Patient Safety - דוקטורס אונלי Doctors Only2018/03/07 · Patient Safety in an era of...
Transcript of Patient Safety - דוקטורס אונלי Doctors Only2018/03/07 · Patient Safety in an era of...
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Patient Safety in an era of inadequate resources
Prof. Arnon Afek, MD, MHA Director of the Sheba General Hospital & Associate Director-General,
Sheba Medical Center
Director the NY/American MD Program, Sackler School of Medicine, Tel Aviv University
Chairman, The National Council of Forensic Medicine & Pathology, Ministry of Health, Israel
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Patient Safety in an era of inadequate resources
The Israeli Healthcare System is based on the Health Insurance Law:
1. Universal coverage
2. Freedom of choice and migration between 4, non-profit
Health Funds (HF)
3. Income-based premium divided to HFs by a capitation formula
4. Health basket – a defined, important package of health benefits
5. Healthcare Delivery:
a. Community care (primary, specialists) - HFs
b. Hospitals - Government, HFs, non-profit Public
c. Private sector - small but rising
Keytruda, included in the Health basket for
Metastatic Melanoma
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Healthcare Indices – Life expectancy at birth, 2013
Israel is ranked 7th in the OECD (82.1y)
Men 3rd (80.3y); Women 9th (83.9y)
Source: Health at a glance 2015 OECD indicators
Patient Safety in an era of inadequate resources
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Patient Safety in an era of inadequate resources
Healthcare Indices – Cardiovascular mortality, 2013
Israel is ranked 4th lowest in the OECD
58% decline in mortality rate (1990-2013)
Source: Health at a glance 2015 OECD indicators
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Patient Safety in an era of inadequate resources
Healthcare Indices – Infant Mortality per 1000 live births
Source: ICBS, OECD
Infant mortality by religion and year of birth, 1955–2014 Infant Mortality Rates in the OECD , 2011
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Health Expenditure as a share of GDP, 2013
Israel spends 7.5% of its GDP on health
USA 16.4%; Germany 11.9%; OECD average 8.9%;
Source: Health at a glance 2015 OECD indicators
Patient Safety in an era of inadequate resources
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USA
OECD
EU15
ISRAEL
Israel Health Expenditure as a share of GDP (1990-2012)
Israel’s spending on health has remained constant for the last 20 years
Israel
EU 15
OECD
USA
Percent of GDP on healthcare expenditure 1990-2012
OECD
Source: Strategic Planning and Economics, Israeli Ministry of Health
Patient Safety in an era of inadequate resources
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OECD Health Care Quality Reviews of Israel, 2012, states:“Israel has established one of the most enviable healthcare systems among OECD countries”
Patient Safety in an era of inadequate resources
Source: OECD Health Care Quality Reviews - Israel, 2012
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Patient Safety in an era of inadequate resources
"If we are victorious in one more battle with the Romans, we shall be utterly ruined". (Pyrrhic victory).
Pyrrhus a Greek general, a statesman and king of Epirus (r. 306–302 BC).
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Patient Safety in an era of inadequate resources
What are the disadvantages of the Israeli Healthcare System?
1) Overcrowded Hospitals
2) No reserve capacity
3) Decreased manager accountability
4) Shortage of nurses
5) Lack of senior physicians
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Patient Safety in an era of inadequate resources
What are the disadvantages of the Israeli Healthcare System?
