¿La innovación y
Sostenibilidad del Sistema
Público de Salud?
Posición de La Sociedad
Española de Cardiología
José Ramón G...
CV mortality and life-spectancy
in Spain 1980 a 2009
García González JM, et al. Rev Esp Cardiol 2013. on line
Women 1980-2...
• Ageing population
• Increased disease burden: chronic
diseases
• Health & care sector unsustainable:
under pressure to r...
1992 219.43
1993 218.64
1994 207.81
1995 202.89
1996 200.50
1997 191.51
1998 190.34
1999 181.30
2000 169.21
2001 163.45
20...
1992 298.45
1993 294.65
1994 278.90
1995 275.50
1996 273.43
1997 262.45
1998 261.42
1999 250.18
2000 233.63
2001 225.96
20...
Spain
Change in the share of the population at risk
of poverty or social exclusion, EU 27 average
and selected countries 2...
Long-term unemployed as a share (%) of
the active population, EU 27 average
and selected countries 2000-2011
Spain
Acceso ...
CV mortality and life-spectancy
in Spain 1980 a 2009
García González JM, et al. Rev Esp Cardiol 2013. on line
Women 1980-2...
8.530 menos muertes
0
-15000
-30000
-45000
1988 2005
Empeoramiento factores de riesgo +13%
•Aumento de obesidad +6%
•Aumen...
Global Effects of Quitting Tabacco
Jha P, Peto R. NEJM 2014; 370: 60-68
STEMI Mortality rate 2010-2012
IAMCAT
II1
2003
IAMCAT
III2
2006
Codi
Infart3
2010
Codi
Infart3
2011
Codi
Infart3
2012
30-d...
SEC quality of care “virtuose circle”
SEC quality of care
“virtuose circle”
RECALCAR 2012
Cardiología Intervencionista
Andalucía 8,33 7,94 -0,39
Aragón 8,13 7,18 -0,95
Asturias 7,99 7,55 -0,44
Baleares 7,47 6,33 -1,14
Canarias 8,03 7,75 -0,2...
CCAA Mortalidad Cir. Bypass aislada (%) Núm. Casos
Andalucía 3,2% 588
Aragón 4,6% 130
Asturias 4,1% 196
Baleares 3,9% 206
...
Trends in in-hospital mortality rates
after isolated CABG surgery in
Ontario 1991-2006
2.95
2.83
3.17
2.83
2.42
2.32
2.2
2...
Three
priorities.
Role SEC
•Excellent
science
•Industrial
leadership
•Societal
challenges
• European Research Council
• Fu...
New CV Drugs vs Other New Drugs
Market share 2014
NOACs New Antiplatet. New
Antidiabetics
New
Antipsicotics
8.530 menos muertes
0
-15000
-30000
-45000
1988 2005
Empeoramiento factores de riesgo +13%
•Aumento de obesidad +6%
•Aumen...
Director
PLAN ESTRATÉGICO
Adecuar la composición y el funcionamiento del CA
Desarrollar dentro de la fórmula de beca no
condicionad...
OBJETIVOS PRINCIPALES
· Ayudarle en la puesta en marcha de medidas de prevención
secundaria
Para los pacientes que han suf...
SEC quality of care “virtuose circle”
SEC quality of care
“virtuose circle”
• First cause of death in Europe
• Costs : 200 Billion per year
• Elderly population
• Co-morbidities (diabetes and obesit...
J.R.G.
JUANATEY
C.H.U.Santiago
La “misión” de la Sociedad
Española de Cardiología: “Reducir
el impacto de las enfermedades...
Definition
Evidence-based health care is...
...the explicit, judicious and conscientious
use of current best evidence from...
By the year 2020, 90% of clinical
decisions will be supported by
accurate, timely, and up-to-date
clinical information and...
* Zerhouni. JAMA. 2005;294:1352-1358
Knowledge Translation Research
Role of Scientific Societies
Lab
Clinical
research
Hea...
Health System Financial Restrictions in
Spain Budget in Million/Eu
-3.585 millon euros from 2008
-6.875 millon euros from ...
Average EC contribution
in CVD projects
682,991
636,870
603,910
532,153
503,037
499,993
484,876
483,157
477,375
425,592
41...
