Transcript Diapositivo 1

Introdução à Medicina II
Class 9
Adviser: Alberto Freitas
PQIs
• Primary Healthcare
Prevention starts here.
•Ambulatory Care Sensitive Conditions
• “avoidable hospitalization rates are a sensitive indicator for
assessing quality of primary ambulatory care” (Niti et al. 2003)
Image source: http://www.parklandhealthcenter.org/phc_content.aspx?id=3778
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
IntroMedI - class 9 - PQIs
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.
IntroMedI - class 9 - PQIs
PARTICIPANTS
• 6199102 patients’ discharge data from
national database (ACSS)
• 94 Acute Care Public Hospitals (continent)
IntroMedI - class 9 - PQIs
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
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• Division in NUTS II
2000
2002
2001
2004
2003
2005
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INCLUSION
• Diagnosis according to PQI
EXCLUSION
•
Age <18
•
MDC = 14 or 15
•
Transferred from
•
Related non-evaluative conditions
IntroMedI - class 9 - PQIs
INVALID
• Address codes missing. non-existent or
belonging to the Azores or Madeira.
• Absurd age (below 0; over 150)
• Undetermined Sex (3)
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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+)
IntroMedII - class 9 - PQIs
IntroMedII - class 9 - PQIs
RESULTS OVERVIEW
IntroMedII - class 9 - PQIs
*
* Overall PQI = Sum of all PQIs except for 2 and 9
IntroMedI - class 9 - PQIs
IntroMedI - class 9 - PQIs
IntroMedII - class 9 - PQIs
IntroMedII - class 9 - PQIs
IntroMedII - class 9 - PQIs
IntroMedII - class 9 - PQIs
Country
PQI1
PQI2
PQI3
PQI5
PQI7
PQI8
PQI9
M
20.04
23.62
89.23
155.77
18.94
156.45
5.24
F
29.27
18.95
89.25
80.84
25.38
190.29
6.01
M
56.24
31.18
135.41
208.1
37.27
463.64
6.00
F
53.31
28.93
118.71
251.39
61.44
512.08
6.53
PQI12
PQI13
PQI14
PQI15
PQI16
PT
Gender
USA
PQI10 PQI11
PT
USA
M
17.75
324.81
58.43
71.37
19.64
11.37
31.38
F
25.35
263.99
107.27
49.79
27.82
27.83
19.34
M
98.72
398.89
101.03
43.74
21.37
67.99
51.22
F
154.39
436.39
249.26
47.97
23.07
170.22
27.64
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Significant Correlations
•Overall PQI
•Acute PQI
No relevant associations found
•Diabetes PQI
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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
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LBW
r= 0.699
Asthma
r=0,499
GIP
per
capita
Urinary
Inf.
r=0,365
Angina
r=0,539
p < 0.05
0.35 < r < 0.7
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Diab. shortterm
r=-0,611
Dehydration
r=-0,399
Life
expectancy
Perf.
Appendix
r=-0,457
Angina
r=-0,503
p < 0.05
-0.62 < r < -0.38
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COPD
Life
expectancy
p < 0.01
r = 0.60
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Diab. shortterm
r= 0,735
Heart
Failure
Health
Centers
r= 0,7
Dehydration
r= 0,731
Diab.
LE amp.
r= 0,631
p < 0.01
0,631< r <0,735
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Diab.
shortterm
r= -0,596
Asthma
Medical
Visits
r= -0,567
Perf.
Appendix
r= -0,761
Urinary
Inf.
r= -0,513
p < 0.05
-0,761< r <-0,513
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COPD
Medical
Visits
p < 0.01
r = 0.71
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Diab.
shortterm
r= -0,675
n. of
doctors
Heart
failure
Perf.
Appendix
r= -0,681
p < 0.02
-0,681< r <-0,530
r= -0,530
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Diab. shortterm
r= -0,647
Diab. LE
amp.
r= -0,615
Perf.
Appendix
r= -0,390
Literacy
Index
p < 0.05
-0,680< r <-0,390
Dehydration
r= -0,644
Heart failure
r= -0,680
IntroMedII - class 9 - PQIs
Asthma
Literacy
Index
p < 0.01
r = 0.37
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Urinary
Inf.
r= 0,472
Education
Angina
Asthma
r= 0,383
p < 0.05
0,383< r <0,472
r= 0,430
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COPD
r= -0,288
Education
Hypertension
p < 0.05
- 0.37 < r < - 0.35
r= -0,357
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p < 0.01
r= 0,64
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What is missing?
Done
To Do
• Indicator Calculation
• Correlation with Costs
• Indicator
• Discuss Results
Stratification
• Indicator Comparison
• Correlations
• Further bibliographic
search
• Comparison with
foreign countries
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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
IntroMedI - class 9 - PQIs
•
Ansari Z, Laditka JN, Laditka SB. Access to Health Care and Hospitalization
for Ambulatory Care Sensitive Conditions. Med Care Res Rev. 2006; 63:71942
•
Billings J, Zeitel L, Lukomnick J, Carey TS, Blank AE, Newman L. Impact of
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Starfield B. Primary care and health: a cross-national comparison. JAMA.
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Kozak LJ, Hall MJ, Owings MF. Trends in Avoidable Hospitalizations, 19801998. Health Aff. 2001; 2 (20): 225-32.
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• Casanova C, Starfield B. Hospitalizations of children and access to primary
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Admissions: What Do They Tell Us? Healthc Q. 2007, 10:26-28.
IntroMedI - class 9 - PQIs
•Niti M, Ng TP. Avoidable hospitalization rates in Singapore, 1991-1998: assessing
trends and inequities of quality primary care, J Epidemiol Community Health.
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avoidable hospitalization in Spain. Med Clin (Barc). 2004; 122(17):653-8.
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insurance status in Massachusetts and Maryland. JAMA. 1992; 268:2388-94.
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Hospitalization inequalities in rates between US socioeconomic groups. Am J
Public Health. 1997; 87:811-6.
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•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.
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Protocol developed by:
Ana Catarina Moura, [email protected]
Ana Margarida Oliveira, [email protected]
Bárbara Mendonça, [email protected]
Cláudia Pereira, [email protected]
Hélio Alves, [email protected]
João Miguel Rego, [email protected]
José Pedro Pinto, [email protected]
Maria Francisca Costa, [email protected]
Maria Guiomar Pinheiro, [email protected]
Nelson Couto, [email protected]
Ricardo Reis, [email protected]
José Alberto Silva Freitas, [email protected]
IntroMedI - class 9 - PQIs
Thank you for your time
IntroMedI - class 9 - PQIs