As part of the federal government’s quality strategy and in accordance with legal requirements, quality indicators are published annually by currently 165 Swiss acute care hospitals. In the course of the publication of the current data (from 2013), the list was expanded.
The quality indicators in this country are called CH-IQI (Swiss Inpatient Quality Indicators) and currently comprise 49 treatments or clinical pictures (divided into 13 areas). These include, for example, heart valve operations, therapies for pneumonia or joint replacements. There are 1-23 indicators per chapter. Since this year, interested patients and physicians can also compare the treatments of skin diseases and the transplantations performed among the individual hospitals.
For its part, the federal government is using the data to pursue the goal of greater coordination and more targeted support for quality improvement efforts.
CH-IQI provide indications but no conclusions regarding quality
The CH-IQI follow the parameters: Number of cases, mortality, proportion values (e.g., proportion of deaths after treatment, proportion of cesarean sections in all births), special information (e.g., mean value of the Barthel index of patients on admission to geriatric early rehabilitation), and length of stay. Overall, 46% of all inpatient cases and 63% of all deaths in acute care hospitals in Switzerland were recorded with the CH-IQI in 2013.
In each case, the observed mortality is related to the expected mortality (risk adjustment for age and sex). The number of cases plays a decisive role for the interpretation: If the number of cases is low, the indicators are strongly influenced by individual cases, which is why a long-term comparison over the years is more meaningful for these hospitals. Proportion values, in turn, indicate, for example, how often an operation was performed using minimally invasive techniques or how often patients with stroke were treated in a specialized stroke unit.
The CH-IQI are to be understood as indications of quality. The more cases treated at a hospital, the more experience is available at that site and the greater the prospect of good quality treatment. However, it goes without saying that no definitive conclusions can be drawn from this. This requires more in-depth analyses that demand medical expertise and also take into account, for example, the hospitals’ care mandate (primary care, cutting-edge medicine). For the time being, the FOPH therefore recommends comparing indicators from functionally comparable hospitals (e.g. university hospitals) or from those with a similar catchment area (e.g. cantonal hospitals).
Source: FOPH media release dated 14.8.2015
HAUSARZT PRAXIS 2015; 10(9): 8
