Quyết định 7051/QD-BYT

Decision No. 7051/QD-BYT dated November 29, 2016, promulgating guidance on pilot establishment of a number of hospital quality indicators

Nội dung toàn văn Decision 7051/QD-BYT promulgating guidance pilot establishment a number of hospital quality indicators

MINISTRY OF HEALTH -------	SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness --------------
No. 7051/QD-BYT	Ha Noi, November 29, 2016

DECISION

PROMULGATING GUIDANCE ON PILOT ESTABLISHMENT OF A NUMBER OF HOSPITAL QUALITY INDICATORS

THE MINISTER OF HEALTH

Pursuant to the Decree No. 63/2012/ND-CP dated August 31, 2012 by the Government defining the functions, tasks, entitlements and organizational structure of the Ministry of Health;

At the request of the Director of Medical Service Administration.

DECIDES

Article 1. The “guidance on pilot establishment of a number of hospital quality indicators” is enclosed with this Decision.

Article 2. The “guidance on pilot establishment of a number of hospital quality indicators” applies to both public and private hospitals.

Article 3. Medical Service Administration shall be the focus point which cooperates with Departments and relevant units guiding and conducting the implementation of the "guidance on pilot establishment of a number of hospital quality indicators” and organizing the assessment and reporting to the Minister of Health.

Article 4. This decision comes into force from the day on which it is signed and promulgated.

Article 5. Chiefs of the Ministry Offices, the Director of Medical Service Administration, the Ministerial Chief Inspector and Directors of Departments, Directors of hospitals affiliated to the Ministry of Health, Directors of the Department of Health of provinces and Departments of Health affiliated to Ministries and regulatory bodies and Heads of relevant units are responsible for implementing this Decision./.

P.P. THE MINISTER
THE DEPUTY MINISTER

Nguyen Viet Tien

GUIDANCE

ON PILOT ESTABLISHMENT OF A NUMBER OF HOSPITAL QUALITY INDICATORS
(Enclosed with the Decision No. 7051/QD-BYT dated November 29, 2016 by the Minister of Health)

I. GENERAL PROVISIONS

1. Notion:

The set of “hospital quality indicator” is a tool to measure respects of healthcare service quality performed in form of numbers, ratios or rates as the basis for the improvement of quality of healthcare service and the comparison of service quality among hospitals.

2. Principles for establishment of hospital quality indicators

- Hospital quality indicators are established to measure quality properties which are important and suitable for most hospitals.

- Hospital quality indicators are used for measuring structural elements (inputs), the process and the outcomes of the healthcare services.

- Such indicators are calculated through the collection and analysis of data and indicators.

- Selected indicators of shall tightly relevant to the healthcare service quality, the feasibility and the value and orient to the improvement of service quality.

- The set of hospital quality indicators is the basis for hospitals to select suitable indicators for period assessment depending on their actual capacity and conditions.

3. Domains of healthcare quality

Professional capacity: the assessment of the provision of healthcare services according to medical advices and regulations on technical classification.

Safety: the harm or risk to patients, health workers and the community during the provision of healthcare service.

Efficiency: the assessment of the optimal use of available resources for providing nursing services with the lowest charge and the best effect.

Clinical effectiveness: the assessment of whether the provision medical care or services achieves desired outcomes.

Staff-centered indicators: the provision of benefits for health workers

Patient-centered indicators: the assessment of the satisfaction of patients regarding non-medical respects, including living facilities and hygiene in hospital wards, employees’ behaviors, etc.

II. LIST OF HOSPITAL QUALITY INDICATORS

Property	Indicator	Component
Professional capacity (2 indicators)	1. Rate of application of therapeutic technique according to healthcare levels	Process
Professional capacity (2 indicators)	2. Rate of surgery of level II or higher level	Process
Safety (4 indicators)	3. Rate of wound infection	Outcomes
	4. Rate of hospital-acquired infection (pneumonia)	Outcomes
	5. Number of serious medical accidents	Outcomes
	6. Number of serious non-medical accidents	Outcomes

Efficiency (4 indicators)	7. Average duration of medical examination	Process
	8. Average duration of hospitalization (applicable to all types of diseases)	Process
	9. Actual usage of patient beds	Outcomes
	10. Efficiency of use of operating rooms	Process

Effectiveness (2 indicators)	11. Mortality rate and rate of poor prognosis (applicable to all types of diseases)	Outcomes
Effectiveness (2 indicators)	12. Rate of referral to higher-level healthcare facilities (applicable to all types of diseases)	Outcomes

