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 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/ 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

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 - questionnaire B.2.2: Number of canceled elective operations 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 B.3.7: Deaths in hospital after planned hospitalization before operation B.3.8: Deaths after hip joint replacement

Quality indicators for hospital care III. Patient safety: B.4.1: Nosocomial infections in health care 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– 913 Results 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 collected questionnaires more than 40% recoverability overall index for every health care facility interval – lowest satisfaction 100 – highest satisfaction minmax 77,2194,51

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

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