Pay for Quality

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120 Pay for Quality KCE Reports 118 outcome) Type of indicators used (if any) Structure indicators (the following list is not complete): staff size, scientific activity (total citation score of the team, clinical research) quality of room, of food, additional services to patients (psychological and social support, pain clinic, esthetical care, revalidation). Process indicators (the following list is not complete): attractiveness index, safety index, check in- diagnosis delay, diagnosis-treatment delay. Outcome indicators (the following list is not complete): diseasefree survival in cancer, quality of life. Purpose of indicators used To publicly rank hospital performance Type of incentives Selection as a centre of reference if selection criteria demonstrate that a certain threshold is reached. Results (if available) Not available Sources (most relevant ones) Not available Total budget Not available Table 17: Hospital accreditation XI. HOSPITAL ACCREDITATION Initiated by Hospitals in cooperation with an accreditation body (Joint Commission International, Nederlands Instituut voor Accreditatie van Ziekenhuizen (NIAZ), International Office for Standardization (ISO)) Overall objective To publicly recognize the level of quality of care offered by a hospital Date of implementation in Hospital specific (2000, 2006…) Belgium Target audience Hospitals, including both its managers as professional care providers Content Initiatives to externally assess hospital performance against predefined explicit published standards in order to encourage continuous improvement of the health care quality. Target standards are applied as intermediate endpoints to achieve. Primary focus (structure, process, outcome) These may cover the entire process model of a hospital. Main focus on structure and process. There is a current lack of using (intermediate) outcome measures to evaluate programme results. Type of indicators used (if any) Limited clinical indicator use due to a focus on organisational and transversal aspects which are not addressed in current available databases. The choice of indicators is mainly accreditation body specific. Examples are the availability of guideline support (structure) and the actual use of guideline support (process) in medical decision making. Purpose of indicators used To improve quality and to strengthen public accountability. Accreditation results in a periodic ‘award’ of recognition. Type of incentives An accreditation initiative often includes charging external services to a hospital by a fee or subscription, next to a cost increase working towards standards. There is no direct positive financial incentive present. Indirectly, a positive public recognition may improve the financial status through higher patient volumes. Results (if available) Evidence is lacking. Sources (most relevant ones) 258 Total budget Undisclosed and programme specific
KCE Reports 118 Pay for Quality 121 Table 18: Hospital benchmarking XII. HOSPITAL BENCHMARKING Initiated by Federal government (PATH project, supported by WHO, multidimensional 360° feedback project, patient safety indicators project), Hospital networks (e.g. Vlaams Ziekenhuisnetwerk), Center for Health Services and Nursing Research-KULeuven + UCL (Navigator, Delta), Institute for Public Health (IQED), sickness funds Overall objective To benchmark quality performance between participants, to analyze trends and identify room for improvement Date of implementation in Belgium Most projects started during the late nineties/ beginning of this century. The 360° feedback project and the patient safety indicators project started respectively in 2006 and 2008. The latter includes a retrospective analysis of the period 1999-2004. Target audience Most projects focus on general hospitals. However, Navigator and Delta also serve nursing homes and psychiatric hospitals as separate target groups. Results from the 360° and the patient safety indicator projects are fed back to all Belgian general hospitals. In 2007 eleven Belgian hospitals participated in PATH. The Initiative for Quality Promotion and Epidemiology in Diabetes Care (IQED) focuses on care provided in all Belgian diabetes convention centres. Eighty three institutions participate in Navigator in 2009, and 37 in Delta. The Vlaams Ziekenhuisnetwerk consists of 18 general hospitals. Data of the sickness funds has the advantage to enable both a primary care and hospital care focus, linked on the individual patient level. Content Iterative cycles of indicator development, application in benchmarking and revision. Benchmark results are used to develop target specific quality improvement strategies as a part of hospital policy, moving from information towards actions. The PATH project includes 7 clinical effectiveness and safety core indicators and 7 tailored indicators on both a national and international level. The 360° feedback project includes 7 clinical performance indicators, 10 economical performance indicators, 4 patient centeredness indicators and 12 capacity, staffing and innovation indicators. The patient safety indicator project includes 20 targets. IQED makes use of a broad diabetes care indicator set. Navigator includes 454 general hospital indicators, 357 psychiatric hospital indicators and 123 nursing home indicators. Most projects also include technical support, educational support, Primary focus (structure, process outcome) etc. PATH, 360°, IQED, Navigator and Vlaams Ziekenhuisnetwerk include process and outcome measures. The patient safety indicator project is mainly outcome driven. Delta targets the measurement of the patient experience of the clinical structures, processes and outcomes. Type of indicators used (if any) Caesarean section rate, mortality rate, readmission rate, prophylactic antibiotic use, day surgery rate, etc. Some are hospital generic, others are medical condition specific. The development and validation process of these indicators varies between initiatives. Purpose of indicators used To benchmark through time and in comparison with peer hospitals with a similar case mix. Type of incentives There are no financial incentives provided. In most projects
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Wettelijk depot : D/2008/10.273/50
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Pay for Quality

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