Three
priorities.
Role SEC
•Excellent
science
•Industrial
leadership
•Societal
challenges
• European Research Council
• Fu...
J.R.G.
JUANATEY
C.H.U.Santiago
REGISTROS SECCIONES CIENTÍFICAS
Registros SEC
Sección Electrofisiología y Arritmias
• Regis...
J.R.G.
JUANATEY
C.H.U.Santiago
• CLARIFY: Prospective observational Longitudinal Registry of Patients with stable coronary...
SEC quality of care “virtuose circle”
Incardio Program not completed
Berlin Myocardial Infarction Registry
10 year changes in treatment and outcome
Jens-Uwe Röehnisch et al # 5207
Berliner He...
Different mortality rates from AMI in Europe
EHS-ACS-2009 Snapshot survey.
www.europeanheartsurvey.org
Regional disparities in baseline characteristics and management
...
Different mortality rates from AMI in Spain
A
13,28%
EXT
10,71%
MUR
9,93%
GAL
11,13%
CLM
11,53%
MORTALIDAD INTRAHOSPITALARIA
TRAS BY-PASS AORTOCORONARIO
Registro CMBD...
Main objective:
To Implement evidence to improve
outcomes
Positive comparison as a means of
improving
Measure Compare
Benchmarking: comparative evaluation
 Determine what and where improvements are called for.
 Analyze how other organizat...
Incardio process:
• Define and select minimal indicators of quality in cardiac
care.
• Review and approval of the document...
INCARDIO
• Identify and recommend the use of quality
markers
Spanish Soc.
of Cardiol.
• Obtain data from hospitals
• Measu...
How to select the indicators?
What is important?
•Perceptions
•Number of patients
•Innovation
•Tecnology
•Cost
•Equity
•Re...
Quality of Care Clusters
Results
Quality
controls
Local
protocols
Staff
expertise
Research
& CME
Guideline
adherence
Accre...
Quality of Care Result
ResultsCost control
Accreditation
Patient
satisfaction
Guideline
compliance
Efficiency
Stroke
Morta...
Minimun Basic Data Set of hospital discharge
MBDS
• It contains very valuable information
about diagnosis and procedures.
...
Minimun quality criteria: they are required to be
1.Minimal and reliable
2.Independent of other parameters
3.Scientificall...
Grading Relevance Difficulty Auditable Evidence
1
Major
outcomes
Data available
in all hospitals
by law
Data public,
avail...
Grading Relevance Difficulty Auditable Evidence
1
Major
outcomes
Data available
in all hospitals
by law
Data public,
avali...
Quality of Care Markers
Results
Other
Outcomes
Surrogates
- Patient satisfaction
- Staff accreditation
- Technology
- Clin...
CONCLUSIONS
• Quality can and must be measured
• Our patients deserve to know
• Benchmarking helps to progressively improv...
Being aware of the reality, is the
first step to improving our practice
Know where your are. Know where you want to go
InnovaSEC
Una iniciativa de la SEC para ordenar la
introducción de innovaciones en el área
de la patología cardíaca en Esp...
Cómo aportamos valor al sistema sanitario?
PAPEL DE LA SOCIEDAD ESPAÑOLA DE CARDIOLOGÍA
Transparencia,
rendimiento de cuen...
