institut universitaire de médecine sociale et préventive
TRANSCRIPT
Qualité des soins et recherche sur la qualité des soins en Suisse
Bernard BurnandUsing routinely collected data to measure quality
and safety in healthcare: international and Swiss
developments
IUMSP Institut universitaire de médecine sociale et préventive
ARS Toscana – Firenze, 7 maggio 2015
Bernard Burnand
Presentation Plan
• Organisation of the Swiss healthcare system • Quality of care in Switzerland
– Context – Quality of care and safety indicators
• Research and development in quality and safety – Switzerland – International
Svizzera • 26 healthcare systems … • Mandatory insurance • Healthcare 11,4% GNP • 6’000 € / individual / year
• Confederation • 26 cantons • 8,2 millions inhabitants
• G 64%, F 24%, I 8%
• Life expectancy • F : 84.8 • H : 80.5
Swiss health care system OECD / WHO 2011
• Performing well, but costly - in general and for a sizable number of persons/families
• Needs to face increasing burden of chronic diseases in an aging population: increasing volume of care, few integrated care - networks
• Improve healthcare information (quality of care) • Improve assessment of quality of care and of healthcare
technologies • Shortage of healthcare professionals • Too many hospitals / hospital beds • Lack of coordination in prevention and health promotion • Insufficient governance and coordination in healthcare system
Swiss health care system Quality of care – law
• In the framework of the mandatory healthcare insurance, all paid care must be effective, appropriate and economical (Art. 32 LAMal)
Swiss health care system Quality of care – law
• Warranting quality (Art. 58 LAMal) … the Federal Council (FC) can manage to organise scientific and systematic assessments to monitor and warrant appropriateness and quality of care …
– The following information should be communicated: …. f. quality of care indicators
Swiss health care system Quality of care – history
Numerous attempts, more or less collaborative, to manage and monitor quality of care
- medical associations & organisations, insurance, hospitals, cantons, …
– Patientensicherheit (2003) – Association Nationale pour la Qualité - anq
(CIQ + AIQ) (2009)
anq – National association for the development of quality in hospitals
Members • Cantons, insurances • Healthcare providers - Association of hospitals
– Aim: • Assess and inform about quality • Develop quality • Improve quality
Patient satisfaction since 2009 Post-operative infections since 2010 Potentially avoidable surgical re- intervention since 2010
Potentially avoidable re- hospitalisation since 2010
Prevalence of falls and decubitus ulceration since 2011
Implant registry since 2012
anq – Quality of care indicators - rehabilitation hospital care
Patient satisfaction since 2013
anq - Quality of care indicators - psychiatric hospital care Assessment of quality in diagnosis and therapeutic process (in German only) Use of quality assessment in practice (in German) Comparative evaluation of quality measures between hospitals
2013
2012
Comparative report for inpatient psychiatric care in children and teens
2013
Indicatori di qualità degli osp
IMPROVING QUALITY OF CARE
Current developments in Switzerland
The Federal Council wants to improve healthcare quality and efficiency Bern, 14.05.2014 • Launch of national programmes to monitor quality
and safety • Systematic check of the efficacy and efficiency of
healthcare interventions (healthcare technology assessment)
• National Centre : quality and healthcare technology assessment
• Better coordination of public and private initiatives • New law on “quality”
– Consultation process and modifications
Main tasks proposed • Launch national programmes targeting quality of
care and safety issues • Develop quality indicators, especially for the
ambulatory sector • Systematic Health Technology Assessment • Evaluate appropriateness of care
Project of new federal law
• Consultation process 2014 • Hearings 2014-15 • Law project revision 2015
Current status, Spring 2015 • « Network » instead of an « Institute » • Report for Federal Council • Message for parliament (end of 2015)
RESEARCH & DEVELOPMENT ON QUALITY OF CARE A - SVIZZERA I
Quality of care – R & D initiatives - Svizzera
