PERFORMANCE ASSESSMENT TOOL FOR QUALITY IMPROVEMENT IN HOSPITALS (PATH): FIRST EXPERIENCES IN CROATIA

PATH (Performance Assessment Tool for Quality Improvement in Hospitals), projekt Regionalnog ureda Svjetske zdravstvene organizacije (SZO) za Europu pruža bolnicama sveobuhvatan i standardiziran alat za vrednovanje vlastitih rezultata i razvoj mjera za unapređenje kvalitete. Program PATH pokrenut je 2008. godine i u Hrvatskoj, a od 2009. godine provodi se u bolnicama koje su se dobrovoljno odlučile u njega uključiti. U ovom radu prikazujemo prva iskustva probne faze uspostavljanja programa PATH, utemeljena na podacima koji su prikupljani u 22 hrvatske bolnice. Analiza prvih rezultata upozorila je na postojanje izraženih razlika među bolnicama, koje su se na primjeru postotka carskih rezova kretale od najmanje 1,1% do najviše 21,4% zabilježenih carskih rezova u pojedinim bolnicama tijekom razdoblja prikupljanja podataka. Stopa smrtnosti infarkta miokarda kretala se od 1,9 do 21,4%, dok se smrtnost moždanog udara kretala od 12,5 do 45,5%. Najviši postotak prijavljenih ubodnih ozljeda za liječnike iznosio je 16,2% osoblja tijekom jedne godine, 6,1% za medicinske sestre i 4,6% za spremačice. Ovo istraživanje upućuje na postojanje mnogih problema i ograničenja u prikupljanju pokazatelja na bolničkoj razini, njihovoj analizi i stvaranju preporuka za unapređenje kvalitete koje se moraju uzeti u obzir prilikom usporedbe bolnica na nacionalnoj ili međunarodnoj razini.
PATH (Performance Assessment Tool for Quality Improvement in Hospitals), a project of the World Health Organization (WHO) for Europe offers hospitals a comprehensive and standardized tool (a set of indicators) to evaluate their own performance and development of measures for quality improvement. PATH Program was launched in Croatia in 2008, and it was conducted in 2009 in hospitals that have voluntarily decided to be involved. Here we present the results of the first phase of pilot experience of establishing the program, based on data collected in 22 Croatian hospitals. Analysis of the first results indicated the existence of marked differences among the hospitals that have taken the example of the percentage of cesarean sections ranging from 1.1% to 21.4%. The mortality rate of myocardial infarction ranged from 1.9 to 21.4%, while the mortality of stroke ranged from 12.5 to 45.5%. The highest percentage of needle-stick injuries reported for physicians was 16.2% of entire hospital staff in one year, 6.1% for nurses and 4.6% for the supportive staff. The result suggests the existence of many problems and limitations in data collection at hospital level, limitations in their analysis and creates recommendations for quality improvements, which must be taken into account when hospitals are compared on the national or international level.