1. Indicators for monitoring primary health care in Lithuania
Edita Bishop
Primary Health Care Cooordination Division
Personal Health Care Department
Stockholm,

2. Structure of primary health care (PHC)
Family medicine
Primary mental health care
Primary dental health care

3. Indicators for monitoring PHC
Direct indicators
Good performance indicators
(bonus payment – 12 indicators: 10 in family medicine,
1 in primary mental care,
1 in primary dental care)
Good performance indicators (no bonus payment at present – indicators)
Other indicators
Certain promotional services (payment conditions – achieved result)
Indicators for evaluation of cardiovascular disease preventive programme
Children immunization rates
Avoidable hospitalization rates

4. Good performance indicators (bonus payment in family medicine)
1. Intensity of children care
2. Intensity of adult care
Calculation
Ratio of number of children (<18 y.) / adults who visited the family physician at least once per year with total number of registered children / adults per year
Visits to primary mental care specialist and primary dental care specialist are not included
Aim – to encourage children and adult care and to promote that a child / adult shall visit the family physician at least once per year

5. Good performance indicators (bonus payment in family medicine)
3. Intensity of children prophylactic examinations
Calculation
Ratio of number of children (<18 y.) in whom prophylactic check-up according to procedure approved by the Minister of Health was performed at least once per year with total number of registered children
Aim – to ensure that all children could undergo prophylactic check-ups in order to diagnose possible diseases as soon as possible

6. Good performance indicators (bonus payment in family medicine)
Performance of cancer preventive programmes:
4. Cervical cancer
5. Prostate cancer
6. Breast cancer
7. Colorectal cancer
Calculation
Ratio of number of patients in whom test taking and evaluation were performed (cytological smear test / blood test for prostate-specific antigen (PSA) / test for occult bleeding) or who were referred for mammography with total number of eligible patients for each programme per determined period
Aim – to promote
performance of cancer
preventive programmes

7. Good performance indicators (bonus payment in family medicine)
Hospitalization of patients with chronic diseases:
8. Arterial hypertension
9. Diabetes
10. Asthma
Calculation
Ratio of number of hospitalization cases due to the chronic disease (arterial hypertension / diabetes/ asthma) with total number of registered patients having that chronic disease per year
Aim – to improve out-patient
care of patients suffering from
chronic diseases and reduce
unnecessary hospital admissions

8. Good performance indicators (bonus payment in primary mental care)
11. Hospitalization of patients with schizophrenia
Calculation
Ratio of number patients hospitalized due to schizophrenia with total number of registered patients having that disease per year
Aim – to improve out-patient
care of patients suffering from
schizophrenia

9. Good performance indicators (bonus payment in primary dental care)
12. Intensity of prophylactic dental screening in children
Calculation
Ratio of number children (<18 y.) in whom prophylactic dental screening was performed at least once per year with total number of registered children per year
Aim – to promote intensity of
children dental screening

10. Evaluation of good performance indicators and bonus payment
Calculated by National health insurance fund under the Ministry of Health
Half-yearly for each PHC institution
Expressed in national units
Sum of notional units is multiplied by the annual average of registered patients (for each PHC institution)
Financial value of one notional unit is received by dividing the amount of money dedicated for payment for good performance results divided from the total number of notional units (of all PHC institutions)
The sum of money for each PHC institution is received by multiplication of financial value of one notional unit by the total number of notional units for each PHC institution
The sum of money is paid in equall parts over 6 months

11. Good performance indicators in 2008–2015 y
Good performance indicators in 2008–2015 y. Intensity of care and performance of preventive programmes

12. Good performance indicators in 2008–2015 y
Good performance indicators in 2008–2015 y. Hospitalization of patients with chronic diseases %

13. Good performance indicators in 2008–2015 y
Good performance indicators in 2008–2015 y. Intensity of prophylactic dental screening in children
Bonus payment since January 2014

14. Good performance indicators (no bonus payment)
1. Hospitalization of patients with chronic obstructive pulmonary disease
Ratio of number of hospitalization cases due to COPD with total number of registered patients having COPD per year
Number of specialist consultations for patients with chronic diseases:
2. Arterial hypertension
3. Diabetes
4. Asthma
5. COPD
Ratio of number of specialist consultations due to the chronic disease (arterial hypertension / diabetes/ asthma / COPD) with total number of registered patients having that chronic disease per year
Not calculated by the National Health Insurance Fund

15. Certain promotional services
Certain promotional services are paid only if result is achieved
1. Early diagnosis of malignant tumours
When family physian or primary dentist suspects malignant tumour in situ or of the 1st stage, refers patient for further examination and the diagnosis is confirmed
2. Cure of patient with tuberculosis
If bacteriological tests (microbiology, culture) during the last 2 months of treatment course are negative (in case of multi-drug resistance – 3 months)
3. Preparing child to school (service provided by primary dentist and nurse)
If child‘s teeth are healthy or cured