1) Overcrowded Hospitals
2) No reserve capacity
3) Decreased manager accountability inadequate funding
4) Shortage of nurses
5) Lack of senior physicians
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1) Hospitals are highly efficient but overcrowded
2) No reserve capacity
3) Decreased manager accountability
Patient Safety in an era of inadequate resources
Disadvantages of the Israeli Healthcare System
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4) Shortage of nurses
Patient Safety in an era of inadequate resources
Disadvantages of the Israeli Healthcare System
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5) Lack of senior physicians
Patient Safety in an era of inadequate resources
Disadvantages of the Israeli Healthcare System
2010-2015רישיונות חדשים ברפואה
345 360 391 417
537484
377
539 526598
647
774722
899 917
1015
11841258
0
200
400
600
800
1000
1200
1400
2010 2011 2012 2013 2014 2015
בוגרי ישראל בוגרי חול כ"סה
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5) Lack of senior physicians
Patient Safety in an era of inadequate resources
Disadvantages of the Israeli Healthcare System
2008-2015פתיחת פנקסי התמחות
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5) Lack of senior physicians
Patient Safety in an era of inadequate resources
Disadvantages of the Israeli Healthcare System
מחסור ברופאים מומחים
-400
-200
0
200
400
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
מתמחים למול צפי פרישת מומחים מחסור בתקני
"צוואר בקבוק"
מחסור בתקני מתמחים
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Patient Safety in an era of inadequate resources
Roni Linder, DeMarker 13.2.18
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Patient Safety in an era of inadequate resources
Overcoming the disadvantages of the Israeli Healthcare System
1) Adequate funding
2) Quality of care
3) Transparency
4) Patient Safety
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השארת המס המקביל הייתה מבטלת את הצורך של המדינה להוסיף תקציבים להשלמת מימון
בשנה₪ מיליארד 2.7–סל הבריאות ואף מאפשרת תוספת של כ
משרד הבריאות, תכנון אסטרטגי וכלכלימינהל: מקור
Patient Safety in an era of inadequate resources
1) (In)adequate funding
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עדכון חלקי של סל הבריאות
0%
50%
100%
150%
200%
250%
מדד יוקר הבריאות
מדד תשמות הבריאות
0
50
100
150
200
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
עדכון דמוגרפי מצטבר
נפשות מתוקננות
אשר עוצבה ועוגנה בחוק ביטוח , זכותם של אזרחי מדינת ישראל לבריאות"
מתרוקנת אט אט מתוכן נוכח השחיקה השיטתית בתקציבי , בריאות ממלכתי
"עליה נדמה שאין חולק-קופות החולים
2012יוני , "קופות החולים"צ "בג
Patient Safety in an era of inadequate resources
1) (In)adequate funding
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תפיסת עולם של מחסור במשאבים
שכיום , אגף התקציבים היה בין המתנגדין הבולטין לחוק ביטוח בריאות ממלכתי"
אגף . האגף רואה בו אבן היסוד החשובה ביותר במערכת הבריאות הישראלית
זאת מתוך אמונה , והרחבתו" אסותא"חולים -התקציבים תמך בהקמתו של בית
אך היום רואה , כי יצליח לשלוט בהיקף פעילותו באמצעות קציבת מיטות אשפוז
בו אחת הבעיות הגדולות של המערכת התעקשותו המסורתית עד לא מזמן של
תוך התעלמות מהמלצות , האגף על הגבלת מספר הסטודנטים לרפואה בישראל
שכל רופא נוסף מעלה את ההוצאה על , הייתה מבוססת על תפיסה, ועדת פזי
המחסור ברופאים הוא אחת הסיבות כי , היום הצוות באגף מודה. בריאות
"לעליית ההוצאה על בריאות
קנדלין 'יוג' פרופ, קובי גלזר' פרופ: המיעוט בוועדת גרמן ד"חווח "דו: מקור
Patient Safety in an era of inadequate resources
1) (In)adequate funding
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א רפואי"בכהמענה למחסור
וועדות כנסת שונות–1949-2008
(ר"משב)ועדת הלוי –1964
(בנק ישראל)חנוך סמית –1964
(ר"משב)ועדת מן –1969
(משרד החינוך)ועדת פלדמן -1972
(א"אוניברסיטת ת)ר אברהם פיזם "ד–1973
(ר"משב)ועדת זוהר –1978
(י"הר)ועדת לוננפלד –1986
ח מבקר המדינה"דו–1987
(ממלכתית)ועדת נתניהו –1990
המדינהח מבקר "דו–1995
(ממלכתית)ועדת אמוראי –2002
ח מבקר המדינה"דו–2002
(ג"מל)ועדת פזי –2002
(ג"מל)ועדת הלוי –2007
(ר"משב)ועדת בן נון –2007
(ר"משב)ועדת חורב –2009
ביס לרפואה של בר אילן–2011
?ביס לרפואה באריאל –2019
ר אסף טוקר"באדיבות ד
Patient Safety in an era of inadequate resources
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Patient Safety in an era of inadequate resources
Overcoming the disadvantages of the Israeli Healthcare System
1) (In)adequate funding
2) Minimal funding - What can be done?
1) Quality of care
(Quality assessment, Indicators, Accreditation – JCI)
2) Transparency
3) Patient Safety
“For every complex problem there is an answer that is clear, simple, and wrong.”
