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MARQuIS : Methods of Assessing Response to Quality Improvement Strategies Rosa Suñol, MD, Ph.D. Director, Avedis Donabedian Foundation Director AD Quality Chair. Fac. of Medicine. Autonomous University of Barcelona 8th European Forum Gastein, October 2005. Overview. MARQuIS team

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  • MARQuIS:Methods of Assessing Response to Quality Improvement Strategies

  • Rosa Suñol, MD, Ph.D.

  • Director, Avedis Donabedian Foundation

  • Director AD Quality Chair. Fac. of Medicine. Autonomous University of Barcelona

    • 8th European Forum

    • Gastein, October 2005


Overview
Overview

  • MARQuIS team

  • EU Context

  • Project description:

    • Objectives

    • Design

    • Expected outcomes

  • Results so far:

    • Quality strategies

    • Type of care provided

    • Patient requirement

  • Recommendations


Involved organizations

PARTNERS

HOPE Standing Committee of the Hospitals of the European Union, Belgium

ESQH European Society for Quality in Healthcare, Ireland;

CEREF Centre for Research and Advanced Training,) Italy

FAD Avedis Donabedian Foundation, Spain

AMC Department of Social Medicine, Academic Medical Centre / University of Amsterdam,) The Netherlands

CBO Dutch Institute for Healthcare Improvement,) The Netherlands

MCHM University of Manchester / Manchester Centre for Healthcare Management, United Kingdom

NCQA, National Centre for Quality Assessment in Health Care Poland

COUNTRY COORDINATORS

École de Santé Publique,Université Libre de Bruxelles, Belgium

Belgium; Katholieke Universiteit Leuven, Belgium

SAK CR Spojena akreditacni komise Ceske republiky, Czech Republic

HAS Haute Autorité de Santé, France

NCQA National Centre for Quality Assessment in Health Care, Poland

FADA Foundation for Accreditation and Health Care Development, Spain

NIAZ Nederlands Instituut voor Accreditatie van Ziekenhuizen, The Netherlands

HQS The Health Quality Service,United Kingdom

INVOLVED ORGANIZATIONS

Coordination: Prof. Rosa Suñol (FAD)


Eu context
EU CONTEXT:

Movement of citizens within the European Union is increasing. Many of the citizens move for reasons unrelated to healthcare, but, whatever the reason, all these movements have a potential impact on health services, creating new needs and demands. Freedom of movement of goods, services, capital and people is also affecting health services.

Countries use this principles to address professional shortage, to support drug policy etc,but some concern arise when they’re also responsible of the care provided in another country(type of service,qualityand cost)


Eu context examples of health policy divergence in europe
EU CONTEXT: Examples of health policydivergence in Europe

  • Health system funding level and sources

  • Health system design/structure

  • Insurance coverage and benefits

  • Co-payment, fees and expenses

  • Treatment thresholds and choices

  • Patient and public expectations

  • Strategies for improving care (accreditation, indicators..)

  • Quality requirements (criteria, standards, etc)

  • Patients’ rights


Project description objectives
PROJECT DESCRIPTION:Objectives

  • Toassess andcompare different quality strategies(accreditation of health care institutions, implementation of clinical guidelines, performance indicators, patient satisfaction surveys…),and their potential use in health services when patients move across borders to obtain care; this would provide a first basis to assess the need and the development of formal, quality procedures at EU level for secondary care institutions.


Project description objectives1
PROJECT DESCRIPTION: Objectives

  • WP-2To identify and analyze quality strategies(including accreditation, certification, indicators,patient surveys, etc.) used at national level (25 countries) based in a specific framework developed by research team

  • WP-3 To identify quality requirements for hospitals (safety and pat. empowerment)

    • Review legislation and jurisprudence (mainly in patient rights)

    • Identify volume and type of care provided to cross border care

    • Identify patients’ requirements

    • Identify providers requirements’ (doctors, nurses and managers)


Project description objectives2
PROJECT DESCRIPTION: Objectives

  • WP-4 /5To describein a sample of stateshow hospitals have applied national quality strategies, how far they meet the defined requirements of cross-border patients and what variables of organisation and methodology are associated with meeting these requirements(questionnaire to 500 hospitals, audit to 100 hospitals)

  • WP-6/7To use these data to draw general conclusions aboutthe association of various national quality strategies and compliance with defined requirements andthe need for developing formal quality procedures at EU level.


Design

Development and applying

measures

Audit

  • Development and applying questionnaires (indicators, standards)

  • Developing and testing questionnaires

  • Distribution and analyses

  • Field test

  • Preliminary conclusions

  • Consultation with governments

Generating hypothesis

Quality strategies

National and international level WP-2

Quality requirements

for cross-border patients WP-3

HOSPITALS

Literature review

Framework

Info retrieval +

validity

Report

  • Regulation and jurisprudence

  • Health financing authorities

  • Statistics on type of care provided

  • Patients requirements

  • Other stake holders requirements

  • Literature review

Structural

Characteristics

  • Organization

  • Quality culture

  • Etc.

Priorities for patients with cross-border care

Design


Questions to answer to eu officers
Questions to answer to EU officers

  • Is it convenient to develop a unique quality strategy/ instrument for Europe?