Staff-centered indicators (2 indicators)	13. Rate of injuries caused by sharp objects	Process
Staff-centered indicators (2 indicators)	14. Rate of HBV inoculation in health workers	Process

Patient-centered indicators (2 indicators)	15. Rate of patients' satisfaction of healthcare services	Outcomes
Patient-centered indicators (2 indicators)	16. Rate of health workers’ satisfaction	Outcomes

III. CONTENTS

Indicator No. 1	Rate of application of therapeutic technique according to healthcare levels
Applicable areas	The whole hospital
Quality property	Professional capacity
Quality component	Process
Reasons	The application of therapeutic technique is an indicator used for assessing the professional capacity of the hospital, a basis for assessing the ability to meet the healthcare demand of citizens of an area as well as a basis for investment in the development of the hospital.
Calculation method
Numerator	Total number of therapeutic techniques being applied
Denominator	Total number of therapeutic techniques according to healthcare levels
Inclusion criteria	Techniques specified in Circular No. 43/2013/TT-BYT
Exclusion criteria	Therapeutic techniques only available in higher level
Data sources	Medical records, surgery monitoring books
Data collection and consolidation	Such data are currently collected and consolidated by hospitals. The measurement of such data does not increase burden on the hospitals.
Data value	High accuracy and reliability
Reporting frequency	Annually or biannually

Indicator No. 2	Rate of surgery of level II or higher level
Applicable areas	Surgery
Quality property	Professional capacity
Quality component	Process
Reasons	Surgeries of level II or higher level are performed at hospitals of districts. However, very few district-level hospitals can perform level-II surgeries. Such type of surgeries is often performed at central and provincial hospitals. The rate of level-II surgeries facilitates the assessment of professional conformity and classification so that suitable measures are taken to enhance the capacity of the lower-level hospitals and reduce the load of the higher-level hospitals.
Calculation method
Numerator	Total number of surgeries of level II or higher level being performed
Denominator	Total surgeries being performed
Data sources	Surgery monitoring books, hospitals’ statistical reports, hospitals’ inspection records.
Data collection and consolidation	Such data are currently collected and consolidated. The measurement of such data does not increase burden on the hospitals.
Data value	High accuracy and reliability because: - Surgeries are classified clearly in a list issued by the Ministry of Health - Information is collected carefully by departments of the hospitals - Allowances are verified by hospitals and insurance offices before being paid
Reporting frequency	Annually or biannually

Indicator No. 3	Rate of hospital-acquired infection (wound infection)
Applicable areas	Surgery
Quality property	Safety
Quality component	Outcomes
Reasons	Wound infection is a common post-surgery complication. Wound infection affects the patient's health, lengthens the hospitalization period and increases the treatment cost. The Ministry of Health shall specify the hospitals subject to investigation, take records of and supervise the hospital-acquired infection, including wound infection
Calculation method
Numerator	Total number of patients suffering wound infection in the reporting period
Denominator	Total number of patients undergoing surgeries in the reporting period
Data sources	Medical records, investigations into wound infection
Data collection and consolidation	Data about wound infection shall be collected depending on regular investigation by infection-controlling staff of the hospitals. Several central hospitals have carried out hospital-acquired infection control. Regarding hospitals which have not conducted hospital-acquired infection surveillance, the collection and consolidation of data shall be carried out by qualified employees and the installed surveillance system.
Data value	Average accuracy and reliability
Reporting frequency	Quarterly, biannually, every 9 months or annually

Indicator No. 4	Rate of hospital-acquired infection (pneumonia)
Applicable areas	Surgery
Quality property	Safety
Quality component	Outcomes
Reasons	Pneumonia caused by hospital-acquired infection is a common complication on patients who receive long-term treatment and/or medical ventilation. Pneumonia caused by hospital-acquired infection affects the patients’ health, lengthens the hospitalization period and increases the treatment cost. The Ministry of Health shall specify the hospitals subject to investigation, take records of and supervise the hospital-acquired infection, including pneumonia.
Calculation method
Numerator	Total number of patients suffering pneumonia caused by hospital-acquired infection in the reporting period
Denominator	Total number of patients receiving medical ventilation or treatment at hospitals for at least 1 month in the reporting period
Data sources	Medical records, investigations into the hospital-acquired infection (pneumonia)
Data collection and consolidation	Data about hospital-acquired infection (pneumonia) shall be collected depending on regular investigation by infection-controlling staff of the hospitals. Hospital-acquired infection control has been carried out by central hospitals. Regarding hospitals which have not conducted hospital-acquired infection surveillance, the collection and consolidation of data shall be carried out by qualified employees and the installed surveillance system.
Data value	Average accuracy and reliability
Reporting frequency	Quarterly, biannually, every 9 months or annually

