Faculdade de Medicina da Universidade do PortoCurso de Mestrado Integrado em Medicina

2008/2009

Faculdade de Medicina da Universidade do Porto

Comparison and Evolution of Medical Care of Inpatients

with Acute Myocardial Infarction in Portuguese

Public Hospitals

Acute myocardial infarction (AMI – ICD9 410) is one of the major causes of death among Western civilization.

Such studies are not widespread among Portuguese institutions

Tool for patients evaluation of hospitals’ medical performance, which may be helpful when choosing the institution provider of best care.

Access to hospitals’ admnistrative data.

Introduction

Background and Justification

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Acute Myocardial Infarction ▪ ICD9 – 410

Inpatient Quality Indicators (IQI’s)

Diagnostic Related Groups (DRG’S)

DRG-database

Medical term for heart attack.

Caused by the blockage of the coronary arteries which will lead to an insufficient blood suply to the heart muscle (myocardium).

Acute Myocardial Infarction ▪ ICD9 – 410

Inpatient Quality Indicators (IQI’s)

Diagnostic Related Groups (DRG’S)

DRG-database

IQI’s reflect the quality of care inside hospitals

Include: inpatient mortality for medical conditions; inpatient mortality for procedures; utilization of procedures for which there

are questions of overuse, underuse, or misuse.

Acute Myocardial Infarction ▪ ICD9 – 410

Inpatient Quality Indicators (IQI’s)

Diagnostic Related Groups (DRG’S)

DRG-database

Used to classify hospital cases into one of approximately 500 groups, according to: ICD diagnoses Procedures Sex Age Presence of complications Comorbidities

The main purpose of this system is to make sure patients with similar diagnoses have equal hospital resources’ use.

Acute Myocardial Infarction ▪ ICD9 – 410

Inpatient Quality Indicators (IQI’s)

Diagnostic Related Groups (DRG’S)

DRG-database

http://health.utah.gov/opha/IBIShelp/codes/DRGCode.htm

Excerpt from the DRG’s index table

RESEARCH QUESTION What is the status of medical care system in

Portugal for AMI and how has it evolved throughout the years?

AIMS Compare hospitals’ quality based on 2 criteria.

Evaluate the improvements of medical care in hospitals.

Inclusion Criteria▪ Patients with Acute Myocardial Infarction as

Main Diagnosis

Exclusion Criteria▪ Patients discharged in less than 24 hours▪ Patients discharged against medical concern▪ Patients who died while being transferred

FLUXOGRAMME

INCLUSION

AND

EXLUSION

CRITERIA

Transversal and longitudinal Study

Data

Data Used

Comparison

2005

Evolution 2000-2005

Data from all Portuguese Public Hospitals, from 2000 to 2005.

Variables: Number of admissions; Fatality rate; Medical procedures:

▪ PCI.

Extract of the database’s codes

Participants and Methods

Data and Variables

Inside each type (Regional classification – type C) of hospital, we are going to compare individual performances based on data from 2005.

Considering evolution, the data used refers to the period between 2000 and 2005 for each type of Hospital

According to the newest hospital classification:

▪ Central hospitals – Including the main hospitals of the main regions in Portugal;

▪ Distrital hospitals – Including the main hospitals of secondary regions in Portugal;

▪ Level 1 hospitals – Including the smallest hospitals.

Fatality Rate = Number of deaths caused by AMI

Number of Admissions by AMI

Rate of PCI usage = Number of PCI interventions Number of Admissions by AMI

Concerning the comparison inside each type, we are expecting to find significant differences between hospitals.

We are also expecting to find great disparities between the different groups, as the sort of patients varies with the type of hospital.

We are expecting to find some improvements even though the concerned period may not be wide enough for them to be significant.

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No information ab0ut pharmacological procedures.

Information relative to the year 2005 and some changes may have occured since then.

Possible information bias in the database.

Choosing the main diagnosis as the inclusion criteria may create unexpected bias.

Understanding the general quality concerning the treatment of AMI in Portuguese Public Hospitals.

It may create the need for improvement.

Stimulating further analysis and future studies.

Providing a guide for general population.

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References