1. Quality of health care Ilembula Lutheran Hospital 21.02.2014 Arto Vehviläinen MD, PhD

2. Quality of health care  Definition of health  Definition of quality of health care  How to messure quality of health care  Problems  Conclusion 2

3. Definition of health, WHO:  The main determinants of health include:  the social and  economic environment,  the physical environment, and  the person's individual characteristics and  behaviors. 3

4. Determinants of health  Income and social status  Social support networks  Education and literacy  Employment/working conditions  Social environments  Physical environments  Personal health practices and coping skills  Healthy child development  Biology and genetics  Health care services  Gender  Culture 4

5. Definition of quality of health care: Health gain  Health gain is health increase which can be mesured for one person or for whole population consisting both the length of life and also the quality of life. 5

6. Definition of quality of health care: Health benefit  Health benefit is such thing that can be shown to produce benefit as lowering costs or increasing health. 6

7. Definition of quality of health care: Health value  Health value is that extra for him what he/she gets from health and well being services 7

8. HOW TO MESURE QUALITY OF HEALTH CARE?  Potential years of life lost (PYLL)  Death rates  According disease (incidence)  Utility: quality of life (15d)  From utility: QALY-units (quality of life and length of life)  Costs/QALY 8

9. 1. Potential Years of Life Lost ( PYLL ) = Life lost due to preventable premature deaths Birth Expected life = 70 years 2. ___________________________________________________> Age at Death = 50 years PYLL <- 70 – 50 = 20 years/person 3. 28 preventable causes of death by WHO PYLL/100 000 citizens age-standardized 9 PYLL

10. 10 PYLL in Finland

11. 11 PYLL: SUICIDES IN FINLAND

12. 12 PYLL, SUICADES Northern Savo

13. 13 PYLL

14. 0 1 00 1 1 0,7 0,8 Before care After care After 10 years Benefit of care 0,8 – 0,7 = 0,1 Benefit during 10 years 0,1 x 10v = 1 QALY Operation 14 QALY 15 D  Utility: quality of life (15d)  From utility: QALY-units (quality of life and length of life)  Costs/QALY

15. Quality of health care  Efficancy, RCT-studies :Can it work?  Effectiveness in real life : Does it work?  Cost-Effectiveness : Is it worth of it?  Feasibility : Does it reach all those who need it? Is it really in use? EBM Policy Audit Development 15

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17. Effectiveness of care Difficulty of disease Not serious diseases Most serious disease 17 Problem of health care

18. comes better 0 comes worse Problem of health care € patientdecils (10%) costs Benefit of care is normally devided, mean zero or little toward + Costs of care are not same. Some costs are enourmous, most are cheap 18

19. PROBLEMS Increase of medicine Ageing Not enough money. Not enough staff. Staff does not have enough strength. Increase of side effects. USA: 44 000 – 98 000 deaths/year. It is impossible to respond to expectations of population It is difficult to master knowledge. Service is still slow Discrepance Expectations of population 19

20. Problem:Social- and health care duties  Social work  Dispensary for behavior and family  Home care  Service for living  Chronic disease department care  Family care  Support for relatives care  Children and young care  Day care for children  Alcoholist care  Specialist care for retarded  Handicap care  Work rehabilisation  Health education  Hospital care and rehabilisation  First aid and ambulace services  Dental care  School health care  Health care for students  Screenings  Occupational health  Environment health care  Mental care services  Specialist care  On call duty services 24h  Bypass operation for brain  Transplantation services  Care for certain malformations  Oxygen care  Demanding first aid (helicopters)  Coordination and developement of mental health work  Coordination and developement of drug addiction  Examination and care for sexually abused  Care and examination for alcohol addict pregnant women  Services connecting research, development and education 20

21. Effectiveness of care Difficulty of disease Not serious diseases Most serious diseases ILH 21

22. Determinants of health  Income and social status  Social support networks  Education and literacy  Employment/working conditions  Social environments  Physical environments  Personal health practices and coping skills  Healthy child development  Biology and genetics  Health care services  Gender  Culture 22

23. ASANTE! 23