Inpatient Quality Indicators in
Portuguese Public Hospitals
Adriana Moreira, Álvaro Moreira
Ana Lúcia Alves, Ana Rita Silva
Bruno Maia, Catarina Aleixo
Diogo Ferreira, Fernando Resende
Joana Vale, Joaquin Estevão
Mara Diva Sousa, Marta Moreira
Sara Soares
fmup.t2@gmail.com
•
•
Background
•
Justification
Importance & Application
•
•
Definition
Research Questions & Aims
•
Participants
•
Type of study
•
Methods
•
•
•
•
Results
Flowchart
Expected results
Bibliographic research
Background
• “The findings suggested that there may be differences in quality in
rural critical access hospital and urban acute care hospitals.”(1)
• “Disparities in clinical process of care measures are largely the
result of differences in where minority and nonminority patients
seek care.”(2)
• “Analysis of data from the new Hospital Quality Allience reporting
system shows that performances varies among hospitals and across
indicators.”(3)
(1)
(2)
(3)
Nawal Lutfiyya M, Bhat DK, Gandhi SR, Nguyen C, Weidenbacher-Hoper VL, Lipsky MS. A comparison of quality of care
indicators in urban acute care hospitals and rural critical access hospitals in the United States. Int J Qual Health Care. 2007
Jun; 19 (3): 141-9.
Hasnain Wynia R, Baker DW, Nerenz D, Feinglass J, Beal AS, Landrum MB, Behal R, Weissman JS. Disparities in health care are
driven by where minority patients seek care: examination of the hospital quality alliance measures. Arch Intern Med. 2007
Jun 25; 167 (12): 1233-9.
Jha AK, Li Z, Orav EJ, Epstein AM. Care in U.S. hospitals- the Hospital Quality Alliance program. N Engl J Med 2005 Jul 21; 353
(3): 265-74
• “The objective of our study was to assess hospital variations in the quality
of care delivered to acute miocardial infarction (AMI) patients among three
Swiss academic medical centers. Our results showed important hospital-tohospital variations. In the quality of care provided to patients with AMI
between these three university.”(4)
• “The different measures led to consistent and plausible relationships
between quality and hospital characteristics.”(5)
• “Patients and health insurance are increasingly interested in the quality of
care provided by hospitals. Quality indicators are often used to evaluate the
quality of inpatient treatment.”(6)
(4) WD, Pitts SR, Burnand B. Variations in the quality of care of patients with AIM among Swiss university hospitals. 2005
(5) Keeler EB, Rubenstein LV, Kahn KL, Draper D, Harrison ER, Mc Ginty MJ, Rogers WH, Brook RH. Hospital characteristics and quality of care.
1992
(6) Drosler SE, Cools A, Kopfer T, Stausberg J. Are quality indicators derived from routine data suitable for evaluating hospital performance?
First results using the AHRQ patient safety indicators in Germany. Z Arztl Fortbild Qualitatssich. 2007; 101 (1): 35-42.
•
“(…)the operations for which surgical mortality has been advocated
has a quality indicator are not performed enough to judge hospital
quality.”(7)
• “Efforts to use volume standards as the basis for evidence-based
hospital referrals should be re-evaluated by all stake-holders before
promoting further efforts to regionalize health care delivery using
volume cutoffs.” (8)
(7) Justin B. Dimick, MD; H.Gilbert Welch, MD, MPH; John D. Birkmeyer, MD. Surgical mortality as an indicator of hospital quality.
JAMA. 2004; 292: 847-851.
(8) Glance LG, Osler TM, Mukamel DB, Dick AW. Estimating the potential impact of regionalizing health care delivery based on
volume standards versus risk-adjusted mortality rate. Int J Qual Health Care. 2007 Aug;19(4):195-202.
