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Quality Indicators from the view of the General Health Insurance Company

Quality Indicators from the view of the General Health Insurance Company. MUDr. Lucia VITÁRIUS, MPH. Slovak Medical Chamber 2. International conference „Quality Indicators of Provided Medical Care and Quality of Life“ May 18, 2007. Legislative framework.

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Quality Indicators from the view of the General Health Insurance Company

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  1. Quality Indicators from the view of the General Health Insurance Company MUDr. Lucia VITÁRIUS, MPH Slovak Medical Chamber 2. International conference „Quality Indicators of Provided Medical Care and Quality of Life“ May 18, 2007

  2. Legislative framework • Law NR SR No. 581/2004 Z. z. on health insurance companies... • Government regulation No. 663/2005...which issues quality indicators for the purpose of quality assessment of provided medical care • Directive of the Ministry of Health for collection of quality indicators for the purpose ofquality assessment of provided medical care

  3. 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

  4. Data sources

  5. Interpretation of quality indicators high/lowlevelof resultingvalue of quality indicator stredná hodnota 2 štandardné odchýlky high/lowlevelof resultingvalue of quality indicator

  6. Quality indicators for specialized ambulatory care Efficiency andadequacy 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 teethor teeth with fillingof 12-year-olds – 911

  7. 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 providerby patient - questionnaire • B.2.2: Number of canceled electiveoperations - 912 • B.2.3: Handling of complaints - 912

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

  9. Quality indicators for hospital care III. Patient safety: • B.4.1: Nosocomial infections in health care - 912 • B.4.2: Wound infections - 912

  10. Division of health care institutionsinto groups • Faculty hospitals • General hospitals (except faculty) • Specialized hospitals with national radius • Specialized hospitals • Medical institutions • Sanatoriums, hospices, nursing homes • CPLDZ

  11. Quality indicators for general ambulatory care I. Efficiency andadequacy of provided health care: • C.1.1: Management of urgent care • C.1.2: Management of permanentcare • C.1.3: Vaccination of children • C.1.4: Vaccination against influenza– 913 Results of provided health care: • C.2.1: Patients examined byEmergency care • C.2.2: Patients with completed preventive examination

  12. 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)

  13. 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 min max 50 75 100 77,21 94,51

  14. Rate your satisfaction:

  15. www.vszp.sk

  16. Importance of Quality indicators • targeted control and revision • long-term monitoring of quality, identification of divergences, unfavourable trends • contractual relations

  17. Thank you for your attention!

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