Investigación y Calidad Asistencial
SEC quality of care “virtuose circle”
Vemo-nos em
Santiago de
Compostela
Sec innovacion
Sec innovacion
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Sec innovacion

  1. 1. ¿La innovación y Sostenibilidad del Sistema Público de Salud? Posición de La Sociedad Española de Cardiología José Ramón González Juanatey Presidente de la Sociedad Española de Cardiología Hospital Clínico Universitario de Santiago de Compostela
  2. 2. CV mortality and life-spectancy in Spain 1980 a 2009 García González JM, et al. Rev Esp Cardiol 2013. on line Women 1980-2009 Men 1980-2009 Lifestyle changes Prevention Health system improvements Treatment RESEARCH INNOVATION
  3. 3. • Ageing population • Increased disease burden: chronic diseases • Health & care sector unsustainable: under pressure to reform • Health industry under pressure for innovative solution Health main challenges
  4. 4. 1992 219.43 1993 218.64 1994 207.81 1995 202.89 1996 200.50 1997 191.51 1998 190.34 1999 181.30 2000 169.21 2001 163.45 2002 160.95 2003 157.93 2004 145.76 2005 145.25 2006 133.33 2007 133.32 2008 129.57 2009 123.20 2010 119.17 2011 116.44 2012 118.3 Mujeres. Cardiovascular
  5. 5. 1992 298.45 1993 294.65 1994 278.90 1995 275.50 1996 273.43 1997 262.45 1998 261.42 1999 250.18 2000 233.63 2001 225.96 2002 223.63 2003 213.52 2004 199.10 2005 198.22 2006 185.86 2007 184.70 2008 176.17 2009 169.36 2010 164.11 2011 158.76 2012 159.1 Hombres. Cardiovascular
  6. 6. Spain Change in the share of the population at risk of poverty or social exclusion, EU 27 average and selected countries 2006-2011
  7. 7. Long-term unemployed as a share (%) of the active population, EU 27 average and selected countries 2000-2011 Spain Acceso a recursos Sanitarios / Fármacos
  8. 8. CV mortality and life-spectancy in Spain 1980 a 2009 García González JM, et al. Rev Esp Cardiol 2013. on line Women 1980-2009 Men 1980-2009 Lifestyle changes Prevention Health system improvements Treatment RESEARCH INNOVATION
  9. 9. 8.530 menos muertes 0 -15000 -30000 -45000 1988 2005 Empeoramiento factores de riesgo +13% •Aumento de obesidad +6% •Aumento de diabetes +7% Mejora de factores de riesgo -54% •Mejora en la PA -19% •Reducción del tabaco -16% •Mejora colesterol -27% •Actividad física -2% Tratamientos farmacológico -48% •Para IAM -10% •Prevención secundaria -10% •Insuficiencia cardiaca -10% •Revascularización -2% •Antihipertensivos -5% •Estatinas (p. primaria) -2% Inexplicables -2% Explicación de la caída en mortalidad CV en España: 1988-2005 Estudio IMPACT -2014 (datos presentados en el congreso ESC 2014)
  10. 10. Global Effects of Quitting Tabacco Jha P, Peto R. NEJM 2014; 370: 60-68
  11. 11. STEMI Mortality rate 2010-2012 IAMCAT II1 2003 IAMCAT III2 2006 Codi Infart3 2010 Codi Infart3 2011 Codi Infart3 2012 30-day mortality 11,7 % 7,4% 6,8% 6,3% 6,4% 1-year mortality NA NA 9,9 % 10,4 % 8,6 % Catalunya Codi Infart 1. www.catcardio.cat 2. Med Clin (Barc) 2009;133:694 3. Registre Codi Infart. Departament de Salut. Generalitat de Catalunya, 2010-2012
  12. 12. SEC quality of care “virtuose circle” SEC quality of care “virtuose circle”
  13. 13. RECALCAR 2012 Cardiología Intervencionista
  14. 14. Andalucía 8,33 7,94 -0,39 Aragón 8,13 7,18 -0,95 Asturias 7,99 7,55 -0,44 Baleares 7,47 6,33 -1,14 Canarias 8,03 7,75 -0,28 Cantabria 8,11 7,56 -0,55 Castilla y León 8,08 7,00 -1,08 Castilla La Mancha 7,28 7,26 -0,02 Cataluña 6,96 6,66 -0,30 Valenciana 9,57 8,49 -1,08 Extremadura 7,98 7,54 -0,44 Galicia 7,64 7,14 -0,50 Madrid 7,73 6,61 -1,12 Murcia 7,78 7,40 -0,38 Navarra 6,06 6,08 0,02 País Vasco 8,71 7,29 -1,42 Rioja 7,34 7,09 -0,25 PROMEDIO 7,84 7,31 -0,53 CCAA Mortalidad IAM (%) Evolución RECALCAR 2012 STEMI. Risk-adjusted Mortality 2011 2012
  15. 15. CCAA Mortalidad Cir. Bypass aislada (%) Núm. Casos Andalucía 3,2% 588 Aragón 4,6% 130 Asturias 4,1% 196 Baleares 3,9% 206 Canarias 7,4% 95 Cantabria 0,0% 66 Castilla y León 2,5% 317 Castilla La Mancha 0,0% 79 Cataluña 2,6% 680 Valenciana 3,6% 779 Extremadura 4,6% 153 Galicia 2,5% 403 Madrid 3,5% 634 Murcia 3,1% 98 Navarra 1,3% 76 País Vasco 4,2% 142 Rioja nd nd PROMEDIO 3,3% 2012