Justification
• There is no specific study published in Pubmed about IQI in
Portuguese Public Hospitals;
• It is important for Portuguese inpatients and hospitals;
• To increase a friendly competition among the hospitals for the
best health care;
• If correctly used, this study may improve the care quality of the
hospitals and promoting member satisfaction;
• If there has been applied different treatment plans, detailed
analysis of longitudinal data will quickly reveal which approaches
deliver better outcomes and which are more cost effective overall.
Importance & Application
• Patients are increasingly interested in the quality of hospitals they
attend;
• Make the information democratically accessible, objective and
systematic;
• Provide precious data on hospital care conditions;
• Help to identify problematic areas that need further investigation.
Definition
“Inpatient Quality Indicators are a set of measures that provide a
perspective on hospital quality, using hospital administrative data. IQI
include inpatient mortality for certain procedures and medical
conditions, utilization of procedure for which there are questions of
overuse, under use and misuse and also volume of procedures for
which there is some evidence that a higher volume of procedures is
associated with lower mortality.”
by the Agency for Healthcare Research & Quality
Type of Indicators
• Indicators that are a volume of patients who undergo through
certain procedures;
• Indicators that are a rate that associates the mortality of a certain
procedure or group of procedures with the volume of patients
treated;
• Indicators that are a rate that associates the number of a certain
procedure or group of procedures with the population in metro
area or country.
Research Questions & Aims
• Suggest the existence of a connection between the quality of the
hospital and its characteristics;
• Compare the quality between 94 Portuguese Public Hospitals by
location (north, south, central) and type (central, district and district
level one);
• Compare the results with the one’s of the best local hospital and
with absolute value in articles or information from experts.
Participants
Portuguese
public
hospitals
Public hospitals
Hospitals
Flowchart
Type of Study
• Observational
• Analyse Unit: Portuguese Public Hospitals
• Longitudinal
• Retrospective data
• Analytic
Methods
1.
Writing IQI’s sintaxe following AHRQ’s technical specifications
2.
Calculating the IQIs
3.
Analyse the indicators already calculated (comparing them with
reference values available in the AHRQ website)
4.
AHRQ Quality Indicators Software Version 3.2 - March 2008 ®
SPSS
Coronary Artery Bypass Graft (CABG) Volume (IQI 5)
Procedure Volume Indicator
Data
1. Writing IQI’s sintaxe
following AHRQ’s
technical specifications
2. Calculating the
IQIs
(IQI5)
3. Analyse the indicators already calculated
(IQI5)
Type A – economic groups
[in Grupo I are the more specialized
hospitals, more complexe and with
better technology]
1
2
3
4
Group I
Group II
Group III
Group IV
Type A
Cumulative
Frequency
Percent Valid Percent
Percent
Valid 1
4900
34,2
34,2
34,2
2
9311
65,0
65,0
99,2
4
Total
117 ,8
14328
,8
100,0
100,0
100,0
IQI5
Type C – administrative groups
Central Hospital
1
Districtal Hospital
2
Districtal level 1 Hospital
3
Type C
Cumulative
Frequency
Valid
1
2
Total
14212
Percent
99,2
116 ,8
14328
Valid Percent
99,2
,8
100,0
Percent
99,2
100,0
100,0
IQI5
Hosp_Reside
060300
110600
111000
131200
131700
Coimbra
Lisboa
Oeiras
Porto
Vila Nova de Gaia
Expected Results
• Significant regional disparities;
• Better indicators in hospitals that operate in the principal urban
areas;
• Better indicators in traditional academic hospitals;
• Higher quality on district hospitals level I;
• Help hospitals’ administrators to plan budgets allowing them to see
which areas need more improvement and therefore more
investment ;
• Change the present healthcare system.
