Transcript PowerPoint-presentasjon

Monitoring and analysing
in primary health care in
Norway
Jan Magne Linnsund
Senioradvisor dpt. Primary Health Care
Norwegian Directorate of Health
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GDP per capita and total health expenditure
per capita 2005 in US dollar (OECD 2007)
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0
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293
215
1 653
1 121
1 216
1 380
1 471
1 530
1 542
1 573
1 606
1 048
864
649
1000
941
2 010
2 040
2 275
2 366
2 428
2 511
3 713
3 663
3 442
3 235
3 328
4 553
4 371
4 553
4 351
4 256
4 124
3 677
3 453
4 904
Public
1 719
2000
3 077
2 898
2 514
3000
3 866
4000
4 819
5000
5 862
6000
5 131
7000
8 713
8000
6 325
Health expenditure per capita 2013 in US
dollar (OECD 2015)
9000
Private
Much is not necessarily better than less !!
• Although I am not fond of being the
messenger of the message, it is no research
in the world that can document that to pour
in money automatically improves quality
Kristin Clemet, norwegian conservative politician;born
in 1957
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Health status - OECD 2015
Indicator
The number
in the cell
indicates
the position
of each
country
Life expectancy at birth Men
Life expectancy at birth Women
Life expectancy at 65 Men *
Life expectancy at 65 Women *
Mortality from
cardiovascular diseases **
Australia
Austria
Belgium
Canada
Chile
Czech Rep.
Denmark
8
18
22
13
27
28
21
7
13
19
17
27
28
25
3
16
23
10
27
29
25
7
13
14
10
28
30
26
7
26
15
5
16
31
10
Estonia
Finland
32
26
31
27
32
23
15
18
17
33
2
15
3
3
5
20
9
34
11
11
8
3
19
9
33
16
23
11
4
1
5
11
34
19
19
20
2
16
13
34
10
19
3
8
6
20
6
28
16
8
9
2
22
11
34
20
24
17
4
1
5
8
32
20
17
24
2
25
27
33
23
21
3
17
1
4
12
22
8
18
Norway
9
13
15
14
11
Poland
30
24
31
25
5
5
1
29
14
26
29
9
31
17
2
13
6
32
24
29
30
23
33
26
3
10
1
32
14
22
28
11
31
14
3
17
5
33
23
25
30
14
34
28
6
19
13
29
9
20
France
Germany
Greece
Hungary
Iceland
Ireland
Israel
Italy
Japan
Korea
Luxembourg
Mexico
Netherlands
New Zealand
Portugal
Slovak Rep.
Slovenia
Spain
Sweden
Switzerland
Turkey
United Kingdom
United States
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Norwegian health services has high
quality in an international perspective
• Nevertheless, there are undesirable variations in
our health ervices
• National guidelines and and quality indicators are tools to
promote desired practises
• Undesirable incidents happens that we must learn
from and it is a need for greater transparency on
such issues
• The debate of prioritization has been more about
the specialist health care than primary health care
and it is a goal that priorities should be:
• More unified and coordinated
• Integrated in management and practice at all levels
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Guidelines in primary health care – too much?
Results from an investigation of
22 primary doctors offices in UK:
•
855 different guidelines (68 cm height and 28
kg weight)
•
75 % were about clinical issues
http://www.bmj.com/content/317/7162/862
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Background
• 2010: Framework for a national
quality indicator system in primaryand specialist helath service
• 2012: New legislation on municipal
health and care services:
«Norwegian Health Directorate should
develop, convey and maintain national
quality indicators as a tool for management
and quality of service, and as a basis for
patients to protect their rights."
•
2012: Stortingsmelding 9 (2012-2013). En innbygger – en journal
•
2013: Stortingsmelding 10 (2012-2013). God kvalitet – trygge tjenester
•
2014: Stortingsmelding 11 (2014 – 2015). Kvalitet og pasientsikkerhet 2013
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Requirements and objectives for national
indicators of quality
Frameworks and
Requirements:
Structure
indicators
resources, expertise,
available equipment,
records
Ex. Has hospitals stroke
unites?
Process
indikctors
Activities in patient care
Ex. diagnostics, waiting time
for further examination and
treatment
Results
indicators
Complications
Patient satisfaction
Health benefit
Survival
Readmission
Momentous
Scientifically justified
Useful
Feasible
Published regularly
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• Published at Helsenorge.no
• Per last publishing 25.aug 2016:
140 national quality indicators; mostly
within specialist care and hospitals!!
“A quality indicator is an indirect
measure, an idea, which
says something about the quality of
the area being measured.”
