Post on 01-Apr-2015
transcript
Creating and using Performance Indicators
inDutch Hospitals
Jan Haeck
Dutch Health Supervisory
OECD 1
Outcome is pivotal!
OECD 2
An indicator is a signal; further investigation is mandatory
OECD 3
IntentionsHealth authority Patientsafety
Effectiveness Appropriateness
Hospital Accountability; TransparencyQuality-improvement
Patient ChoiceQuality-assurance
Healthinsurance Value for money
World Health Care Congress 1
OECD 4
Selection criteria
• Feasibility• Focus on hospital care• Clinical relevance• Frequent manifestation• Obvious and rapid improvement of quality
outcome
OECD 5
….All Dutch hospitals participate
….All data are publicly available
....Hospitals present data and their interpretation on www
.... Annualy maximal 25% of the set will be renewed
IMPORTANT CONDITIONS
OECD 6
!
The Set: External Indicators
Internal Indicators
Clinical Scientific Societies
oecd 7
0,0
5,0
10,0
15,0
20,0
25,0
1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65
hospitals
perc
en
tag
e
0
5
10
15
20
25
30
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67
hospitals
per
cen
tag
e
2004
2003
6%
11%
Annual pressure-ulcer point-prevalence
measurement
oecd 8
Results Set Performance
Indicators
+
Results specific inspections
Annual meeting with the executive
board
Disciplinary measures(if necessary)
oecd 9
0
20
40
60
80
100
120
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55
Hospitals
Per
cen
tag
e
2003 (78%)
2004 (79%)
Percentage of patients to get surgery after a hip fracture within
24 hours
0
20
40
60
80
100
120
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61
Hospitals
Per
cen
tag
e
oecd 10
0102030405060708090
100
pa
inse
rvic
e
inte
gra
ted
dia
be
tesc
are
he
art
failu
reo
utp
atie
ntc
linic
stro
kese
rvic
e
bre
ast
can
cer
ou
tpa
tien
tclin
ic
ho
sp
ita
ls (
%) service available in
2003service available in2004data available in 2003
data available in 2004
Innovations in quality2003/2004
oecd 11
2004
6514
20
6
known
unknown
no answer
not applicable
2003
36
49
14
6
Data available about readmissions for heartfailure within 12 weeks after
discharge
(number of hospitals)
oecd 12
25
20
50
2
all patients
selected patients
no
no answer
85
15
3 2
73
25
5 2
2003
2004Data available for standardized pain
measurement within 72 hours postoperative
(number of hospitals) Recovery room
All hospital wards
oecd 14
0
10
20
30
40
50
60
70
80
90
1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89
hospitals
num
ber o
f OC
R p
roce
dure
s
0
10
20
30
40
50
60
70
80
90
1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89
Hospitals
Nu
mb
er o
f O
CR
pro
ced
ure
s
2003
2004
Oesophagus-cardia resectie
oecd 16
0
2
4
6
8
10
12
Ave
rag
e ve
nti
lati
on
per
iod
in
day
s
level 3 level 2 level 1
2003
oecd 18
Conclusions
Health authority Supervision only in risk-bearing hospitals
Hospital More data; improved quality of care; 100% transparent; guidelines by professionals
Patient Safety indicators; choice because of transparency
Health insurance Value for money (yet to be proven)
oecd 20
Perverse effects?
• 'gaming the numbers‘• Increase in bureaucracy: • An obstacle for innovations and ambitions• A decrease in solidarity between hospitals
oecd 21
Thank you
Oecd 22