  16. 16. Trends in in-hospital mortality rates after isolated CABG surgery in Ontario 1991-2006 2.95 2.83 3.17 2.83 2.42 2.32 2.2 2.29 2.18 2.32 2.08 1.03 1.23 1.39 1.1 1.17 0 0.5 1 1.5 2 2.5 3 3.5 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Fiscal Year In-HospitalMortalityRate(%) Confidential reporting Public reporting
  17. 17. Three priorities. Role SEC •Excellent science •Industrial leadership •Societal challenges • European Research Council • Future and Emerging Technologies • Marie Skłodowska-Curie actions • Research infrastructures • Reserch Grants • Leadership in enabling and industrial technologies • Access to risk finance • Innovation in SMEs Innova-SEC • Health, demographic change and wellbeing • Food security, sustainable agriculture and forestry, marine and maritime and inland water research and the Bioeconomy • Secure, clean and efficient energy • Smart, green and integrated transport • Climate action, environment, resource efficiency and raw materials • Inclusive, innovative and reflective societies • Secure societies • Science with and for society • Spreading excellence and widening participation • RECALCAR/INCA RDIO
  18. 18. New CV Drugs vs Other New Drugs Market share 2014 NOACs New Antiplatet. New Antidiabetics New Antipsicotics
  19. 19. 8.530 menos muertes 0 -15000 -30000 -45000 1988 2005 Empeoramiento factores de riesgo +13% •Aumento de obesidad +6% •Aumento de diabetes +7% Mejora de factores de riesgo -54% •Mejora en la PA -19% •Reducción del tabaco -16% •Mejora colesterol -27% •Actividad física -2% Tratamientos farmacológico -48% •Para IAM -10% •Prevención secundaria -10% •Insuficiencia cardiaca -10% •Revascularización -2% •Antihipertensivos -5% •Estatinas (p. primaria) -2% Inexplicables -2% Explicación de la caída en mortalidad CV en España: 1988-2005 Estudio IMPACT -2014 (datos presentados en el congreso ESC 2014)
  20. 20. Director
  21. 21. PLAN ESTRATÉGICO Adecuar la composición y el funcionamiento del CA Desarrollar dentro de la fórmula de beca no condicionada, paquetes de servicios integrados Potenciar la actividad de colaboración SEC- industría en América Latina Potenciar el uso y aplicación de las TIC Impulsar la FMC (Formación multidisciplinar y el desarrollo de ACE). Vincular la FME a procesos de acreditación de profesionales Proyectos de Investigación en servicios de salud Proyectos de mejora en CV dirigida a población en general, a grupos de riesgo y pacientes con enfermedades CV Proyectos de mejora de la calidad asistencial (acreditación de unidades, benchmarking etc..) Impulsar proyectos de gestión clínica y desarrollar instrumentos de mejora de la gestión Clínica
  22. 22. OBJETIVOS PRINCIPALES · Ayudarle en la puesta en marcha de medidas de prevención secundaria Para los pacientes que han sufrido un episodio coronario agudo, lograr que: · Conozcan mejor su enfermedad · Sean más conscientes de su importancia en su propio cuidado · Sean capaces de responsabilizarse de su autocuidado de manera efectiva Para los cardiólogos: Coordinadora. Almudena Castro Conde
  23. 23. SEC quality of care “virtuose circle” SEC quality of care “virtuose circle”
  24. 24. • First cause of death in Europe • Costs : 200 Billion per year • Elderly population • Co-morbidities (diabetes and obesity) • Limited innovation in recent years • Stratification of patients to predict successful treatment CVD main challenges
  25. 25. J.R.G. JUANATEY C.H.U.Santiago La “misión” de la Sociedad Española de Cardiología: “Reducir el impacto de las enfermedades CV en España”; pero ¿Cómo? …. DOCENCIA INVESTIGACIÓN ASISTENCIA
  26. 26. Definition Evidence-based health care is... ...the explicit, judicious and conscientious use of current best evidence from health care research in making decisions about the health care of individuals or populations.
