Introduction

Objective:

Has there been quality improvement?

Long-term trends of quality indicators in 58 Swiss

hospitals

Wolfgang Wiedermann a,b

Dirk Wiedenhfer c
Barbara Eckl c
Ulrich Frick a,d,e

Method:

a) Research Institute on Public Health and Addiction, University of Zurich, Switzerland

b) Faculty of Psychology, University of Vienna, Austria
c) Health Care Research Institute AG, Zurich, Switzerland
d) Psychiatric University Hospital, University of Regensburg, Germany
e) Dept. Health Care Management, Carinthia University of Applied Sciences, Austria

To determine the potential impact of annual quality reports on

service delivery.
Analysis of long-term trends in incidence of pressure ulcer (PU),
anesthesia complications (AC) and patients or after caring
institutions discharge dissatisfaction (DD).

Clinical and sociodemographic data were reported to an

independent data centre between 2001 and 2011.
PU (n = 179,256; 58 hospitals) and AC (n = 69,899; 53 hospitals) were
registered via expert judgments. DD (n = 15,116; 31 hospitals) was
registered via self-administered questionnaires.
Statistical Analysis: Multilevel modelling approach (2 levels of
variables: patient and hospital characteristics; + historical time).

Pressure Ulcer:

Introduction
Objective:

pressure ulcer rates (relative frequencies)

Results
Decline in crude rates from 2.6% to 1.6%

Observation period: 2004 2010

To determine the potential impact of annual quality reports on

service delivery.
Analysis of long-term trends in incidence of pressure ulcer (PU),
anesthesia complications (AC) and patients or after caring
institutions discharge dissatisfaction (DD).

Patients age, gender, LOS, degree of health impairment,

and health insurence coverage beyond legal minimum (HIC)
were significantly related to PU risk (+ seasonal component).
Adjusted PU risk declined during the 6 yrs (OR = 0.998 per
month) & significant differences across hospitals and time
trends (age, LOS, and HIC proportion related to PU risk).

Anesthesia Complications:

Method:

Clinical and sociodemographic data were reported to an

independent data centre between 2001 and 2011.
PU (n = 179,256; 58 hospitals) and AC (n = 69,899; 53 hospitals) were
registered via expert judgments. DD (n = 15,116; 31 hospitals) was
registered via self-administered questionnaires.
Statistical Analysis: Multilevel Modeling (incl. patient and hospital
characteristics and historical time).

Intended increase in AC rates (2% vs. 6% since 2006)

due to a more sensitive documentation form.
Since 2006: Decrease in AC risk suggests quality
improvement (OR = 0.997 per quarter).
Significant hospital differences after adjusting for
gender, HIC, intubation, seasonal components and ASA
risk-score.

Discharge Dissatisfaction:

Stable DD proportions over 5 yrs (~ 30%).

Patients age, LOS, involvement of GP and/or after caring
institutions as well as emegency admissions were
significantly related to DD risk.
Additionally significant differences across wards.
After Adjustment: Larger hospitals display higher DD risks.

only 44 observations

Take Home Messages

Take Home Messages

Service delivery can be supported by annual quality

reports across hospitals.
Quality indicators under control of health professionals
(such as PU or AC) seem more sensitive for quality
change.
Complex and uncontrollable indicator (patient reported
outcomes) seem less sensitive for quality change.
Patient reported outcomes seem useful for identifying
hospital differences (bechmarking, best-practice
models).

Service delivery can be supported by annual quality

reports across hospitals.
Quality indicators under control of health professionals
(such as PU or AC) seem more sensitive for quality
change.
Complex and uncontrollable indicator (patient reported
outcomes) seem less sensitive for quality change.
Patient reported outcomes seem useful for identifying
hospital differences (bechmarking, best-practice
models).

Definition of PU

Definition of AC

Stage 0: no pressure ulcer

Stage 1: intact skin with nonblanchable redness
Stage 2: Partial thickness loss of dermis
Stage 3: Full thickness tissue loss of dermis
Stage 4: Full thickness tissue loss of dermis with exposed bone,
tendon, muscle; necrosis

2001 2005:
Unplaned ventilation after surgery
Re-intubation within one hour after primary extubation
Injuries of skin or nerves
Medication errors
Other injuries due to anesthesia
Hypothermia < 35 C

A) Existing PU with deterioration

Stage at admission > 1.
Stage increases > 0.
B) Incidence of PU

Additionally since 2006:

Nausea in recovery room
Dental injuries
Perioperative pressure ulcers

Multilevel Modelling: PU
Level 1

log[p/(1 p)] = 0 + 1 nursing home + 2 LOS + 3 age

+ 4 gender + 5 emergency admission + 6 HIC
+ 7 time + 8 QM-participation
+ 9 discharging ward + 10 GP + 11 month

Level 2

0 = 00 + 01 mean LOS + 02 prop. females

+ 03 mean age + 04 bed-capacity + u00
Random Intercept
1 = 10
2 = 20
k = k0 + k1 mean LOS + uk0
Random Slope
6 = 60
7 = 70