IMPLEMENTATION OF A QUALITY SYSTEM LINKED TO ECONOMIC INCENTIVES IN A HEALTH CONSORTIUM

IN CATALONIA: EVALUATION OF THE FIRST YEAR

The Consortium of Primary Health Care of l’Eixample (CAPSE) is a public health provider located in a district of Barcelona. CAPSE, founded in 2001, is owned by the two main health providers in Catalonia.

There are 98 health workers in CAPSE delivering healthcare to approximately 70,000 people.

The implementation of a total quality system began in 2004 with the aims of establishing tools for the continuous quality improvement in various dimensions

The SWOT analysis showed that there was:

• variability among health care delivery

• low orientation to the needs of the patients

• gaps between the needs / demands of the population and the Public Insurance objectives

• doctors’ and nurses’ economic incentives poorly linked to objectives

These improvement opportunities were implemented:

• on time: 56%• delayed: 18%• unsuccessfully: 26%

Process management: difficulties encountered

• The use of indicators over time

• Opposing strategies between directive staff and quality improvement team

• Imbalanced data register: management indicators differ from quality indicators

• Low involvement of patients in decision-making

Two examples: 1.- Preventive medicine and Promotion of Health Activities (PPHA)

• Routine activities, carried out mainly by nurses in all public PHC centres in Catalonia

• Promoted by the MoH

• Goal: primary prevention of the more prevalent diseases

• Candidates: referrals to the nurse, who carries out prevention and health promotion activities

• Improvement: appointment for all new patients who are to receive prevention and health promotion activites, independently of their demands

2.- Chronic Prescriptions

• Computorised drug prescriptions delivered by clerks to the patients registered as Chronic Patients

• There were mistakes in the issue of prescriptions due to the unreliability of data

• Improvement: to review Chronic Prescriptions in order to improve the reliability of data

Aquí van los créditos (Cuerpo 17)

Challenges for the near future

• To involve patients in decision–making

• To implement a community plan

• To promote disease management programmes

• To evaluate the effectiveness of improvement opportunities related to patients

Aquí van los créditos (Cuerpo 17)Thank you very much

vilaseca@clinic.ub.es