• Variation of care • Patient satisfaction and experiences • Appropriateness of care, over- and underuse of
care • Adaptation and implementation of clinical
practice guidelines • Potentially avoidable hospitalisation • Retrospective survey of hospital adverse events:
1 survey in 1 hospital
Quality of care – R & D initiatives - Svizzera
Quality and safety indicators based on routinely collected data / administrative data – Potentially avoidable re-hospitalisation – Potentially avoidable surgical re-intervention – Swiss Anaesthesia Databank (ADS) – Patient Safety Indicators (AHRQ)
To use selected Patient Safety Indicators (PSI - AHRQ) and their algorithm refinement for assessing the impact of DRG implementation in Switzerland (SNF - Sinergia)
1. To explore and document the frequency, variations and potential biases of PSI, using Swiss hospital data collected by the Federal Office of Statistics
2. To evaluate trends in PSI in Swiss hospitals 2008 – 2015 Impact of 2012 changes in DRG implementation
3. To assess the accuracy of a subset of PSI
Quality and safety indicators
ICD-10 hospital discharge diagnoses codes - WHO ICD-10 since 1998 - German modification since 2011 (ICD-10-GM)
Medical and Surgical Procedures - CHOP (ICD-9-CM)
Diseases Related Groups - SWISS-DRG, mandatory since 2012
Methods : Data sources
disorders • Post-operative Deep Vein Thrombosis and
Pulmonary Embolism (VTE - Venous Thrombo-Embolism)
• Post-operative sepsis • Obstetric Trauma during vaginal delivery
with/without instrument
• Baseline risk of Postoperative VTE in patients undergoing hip arthroplasty, under appropriate VTE prophylaxis - Systematic review (meta-analysis)
- Januel JM. JAMA 2012
• Estimation and comparison of adjusted occurrence rates of VTE PSI in patients undergoing hip arthroplasty
• Comparison between Switzerland and France – and with a benchmark
VTE PSI in patients undergoing hip arthroplasty
0
1
2
)
Expected values (from Models) using Swiss and French Nationwide Data, stratified by Length of Stay and by Year
[8 - 18[ ≥ 18 days< 8 days
LMWH = 0.58% (0.35% - 0.81%)
Comparisons stratified on length
of stay 76.4% 74.1%
Quality of care – International R & D initiatives
• Quality and safety indicators based on routinely collected data / administrative data – IMECCHI Consortium
• Contribution to new classification – ICD-11 – WHO – Topic Advisory Group (TAG)
on Quality and safety • Conceptual and practical developments
ICD-11 for quality and safety Overview of the WHO Quality and Safety Topic Advisory Group (WHO-TAG Q&S)
i. Cataloguing existing ICD-9 and ICD-10 quality and safety indicators
ii. Reviewing ICD morbidity coding rules for main condition, diagnosis timing, numbers of diagnosis fields and diagnosis clustering
iii. Substantial restructuring of the health-care related injury concepts coded in the ICD-10 chapters 19/20
Ghali WA et al. Int J Qual Health Care 2013;25:621-5
ICD-11 for quality and safety Overview of WHO-TAG Q&S
iv. Mapping of ICD-11 quality and safety concepts to the information model of the WHO's International Classification for Patient Safety and the AHRQ Common Formats
v. Review of vertical chapter content in all chapters of the ICD-11 beta version
vi. Downstream field testing of ICD-11 prior to its official release
Ghali WA et al. Int J Qual Health Care 2013;25:621-5
WHO-TAG Q&S International variation in the definition of ‘main
condition’ in ICD-coded health data
• ‘main condition’ not defined in a consistent manner internationally – ‘reason for admission’ – ‘resource use’
• a few countries have recently transitioned from one of these approaches to the other
• definition of ‘main condition’ matters (DRG’s, risk adjustment)
Quan H et al. Int J Qual Health Care 2014;26:511-5
WHO-TAG Q&S
• International variation in the definition of ‘main condition’ in ICD-coded health data
• WHO-TAG Q&S proposes a method of harmonizing the international definition
• to improve health data comparisons across countries and hospitals consistently
• inter-observer reliability of alternative harmonization approaches should be evaluated
Quan H et al. Int J Qual Health Care 2014;26:511-5
WHO-TAG Q&S How many diagnosis fields are needed to capture
safety events in administrative data? Findings and recommendations
• What is the optimal number of secondary diagnosis fields for meta-analyses?
