Introdução à Medicina
2008/2009
Quality Indicators And
Healthcare
A First Step To The Evaluation Of A Hospital’s Performance
Authors
Ana Cristina Pereira
Ana Teresa Carapenha
Ana Rita Oliveira
André Vinha
Catarina Vieira
Eduardo Freitas
João Rebelo
Mariana Oliveira
Marli Cruz
Nuno Ribeiro
Paulo Guedes
Victoriano Costa
Quality Of Healthcare
The indicators are the source of information to evaluate the performance
of a hospital.
KIRKMAN, Jamie John, BOUAMRA, Omar , 2008.
Introdução à Medicina - Turma 10
Quality Of Healthcare
EDDY, David M., 1998
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Research Question and Main Aim
How did quality and performance indicators evolve through the
years in a central hospital?
Our main objective is to calculate these indicators concerning
different variables and to have a perspective of the performance of
the hospital in case.
Used data: episodes in a central hospital, between 1999 and 2008.
Introdução à Medicina - Turma 10
Specific Aims
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Obtained Results
Top ten DRGs with highest mortality
(****)
Deceased
Alive
Total
Respiratory disorder (except infections, bronchitis and asthma) with major CC (****)
1273
4263
5536
Other nervous system disorders (except transient ischemic attack , seizure and headache) with major CC
798
1922
2720
Septicemia with major CC
585
779
1364
Hepatobiliary and pancreas disorders with major CC
540
1709
2249
Respiratory neoplasms
537
1295
1832
Intracranial hemorrhage
527
1559
2086
Extracorporeal membrane oxygenation or tracheotomy with mechanical ventilation for more than 96 hours
or tracheotomy with pdx except face/mouth/neck dx
474
828
1302
Major stomach, oesophageal, duodenal, small and large bowel procedure with major CC
466
1100
1566
Simple pneumonia and pleurisy with CC (age >17)
457
3669
4126
Circulatory disorders with AMI, expired
436
0
436
CC: complications and commorbilities. (HCUP -3 Nationwide Inpatient Sample for 1994: Diagnosis-Related Groups: http://www.hcup-us.ahrq.gov/reports/natstats/94drga.htm#146)
Introdução à Medicina - Turma 10
Obtained Results
Top ten DRGs with highest intrinsic mortality
Alive (%)
Deceased (%)
Total (%)
Cardiac arrest, unexplained
25,0%
75,0%
100,0%
HIV with ventilator or nutritional support
42,4%
57,6%
100,0%
Tracheotomy for HIV infection
46,2%
53,8%
100,0%
Craniotomy for multiple significant trauma
46,5%
53,5%
100,0%
Neonate, birthweight between 1500-1999g, with significant OR procedure, without multiple major
problems
50,0%
50,0%
100,0%
Pneumocystosis
50,0%
50,0%
100,0%
HIV with OR procedure and ventilator or nutritional support
52,6%
47,4%
100,0%
Craniotomy for multiple significant trauma with non-traumatic major CC
56,4%
43,6%
100,0%
Septicemia with major CC
57,1%
42,9%
100,0%
Major skin and breast disorders with major CC
62,3%
37,7%
100,0%
Introdução à Medicina - Turma 10
Obtained Results
Deceased
Alive
Total
1273
4263
5536
798
1922
2720
585
540
537
527
779
1709
1295
1559
1364
2249
1832
2086
Extracorporeal membrane oxygenation or tracheotomy with mechanical ventilation for
more than 96 hours or tracheotomy with pdx except face/mouth/neck dx
474
828
1302
Major stomach, oesophageal, duodenal, small and large bowel procedure with major CC
466
1100
1566
Simple pneumonia and pleurisy with CC (age >17)
Circulatory disorders with AMI, expired
457
436
3669
0
4126
436
Respiratory disorder (except infections, bronchitis and asthma) with major CC
Other nervous system disorders (except transient ischemic attack , seizure and
headache) with major CC
Septicemia with major CC
Hepatobiliary and pancreas disorders with major CC
Respiratory neoplasms
Intracranial hemorrhage
Alive (%)
Deceased (%)
Total (%)
Cardiac arrest, unexplained
25,0%
75,0%
100,0%
HIV with ventilator or nutritional support
42,4%
57,6%
100,0%
Tracheotomy for HIV infection
46,2%
53,8%
100,0%
Craniotomy for multiple significant trauma
46,5%
53,5%
100,0%
Neonate, birthweight between 1500-1999g, with significant OR procedure, without multiple
major problems
50,0%
50,0%
100,0%
Pneumocystosis
50,0%
50,0%
100,0%
HIV with OR procedure and ventilator or nutritional support
52,6%
47,4%
100,0%
Craniotomy for multiple significant trauma with non-traumatic major CC
56,4%
43,6%
100,0%
Septicemia with major CC
57,1%
42,9%
100,0%
Major skin and breast disorders with major CC
62,3%
37,7%
100,0%
Introdução à Medicina - Turma 10
Obtained Results
Septicemia
 Full-body inflamatory state developed by microrganisms
 Can lead to multiple organ disfunction or death
• Moerer O, Quintel M. Sepsis in adult patients - definitions, epidemiology and economic aspects. Internist (Berl). 2009 May 14.
Introdução à Medicina - Turma 10
Obtained Results
400
Number of cases of septicemia with major CC
between 1999 and 2008
300
200
Number of cases
100
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Number of deaths caused by septicemia with
major CC between 1999 and 2008
120
100
80
60
40
20
0
Deceased
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
• Salive ME, Wallace RB, Ostfeld AM, Satterfield S, Havlik RJ. Risk factors for septicemia-associated mortality in older adults. Public Health Rep. 1993 Jul-Aug;108(4):447-53.