  • Is a convergence process possible and acceptable for the governments and involved organizations?

  • What are the key quality requirements to promote ?

  • Can they be used as a guidance for quality development in hospitals?

  • Are there special requirements when patients moving across borders?

  • What is the relationship of Quality requirements with purchasing services between countries?

  • What are the next steps to cover?


Eu context patient mobility in europe
EU CONTEXT: Patientmobility in Europe

  • Tourism and short time stay (transport) and “false tourists”

  • Residents: People living and working in another EU state (elderly, ..etc)

  • Capacity transfer initiatives (waiting lists)

  • Private patients (in vitro-fertilization, aesthetic surgery, others..)

  • Border regions

  • Highly specialised care


Quality strategies in europe
QUALITY STRATEGIES IN EUROPE:

Conceptual framework:

Policy development

Policy implementation

Policy outcomes/ impact

Quality strategies

Literature review

Information retrieval and validation in 25 countries

Accreditation

ISO

EFQM

Indicators

Contracts


Quality requirements
QUALITY REQUIREMENTS:

Patient requirements

Regulation & jurisprudence

Quality requirements

Other stakeholders requirements (doctors,nurses,managers..

Volume and type of care provided

Literature review


Type of care provided
TYPE OF CARE PROVIDED

  • A. Border regions projects

  • B. Case study. Catalonia

  • C. Purpose sample: 18 hospitals

  • D. Insurance companies


A. COOPERATION IN BORDER REGIONS

Border region areas: 35

Hospital cooperation programs: 170

Treatment cooperation programs: 123

AREAS OF COOPERATION:

Emergency

Management

Conferences, seminars, meetings

Funding / social security agreements

Common structure

Language course

Care/ medical treatment

Exchange of professionals

Research

Telemedicine

Education / training

Equipment shared

HOPE: Hospital co-operation in border regions in Europe, June 2003


B case study catalu a
B. CASE STUDYCataluña

  • Field of study:

  • Admissions to the Public Catalan System Hospitals during 2003

  • Source of data:

  • CMBD de Cataluña, Servei Català de la Salut

  • Main results:

  • Total patients admitted: 714.404

  • Total EU patients admitted: 1502

  • % EU patients out of all admissions: 0.21%


Proposed diagnosis list to study
PROPOSED diagnosisLIST TO STUDY

  • Acute myocardial infarction

  • Deliveries

  • Appendicitis

  • Several kinds of fractures

  • Ophthalmology

  • Cancer

  • Diagnostic procedures


Patient requirements methodology
PATIENT REQUIREMENTS: Methodology

  • Qualitative research using semi-structured interviews

  • Patients from an EU country admitted to a hospital abroad

  • Expected number of interviews: 60

  • Countries of study:

  • Italy, Spain, Netherlands, Belgium

  • Goal: to identify relevant issues and priorities of individual patients using care across national borders


Patient requirements preliminary findings

ENVIROMENTAL / ORGANIZATIONAL ISSUES

Cleanliness

Food

Noise / visitors

Environment of care

Organization of the environment of care

Daily routine

ATTENTION TO PATIENTS

Help / attention to patients

Timeliness

Professional attitude

- ATTENTION TO RELATIVES

COMMUNICATION / INFORMATION

Translation/communication in other languages

Information about illness and treatment

Involvement of care / informed consent

Information about hospital procedures

Information to family doctor at home

- PROFESIONAL CAPABILITIES

- GENERAL COMMENTS

PATIENT REQUIREMENTS: Preliminary findings


Lessons learned so far
LESSONS LEARNEDSO FAR:

  • 1- Cross-border hospitalization in Europe varies widely, it seems to be a low occurrence phenomena, but underestimation could be important

  • 2- The volume of care provided to EU patients at the emergency unit seems to be higher than the events of hospitalization for this population

  • 3- Even when DRG codification system is only used in some European countries, all countries involved on this study use ICD either version 9 or 10, so data could be compared


Lessons learned so far1
LESSONS LEARNEDSO FAR:

  • 4- EU patients hospitalized abroad seem to have a more homogeneous pathology than the regular population admitted to the same hospital

  • 5- Most frequent diagnosis for hospitalized EU patients, are acute myocardial infarction, deliveries, appendicitis, disrhytmias and several kinds of fractures (this accounts for 25% of all cases)

  • 6- Preliminary analysis of patients requirements seems to show differences between EU patients and local patients needs (different diagnosis, specific groups, extra patients needs due to information and language problems and lack of family environmental support)


Recommendations
Recommendations:

  • 1- In order to be able to perform valid studies about the cross-border care, it would be necessary to include some common equivalent fields on hospitals and national healthcare databases. So it’s recommended to: Include country of origin as a mandatory field in hospitals and country databases. (data available in hospitals but not at country levels) both in inpatients and emergency areas

  • 2- It would be interesting to agree among different research groups on the typology of cross border care (also from patients point of view)

  • 3- The information currently available does not include the data that would be needed to independently study different categories of cross-border care (residents,,turists etc) Once country is identified, health information databases of EU countries should progressively start incorporating the information on types of cross border care as mandatory fields.

  • 4- Specific discharge information seems necessary for cross border care. It will be useful to consider a common content of the discharge letter in EU hospitals



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