• PSI information from administrative hospital data of 19-20 OECD countries in 2009 and 2011 (+ CA &FL in USA)
• Comparison of PSI rates in 3 countries with expanded # of secondary diagnosis fields vs 6 countries with limited # secondary diagnosis fields
Drösler SE et al. Int J Qual Health Care 2014;26:16-25
WHO ICD-11 TAG Q&S - number of secondary diagnoses fields • Increased # of secondary diagnosis fields not
associated with overall increase in PSI rates • High proportions of PSI-related diagnoses appeared
beyond the 6th secondary diagnosis field • Distribution of 3 PSI in CA and FL
– 89-90% of central venous catheter infections and – 97-99% of retained foreign bodies and accidental
punctures or lacerations captured within 15 secondary diagnosis fields
Drösler SE et al. Int J Qual Health Care 2014;26:16-25
WHO ICD-11 TAG Q&S
Capturing diagnosis-timing in ICD coded hospital data
• narrative literature review • scan of national experiences focusing on
countries currently using timing flags • series of meetings • formal recommendations regarding diagnosis-
timing reporting
Sundararajan V et al. Int J Qual Health Care. Accepted
WHO ICD-11 TAG Q&S diagnosis-timing in ICD hospital data Recommendations
• yes/no classification of ‘arising after admission’ • permitted designations of ‘unknown or clinically
undetermined’ – to facilitate coding while providing flexibility when
there is coding uncertainty • clear coding standards and guidelines
– ongoing coder education • ensure reliability of diagnosis-timing flag
Sundararajan V et al. Int J Qual Health Care. Accepted
WHO ICD-11 TAG Q&S New concept to capture “harm & injuries” Develop a new conceptual approach to
capturing healthcare-related harms and injuries in ICD-coded data
• Four categories of source of “event” a) Medications and substances taken for
therapeutic purposes b) Procedures c) Devices d) Other aspects of care
WHO ICD-11 TAG Q&S New concept to capture “harm & injuries”
• Proposed multiple coding approach • Each source of harm coded with a combination
of codes • Use of new code clustering in ICD-11
– “cause” of harm – “mode or mechanism” of harm – “actual injury or harm” that resulted from
the event
Harm" that resulted
from the event
“Mode or Mechanism” of harm e.g. overdose/underdose for substances
e.g. accidental perforation for procedures e.g. dislodgement/malfunction for devices e.g. mismatched blood used in transfusion
for other aspects of care
WHO ICD-11 TAG Q&S New concept to capture “harm & injuries”
• Proposed information model provides a more flexible, yet still simple and non-duplicative, approach to recording quality and safety events in ICD-coded data
• Linked to broader proposal from the Injury TAG for revision/enhancement for the external cause and injury chapters
WHO ICD-11 TAG Q&S New concept to capture “harm & injuries”
• Introduction of a diagnosis-timing capacity (i.e., distinguishing present on admission vs. arising during hospital stay)
• Revised set of codes in ICD-11’s Chapter 24 capturing “Factors influencing health status and contact with health services”
RESEARCH & DEVELOPMENT ON QUALITY OF CARE C - SVIZZERA II
Over- et underuse of upper gastro-intestinal endoscopy - possible public health impact
0
20000
40000
60000
80000
Patients screened for enrolment n = 8760
With lower gastrointestinal symptoms n = 651
Referral for colonoscopy
Gastrointest Endosc 2000;52:593–9.
Appropriateness of 5-ASA (5-aminosalicylates) treatment in patients with Crohn’s disease
• Swiss Inflammatory Bowel Diseases Cohort Study
• Absence of evidence of effectiveness of 5- ASA in Crohn’s disease patients
• 835 / 1420 patients (59%) treated with 5-ASA • Perception of effectiveness of treatment by
46% of patients – Subjective and may correspond to natural history
of disease Schoepfer A et al. 2014
ADS Adverse events occurrence during surgical intervention according to ASA group
(1996-2006) N = 532’485
Other incidents
Cardio-circulatory incidents
Hypertension and adverse events occuring during surgery, multicenter registry in Switzerland (ADS)
• Elective surgery, 24 hospitals, 2000-4 • 124’939 interventions, 27’881 hypertensive patients (22%)
• ≥ 1 cardiovascular events 7’549 (6%) • Cardiovascular event in presence of hypertension - OR= 1.38 (95% CI 1.27–1.49) • Important variation by hospital - OR adjusted 0.41 up to 2.25 • Persistence of increased anaesthesia risk in hypertensive individual • Due to coding or practice variations?
