Evaluating Portuguese primary healthcare through Prevention Quality Indicators (PQIs)

Introdução à Medicina IIClass 9Adviser: Alberto Freitas

PQIs

• Primary Healthcare

•Ambulatory Care Sensitive Conditions

• “avoidable hospitalization rates are a sensitive indicator for assessing quality of primary ambulatory care” (Niti et al. 2003)

IntroMedI - class 9 - PQIsImage source: http://www.parklandhealthcenter.org/phc_content.aspx?id=3778

Prevention starts here.

IntroMedI - class 9 - PQIs

Source: Ansari Z. Laditka JN. Laditka SB. Access to Health Care and Hospitalization for Ambulatory Care Sensitive Conditions. Med Care Res Rev. 2006; 63:719-742

AIMS

• Assessment of the primary healthcare

system quality, in an outpatient setting.

• Compare different level 2 NUTS*, trends

2000-2005

• Lay an hypothesis for the likely observed

differences. *except for Azores and Madeira.


PARTICIPANTS

• 6199102 patients’ discharge data from

national database (ACSS)

• 94 Acute Care Public Hospitals (continent)


DATA COLLECTION

• Data collected from acute care hospital

database

• Variables of interest present in the

database or calculated from others

• INE (Instituto Nacional de Estatística)

provides populational and other statistical

data


• Division in NUTS II


INCLUSION

• Diagnosis according to PQI

EXCLUSION• Age <18

• MDC = 14 or 15

• Transferred from

• Related non-evaluative conditions



INVALID

• Address codes missing. non-existent or

belonging to the Azores or Madeira.

• Absurd age (below 0; over 150)

• Undetermined Sex (3)

IntroMedII - class 9 - PQIs

STRATIFICATION

• NUT II (Norte, Centro, Lisboa, Alentejo, Algarve)

• Year (2000-2005)

• Gender

• Age (0-17; 18-24; 25-34; 35-44; 45-54; 55-64; 65-

74; 75+)


RESULTS OVERVIEW

IntroMedI - class 9 - PQIs* Overall PQI = Sum of all PQIs except for 2 and 9

*


Significant Correlations

•Overall PQI

•Acute PQI

•Diabetes PQI

No relevant associations found


Significant Correlations• Life Quality

• GIP per Capita• Life Expectancy at Birth

• Healthcare Facilities• Number of Health Centers per 100.000 pop.

• Medical visits per inhabitant

• Number of doctors per 1000 pop.

• Education• Literacy Index• Proportion of active population with minimum education (“3º Ciclo”)• Proportion of active population with secondary education or higher

• Neonatal• Age of first pregnancy• Neonatal mortality rate


p < 0.050.35 < r < 0.7

r= 0.699

r=0,539r=0,499

r=0,365


p < 0.05-0.62 < r < -0.38

r=-0,611

r=-0,457

r=-0,503

r=-0,399


p < 0.01r = 0.60


p < 0.010,631< r <0,735

r= 0,7

r= 0,631

r= 0,731

r= 0,735


p < 0.05-0,761< r <-0,513

r= -0,567 r= -0,761

r= -0,513

r= -0,596


p < 0.01r = 0.71


p < 0.02-0,681< r <-0,530

r= -0,681

r= -0,530

r= -0,675


p < 0.05-0,680< r <-0,390

r= -0,615

r= -0,644 r= -0,680

r= -0,390

r= -0,647


p < 0.01r = 0.37


p < 0.050,383< r <0,472

r= 0,472

r= 0,383 r= 0,430


p < 0.05- 0.37 < r < - 0.35

r= -0,288

r= -0,357


p < 0.01r= 0,64


What is missing?


REFERENCES

• Farquhar, M. AHRQ Quality Indicators [slides]. Rockville (MD): Agency for Healthcare Research and Quality; 2005. 20 slides colour.

•General Questions about the AHRQ QIs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality; July 2004 [cited 2007 Oct 31]. Available from: http://www.qualityindicators.ahrq.gov/general_faq.htm

•Agency for Healthcare Research and Quality. Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions. Version 3.1. Rockville (MD): Agency for Healthcare Research anm,mid Quality; March 2007.

