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Plano de estudos do Curso de Medicina da

VIEWS: 14 PAGES: 23

									                                        Introdução à Medicina
                                                    2008/2009




    Quality Indicators And
          Healthcare
A First Step To The Evaluation Of A Hospital’s Performance


                                                             Authors

                                                   Ana Cristina Pereira
                                                 Ana Teresa Carapenha
                                                      Ana Rita Oliveira
                                                           André Vinha
                                                        Catarina Vieira
                                                       Eduardo Freitas
                                                           João Rebelo
                                                       Mariana Oliveira
                                                              Marli Cruz
                                                          Nuno Ribeiro
                                                         Paulo Guedes
                                                       Victoriano Costa
                                  Quality Of Healthcare




      The indicators are the source of information to evaluate the performance
                                    of a hospital.




KIRKMAN, Jamie John, BOUAMRA, Omar , 2008.



                                                        Introdução à Medicina - Turma 10
                       Quality Of Healthcare




EDDY, David M., 1998



                                         Introdução à Medicina - Turma 10
Research Question and Main Aim


How did quality and performance indicators evolve through the
                  years in a central hospital?


   Our main objective is to calculate these indicators concerning
  different variables and to have a perspective of the performance of
                           the hospital in case.


 Used data: episodes in a central hospital, between 1999 and 2008.




                                                  Introdução à Medicina - Turma 10
Specific Aims




                Introdução à Medicina - Turma 10
                                                        Obtained Results

                                                               Top ten DRGs with highest mortality
                                                                                                                              Deceased           Alive           Total

                     Respiratory disorder (except infections, bronchitis and asthma) with major CC (****)                       1273             4263            5536

                     Other nervous system disorders (except transient ischemic attack , seizure and headache) with major CC      798             1922            2720

                     Septicemia with major CC                                                                                    585              779            1364

                     Hepatobiliary and pancreas disorders with major CC                                                          540             1709            2249

                     Respiratory neoplasms                                                                                       537             1295            1832

                     Intracranial hemorrhage                                                                                     527             1559            2086

                     Extracorporeal membrane oxygenation or tracheotomy with mechanical ventilation for more than 96 hours
                                                                                                                                 474              828            1302
                     or tracheotomy with pdx except face/mouth/neck dx


                     Major stomach, oesophageal, duodenal, small and large bowel procedure with major CC                         466             1100            1566


                     Simple pneumonia and pleurisy with CC (age >17)                                                             457             3669            4126

                     Circulatory disorders with AMI, expired                                                                     436               0              436




(****)   CC: complications and commorbilities. (HCUP -3 Nationwide Inpatient Sample for 1994: Diagnosis-Related Groups: http://www.hcup-us.ahrq.gov/reports/natstats/94drga.htm#146)



                                                                                                                                 Introdução à Medicina - Turma 10
                              Obtained Results

                       Top ten DRGs with highest intrinsic mortality

                                                                                                 Alive (%)   Deceased (%)   Total (%)

Cardiac arrest, unexplained                                                                       25,0%         75,0%       100,0%


HIV with ventilator or nutritional support                                                        42,4%         57,6%       100,0%


Tracheotomy for HIV infection                                                                     46,2%         53,8%       100,0%


Craniotomy for multiple significant trauma                                                        46,5%         53,5%       100,0%


Neonate, birthweight between 1500-1999g, with significant OR procedure, without multiple major
                                                                                                  50,0%         50,0%       100,0%
problems


Pneumocystosis                                                                                    50,0%         50,0%       100,0%


HIV with OR procedure and ventilator or nutritional support                                       52,6%         47,4%       100,0%


Craniotomy for multiple significant trauma with non-traumatic major CC                            56,4%         43,6%       100,0%


Septicemia with major CC                                                                          57,1%         42,9%       100,0%


Major skin and breast disorders with major CC                                                     62,3%         37,7%       100,0%




                                                                                                   Introdução à Medicina - Turma 10
                                            Obtained Results
                                                                                           Deceased        Alive        Total

Respiratory disorder (except infections, bronchitis and asthma) with major CC                1273          4263         5536
Other nervous system disorders (except transient ischemic attack , seizure and
                                                                                             798           1922         2720
headache) with major CC
Septicemia with major CC                                                                     585           779          1364
Hepatobiliary and pancreas disorders with major CC                                           540           1709         2249
Respiratory neoplasms                                                                        537           1295         1832
Intracranial hemorrhage                                                                      527           1559         2086

Extracorporeal membrane oxygenation or tracheotomy with mechanical ventilation for
                                                                                             474           828          1302
more than 96 hours or tracheotomy with pdx except face/mouth/neck dx