Indicator No. 5	Number of serious medical accidents
Applicable areas	The whole hospital
Quality property	Safety
Quality component	Outcomes
Reasons	Serious medical accidents are accidents due to professional mistakes or the side effects of the drugs that lead to serious consequence for patients’ health and life (lifelong sequel or death). Though the number of serious accidents is not remarkable, it requests handling and preventive measures as soon as possible.
Calculation method	Number of serious medical accidents - Serious medical accidents due to the use of drugs + Serious medical accidents due to side effects of drugs + Serious medical accidents due to surgical operations + Serious medical accidents due to medical procedures + Serious medical accidents due to blood transfusion + Other serious medical accidents
Data sources	Medical records, professional accidents records, medical accident reporting system, minute books of criticism about deaths, discipline-exercising monitoring book.
Data collection and consolidation	Hospital are collecting and consolidating data about accidents (caused by the use of drugs, side effects of drugs, surgical operations, medical procedures, blood transfusion, etc.). The measurement of such data does not increase burden on data collection and consolidation.
Data value	Low accuracy because health workers and the hospitals do not often make records of and reports on medical accidents. However, data in reports on serious medical accidents are highly reliable.
Reporting frequency	Annually or biannually

Indicator No. 6	Number of serious non-medical accidents
Applicable areas	The whole hospital
Quality property	Safety
Quality component	Outcomes
Reasons	Serious non-medical accidents are accidents not caused by professional mistakes nor the side effects of drugs that lead to serious consequence for health and life of patients, health workers and the community (lifelong sequel or death). Though the number of serious accidents is not remarkable, it requests handling and preventive measures as soon as possible.
Calculation method	Number of serious non-medical accidents + Suicide + Falling from heights + Kidnapping + Assault, rape, murder + Fire + Leak or loss of materials or highly hazardous waste + Other accidents
Data sources	Monitoring books, handover books, discipline-exercising monitoring books, inspection dossiers, etc.
Data collection and consolidation	Though such contents are not included in regular reporting system, data are collected and consolidated because of their seriousness and relevance to regulatory authorities. The measurement of such indicator does not place a remarkable burden on the collection and consolidation of data in the hospitals.
Data value	Average accuracy, because hospitals rarely make reports on the accidents no matter how serious they are. However, data on reported accidents have high reliability.
Reporting frequency	Biannually or annually

Indicator No. 7	Average duration of medical examination
Applicable areas	Consulting room
Quality property	Efficiency
Quality component	Process
Reasons	Patients often complaint about the long duration of medical examinations, especially those conducted at provincial and central hospitals. The duration of medical examination reflects the patient overload as well as the healthcare organization of the hospitals. The measurement of duration of medical examination contributes in the improvement in the patients’ satisfaction and the efficiency of the consulting room
Calculation method	Duration of medical examination is the period of time when the patients complete the medical examination procedures from the time of registration of medical examination to the time they receive the diagnoses, prescriptions or instructions from doctors at the consulting rooms
Numerator	Total duration of medical examination of all patients
Denominator	Total number of patients receiving medical examination
Inclusion criteria	Total number of patients registering the medical examination
Exclusion criteria	Patients failing to comply with the medical examination procedures
Data sources	Measuring such indicator, it is required that hospitals will collect and consolidate data about time of medical examination Regarding hospitals applying information technology in the management of outpatient, the time of registration and the finish time of the examination are displayed on computers. For hospitals not recording the time of registration and the finish time of the examination, such information shall be added to the examination registration books or the examination books.
Data collection and consolidation	If the registration time and finish time of examination are recorded, the burden on the collection and consolidation of data is minor.
Data value	High accuracy and reliability
Reporting frequency	Quarterly, biannually, every 9 months or annually

Indicator No. 8	Average duration of hospitalization (applicable to all types of diseases)
Applicable areas	The whole hospital
Quality property	Efficiency
Quality component	Process
Reasons	The increase in the length of hospitalization increases the seriousness of the overload and the treatment cost the patients must pay. The length of hospitalization reflects the efficiency and the suitability of the treatment and healthcare provided by hospitals.
Calculation method
Numerator	Total number of days of inpatient treatment in the reporting period
Denominator	Total number of persons receiving inpatient treatment in the reporting period
Inclusion criteria	All of patients having the inpatient treatment records
Exclusion criteria	Patients referred from other hospitals where they have received inpatient treatment; Patients referred to other hospitals where they continue receiving inpatient treatment
Data sources	Medical records, hospital admission - discharge - referral books, hospital statistic reports
Data collection and consolidation	Such data are currently collected and consolidated by hospitals. The measurement of such data does not increase burden on the hospitals.
Data value	High accuracy and reliability
Reporting frequency	Quarterly, biannually, every 9 months or annually

