ANALYSIS OF THE PORTUGUESE PUBLIC HOSPITAL’S PERFORMANCE THROUGH

QUALITY AND MANAGEMENT INDICATORSIntrodução à Medicina

2008/2009Turma 18

Alexandre Almendra

Ana Cunha

António Miranda

Cristina Costa

Gabriela Gonçalves

Joana Esteves

João Pedro P. Barreto

Luísa Costa

Mariana Carvalho

Mónica Garrido

Pedro Canão

Pedro Valente

Rita Costa

Sara Braga

Tiago Magalhães

Advisor: Alberto Freitas

1. INTRODUCTION

International Quality Project

INTRODUCTION

largest international data set of quality indicators

2. INDICATORS

Tools that allow us to assess the condition in a simple, understandable, and comparable way[4]

INDICATORS

Used by health institutions: Fundamental for management evaluation, efficiency and

health effectiveness Evaluate the economical performance and hospitalar

productivity ( outcome patients,newborns ) Evaluate healthcare quality

Tools that allow us to assess the condition in a simple, understandable, and comparable way[4]

Used by health institutions: Fundamental for management evaluation, efficiency and

health effectiveness Evaluate the economical performance and hospitalar

productivity Evaluate healthcare quality

outcome patients,newborns )

(

[4] Correia L F. Indicadores de Desempenho Económico na Saúde. 2005

EXAMPLE

[18] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2006. Grupos de Diagnósticos Homogéneos. 2006.

2002 2003 2004 2005 2006

NORTE 297.444 299.725 296.927 300.520 303.584

CENTRO 246.868 254.874 254.367 253.625 250.157

LVT 333.605 340.202 336.187 344.067 332.776

ALENTEJO 35.059 35.366 35.528 34.493 34.576

ALGARVE 35.108 36.863 37.244 37.441 37.513

TOTAL 948.084 967.030 960.253 970.146 958.606

2002 2003 2004 2005 2006

NORTE 297.444 299.725 296.927 300.520 303.584

CENTRO 246.868 254.874 254.367 253.625 250.157

LVT333.60

5340.20

2336.18

7344.06

7332.77

6

ALENTEJO 35.059 35.366 35.528 34.493 34.576

ALGARVE 35.108 36.863 37.244 37.441 37.513

TOTAL 948.084 967.030 960.253 970.146 958.606EXAMPLE

[18] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2006. Grupos de Diagnósticos Homogéneos. 2006.

Tools that allow us to assess the condition in a simple, understandable, and comparable way[4]

INDICATORS

Used by health institutions: Fundamental for management evaluation, efficiency and

health effectiveness Evaluate the economical performance and hospitalar

productivity ( outcome patients,newborns ) Evaluate healthcare quality

(Discharged patients,Exceptional admission episodes,Surgical admission time, Complication-free long-term admissions, Readmissions, Newborns, Vaginal Delivery, Unspecified surgical procedures, Medical DRG’s complications )

Tools that allow us to assess the condition in a simple, understandable, and comparable way[4]

Used by health institutions: Fundamental for management evaluation, efficiency and

health effectiveness Evaluate the economical performance and hospitalar

productivity ( outcome patients,newborns ) Evaluate healthcare quality

(Discharged patients,Exceptional admission episodes,Surgical admission time, Complication-free long-term admissions, Readmissions, Newborns, Vaginal Delivery, Unspecified surgical procedures, Medical DRG’s complications )

[4] Correia L F. Indicadores de Desempenho Económico na Saúde. 2005

Misdiagnosis

Incomplete treatment

Complications

Readmissions

EXAMPLE

Vaginal Delivery

Percentage of C -sections within the total number of deliveries (in Portugal)

EXAMPLE[18] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2006. Grupos de Diagnósticos Homogéneos. 2006.

[22] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2003. Grupos de Diagnósticos Homogéneos. 2005 Mar.[23] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2004. Grupos de Diagnósticos Homogéneos. 2005 Sep.[24] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2005. Grupos de Diagnósticos Homogéneos. 2006 Aug.

The financing of Health entities is based on Diagnosis Related Groups (DRGs)

System to classify hospital cases into one of approximately 500 groups

expected to have similar hospital resource us

ACHS - Australian Council on Healthcare Standards

AHRQ - Agency for Healthcare Research and Quality

ACSS - Administração Central do Sistema de Saúde

Developed by: ACS - Alto

comissariado da Saude

ACS – Alto comissariado da Saude AHQR – Agency for Healthcare Research

and Quality ACHS - Australian Council on Healthcare

Standards ACSS – Administração Central do Sistema

de Saúde

INDICATORS

Relevance Objectivity Sensibility Precision Availability Cost-efficiency Reliability

INDICATORS

[3] Ribeiro N. Indicadores de Gestão para Administração Pública. TOC. 2000 June

Problems associated:

Probabilistic natured problems Probabilistic natured problems Inadequacies of information systems Inadequacies of information systems Variety of measurers and measures Variety of measurers and measures Complexity of health plans Complexity of health plans Availability of funding[6] Availability of funding[6]

Confusion factors and problems with robustness, sensitivity and specificity[7].

