http://www.slovak.com/language/phrases/health/health_p1/musim_ist_k_lekarovi.wav

How to facilitate supervision? How to improve quality?

How to improve transparency?

Dutch hospitals

• 1996 “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

PatientsafetyReducing Medical Errors requires National Computerized Information Systems;

Data Standards Are Crucial to Improving Patient Safety

Supervision

Quality

Tranparency

Gefaseerd toezicht

LOWRISK

Fase 2: TESTING

TEST ATRANDOM

QUALITY ASPECTS

HOSPITALS

FINISHOR

TESTING

HIGHRISK

Fase 1: COLLECTING INFORMATION

MINIMAL SET INDICATORS

Risico-analyse

RISKANALYSIS

EXTERNAL DATA RESOURCES

RISK MODEL

Fase 3: INTERVENTION

•Death

•Disease

•Discomfort

•Disability

•Dissatisfaction

Proces

Indicators

Structure / Organisation

Indicators

OutcomeIndicators

Patient

An Indicator:

• Signal function

• consequences only after inspection

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

Selection criteria

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

outcome

Procedure

• Indicator acquisition by

– Literature search– Stakeholders interviews– Expert interviews– Expert meetings– Scientific board meetings

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.

Hospital-wide

Indicator Structure Process

Outcome

1. Pressure Ulcer 1.1Registration of Pressure Ulcer prevalence/incidence

1.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 1.Availability inpatient and outpatient medication overview2.Availability regional medication overview

4. Information Technology 1.Availability of electronic data in the outpatient consultation rooms and on the hospital wards2.Availability of process-supporting IT in the outpatient consultation rooms and on the hospital wards3.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

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

1.2SPercentage of patients whose pain score is less than 4 within the first 72 hours

2. Volume of high risk interventions

1.Volume of acute aneurysm of the abdominal aorta surgery2.Volume of esophageal resections for esophageal carcinoma

3. Laparoscopic surgery

3.1aSRatio of laparoscopic versus open cholecystectomy3.1bSRatio of laparoscopic cholecystectomy in day care versus inpatient laparoscopic cholecystectomy

3.2SPercentage 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-operations5.1b 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

Condition- or intervention-specific indicators

Indicator Structure Process Outcome

1. Pregnancy 1.Percentage of cesarean sections1.2SPercentage of vaginal deliveries after cesarean section

2. Diabetes 2.1Presence of Integrated Diabetes Care service

1.Mean HbA1C value2.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 mortality4.2S 30 days mortality

5.Cerebrovascular accident

5.1Presence of Stroke-service / hospital stroke unit

5.1 In- hospital mortality5.2S 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 1.Presence of cataract surgery unit and care pathway2.Presence of cataract surgery complication registry

9.3aCorrected post-operative vision9.3bMean difference between the actual and the intended refraction after cataract surgery

10.Refraction surgery

10.1Reduction in refraction

Time table• January 1. Hospitals received the set.• June 1. Deadline for hospitals• July 1. All hospitals had responded; • Autumn 2004; Analysis of data• February; Publication set 2004• May 2005: General report 2003• June 2005; Publication set 2005• July 1. Deadline for hospitals• September; Publication set 2006

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According to Hospital According to standards

Level 1 Level 2 Level 3 No data