comparative evaluation of selected international primary healthcare services using pqis 21-05-2010...
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Prevention Quality IndicatorsComparative evaluation of selected
international primary healthcare services using PQIs
21-05-2010
Unidade Curricular de Introdução à Medicina II
Head teacher : Altamiro da Costa-Pereira, MD, PhDSupervisors : Alberto Freitas, PhD and Ricardo Reis
Introduction“Of all the ways to face pathologies perhaps the
most important one is PREVENTION.” [1]
Healthcare system quality analysis:
AVOID unnecessary hospital admissions
SAVE time and resources
IMPROVE quality of life
...through analysis of PQIs.
[1] Agency for Healthcare Research and Quality. Guide to Prevention Quality Indicators, Ver 3.1 [Internet]. 2007 Mar [cited 2009 Dec 7]. 59p. Available from: http://www.qualityindicators.ahrq.gov/downloads/pqi/pqi_guide_v31.pdf
Introduction“Of all the ways to face pathologies perhaps the
most important one is PREVENTION.” [1]
• Conditions for which good outpatient care can potentially prevent the need for hospitalization
• Or for which early intervention can prevent complications or more severe disease [2]
ACSCs
[1] Agency for Healthcare Research and Quality. Guide to Prevention Quality Indicators, Ver 3.1 [Internet]. 2007 Mar [cited 2009 Dec 7]. 59p. Available from: http://www.qualityindicators.ahrq.gov/downloads/pqi/pqi_guide_v31.pdf[2] Moura, A. C., A. M. Oliveira, et al. (2008). "[Evaluating Portuguese primary healthcare through Prevention Quality Indicators (PQIs)]." 35. Unpublished data.
PQI’s
Evaluate the quality of oupatient healthcare
Improvement of the healthcare
system
Included in QI’s
Created by AHRQ
Based on ACSC’s
PQI’s by AHRQ
PQI1: Diabetes short term
complicationPQI2: Perforated
appendix
PQI3: Diabetes long-term
complication
PQI5: Chronic obstructive
pulmonary disease
PQI7: Hypertension
PQI8: Congestive heart failure
PQI9: Low Birth Weight
PQI10: Dehydration
PQI11: Bacterial pneumonia
PQI12: Urinary tract infection
PQI13: Angina admission without
procedure
PQI14: Uncontrolled Diabetes
PQI15: Adult Asthma
PQI16: Lower-extremity
amputation among diabetics
PQI1: Diabetes short term complication
Using several PQIs, compare Portugal`s primary healthcare system with other countries.
(USA, Italy, Spain and Singapore)
Aims
Participants & Methods
• Database with hospitalizations in
Portuguese mainland public hospitals
• 2000 - 2007
Portugal
All the following conditions
Participants & Methods
• Patients between 20-64 years-old admitted in
four Italian cities (Turin, Milan, Bologna, Rome)
• 2000 - 2007
Italy
PQI#3 Diabetes Long-term Complications Admission RatePQI#5 - Chronic Obstructive Pulmonary DiseasePQI#7 - Hypertension without proceduresPQI#8 - Congestive Heart Failure without proceduresPQI#13 - Angina without procedures
Participants & Methods
Angina AsthmaCellulitisCongestive heart failureCongestive pulmonar diseaseDehydrationDiabetesGastroenteritis Great evilHypertension
HypoglycemiaUrinary and kidney tract infectionsPneumoniaSevere ENT InfectionsImmunizable disordersConvulsionsPulmonary TuberculosisOther tuberculosisCongenital syphilis
Dental problemsIron deficiency anemiaNutritional deficiencyGrowth FailurePelvic inflammatory disease
• Patients between 0-44 years-old
admitted in public Spanish hospitals [3]
• January – December (2000)
[3] José Luis Alfonso, S., V. Joan Sentís, et al. (2004). "[Characteristics of avoidable hospitalization in Spain]." Med Clin (Barc) 122(17): 653-658.
Spain
• Nationwide data with
hospitalizations in Singapore [4]
• 1991 - 1998
Participants & Methods
•Asthma• Congestive heart failure•Chronic obstructive pulmonary diseases• Diabetes mellitus• Hypertension
Singapore
[4] Niti M, Ng TP. Avoidable hospitalization rates in Singapore, 1991-1998: assessing trends and inequities of quality primary care. J Epidemiol Community Health. 2003; 57: 17-22.
