Quality of Health Care in Quality of Health Care in SloveniaSlovenia

Results of Quality assResults of Quality asseesment in sment in operative gynecology and operative gynecology and

perinatologyperinatology..  

prof.dr. Marjan PAJNTAR

prof.dr. Marjan PAJNTAR

Medical chamber of SloveniaMedical chamber of Slovenia

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Providing Providing quality quality of of health health serviceservice in in the Republic of Slovenia on thethe Republic of Slovenia on the whole whole is a basic component ofis a basic component of stability and stability and perspective of theperspective of the entire health entire health service systemservice system development and development and shshallall be a be a distinctive preferential distinctive preferential strategic aim of this area.strategic aim of this area.

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The first The first operative operative step isstep is r recognition ecognition of the problem or imperfectionof the problem or imperfection.. This This requires requires continuous or periodicalcontinuous or periodical qualityquality assessassessmentment. .

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Our assessmentOur assessment is is based on based on QQuality uality IIndexes,ndexes, which can be which can be calculated from datacalculated from data gathered gathered and and pprocessedrocessed for this purpose.for this purpose.

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The quality indexes, as a system The quality indexes, as a system of control, provide of control, provide distindistinctionction among among individual institutions and individual institutions and individual doctors,individual doctors, issue guidelines issue guidelines to take measures.to take measures.

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ProjectProject "Quality of health"Quality of health care care in Slovenia" in Slovenia" Medical Chamber of SloveniaMedical Chamber of Slovenia Ministry of HealthMinistry of Health 1999 the begining, pilot study1999 the begining, pilot study 2002 regular collection of the data.2002 regular collection of the data.

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Scheme systemScheme system

SQL www FW

internet

delovna postaja

delovna postaja

delovna postaja

delovna postaja

dlančnik

delovna postaja

delovna postajadelovna postaja

prenosnik

prenosnik

podatkovni strežnik spletni strežnik

požarni zid

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Zagotavljanje kakovosti v zdravstvu,

Okulistika: Operacija presenilnih in senilnih katarakt  01. Ime in priimek pacienta: 02. Številka popisa: 03. Ustanova in šifra ustanove: / 04. Datum rojstva: / / 05. Spol 1 moški 2 ženski Bolezni pacienta 06. Sladkorna bolezen 1 da 2 ne 07. Retinopatija diabetika neproliferativna 1 da 2 ne 08. Retinopatija diabetika proliferativna 1 da 2 ne 09. Krvni pritisk: / 10. Antikoagulantna terapija 1 da 2 ne 11. Ostrina vida pred operacijo: 12. Očesni pritisk – tonus aplanacijsko: Spremembe na očesnem ozadju 13. Oftalmoskopski pregled 1 da 2 ne 14. Degeneracija makule 1 da 2 ne 15. Krvavitev mrežnice 1 da 2 ne 16. Odstop mrežnice 1 da 2 ne Komplikacije operacije 17. Tip vstavljene intraokularne leče: 18. Poškodba zadnje lečne ovojnice: 1 da 2 ne 19. Padec lečnega jedra v steklovino: 1 da 2 ne 20. Fibroza zadnje lečne ovojnice: 1 da 2 ne 21. Vnetje očesa po operaciji: zunanje 1 da 2 ne notranje 1 da 2 ne 22. Sekundarni glavkom: 1 da 2 ne Rezultati operacije 23. Vidna ostrina po operaciji brez korekcije: s korekcijo: 24. Zdravnik: št.

Sheet protocol

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Internet (WWW) protocol

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Data communication with the server is Data communication with the server is secure secure (SSL protocol).(SSL protocol).Data are collected in the central Data are collected in the central SQL SQL database.database.

Data input and protectionData input and protectionEach user has a Each user has a usernameusername and a and a passwordpassword for access to for access to his own internet his own internet protocol.protocol.

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From year 1999 we have From year 1999 we have collected more thancollected more than

200.000200.000questionariesquestionaries

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We begane in 1999 with pilot We begane in 1999 with pilot study in 47 medical branches.study in 47 medical branches.

Regular collection is from 2002 Regular collection is from 2002 in 35 medical branches,in 35 medical branches,

20 are doing well.20 are doing well.Except for perinatology the Except for perinatology the

data are collected voluntarilydata are collected voluntarilyin 34 medical branches.in 34 medical branches.

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Collection of perinatal data in Collection of perinatal data in NPISS is running from 1986. NPISS is running from 1986. We are collecting more than We are collecting more than 300 items of genetic data, 300 items of genetic data, pregnancy, delivery and pregnancy, delivery and

neonatal period in all neonatal period in all maternity hospitals (14) in maternity hospitals (14) in

Slovenia and is obligatory by Slovenia and is obligatory by law.law.

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Each department get results in statistical and Each department get results in statistical and grafical way for their grafical way for their departmentdepartment and with and with

comparision with average result of all other comparision with average result of all other departments.departments.

Analysis of quality indicators are made also for Analysis of quality indicators are made also for results of results of individual doctorsindividual doctors with comparision to with comparision to

other doctors results.other doctors results.

Each department get results in statistical and Each department get results in statistical and grafical way for their grafical way for their departmentdepartment and with and with

comparision with average result of all other comparision with average result of all other departments.departments.

Analysis of quality indicators are made also for Analysis of quality indicators are made also for results of results of individual doctorsindividual doctors with comparision to with comparision to

other doctors results.other doctors results.

