Post on 12-Jan-2016
How to facilitate supervision? How to improve quality?
How to improve transparency?
Dutch hospitals
• 1996 “KWALITEITSWET” (Act on Quality)»Legislation with quality guarantees
within institutions for health care.
»Description of quality systems is no guaranty for outcome in complex organisations
»High expectations, poor results
PatientsafetyReducing Medical Errors requires National Computerized Information Systems;
Data Standards Are Crucial to Improving Patient Safety
Supervision
Quality
Tranparency
Gefaseerd toezicht
LOWRISK
Fase 2: TESTING
TEST ATRANDOM
QUALITY ASPECTS
HOSPITALS
FINISHOR
TESTING
HIGHRISK
Fase 1: COLLECTING INFORMATION
MINIMAL SET INDICATORS
Risico-analyse
RISKANALYSIS
EXTERNAL DATA RESOURCES
RISK MODEL
Fase 3: INTERVENTION
•Death
•Disease
•Discomfort
•Disability
•Dissatisfaction
Proces
Indicators
Structure / Organisation
Indicators
OutcomeIndicators
Patient
An Indicator:
• Signal function
• consequences only after inspection
Outcome indicator
• Signal function no representation• Consequences only after specific research• Maturity model• Interpretation by the hospital itself• Efficiency profit for hospitals as well as IGZ• Public presentation on www hospital
Selection criteria
• Feasibility• Focus on hospital care• Clinical relevance• Frequent manifestation• Obvious and rapid improvement of quality
outcome
Procedure
• Indicator acquisition by
– Literature search– Stakeholders interviews– Expert interviews– Expert meetings– Scientific board meetings
Categories
• Set reflecting the outcome of the hospital in general (bedsores, medication etc)
• Set reflecting the outcome of high risk departments as ICU, Surgery and Emergency
• Set reflecting specific categories of diseases as diabetes, cardiac failure etc.
Hospital-wide
Indicator Structure Process
Outcome
1. Pressure Ulcer 1.1Registration of Pressure Ulcer prevalence/incidence
1.Point prevalence pressure ulcers I.2 S Incidence of pressure ulcers by patients with an indication for total hip replacement
2. Blood Transfusion 2.1 Presences transfusion reactions registration
2.2 S Transfusion Reactions
3. Medication Safety 1.Availability inpatient and outpatient medication overview2.Availability regional medication overview
4. Information Technology 1.Availability of electronic data in the outpatient consultation rooms and on the hospital wards2.Availability of process-supporting IT in the outpatient consultation rooms and on the hospital wards3.Free access to Internet and internal and external e-mail for care professionals
5. Wound Infections 5.1Wound infection registration
6. Complication registration 6.1Complication registration per specialty/discipline
6. Risk Inventory 7.1Availability of clinical risk inventory
The emergency ward, operation theatre and intensive care units
Indicator Structure Process Outcome
1. Post-operative pain
1.1 Percentage of post-operative patients having received standardized pain measurements
1.2SPercentage of patients whose pain score is less than 4 within the first 72 hours
2. Volume of high risk interventions
1.Volume of acute aneurysm of the abdominal aorta surgery2.Volume of esophageal resections for esophageal carcinoma
3. Laparoscopic surgery
3.1aSRatio of laparoscopic versus open cholecystectomy3.1bSRatio of laparoscopic cholecystectomy in day care versus inpatient laparoscopic cholecystectomy
3.2SPercentage of conversions from laparoscopic to open cholecystectomy
4. Cancelled operations
4.1Number of elective operations cancelled within 24 hours before surgery
5.Unplanned re-operations
5.1a Percentage of unplanned re-operations5.1b Top three unplanned re-operation indications
6.Intensive Care 6.1 24-hour availability of a registered intensivist
6.2Mean and median of number of artificial respiration days per patient requiring artificial respiration
Condition- or intervention-specific indicators
Indicator Structure Process Outcome
1. Pregnancy 1.Percentage of cesarean sections1.2SPercentage of vaginal deliveries after cesarean section
2. Diabetes 2.1Presence of Integrated Diabetes Care service
1.Mean HbA1C value2.Percentage of patients receiving an eye examination every two years
3.Heart failure 3.1Presence of Outpatient Heart Failure Clinic
3.2Readmission rate for heart failure patients
4. Acute myocard infarct
4.1 In- hospital mortality4.2S 30 days mortality
5.Cerebrovascular accident
5.1Presence of Stroke-service / hospital stroke unit
5.1 In- hospital mortality5.2S 30 days mortality
6.Hip fracture 6.1Percentage of patients operated within 24 hours after admission
7.Total hip replacement
7.1Presence of Joint Care service
8.Mamma tumor 8.1Presence of Outpatient Mamma Care Clinic
8.2Percentage of patients receiving diagnosis within five days of first outpatient visit
9.Cataract surgery 1.Presence of cataract surgery unit and care pathway2.Presence of cataract surgery complication registry
9.3aCorrected post-operative vision9.3bMean difference between the actual and the intended refraction after cataract surgery
10.Refraction surgery
10.1Reduction in refraction
Time table• January 1. Hospitals received the set.• June 1. Deadline for hospitals• July 1. All hospitals had responded; • Autumn 2004; Analysis of data• February; Publication set 2004• May 2005: General report 2003• June 2005; Publication set 2005• July 1. Deadline for hospitals• September; Publication set 2006
0
5
10
15
20
25
30
hospitals
per
centa
ge
of
pat
iënts
w
ith d
ecubit
us
28
65
5
J a
Nee
geen antwoord
5340
5
J a
Nee
geen antwoord
Electronic medication information available in the clinic
Electronic medication information available in the out-patient clinic
25
20
50
2
bij alle patiënten
bij deel van de patiënten
nee
geen antwoord
Pain measurement in a standard way
51
34
12
ja
nee
geen antwoord
Pain measurement
0
10
20
30
40
50
60
70
80
90pe
rcen
tage
hos
pita
ls
painservice integrated diabetescare
heartfailureoutpatientclinic
strokeservice breastcanceroutpatientclinic
service available data available
Post surgical pain
0
20
40
60
Small hospitals Big hospitals Academic hospitals
aantal
protocol
acute pain service
data obtained in all patients
data obtained in specific patientgroups
0
10
20
30
40
50
60
70
80
90
100
110
120
hospitals
num
ber
of
AA
A p
rocedure
s
05
10152025303540455055606570758085
hospitals
num
ber
OC
R
pro
cedure
s
0
10
20
30
40
50
60
According to Hospital According to standards
Level 1 Level 2 Level 3 No data