Geen diatitel

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How to facilitate supervision? How to improve
quality?How to improve transparency?
Dutch hospitals
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• 1995 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

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Patientsafety

• Reducing Medical Errors requires National
  Computerized Information Systems
• Data Standards Are Crucial to Improving Patient
  Safety

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Supervision
Quality
Tranparency
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Gefaseerd toezicht

QUALITY ASPECTS HOSPITALS
MINIMAL SET INDICATORS
EXTERNAL DATA RESOURCES
Fase 1 COLLECTING INFORMATION
FINISH OR
TEST AT RANDOM
Risico-analyse
RISK ANALYSIS
LOW RISK
RISK MODEL
HIGH RISK
Fase 2 TESTING
TESTING
Fase 3 INTERVENTION
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• Death
• Disease
• Discomfort
• Disability
• Dissatisfaction

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Riscmodel
Patient

• Proces
• Indicators

• Structure / Organisation
• Indicators

Outcome Indicators
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An Indicator

• Signal function
• consequences only after inspection

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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

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OUTCOME INDICATORS

• Benefits for IGZ
• Better preventive supervision
• Better focus on patientsafety
• More results
• More efficient

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Procedure

• Indicator acquisition by
• Literature search
• Stakeholders interviews
• Expert interviews
• Expert meetings
• Scientific board meetings

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Selection criteria

• Feasibility
• Focus on hospital care
• Clinical relevance
• Frequent manifestation
• Obvious and rapid improvement of quality outcome

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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.

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Examples

• Bedsores
• Frequency in general eg. prevalence
• Incidence in patients with a femoral fracture

• Quality of care in ICU-patients
• How many days mechanical ventilation
• Hospital acquired infections

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Time table

• January 1. Hospitals received the 40 Indicators
• Winter 2004 Information tour
• June 1. Hospital reports set 2003 should be send
  to IGZ and placed on the hospital websites
• July 1. All 96 hospitals had responded
• Summer 2004 Analysis of data
• October 2004 Reports from IGZ to the hospital

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Hospital-wide Hospital-wide Hospital-wide Hospital-wide
Indicator Structure Process Outcome
1. Pressure Ulcer 1.1Registration of Pressure Ulcer prevalence/incidence 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 Availability inpatient and outpatient medication overview Availability regional medication overview
4. Information Technology Availability of electronic data in the outpatient consultation rooms and on the hospital wards Availability of process-supporting IT in the outpatient consultation rooms and on the hospital wards 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
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The emergency ward, operation theatre and intensive care units The emergency ward, operation theatre and intensive care units The emergency ward, operation theatre and intensive care units 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 1.2S Percentage of patients whose pain score is less than 4 within the first 72 hours
2. Volume of high risk interventions Volume of acute aneurysm of the abdominal aorta surgery Volume of esophageal resections for esophageal carcinoma
3. Laparoscopic surgery 3.1aSRatio of laparoscopic versus open cholecystectomy 3.1bSRatio of laparoscopic cholecystectomy in day care versus inpatient laparoscopic cholecystectomy 3.2S Percentage 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-operations 5.1b 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
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Condition- or intervention-specific indicators Condition- or intervention-specific indicators Condition- or intervention-specific indicators Condition- or intervention-specific indicators
Indicator Structure Process Outcome
1. Pregnancy Percentage of cesarean sections 1.2S Percentage of vaginal deliveries after cesarean section
2. Diabetes 2.1Presence of Integrated Diabetes Care service Mean HbA1C value 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 mortality 4.2S 30 days mortality
5.Cerebrovascular accident 5.1Presence of Stroke-service / hospital stroke unit 5.1 In- hospital mortality 5.2S 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 Presence of cataract surgery unit and care pathway Presence of cataract surgery complication registry 9.3a Corrected post-operative vision 9.3b Mean difference between the actual and the intended refraction after cataract surgery
10.Refraction surgery 10.1 Reduction in refraction
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Bedulcer Prevalence
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Number of OCR procedures and ICU Level

• Level I (0-78) Level II ( 0-30) level
  III (0-10)

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Postoperative Pain
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Average number of Ceasarian sectios

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The Future

• IGZ will produce a hospitalspecific and a general
  report
• The 2004 set will be published at the end of this
  month data should be published June 1., 2005
  2004 is almost equal to 2003
• The 2005 set will be produced in december 2004
  data should be published June 1. 2006.

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