Comparison of Medical Care of Hospitalized Patients with
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Transcript Comparison of Medical Care of Hospitalized Patients with
Faculdade de Medicina da Universidade do Porto
Curso de Mestrado Integrado em Medicina
2008/2009
Comparison and Evolution of
Medical Care of Inpatients with
Acute Myocardial Infarction in
Portuguese Public Hospitals
Faculdade de Medicina da Universidade do Porto
Introduction
Background and Justification
Acute myocardial infarction (AMI – ICD9 410) is one of the
major causes of death among Western civilization.
Such studies are not widespread among Portuguese
institutions
Tool for patients evaluation of hospitals’ medical
performance, which may be helpful when choosing the
institution provider of best care.
Access to hospitals’ admnistrative data.
Number of Deaths
200
180
160
140
120
100
80
60
40
20
0
1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002
Years
Acute Myocardial Infarction
▪ ICD9 – 410
Inpatient Quality Indicators (IQI’s)
Diagnostic Related Groups (DRG’S)
DRG-database
Medical term for heart
attack.
Caused by the blockage
of the coronary arteries
which will lead to an
insufficient blood suply
to the heart muscle
(myocardium).
Acute Myocardial Infarction
▪ ICD9 – 410
Inpatient Quality Indicators (IQI’s)
Diagnostic Related Groups (DRG’S)
DRG-database
IQI’s reflect the quality of care inside
hospitals
Include:
inpatient mortality for medical conditions;
inpatient mortality for procedures;
utilization of procedures for which there are
questions of overuse, underuse, or misuse.
Acute Myocardial Infarction
▪ ICD9 – 410
Inpatient Quality Indicators (IQI’s)
Diagnostic Related Groups (DRG’S)
DRG-database
Used to classify hospital cases into one of
approximately 500 groups, according to:
ICD diagnoses
Procedures
Sex
Age
Presence of complications
Comorbidities
The main purpose of this system is to make sure
patients with similar diagnoses have equal hospital
resources’ use.
Acute Myocardial Infarction
▪ ICD9 – 410
Inpatient Quality Indicators (IQI’s)
Diagnostic Related Groups (DRG’S)
DRG-database
Excerpt from the DRG’s index table
http://health.utah.gov/opha/IBIShelp/codes/DRGCode.htm
RESEARCH QUESTION
What is the status of medical care system in Portugal for AMI
and how has it evolved throughout the years?
AIMS
Compare hospitals’ quality based on 2 criteria.
Evaluate the improvements of medical care in hospitals.
Inclusion Criteria
▪ Patients with Acute Myocardial Infarction as Main
Diagnosis
Exclusion Criteria
▪ Patients discharged in less than 24 hours
▪ Patients discharged against medical concern
▪ Patients who died while being transferred
F
L
U
X
O
G
R
A
M
M
E
I
N
C
L
U
S
I
O
N
A
N
D
E
X
L
U
S
I
O
N
C
R
I
T
E
R
I
A
Transversal and longitudinal Study
Data
Data Used
Comparison
2005
Evolution
2000-2005
Participants and Methods
Data and Variables
Data from all Portuguese Public Hospitals, from
2000 to 2005.
Variables:
Number of admissions;
Fatality rate;
Medical procedures:
▪ PCI.
Extract of the database’s codes
Inside each type (Regional classification – type C)
of hospital, we are going to compare individual
performances based on data from 2005.
Considering evolution, the data used refers to
the period between 2000 and 2005 for each type
of Hospital
According to the newest hospital classification:
▪ Central hospitals – Including the main hospitals of the main regions
in Portugal;
▪ Distrital hospitals – Including the main hospitals of secondary
regions in Portugal;
▪ Level 1 hospitals – Including the smallest hospitals.
Fatality Rate = Number of deaths caused by AMI
Number of Admissions by AMI
Rate of PCI usage = Number of PCI interventions
Number of Admissions by
AMI
Concerning the comparison inside each type, we are
expecting to find significant differences between
hospitals.
We are also expecting to find great disparities
between the different groups, as the sort of patients
varies with the type of hospital.
We are expecting to find some improvements even
though the concerned period may not be wide
enough for them to be significant.
Number of Deaths
200
180
160
140
120
100
80
60
40
20
0
1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002
Years
No information ab0ut pharmacological procedures.
Information relative to the year 2005 and some
changes may have occured since then.
Possible information bias in the database.
Choosing the main diagnosis as the inclusion criteria
may create unexpected bias.
Understanding the general quality concerning the
treatment of AMI in Portuguese Public Hospitals.
It may create the need for improvement.
Stimulating further analysis and future studies.
Providing a guide for general population.
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