Download Slides SINAS UA/ICBAS

SINAS
The National System of Health Quality
Assessment
Álvaro Moreira da Silva
Board of Direction ERS
Porto, 08 May 2014
Outline
1. Framework for assessing global quality
2. SINAS@Hospitais (Hospitals)
3. SINAS@Saúde.Oral (Dental Care)
Legal framework
ERS have a legal obligation to develop an evaluation
system, which aims to assess health care providers in
terms of global quality of services
The National System of Health Quality Assessment
SINAS
 Inform patients on quality of health care services
 Encourage continuous improvement in the quality of
health care services
SINAS: Assessment model
 Rating System
 Voluntary collaboration of health care providers
 Data are collected in different formats, which result
in the classification of each establishment
 ERS conducts audits of randomly selected
establishments, in order to validate the information
submitted
Global Quality Assessment
 Quality in health care:
 No consensus on a closed form definition
 Conceptualizations of quality depend on how broad is
the model of care considered (e.g, just medical care
or nursing care included?)
 Health care services includes more than just health
care
 Multidimensional approach needed
SINAS framework
 Modularity of the SINAS project:
 Type of health care provider (“SINAS modules”)
 Quality dimensions
SINAS@Hospitais
SINAS@Saúde.Oral
Clinical Excellence
Registration and licensing
Patient Safety
Organization and Procedures
Comfort of facilities
Patient Safety
Patient Focus
Comfort of Facilities
Patient Satisfaction
Patient Satisfaction
Methodologies
 Specificities
 Quality dimensions being assessed are type-ofprovider-specific
 Methodologies
for
quality
assessment
are
dimension-specific
 Technical coherence (same methodologies for
similar indicators)
 Methodologies for performance measurement
 Methodologies for producing ratings
Assessment scheme: stars and ratings
1st level of assessment: awarding stars
provider complies with compliance with all required
all required quality quality standards could not be
standards
confirmed
provider did not
collaborate with the
assessment
↓
↓
↓
Access to
RATING
No access to
RATING
No access to
RATING
Assessment scheme: stars and ratings
2nd level of assessment: awarding ratings
quality level III
quality level II
quality level I
insufficient sample
provider with above
average performance
provider with average
performance
provider with be low
average performance
sample size was insufficient for
statistical inference
unreliable data
inconsistencies in data were
detected
not assessed area
starting
assessement
data not supplied
Schedule of assessments and public disclosure
 Frequency: twice a year
 Communication channel: dedicated website
www.websinas.com
Public disclosure of star and rating coded results
 Provider-specific reports
 With detailed results of performance on each
indicator
 Transparency: all methodological aspects of the
assessments fully described in the website
SINAS implementation
 SINAS modules currently implemented
SINAS@Hospitais
 Assessment of hospitals
SINAS@Saúde.Oral
 Dentists offices and dental care clinics
Outline
1. Framework for assessing global quality
2. SINAS@Hospitais (Hospitals)
3. SINAS@Saúde.Oral (Dental Care)
SINAS@Hospitais
Quality dimensions
Status
Clinical Excellence
Implemented
Patient Safety
Implemented
Adequacy and Comfort
of Facilities
Implemented
Patient Focus
Implemented
Patient Satisfaction
Being developed
SINAS@Hospitais
Clinical Excellence
 Clinical areas being assessed
 Orthopaedics, Gynaecology, Obstetrics, Paediatrics, Acute
Myocardial Infarction, Stroke, Ambulatory Surgery, Vascular
Surgery, Cardiac Surgery, Colon surgery and Intensive Care
Units
 Clinical indicators
 Process indicators
 Outcome indicators
 Methodologies
 For process indicators: no risk adjustment
 For outcome indicators: risk adjustment model
SINAS @ Hospitais
Adequacy and Comfort of Facilities
 Model of performance assessment
 Assessment based on a check-list covering structural
and organisational characteristics of facilities
 Issues considered in assessment check-list
Adequacy
Comfort
1. Accessibility
5. Hospitalization
2. Maintenance
6. Additional areas
3. Self protection measures
7. Comfort
4. Risk assessment
8. Quality control
SINAS @ Hospitais
Adequacy and Comfort of Facilities
 Performance indicator:
Percentage of items in check-list that are present
 Methodology for producing ratings:
Clustering: assigning a set of objects into groups so that the
objects in the same group are more similar to each other than
to those in other groups.
SINAS @ Hospitais
Patient Safety
 Two perspectives of assessment
1) Ex-ante: patient safety culture
2) Ex-post: indicators (rates) of adverse events incidence
 Methodologies
 Patient safety culture: assessment by check-list →
clustering
 Rates of adverse events: outcome indicators → risk
adjustment model
SINAS @ Hospitais
Patient Safety
 Patient safety culture
 Commitment of health care organisations to safety at
all levels, including structures and facilities, procedures
and human resources
 Assessment with check-list
 Main background:
• “Patient Safety Practices” of Agency for Healthcare
Research and Quality (AHRQ)
• “Safe Practices for Better Healthcare 2010” of
National Quality Forum (NQF)
• “International Patient Safety
Commission International (JCI)
Goals”
of
Joint
SINAS @ Hospitais
Patient Safety
 Issues considered in assessment check-list
 Safety Culture
 Patients Identification
 Communication with patients
 Information to patients
 Safe use of medications
 Safe Surgery Checklist
SINAS @ Hospitais
Patient Safety
 Adverse events indicators
 Measures that screen for problems that patients
experience as a result of exposure to the healthcare
system and that are likely amenable to prevention.
