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Quality Indicators from the view of the General Health Insurance Company. MUDr. Lucia VITÁRIUS, MPH. Slovak Medical Chamber 2. International conference „Quality Indicators of Provided Medical Care and Quality of Life“ May 18, 2007. Legislative framework.

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quality indicators from the view of the general health insurance company
Quality Indicators from the view of the General Health Insurance Company

MUDr. Lucia VITÁRIUS, MPH

Slovak Medical Chamber

2. International conference

„Quality Indicators of Provided Medical Care and Quality of Life“

May 18, 2007

legislative framework
Legislative framework
  • Law NR SR No. 581/2004 Z. z. on health insurance companies...
  • Government regulation No. 663/2005...which issues quality indicators for the purpose of quality assessment of provided medical care
  • Directive of the Ministry of Health for collection of quality indicators for the purpose ofquality assessment of provided medical care
areas of assessment
Areas of assessment
  • Accessibility of health care
  • Effective using of sources
  • Effectiveness and adequacy of provided health care
  • Perception of provided health care by the patient
  • Results of health care
interpretation of quality indicators
Interpretation of quality indicators

high/lowlevelof resultingvalue of quality indicator

stredná hodnota

2 štandardné odchýlky

high/lowlevelof resultingvalue of quality indicator

quality indicators for specialized ambulatory care
Quality indicators for specialized ambulatory care

Efficiency andadequacy of provided health care:

  • A.1.1: Screening of neck of the womb cancer
  • A.1.2: Management of permanent care – diabetology
  • A.1.3: Management of permanent care – pneumology
  • A.1.4a, b: Unexpected hospitalisations after one day surgery

Results of provided health care:

  • A.2.1: caries, missing teethor teeth with fillingof 12-year-olds – 911
quality indicators for hospital care i
Quality indicators for hospital care I.

Effective usage of resources:

  • B.1.1a,b: Day treatment

Perception of health care by patient:

  • B.2.1: Assessment of the providerby patient - questionnaire
  • B.2.2: Number of canceled electiveoperations - 912
  • B.2.3: Handling of complaints - 912
quality indicators for hospital care ii
Quality indicators for hospital care II.

Results of provided health care

  • B.3.1: Urgentrepeated hospitalizations after release– AIM
  • B.3.2: Urgentrepeated hospitalizations after release - pneumonia
  • B.3.3: Deaths after fracture of thighbone neck (over 65 years of age)
  • B.3.4: Deaths due to IM after urgent hospitalization (35-74 years)
  • B.3.5: Deaths of acute apoplexy
  • B.3.6: Deaths in hospital after urgent hospitalization before operation - 912
  • B.3.7: Deaths in hospital after planned hospitalization before operation - 912
  • B.3.8: Deaths after hip joint replacement
quality indicators for hospital care iii
Quality indicators for hospital care III.

Patient safety:

  • B.4.1: Nosocomial infections in health care - 912
  • B.4.2: Wound infections - 912
division of health care institutions into groups
Division of health care institutionsinto groups
  • Faculty hospitals
  • General hospitals (except faculty)
  • Specialized hospitals with national radius
  • Specialized hospitals
  • Medical institutions
  • Sanatoriums, hospices, nursing homes
  • CPLDZ
quality indicators for general ambulatory care i
Quality indicators for general ambulatory care I.

Efficiency andadequacy of provided health care:

  • C.1.1: Management of urgent care
  • C.1.2: Management of permanentcare
  • C.1.3: Vaccination of children
  • C.1.4: Vaccination against influenza– 913

Results of provided health care:

  • C.2.1: Patients examined byEmergency care
  • C.2.2: Patients with completed preventive examination
patient assessment of health care providers
Patient assessment of health care providers
  • Quality indicator B.2.1
  • based on the results of a representative survey
  • reflects subjective assessment of health care provider from the patient point of view
  • Created as a synthesis of assessment indexes of health care providers , covering at least areas:
    • Assessment of overall satisfaction with medical staff care
    • Assessment of accommodation and food quality
    • Assessment of satisfaction with provided health care (subjective feeling of the success of treatment)
evaluation of questionnaires
Evaluation of questionnaires
  • more than 16 800 collected questionnaires
  • more than 40% recoverability
  • overall index for every health care facility
  • interval 0-100
    • 0 – lowest satisfaction
    • 100 – highest satisfaction

min

max

50

75

100

77,21

94,51

importance of quality indicators
Importance of Quality indicators
  • targeted control and revision
  • long-term monitoring of quality, identification of divergences, unfavourable trends
  • contractual relations