A-QUACH – alles wasserklar ?Improving Anesthesia QUAlity in Switzerland
Workshop vom 08.11.2018Prof. Dr. med. Michael Ganter
SGAR/SSAR Annual Meeting08 –10. November 2018, Interlaken
Agenda
Why A-QUACH ?Improving Anesthesia QUAlity in Switzerland
... to measure is to know –if you cannot measure it, you cannot improve it ...
Lord Kelvin (William Thomson) 1824-1907
Structuresetting in which care occurs
Ressourcespersonnel (FTE), beds, technology, materials, equipment, supply
Organizationfacility, rules, procedures
Quality indicators – types
Processwhat is actually done in giving
and receiving care
Patientactivities in seeking care and carrying it out
Practitionermaking the diagnosis andrecommending orimplementing treatment(incl. appropriateness)
Outcomethe effects of care on the health
status of patients andpopulations
Morbidity andmortality
Quality of life
Patient satisfaction
Donabedian A. The Quality of Care. JAMA 1988; 260:1743-48
A-QUACH – summary
Part A.
StructureData from institution"module 1"
1. Institution– setting and structure– summary of activities– staff requirements
Part B.
Process & OutcomeData from individual cases"module 2-5"
2. Activities– type of anesthesia or service, monitoring– procedure codes, discipline, location– time stamps, urgency, in-/outpatient
3. Pre-op risk4. Intra-op events5. Post-op events
Swiss Society of Anesthesiologists (SGAR/SSAR) http://www.sgar-ssar.ch/ - A-QUA
2015GV
ADS / A-QUACH – history
ADS AMDS
1996 1999 2014GV
A-QUACH
2016GV
ADS
laun
ch
SGAR
/SSA
Rsu
ppor
t
2007
AMD
Sla
unch
KDQ
,Pro
tec
AG
A-Q
UAla
unch
ADS
end
2011GV
Proj
ecti
nitia
tion
Proj
ect
2015
Part
A
WBS
man
dato
ry
2020/2
Part
B
WBS
man
dato
ry
today2012
Revi
sed
prog
ram
war
rant
ed
QM – part of the SGAR/SSAR-specific quality program, fulfilling criteria of the legal basis for quality assurance (Art. 58 KVG, Art. 77 KVV) Mapping – Swiss anesthesia development
over time on different levels Politics / health insurances etc. – basis and
tool for negotiations Research – database for longitudinal studies,
clarification of specific, scientific questions
A-QUACH – goals
http://www.sgar-ssar.ch/ - KDQ, A-QUA
A-QUACH is mandatory
A-QUA IS MANDATORYPart A – since 2016Part B – transitional period
1.1.2020 (1.1.2022)
PART A – A-QUACH
STRUCTURE – data from institution
Annual data entry (head of department), Q1 KDQ validation, clearance Free of charge Reports: Structured, Benchmark, XLS
http://www.sgar-ssar.ch/ - A-QUA and https://www.healthbase.ch/aqua/
Part A – Structuredata from institution
Part A – Structureparticipating institutions
60
65
70
75
80
85
90
95
100
2014 2015 2016 2017
inst
itutio
nsn=
99an
esth
esia
sn=
782'
344
Entered data report, example
Department xxx
Department xxx
...
Benchmarking
https://www.healthbase.ch/aqua/ - Report: Abteilung im Benchmark
Opt
ions
toch
oose
Benchmark report, example
all training centers (WBS) do ~500,000 anesthesia cases
Department xxx
https://www.healthbase.ch/aqua/ - Report: Abteilung im Benchmark
...
https://www.healthbase.ch/aqua/ - Report: Abteilung im Benchmark
https://www.healthbase.ch/aqua/ - Report: Abteilung im Benchmark
Detailed and structured report: numbers and graphsB Benchmark: Median (Minimum / Maximum)
PART B – A-QUACH
PROCESS & OUTCOME – data from individual cases
Continuous data acquisition (local/online) Data import into A-QUA, validation, clearance Costs per entered datasets Reports: Structured, Benchmark, XLS
http://www.sgar-ssar.ch/ - KDQ, A-QUA and https://www.healthbase.ch/aqua/
Part B – Process & Outcomedata from individual cases
ActivitiesAnesthesia (module 2a) – case by case201xx Case identification (InstID, PID, FID, LNR, DAN, DOB, SEX, LTYP1)
202xx In-/outpatient; Urgency
203xx Specialty
204xx Type of procedure (A-QUA Code)
205xx Location (procedure, post-anesthesia unit)
206xx Time stamps
207xx Type of anesthesia, anesthesia techniques
208xx Monitoring, additional techniques
Service (module 2b) – case by case or cumulative (new)201xx Case identification (InstID, PID, FID, LNR, DAN, DOB, SEX, LTYP2)
209xx Services
210xx Time stamps
Classification of urgency
Elective case, no urgency
• Interventions that can be scheduled ahead
Emergency 6-24h, not threatened vital (deferred urgent intervention )
