Ahmed Aboulghate ,   MBBCh, MPhil University of Cambridge PhD student, Cambridge Overseas Scholar Developing Quality Indic...
 
Egypt; background <ul><li>Population 73 million </li></ul><ul><li>Lower-middle income country (Poverty level 16.7%) </li><...
Egyptian Health Care System <ul><li>Social insurance </li></ul><ul><ul><ul><ul><li>Free for eligible patients (48% of popu...
1997: Health Sector Reform Project <ul><li>Universal coverage </li></ul><ul><li>High quality </li></ul><ul><li>Equity </li...
Reforming the Primary Care <ul><li>Infra structure: </li></ul><ul><ul><ul><ul><li>Renovating and building PC facilities </...
Current Indicators in the Egyptian Primary Care <ul><li>Limitations of the current indicators </li></ul><ul><ul><li>Emphas...
Aims of the study <ul><li>NOT  TO : Copy and Paste indicators (e.g. QOF) </li></ul><ul><li>BUT  TO : Transfer technologies...
1. Choosing the conditions <ul><li>The most common conditions presenting to primary care units  </li></ul><ul><ul><ul><ul>...
2. Developing the indicators <ul><li>The RAND/UCLA appropriateness method </li></ul><ul><ul><ul><ul><li>Literature and gui...
3. Piloting the indicators <ul><li>Extracting Indicators scores from patients records </li></ul><ul><li>Testing the time a...
Opportunities <ul><li>Measure the feasibility of applying the new indicators </li></ul><ul><li>Propose modifications to th...
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Session 3: Ahmed Aboulghate

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Ahmed Aboulghate: “Developing quality indicators for the Egyptian Primary Care system”

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Session 3: Ahmed Aboulghate

  1. 1. Ahmed Aboulghate , MBBCh, MPhil University of Cambridge PhD student, Cambridge Overseas Scholar Developing Quality Indicators for the Egyptian Primary Care System
  2. 3. Egypt; background <ul><li>Population 73 million </li></ul><ul><li>Lower-middle income country (Poverty level 16.7%) </li></ul><ul><li>Dual burden of disea se. </li></ul>National Burden of Disease NCD 74% Communicable 9% Injuries 7% Others 10% Leading contributors to National Burden of Disease Ischaemic Heart Disease 11 % Unipolar Depression 5 % Asthma, COPD 4 % Cerebrovascular Disease 4 % Respiratory Infections 3 % Cataract 3 % Adult Onset Hearing Loss 3 % Hypertensive Heart Disease 3 % Drug Use Disorders 2 % Liver Cirrhosis 2 %
  3. 4. Egyptian Health Care System <ul><li>Social insurance </li></ul><ul><ul><ul><ul><li>Free for eligible patients (48% of population) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Employees, infants, school children, pensioners, widows </li></ul></ul></ul></ul><ul><li>State run facilities </li></ul><ul><ul><ul><ul><li>Everyone is eligible </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Limited resources, low quality </li></ul></ul></ul></ul><ul><li>Private sector </li></ul><ul><ul><ul><ul><li>Out of pocket (60% of national health expenditure) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Serves all population categories </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Varying quality and price </li></ul></ul></ul></ul>
  4. 5. 1997: Health Sector Reform Project <ul><li>Universal coverage </li></ul><ul><li>High quality </li></ul><ul><li>Equity </li></ul><ul><li>Efficiency </li></ul><ul><li>Sustainability </li></ul><ul><ul><ul><ul><li>To shift the focus of care from heavy reliance on inpatient care to a more integrated and less costly primary care model. (Berman et al, 1998). </li></ul></ul></ul></ul>
  5. 6. Reforming the Primary Care <ul><li>Infra structure: </li></ul><ul><ul><ul><ul><li>Renovating and building PC facilities </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Today: 5500 PC facilities </li></ul></ul></ul></ul><ul><li>Care providers </li></ul><ul><ul><ul><ul><li>Financial and career incentives </li></ul></ul></ul></ul><ul><li>Quality control </li></ul><ul><ul><ul><ul><li>Accreditation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Pay for performance through Quality Indicators </li></ul></ul></ul></ul>
  6. 7. Current Indicators in the Egyptian Primary Care <ul><li>Limitations of the current indicators </li></ul><ul><ul><li>Emphasis on ‘structure’ indicators </li></ul></ul><ul><ul><li>‘ Process’ indicators are vague and broadly defined </li></ul></ul><ul><ul><li>Scores are manually collected through inspection visits </li></ul></ul>Type Number of indicators included Total 34 Structure 25 Process 6 Outcome 3
  7. 8. Aims of the study <ul><li>NOT TO : Copy and Paste indicators (e.g. QOF) </li></ul><ul><li>BUT TO : Transfer technologies and methods </li></ul><ul><li>Methodology </li></ul><ul><li>Choose the medical conditions </li></ul><ul><li>Develop indicators for them </li></ul><ul><li>Pilot the new indicators </li></ul>
  8. 9. 1. Choosing the conditions <ul><li>The most common conditions presenting to primary care units </li></ul><ul><ul><ul><ul><li>Primary data collection </li></ul></ul></ul></ul><ul><ul><ul><ul><li>>2000 patients </li></ul></ul></ul></ul><ul><ul><ul><ul><li>12 primary care units </li></ul></ul></ul></ul><ul><li>National Burden of Disease </li></ul><ul><li>Basic Benefit Package </li></ul>
  9. 10. 2. Developing the indicators <ul><li>The RAND/UCLA appropriateness method </li></ul><ul><ul><ul><ul><li>Literature and guidelines review </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Developing preliminary set of indicators </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Rating the indicators by a group of local experts </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Panel meeting to discuss and re-rate the indicators </li></ul></ul></ul></ul>Indicator Quality of evidence References Benefits/ summary Necessity Validity Patients with CAD should be advised to take aspirin at a dose of 75-100 mg/day unless contraindicated I Yusuf et al, 1998 ATC, 1994 Absolute reduction in vascular events of 5% (1-9) (1-9)
  10. 11. 3. Piloting the indicators <ul><li>Extracting Indicators scores from patients records </li></ul><ul><li>Testing the time and resources required to extract the indicators </li></ul><ul><li>Testing the inter-rater reliability </li></ul>
  11. 12. Opportunities <ul><li>Measure the feasibility of applying the new indicators </li></ul><ul><li>Propose modifications to the electronic recording system to implement automated indicator score calculation </li></ul><ul><li>Building a culture of Evidence Informed policy making </li></ul>
  12. 13. Thank you

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