Indicator No. 9	Actual usage of patient beds
Applicable areas	The whole hospital
Quality property	Efficiency
Quality component	Outcomes
Reasons	The overload of hospitals, especially of central levels, is an imperative issue. Although the actual number of patient beds is higher than the planned one, most hospitals use the planned number to calculate the usage of patient beds. The usage of patient beds calculated according to the actual number of patient beds reflects more accurately the rate of overload and assist the supervision of changes in the operation of a hospital.
Calculation method
Numerator	Total number of days of inpatient treatment in the reporting period
Denominator	Actual number of patient beds in total multiplying the number of days in the reporting period
Data sources	Medical records, hospital admission - discharge - referral books
Data collection and consolidation	Such data are currently collected and consolidated by hospitals. The measurement of such data does not increase burden on the hospitals.
Data value	High accuracy and reliability
Reporting frequency	Biannually or annually

Indicator No. 10	Efficiency of use of operating rooms
Applicable areas	Surgery
Quality property	Efficiency
Quality component	Process
Reasons	Operating rooms receive the most investment of the hospitals. In several hospitals, the unreasonable organization of operating rooms leads to the overload and the extension of surgery-pending period while in other hospitals operating rooms are rarely used. The measurement and improvement of the usage of operating rooms contributes in the reduction of load of the hospital and the efficient use of current resources.
Calculation method
Numerator	Total amount of using time of operating rooms (depending on the entering and leaving time) in a quarter
Denominator	The number of operating rooms * 8 hours * 5 days/week
Inclusion criteria	Elective and urgent surgeries
Exclusion criteria	-
Data sources	Currently, data about using time of operating rooms are not collected and consolidated by hospitals. The measurement of such indicator requires the recording of the time the patients enter or leave the operating rooms to the monitoring books or handover books of the operating rooms or the operating monitoring books
Data collection and consolidation	If such data are recorded, the burden on the collection and consolidation of data is minor.
Data value	High accuracy and reliability
Reporting frequency	Quarterly, biannually, every 9 months or annually

Indicator No. 11	Mortality rate and rate of poor prognosis (applicable to all types of diseases)
Applicable areas	The whole hospital
Quality property	Effectiveness
Quality component	Outcomes
Reasons	Mortality rate is a common treatment quality indicator. In Vietnam, for most complex cases where patients are predicted to die, their families apply for discharge for resting at home. Nowadays, since the patients may be admitted after receiving inpatient treatment from other hospitals, the comparison of the efficiency and safety in treatment using hospitals’ mortality rate is not very suitable
Calculation method
Numerator	Total number of patients died at the hospital and predicted to die and discharged on request in the reporting period
Denominator	Total number of persons receiving inpatient treatment in the reporting period
Inclusion criteria	All persons receiving inpatient treatment
Exclusion criteria	Patients referred from other hospitals where they have received inpatient treatment;
Data sources	Medical records, hospital admission - discharge - referral books
Data collection and consolidation	Data about mortality and poor prognosis are currently collected and consolidated by hospitals. However, such data includes patients referred from other hospitals. The measurement of such data does not increase burden on data collection but requires a minor change in data collection
Data value	High accuracy and reliability
Reporting frequency	Quarterly, biannually, every 9 months or annually

Indicator No. 12	Rate of referral to higher-level healthcare facilities (applicable to all types of diseases)
Applicable areas	The whole hospital
Quality property	Effectiveness
Quality component	Outcomes
Reasons	Referral rate is a common treatment quality indicator. In Vietnam, most complex cases are referred to higher-level hospitals because lower-level hospitals do not have sufficient conditions and capacity to apply the required therapeutic techniques and treatment regimens, etc. Nowadays, since the patients or their families may apply for discharge to finish the current treatment and receive treatment from higher-level hospitals without decisions of current hospitals, the comparison of the efficiency and safety in treatment using the referral rate is not very suitable
Calculation method
Numerator	Total number of patients referred to higher-level hospitals under decisions of current hospital in the reporting period
Denominator	Total number of persons receiving inpatient treatment in the reporting period
Inclusion criteria	-
Exclusion criteria	Patients applying for discharge from hospitals to finish the current treatment and referral to higher-level hospitals without decisions of current hospitals; patients referred to higher-level hospitals for emergency under decisions of current hospitals
Data sources	Medical records, hospital admission - discharge - referal books
Data collection and consolidation	Such data are currently collected and consolidated by hospitals. The measurement of such data does not increase burden on data collection
Accuracy and reliability	Average accuracy and reliability
Reporting frequency	Quarterly, biannually, every 9 months or annually

