Session 3: Ahmed Aboulghate
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Transcript of Session 3: Ahmed Aboulghate
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Ahmed Aboulghate, MBBCh, MPhil
University of CambridgePhD student, Cambridge Overseas
Scholar
Developing Quality Indicators for the Egyptian
Primary Care System
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Egypt; backgroundPopulation 73 million
Lower-middle income country
(Poverty level 16.7%)
Dual burden of disease.
National Burden of Disease
NCD 74%
Communicable 9%
Injuries 7%
Others 10%
Leading contributors to National Burden of Disease
Ischaemic Heart Disease 11 %
Unipolar Depression 5 %
Asthma, COPD 4 %
Cerebrovascular Disease 4 %
Respiratory Infections 3 %
Cataract 3 %
Adult Onset Hearing Loss 3 %
Hypertensive Heart Disease 3 %
Drug Use Disorders 2 %
Liver Cirrhosis 2 %
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Egyptian Health Care SystemSocial insurance
• Free for eligible patients (48% of population) • Employees, infants, school children, pensioners, widows
State run facilities• Everyone is eligible• Limited resources, low quality
Private sector• Out of pocket (60% of national health expenditure)• Serves all population categories• Varying quality and price
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1997: Health Sector Reform Project
Universal coverageHigh qualityEquityEfficiencySustainability
To shift the focus of care from heavy reliance on inpatient care to a more integrated and less costly primary care model. (Berman et al, 1998).
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Reforming the Primary Care
Infra structure:Renovating and building PC facilitiesToday: 5500 PC facilities
Care providersFinancial and career incentives
Quality controlAccreditationPay for performance through Quality Indicators
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Current Indicators in the Egyptian Primary Care
Type Number of indicators included
Total 34
Structure 25
Process 6
Outcome 3
Limitations of the current indicators
• Emphasis on ‘structure’ indicators• ‘Process’ indicators are vague and broadly defined• Scores are manually collected through inspection
visits
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Aims of the study
NOT TO: Copy and Paste indicators (e.g. QOF)BUT TO: Transfer technologies and methods
Methodology1. Choose the medical conditions2. Develop indicators for them3. Pilot the new indicators
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1. Choosing the conditions
The most common conditions presenting to primary care units
Primary data collection>2000 patients12 primary care units
National Burden of Disease
Basic Benefit Package
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2. Developing the indicators
The RAND/UCLA appropriateness methodLiterature and guidelines reviewDeveloping preliminary set of indicatorsRating the indicators by a group of local expertsPanel meeting to discuss and re-rate the indicators
Indicator Quality of evidence
References Benefits/ summary
Necessity Validity
Patients with CAD should be advised to take aspirin at a dose of 75-100 mg/day unless contraindicated
I
Yusuf et al, 1998ATC, 1994
Absolute reduction in vascular events of 5%
(1-9) (1-9)
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3. Piloting the indicators
Extracting Indicators scores from patients records
Testing the time and resources required to extract
the indicators
Testing the inter-rater reliability
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Opportunities
Measure the feasibility of applying the new indicators
Propose modifications to the electronic recording system to implement automated indicator score calculation
Building a culture of Evidence Informed policy making
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Thank you