INDICATORS

[6] Eddy D M. Performance measurement: problems and solutions. 1998 [7] Freeman T, Using performance indicators to improve health care quality in the public sector: a review of the literature. 2002

The challenge of every health system is to find ways to apply management and quality indicators adequately, seeking to promote significant improvements in health[9].

[9] Thomson R G, Lally J. Performance management at the crossroads in the NHS: don't go into the red 2000

3. 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?

RESEARCH QUESTION

4. OBJECTIVES

Compare the numbers of the last years

OBJECTIVES

Evolution of the services’ quality and

efficiency

Establish a comparison between the different

areas of Portugal

OBJECTIVES

Suggest some possible causes that might have led to the obtained results

Portuguese public Hospitals’ database between 2000 and 2007

DGH

DDX

TOTAL ADMISSION TIME

HOSPITALS LOCATIONS

TARGET POPULATION:

SOFTWARE: SPSS

Portuguesepopulation

5. VARIATIONS IN INDICATORS

VARIATIONS IN INDICATORS

Evolution through the years

2000 2007

VARIATIONS IN INDICATORS

Statistical regions in which territory is divided (7 regions, in Portugal)

Regional(NUTS II)

• Norte• Norte• Centro• 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.

6. EXPECTED RESULTS

EX

PEC

TED

RE

SU

LTS

EX

PEC

TED

RE

SU

LTS

EX

PEC

TED

RE

SU

LTS

“Economical science is the study of the way people and society choose, with or

without using money,the management of limited productive resources in alternative aplications, so they can prduce goods and

spread them for consumption, nowadays or in the future”

References[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. Revista Gestão Hospitalar. 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. 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[12] 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/.[13] 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.

[18] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2006. Grupos de Diagnósticos Homogéneos. 2006.[19] J Thomas, S Paranjothy Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit. National Sentinel Caesarean Section Audit Report. RCOG Press; 2001.[20] Faúndes A, Pádua K S, Osis M J D, Cecatti J G, Sousa M H. Brazilian women and physicians' viewpointson their preferred route of delivery. Revista de Saúde Pública. 2004; 38(4):488-94[21] Reynolds A, Ayres-de-Campos D, Costa M A, Santos C, Campos I, Montenegro N, Influence of three organisational measures on the cesarean, Acta Médica Portuguesa. 2004; 17:193-198.[22] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2003. Grupos de Diagnósticos Homogéneos. 2005 Mar.[23] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2004. Grupos de Diagnósticos Homogéneos. 2005 Sep.[24] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de 2005. Grupos de Diagnósticos Homogéneos. 2006 Aug.[25] Nomenclatura de Unidades Territoriais para fins estatísticos [Internet], Wikipédia, 2008 Dec 13 [accessed 2008 Dec 16]. Available from: http://pt.wikipedia.org/wiki/NUTS[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.[27] SPSS for Windows, Rel. 16.0.0 2007. Chicago (IL): SPSS Inc.[28] Pereira A C, Pinto A T, Parry G, Vieira P, Azevedo L F, Martins C, Vieira A, Desenhos de estudos [Internet]. Universidade do Porto, Serviço de Bioestatística e Informática Médica [accessed 2008 Dec 16]. Available from: http://stat2.med.up.pt/cursop/main.php3?capitulo=desenhos_estudo& numero=1&titulo=Desenhos+de+estudo[29] Alto Comissariado da Saúde - Ministério da Saúde. Indicadores e Metas do PNS [Internet]. 2008 [accessed 2008 Dec 10]. Available from: http://195.22.11.132/websig/acsv2/gui/index.php?par=acs&lang=PRT#[30] Lista de distritos portugueses ordenados por população [Internet]. [updated 2008 Nov 14; accessed 2008 Dec 14]. Available from: http://pt.wikipedia.org/wiki/Distritos_portugueses_ordenados _por_ popula%C3%A7%C3%A3o[31] Sistema Nacional de Saúde. Indicadores de Desempenho 2004 – 2006 [Internet]. [acessed 2008 Dec 14]. Available from: http://www.portugal.gov.pt/NR/rdonlyres/A03A04DB-7EE1-43D6-8B69-2FE9118D43D9/0/Indicadores_SNS_2006.pdf. 

References

Thank you for your time

THE

END