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MARQUIS_ Methods of Assessing Response to Quality Improvement

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					MARQuIS:
    Methods of Assessing Response to Quality Improvement
    Strategies



   PRIORITIES WHEN USING CARE ABROAD –
    PATIENTS’, PROFESSIONALS’, FINANCERS’
    views
    (Groene, Poletti, Vallejo, Suñol, Klazinga,
    Kutryba)

   PATIENT-CENTEREDNESS IN EUROPEAN
    HOSPITALS
    (Lombarts, Rupp, Klazinga, Suñol et al)
MARQuIS:
  Methods of Assessing Response to Quality Improvement
  Strategies




2. PRIORITIES WHEN USING
   CARE ABROAD (PATIENTS,
   PROFESSIONALS, FINANCERS)
Objectives

To identify and prioritize issues relevant
for patients’ safety and centeredness as
defined by patients, health care
providers and health care financing
bodies.
 Methods
Qualitative, semi-structured interviews
addressing the patients pathway (admission
issues & diagnosis & treatment, discharge).
 Population      Interviewees   Countries participating
  studied
   Patients           40            Italy (23), Spain (17)

                                Belgium (6), Czech Republic
 Professionals        30         (7), Ireland (3), Poland (8),
                                 Spain (3), Netherlands (3)
   Financing                    Belgium (2), The Netherlands
                      3
    bodies                                   (1)


Discourse analysis to elect issues and priorities
and comparison of grouped themes and contents.
Results
Themes


1. Differences between countries in
   administrative arrangements.
2. Communication processes and
   language barriers.
3. Differences between countries in
   clinical procedures.
4. Demands on the physical structure
   and hotel services.
Results (1/4)
Specific quality requirements for
administrative arrangements
Administrative requirements in general do not
pose problems; difficulties in making
arrangements with multiple purchasers.
Professionals and financers considered CBP as
more time-consuming and expensive.
Financers would like to selectively contract with
providers - professionals think that contracts
should be made at health system level.
Where authorization of treatment is required, free
movement of patients does not seem to be fully
ensured (assessment of eligibility based on
clinical/adminstrative criteria).
Results (2/4)
Specific quality requirements for
Communication and language barriers

Cross-border patients (CBP) have higher
information and communication needs
throughout the care process.
Cultural differences with regard to patient and
family involvement.
Differences in unit organization and
professionals roles confusing.
Lack of information of patients at discharge,
differences in discharge policies.
Difficulties in arranging back-transfer.
Results (3/4)
Specific quality requirements for clinical
procedures

 Informed consent procedures differ greatly
 (extent, language, legal issues).
 Some differences exist with regard to medical
 procedures:
 • transplantations (organs of non-heart beating patients)
 • rehabilitation
 • caesarean section on demand.
 Quality problems may result from lack of
 coordination of follow up care, in particular
 with regard to names and dosage of drugs and
 discharge information.
Results (4/4)
Specific quality requirements for physical
structure and hotel services
 Patients, professionals and financers state that
 CBP have higher demands on hotel services.
 Most common issues/demands:
       -   Timing and scope of meals
       -   Privacy
       -   Respect for families or carers’ needs
       -   Accomodation,
       -   Purchasable items
 There are differences in expectations and
 cultures between patients from different
 geographical areas.
MARQuIS:
     Methods of Assessing Response to Quality Improvement
     Strategies




3.   PATIENT-CENTEREDNESS IN EUROPEAN
     HOSPITALS (Lombarts, Rupp, Klazinga,
     Suñol et al)
               Objectives
The strategic objective of work package 4 is to
describe in a sample of EU member states how
hospitals have applied national quality
strategies, to what extend they meet the defined
requirements of cross-border patient care and
what organizational and/or methodological
variables are associated with (non-)compliance of
requirements.
Further, WP4 is to validate the statistical results
provided by WP3 concerning types and quantity of
health services used by patients from another
European member state.
Hospitals in the sample
Hospitals in the sample
1. Administrative requirements
Patient rights and service
Designated person to support EU patients with
administrative procedures
        Total (n)                     By country (%)
  360
  330
                 7
                                 100
  300
  270           131
  240                                80
  210
  180
  150                                60
  120
                211
   90
                                     40
   60
   30
   0
                                     20
         y es   no    n a -dk

                                      0




                                                             )
                                          )

                                                           4)




                                                           8)
                                                             )
                                                            )
                                                           2)




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                                                          =9
                                       06




                                                          25

                                                         =8
                                                        =6




                                                        =3
                                                        =2
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                                     =1




                                                        =
                                                        =

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1. Administrative requirements
Patient rights and service
Procedure with regard to transferring EU patients to home
country
         Total (n)                              By country (%)
  360
  330                             100
                 22
  300
  270
                                      90
  240                                 80
  210            213                  70
  180
  150                                 60
  120                                 50
   90
                                      40
   60
                 98
   30                                 30
   0
                                      20
          y es   no    n a -dk        10
                                      0




