Evaluating HealthCare Service(rev).pptx

7/30/2019 Evaluating HealthCare Service(rev).pptx

1/29

Evaluating HealthCareService

Public Health Department, Medical Faculty Brawijaya

University


2/29

SolutionGeneration

ResourceMobilisation

ImplementationImpact

Assesment

Intermediate &Outcome

assesment

ProblemDefinition

Impact

evaluation

Where is the place of Evaluation


3/29

Evaluation Benefit


4/29

The Impact of Evaluation on

Finance

Process of careCost Impact

Positive Negative

Hospital Wide

Nosocomial Infection

Rate

No Infection

Short LOS

Infection

Long LOS

High Risk environment

(cardiac surgery)

Operating Room

Intensive Care Unit

No Complication

Short LOS

No Complication

Minimal Use

Complication

Long LOS

Reoperation

High Consumption

Medication Delivery Minimal Use High Consumption

LOS : Length of Stay


5/29

The Impact of Evaluation on Health

Status70 Million Americans Benefit from Quality Measurement 96% of heart attack victims were

prescribed beta-blocker treatment in

2005, up from 62% in 1996*

77.7% of children enrolled in private

health plans received all

recommended immunizations, up 5%

from 72.5% in 2004*

Evidence-based guidelines from the

American College of Cardiology andthe American Heart Association have

reduced mortality among patients

who have had a heart attack

*National Committee for Quality Assurance in US


6/29

Evidence Based Medicine (EBM)(Example of Global Evaluation on Medical

Treatment)

The

integration of individual clinicalexpertise with the bestavailable

clinical evidence from systematic

research. David L Sackett, W Scott Richardson, William

Rosenberg, R BrianHaynes Evidence Based

Medicine--How to Practice and Teach EBM, 1996


7/29

Uses of EBM

Use of empirically-verified treatments

in the care of patients

Incorporation of research results intothe process of care

Ability to critically appraise research

results


8/29

Motivation: EBM Successes

Theophylline and asthma

We were doing the wrong thing

Littenberg, 1988

Beta blockers and Myocardial Infarcts

We werent doing the right thing

Yusuf, 1987
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3278146&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2887096&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2887096&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3278146&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3278146&dopt=Abstract


9/29

Levels of Evidences

(I-1) a well done systematic review of 2 or moreRCTs

(I-2) a RCT

(II-1) a cohort study (II-2) a case-control study

(II-3) a dramatic uncontrolled experiment

(III) respected authorities, expert committees, etc..

(IV) ...someone once told me....

Note : RCT = Randomized Control Trial


10/29

What to measure (evaluate)

If We can not measure, we can not

manage


11/29

Who Is the Healthiest One?


12/29

Physical Social

Environment Human Biology Life Style/Behavior Risk Factors Health Care System

Determinants of Health

Subjective Health Mortality Morbidity Injury MCH/Others

Health Status

Quality of Life Health Service Utilization Use of Medication Others

Consequences of Health

Health Model


13/29

How To Measure Health?

(Community Approach) Mortality-based measures

Crude mortality

Age-specific mortality

Age adjusted mortality

Leading causes of deaths

Life expectancy

Years of potential life lost (YPLL)


14/29

How To Measure Health?

Morbidity and injury

Risk behavioral factors

Social and cultural influence

Genetic factors


15/29

What to Measure ? (1)

Leadership defines priorities byanswering such questions as these :

What aspects of the organization are

critical to its succeed What expenses are most and least

profitable

How can exelent patient outcomes be

achieved efficiently and aconomically

What variables influence patient

satisfaction ?


16/29


Developing a Performance

Improvement Plan (Remember PDCA

Cycle) Plan

Do

Check

Act


17/29


Monitoring Variation from the standard

BOR,LOS,BTO,GDR,NDR

f Q


18/29

The concept of Quality in Health

Care (HealthCare Organization

Approach) Structure (input), process, outcome

Quality Domains: effectiveness,responsiveness .

Quality of services versus quality ofsystems

Health care helps individuals andpopulations to realize their potentialhealth

Quality relates to compliance of practiceswith evidence

Quality relates to health outcomes


19/29

Source: Arah OA, et al. A conceptural framework

for the OECD Health Care Quality Indicators

Project.Int J Quality Health Care. 2006; Sep 18;

Suppl.1:5-13.


20/29

The Key of Evaluation is Data

Data Sources

Administrative DataDemographics, Diagnosis, Treatment,

Medication, Laboratory, Mortality/morbidity,

etc

Primary DataAdverse outcomes, inpatient indicators,

infection control,APACHE for ICU,Medical records,etc

Data

Warehouse(Storing and

Organize Data)

Data

Analyses

* APACHE : Acute Physiology, age, and Chronic Health Evaluation)


21/29

Regular data Collection

Outcome Measures Implementation Measures

Initial Indicator Set

Breast Cancer Survival Mammography ScreeningCervical Cancer Survival Cervical Cancer Screening

Colorectal Cancer Survival Coverage for basic vaccinationAsthma mortality rate Waiting time for femur fracture surgeryAMI 30-day case fatality rate Influenza vaccination for adults over 65Stroke 30-day case fatality rate Smoking ratesIncidence of Vaccine Preventable Diseases

Additional Indicator Set (in 2006 collection)Lower extremity amputation rates for

diabetics

Annual eye examination for diabetics

Transfusion reaction ratePostoperative hip fracture rate

Uncontrolled diabetes admission rate

Adult asthma admission rate

Hypertension admission rate


22/29

Benign Prostate Hypertrophy

Health Status Indicator: Functional status: dysuria

Health Determinants:

Age

Sex

Other risk factor

Impact of BPH or treatment of BPH: Sexual dysfunction


23/29

BPH-community

Health Status: Morbidity: incidence or prevalence

Disability

Health Determinants:Age specific morbidity

Health Impact


24/29

Hospital Care Evaluation for

BPH Input:

Characteristic of patient

Provider skill

Standard of facility

Process: Waiting time in outpatient service

Operation waiting time

Readmission to OT

Output: Healing time

Impact: Quality of life including sexual life


25/29


26/29


27/29

Example : ICU Data Collected by

System Hospitals

Indicators 2003 2004 2005

Number of admissions

ICU LOS

Number of mortalities

Number of ventilated patients

Number of readmission within

72 hours

Number of low-risk patients

(based on APCHE score)


28/29

Example : Calculating the Impact

of Sedation on Patient Falls

Quality Measure = Event / Oppurtunity

= Numerator (N) / Denominator (D)

N = Number of Sedated Patients who Fell

D = Total Number of Patient Falls

Opportunity

Event


29/29

Medicine used to be simple,ineffective and relatively safe.Now it is complex, effective andpotentially dangerous.

Sir Cyril Chantler, former Dean

Guys, King and St. Thomass Medical

and Dental School, Lancet 1999

Documents

Evaluating HealthCare Service(rev).pptx