Participants & MethodsUSA
• Patients over 18 years old
admitted in hospitals of USA
• Data calculated and made
available by AHRQ [1]
• 2004 - 2007
All 14 PQIs
[1] Agency for Healthcare Research and Quality. Guide to Prevention Quality Indicators, Ver 3.1 [Internet]. 2007 Mar [cited 2009 Dec 7]. 59p. Available from: http://www.qualityindicators.ahrq.gov/downloads/pqi/pqi_guide_v31.pdf
Data retrieved from acute care hospital database
Variables of interest present in selected articles from other countries (Pubmed,INE…)
We retrieved articles from PubMed using the following query: "prevention quality indicators" OR "ambulatory care sensitive" OR
Data Collection
"avoidable hospitalizations" OR "avoidable hospitalization" OR "preventable hospitalization" OR "preventable hospitalizations" OR "PQI" OR "primary care quality" AND ”(country of interest)
To calculate, we used a syntax (it allows filter
admittance for a given disease) for each indicator
of each article and also data provided by AHRQ
After obtaining a certain frequency for each case
we divide it by the entire population of Portugal
which results on a quotient similar to PQI. For PQI
2 and PQI 9 the denominator is not related to the
population.
Indicator Calculation
By AHRQ [1] and other sources (depending on the studied country)
Based on Diagnoses Codes ICD-9-CM
Different criteria for different PQIs
Inclusion
Pregnancy
Childbirth
Puerperium
Newborn (or other neonates)
Cases transferred from other institutions. [1]
PQI specific
Exclusion
[1] Agency for Healthcare Research and Quality. Guide to Prevention Quality Indicators, Ver 3.1 [Internet]. 2007 Mar [cited 2009 Dec 7]. 59p. Available from: http://www.qualityindicators.ahrq.gov/downloads/pqi/pqi_guide_v31.pdf
Criteria
Study Design
COMPARE
Results: Graphics and Tables
ADAPT
Portugal’s Methods and Data Other Countries
USE
Articles with data of the selected countries
Data management
Examples of Portuguese Database (in SPSS)
Results…
Portugal 2000-2007Nº per 100000 inhabitants
PQI’s 1 to 8 (except PQIs 4 and 6)
[8] Statistics Portugal [internet]. Lisbon: INE 1864- [cited 2010 April 06]. Available from: http://www.ine.pt
Portugal 2000-2007
Nº per 100000 inhabitants
PQI’s 10 to 16
[8] Statistics Portugal [internet]. Lisbon: INE 1864- [cited 2010 April 06]. Available from: http://www.ine.pt
Portugal 2000-2007
[8] Statistics Portugal [internet]. Lisbon: INE 1864- [cited 2010 April 06]. Available from: http://www.ine.pt[1] Agency for Healthcare Research and Quality. Guide to Prevention Quality Indicators, Ver 3.1 [Internet]. 2007 Mar [cited 2009 Oct 27]. 59p. Available from: http://www.qualityindicators.ahrq.gov/downloads/pqi/pqi_guide_v31.pdf
USA vs Portugal
[8] Statistics Portugal [internet]. Lisbon: INE 1864- [cited 2010 April 06]. Available from: http://www.ine.pt[5] Rizza P, Bianco A, Pavia M, Angelillo I. Preventable hospitalization and access to primary health care in an area of Southern Italy. BMC Health Services Research. 2007;7(1):134.[9] Agabiti N, Pirani M, Schifano P, Cesaroni G, Davoli M, Bisanti L, et al. Income level and chronic ambulatory care sensitive conditions in adults: a multicity population-based study in Italy. BMC Public Health. 2009;9(1):457.
Portugal vs Italy
[8] Statistics Portugal [internet]. Lisbon: INE 1864- [cited 2010 April 06]. Available from: http://www.ine.pt[3] José Luis Alfonso S, Joan Sentís V, Sergio Blasco P, Isabel Martínez M. [Characteristics of avoidable hospitalization in Spain]. Med Clin (Barc). 2004;122(17):653-8.
Portugal vs Spain
[8] Statistics Portugal [internet]. Lisbon: INE 1864- [cited 2010 April 06]. Available from: http://www.ine.pt
[8] Statistics Portugal [internet]. Lisbon: INE 1864- [cited 2010 April 06]. Available from: http://www.ine.pt[3] José Luis Alfonso S, Joan Sentís V, Sergio Blasco P, Isabel Martínez M. [Characteristics of avoidable hospitalization in Spain]. Med Clin (Barc). 2004;122(17):653-8.
Portugal vs Spain
[8] Statistics Portugal [internet]. Lisbon: INE 1864- [cited 2010 April 06]. Available from: http://www.ine.pt[4] Niti M, Ng TP. Avoidable hospitalization rates in Singapore, 1991–1998: assessing trends and inequities of quality in primary care. Journal of Epidemiology and Community Health. 2003 January 2003;57(1):17-22.
