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The Implications for Measurements of Healthcare The W ay F orward : The Czech C ase. Petr Tůma 05.03.2009 Prague. Which quality and performance indicators are measured. Performance indicators only - based on IR-DRGs data

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the implications for measurements of healthcare the w ay f orward the czech c ase

The Implications for Measurements of Healthcare The Way Forward: The Czech Case

Petr Tůma

05.03.2009

Prague

which quality and performance indicators are measured
Which quality and performance indicators are measured
  • Performance indicators only - based on IR-DRGs data
  • Quality indicators tested, but not used- based on AHRQ1) Inpatient Mortality Indicators- based on AHRQ ACSC2) Indicators
  • Quality indicators proposed, but not tested, not used- based on PQRI3) Process Indicators

1) AHRQ = the Agency for Health Care and Research Quality

2) ACSC = Ambulatory Care Sensitive Conditions

3) PQRI = Physician Quality Reporting Initiative

currently accessible internet sites
Currently Accessible Internet Sites
  • South Bohemia Region Hospitals Comparison (Reg-SB)http://www.zebricky.cz/
  • Vysočina Region Hospitals Comparison (Reg-VYS)http://www.zdravi-vysociny.cz/cz/Content/HtmlPage.aspx?folderid=27
  • National Reference Centre - „Jak se kde léčí“1) (NRC-1)http://www.jaksekdeleci.cz/vitejte.php
  • National Reference Centre - „BRIX“(NRC-2)http://brix.nrc.cz/BRIX/faces/pages/login.jsp

1) „How the Health Care is Delivered“

how is data collected how is data processed
How is data collected; How is data processed
  • Administrative data only
  • Routine payment claim (Health Insurance Companies bills)
  • Data is processed by IR-DRG grouper
  • Measures:- patients number- ALOS- mortality rates- complexity level (severity level)- ...
cz data measures characteristics
CZ data & measures characteristics

CZ administrative data is

  • very rich in details
  • of poor quality (especially ICD-10 coding)
  • not audited

Measures are

  • not standardised
  • not labelled with simple language
how are the results published what is accessible for experts what is available for general public
How are the results published (what is accessible for experts, what is available for general public)
  • All three sites (Reg-SB; Reg-VYS; NRC-1) are - available for general public - difficult to understand for general public (due to IR-DRG complexity and terminology)
  • The utility for general public was not tested
  • The utility for professionals was not evaluated
key lessons learned
Key lessons learned
  • With the exception of an early interest of media, the general reaction both of professionals and general public is silence and indifference
  • IR-DRG is not suitable basis for measures aimed at general public
  • Measures often does not demonstrate the difference in performance but the difference of coding routine
  • The need of data set innovation and a new Procedure Classification System adoption is unconditional
next steps expected development and recommendations
Next steps - expected development and recommendations

Suggestions:

  • Adoption of process quality indicators

=> Additional data collection=> Clinical guidelines improvement

  • Larger involvement of clinicians
  • The utility enhancement for general public via adoption of the AHRQ/ National Quality Forum „Guidelines for Consumer-focused Public Reporting“ www.qualityforum.org
  • Individual QI indicators grouped into categories rather then „QI composites“