3rd meeting of young researchers at UP 1 - IJUP - Universidade do ...

Portuguese primary care evaluation through Prevention Quality
Indicators
R. Soares-dos-Reis 1,2 , J.A.S. Freitas 1,2 and A. Costa-Pereira 1,2
1 Department of Biostatistics and Medical Informatics, Faculty of Medicine, University of Porto,
Portugal.
2 CINTESIS, Center for Research in Health Technologies and Information Systems, University of
Porto, Portugal
Ambulatory Care Sensitive Conditions (ACSCs) are conditions for which timely and adequate
outpatient care should prevent, at least in part, the need for hospitalization. Therefore,
hospitalization rates for these conditions seem to be good measures of the quality of healthcare
provided in an outpatient setting, especially in preventing medical complications [1]. After the
seminal works of John Billings and others [2], the Agency for Healthcare Research and Quality
(AHRQ) developed this concept into Prevention Quality Indicators (PQIs), which are arealevel
hospitalization rates for 14 selected ACSCs: diabetes complications, hypertension,
perforated appendix, among others. Although these indicators use hospital administrative data,
they provide information on the level of primary care on the community as a whole [1].
Using Portuguese inpatient hospitalization data (2000-2007) obtained from ACSS (Health
System Central Administration) and demographical data obtained from INE (National
Statistics Institute), we calculated the whole set of PQIs, following AHRQ guidelines. The
country was divided into 5 regions – North, Centre, Lisbon, Alentejo and Algarve, and they
were compared over time. Rates were standardized for age and gender using the Portuguese
mean population for the period. PQIs and Regional Health Administration (ARS) expenses
were also compared.
Striking, but not self-evident differences were found among regions. After standardization,
Alentejo and North were the regions with better overall performance and also the regions with
the best overall quality/expenses ratio. This regional heterogeneity may reflect actual regional
variations on the pattern and standards of primary care, or be a result of coding issues,
differences in urbanization, varying prevalence of predisposing conditions or risk factors and
of propensity to seek care [3].
References:
[1]Agency for Healthcare Research and Quality. (March 2007). Guide to Prevention Quality Indicators:
Hospital Admission for Ambulatory Care Sensitive Conditions v3.1. Rockville, MD [cited 20-12-2009].
Available from: http://www.qualityindicators.ahrq.gov/downloads/pqi/pqi_guide_v31.pdf.
[2]Billings, J., L. Zeitel, et al. (1993), Impact of socioeconomic status on hospital use in New York City.
Health Aff (Millwood) 12(1): 162-173.
[3]Rizza, P., A. Bianco, et al. (2007), Preventable hospitalization and access to primary health care in
an area of Southern Italy. BMC Health Serv Res 7: 134.
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