Determination and evaluation of

the quality indicators

dr Yahya Setiawan
 Background

innumerable

?
advances have Quality
occurred in improvement
medicine and and patient
technology safety
 Data

The publication To Err is Human from the Institute of

Medicine galvanized health care system response and
public demand for change when the US population
learned that medical errors cause 44,000 to 98,000
deaths annually.

Mayo Clin Proc. 2007;82(6):735-739

 Data

The abyss between what physicians know should be done for

patients and what is actually done accounts for more than $9
billion per year in lost productivity and nearly $2 billion per
year in hospital costs

Mayo Clin Proc. 2007;82(6):735-739

 Data

Americans receive appropriate, evidence-based care when

they need it only 55 percent of the time.[5] And all
Americans are at risk of receiving poor care regardless of
where they live, how much money they have, or their race,
education or health insurance

The National Committee for Quality Assurance

(NCQA)).
 Data

As many as 91,000 Americans die each year because

they dont receive the right evidence-based care for
such chronic conditions as high blood pressure,
diabetes and heart disease.

The National Committee for Quality Assurance

(NCQA).
 Data

Nearly 90,000
people die every year, at least in part because they obtain an
infection while in the hospital

The National Committee for Quality Assurance

(NCQA).
 What is the problem ?

Underuse Misuse overuse

The National Committee for Quality

Assurance (NCQA). The Essential Guide to
Health Care Quality
What is the quality in health care?

Effective Accessible Equitable

WHO defines Quality in several dimensions

efcient acceptable Safe

World Health Organization (WHO).

Quality of Care. A Process for Making
Strategic Choices in Health Systems
What is the quality in health care?
The Agency for Healthcare
The U.S Institute of Research and Quality
Medicine (IOM ) (AHRQ)

Quality health care

Quality health care as
as doing the right
safe, effective,
thing for the right
patient-centered,
patient, at the right
timely, efficient and
time, in the right way
equitable
to achieve the best
possible result.
The National Committee for Quality
Assurance (NCQA). The Essential Guide
to Health Care Quality.
What is the Continuous Quality Improvement ?

Continuous Quality Improvement is a philosophy

that encourages all health care team members to
continuously ask: How are we doing? and Can we
do it better?

The National Learning Consortium (NLC).

Continuous Quality Improvement (CQI)
Strategies to Optimize your Practice
 key principles

QI work as systems INPUTS ACTIVITIES RESULT (OUTPUTS

( RESOURCES) (PROSESSES )) OR OUTCOMES)
and processes
HEALTH SERVICES
PEOPLE DELIVERED
INFRASTUCTURE CHANGE IN
WHAT IS DONE HEALTH BEHAVIOR
Focus on patients MATERIALS
HOW IT IS DONE CHANGE IN
TECHNOLOGY HEALTH STATUS
INFORMATION PATIENT
SATISFACTION

Focus on being part

DONABEDIAN MODEL
of the team
U.S Department of Health and Human
Focus on use of Services.
the data Health Resources and Services
Administration (HRSA). Quality
Improvement
 how do we start ?

1. What are the funding agencys expectations?

2. What are the regulatory or monitoring agencys
Determine requirements?
priorities 3.
4.
What are the patients issues and concerns?
What are the staffs issues and concerns?
5. What are the leaderships priorities ?

High
Highvolume
volume High
Highvolume
volume High
Highvolume
volume
High
Highvolume High volume High volume
Highvolume
volume High volume
High frequency
High volume
High risk

U.S Department of Health and Human Services.

Health Resources and Services Administration
(HRSA). Quality Improvement
 Quality indicator

If you cannot measure it,

you cannot improve it

Dr. John Houghom. Five Deming

Principles that Help Healthcare
Process Improvement.
 Quality indicator

Quality measurement in health care is the

process of using data to evaluate the
performance of health plans and health care
providers against recognized quality standards.

Families USA. Measuring Health

Care Quality: An Overview of
Quality Measures
 Quality indicator

Structure Process
Measures Measures
Types of Quality
Measures
Patient
Outcome
Experience
Measures Measures

Families USA. Measuring Health

Care Quality: An Overview of
Quality Measures
 Quality indicator profile

quality indicator profile shows the specifications of

indicators as basic guidelines for data collection and
quality measurement

title Denominator type

Operational
definition
formula Person in charge

Reason for
Numerator target selecting indicator
 Evaluation of Quality indicator

Trend
Compared with other hospitals
Compared with the standard and best practice

To find the cause of the problem :

5 why
Fishbone analysis
THANK YOU