Health policy questions Flashcards
Main public health problems in the Central and Eastern Europe coutry
high mortality rate
high rate of noncommunicable disease morbidity
unfavourable health behaviors
insufficient public health training
low level of interaction between public health professionals and health policy maker
Communication between public health professionals and health policy maker
decision making based on solid epidemiology data like planning and organizing health care service
evidence based public health action/intervention
positively discriminative resource allocation
continous health monitoring system
Health care financing in Hungary
Dual financing
informal payment
DRG system (inpatient care)
Per capitat (General practician)
Meaning of quality in healthcare service
Quality is when the product and services characteristics that meet costumer expectations Doing the right thing For the right person At the right time And do them right at the first time
Quality focus on
Process of care
Aprropriateness of care
Clinical effectiveness
Medical errors
Inappropriate or incomplete diagnosis and treatment Injury Behaviour Syndrome Infection and other ailment
Cause of medical errors
Underuse, overuse of variation in services
Communication problems
Lack of using evidence (EBM)
Dissatified patients
Evidence based medicine
is the process of systemically finding, appraising and using contemporaneous research finding as basic for clinical decisions
Fundamental principle of EBM
- EBM posits a hierarchy of evidences to guide clinical decision making
- Evidence alone is never sufficient to make a clinical decision
Steps of EBM
1, Patient
- Question
- Resource
- Evaluation
- Patient
- Self-evaluation
Possible sources of evidence
Result of primer research, clinical epidemiology study
Systemically review of literature
Result of HTA (health technology assessment)
Guideline recommendations
Potential benefits of clinical practice guidelines
Improve the quality of clinical decisions
Support the quality improvement activites
Medical researcher benefits from the spotlight that evidence based guideline shine on gaps in the evidence
Widen the boundary between benefits and harms
Classification of evidence
Grade A: Very strong evidence
(from randomized control trials)
Grade B: Fairly strong evidence
(from non-randomized control trial, good observable studies)
Grade C: More limited evidence
(Poor method observable studies, case report)
Clinical/Medical Audit
Systemic, critical analysis of the quality of healthcare, including the procedures used for diagnosis and treatment to improve patient outcomes
Effects: decrease the variation of services
Increase the likelihood of desired health outcome
Building block of clinical audit
1, Time and resoucres
2, Confidential, link to management
3, Educational, multidisciplinary
4, Standards, Objective measurement, willingness to change
Driving force of change
New people New technology Competition Incentives Managerial pressure Quality approach
Resisting force of change
unwilling for quality thinking job insecurity complacency skill decifits established work pattern
Level of quality
Adequacy to standard
Adequacy to efficient usability
Adequacy to the explicit expectations of the customer
Adequacy to the latent expectations of the customers
Quality management
include all the activites (planning, assurance, improvement) that organization use to control, direct, coordinate quality