 Main background:
• Agency for Healthcare Research and Quality
(AHRQ)
• Safety Improvement
(SImPatIE)
for
Patients
• OCDE Health Care Quality Indicators
In
Europe
SINAS @ Hospitais
Patient Safety
 SINAS selection of adverse events indicators
SSD1 – Death in Low-Mortality DRGs
SSD2 – Stage III and IV Decubitus Ulcer
SSD3 – Nosocomial Infection (Catheter-Associated Infection)
SSD4 – Postoperative Hip Fracture
SSD5 – Postoperative Hemorrhage or Hematoma with Reexploration Required
SSD6 – Nosocomial Infection (Postoperative Sepsis)
SSD7 – Postoperative Wound Dehiscence
SSD8 – Accidental Puncture or Laceration
SINAS @ Hospitais
Patient Focus
 Aim:
 Objective assessment of how much are health care
organisations centred on patient needs and preferences
 Background:
 Standards of Patient and Family Rights of Joint
Commission International (JCI)
 Model of performance assessment :
 Assessment based on a check-list covering structural
characteristics, human and physical resources and
organisational procedures, that contribute to patientcentred care
SINAS @ Hospitais
Patient Focus
 Issues considered in assessment check-list















Informed consent
Scheduling of services
In patient
Access to second opinion
Religious aid
Visits to in-patients
Food
Training
Communication with patients
Terminally ill patients
Waiting times
Post discharge follow up
Patient privacy
Suggestions, complaints or claims handling
Satisfaction Surveys
SINAS @ Hospitais
Patient Satisfaction
 Aim:
 Subjective assessment of patient satisfaction with
health care services
 Types of care to be assessed:
 Emergency care, inpatient care, ambulatory surgery,
outpatient consultations
 Model of performance assessment:
 Survey study
SINAS@Hospitais: overall results
Distribution of participants
(Ref.30/12/2013)
Private
Public
Social
Providers
Providers
Providers
Norte
18
30
15
Centro
8
22
5
LVT
16
30
5
Alentejo
1
5
1
Algarve
3
3
-
Total
46
90
26
ARS
SINAS @ Hospitais – Clinical Excellence
Evolution of participation
Published
Number of
Hospitals
Increase
Assessed areas
15-12-2009
36
-
ORTH
1.ª Collection
22-09-2010**
63
75,0%
ORTH
2.ª Collection
28-01-2011
66
4,8%
ORTH; GYN; OBS; PAED
3.ª Collection
11-07-2011**
79
19,7%
ORTH; GYN; OBS; PAED
4.ª Collection
28-11-2011**
85
7,6%
ORTH; GYN; OBS; PAED; AMI; STRO;
AMBS
5.ª Collection
04-08-2012**
85
0,0%
ORTH; GYN; OBS; PAED; AMI; STRO;
AMBS
6.ª Collection
15-11-2012**
86
1,2%
ORTH; GYN; OBS; PAED; AMI; STRO;
AMBS
7.ª Collection
23-04-2013**
102
29,1%
ORTH; GYN; OBS; PAED; AMI; STRO;
AMBS; COLS; CARDS; VASCS; ICU
8.ª Collection
30-12-2013**
116
0,1%
ORTH; GYN; OBS; PAED; AMI; STRO;
AMBS; COLS; CARDS; VASCS; ICU
Collection
Pilot Project
SINAS @ Hospitais
Ambulatory Surgery
Evolution of results
Number of Hospitals
Quality Level
Published
Published
Published
15/11/2012
23/04/2013
30/12/2013
Quality level III
8 (28%)
15 (36%)
15 (34%)
Quality level II
17 (59%)
24 (57%)
23 (52%)
Quality level I
3 (10%)
2 (5%)
3 (7%)
1 (3%)
1 (2%)
3 (7%)
29
42
44
Insufficient sample
Total Providers Assessed
SINAS @ Hospitais
Ambulatory Surgery
Evolution of the reference values
Reference Values (rate %)
Indicators
Published
15/11/2012
Published
23/04/2013
Published
30/12/2013
50-60
60-70
65-70
60-70
60-70
75-80
60-70
70-80
85-90
Prophylaxis of nausea and vomiting
selecting
70-80
70-80
75-80
Provide telephone contact
70-80
70-80
85-90
Pain assessment in the postoperative
80-90
90-95
90-95
Follow up care (education after discharge)
90-95
90-95
95-100
Providing analgesia at discharge
Postoperative evaluation within 24 hours
after discharge
Patient Selection to prophylaxis of nausea
and vomiting
Outline
1. Framework for assessing global quality
2. SINAS@Hospitais (Hospitals)
3. SINAS@Saúde.Oral (Dental Care)
SINAS@Saúde.Oral
Quality dimensions
Status
Registration and Licensing
Implemented
Organisation and
Procedures
Implemented
Adequacy and Comfort of
Facilities
Implemented
Patient Safety
Implemented
Patient Satisfaction
Being developed
SINAS@Saúde.Oral
Status of implementation:
 First publication of results – August 2013
 Provide to population an assessement of 800 dental
care providers
 Add clinical indicators to the system
SINAS@Saúde.Oral
N.º of Providers
Organisation and
Procedures
Patient
Safety
Adequacy
and Comfort
of Facilities
Quality level III
331 (53%)
305 (56%)
415 (56%)
Quality level II
222 (35%)
159 (29%)
258 (35%)
Quality level I
78 (12%)
84 (15%)
66 (9%)
631 (100%)
548 (100%)
739 (100%)
Rating
National System of Health Assessement
better care, better outcomes
[email protected]