Major stomach, oesophageal, duodenal, small and large bowel procedure with major CC          466           1100         1566
Simple pneumonia and pleurisy with CC (age >17)                                              457           3669         4126
Circulatory disorders with AMI, expired                                                      436            0            436
                                                                                                                                      Alive (%)   Deceased (%)   Total (%)
                                           Cardiac arrest, unexplained                                                                 25,0%         75,0%       100,0%
                                           HIV with ventilator or nutritional support                                                  42,4%         57,6%       100,0%
                                           Tracheotomy for HIV infection                                                               46,2%         53,8%       100,0%
                                           Craniotomy for multiple significant trauma                                                  46,5%         53,5%       100,0%
                                           Neonate, birthweight between 1500-1999g, with significant OR procedure, without multiple
                                                                                                                                       50,0%         50,0%       100,0%
                                           major problems
                                           Pneumocystosis                                                                              50,0%         50,0%       100,0%
                                           HIV with OR procedure and ventilator or nutritional support                                 52,6%         47,4%       100,0%
                                           Craniotomy for multiple significant trauma with non-traumatic major CC                      56,4%         43,6%       100,0%
                                           Septicemia with major CC                                                                    57,1%         42,9%       100,0%
                                           Major skin and breast disorders with major CC                                               62,3%         37,7%       100,0%




                                                                                                                        Introdução à Medicina - Turma 10
                                                  Obtained Results



                  Septicemia
                                    Full-body inflamatory state developed by microrganisms
                                    Can lead to multiple organ disfunction or death




• Moerer O, Quintel M. Sepsis in adult patients - definitions, epidemiology and economic aspects. Internist (Berl). 2009 May 14.




                                                                                                                                   Introdução à Medicina - Turma 10
                                               Obtained Results

                  Number of cases of septicemia with major CC
                            between 1999 and 2008
         400

         300

         200                                                                                Number of cases

         100

            0
                 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008


                                                                                     Number of deaths caused by septicemia with
                                                                                         major CC between 1999 and 2008
                                                                            120
                                                                            100
                                                                             80
                                                                             60
                                                                                                                                                                 Deceased
                                                                             40
                                                                             20
                                                                              0
                                                                                   1999 2000 2001 2002 2003 2004 2005 2006 2007 2008


• Salive ME, Wallace RB, Ostfeld AM, Satterfield S, Havlik RJ. Risk factors for septicemia-associated mortality in older adults. Public Health Rep. 1993 Jul-Aug;108(4):447-53.
• Castellheim A, Brekke OL, Espevik T, Harboe M, Mollnes TE. Innate immune responses to danger signals in systemic inflammatory response syndrome and sepsis. Scand J Immunol. 2009
Jun;69(6):479-91.
                     Obtained Results


                              Mortality by year
5.0%

4.5%

4.0%

3.5%

3.0%

2.5%

2.0%

1.5%

1.0%

.5%

.0%
       1999   2000    2001   2002   2003   2004   2005      2006    2007   2008




                                                         Introdução à Medicina - Turma 10
                                                 Obtained Results

                                                  Mortality by gender through the years
              7.0%


              6.0%


              5.0%


              4.0%
                                                                                                                                                   male
              3.0%                                                                                                                                 female


              2.0%


              1.0%


                .0%
                          1999          2000         2001         2002          2003         2004         2005         2006         2007   2008



• Wingard DL. The sex differential in morbidity, mortality, and lifestyle. Annu Rev Public Health. 1984;5:433-58.
• Lang E, Arnold K, Kupfer P. Women live longer - biological, medical and sociologic causes. Z Gerontol. 1994 Jan-Feb;27(1):10-5.
• Waldron I. Sex differences in human mortality: the role of genetic factors. Soc Sci Med. 1983;17(6):321-33.



                                                                                                                               Introdução à Medicina - Turma 10
                                                Obtained Results

                                        Mortality by age group concerning the gender
                   35.0%


                   30.0%


                   25.0%


                   20.0%
                                                                                                                                           male
                   15.0%                                                                                                                   female


                   10.0%


                    5.0%


                     .0%
                                        0-14                          15-24                         25-64                           64+

•   Verbrugge LM. Sex differentials in health. Public Health Rep. 1982 Sep-Oct;97(5):417-37.
•   Waldron I. The contribution of smoking to sex differences in mortality. Public Health Rep. 1986 Mar-Apr;101(2):163-73.
•   Schneider, EL. Infectious diseases in the elderly. Annals of Nutrition & Metabolism 2000;44:256-262
•   Statistics Portugal: http://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_cont_inst&ine_smenu.boui=13918434&INST=53864&xlang=en



                                                                                                                         Introdução à Medicina - Turma 10
                                              Obtained Results


