Assessment of health care quality in the tertiary level pediatric hospitals in Serbia

Abstract

Background/Aim. It is necessary to improve the quality of health care for children. Assessment data would provide new insights into better treatment outcomes. The aim of this descriptive study was to estimate and to compare applied quality indicators in five pediatric inpatient tertiary level institutions in Serbia during the period from January 1st to December 31st 2008. Methods. Quality data and indicators were collected in the Institute for Public Health of Serbia ?Dr. Milan Jovanovic Batut?. Descriptive statistics and chisquare test were used for data analysis. Results. The average length of stay (ALOS) in pediatric departments was 7.51 ? 1.30 days (5.88-8.91 days). In the same period, ALOS in pediatric surgery departments was 5.85 ? 1.50 days (3.58-7.57 days). The average number of nurses per occupied bed was 0.76 ? 0.20 and 1.09 ? 0.36 in pediatric and in pediatric surgery departments, respectively. The number of operated patients per surgeon was in the range 51.0-160.5. The annual case fatality rate in pediatric departments was estimated to 0.72% ? 0.20%, whereas in pediatric surgery departments it was 0.34% ? 0.25%. The autopsy rate was estimated to 0.00%-63.16% in pediatric departments, and 37.14%-80.00% in pediatric surgery departments. There was statistically significant difference among the five hospitals regarding the following indicators of quality of work: total annual mortality rate of patients, autopsy rate, number of rate of patients, autopsy rate, number of patients referred to other institutions, both in pediatric and pediatric surgery departments. Conclusion. There is a significant difference among the five hospitals regarding indicators of quality of work. Obligatory set of quality indicators on the basis of legislative acts are the indicators of general quality of work in hospital. It is necessary to establish specific pediatric quality indicators and to define national standards related to these indicators.Uvod/Cilj. Potrebno je da se poboljsa kvalitet zdravstvene zastite za decu. Procena podataka omogucice nove uvide u bolji ishod lecenja. Cilj ovog rada bila je procena i uporedjivanje dostupnih pokazatelja kvaliteta rada u pet stacionarnih ustanova tercijarnog nivoa zdravstvene zastite namenjenih lecenju obolele dece u Srbiji u periodu od 1. januara do 31. decembra 2008. godine. Metode. Analizirani su obavezni pokazatelji kvaliteta rada za pedijatrijske grane medicine iz baze podataka o kvalitetu rada zdravstvenih ustanova u Republici Srbiji u Institutu za javno zdravlje Srbije ?Dr Milan Jovanovic Batut?. U analizi podataka koriscene su metode deskriptivne statistike i ?2-test. Rezultati. Duzina lecenja na pedijatrijskim odeljenjima iznosila je 7,51 ? 1,30 dana (5,88-8,91 dana), a na hirurskim odeljenjima 5,85 ? 1,50 dana (3,58-7,57 dana). Na pedijatrijskim odeljenjima efektivno je radilo 0,76 ? 0,20, a na hirurskim 1,09 ? 0,36 sestara po zauzetoj postelji. Broj operisanih bolesnika po jednom hirurgu kretao se u rasponu od 51,0 do 160,5. Stopa letaliteta na pedijatrijskim odeljenjima iznosila je 0,72 ? 0,20%, dok je na hirurskim odeljenjima bila 0,34 ? 0,25%. Procenat obdukovanih kretao se u rasponu 0,00-63,16% na pedijatrijskim i 37,14-80,00% na hirurskim odeljenjima. Nadjene su statisticki znacajne razlike izmedju pet analiziranih zdravstvenih ustanova u sledecim pokazateljima kvaliteta: stopi letaliteta, procentu obdukovanih u odnosu na broj umrlih bolesnika i procentu bolesnika upucenih u druge zdravstvene ustanove, i to kako na pedijatrijskim, tako i na odeljenjima decje hirurgije. Zakljucak. Postoji znacajna razlika u odredjenim pokazateljima kvaliteta rada izmedju pet analiziranih zdravstvenih ustanova. Zakonski propisan paket obaveznih pokazatelja za pedijatrijsku delatnost predstavlja opste pokazatelje kvaliteta rada. Neophodno je ustanoviti specificne pedijatrijske pokazatelje kvaliteta rada i definisati nacionalne standarde za ove pokazatelje.