International Quality Project largest international data set of quality indicators

Tools that allow us to assess the condition in a simple, understandable, and comparable way [4] Used by health institutions: Fundamental for management evaluation, efficiency and health effectiveness Evaluate the economical performance and hospitalar productivity ( outcome patients,newborns ) Evaluate healthcare quality Tools that allow us to assess the condition in a simple, understandable, and comparable way [4] Used by health institutions: Fundamental for management evaluation, efficiency and health effectiveness Evaluate the economical performance and hospitalar productivity Evaluate healthcare quality outcome patients,newborns ) ( [4] Correia L F. Indicadores de Desempenho Económico na Saúde. 2005

EXAMPLEEXAMPLE [18] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de Grupos de Diagnósticos Homogéneos

NORTE CENTRO LVT ALENTEJO ALGARVE TOTAL NORTE CENTRO ALENTEJO ALGARVE TOTAL EXAMPLEEXAMPLE [18] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de Grupos de Diagnósticos Homogéneos

Tools that allow us to assess the condition in a simple, understandable, and comparable way [4] Used by health institutions: Fundamental for management evaluation, efficiency and health effectiveness Evaluate the economical performance and hospitalar productivity ( outcome patients,newborns ) Evaluate healthcare quality (Discharged patients,Exceptional admission episodes,Surgical admission time, Complication-free long-term admissions, Readmissions, Newborns, Vaginal Delivery, Unspecified surgical procedures, Medical DRGs complications ) Tools that allow us to assess the condition in a simple, understandable, and comparable way [4] Used by health institutions: Fundamental for management evaluation, efficiency and health effectiveness Evaluate the economical performance and hospitalar productivity ( outcome patients,newborns ) Evaluate healthcare quality (Discharged patients,Exceptional admission episodes,Surgical admission time, Complication-free long-term admissions, Readmissions, Newborns, Vaginal Delivery, Unspecified surgical procedures, Medical DRGs complications ) [4] Correia L F. Indicadores de Desempenho Económico na Saúde. 2005

Misdiagnosis Incomplete treatment Complications EXAMPLEEXAMPLE

Percentage of C -sections within the total number of deliveries (in Portugal) EXAMPLEEXAMPLE [18] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de Grupos de Diagnósticos Homogéneos [22] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de Grupos de Diagnósticos Homogéneos Mar. [23] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de Grupos de Diagnósticos Homogéneos Sep. [24] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de Grupos de Diagnósticos Homogéneos Aug.

The financing of Health entities is based on Diagnosis Related Groups (DRGs) System to classify hospital cases into one of approximately 500 groups expected to have similar hospital resource us

ACHS - Australian Council on Healthcare Standards AHRQ - Agency for Healthcare Research and Quality ACSS - Administração Central do Sistema de Saúde Developed by: ACS - Alto comissariado da Saude ACS – Alto comissariado da Saude AHQR – Agency for Healthcare Research and Quality ACHS - Australian Council on Healthcare Standards ACSS – Administração Central do Sistema de Saúde

Relevance Objectivity Sensibility Precision Availability Cost-efficiency Reliability [3] Ribeiro N. Indicadores de Gestão para Administração Pública. TOC June

Problems associated: Probabilistic natured problems Inadequacies of information systems Variety of measurers and measures Complexity of health plans Availability of funding [6] Confusion factors and problems with robustness, sensitivity and specificity [7]. [6] Eddy D M. Performance measurement: problems and solutions [7] Freeman T, Using performance indicators to improve health care quality in the public sector: a review of the literature. 2002

The challenge of every health system is to find ways to apply management and quality indicators adequately, seeking to promote significant improvements in health [9]. [9] Thomson R G, Lally J. Performance management at the crossroads in the NHS: don't go into the red 2000

Compare the numbers of the last years Evolution of the services quality and efficiency Establish a comparison between the different areas of Portugal

Suggest some possible causes that might have led to the obtained results

Portuguese public Hospitals database between 2000 and 2007 DGH DDX TOTAL ADMISSION TIME HOSPITALS LOCATIONS TARGET POPULATION: SOFTWARE: SPSS Portuguese population

Evolution through the years

Statistical regions in which territory is divided (7 regions, in Portugal) Statistical regions in which territory is divided (7 regions, in Portugal) Regional(NUTS II) Norte Centro Lisboa Alentejo Algarve Região Autónoma dos Açores Região Autónoma da Madeira [25] Nomenclatura de Unidades Territoriais para fins estatísticos, Wikipédia, 2008 [26] Parlamento Europeu, Conselho da União Europeia. Regulamento (CE) N.º 1059/2003 do Parlamento Europeu e do Conselo, relativo à instituição de uma Nomenclatura Comum das Unidades Territoriais Estatísticas (NUTS), Jornal Oficial da União Europeia May 26.