16. Cardiovascular disease preventive programme Integration of personal and public health care
Health promotion programme for patients identified as having risk for cardiovascular diseases
Started in
Organized by Municipal Public Health Office specialists
Voluntary, free for patients
Lectures, discussions, demonstrations, case studies, practical teaching
Specialists: cardiologist, family physician, psychologist, dietitian, physical therapist, public health specialist, others if needed
Duration: 16 teaching meetings (~ twice a week)
Control meetings after 3 months and 1 year from the commencement
Biochemistry tests at the commencement and after 1 year
Health indicators (physical, circulatory, biochemical, lifestyle) improved in ~68% of participants
From the Programme will also include patients identified as having risk for diabetes

17. Indicators for evaluation of Health promotion programme
Start
After 3 months
After 1 year 1.
Body weight (kg) √ 2.
Body mass index 3.
Waist circumference (cm) 4.
Seated pulse rate (beats/min) 5.
Blood pressure (mmHg) - 6.
Serum cholesterol (total, mmol/l) 7.
Low-density lipoprotein cholesterol (mmol/l) 8.
High-density lipoprotein cholesterol (mmol/l) 9.
Serum triglycerides (mmol/l)
10.
Fasting glucose (mmol/l)
11.
Changes in patient lifestyle (physical activity, vegetable and fruit consumption, salt, fat food, sugar consumption, smoking habits, alcohol consumption) and general feeling

18. Children immunization calendar
Children immunization calendar approved by the order of the Minister of Health
Immunization for
<24 h
2-3 d
1 mo
2 mo
4 mo
6 mo
12-15 mo
15-16 mo
18mo
6-7 y
11y
15-16 y
Tubeclulosis √
Hepatitis B
Pertussis, diphtheria, tetanus
Haemophilus influenzae type B
Poliomyelitis
Pneumococcus
Measles, mumps, rubella
Human papilloma virus (in girls)

19. Children <2 years immunization rates
Aim - to maintain the immunization rates of no less than % across the country and in each municipality

20. Avoidable hospitalization rates
23 indicators
Calculated yearly for each municipality (60 municipalities)
Children <1 year of age are not included in calculation
Calculated by Hygiene Institute since 2012 y., methodology approved by the order of the Minister of Health in May 2015
Based on the methodology applied in Australia

21. Avoidable hospitalization rates per 1000 of population
Pneumonia (J13, J14, J15.4, J15.7, J15.9, J16.8, J18.1, J18.8, J18.9 – all cases, exception – comorbidity with D57)
2012 y.
2013 y.
2014 y.
2015 y. 1.
Due to pneumonia, age 1-17 y.
7,46
7,36
6,41
6,67 2.
age y.
3,19
3,4
2,85
3,12 3.
age 65+ y.
20,17
23,64
22,11
23,52
Asthma (J45, J46 – all cases)
2012 y.
2013 y.
2014 y.
2015 y. 4.
Due to asthma, age 1-17 y.
3,4 3
3,1
2,96 5.
age y.
0,38
0,39
0,34
0,31 6.
age 65+ y.
1,9
1,91
1,69
1,74
Congestive heart failure (I50, I11.0, exception – certain health interventions (51))
2012 y.
2013 y.
2014 y.
2015 y. 7.
Due to congestive heart failure, age y.
2,45 2
1,79
1,57 8.
age 65+ y.
31,61
29,74
29,83
28,43

22. Avoidable hospitalization rates per 1000 of population
Diabetes and its complications (E10, E11 – all cases and comorbidity with certain diseases)
2012 y.
2013 y.
2014 y.
2015 y. 9.
Due to diabetes and its complications, age 18+ y.
7,83
7,17
6,79
6,94
10.
type 1, age y.
0,93
0,87
0,82
0,83
11.
type 2, age y.,
2,98
2,63
2,51
2,52
12.
age 65+ y.
20,99
19,39
18,17
18,52
Chronic obstructive pulmonary disease (J41–J44, J47 – all cases and underlying with J20)
2012 y.
2013 y.
2014 y.
2015 y.
13.
Due to COPD, age 1-17 y.
1,92
2,3
3,01
3,39
14.
age y.
0,9
0,93
0,77
0,8
15.
age 65+ y.
10,79
10,92
9,56
9,96
Angina pectoris (I20, I24.0, I24.8, I24.9, exception – certain health interventions)
2012 y.
2013 y.
2014 y.
2015 y.
16.
Due to angina pectoris, age y.
2,77
2,15
1,78
1,52
17.
age 65+ y.
23,7
21,39
18,48
17,51

23. Avoidable hospitalization rates per 1000 of population
Hypertension (I10, I11.9, exception – certain health interventions (51))
2012 y.
2013 y.
2014 y.
2015 y.
18.
Due to hypertension, age y.
1,55
1,33
1,4
1,32
19.
age 65+ y.
5,44
4,64
5,23
5,09
Pyelonephritis (N10–N12, N13.6, N39.0 – all cases)
2012 y.
2013 y.
2014 y.
2015 y.
20.
Due to pyelonephritis, age 1-17 y.
3,13
3,18
3,37
3,28
21.
age y.
1,16
1,15
1,13
22.
age 65+ y.
4,45
4,89
5,91
6,24
Ear, nose, throat infections (H66, H67, J02, J03, J06, J10, J11, J31.2, exception - comorbidity of J10, J11 with D57)
2012 y.
2013 y.
2014 y.
2015 y.
23.
Due to ear, nose, throat infections, age 1-17 y. 17
23,11
20,22
20,44

24. Thank You For Your Attention