  27. 27. By the year 2020, 90% of clinical decisions will be supported by accurate, timely, and up-to-date clinical information and will reflect the best available evidence. IOM Roundtable on Evidence-Based Medicine This can’t happen without better understanding of how to translate knowledge into practice.
  28. 28. * Zerhouni. JAMA. 2005;294:1352-1358 Knowledge Translation Research Role of Scientific Societies Lab Clinical research Health care KT Type 2 † Hulley et al. Designing Clinical Research, 2007 Comparative effectiveness research Dissemination & implementation research † * Implementation Science Patient-Centered Outcomes Research Initiative
  29. 29. Health System Financial Restrictions in Spain Budget in Million/Eu -3.585 millon euros from 2008 -6.875 millon euros from 2010 -11% from 2010 -160 euros menos per person/year El Pais 25.2.2014
  30. 30. Average EC contribution in CVD projects 682,991 636,870 603,910 532,153 503,037 499,993 484,876 483,157 477,375 425,592 417,189 399,831 369,400 368,340 353,745 349,414 339,891 332,963 265,484 257,132 236,327 234,854 227,135 217,468 215,038 213,240 191,590 190,921 190,907 189,136 167,998 152,486 104,899 100,383 0 0 0 382,185 Netherl… Finland Sweden Israel Germany Switzer… Belgium France United… Turkey Iceland Denmark Greece Ireland Spain Italy Austria Norway Serbia Portugal Luxemb… Bulgaria Lithuania Hungary Czech… Moldov… Latvia Poland Romania Slovakia Cyprus Estonia Slovenia Croatia Malta
  31. 31. Three priorities. Role SEC •Excellent science •Industrial leadership •Societal challenges • European Research Council • Future and Emerging Technologies • Marie Skłodowska-Curie actions • Research infrastructures • Reserch Grants • Leadership in enabling and industrial technologies • Access to risk finance • Innovation in SMEs Innova-SEC • Health, demographic change and wellbeing • Food security, sustainable agriculture and forestry, marine and maritime and inland water research and the Bioeconomy • Secure, clean and efficient energy • Smart, green and integrated transport • Climate action, environment, resource efficiency and raw materials • Inclusive, innovative and reflective societies • Secure societies • Science with and for society • Spreading excellence and widening participation • Registries/Standards
  32. 32. J.R.G. JUANATEY C.H.U.Santiago REGISTROS SECCIONES CIENTÍFICAS Registros SEC Sección Electrofisiología y Arritmias • Registro Nacional de Desfibrilador Automático Implantable. • Registro Nacional de Ablación por Catéter Sección Estimulación Cardiaca • Registro Español de Marcapasos Sección Insuficiencia Cardiaca y Trasplante • Registro Nacional de Trasplante Cardiaco REGISTROS EN COLABORACIÓN CON LA ESC • Atrial Fibrillation Ablation Long-Term Registry • Long Term Registry on Patients with Heart Failure • Atrial Fibrillation General Long-Term Registy
  33. 33. J.R.G. JUANATEY C.H.U.Santiago • CLARIFY: Prospective observational Longitudinal Registry of Patients with stable coronary artery disease • EVICARD: Estudio observacional para evaluar la relación entre la infección por CMV y la supervivencia y evolución de la enfermedad vascular del injerto en una cohorte de pacientes trasplantados cardiacos: 8 años de seguimiento • EXAMINATION: Evaluación clínica del sistema de stent coronario con liberación de everolimus en el infarto agudo de miocardio con elevación del segmento ST • FANTASIIA: Influencia del tipo y adecuacion de la anticoagulacion oral