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                                                  4)
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                                                 =7
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                                      N
                                                    y es   no   na-dk
2. Information requirements
Patient rights and service
Information leaflets in other EU languages

         Total (n)
                                                     By country (%)
   360
   330
                 8
  300
                                  100
   270
   240
                 235                  80
   210
   180
   150                                60
   120
   90
   60
                 105                  40
   30
    0
                                      20
          y es   no    n a -dk

                                       0




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                                                            3)




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                                           )




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                                                             )
                                                            3)




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                                                           =9
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                                                           25

                                                          =8
                                                         =6




                                                         =3
                                                         =2
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                                                         =
                                                         =

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                                            (n




                                                      (n
                                                      (n
                                                      (n
                                                      (n
                                  (n




                                                      K




                                                     H
                                           FR




                                                    E
                                                 U




                                                    L
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                                                  ET
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                                                  B




                                                PO
                                                 IR




                                                N
                                                         y es   no   na-dk
2. Information requirements
Patient rights and service
CB-care arrangements & support

      360
      330
      300
      27 0
      240
      210
      180
      150
      120
       90
       60
       30
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2. Information requirements
Patient rights and service
Formalized arrangements with translation service for EU
patients
         Total (n)                                   By country (%)
  360
  330
                 6
                                  100
  300
  270
  240                                 80
  210            246
  180
  150                                 60
  120
   90
                                      40
   60
                 96
   30
   0                                  20
          y es   no    n a -dk

                                       0




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                                           )




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                                                             )
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                                                           =9
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                                                         =6




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                                                         =2
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                                      =1




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                                                         =

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                                                      (n
                                                      (n
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                                                 U




                                                    L
                                                   E




                                                  ET
                                 SP




                                                  B




                                                PO
                                                 IR




                                                N
                                                         y es   no   na-dk
2. Information requirements
Patient rights and service
Availability written policies
         360
         330
         300
         27 0
         240
         210
         180
         150
         120
          90
          60
          30
            0
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3. Clinical requirements
Patient safety:
designated responsible person for…

    360
    330
    300
    27 0
    240
    210
    180
    15 0
    120
     90
     60
     30
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                                                 180
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                        it            el
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                     ng              st
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                 nu            ng
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y es
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n a -dk
             Fo                           e
                re
                   ig
                      n
                                                                              Patient rights and service
                                                                              4. Physical infrastructure




                        ne
                            w            TV
                              sp
                    Sm            ap
                         ok           er
                            in
                              g
                                  ro
                                     om
Variance overall
classification score
                        min.       max.
Belgium (n=24)          2.10   -   3.10
Czech Republic (n=38)   1.50   -   3.00
France (n=65)           1.87   -   3.25
Ireland (n=23)          1.90   -   3.08
The Netherlands (n=8)   2.09   -   2.52
Poland (n=76)           1.86   -   3.45
Spain (n=105)           1.70   -   3.26
UK (n=10)               1.77   -   2.37
Total (n=349)           1.50   -   3.45
External pressure and
classification score



                 Total          Most          Inter-        Least
                               mature        mediate        mature
External      2.25 (0.79)   1.72 (0.64)*    2.23 (0.71)   2.79 (0.73)
pressure, 9     n= 310         n=75           n=157          n=78
items,
alpha: 0.68

 * Statistically significant (Student t-test) between the most
 mature and the least mature
Patients’ rights and
classification score
                  Total      Most mature        Inter-      Least mature
                                               mediate

General part   1.13 (0.16)   1.07 (0.11)***   1.10 (0.12)    1.25 (0.2)
                 n=350           n=87           n=172          n=86
AMI             1.55 (0.4)    1.46 (0.37)*    1.56 (0.39)    1.61 (0.43)
                  n=310          n=73           n=151           n=81

Appendicitis   1.52 (0.39)   1.36 (0.32)***   1.52 (0.38)    1.66 (0.42)
                 n=307            n=75          n=150           n=79

Deliveries     1.62 (0.39)   1.49 (0.34)**    1.65 (0.39)    1.67 (0.40)
                 n=272           n=64           n=136           n=69



 * Statistically significant (Student t-test) between the most
 mature and the least mature are flagged; *p<0.05, **p<0.01,
 p***<0.001
Summary
First study on cross-border care quality and
 safety requirements in a large sample of
 European hospitals,
There are CB-care collaboration, arrangements
 and services, although there appears considerable
 variation,
Some quality strategies (such as patient rights)
 appear reasonable on paper,
Patient safety requirements appear adequate
 overall, but wide differences per system,
External pressure appears to be associated with
 the implementation of quality requirements.
Acknowledgements
Authors and co-authors.
Country Coordinators for their
 coordination efforts and support.
Hospital coordinators who filled in the
 questionnaire: thank you!
This project was funded by the European
 Commission through its "Scientific
 Support to Policies" action under the Sixth
 Framework Programme for Research.

				
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