Meeting with EG PHC 2016-10-21 Ev. underrubrik Förnamn Efternamn

Indicator Based Evaluations of National Guidelines

Our model to develop good healthcare and social services Problem analysis Common terms and information structure Best available knowledge Results Good healthcare and social services for the entire population Guidelines Recommen- dations Indicators Targets Statistics Follow up Evaluation Regulations Healthcare and social services at local and regional level The model for developing good health, healthcare and social services

Aim of National Guidelines Indicate the benefits and risks of different interventions to support evidence-based practice in health care Support professionals in prioritizing the most appropriate interventions for those with the greatest need Contribute to efficient use of health care resources, distributed according to need, and governed by systematic and transparent priority setting.

National Guidelines consist of: Support for governance and management Key recommendations Assessments of the recommendations’ financial and organizational consequences A list of conditions and interventions for all recommendations Indicators and target levels (follow-up tools) Evidence base Published on the NBHW’s website

Indicators

Indicators Based on key recommendations in the National Guidelines Used for: Assessments of compliance to National Guidelines As tools for performance assessments Monitoring and evaluating processes and outcome of care over time Improving quality and efficiency of health care and social services

Types of indicators Organizational indicators – reflect conditions E.g. number of available specialized diabetes nurses per patient Process indicators – reflect ”what, when, how and why” E.g. proportion of patients that receive counseling for smoking cessation Outcome indicators – reflect results E.g. proportion of patients that quit smoking following counseling for smoking cessation

Formulation of an indicator – example Diabetes care Wanted: Proportion of diabetes patients with a blood pressure < 140/85 mmHg Numerator: Number of patients with diabetes registered in the National Diabetes registry with a blood pressure < 140/85 mmHg Denominator: Total number of patients with diabetes with registered blood pressure values in the National Diabetes registry

Target levels

Target levels for indicators in National Guidelines Important tool for quality improvement Indicate the proportion of a particular patient group that ought to be subject to a specific recommended treatment or intervention County councils and municipalities are expected to work towards reaching the targets

Determination of target levels A standardised procedure is used Expert committee needed to draft a proposal Ask for opinions among stakeholders: Head of councils Patient organisations Health care professionals Experts, specialists Others Decision by the National Board for Health and Welfare

For BP in Type 1 diabetes patients Target level set to ≥ 90 procent Target level ≥ 90% Blood pressure < 140/85 mmHg, Type 1 diabetes Proportion of persons with Type 1 diabetes with a blood pressure < 140/85 Source: National Diabetes Register 2019-11-09

Performance assessment

Performance assessments To improve the quality and the efficiency of health care and social services To assess equality of care with the aim to monitor if patients receive good quality care regardless of their geographic location, gender, age, educational level and country of origin Tools: National Guideline indicators and target levels

The performance assessment suggests that… Considerable variation Large gap between actual and optimal level of care Target level ≥ 90% Blood pressure < 140/85 mmHg, Type 1 diabetes Proportion of persons with Type 1 diabetes with a blood pressure < 140/85 Source: National Diabetes Register 2019-11-09

The recommendation issued to the health services Health care and medical services can improve the diabetes care by: Reducing the proportion of patients with type 1 and type 2 diabetes that have a blood pressure over 140/85 mmHg 2019-11-09

Available performance assessments 2009 2010 2011 2013 2014 2015 Available assessments Cardiac care (av. in English, 2009) Breast, prostate or colorectal cancer Musculoskeletal diseases, (av. in English, 2014) Asthma and COPD Diabetes (av. in English, 2012) Psychiatric diseases Dental care Stroke (av. in English, 2011) Depression, anxiety and schizophrenia Dementia Disease prevention Ongoing Cardiac care up(date) Lung cancer Palliative care MS and Parkinson's disease Currently 11 performance assessments available 4 more ongoing Ambition to update the assessments within 2-4 years

Aim of the workshop - Follow up Share information on methods and indicators used in partner countries - What, why and how we measure PHC Find out similarities and differences between our countries as a basis for coming discussions Find out opportunities to learn from each other and to develop methods and tools together Inspire a discussion on how EG PHC can support primary health care in the Nordic Dimension. x/x/20xx

Template for primary health indicators Bildtext