1. T HE I MPLICATIONS FOR M EASUREMENTS OF H EALTHCARE T HE W AY F ORWARD : T HE C ZECH C ASE Petr Tůma 05.03.2009 Prague

2. W HICH QUALITY AND PERFORMANCE INDICATORS ARE MEASURED Performance indicators only - based on IR-DRGs data Quality indicators tested, but not used - based on AHRQ 1) Inpatient Mortality Indicators - based on AHRQ ACSC 2) Indicators Quality indicators proposed, but not tested, not used - based on PQRI 3) Process Indicators 1) AHRQ = the Agency for Health Care and Research Quality 2) ACSC = Ambulatory Care Sensitive Conditions 3) PQRI = Physician Quality Reporting Initiative

3. C URRENTLY A CCESSIBLE I NTERNET S ITES South Bohemia Region Hospitals Comparison (Reg-SB) http://www.zebricky.cz/ http://www.zebricky.cz/ Vysočina Region Hospitals Comparison (Reg-VYS) http://www.zdravi- vysociny.cz/cz/Content/HtmlPage.aspx?folderid=27 http://www.zdravi- vysociny.cz/cz/Content/HtmlPage.aspx?folderid=27 National Reference Centre - „Jak se kde léčí“ 1) (NRC-1) http://www.jaksekdeleci.cz/vitejte.php http://www.jaksekdeleci.cz/vitejte.php National Reference Centre - „BRIX“ (NRC-2) http://brix.nrc.cz/BRIX/faces/pages/login.jsphttp://brix.nrc.cz/BRIX/faces/pages/login.jsp 1) „How the Health Care is Delivered“

4. CZ I NTERNET S ITES C HARACTERISTICS

5. H OW IS DATA COLLECTED ; H OW IS DATA PROCESSED Administrative data only Routine payment claim (Health Insurance Companies bills) Data is processed by IR-DRG grouper Measures: - patients number - ALOS - mortality rates - complexity level (severity level) -...

6. CZ DATA & MEASURES CHARACTERISTICS CZ administrative data is very rich in details of poor quality (especially ICD-10 coding) not audited Measures are not standardised not labelled with simple language

7. H OW ARE THE RESULTS PUBLISHED ( WHAT IS ACCESSIBLE FOR EXPERTS, WHAT IS AVAILABLE FOR GENERAL PUBLIC ) All three sites (Reg-SB; Reg-VYS; NRC-1) are - available for general public - difficult to understand for general public (due to IR-DRG complexity and terminology) The utility for general public was not tested The utility for professionals was not evaluated

8. K EY LESSONS LEARNED With the exception of an early interest of media, the general reaction both of professionals and general public is silence and indifference IR-DRG is not suitable basis for measures aimed at general public Measures often does not demonstrate the difference in performance but the difference of coding routine The need of data set innovation and a new Procedure Classification System adoption is unconditional

9. N EXT STEPS - EXPECTED DEVELOPMENT AND RECOMMENDATIONS Suggestions: Adoption of process quality indicators => Additional data collection => Clinical guidelines improvement Larger involvement of clinicians The utility enhancement for general public via adoption of the AHRQ/ National Quality Forum „Guidelines for Consumer-focused Public Reporting“ www.qualityforum.org www.qualityforum.org Individual QI indicators grouped into categories rather then „QI composites“