Josep Maria Argimon, AQuAS Director
Central de Resultats’ reports consolidate some data and some analysis based on: patient-centered care, appropriateness, patient safety, efficiency, economic sustainability and training. This is thus a repository of knowledge tuned each year by counting on experience and innovation.
Regarding the issue of the Central de Resultats for 2014 (based on data 2013) the following methodological developments are the most remarkable:
- Primary care report’s innovations. The most highlighted technical novelty for primary care is that for the first time the data from Central de Resultats feed from minimum basic data set (EHR), which opens a new range of possibilities for future processes. Another novelty is the incorporation in this report of the segmentation based on Clinical Risk Group differentiated for the population assigned to each of the 369 primary care teams of the public network.
- Monograph report of diabetes. Since 1993, when the program of continuous improvement of the care quality was initiated from the indicators of “Group study of diabetes in primary care” (GEDAPS), there has been a gradual improvement in diabetes care, both of process indicators and of outcome. For this reason, this year it has been convenient to entrust a monograph report to “Diabetes Epidemiological Research Group from Primary Care – IDIAP J. Gol”, in order to confirm that the strategy of enhancing competency among teams of primary care in this clinical process is the most appropriate.
- Hospital activity’s synthetic appropriateness index. The appropriate use of hospitals, the most expensive resource of all health care systems is key to the overall sustainability for the health sector. After a couple years of internal testing, now a monograph on this new synthetic indicator is presented which consists of 10 specific indicators that reflect: a) ambulatory care sensitive conditions for 5 chronic diseases, b) appropriate use of hospital emergencies, c) excessive consumption of hospital stays for femur fractures and ictus, and d) surgical overacting (caesarean section rate). The results of the synthetic adequacy index are shown both for hospitals as well as for each territory.
- Mortality at 30 days from hospital admission. The traditional way to measure hospital mortality is the one that emerges from the hospital minimum basic data set (MBDS), when the circumstance of hospital admission records the “death”. Clearly, this is a very limited source for the analysis of mortality, since after hospitalization for certain severe diseases, people can die in a geriatric home, at home or in another hospital admission that differs from the first. Motivated by this limitation of traditional indicators of mortality, several agencies, most notably Medicare in the US and Dr. Foster Intelligence in the UK, have promoted the intersection of databases to detect mortality at 30 days from the hospital admission, regardless of the place of death. Following this same hint, this Central de Resultats edition, after crossing, from MSIQ – CatSalut, the MBDS with the central registry of insured, offers the novelty of hospital mortality at 30 days of admission duly adjusted for age, sex and morbidity, for a group of selected diseases, but also, specifically, for 5 conditons.
- New specific indicators for 3 clinical processes: myocardial infarction code, stroke code and hip fractures. From the heart attack and stroke codes sources and from the arthroplasty (RACat) data, this year the Central de Resultats incorporates circuits’ efficacy data (time to effective clinical intervention: angioplasty, fibrinolysis or surgery).
- Information technology and communication trends map. The hospitals report includes, this year, the TICSalut map of trends in information technology and communication. The indicator consisting of eHealth Benchmarking IC-EU27, which puts Catalan hospitals on a high level of development of these technologies and, specifically, the electronic health record, is notable.
- Novelties in the report for chronic care area. This second report for the chronic care area is more dynamic and functional than the first, in the sense that not only performance data and sustainability of suppliers are provided, but also the lines of analysis that make sense for groups of well defined patients has been open: the end of life period, dementia and neurological diseases with disabilities. The report also contains a section for older people with chronic conditions, that provides a significant methodological innovation due to the fact that it combines the hospital and chronic care stays for patients with hip fracture and stroke.
Acknowledgments. The Central de Resultats’ exercise of transparency emanates from a political decision of the Department of Health, but to make this possible, the innovative cleverness of professionals working in the different information systems from the Department of Health, CAtSalut, AQuas Observatori de Salut and specific directory plans, has been essential. To all of them, I want to express my appreciation and my plea not to lose the drive which is indispensable to consolidating the experience, while continuing to refine the proposed analysis.