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

Andrija Štampar School of Public Health School of Medicine, University of Zagreb Accreditation in Croatian family medicine – ideas and lessons from past experience 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? What have we learned? • How difficult is to recognize quality of GP work (by lay people) • How important is to perform quality assessment Harold Shipman � � ��� ��������������������������������� � � � � � � ��� ��� ����� �� �� ����������������������������������� ��������������������������������� ��������������������������������� • What can happen if we miss to re-evaluate quality of It seems to be obvious only in case of mistake work

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 Affairs & Ministry of Health and Social Affair Ministry of Health and Social Affair s & Croatian Medical Chamber s & s & 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 Medical procedure code • ICD-10 classification ICD-10 classification “blue book” code “blue book” code • DTP code • Preventive activity report • Compulsory monthly report Compulsory yearly report (incl. some curative and preventive procedure data) RESULT: almost none!? RESULT: Croatian Health Care Yearbook

How process data are systematically used ? Medical procedure code No yearbook, “blue book” code • no systematic review. no systematic review. DTP code • Preventive activity report • Reports are used for Compulsory monthly report utilization control, contract obligation control including What does it mean almost none? 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 Procedure profile (9) Preventive - health education (1) indicators: Results/performance (5) Prescriptions – antibiotics (2) procedures/patinet prescription/procedure Patients (6) Prescription – antihypertensive procedure/procedure drugs (2) etc 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.