1 / 43

Assessment of the Portuguese Pediatric Healthcare Services

Assessment of the Portuguese Pediatric Healthcare Services. Adriana Alves de Sá Lemos Pinto Ana Isabel Moreira Ferrão Ana Rita Ribeiro Mieiro Pinto Dias Fátima Daniela Almeida Ribeiro Guadalupe Maria da Silva Costa Marinho Joana Gomes Amorim João Sérgio de Lima Soares Neves

jesus
Télécharger la présentation

Assessment of the Portuguese Pediatric Healthcare Services

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. AssessmentofthePortuguesePediatricHealthcareServices

  2. Adriana Alves de Sá Lemos Pinto • Ana Isabel Moreira Ferrão • Ana Rita Ribeiro Mieiro Pinto Dias • Fátima Daniela Almeida Ribeiro • Guadalupe Maria da Silva Costa Marinho • Joana Gomes Amorim • João Sérgio de Lima Soares Neves • Luís Miguel Fernandes Teles • Mafalda Sofia Ferreira Gonçalves • Pedro Martins Pereira • Sara Daniela Correia Miranda • Sara Margarida Preto Roca Class 1 Prof. Alberto Freitas

  3. Introduction Background Justification Aims Participants Methods Description of the chosen PDIs Result Analysis Comparison with SábadoMagazine Expected results Flow Chart References

  4. Introdução à Medicina I 2007/2008 Pediatric Quality Indicators

  5. INTRODUCTION “Quality day care from infancy clearly has positive effects on children’s intellectual, verbal, phisical and cognitive development, especially when children would otherwise experience impoverished and relatively unstimulating home environments. Care of unknown quality may have deleterious effects.” Lamb’s,Michael. Handbook of Child Psychology 1998. 104

  6. Background • In 1994 the Health Care Cost and Utilization Project were developed at the Agency for Health Care Research and Quality; (1) • 33 indicators were designed to evaluate quality at hospitals; (1) www.qualityindicators.ahrq.gov/documentation.htm (1) AHRQ: Agency for healthcare research and quality [Internet]. USA; Measures of Pediatric Health Care Quality Based on Hospital Administrative Data, The Pediatric Quality Indicators.2007 [about 1 screen] Available from: http://www.qualityindicators.ahrq.gov/downloads/pdi/

  7. Background • Pediatric Quality Indicators - “Set of measures that focus on children’s health care quality” (1) - were created; • The population in study is submitted to several requirements; SS (1) AHRQ: Agency for healthcare research and quality [Internet]. USA; Measures of Pediatric Health Care Quality Based on Hospital Administrative Data, The Pediatric Quality Indicators.2007 [about 1 screen] Available from: http://www.qualityindicators.ahrq.gov/downloads/pdi/

  8. Background • Provider-level indicators – include cases where a secondary diagnosis code flags a potentially preventable complication;(1) • Accidental Puncture or Laceration • Decubitus Ulcer • Foreign Body Left During Procedure • Iatrogenic Pneumothorax in Neonates • Iatrogenic Pneumothorax in Non-neonates • Pediatric Heart Surgery Mortality • Pediatric Heart Surgery Volume (1). AHRQ: Agency for healthcare research and quality [Internet]. USA; Measures of Pediatric Health Care Quality Based on Hospital Administrative Data, The Pediatric Quality Indicators.2007 [about 1 screen] Available from: http://www.qualityindicators.ahrq.gov/downloads/pdi/

  9. Postoperative Hemorrhage or Hematoma • Postoperative Respiratory Failure • Postoperative Sepsis • Postoperative Wound Dehiscence • Selected Infections Due to Medical Care • Transfusion Reaction • Area-level indicators – cases where a patient’s risk of the complication occurred in a separate hospitalization;(1) • Asthma Admission Rate • Diabetes Short-term Complication Rate • Gastroenteritis Admission Rate • Perforated Appendix Admission Rate • Urinary Tract Infection Admission Rate • (1). AHRQ: Agency for healthcare research and quality [Internet]. USA; Measures of Pediatric Health Care Quality Based on Hospital Administrative Data, The Pediatric Quality Indicators.2007 [about 1 screen] Available from: http://www.qualityindicators.ahrq.gov/downloads/pdi/

  10. Justification This study can be considered important and innovative since pediatric care is significantly different from adult care: • Evaluation of hospitals’ conditions focused on the quality of the pediatric services provided.

  11. Justification Spread the results of our PDI’s studies Choose the best pediatric services

  12. Justification Appeal to hospital’s attention in what concerns to their position in the ranking Improve services’ quality

  13. Aims • Evaluate and compare the quality of Pediatric services in Portugal. • Considering: Location; economical groups and evolution among several years • Compare our results with other studies that have already been done: Sábado Magazine and USA Pediatric Quality Indicators.

  14. Tipe of study • Retrospective • Analytic study • Longitudinal • Observational

  15. Participants1. Targetpopulation Our study will focus on all impatient pediatric episodes of Portuguese Hospitals, based on administrative and clinical data, from 2000 to 2005. But…

  16. Who is included in pediatric care? • People aged under 18 years; • Not in Major Diagnostic Category 14 (Pregnancy, Childbirth & the Puerperium); • Not in adult Diagnostic Related Groups. (1) (1). AHRQ: Agency for healthcare research and quality [Internet]. USA; Measures of Pediatric Health Care Quality Based on Hospital Administrative Data, The Pediatric Quality Indicators.2007 [about 1 screen] Available from: http://www.qualityindicators.ahrq.gov/downloads/pdi/