Economical science is the study of the way people and society choose, with or without using money,the management of limited productive resources in alternative aplications, so they can prduce goods and spread them for consumption, nowadays or in the future

[1] Entidade Reguladora da Saúde. Relatório da Actividade Reguladora de 2007 [Internet]. Porto: 2008 August [accessed 2008 October 30]. Available from Reguladora% pdf/ view [2] Ministério da Saúde. Diário da República [Internet] January 23 [accessed 2008 October 30]. Portaria n.º 110-A/2007 – 1.ª Série – N.º16. Available from [3] Ribeiro N. Indicadores de Gestão para Administração Pública. TOC June [accessed 2008 October 27]; N.º3. Available from /noticias/Confer Forum.htm. [4] Correia L F. Indicadores de Desempenho Económico na Saúde [Internet] December [accessed 2008 October 27]. Available from Dezembro-2005/ pdf. [5] Bentes M, Gonçalves M, Urbano J, Tranquada S. A utilização dos GDHs como instrumento de financiamento hospitalar. Revista Gestão Hospitalar December-1997 January;33: [6] Eddy D M. Performance measurement: problems and solutions. PubMed [Internet] July-August [accessed 2008 October 27]; 17(4):7-25. Available from EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum. [7] Freeman T, Using performance indicators to improve health care quality in the public sector: a review of the literature. PubMed [Internet] May [accessed 2008 October 27]; 15(2): Available from pubmed/ [8] Collopy B T. Clinical indicators in accreditation: an effective stimulus to improve patient care. PubMed [Internet] June [accessed 2008 October 27]; 12(3): Available from PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum. [9] Thomson R G, Lally J. Performance management at the crossroads in the NHS: don't go into the red. PubMed Central [Internet] [accessed 2008 October 27]; 9: Available from picrender.fcgi?artid = &blobtype=pdf. [10] Agency for Healthcare Research and Quality (AHRQ). AHRQ Summary Statement on Comparative Hospital Public Reporting [Internet]. United States of America: Health and Human Services. [accessed 2008 October 27]. Available from: pdf. [11] Kondro W. The joys of quality indicators. Canadian Medical Association Journal January 15; 178(2): 142–143. Shojania K G, Forster A J. Hospital mortality: when failure is not a good measure of success. Canadian Medical Association Journal July 15; 179(2): [12] Machado M C S. O Plano Nacional da Saúde [Internet]. Portugal (PT): Alto Comissariado da Saúde. [accessed 2008 October 27]. Available from [13] Geraedts M, Schwartze D, Molzahn T. Hospital quality reports in Germany: patien and physician opinion of the reported quality indicators. Canadian Medical Association Journal September 28; 7: 157. [15] Galvin R S. Are performance measures relevant?. Health Affairs July-August; 29–31. [16] McGlynn E A. Selecting common measures of quality and system performance. Medical Care January; 41(1 Suppl):I [17] Thomson R, Taber S, Lally J, Kazandjian V. UK Quality Indicator Project (UK QIP) and the UK independent health care sector: a new development. International Journal for Quality in Health Care April; 16 Suppl:i51-i56.

[18] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de Grupos de Diagnósticos Homogéneos [19] J Thomas, S Paranjothy Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit. National Sentinel Caesarean Section Audit Report. RCOG Press; [20] Faúndes A, Pádua K S, Osis M J D, Cecatti J G, Sousa M H. Brazilian women and physicians' viewpoints on their preferred route of delivery. Revista de Saúde Pública. 2004; 38(4): [21] Reynolds A, Ayres-de-Campos D, Costa M A, Santos C, Campos I, Montenegro N, Influence of three organisational measures on the cesarean, Acta Médica Portuguesa. 2004; 17: [22] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de Grupos de Diagnósticos Homogéneos Mar. [23] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de Grupos de Diagnósticos Homogéneos Sep. [24] Instituto de Gestão Informática e Financeira da Saúde, Ministério da Saúde. Relatório Nacional de Grupos de Diagnósticos Homogéneos Aug. [25] Nomenclatura de Unidades Territoriais para fins estatísticos [Internet], Wikipédia, 2008 Dec 13 [accessed 2008 Dec 16]. Available from: [26] Parlamento Europeu, Conselho da União Europeia. Regulamento (CE) N.º 1059/2003 do Parlamento Europeu e do Conselo, relativo à instituição de uma Nomenclatura Comum das Unidades Territoriais Estatísticas (NUTS), Jornal Oficial da União Europeia May 26. [27] SPSS for Windows, Rel Chicago (IL): SPSS Inc. [28] Pereira A C, Pinto A T, Parry G, Vieira P, Azevedo L F, Martins C, Vieira A, Desenhos de estudos [Internet]. Universidade do Porto, Serviço de Bioestatística e Informática Médica [accessed 2008 Dec 16]. Available from: numero=1&titulo=Desenhos+de+estudo numero=1&titulo=Desenhos+de+estudo [29] Alto Comissariado da Saúde - Ministério da Saúde. Indicadores e Metas do PNS [Internet] [accessed 2008 Dec 10]. Available from: [30] Lista de distritos portugueses ordenados por população [Internet]. [updated 2008 Nov 14; accessed 2008 Dec 14]. Available from: _por_ popula%C3%A7%C3%A3ohttp://pt.wikipedia.org/wiki/Distritos_portugueses_ordenados [31] Sistema Nacional de Saúde. Indicadores de Desempenho 2004 – 2006 [Internet]. [acessed 2008 Dec 14]. Available from: