Analysis of the evolution of
quality and management
indicators in a Central Hospital
Introdução à Medicina I
Class 21
Adviser: Alberto Freitas
Outline
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Indicators
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Definition
Function
Diagnoses Related Group
Indicators of Health Care Quality
Indicators of Activity/Production
Indicators of Data Quality
Participant and Methods
Research Question
Aims
Predicted Results
References
Indicators: definition
In general, indicators are units of
measurement for an activity which can be
used as guides to monitor and evaluate the
quality of care provided to patients(1) and to
evaluate the efficiency and effectiveness of
a hospital.
1. Geraedts M, Schwartze D, Molzahn T
Indicators: function
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Trough comparison within intern and
external references it is possible to know
the changes produced on variables in
different moments of its implementation.
Indicators: functions
Indicators
Evolution
Evaluation
Use data collected to
obtain a descripton
that allows an
Which shows an
The analysis and
implementation of certain
measures should lead to an
Improvement
of health care
Diagnose Related Group (DRG)
System used on hospitals that treat acute
illness, to classify patients in groups with the
same needs.(2)
2. M Bentes, ML Gonsalves, S Tranquada, J Urbano
Indicators of Health Care
Quality
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Responsible for an evaluation on how the
services provided to patients while they are
under medical care at the hospital have
changed through time.
Exceptional Hospitalization Episodes
Surgery Length of Stay
Readmissions
Natural childbirth
Medical DRGs complications
Exceptional Hospitalization
episodes
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Short
term
exceptional
hospitalization episodes
Exceptional
hospitalization
episodes of extended evolution
Hospitalization episodes of
short duration
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Episodes whose time of hospitalization are at or below the
lower threshold for exclusion from its Diagnose Related
Group(3), which corresponds to 1,96 Standard Deviations
below the national average delay for the same DRG;
The time of an hospitalization could be substantially reduced
in case of deceased patients, patients transferred to another
hospital or those who left against medical advice;
3. IGIF (Instituto de Gestão Informática e Financeira da Saúde)
Hospitalization episodes of
extended evolution
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Episodes whose time of hospitalization are at or
above the maximum threshold of a certain DRG
(twice the upper threshold minus the average delay
of that DRG) (3)
3. IGIF (Instituto de Gestão Informática e Financeira da Saúde)
Surgery Length of Stay
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It is an indicator which aims to count the
total number of days used by all admitted
patients for surgical purposes (with the
exception of medical discharge of the same
patients).
This indicator is calculated by the sum of the
times pre and post surgery. The less preoperative time, the higher efficiency of the
hospital.
Readmissions
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Hospitalization episodes, consecutive to another episode, which
occurred over a period of time equal to or less than 30 days,
unless the second episode is ranked in DRGs 249, 317, 409,
410, 465, 466 and 492 (3);
Hospitalizations within a period of 72 hours running from the
date of discharge, except in cases where the subsequent
internment is not medically related to the former, if it is an
oncological episode, if the subsequent hospitalization occurs
after leaving against medical advice or if the patient has been
transferred to make exams that forced internment, with
subsequent treatment at the hospital of origin (4);
3. IGIF (Instituto de Gestão Informática e Financeira da Saúde)
4. http://dre.pt/pdf1sdip/2007/01/01601/00020124.PDF
Natural childbirth
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It is an indicator that measures the proportion of
vaginal births in all births assisted (Natural and
Cesarean births), by analyzing the statements of live
births in the central hospital in study.
There are many codes for this indicator; they include
V27x (in diagnosis) except those relating to cesarean
births which are coded 74xx (in procedures).
Medical DRGs complications
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Complications are situations whose presence, together with
the primary diagnosis, leads to an extension of the internment
of at least a day in 75 or more % of patients
As a result there is an increase of the time of hospitalization
as well as the resources spent
Used in the system of classification of DRGs to distinguish
pairs of groups that with the same characteristics (primary
diagnosis, procedures, secondary diagnosis, age, sex and
destination after discharge) have one or more additional
diagnosis
Indicators of Activity/Production
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Outpatiens
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Newborns
Outpatients
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Number of patients who left the internment in a hospital with
medical discharge in a given year (5)
Total number of patients who no longer reside in their service
during the period of time considered, according to the following
situations : medical discharge or transference to another
hospital, death or transference for another department from the
hospital (6)
5. INE (Instituto Nacional de Estatística)
6. DGS (Direcção Geral de Saúde)
Newborns
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The product of a pregnancy, a child that has just
been born, a baby aged up to four weeks (28 days)
They are defined by internment episodes where the
code begins with the primary diagnosis “V3”, which
means every code is represented as “V3x.xx”.
Indicators of Data Quality
This indicators allow an evaluation of the
quality of the services.
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Long Term Hospitalizations without CC
Short Term Undue Hospitalizations
Nonspecific surgery procedures
Long Term Hospitalizations without CC
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All internment episodes of long term that
occured without any medical explanation
for that
Normally those are situations when patients
have nowhere to go and stay in the hospital
for an unlimited period.
Short Term Undue Hospitalizations
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Hospitalizations that correspond to ambulatory
episodes (episode of medical consultation,
emergency or additional means of diagnosis and
therapy, such as Physiotherapy or Imagery)
incorrectly included in the production of hospital
DRGs
Nonspecific surgery
procedures
Includes all surgery procedures
on operatory room that are not
specific, because they haven´t
relevance
enough
for
being
classified as that.
Participants and Methods
For this protocol it is going to be used
information about inpatient episodes in a Central
Hospital since 1990 to 2007.
The SPSS will be used to analyze the data of
each indicator following specific rules to each
one.
As reference of DRGs will be used the
portaria n.o 110-A/2007, January 23, published
by Ministério da Saúde in Diário da República.
Research Question
Do the indicators show any
changes overtime in the quality
of the service in the Central
hospital?
Aims
Evaluate the evolution of the indicators
mentioned earlier, in a central hospital in
Portugal, and try to conclude if there is an
improvement of health care over the past
18 years (since 1990).
Aims
Examine if these developments are
independent or are likely to be related.
However, our goal is not to propose any
solution, regardless of the outcome,
since it would require more information
and analysis.
Predicted results
We can expect that with the
technological development and the
increasing concern on the quality of the
services the indicators reveal an
improvement of the quality of health
care in the last 18 years.
References
1.
2.
Geraedts M, Schwartze D, Molzahn T. Hospital quality reports in Germany:
patient and physician opinion of the reported quality indicators. BMC Health
Serv Res. 2007 Sep 28;7:157.
M Bentes, ML Gonsalves, S Tranquada, J Urbano - Revista de Gestão
Hospitalar
3.
IGIF (Instituto de Gestão Informática e Financeira da Saúde)
4.
http://dre.pt/pdf1sdip/2007/01/01601/00020124.PDF
5.
6.
Instituto Nacional de Estatística (INE), Estatísticas da Saúde, 1997, Conceitos
e Notas Explicativas
DGS (Direcção Geral de Saúde)
Protocol Developed By:
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Ana Luísa Fonseca, analcmf@gmail.com
Bárbara Azevedo, barbarazevedo4@hotmail.com
Gonçalo Marinho, marinhogoncalo@hotmail.com
Joana Raquel Santos, joaninha_rnms@hotmail.com
Pedro Tavares, pedro_f_tavares@hotmail.com
Rosana Maia, mimed08227@med.up.pt
Tiago Machado, mimed08233@med.up.pt
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José Alberto Silva Freitas, adviser alberto@med.up.pt
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