47
Journée régionale du jeudi 15 octobre 2009 à Bourg-en- Bresse
Hypertension and adverse events occuring during surgery, multicenter registry in Switzerland (ADS) (Beyer K 2009)
48
Comments
enough considered and developed currently
– Lack of data and indicators – Lack of research and specific support to
health services research – New federal concept ongoing
Comments • International • WHO - TAG
– Important contributions to ICD-11 to enhance capture of quality and safety issues
– Scientific approach to ICD revision by WHO-TAG Q&S
– New concept to capture “harm & injuries” related to healthcare in ICD-11
Grazie per l'attenzione [email protected]
Presentation Plan
Swiss health care system Quality of care – law
Swiss health care system Quality of care – law
Swiss health care system Quality of care – history
anq – National association for the development of quality in hospitals
anq – Quality of care indicators - acute somatic hospital care
anq – Quality of care indicators - rehabilitation hospital care
anq - Quality of care indicators - psychiatric hospital care
Diapositive numéro 12
Diapositive numéro 13
Diapositive numéro 14
The Federal Council wants to improve healthcare quality and efficiency
Project of new federal law
Project of new federal law
Research & development on quality of careA - Svizzera I
Quality of care – R & D initiatives - Svizzera
Quality of care – R & D initiatives - Svizzera
Diapositive numéro 22
Diapositive numéro 23
Diapositive numéro 24
Diapositive numéro 25
Diapositive numéro 26
Quality of care – International R & D initiatives
ICD-11 for quality and safety Overview of the WHO Quality and Safety Topic Advisory Group (WHO-TAG Q&S)
ICD-11 for quality and safety Overview of WHO-TAG Q&S
WHO-TAG Q&S
WHO-TAG Q&S
WHO-TAG Q&S
WHO ICD-11 TAG Q&S - number of secondary diagnoses fields
WHO ICD-11 TAG Q&S
WHO ICD-11 TAG Q&Sdiagnosis-timing in ICD hospital data
WHO ICD-11 TAG Q&SNew concept to capture “harm & injuries”
WHO ICD-11 TAG Q&SNew concept to capture “harm & injuries”
Diapositive numéro 39
WHO ICD-11 TAG Q&SNew concept to capture “harm & injuries”
WHO ICD-11 TAG Q&SNew concept to capture “harm & injuries”
Research & development on quality of careC - Svizzera II
Over- et underuse of upper gastro-intestinal endoscopy - possible public health impact
Diapositive numéro 44
Appropriateness of 5-ASA (5-aminosalicylates) treatment in patients with Crohn’s disease
Diapositive numéro 46
Diapositive numéro 47
Diapositive numéro 48
IUMSP Institut universitaire de médecine sociale et préventive
ARS Toscana – Firenze, 7 maggio 2015
Bernard Burnand
Presentation Plan
• Organisation of the Swiss healthcare system • Quality of care in Switzerland
– Context – Quality of care and safety indicators
• Research and development in quality and safety – Switzerland – International
Svizzera • 26 healthcare systems … • Mandatory insurance • Healthcare 11,4% GNP • 6’000 € / individual / year
• Confederation • 26 cantons • 8,2 millions inhabitants
• G 64%, F 24%, I 8%
• Life expectancy • F : 84.8 • H : 80.5
Swiss health care system OECD / WHO 2011
• Performing well, but costly - in general and for a sizable number of persons/families
• Needs to face increasing burden of chronic diseases in an aging population: increasing volume of care, few integrated care - networks
• Improve healthcare information (quality of care) • Improve assessment of quality of care and of healthcare
technologies • Shortage of healthcare professionals • Too many hospitals / hospital beds • Lack of coordination in prevention and health promotion • Insufficient governance and coordination in healthcare system
Swiss health care system Quality of care – law
• In the framework of the mandatory healthcare insurance, all paid care must be effective, appropriate and economical (Art. 32 LAMal)
Swiss health care system Quality of care – law
• Warranting quality (Art. 58 LAMal) … the Federal Council (FC) can manage to organise scientific and systematic assessments to monitor and warrant appropriateness and quality of care …
– The following information should be communicated: …. f. quality of care indicators
Swiss health care system Quality of care – history
Numerous attempts, more or less collaborative, to manage and monitor quality of care
- medical associations & organisations, insurance, hospitals, cantons, …
– Patientensicherheit (2003) – Association Nationale pour la Qualité - anq
(CIQ + AIQ) (2009)
anq – National association for the development of quality in hospitals
Members • Cantons, insurances • Healthcare providers - Association of hospitals
– Aim: • Assess and inform about quality • Develop quality • Improve quality
Patient satisfaction since 2009 Post-operative infections since 2010 Potentially avoidable surgical re- intervention since 2010