H L Mencken, American writer 1880-1956
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55%–א "כ
33%–תשתיות
זיהומים12%
,בני ציון
, העמק
וולפסון
מאיר, כרמל
הדסה הר , נצרת-האנגלי, הדסה עין כרם,הצופים, שיבא, ם"רמב,פוריה
שערי צדק , שניידר
, נצרת-האיטלקי, ברזילי, אסף הרופא, ליס, זיו, נצרת-הצרפתי,,הלל יפה
.קפלן, סורוקה, הישועה נהריהמעייני
תקצוב ותמחור והאיגוד הישראלי לנאונטולוגיה, האגף לתכנון, מנהל רפואה: מקור
'קבוצה א
212,507:תעריף חדש
'קבוצה ב
202,754:תעריף חדש
קבוצת הבסיס
192,992:תעריף חדש
:תעריף הפג הקודם
176,061
15.2.15ח ב "י בי"פרסום מזוהה עפ-( מודל הכוכבים)מודל תמרוץ הפגיות
(2014)י משקל "מדדים נבחרים עפ
ל משרד הבריאות"מנכ, ארנון אפק' פרופ
Patient Safety in an era of inadequate resources
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מודל משתנה –( מודל הכוכבים)הפגיות תמרוץ
2014
תוספת לתעריף הבסיסי
פגיות 5מצטיינות
תוספת כפולה
פגיות 8ביניים תוספת
יחידה
2015
בונוס על שיפור בין השנים
הגדלת הציון היחסי לאיכות
2016
הגדלת כמות פרמטרים לאיכות
עדכון הכשרה על החייאה
פרוטוקולים להפחתת קרינה
2017
הוספת מדדי איכות נוספים
כניסת מקצועות בריאות נוספים
2018מתוכנן
הוספת סקר חווית מטפל\המטופל
כניסת מקצוע פסיכולוג
הוספת מדדי איכות נוספים כגון חלב אם וטיפול תומך
Patient Safety in an era of inadequate resources
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בממוצע ציון הבקרות בפגיות שיפור -תוצאות
2017ל 2014בין
ציון כלל הפגיות עלה בכלל המערכת
2014תחילת 2014סוף 2015סוף 2016סוף 2017סוף
75%
58%
39%33%
12345
85%
Patient Safety in an era of inadequate resources
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בכלל הפגיות( ספסיס)שיעור אירועי אלח דם נרכש –תוצאות
(2014-17בשנים )
!בכמות אירועי זיהום70%ירידה של
2014
ממוצע אירועי
אלח דם נרכש
ימי 1000-ל
אשפוז
1.20
2.01
2.29
4.02
1234 2015 2016 2017
Patient Safety in an era of inadequate resources
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-דקות 90תוך (STEMI)צנתור בחולים עם אוטם חריף ביצוע : המדד
שיפור התהליך בבית החולים כרמל
ח כרמל"ביפליגלמןמשה ' פרופ-השקף באדיבות
איכות ושקיפות כמחוללי שינוי
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Patient Safety in an era of inadequate resources
Overcoming the disadvantages of the Israeli Healthcare System
1) Adequate funding
2) Minimal funding - What can be done with?
1) Quality of care (Quality assessment, Quality Indicators,
Accreditation – JCI)
2) Transparency
3) Patient Safety
“For every complex problem there is an answer that is clear, simple, and wrong.”
H L Mencken, American writer 1880-1956
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Patient Safety in an era of inadequate resources
Transparency שקיפות-
Source: OECD Health Care Quality Reviews - Israel, 2012
“Israel may not yet have exploited the full potential of transparency to drive improvements in the quality of care."
21/4/15ישראל היום , רן רזניק
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Patient Safety in an era of inadequate resources
Overcoming the disadvantages of the Israeli Healthcare System
1) Adequate funding
2) Minimal funding
1) Quality of care (Quality assessment, Quality Indicators,
Accreditation – JCI, Transparency)
2) Patient centered care
3) Patient Safety
“For every complex problem there is an answer that is clear, simple, and wrong.”
H L Mencken, American writer 1880-1956
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Does Medical Malpractice Law Improve
Healthcare Quality?
Michael Frakes and Anupam Jena
• The relationship between medical liability forces, medical errors and health care quality.
• Using data from the 1979 to 2005 National Hospital Discharge Surveys and the 1987 to 2008 Behavioral Risk Factor Surveillance System records.
• We estimate that the current liability system plays at most a modest role in inducing higher levels of health care quality.
• These findings suggest that that medical liability forces—under the right structural framework—hold the potential to elevate the quality floor.
Available at: https://scholarship.law.duke.edu/faculty_scholarship/3641
Patient Safety in an era of inadequate resources
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Patient Safety in an era of inadequate resources
Overcoming the disadvantages of the Israeli Healthcare System
Minimal funding - What can be done?
1) Quality of care (Quality assessment, Quality Indicators,
Accreditation – JCI, Transparency)
2) Patient centered care
3) Patient Safety
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סיכום
36
“It is Not the Strongest of the Species that Survives,
nor the most intelligent that survive,
But the Most Adaptable to change”
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Israeli hospital treats Syrian war-wounded20 August 2013 BBC News
As the conflict in Syria continues, the number of injured Syrians reaching Israel to receive treatment is rising.
Patient Safety in an era of inadequate resources
Medicine as a “bridge over troubled water”
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Ayah, an 8 year old Syrian girl treated in Israel,is walking again
Patient Safety in an era of inadequate resources
I LOVE YOU Dr Lernner
Peace is a journey of a thousand miles and it must be taken one step at a time. President Lyndon B Johnson