sobre la incidencia de eventos tromboembólicos y hemorrágicos en una población española no seleccionada de pacientes con fibrilacion auricular no valvular: un estudio en la ”vida real” • LONGPRIME: Eficacia y seguridad del stent coronario de Co-Cr liberador de everolimus en lesiones largas. • OCT: Estudio comparativo con tomografía de coherencia óptica a 6 y 12 meses entre stents farmacoactivos de polímero absorbible y stents farmacoactivos con plataforma totalmente bioabsorbible. • PROBNP: Estudio de mejora de la estrategia diagnóstica al paciente con insuficiencia cardiaca de Novo en Atención Primaria. • RECALCAR II: Registro de Unidades Asistenciales en Cardiología (2ª año) • REPAR: Registro Español sobre el control lipídico en Pacientes de muy alto Riesgo que acuden a consultas de Cardiología • REPARA: Registro de pacientes con dispositivo iorreabsorbible en la práctica clínica habitual. • RENAL: Worsening of Renal Function and prognostic implications in patients with Acute Heart Failure. • RIBS VI: Estudio Prospectivo del Tratamiento Percutáneo con Dispositivo Vascular Bioabsorbible (DVB) (ABSORB) en Pacientes con Reestenosis Intrastent • TICS-DM: Comparación entre Ticagrelor y Clopidogrel en pacientes con cardiopatía isquémica y Diabetes Mellitus tipo 2 (TICS- DM): Un estudio farmacodinámico aleatorizado AGENCIA DE INVESTIGACIÓN Proyectos en Marcha 2014:
  34. 34. SEC quality of care “virtuose circle”
  35. 35. Incardio Program not completed
  36. 36. Berlin Myocardial Infarction Registry 10 year changes in treatment and outcome Jens-Uwe Röehnisch et al # 5207 Berliner Herzinfarktregister Hospital Mortality for STEMI & NSTEMIMedications and Reperfusion therapy Year Ptrend<0.001 N=9830 ECC 2010
  37. 37. Different mortality rates from AMI in Europe
  38. 38. EHS-ACS-2009 Snapshot survey. www.europeanheartsurvey.org Regional disparities in baseline characteristics and management N=3209 AMI, 485 sites North East Med West P< Age 68 64 65 66 0.03 Grace score 155 154 154 159 ns Statins 94 91 94 92 ns PCI 57 44 59 73 0.001 STEMI (60%) No reperfusion 18 37 22 20 1º PCI 52 42 56 72 0.001 Lytics 30 21 23 8 0.001 Hospital Mortality (global 6,2%) 5 8,7 6,1 5,2 0.001 Important differences in patient profile, management & outcomes
  39. 39. Different mortality rates from AMI in Spain
  40. 40. A 13,28% EXT 10,71% MUR 9,93% GAL 11,13% CLM 11,53% MORTALIDAD INTRAHOSPITALARIA TRAS BY-PASS AORTOCORONARIO Registro CMBD 2011 Ministerio de Sanidad, Servicios Sociales e Igualdad .000% 1.000% 2.000% 3.000% 4.000% 5.000% 6.000% 7.000% 8.000% 9.000% EXT PV CAT NAV GAL VAL AS MAD A CLM AR CyL CA MUR 2.130% 3.610% 3.940% 4.440% 4.670% 5.530% 6.010% 6.160% 6.500% 7.290% 7.460% 7.690% 8.000% 8.960%
  41. 41. Main objective: To Implement evidence to improve outcomes
  42. 42. Positive comparison as a means of improving Measure Compare
  43. 43. Benchmarking: comparative evaluation  Determine what and where improvements are called for.  Analyze how other organizations achieve their high performance levels.  Use this information to improve performance.
  44. 44. Incardio process: • Define and select minimal indicators of quality in cardiac care. • Review and approval of the document by the Spanish Society of Cardiology, SS of Cardiothoracic surgery, official health authorities. • Review by the AHA-ACC / ESC • Collection of data from hospitals, in the different autonomous communities (RECALCAR project). • Make the data auditable and public.