Portugal vs Singapore
DiscussionDiscussion
DiscussionDiscussion
Italy vs Portugal• Higher rates in Italy in all of the five conditions compared.
• Worse food habits might be a reason, due to a diet rich in lipids, carbohydrates, fats and vegetable oils. [8]
• Therefore, cultural, social and economical disparities are, among other factors, na explanation for the results obtained [8].
[8] Statistics Portugal [internet]. Lisbon: INE 1864- [cited 2010 April 06]. Available from: http://www.ine.pt
DiscussionDiscussion
Singapore vs. PortugalPortugal has for Chronic Obstructive Pulmonary disease, Diabetes Mellitus and Hypertension higher rates, explained by:• Environmental issues• Cultural issues
Singapore presents higher rates for:• Asthma (climate)• Congestive heart failure (diet enriched in lipids)
Comparison between these two countries is not reliable as this two countries have great cultural, economical and social disparities and the results for Singapore match the year 1998, as Portuguese results match the year 2000.
USA vs Portugal
DiscussionDiscussion
• USA hospitalization rates are higher than in Portuguese ones except PQI 13 and 14, which are related with angina and diabetes, respectively.
WHY?• USA is more developed than us and therefore:• greater pollution;• greater racial disparities;• greater obesity;• other conditions that may lead to
higher rates of unnecessary hospitalizations.
• However PQI 13 and 14 may be explained by our diet, which is often exaggerated in quantity and impoverished in quality.
DiscussionDiscussion
Spain vs Portugal • In the comparison made with Spain, we found that in the 24 conditions faced Portugal has, in eight of them, higher rates.
• This is one of the most reliable of our comparisons because Portugal and Spain have cultural and ethnical similarities due to geographical proximity (same pollution values, same food habits, etc).
• Overall, we may infer that spain’s prevention system is worst than ours
1. Agency for Healthcare Research and Quality. Guide to Prevention Quality Indicators, Ver 3.1 [Internet]. 2007 Mar [cited 2009 Dec 7]. 59p. Available from: http://www.qualityindicators.ahrq.gov/downloads/pqi/pqi_guide_v31.pdf
2. Moura, A. C., A. M. Oliveira, et al. (2008). "[Evaluating Portuguese primary healthcare through Prevention Quality Indicators (PQIs)]." 35. Unpublished data.
3. José Luis Alfonso, S., V. Joan Sentís, et al. (2004). "[Characteristics of avoidable hospitalization in Spain]." Med Clin (Barc) 122(17): 653-658.
4. Niti M, Ng TP. Avoidable hospitalization rates in Singapore, 1991-1998: assessing trends and inequities of quality primary care. J Epidemiol Community Health. 2003; 57: 17-22.
5. Rizza P, Bianco A, Pavia M, Angelillo IF. Preventable hospitalization and access to primary healthcare in an area of Southern Italy. BMC Health Serv Res. 2007; 7:134.
6. Ansari Z, Laditka JN, Laditka SB. Access to Healthcare and Hospitalization for Ambulatory Care Sensitive Conditions. Med Care Res Rev. 2006; 63:719-42
7. Alfradique, M. E., P. d. F. Bonolo, et al. (2009). "Internações por condições sensíveis à atenção primária: a construção da lista brasileira como ferramenta para medir o desempenho do sistema de saúde (Projeto ICSAP - Brasil)." Cadernos de Saúde Pública 25: 1337-1349.
8. Statistics Portugal [internet]. Lisbon: INE 1864- [cited 2010 April 06]. Available from: http://www.ine.pt
9. Agabiti N, Pirani M, Schifano P, Cesaroni G, Davoli M, Bisanti L, et al. Income level and chronic ambulatory care sensitive conditions in adults: a multicity population-based study in Italy. BMC Public Health. 2009;9(1):457.
References
Ana Sara Ferreira, mimed09219@med.up.pt
Andreia Sofia Teixeira, mimed09242@med.up.pt
Catarina Lombo, mimed09237@med.up.pt
Diogo Milheiro, mimed09049@med.up.pt
Diogo Teixeira, mimed09046@med.up.pt
Henrique Teixeira, mimed09042@med.up.pt
Inês Pessanha Silva, mimed09059@med.up.pt
Mariana Magalhães, mimed09100@med.up.pt
Miguel Coimbra, mimed09120@med.up.p
Pedro Carvalho, mimed09135@med.up.pt
Paulo Lopes, mimed09250@med.up.pt
Samuel Queirós, mimed09150@med.up.pt
Tiago Barbosa, mimed09188@med.up.pt
Class 10
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