Accreditation in Croatian family medicine ideas and lessons from - - PowerPoint PPT Presentation

Accreditation in Croatian family medicine – ideas and lessons from past experience

Andrija Štampar School of Public Health School of Medicine, University of Zagreb

Hrvoje Tiljak, MD, GP, PhD

assistant professor Department of Family Medicine School of Medicine, University of Zagreb

Who is the most famous GP in last 20 years?

• How difficult is to recognize

quality of GP work (by lay people) What have we learned?

• How important is to

perform quality assessment

• What can happen if we miss

to re-evaluate quality of work

Harold Shipman

• It seems to be obvious only in case of mistake

Croatian accreditation system - doctors

• License to work in health care
• Compulsory re-licensing of all medical doctors

working in health care

– introduced in 1996 – introduced in 1996 – 6-year period – 120 points: CME, publication… – third cycle in progress (1996-2002, 2002-2008, 2008- )

Croatian Medical Chamber Croatian Medical Chamber Croatian Medical Chamber Croatian Medical Chamber

Weak point for GP is entering point: no compulsory training!

Croatian accreditation system - practices

Strong point is entering point

• Compulsory accreditation on start
• Surveillance

Ministry of Health and Social Affair Ministry of Health and Social Affair Ministry of Health and Social Affair Ministry of Health and Social Affairs & s & s & s & Croatian Medical Chamber Croatian Medical Chamber Croatian Medical Chamber Croatian Medical Chamber

regular control – regular control – incidental control – NO official re-accreditation beside specific medical equipment quality control

Weak point for GP is absence of progress stimulation!

Croatian experience in GPs’ work process evaluation Each contact to patient is described by:

Morbidity code

• ICD-10 classification

Medical procedure code

• “blue book” code

ICD-10 classification Compulsory yearly report

(incl. some curative and preventive procedure data) RESULT: Croatian Health Care Yearbook

“blue book” code

• DTP code
• Preventive activity report

Compulsory monthly report

RESULT: almost none!?

How process data are systematically used ?

Medical procedure code

• “blue book” code

No yearbook, no systematic review.

• DTP code
• Preventive activity report

Compulsory monthly report

What does it mean almost none?

no systematic review.

Reports are used for utilization control, contract

• bligation control including

punishments.

What have Croatian GPs done?

• 25 indicators instrument (2000)
• New Contract Quality Index (2003)
• EuroPEP (2003-2008)
• CQI (PEI) (2004)
• DRHTI indeks (2010)

Overwiev of Croatian instruments

25 indicators New Contract Quality Index DRHTI index Structure (4) Preventive – screening (4) 2 structure indictors per 10 procedure indicators: Procedure profile (9) Preventive - health education (1) procedures/patinet prescription/procedure procedure/procedure etc Results/performance (5) Prescriptions – antibiotics (2) Patients (6) Prescription – antihypertensive drugs (2) Professional tasks (1)

What have Croatian GPs learned?

• State/ government involvement do not guarantee

continuity

• Quality indicators are developed and tested
• Plethora of data circulate without adequate

Plethora of data circulate without adequate function

• There is no quality improvement stimulation
• Different opinion among GPs is constant obstacle

DNOOM HDOD HLZ

What Croatian GPs want?

• Independent body
• Accreditation and re-accreditation of practices
• Quality leveling and labeling
• Better collaboration all around

We often insist on differences and build barriers between GPs and other specialists, hospital doctors and doctors in PHC, city doctors and rural doctors. These differences are not important.

The only difference that counts is difference between good and bad doctors.