Potentially avoidable re- hospitalisation since 2010
Prevalence of falls and decubitus ulceration since 2011
Implant registry since 2012
anq – Quality of care indicators - rehabilitation hospital care
Patient satisfaction since 2013
anq - Quality of care indicators - psychiatric hospital care Assessment of quality in diagnosis and therapeutic process (in German only) Use of quality assessment in practice (in German) Comparative evaluation of quality measures between hospitals
2013
2012
Comparative report for inpatient psychiatric care in children and teens
2013
Indicatori di qualità degli osp
IMPROVING QUALITY OF CARE
Current developments in Switzerland
The Federal Council wants to improve healthcare quality and efficiency Bern, 14.05.2014 • Launch of national programmes to monitor quality
and safety • Systematic check of the efficacy and efficiency of
healthcare interventions (healthcare technology assessment)
• National Centre : quality and healthcare technology assessment
• Better coordination of public and private initiatives • New law on “quality”
– Consultation process and modifications
Main tasks proposed • Launch national programmes targeting quality of
care and safety issues • Develop quality indicators, especially for the
ambulatory sector • Systematic Health Technology Assessment • Evaluate appropriateness of care
Project of new federal law
• Consultation process 2014 • Hearings 2014-15 • Law project revision 2015
Current status, Spring 2015 • « Network » instead of an « Institute » • Report for Federal Council • Message for parliament (end of 2015)
RESEARCH & DEVELOPMENT ON QUALITY OF CARE A - SVIZZERA I
Quality of care – R & D initiatives - Svizzera
• Variation of care • Patient satisfaction and experiences • Appropriateness of care, over- and underuse of
care • Adaptation and implementation of clinical
practice guidelines • Potentially avoidable hospitalisation • Retrospective survey of hospital adverse events:
1 survey in 1 hospital
Quality of care – R & D initiatives - Svizzera
Quality and safety indicators based on routinely collected data / administrative data – Potentially avoidable re-hospitalisation – Potentially avoidable surgical re-intervention – Swiss Anaesthesia Databank (ADS) – Patient Safety Indicators (AHRQ)
To use selected Patient Safety Indicators (PSI - AHRQ) and their algorithm refinement for assessing the impact of DRG implementation in Switzerland (SNF - Sinergia)
1. To explore and document the frequency, variations and potential biases of PSI, using Swiss hospital data collected by the Federal Office of Statistics
2. To evaluate trends in PSI in Swiss hospitals 2008 – 2015 Impact of 2012 changes in DRG implementation
3. To assess the accuracy of a subset of PSI
Quality and safety indicators
ICD-10 hospital discharge diagnoses codes - WHO ICD-10 since 1998 - German modification since 2011 (ICD-10-GM)
Medical and Surgical Procedures - CHOP (ICD-9-CM)
Diseases Related Groups - SWISS-DRG, mandatory since 2012
Methods : Data sources
disorders • Post-operative Deep Vein Thrombosis and
Pulmonary Embolism (VTE - Venous Thrombo-Embolism)
• Post-operative sepsis • Obstetric Trauma during vaginal delivery
with/without instrument
• Baseline risk of Postoperative VTE in patients undergoing hip arthroplasty, under appropriate VTE prophylaxis - Systematic review (meta-analysis)
- Januel JM. JAMA 2012
• Estimation and comparison of adjusted occurrence rates of VTE PSI in patients undergoing hip arthroplasty
• Comparison between Switzerland and France – and with a benchmark
VTE PSI in patients undergoing hip arthroplasty
0
1
2
)
Expected values (from Models) using Swiss and French Nationwide Data, stratified by Length of Stay and by Year
[8 - 18[ ≥ 18 days< 8 days
LMWH = 0.58% (0.35% - 0.81%)
Comparisons stratified on length
of stay 76.4% 74.1%
Quality of care – International R & D initiatives
• Quality and safety indicators based on routinely collected data / administrative data – IMECCHI Consortium
• Contribution to new classification – ICD-11 – WHO – Topic Advisory Group (TAG)
on Quality and safety • Conceptual and practical developments
ICD-11 for quality and safety Overview of the WHO Quality and Safety Topic Advisory Group (WHO-TAG Q&S)
i. Cataloguing existing ICD-9 and ICD-10 quality and safety indicators
ii. Reviewing ICD morbidity coding rules for main condition, diagnosis timing, numbers of diagnosis fields and diagnosis clustering
iii. Substantial restructuring of the health-care related injury concepts coded in the ICD-10 chapters 19/20
Ghali WA et al. Int J Qual Health Care 2013;25:621-5
ICD-11 for quality and safety Overview of WHO-TAG Q&S