Processing of the dataProcessing of the data

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We are collecting data in all We are collecting data in all departments in Slovenia for:departments in Slovenia for:

PerinatologyPerinatologyGastrosurgery - Gall bladderGastrosurgery - Gall bladderGynecologyc surgery Gynecologyc surgery (hysterectomy, adnexal lap.op.) (hysterectomy, adnexal lap.op.) ReproductionReproductionTorakal surgery (Ca Pullmonum)Torakal surgery (Ca Pullmonum)Infantile diabetesInfantile diabetes

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We are collecting data in many We are collecting data in many departments in Slovenia for:departments in Slovenia for:

Internal intensiv careInternal intensiv careOperative intensive care Operative intensive care Pneumonia – hospital aquiredPneumonia – hospital aquiredNuclear medicineNuclear medicineOculistic-Operative cataractaOculistic-Operative cataractaBrest cancer surgeryBrest cancer surgeryPediatric nefrologyPediatric nefrologyPlastic surgery – carpal syndromPlastic surgery – carpal syndromPsychiatry - schPsychiatry - schTraumatology- hip opTraumatology- hip opUrology, op benig. tumor prostataeUrology, op benig. tumor prostataeOtolaringology- nasal polyp opOtolaringology- nasal polyp opMed. geneticMed. genetic

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In the last 5 years we have collected:In the last 5 years we have collected:

More than More than 17.30017.300 operative gynecological cases operative gynecological casesMore than More than 76.00076.000 perinatal cases perinatal cases

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q004q004Gynecological Gynecological

operationsoperationsHysterectomy, laparoscopic Hysterectomy, laparoscopic

adnexal operationsadnexal operations

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q028q028PerinatologyPerinatology

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delež carskih rezov po zdravnikih med leti 2002 in 2005 [%]

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60,0%

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po

vpre

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zdravniki

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tki

MeasuresMeasuresIndividual position,Individual position,Individual position,Individual position,

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StudyResults of comparission

between all deliveries with deliveries of healthy primipara

StudyResults of comparission

between all deliveries with deliveries of healthy primipara

31Year

1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

% o

f ce

sare

ans

0

2

4

6

8

10

12

14

Healthy multipara **

Healthy primipara *

Overall percentage

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0,0

5,0

10,0

15,0

20,0

25,0

30,0

ca

rsk

i re

z, f

orc

ep

s,

va

ku

um

[%

]

PO JE TR NG MB LJ MS KP CE NM BR PT SG KR skupaj

bolnišnica

q028 operativno dokončanje poroda (leto 2002-2005)

vsi porodi

0,0

5,0

10,0

15,0

20,0

25,0

30,0

ca

rsk

i re

z, f

orc

ep

s,

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ku

um

[%

]

PO JE TR NG MB LJ MS KP CE NM BR PT SG KR skupaj

bolnišnica

q028 operativno dokončanje poroda (leto 2002-2005)

vsi porodi

standardna primipara

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0,0

0,5

1,0

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3,0

[%]

BR NG PT TR CE KP MB LJ JE NM MS SG PO KR skupaj

bolnišnica

q028 transfuzija (leto 2002-2005)

vsi porodi

0,0

0,5

1,0

1,5

2,0

2,5

3,0

[%]

BR NG PT TR CE KP MB LJ JE NM MS SG PO KR skupaj

bolnišnica

q028 transfuzija (leto 2002-2005)

vsi porodi

standardna primipara

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14.0%ime boln št por APGA p= %ZN sc %

1 Djukanović Saša PT 740 2 0,001 0 11,52 Mileta Stjepan PT 736 2 0,001 0 14,53 Bindas Alenka CE 650 0 0,001 0 15,74 Pavičevič Liljana CE 617 1 0,001 1 12,65 Brus Nataša CE 650 2 0,01 0 136 Sredanović JE 500 1 0,01 0 11,47 Ocvirk Marija CE 346 0 0,01 0 6,98 Jordan Tanja PO 320 0 0,01 0 12,89 Juvan Katja SG 168 0 0,01 0 12,5

12.3%

The best obstetriciansThe best obstetricians

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Compliments for good work!Compliments for good work!

For best departmentsFor best departments For best individual doctorsFor best individual doctors

  

Compliments for good work!Compliments for good work!

For best departmentsFor best departments For best individual doctorsFor best individual doctors

MeasuresMeasures

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On-line collectionOn-line collection

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ProblemsProblems• Motivation.Motivation.

It is still great problem with motivation It is still great problem with motivation for partitipation. Many doctors are not for partitipation. Many doctors are not aware that collected data serve aware that collected data serve themselves to asses their own results themselves to asses their own results and to compare their results with other and to compare their results with other doctors with the other departments. doctors with the other departments. Especially bad is in the departments Especially bad is in the departments where heads are not aware of where heads are not aware of importance of quality assesment.importance of quality assesment.

• FFinanciinancial problems of the projectal problems of the project..

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ConclusioConclusionn

There is no one who would do There is no one who would do things in such a way that they things in such a way that they could not be done better, and could not be done better, and

there is nothing that could not be there is nothing that could not be still perfected.still perfected.

https://kakovost.mf.uni-https://kakovost.mf.uni-lj.silj.si

kakovost@zzs-mcs.sikakovost@zzs-mcs.si

Vesoljski teleskop SpitzerVesoljski teleskop Spitzer

NGC 7293, objavljeno NGC 7293, objavljeno 12.02.200712.02.2007