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Some of the quality indicators within the specialist
service in Norway
General indicators: :
• Discharge report sent to GP within 7
days
• Patients located in a corridor (1,4%)
• Average waitingtime
• Postponement of planned operations
• Patients' experiences with hospital
• 30-day overall survival after
hospitalization
• Hospital Infections
• Re-admissions of elderly patients
Fracture colli femoris:
• Operation within 48 hours
• 30 days survival
Cancer:
• Started treatment for colon
cancer within 20 workdays
• Started treatment for lung
cancer within 20 workdays
• Started treatment for breast
cancer within 20 workdays
• 5 years survival colon cancer
• 5 years survival rectum cancer
• 5 years survival lung cancer
• 5 years survival breast cancer
• 5 years survival prostatic cancer
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Some examples
• Discharge report from hospitals
– In the country as a whole; in 2015 44,0 % of the discharge
reports was sent from the hospital within 1 day and 80,8 %
within 7 days.
• Heart lung rescue done by the population
– In 2015 had present people started Heart-lung-rescue
before the ambulance arrived in 74,6 % of the cases
nationwide
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Patients in nursing homes with medical consultation last 12 mnd.
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Doctors’s time for residents in nursing homes
Doctor hours per resident
per week
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Waitingtime for health and care services in the municipalities;
last four – ready for publishing 25. aug. 2016
National
indicatores of
quality
Waitingtime
0-15 days *
Waitingtime
16-30 days *
Waitingtime
31 days or more *
Waitingtime for
daily activities
83,2%
6,2 %
10,6 %
Waitingtime for
home nursing care
95,9 %
1,6 %
2,5 %
Waitingtime for
supportive contact
84,8 %
6,6 %
8,6 %
Waitingtime for
nursing home
90,0 %
4,4 %
5,7 %
*The numbers shows the national average in 2015.
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For diskusjon
KPR shall safeguard stakeholders need for
information
Information about activities and results
from the health and care service
KPR =
Municipality
Patient Register
Professional and quality
development in the health
and care service…
Patient and user
Service and
organization
Health condition and
service needs
Patient- and
usercontact
Treatment and
follow-up
Capacity, expertise
and resources
Results and
consequenes
Collaboration
Samhandling
(pasientforløp)
Research and innovation
The exercise of authority and management to
ensure good, comprehensive and equitable
distributed healthcare
Why do we need KPR ?
• Too little comprehensive knowledge of health and care
services in the municipalities.
• Good experience with having a national patient registry for
specialist services (NPR from 2007) that provides information
which is including management, statistics and research.
• Along with NPR will KPR could give a comprehensive picture
of the patient's situation and needs and how health services
meet and solve these across administrative levels.
• KPR will give municipalities the basis for better and more
efficient planning and management of resources and
activities within the health and care services.
• KPR will provide a knowledge base and create better
conditions for quality improvement and patient safety work.
• Provide data for research, health analysis and innovation.
OECD and Norway – and NDPHS
• OECD has pointed out that there is a “black
hole” in the knowledge of primary health care
in Norway.
• In this field Norway are poorer than many
comparable countries - and countries we
usually do not think of comparing ourselves
with that Portugal and Israel
• Common indicators to manage to compare or
- let the thousand flowers bloom!?
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funksjonalitet
KPR will be developed incrementally
KUHR Control and payment of health reimbursement
IPLOS Individual-based care and nursing registry
Data from all service areas
within primary care
available
• Establish a common
reporting directly from the
Expanding with new data from service
•Coordinated with “One
multiple services
resident – one journal”,
Build upon current data
•KUHR
•IPLOS
•More data from GP’s and
nursing and care
•Services like dental
health, health clinics for
children and school
health
•Develop technical
solution with
automated data
capture
•Strength analysis
capabilities
a huge national project
with a prestigious goal:
a common electronic
patient journal
•From 2017?
KPR 1.0
KPR 2.0
KPR 3.0
tid
KPR 4.0
SKIL
Centre for Quality Improvement in Medical
Practices
Norwegian Medical Association (NMA)
AIMs
Implement Quality Improvement (QI) in
medical practices
Cooperate with authorities
Cooperate with research institutions
S K I L’s M A I N T H E M E S
Medication Review
Started November 2015, about 220 doctors have joined so far
Better Antibiotics Prescription
Starting January 2017
Coordinated Care for Multimorbid Patients
Starting 2017/2018
A G G R E G AT E D D ATA
PATIENTS WITH 4+ MEDICATIONS WHERE MEDICATION
REVIEW HAS BEEN DONE AND DOCUMENTED LAST 12
MONTHS
% Medication review
30%
25%
20%
15%
10%
5%
0%
27.22%
11.32%
6.48%
1
2
3
I can’t get no
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Cost of satisfaction
Arch Intern med/vol 172 (no 5) Mar 12, 2012
• Medical Expenditure Panel Survey 2000 -2007; en prospectiv
cohort study; total - N = 51 946
– Use of health services
– Total costs and expenses for drugs
– Mortality
• High degrees of patient satisfaction was associated with:
–
–
–
–
–
Lower use of emergency department
Higher use of general practitioner
Larger total health expenditure
Greater spending on drugs
Higher mortality
• Satisfaction – a doubled-edged sword?
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