• Non-vital emergency, requiring care within 24 hours
Emergency 1-6h, not threatened vital (urgent intervention )
• Non-vital emergency, but requires urgent care within 6 hours
Emergency <1h, threatened vital (immediate intervention necessary )
• Vital emergency requiring immediate care
Procedures
Main procedure (1)Secondary procedures (3)
to be coded by
A-QUA Codes (n=165) – Procedure groups– Well defined, standard
interventionshttp://www.sgar-ssar.ch/ - KDQ, A-QUA Codes
A-QUA Codes
Working principle Chapters (ex TARMED)
e.g. 06
Procedure group (Name) e.g. Code 0602: Diskushernien OP LWS, eine Etage (Standardeingriff)– Well defined, standard
intervention– Definition of procedure(s)
LWS Dekompression ein- oder beidseitig bei Discushernie, eine Etage, alleiniger Eingriff
– Key wordsDiscushernie, Fenestration, Hemilaminektomie, Laminotomie
– Surgical risk class = 3
Time stamps (A1-A12)
2014 (Version 1) firstpublished by SGAR / SSAR
2017 (Version 2) minimal adjustments due to revision of the «Deutsches Glossar perioperativer Prozesszeiten und Kennzahlen» (BDA/DGAI, BDC/DGCH, VOPM)available D, F, I
Association of Swiss hospitalshas adopted these definitions(REK 14_006)
Time stamps (A1-A12)mandatory for A-QUA, REKOLE
A = für A-QUA verpflichtendAnästhesie Betreuungszeit (A1-A12), Ein-Ausleitung (A2-A10), Schnitt-Naht (A7-A8)
R = für REKOLE® verpflichtend (REK® Entscheid 14_006)Empfehlungen der SGAR/SSAR bezüglich Interpretation der REKOLE Zeiten:• Anästhesie Betreuungszeit (Anästhesie Leistungszeit im OP Saal, AnLZ)
Beginn Anästhesiebetreuung (A1) bis Ende Anästhesiebetreuung (A12)• OP Saal-Zeit
Beginn op. Vorbereitung (nicht-ärztlich, Lagerung; A4) bis Saalausfahrt (A11)• Ärztlich chirurgische Leistungszeit (chLZ)
Beginn op. Vorbereitung (ärztlich, Desinfektion; A6) bis Ende op. Nachbereitung (A9)
Pre-op riskA-QUA module 3
Intra-op events (1)A-QUA module 4
Intra-op events (2)A-QUA module 4
Post-op events, 24h (1)A-QUA module 5
Post-op events, 24h (2)A-QUA module 5
Entered data report, example
...
DATA DELIVERY PART BI. Upload (XML) / II. Online / III. Cumulative
Upload formate: XML(Extensible Markup Language): file-upload or webservice
Interface specifications tobe ordered @[email protected]
I. UPLOAD (XML formate)of locally stored data, interface
XML file – example
Data validation
SGAR SSAR – A-QUACHRESTful A-QUA Webservice
R. Meier
RESTful A-QUA Webservice
SGAR SSAR – A-QUACH
Institution A-QUA Portal
KIS,PDMS
Internet
Webservice
Validierung Datenbank
Einzelne Anästhesie
(XML-Meldung)
Rückmeldung: Ok oderFehler
REST Webservice
SGAR SSAR – A-QUACH
Kann in den Anästhesie-Gesamtprozess integriert werden
Datenlieferung direkt nach Abschluss der Anästhesie-Dokumentation
Kein administrativer Zusatzaufwand für Export/Import
Aktueller Datenstand im A-QUA
II. ONLINE data entrycase by case online into A-QUA platform
https://www.healthbase.ch/aqua/portal/portalAqua/index.php
1. Configuration
2. Data entry
III. CUMULATIVE manual entryVar. 209xx (module 2b, Services)
https://www.healthbase.ch/
CONTRACTS AND COSTSHousekeeping
ID: secret, reproducible code
Data check
Ø FID, PID,BD,
LNR
De-personalisation, database
http://www.sgar-ssar.ch/ A-QUA – Basisdokumente A-QUA
Contract, data protection
+
http://www.sgar-ssar.ch/ A-QUA – Basisdokumente A-QUA
Part B – costs (degression)
SGAR/SSAR bezahlt jährliche Basiskosten und leistet zusätzliche Anschub-finanzierung (max. 20'000 CHF/y) bis 300’000 Datensätze/y eingehen Abteilungen bezahlen max. 31 RAPPEN pro Datensatz (Betriebskosten)Bsp. 10’000 Anästhesien/y jährliche Kosten max. 3’100 CHF
Presented at General Assembly SGAR/SSAR November 2015
FURTHER INFORMATIONSProgram A-QUA
Questions ? Contact us !
Further information
http://www.sgar-ssar.ch https://www.healthbase.ch/
-> Exhibition-> Workshop
... groups that understand their ownperformance are best positioned to improve it,
and can use this understanding to win andmaintain their service contracts ...
Richard P. Dutton, MD MBAOxford University Press 2016
Why measuring data ?
Measure and monitor your data !!!
Program A-QUA is ready The dataset and each variable is well defined Meaningful benchmarking becomes available
Why A-QUACH ?Improving Anesthesia QUAlity in Switzerland