•AHRQ Prevention Quality Indicators Overview [Internet]. Rockville (MD): Agency for Healthcare Research and Quality; July 2004 [cited 2007 Oct 31]. Available from: http://www.qualityindicators.ahrq.gov/pqi_overview.htm


• Ansari Z, Laditka JN, Laditka SB. Access to Health Care and Hospitalization for Ambulatory Care Sensitive Conditions. Med Care Res Rev. 2006; 63:719-42

• Billings J, Zeitel L, Lukomnick J, Carey TS, Blank AE, Newman L. Impact of socioeconomic status on hospital use in New York City. Health Aff (Millwood). 1993; 2:162-9.

• Starfield B. Primary care and health: a cross-national comparison. JAMA. 1991; 266:2268-71.

• Sanderson C, Dixon J. Conditions for which onset or hospital admission is potentially preventable by timely and effective ambulatory care. J Health Serv Res Policy. 2000, 5:222-30.

• Kozak LJ, Hall MJ, Owings MF. Trends in Avoidable Hospitalizations, 1980-1998. Health Aff. 2001; 2 (20): 225-32.


• Casanova C, Starfield B. Hospitalizations of children and access to primary care: a cross-national comparison. Int J Health Serv. 1995; 25:283-94.

•Ansari Z, Barbetti T, Carson NJ, Auckland MJ, Cicuttini F: The Victorian ambulatory care sensitive conditions study: rural and urban perspectives. Soz Praventivmed. 2003; 48:33-43.

•Sheerin I, Allen G, Henare M, Craig K. Avoidable hospitalizations: potential for primary and public health initiatives in Canterbury, New Zealand. N Z Med J. 2003; 119(1236).

• Roos LL, Walld R, Uhanova J, Bond R: Physician visits, hospitalizations, and socioeconomic status: ambulatory care sensitive conditions in a Canadian setting. Health Serv Res. 2005, 40:1167-85.

• Porter J, Herring J, Lacroix J, Levinton C. Avoidable Admissions and Repeat Admissions: What Do They Tell Us? Healthc Q. 2007, 10:26-28.


•Niti M, Ng TP. Avoidable hospitalization rates in Singapore, 1991-1998: assessing trends and inequities of quality primary care, J Epidemiol Community Health. 2003; 57: 17-22.

• Rizza P, Bianco A, Pavia M, Angelillo IF. Preventable hospitalization and access to primary health care in an area of Southern Italy. BMC Health Serv Res. 2007; 7:134.

• Sanchez JLA, Vilalta JS, Perepérez SB, Martínez IM. Characteristics of avoidable hospitalization in Spain. Med Clin (Barc). 2004; 122(17):653-8.

• Weissman JS, Gatsonis C, Epstein AM. Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. JAMA. 1992; 268:2388-94.

• Pappas G, Hadden WC, Kozak LJ, Fisher GF. Potentially Avoidable Hospitalization inequalities in rates between US socioeconomic groups. Am J Public Health. 1997; 87:811-6.


•Booth GL, Hux JE. Relationship Between Avoidable Hospitalizations for

Diabetes Mellitus and Income Level. Arch Intern Med. 2003; 163:101-6.

•Regulation (EC) No 1059/2003 of the European Parliament and of the

Council of 26 May 2003 on the establishment of a common classification of

territorial units for statistics (NUTS) (Official Journal L 154, 21/06/2003)

•Agency for Healthcare Research and Quality. Prevention Quality Indicators:

Technical Specifications. Version 3.2. Rockville (MD): Agency for Healthcare

Research and Quality; March 2008.

•SPSS for Windows, Rel. 15.0.0 2006. Chicago (IL): SPSS Inc.


Protocol developed by:

Ana Catarina Moura, [email protected] Margarida Oliveira, [email protected]árbara Mendonça, [email protected]áudia Pereira, [email protected]élio Alves, [email protected]ão Miguel Rego, [email protected]é Pedro Pinto, [email protected] Francisca Costa, [email protected] Guiomar Pinheiro, [email protected] Couto, [email protected] Reis, [email protected] José Alberto Silva Freitas, [email protected]


Thank you for your time

Evaluating Portuguese primary healthcare through Prevention Quality Indicators (PQIs)

Documents

Transcript of Evaluating Portuguese primary healthcare through Prevention Quality Indicators (PQIs)