Post on 01-Apr-2015
Quality of health careIlembula Lutheran Hospital 21.02.2014
Arto Vehviläinen MD, PhD
Quality of health care
Definition of health Definition of quality of health
care How to messure quality of
health care Problems Conclusion
2
Definition of health, WHO:
The main determinants of health include:the social and economic environment, the physical environment, and the person's individual characteristics
and behaviors.
3
Determinants of health Income and social status Social support networks Education and literacy Employment/working
conditions Social environments Physical environments
Personal health practices and coping skills
Healthy child development
Biology and genetics
Health care services Gender Culture
4
Definition of quality of health care: Health gain
Health gain is health increase which can be mesured for one person or for whole population consisting both the length of life and also the quality of life.
5
Definition of quality of health care: Health benefit
Health benefit is such thing that can be shown to produce benefit as lowering costs or increasing health.
6
Definition of quality of health care: Health value
Health value is that extra for him what he/she gets from health and well being services
7
HOW TO MESURE QUALITY OF HEALTH CARE? Potential years of life lost
(PYLL) Death rates According disease (incidence) Utility: quality of life (15d) From utility: QALY-units (quality
of life and length of life) Costs/QALY
8
1. Potential Years of Life Lost (PYLL) =
Life lost due to preventable premature deaths
Birth Expected life = 70 years
2. ___________________________________________________>
Age at Death = 50 years
PYLL <- 70 – 50 = 20 years/person
3. 28 preventable causes of death by WHO PYLL/100 000 citizens age-standardized
9 PYLL
10 PYLL in Finland
11 PYLL: SUICIDES IN FINLAND
12 PYLL, SUICADES Northern Savo
13
Rank Country Female YPLL Male YPLL Date
1 Mexico 5027 8528 2006
2 Hungary 4032 9235 2005
3 United States 3633 6291 2005
4 Slovakia 3343 7732 2005
5 Poland 3211 7962 2006
6 Portugal 2858 6024 2003
7 Belgium 2848 5471 1999
8 New Zealand 2747 4540 2005
9 United Kingdom 2564 4220 2007
10 Canada 2554 4168 2004
11 Denmark 2493 4311 2006
12 Czech Republic 2430 5486 2007
13 Luxembourg 2378 4080 2005
14 Australia 2289 3946 2004
15 Ireland 2289 4008 2007
16 Finland 1492 2995 2009
17 France 2252 4665 2006
18 South Korea 2227 4568 2006
19 Germany 2212 4044 2006
20 Norway 2118 3710 2006
21 Switzerland 2100 3488 2006
22 Austria 2068 4143 2007
23 Greece 2017 4562 2007
24 Sweden 2011 3191 2006
25 Spain 2000 4399 2005
PYLL
0
1
0 0
1 1
0,7
0,8
Before care After care After 10 years
Benefit of care0,8 – 0,7 = 0,1
Benefit during 10 years0,1 x 10v = 1 QALY
Operation
14 QALY
15 D
Utility: quality of life (15d)
From utility: QALY-units (quality of life and length of life)
Costs/QALY
Quality of health care Efficancy, RCT-studies:Can it work?
Effectiveness in real life: Does it work?
Cost-Effectiveness: Is it worth of it?
Feasibility: Does it reach all those who need it? Is it really in use?
EBM
Policy
Audit
Development
15
16
Effectiveness of care
Difficulty of disease
Not serious diseases
Most serious disease
17 Problem of health care
comes better 0 comes worse
Problem of health care
€
patientdecils (10%) costs
Benefit of care is normally devided, mean zero or little toward +
Costs of care are not same. Some costs are enourmous, most are cheap
18
PROBLEMS
Increase of medicine
Ageing
Not enough money.
Not enough staff.
Staff does not have enough strength.
Increase of side effects.USA: 44 000 – 98 000 deaths/year.
It is impossible to respond to expectations of population
It is difficult to master knowledge.
Service is still slow
DiscrepanceExpectations of population
19
Problem:Social- and health care duties Social work Dispensary for behavior and
family Home care Service for living Chronic disease department
care Family care Support for relatives care Children and young care Day care for children Alcoholist care Specialist care for retarded Handicap care Work rehabilisation Health education Hospital care and rehabilisation First aid and ambulace services Dental care School health care
Health care for students
Screenings
Occupational health
Environment health care
Mental care services
Specialist care
On call duty services 24h
Bypass operation for brain
Transplantation services
Care for certain malformations
Oxygen care
Demanding first aid (helicopters)
Coordination and developement of mental health work
Coordination and developement of drug addiction
Examination and care for sexually abused
Care and examination for alcohol addict pregnant women
Services connecting research, development and education
20
Effectiveness of care
Difficulty of disease
Not serious diseases
Most serious
diseases
ILH21
Determinants of health Income and social status Social support networks Education and literacy Employment/working
conditions Social environments Physical environments
Personal health practices and coping skills
Healthy child development
Biology and genetics
Health care services Gender Culture
22
ASANTE!
23