• Castellheim A, Brekke OL, Espevik T, Harboe M, Mollnes TE. Innate immune responses to danger signals in systemic inflammatory response syndrome and sepsis. Scand J Immunol. 2009
Jun;69(6):479-91.
Obtained Results
Mortality by year
5.0%
4.5%
4.0%
3.5%
3.0%
2.5%
2.0%
1.5%
1.0%
.5%
.0%
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Introdução à Medicina - Turma 10
Obtained Results
Mortality by gender through the years
7.0%
6.0%
5.0%
4.0%
male
female
3.0%
2.0%
1.0%
.0%
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
• Wingard DL. The sex differential in morbidity, mortality, and lifestyle. Annu Rev Public Health. 1984;5:433-58.
• Lang E, Arnold K, Kupfer P. Women live longer - biological, medical and sociologic causes. Z Gerontol. 1994 Jan-Feb;27(1):10-5.
• Waldron I. Sex differences in human mortality: the role of genetic factors. Soc Sci Med. 1983;17(6):321-33.
Introdução à Medicina - Turma 10
Obtained Results
Mortality by age group concerning the gender
35.0%
30.0%
25.0%
20.0%
male
female
15.0%
10.0%
5.0%
.0%
0-14
•
•
•
•
15-24
25-64
64+
Verbrugge LM. Sex differentials in health. Public Health Rep. 1982 Sep-Oct;97(5):417-37.
Waldron I. The contribution of smoking to sex differences in mortality. Public Health Rep. 1986 Mar-Apr;101(2):163-73.
Schneider, EL. Infectious diseases in the elderly. Annals of Nutrition & Metabolism 2000;44:256-262
Statistics Portugal: http://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_cont_inst&ine_smenu.boui=13918434&INST=53864&xlang=en
Introdução à Medicina - Turma 10
Obtained Results
Mean of length of stay
Mean of days
10
9
8
7
6
5
4
3
2
1
0
Year
• Johnson T, McNutt R, Odwazny R, Patel D, Baker S. Discrepancy between admission and discharge diagnoses as a predictor of hospital length of stay. J Hosp Med. 2009 Apr;4(4):234-9
• Thomas JW, Guire KE, Horvat GG. Is patient length of stay related to quality of care? Hosp Health Serv Adm. 1997 Winter;42(4):489-507
Introdução à Medicina - Turma 10
Obtained Results
Percentage of postponed surgeries relatively to surgical DRGs
5%
Postponed Surgeries
Performed surgeries
95%
Introdução à Medicina - Turma 10
Obtained Results
Postponed surgeries by reason
13%
11%
Contraindication
Patient's desire
Other reasons
76%
Introdução à Medicina - Turma 10
Obtained Results
Percentage of outpatient surgeries
6%
Outpatient surgeries
Other episodes
94%
Introdução à Medicina - Turma 10
Obtained Results
Number of outpatient surgeries through the years
5000
4500
4000
3500
3000
2500
2000
Outpatient episodes
1500
1000
500
0
• Portaria Série I nº 132/2009 – 30 de Janeiro
Introdução à Medicina - Turma 10
Obtained Results
Number of outpatient surgeries in comparison to the total number of
outpatient episodes through the years
5000
4500
4000
3500
3000
2500
Outpatient episodes
2000
Outpatient surgeries
1500
1000
500
0
• Portaria Série I nº 132/2009 – 30 de Janeiro
Introdução à Medicina - Turma 10
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Introdução à Medicina - Turma 10
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Introdução à Medicina - Turma 10
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• HCUP-3 Nationwide Inpatient Sample for 1994: Diagnosis-Related Groups. Available from: http://www.hcup-us.ahrq.gov/reports/natstats/94drga.htm#146.
• Moerer O, Quintel M. Sepsis in adult patients - definitions, epidemiology and economic aspects. Internist (Berl). 2009 May 14.
• Salive ME, Wallace RB, Ostfeld AM, Satterfield S, Havlik RJ. Risk factors for septicemia-associated mortality in older adults. Public Health Rep. 1993 JulAug;108(4):447-53.
• Castellheim A, Brekke OL, Espevik T, Harboe M, Mollnes TE. Innate immune responses to danger signals in systemic inflammatory response syndrome and sepsis.
Scand J Immunol. 2009 Jun;69(6):479-91.
Introdução à Medicina - Turma 10
References
• Wingard DL. The sex differential in morbidity, mortality, and lifestyle. Annu Rev Public Health. 1984;5:433-58.
• Lang E, Arnold K, Kupfer P. Women live longer - biological, medical and sociologic causes. Z Gerontol. 1994 Jan-Feb;27(1):10-5.
• Waldron I. Sex differences in human mortality: the role of genetic factors. Soc Sci Med. 1983;17(6):321-33.
• Verbrugge LM. Sex differentials in health. Public Health Rep. 1982 Sep-Oct;97(5):417-37.
• Waldron I. The contribution of smoking to sex differences in mortality. Public Health Rep. 1986 Mar-Apr;101(2):163-73.
• Schneider, EL. Infectious diseases in the elderly. Annals of Nutrition & Metabolism 2000;44:256-262.
• Sociedade Portuguesa de Cirurgias em Ambulatório: http://www.apca.com.pt/
• Ministério da Saúde : http://www.portaldasaude.pt/portal
• Johnson T, McNutt R, Odwazny R, Patel D, Baker S. Discrepancy between admission and discharge diagnoses as a predictor of hospital length of stay. J Hosp
Med. 2009 Apr;4(4):234-9
• Thomas JW, Guire KE, Horvat GG. Is patient length of stay related to quality of care? Hosp Health Serv Adm. 1997 Winter;42(4):489-507
• Portaria Série I nº 132/2009 – 30 de Janeiro
Introdução à Medicina - Turma 10