  45. 45. INCARDIO • Identify and recommend the use of quality markers Spanish Soc. of Cardiol. • Obtain data from hospitals • Measure and audit outcomes Health care authorities • Benchmarking of outcomes • Controlled access to data Health care authorities • Certification y accreditation
  46. 46. How to select the indicators? What is important? •Perceptions •Number of patients •Innovation •Tecnology •Cost •Equity •Results: • To live longer? • To live better? • …?
  47. 47. Quality of Care Clusters Results Quality controls Local protocols Staff expertise Research & CME Guideline adherence Accreditation Institution Technology Unique Programs Hospital volume Delivery of care Budget Attitude Professionalism Patient
  48. 48. Quality of Care Result ResultsCost control Accreditation Patient satisfaction Guideline compliance Efficiency Stroke Mortality Hospitalization Heart failure Arrhythmia Open artery Iatrogenia Medical errors Results
  49. 49. Minimun Basic Data Set of hospital discharge MBDS • It contains very valuable information about diagnosis and procedures. • accessible to everyone. • mandatory. • regularly updated.
  50. 50. Minimun quality criteria: they are required to be 1.Minimal and reliable 2.Independent of other parameters 3.Scientifically backed up 4.Easy to report 5.Fully acceptable within the scientific community and by the health authorities 6.Auditable 7.Suitable for public reporting (transparent)
  51. 51. Grading Relevance Difficulty Auditable Evidence 1 Major outcomes Data available in all hospitals by law Data public, available on file Self evident Class I, Level A in ESC / AHA / ACC guidelines 2 Outcome surrogates Class I in guidelines Data available in hospitals Voluntary disclosures < Class I, Level A in ESC / AHA / ACC guidelines 3 Outcome surrogates Class < I in guidelines Easy data, not in all hospitals Data on file but difficult Level C in guidelines 4 Opinion Need of an organized registry Data impossible Opinion surveys Grading of Quality Markers / Metrics
  52. 52. Grading Relevance Difficulty Auditable Evidence 1 Major outcomes Data available in all hospitals by law Data public, avaliable on file Self evident Class I, Level A in ESC / AHA / ACC guidelines Grading of Quality Markers / Metrics Metric Relevance Difficulty Auditable Reference Comment Mortality 1 1 1 Self evident Needs standarization Re- Hospitalization 1 1 1 Common in quality programs Not 100% objective Stroke 1 1 1 Common in quality programs Only disabling stroke
  53. 53. Quality of Care Markers Results Other Outcomes Surrogates - Patient satisfaction - Staff accreditation - Technology - Clinical research - Cath lab 24h - Cardiac Rehab program - … - % of patients with LDL<70 mg/dl - % of diabetic patients with A1c<7% - % of wound infection - % of use o BBl in HF - % of OAC in AF - Mortality - Re-hospitalization - Stroke
  54. 54. CONCLUSIONS • Quality can and must be measured • Our patients deserve to know • Benchmarking helps to progressively improve results • Quality metrics should be: • Simple, well selected • Reliable • Mandatory (universal) • Available to professionals and patients • Scientific Societies as opinion leaders • Health authorities should make decisions according to data
  55. 55. Being aware of the reality, is the first step to improving our practice Know where your are. Know where you want to go
  56. 56. InnovaSEC Una iniciativa de la SEC para ordenar la introducción de innovaciones en el área de la patología cardíaca en España Comité Científico: Dr. Josep Brugada (Presidente) Dra. Laura Sampietro-Colom Dr. Mariano Larman Tellechea Dr. Alberto San Roman Calvar Dr. Fernando Worner Diz
  57. 57. Cómo aportamos valor al sistema sanitario? PAPEL DE LA SOCIEDAD ESPAÑOLA DE CARDIOLOGÍA Transparencia, rendimiento de cuentas y benchmarking RECALCAR INCARDIO OPTIMACS OPTIMIC OPTICIC (Más Valor a la Información de Salud de España) Análisis de la variabilidad de la práctica clínica y ayuda a la toma de decisiones Explotación y análisis de información de salud Innovación en Gestión Vias Clínicas SEC/SEMFYC Identificación y extensión de mejores prácticas al conjunto del sistema
  58. 58. Investigación y Calidad Asistencial
  59. 59. SEC quality of care “virtuose circle”
  60. 60. Vemo-nos em Santiago de Compostela

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