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

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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.

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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

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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.

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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.

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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

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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

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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

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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

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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

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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

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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

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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

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ASANTE!

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