  17. Methods

  18. Example – Accidental Puncture or Laceration (PDI1) • The Accidental Puncture or Laceration indicator is intended to flag cases of complications that arise due to technical difficulties in medical care, specifically those involving an accidental puncture or laceration. (2) (2). U.S. department of health and human services; AHRQ Quality Indicators Pediatric Quality Measures Clearinghouse [internet], USAgovernment; 2007, March; Available from http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?doc_id=10696

  19. Open SPSS data base and apply the general inclusion and exclusion criteria

  20. b) Calculate the numerator Discharges among cases meeting the inclusion and exclusion rules for the denominator with ICD-9-CM code denoting accidental cut, puncture, perforation, or hemorrhage during medical care in any secondary diagnosis field. (3) (3). McDonald, K., Measures of Pediatric Health Care Quality Based on Hospital Administrative Data: The Pediatric Quality Indicators, 2006 February 20. 32

  21. 1. Apply the specific inclusion and exclusion criteria of the numerator of the chosen PDI • ICD-9-CM Accidental Puncture or Laceration Codes Obtained numerator: 997

  22. c) Calculate the denominator 1. Apply the general inclusion and exclusion criteria of PDI’s 2. Apply the specific inclusion and exclusion criteria of the denominator of the chosen PDI Included cases: • All medical and surgical discharges under age 18 defined by specific DRGs - Diagnostic Related Groups, using ICD-9-CM codes available in Appendix B (Surgical Discharge DRGs) and E (Medical Discharge DRGs).

  23. Excluded cases: • with ICD-9-CM code denoting technical difficulty (e.g., accidental cut, puncture, perforation, or laceration) in the principal diagnosis field; • MDC 14 (pregnancy, childbirth, and puerperium); • normal newborn (DRG 391); • Newborns with birth weight less than 500 grams, available in Appendix G: Low Birth Weight Categories. • Obtained denominator: 784820

  24. d) Divide the numerator by the denominator to obtain the final result. Final result: (779/ 784820) = 1,245 per 1000 Comparative Result from AHRQ (4):0,871 per 1000 (4). U.S. department of health and human services; AHRQ Quality Indicators Pediatric Quality Indicators Comparative Data for Provider Indicators [internet], USAgovernment; 2007, March; Available from: http://www.qualityindicators.ahrq.gov/downloads/pdi/pdi_provider_comparative_v31.pdf

  25. Chosen PDI’s

  26. Chosen PDI’s

  27. Chosen PDI’s

  28. Results

  29. Results were divided in: • Discharge Data: evaluation and comparison of the PDI’s along the years, from 2000 to 2005 • Tipe A: analysis by economic groups: • 1 • 2 • 3 • 4 • Tipe C: analysis by administrative division • 1 – Central Hospital • 2 – District Hospital • 3 – Distric Hospital of level 1 • Hospital reside :study includes the analysis of the variable “Hospital ID”, which means the values of Pediatric Quality Indicators were calculated to each Hospital and compared. Decrease of tecnology, complexity and specialisation

  30. PDI 1 - Accidental Puncture or Laceration PDI 1= 997 / 784820 = 1,245 per 1000 Rate per 1000 (AHRQ)= 0,871

  31. PDI 3 - Foreign Body left during procedure PDI 3 = 34 / 784810 = 0,043322588 per 1000 Rate per 1000 (AHRQ)= 0,034

  32. PDI 7 - Pediatric Heart Surgery Volume PDI 7 frequency = 118

  33. PDI 12 - Selected infection due to medical care Central Hospitals 8 7 6 5 ‰ 4 3 2 1 PDI 12 = 69 / 569861 = 0,12 per 1000 0 Rate per 1000 (AHRQ)= 2.677 2 6 24 54 88

  34. PDI 16 - Gastroenteritis admission rate PDI 16 frequency = 38469

  35. 5. Compare our PDIs results with the ones obtained in other studies

  36. There are studies that evaluate the Quality of Pediatric Services based on Pediatric Quality Indicators

  37. Investigation published by Sábado Magazine • Ranking of the best pediatric services in Pediatric Health care (5) (5). Sábado, 2007, December, Supl 188: 8-18.

  38. Methods used in the investigation

  39. Methods used in the investigation

  40. Methods used in Sábado Magazine

  41. Expected Results • Differences between results of litoral and inner country PDIs, being the litoral services the most developed. • Evolution of the PDIs from 2000 to 2005. • Similarites and differences between our results and the ones obtained by other studies.

  42. References • AHRQ: Agency for healthcare research and quality [Internet]. USA; Measures of Pediatric Health Care Quality Based on Hospital Administrative Data, The Pediatric Quality Indicators.2007 [about 1 screen] Available from: http://www.qualityindicators.ahrq.gov/downloads/pdi/ • IBIS-PH: Utah’s Indicator-Based Information System for Public Health [Internet]. Salt Lake City: Center for Health Data Utah Department of Health; Indicators Profile - Complete Indicator Profile of Ambulatory Care Sensitive Conditions: Asthma Hospital Discharges Among Children; November 2004. [about 9 screens]; Available from: http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=citmed.section.59530 • McDonald, K., Measures of Pediatric Health Care Quality Based on Hospital Administrative Data: The Pediatric Quality Indicators, 2006 February 20. 32 • U.S. department of health and human services; AHRQ Quality Indicators Pediatric Quality Indicators Comparative Data for Provider Indicators [internet], USAgovernment; 2007, March; Available from: http://www.qualityindicators.ahrq.gov/downloads/pdi/pdi_provider_comparative_v31.pdf, • Sábado, 2007, December, 188[suppl]: 8-18. 6. Costa C, Lopes S. Avaliação do Desempenho dos Hospitais Públicos em Portugal Continental – 2005. ENSP, 2007 (www.ensp.unl.pt).

More Related