iv. Mapping of ICD-11 quality and safety concepts to the information model of the WHO's International Classification for Patient Safety and the AHRQ Common Formats
v. Review of vertical chapter content in all chapters of the ICD-11 beta version
vi. Downstream field testing of ICD-11 prior to its official release
Ghali WA et al. Int J Qual Health Care 2013;25:621-5
WHO-TAG Q&S International variation in the definition of ‘main
condition’ in ICD-coded health data
• ‘main condition’ not defined in a consistent manner internationally – ‘reason for admission’ – ‘resource use’
• a few countries have recently transitioned from one of these approaches to the other
• definition of ‘main condition’ matters (DRG’s, risk adjustment)
Quan H et al. Int J Qual Health Care 2014;26:511-5
WHO-TAG Q&S
• International variation in the definition of ‘main condition’ in ICD-coded health data
• WHO-TAG Q&S proposes a method of harmonizing the international definition
• to improve health data comparisons across countries and hospitals consistently
• inter-observer reliability of alternative harmonization approaches should be evaluated
Quan H et al. Int J Qual Health Care 2014;26:511-5
WHO-TAG Q&S How many diagnosis fields are needed to capture
safety events in administrative data? Findings and recommendations
• What is the optimal number of secondary diagnosis fields for meta-analyses?
• PSI information from administrative hospital data of 19-20 OECD countries in 2009 and 2011 (+ CA &FL in USA)
• Comparison of PSI rates in 3 countries with expanded # of secondary diagnosis fields vs 6 countries with limited # secondary diagnosis fields
Drösler SE et al. Int J Qual Health Care 2014;26:16-25
WHO ICD-11 TAG Q&S - number of secondary diagnoses fields • Increased # of secondary diagnosis fields not
associated with overall increase in PSI rates • High proportions of PSI-related diagnoses appeared
beyond the 6th secondary diagnosis field • Distribution of 3 PSI in CA and FL
– 89-90% of central venous catheter infections and – 97-99% of retained foreign bodies and accidental
punctures or lacerations captured within 15 secondary diagnosis fields
Drösler SE et al. Int J Qual Health Care 2014;26:16-25
WHO ICD-11 TAG Q&S
Capturing diagnosis-timing in ICD coded hospital data
• narrative literature review • scan of national experiences focusing on
countries currently using timing flags • series of meetings • formal recommendations regarding diagnosis-
timing reporting
Sundararajan V et al. Int J Qual Health Care. Accepted
WHO ICD-11 TAG Q&S diagnosis-timing in ICD hospital data Recommendations
• yes/no classification of ‘arising after admission’ • permitted designations of ‘unknown or clinically
undetermined’ – to facilitate coding while providing flexibility when
there is coding uncertainty • clear coding standards and guidelines
– ongoing coder education • ensure reliability of diagnosis-timing flag
Sundararajan V et al. Int J Qual Health Care. Accepted
WHO ICD-11 TAG Q&S New concept to capture “harm & injuries” Develop a new conceptual approach to
capturing healthcare-related harms and injuries in ICD-coded data
• Four categories of source of “event” a) Medications and substances taken for
therapeutic purposes b) Procedures c) Devices d) Other aspects of care
WHO ICD-11 TAG Q&S New concept to capture “harm & injuries”
• Proposed multiple coding approach • Each source of harm coded with a combination
of codes • Use of new code clustering in ICD-11
– “cause” of harm – “mode or mechanism” of harm – “actual injury or harm” that resulted from
the event
Harm" that resulted
from the event
“Mode or Mechanism” of harm e.g. overdose/underdose for substances
e.g. accidental perforation for procedures e.g. dislodgement/malfunction for devices e.g. mismatched blood used in transfusion
for other aspects of care
WHO ICD-11 TAG Q&S New concept to capture “harm & injuries”
• Proposed information model provides a more flexible, yet still simple and non-duplicative, approach to recording quality and safety events in ICD-coded data
• Linked to broader proposal from the Injury TAG for revision/enhancement for the external cause and injury chapters
WHO ICD-11 TAG Q&S New concept to capture “harm & injuries”
• Introduction of a diagnosis-timing capacity (i.e., distinguishing present on admission vs. arising during hospital stay)
• Revised set of codes in ICD-11’s Chapter 24 capturing “Factors influencing health status and contact with health services”
RESEARCH & DEVELOPMENT ON QUALITY OF CARE C - SVIZZERA II
Over- et underuse of upper gastro-intestinal endoscopy - possible public health impact
0
20000
40000
60000
80000
Patients screened for enrolment n = 8760
With lower gastrointestinal symptoms n = 651
Referral for colonoscopy
Gastrointest Endosc 2000;52:593–9.
