Transcript Global health indicators are improving … But not in all

International Perspective
and Conclusion
Gérard Schmets
WHO EUROPE
Global health indicators are
improving overall in the world…
But not in all places, not for all social
groups and not at the same speed
Life expectancy at birth, males, 1970-2002
Life Expectancy at birth, in years
80
75
EU(15-prior 1.05.2004) average
CIS(12) average
70
65
60
1970
1980
Source: Health For All Database, July 2004
1990
2000
2010
Of course, empoverishment explains
a big part of these results…
but not all!
Inter-country variations in levels of mortality in 67 developing
countries explained by indicators of care and context
100
Unexplained
variation
90
Variation explained
by financial inputs
and responsiveness
% of variation explained
80
70
Variation explained
by human resource
density
60
50
Variation explained
by interaction
between care and
context
40
30
20
Variation explained
by contextual
factors
10
0
Maternal
Mortalityl
Neonatal
Mortality
Fuente: World Health Report 2005, pg 83,
Postneonatal
Mortality
Infant
Mortality
health has to do with:
economic
development
democracy
and values
health
system
effectiveness
Can anything be done to
accelerate health gain?
Strengthening Health System
saves lives
Health systems framework
FUNCTIONS THE SYSTEM
PERFORMS
Stewardship
(oversight)
Creating resources
Health
(level and
equity)
Responsiveness
(investment and training)
(to people’s nonmedical expectations)
Delivering services
Financial protection
(provision)
and fair distribution of
burden of funding
Financing
(collecting, pooling
and purchasing)
Performance
Health System Framework
to Improve Safety
Exercise Stewardship
• Evidence-based
policies
• Non-punitive error
reporting system
• Supportive
supervision and
control
Finance the System
Safety Issue:
Accidental Death
Generate Resources
•
•
•
•
Computerize medical records
Medications with bar-codes
Train staff in reporting errors
Special certification in critical
care
• Assess cost of errors
• Financial incentives
for performance
according to
standards
• Invest in safer care
interventions
Organize Service Delivery
• Computerized reminders
and alert systems
• Evidence-based guidelines,
standardized procedures and
safety interventions
• Team-based quality
improvement projects
QUALITY & SAFETY:
KEY ELEMENTS
In European Hospitals:
‘Every 10th patient
suffers from preventable harm’
(it is suspected this is higher at
Primary Health Care level)
Identify actions that lead to objectives
Function
Possible reform
Service
Delivery
Computerized reminders
Financing
Stewardship
National
objective
Evidence-based
guidelines
New GP and family
nursing curricula
Renovate and equip
maternity services
Introduce incentives
for performance
Invest in safer care
interventions
Monitor compliance
with new guidelines
Promote non-punitive
reporting & safety
culture
Reduce accidental
deaths
Improved safety in
antenatal and delivery
care
Improved access to
safe delivery services
Strengthen Safety
Culture
Improve
patient safety
Resource
Creation
Intermediate
objectives
IN PRACTICE
On the International Agenda
• International agencies support
• World Alliance for Patient Safety
• In Europe, EU, EC, CoE, OECD, WHO-Europe
• WHO-EURO:
– PHC: QI at country level
– HOSPITALS: PATH project (Performance
assessment tool for quality improvement in
hospitals)
SITUATION IN EUROPE:
WHO EURO
PATIENT SAFETY
SURVEY
A European baseline
survey on patient safety
Aims:
 Respond to
identified need to fill
the information gap
 Target: 52 members
states
 Questionnaire
based
 Raising awareness on
patient safety
 Identifying national
focal points
 Evaluating major
problems at national
and regional levels
• Overall response rate: 76.9%
• The first to respond: new EU
and accession countries
• The lowest response rate: NIS
Arising from the survey
 Fragmented
interventions
 Gap between
policy and
implementation
 Unclear reporting
schemes & data
use
 Patient
expectations are
high
 Need for
consistent
approach
 Need for efficient
mechanisms to
support
implementation
 Guidelines for
reporting systems
 Patient
empowerment and
information
Safety culture and multidisciplinary team work,
with the patient as part of the team require immediate attention
Common obstacles
 The lack of a safety culture (individual
and institutional)
 The lack of communication between
professionals and between
professionals and patients
 The weak pro-active risk assessment
 The limitation of funds and sometimes
subsequent access to technologies
Quality & Safety
Developments in WHO
EUROPE
• PHC: QI at country level
• HOSPITALS: PATH project
Hospitals: PATH project:
Performance assessment tool for
quality improvement in hospitals
-
Initiated in 2003
51 Hospitals from 6 countries
internal quality assessment,
multidimensional perspective on hospital
performance (safety is one of the
dimension)
- Pilot phase terminated
=> demonstrates important differences in
performance, including patient safety
Core Safety Indicators
Patient safety:
- In-hospital mortality rates for tracer conditions: (acute
myocardial
infaction, community aquired pneumonia, hip
replacement, stroke; hip
fracture)
- Readmission to intensive care unit
- Caesarean section
- Pressure Ulcers [not collected in pilot]
- Nosocomial Infections [not collected in pilot]
Staff safety:
- Excessive Working Hours
- Needle Injuries
Patient and staff safety are inextricably linked.
Next steps for PATH
Preparation of 2nd wave of data collection
in 2006 (from 51 hospitals in 6 countries to
>200 hospitals in 10 countries).
Technical workshop 13/14 October 2006 in
Barcelona to agree on revised indicators:
harmonization with other indicator sets
and strengthening the patient safety
component (OECD, AHRQ, SIMPATIE …)
Next steps for WHO EURO
WHO supports patient safety initiatives
WHO develop activities and a position
paper on patient safety for the European
region
Harmonization of indicators with other
international agencies is one of WHO’s aim
Patient safety and quality are inextricably
linked and will be addressed at Health
Systems Conference 2008
CONCLUSION
Safety Information is on the Agenda at all
levels: patient, region, country, international
But not in all places and not at the same
speed
Which interventions to promote the safety
information agenda from the Patient
Perspective, the National Perspective, the
Regional Perspective or the International
Perspective?