Results
PTCA Mortality Rate (IQI 30)
Related Volume and Mortality Indicators for Inpatient Procedures
Abdominal Aortic Artery (AAA) Repair Mortality
Rate (IQI 11)
Mortality Indicators for Inpatient Procedures
Acute Stroke Mortality Rate (IQI 17)
Mortality Indicators for Inpatient Medical Conditions
Primary Cesarean Delivery Rate (IQI 33)
Procedure Utilization Indicators
Type A - Economic Groups
35.00%
30.00%
25.00%
20.00%
IQI 33
15.00%
Comparative data
Type C - Administrative Groups
10.00%
5.00%
35.00%
0.00%
30.00%
Group I
Group II
Group III
Group IV
25.00%
20.00%
IQI 33
15.00%
Comparative data
10.00%
5.00%
0.00%
Group I
Group II
Group III
Limitations
• It may not reflect the actual and real situation of the hospitals
considered;
• Data is usually collected for billing purposes instead of specific
clinical purposes;
• Data may lead to wrong conclusions;
• The data is not in the same format that the one used in the
IQIs’ software;
• We have still no access to population in metro area or county,
age 40 years and older, and aged 18 years and older.
Bibliographic research (Pubmed)
•
Jha AK, Li Z, Orav EJ, Epstein AM. Care in U.S. hospitals- the Hospital Quality Alliance program.
N Engl J Med 2005 Jul 21; 353 (3): 265-74.
•
Krauss J, Maclean R. Inpatient mortality: a reflection of quality care? Outcomes Manag. 2002
Oct-Dec;6(4):169-73.
•
Nawal Lutfiyya M, Bhat DK, Gandhi SR, Nguyen C, Weidenbacher-Hoper VL, Lipsky MS. A
comparison of quality of care indicators in urban acute care hospitals and rural critical access
hospitals in the United States. Int J Qual Health Care. 2007 Jun; 19 (3): 141-9.
•
Hasnain Wynia R, Baker DW, Nerenz D, Feinglass J, Beal AS, Landrum MB, Behal R, Weissman
JS. Disparities in health care are driven by where minority patients seek care: examination of
the hospital quality alliance measures. Arch Intern Med. 2007 Jun 25; 167 (12): 1233-9.
•
Zhang W, Ayanian JZ, Zaslavsky AM .Patient characteristics and hospital quality for colorectal
cancer surgery. Int J Qual Health Care. 2007 Feb;19(1):11-20.
•
Luthi JC , McClellan WM, Flanders WD, Pitts SR, Burnand B. Variations in the quality of care of
patients with acute myocardial infarction among Swiss university hospitals. : Int J Qual Health
Care. 2005 Jun
•
Drosler SE, Cools A, Kopfer T, Stausberg J. Are quality indicators derived from routine data
suitable for evaluating hospital performance? First results using the AHRQ patient safety
indicators in Germany. Z Arztl Fortbild Qualitatssich. 2007; 101 (1): 35-42.
•
Laditka JN, Laditka SB, Cornman CB. Evaluating hospital care for individuals with Alzheimer's
disease using inpatient quality indicators. Am J Alzheimers Dis Other Demen. 2005 JanFeb;20(1):27-36.
•
Weiner BJ, Alexander JA, Shortell SM, Baker LC, Becker M, Geppert JJ. Quality improvement
implementation and hospital performance on quality indicators. Health Serv Res. 2006
Apr;41(2):307-34.
•
Glance LG, Osler TM, Mukamel DB, Dick AW. Estimating the potential impact of regionalizing
health care delivery based on volume standards versus risk-adjusted mortality rate. Int J Qual
Health Care. 2007 Aug;19(4):195-202.
•
Justin B. Dimick, MD; H.Gilbert Welch, MD, MPH; John D. Birkmeyer, MD. Surgical mortality as
an indicator of hospital quality. JAMA. 2004; 292: 847-851.
•
Keeler EB, Rubenstein LV, Kahn KL, Draper D, Harrison ER, Mc Ginty MJ, Rogers WH, Brook RH.
Hospital characteristics and quality of care. 1992
•
WD, Pitts SR, Burnand B. Variations in the quality of care of patients with AIM among Swiss
university hospitals. 2005