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=

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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 @a-qua@healthbase.ch

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

etc. etc.

A-QUA platform

m2

m4

m3 m5

https://www.healthbase.ch/

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

Thank youProf. Dr. med. Michael Ganter

Institute of AnesthesiologyKantonsspital Winterthurmichael.ganter@ksw.ch