SINAS@Saúde.Oral • Dentists offices and dental care clinics

12. Outline • Framework for assessing global quality • SINAS@Hospitais (Hospitals) • SINAS@Saúde.Oral (Dental Care)

13. SINAS@Hospitais Quality dimensions Status Implemented Clinical Excellence Patient Safety Implemented Adequacy and Comfort of Facilities Implemented Implemented Patient Focus Patient Satisfaction Being developed

14. SINAS@HospitaisClinical Excellence • Clinical areas being assessed • Orthopaedics, Gynaecology, Obstetrics, Paediatrics, Acute Myocardial Infarction, Stroke, Ambulatory Surgery, Vascular Surgery, Cardiac Surgery, Colon surgery and Intensive Care Units • Clinical indicators • Process indicators • Outcome indicators • Methodologies • For process indicators: no risk adjustment • For outcome indicators: risk adjustment model

15. SINAS @ HospitaisAdequacy and Comfort of Facilities • Model of performance assessment • Assessment based on a check-list covering structural and organisational characteristics of facilities • Issues considered in assessment check-list

16. SINAS @ HospitaisAdequacy and Comfort of Facilities • Performance indicator: Percentage of items in check-list that are present • Methodology for producing ratings: Clustering: assigning a set of objects into groups so that the objects in the same group are more similar to each other than to those in other groups.

17. SINAS @ HospitaisPatient Safety • Two perspectives of assessment 1) Ex-ante: patient safety culture 2) Ex-post: indicators (rates) of adverse events incidence • Methodologies • Patient safety culture: assessment by check-list →clustering • Rates of adverse events: outcome indicators → risk adjustment model

18. SINAS @ HospitaisPatient Safety • Patient safety culture • Commitment of health care organisations to safety at all levels, including structures and facilities, procedures and human resources • Assessment with check-list • Main background: • “Patient Safety Practices” of Agency for Healthcare Research and Quality (AHRQ) • “Safe Practices for Better Healthcare 2010” of National Quality Forum (NQF) • “International Patient Safety Goals” of Joint Commission International (JCI)

19. SINAS @ HospitaisPatient Safety • Issues considered in assessment check-list • Safety Culture • PatientsIdentification • Communication with patients • Information to patients • Safe use of medications • Safe SurgeryChecklist

20. SINAS @ HospitaisPatient Safety • Adverse events indicators • Measures that screen for problems that patients experience as a result of exposure to the healthcare system and that are likely amenable to prevention. • Main background: • Agency for Healthcare Research and Quality (AHRQ) • Safety Improvement for Patients In Europe (SImPatIE) • OCDE Health Care Quality Indicators

21. SINAS @ HospitaisPatient Safety • SINAS selection of adverse events indicators

22. SINAS @ HospitaisPatient Focus • Aim: • Objective assessment of how much are health care organisations centred on patient needs and preferences • Background: • Standards of Patient and Family Rights of Joint Commission International(JCI) • Model of performance assessment : • Assessment based on a check-list covering structural characteristics, human and physical resources and organisational procedures, that contribute to patient-centred care

23. SINAS @ HospitaisPatient Focus • Issues considered in assessment check-list • Informed consent • Scheduling of services • In patient • Access to second opinion • Religiousaid • Visits to in-patients • Food • Training • Communication with patients • Terminallyillpatients • Waiting times  • Post discharge follow up • Patient privacy • Suggestions, complaintsorclaims handling • SatisfactionSurveys

24. SINAS @ HospitaisPatient Satisfaction • Aim: • Subjective assessment of patient satisfaction with health care services • Types of care to be assessed: • Emergency care, inpatient care, ambulatory surgery, outpatient consultations • Model of performance assessment: • Survey study

25. SINAS@Hospitais: overall results Distribution of participants (Ref.30/12/2013)

26. SINAS @ Hospitais – ClinicalExcellence Evolution of participation

27. SINAS @ Hospitais Ambulatory Surgery Evolution of results

28. SINAS @ Hospitais Ambulatory Surgery Evolution of the reference values

29. Outline • Framework for assessing global quality • SINAS@Hospitais (Hospitals) • SINAS@Saúde.Oral (Dental Care)

30. SINAS@Saúde.Oral Quality dimensions Status Implemented Registration and Licensing Organisation and Procedures Implemented Adequacy and Comfort of Facilities Implemented Implemented Patient Safety Patient Satisfaction Being developed

31. SINAS@Saúde.Oral Status of implementation: • First publication of results – August 2013 • Provide to populationanassessementof 800 dental careproviders • Addclinicalindicators to thesystem

32. SINAS@Saúde.Oral

33. National System of Health Assessement bettercare, betteroutcomes sinas@ers.pt