Appropriateness of 5-ASA (5-aminosalicylates) treatment in patients with Crohn’s disease
• Swiss Inflammatory Bowel Diseases Cohort Study
• Absence of evidence of effectiveness of 5- ASA in Crohn’s disease patients
• 835 / 1420 patients (59%) treated with 5-ASA • Perception of effectiveness of treatment by
46% of patients – Subjective and may correspond to natural history
of disease Schoepfer A et al. 2014
ADS Adverse events occurrence during surgical intervention according to ASA group
(1996-2006) N = 532’485
Other incidents
Cardio-circulatory incidents
Hypertension and adverse events occuring during surgery, multicenter registry in Switzerland (ADS)
• Elective surgery, 24 hospitals, 2000-4 • 124’939 interventions, 27’881 hypertensive patients (22%)
• ≥ 1 cardiovascular events 7’549 (6%) • Cardiovascular event in presence of hypertension - OR= 1.38 (95% CI 1.27–1.49) • Important variation by hospital - OR adjusted 0.41 up to 2.25 • Persistence of increased anaesthesia risk in hypertensive individual • Due to coding or practice variations?
47
Journée régionale du jeudi 15 octobre 2009 à Bourg-en- Bresse
Hypertension and adverse events occuring during surgery, multicenter registry in Switzerland (ADS) (Beyer K 2009)
48
Comments
enough considered and developed currently
– Lack of data and indicators – Lack of research and specific support to
health services research – New federal concept ongoing
Comments • International • WHO - TAG
– Important contributions to ICD-11 to enhance capture of quality and safety issues
– Scientific approach to ICD revision by WHO-TAG Q&S
– New concept to capture “harm & injuries” related to healthcare in ICD-11
Grazie per l'attenzione [email protected]
Presentation Plan
Swiss health care system Quality of care – law
Swiss health care system Quality of care – law
Swiss health care system Quality of care – history
anq – National association for the development of quality in hospitals
anq – Quality of care indicators - acute somatic hospital care
anq – Quality of care indicators - rehabilitation hospital care
anq - Quality of care indicators - psychiatric hospital care
Diapositive numéro 12
Diapositive numéro 13
Diapositive numéro 14
The Federal Council wants to improve healthcare quality and efficiency
Project of new federal law
Project of new federal law
Research & development on quality of careA - Svizzera I
Quality of care – R & D initiatives - Svizzera
Quality of care – R & D initiatives - Svizzera
Diapositive numéro 22
Diapositive numéro 23
Diapositive numéro 24
Diapositive numéro 25
Diapositive numéro 26
Quality of care – International R & D initiatives
ICD-11 for quality and safety Overview of the WHO Quality and Safety Topic Advisory Group (WHO-TAG Q&S)
ICD-11 for quality and safety Overview of WHO-TAG Q&S
WHO-TAG Q&S
WHO-TAG Q&S
WHO-TAG Q&S
WHO ICD-11 TAG Q&S - number of secondary diagnoses fields
WHO ICD-11 TAG Q&S
WHO ICD-11 TAG Q&Sdiagnosis-timing in ICD hospital data
WHO ICD-11 TAG Q&SNew concept to capture “harm & injuries”
WHO ICD-11 TAG Q&SNew concept to capture “harm & injuries”
Diapositive numéro 39
WHO ICD-11 TAG Q&SNew concept to capture “harm & injuries”
WHO ICD-11 TAG Q&SNew concept to capture “harm & injuries”
Research & development on quality of careC - Svizzera II
Over- et underuse of upper gastro-intestinal endoscopy - possible public health impact
Diapositive numéro 44
Appropriateness of 5-ASA (5-aminosalicylates) treatment in patients with Crohn’s disease
Diapositive numéro 46
Diapositive numéro 47
Diapositive numéro 48