                                                                Mean of length of stay


                                    10
                                      9
                    Mean of days




                                      8
                                      7
                                      6
                                      5
                                      4
                                      3
                                      2
                                      1
                                      0




                                                                                       Year

• Johnson T, McNutt R, Odwazny R, Patel D, Baker S. Discrepancy between admission and discharge diagnoses as a predictor of hospital length of stay. J Hosp Med. 2009 Apr;4(4):234-9
• Thomas JW, Guire KE, Horvat GG. Is patient length of stay related to quality of care? Hosp Health Serv Adm. 1997 Winter;42(4):489-507



                                                                                                                          Introdução à Medicina - Turma 10
      Obtained Results

Percentage of postponed surgeries relatively to surgical DRGs


                                5%




                                                           Postponed Surgeries

                                                           Performed surgeries




                         95%




                                                      Introdução à Medicina - Turma 10
Obtained Results

  Postponed surgeries by reason


                       13%




                                  11%

                                                   Contraindication
                                                   Patient's desire
                                                   Other reasons




     76%




                                        Introdução à Medicina - Turma 10
Obtained Results

 Percentage of outpatient surgeries


            6%




                                          Outpatient surgeries
                                          Other episodes




      94%




                                  Introdução à Medicina - Turma 10
                                             Obtained Results

                                             Number of outpatient surgeries through the years
                               5000

                               4500

                               4000

                               3500

                               3000

                               2500
                                                                                       Outpatient episodes
                               2000

                               1500

                               1000

                                 500

                                    0




• Portaria Série I nº 132/2009 – 30 de Janeiro




                                                                                Introdução à Medicina - Turma 10
                                             Obtained Results

                                        Number of outpatient surgeries in comparison to the total number of
                                                      outpatient episodes through the years
                         5000

                         4500

                         4000

                         3500

                         3000

                         2500                                                                       Outpatient episodes
                         2000                                                                       Outpatient surgeries

                         1500

                         1000

                          500

                             0




• Portaria Série I nº 132/2009 – 30 de Janeiro




                                                                                           Introdução à Medicina - Turma 10
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                                                                                                              Introdução à Medicina - Turma 10
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dissatisfaction with deep sedation/general anesthesia. J Oral Maxillofac Surg. 2005 Feb;63(2):163-72.
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• HCUP-3 Nationwide Inpatient Sample for 1994: Diagnosis-Related Groups. Available from: http://www.hcup-us.ahrq.gov/reports/natstats/94drga.htm#146.
• Moerer O, Quintel M. Sepsis in adult patients - definitions, epidemiology and economic aspects. Internist (Berl). 2009 May 14.
• Salive ME, Wallace RB, Ostfeld AM, Satterfield S, Havlik RJ. Risk factors for septicemia-associated mortality in older adults. Public Health Rep. 1993 Jul-
Aug;108(4):447-53.
• Castellheim A, Brekke OL, Espevik T, Harboe M, Mollnes TE. Innate immune responses to danger signals in systemic inflammatory response syndrome and sepsis.
Scand J Immunol. 2009 Jun;69(6):479-91.




                                                                                                                     Introdução à Medicina - Turma 10
                                                     References

• Wingard DL. The sex differential in morbidity, mortality, and lifestyle. Annu Rev Public Health. 1984;5:433-58.
• Lang E, Arnold K, Kupfer P. Women live longer - biological, medical and sociologic causes. Z Gerontol. 1994 Jan-Feb;27(1):10-5.
• Waldron I. Sex differences in human mortality: the role of genetic factors. Soc Sci Med. 1983;17(6):321-33.
• Verbrugge LM. Sex differentials in health. Public Health Rep. 1982 Sep-Oct;97(5):417-37.
• Waldron I. The contribution of smoking to sex differences in mortality. Public Health Rep. 1986 Mar-Apr;101(2):163-73.
• Schneider, EL. Infectious diseases in the elderly. Annals of Nutrition & Metabolism 2000;44:256-262.
• Sociedade Portuguesa de Cirurgias em Ambulatório: http://www.apca.com.pt/
• Ministério da Saúde : http://www.portaldasaude.pt/portal
• Johnson T, McNutt R, Odwazny R, Patel D, Baker S. Discrepancy between admission and discharge diagnoses as a predictor of hospital length of stay. J Hosp
Med. 2009 Apr;4(4):234-9
• Thomas JW, Guire KE, Horvat GG. Is patient length of stay related to quality of care? Hosp Health Serv Adm. 1997 Winter;42(4):489-507
• Portaria Série I nº 132/2009 – 30 de Janeiro




                                                                                                                Introdução à Medicina - Turma 10

								
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