Quality Indicators from the view of the General Health Insurance

Company

MUDr. Lucia VITÁRIUS, MPH

Slovak Medical Chamber2. International conference

„Quality Indicators of Provided Medical Care and Quality of Life“May 18, 2007

Legislative framework

Law NR SR No. 581/2004 Z. z. on health insurance companies...

Directive of the Ministry of Health for collection of quality indicators for the purpose of quality assessment of provided medical care

Government regulation No. 663/2005...which issues quality indicators for the purpose of quality assessment of provided medical care

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

Data sources

Quality

Indicators

2006

Data of health insurance companies

Data from new dávok of health care providers

Questionnaire survey

Specialized ambulatory care

A.1.1, A.1.2, A.1.3, A.1.4a, A.1.4b

A.2.1

hospital

health

care

B.1.1a, B.1.1b, B.3.1, B.3.2, B.3.3, B.3.4, B.3.5, B.3.8,

B.2.2, B.2.3, B.3.6, B.3.7, B.4.1, B.4.2

B.2.1

general ambulatory care

C.1.1, C.1.2, C.1.3, C.2.1, C.2.2

C.1.4

Interpretation of quality indicators

stredná hodnota

2 štandardné odchýlky

high/low level of resulting value of quality indicator

high/low level of resulting value of quality indicator

Quality indicators for specialized ambulatory care

Efficiency and adequacy 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 teeth or teeth with filling of 12-year-olds – 911

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 provider by

patient - questionnaireB.2.2: Number of canceled elective

operations - 912

B.2.3: Handling of complaints - 912

Quality indicators for hospital care II.Results of provided health care B.3.1: Urgent repeated hospitalizations after release– AIM B.3.2: Urgent repeated 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.

Patient safety:

B.4.1: Nosocomial infections in health care - 912

B.4.2: Wound infections - 912

Division of health care institutions into 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.Efficiency and adequacy of provided health care:

C.1.1: Management of urgent care C.1.2: Management of permanent care C.1.3: Vaccination of children C.1.4: Vaccination against influenza– 913Results of provided health care:

C.2.1: Patients examined by Emergency care C.2.2: Patients with completed preventive

examination

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

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

50 75 100

min max

77,21 94,51

Rate your satisfaction:

Ako ste boli spokojný/á:

90.8

9

90.8

8

90.5

8

90.1

9

89.9

2

88.2

6

88.2

6

88.2

4

85.0

9

84.5

6

78.0

9

72.7

6

0

20

40

60

80

100

www.vszp.sk

Importance of Quality indicators

targeted control and revision

long-term monitoring of quality, identification of divergences, unfavourable trends

contractual relations

Thank you for your attention!