Indicator No. 13	Ratio of injuries caused by sharp objects to 1000 persons
Applicable areas	The whole hospital
Quality property	Staff’s orientation
Quality component	Process
Reasons	Injuries caused by sharp objects is a main reasons of occupational diseases transmitted through bloodstream which is popular in health workers.
Calculation method
Numerator	Total number of health workers suffering injuries caused by sharp objects in the reporting period * 1000
Denominator	Total number of health workers
Data sources	Such data are currently collected and consolidated by hospitals. However, such accidents are often not reported and recorded by health workers. Data sources should be health workers’ occupational health dossiers and medical interview results (made and recorded in periodic check-ups which are held every 6 months according to regulations)
Data collection and consolidation	The collection and consolidation of information about injuries caused by sharp objects will not cause any noticeable burden on hospitals which seriously comply with regulations on check-up and occupational disease management for employees.
Accuracy and reliability	Average accuracy and reliability
Reporting frequency	Biannually or annually

Indicator No. 14	Rate of HBV inoculation in health workers
Applicable areas	The whole hospital
Quality property	Staff orientation
Quality component	Process
Reasons	The Ministry of Health prescribes that health workers shall have HBV inoculation. However, hospitals do not highly comply with such regulation.
Calculation method
Numerator	Total number of health worker having 3 doses of HBV inoculation * 100%
Denominator	Total number of health workers requested to have HBV inoculation
Data sources	Health workers’ occupational health dossier Results of medical interview of health workers in each periodic check-ups
Data collection and consolidation	The measurement of such indicator shall depend on the occupational health survey conducted in the periodic check-ups provided for health workers according to regulations. The collection and consolidation of information about injuries caused by sharp objects will not cause any noticeable burden on hospitals which seriously comply with regulations on check-up and occupational disease management for employees.
Data value	Average accuracy and reliability
Reporting frequency	Biannually or annually

Indicator No. 15	Rate of patients' satisfaction of healthcare services
Applicable areas	The whole hospital
Quality property	Patients’ satisfaction
Quality component	Outcomes
Reasons	Patients’ satisfaction is an important outcome of hospitals. Patients' satisfaction is also relevant to the total number of patients coming to hospitals to receive examination and the future usage of patient beds. As prescribed by the Ministry of Health, hospitals shall regularly conduct the assessment of patients’ satisfaction. Nowadays, many complaints about the behavior of hospitals' staff have been received.
Calculation method
Numerator	Total number of patients satisfied with the behavior of health workers * 100
Denominator	Total number of patients interviewed
Inclusion criteria	Patients was and being discharged from the hospital
Exclusion criteria	Patients receiving inpatient treatment
Data sources	Surveys on patients' satisfaction
Data collection and consolidation	The measurement of such indicator does not cause any noticeable burden on hospitals which seriously comply with regulations on assessment of patients’ satisfaction
Data value	Changeable accuracy and reliability, depending on types of samples and questions and the processing of data. The Ministry of Health shall issue a consistent questionnaire used for all hospitals to reduce the variance in data
Reporting frequency	Quarterly, biannually, every 9 months or annually

Indicator No. 16	Rate of health workers’ satisfaction
Applicable areas	The whole hospital
Quality property	Staff orientation
Quality component	Outcomes
Reasons	Health workers’ satisfaction is an important outcome of hospitals. Health workers’ satisfaction is also related to their behavior during the provision of healthcare services. As prescribed by the Ministry of Health, hospitals shall regularly conduct the assessment of health workers’ satisfaction. Nowadays, many complaints about the behavior of health workers have been received.
Calculation method
Numerator	Total number of health workers satisfied with their hospitals’ management * 100
Denominator	Total number of health workers in the hospital
Inclusion criteria	All the health workers in the hospital
Data sources	Surveys on health workers’ satisfaction
Data collection and consolidation	The measurement of such indicator does not cause any noticeable burden on hospitals which seriously comply with regulations on assessment of health workers’ satisfaction
Data value	Changeable accuracy and reliability, depending on types of questions and the processing of data. The Ministry of Health shall issue a consistent questionnaire used for all hospitals to reduce the variance in data
Reporting frequency	Quarterly, biannually, every 9 months or annually

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Decision 7051/QD-BYT promulgating guidance pilot establishment a number of hospital quality indicators
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