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MINISTRY OF HEALTH
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SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
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No. 7051/QD-BYT
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Ha Noi, November 29, 2016
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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.
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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
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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.
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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)
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Process
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
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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)
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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)
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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
14. Rate of HBV inoculation in health workers
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Patient-centered indicators
(2 indicators)
15. Rate of patients' satisfaction of healthcare services
Outcomes
16. Rate of health workers’ satisfaction
Outcomes
III.
CONTENTS
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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.
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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
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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
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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
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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
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- 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
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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
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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
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Indicator
No. 4
Rate of
hospital-acquired infection (pneumonia)
Applicable
areas
Surgery
Quality
property
Safety
Quality
component
Outcomes
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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)
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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
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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
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+ 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
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Reporting
frequency
Annually or
biannually
Indicator
No. 6
Number of serious
non-medical accidents
Applicable
areas
The whole hospital
Quality
property
Safety
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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
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+ 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
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Indicator
No. 7
Average duration of
medical examination
Applicable areas
Consulting room
Quality
property
Efficiency
Quality
component
Process
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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
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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
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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
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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
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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
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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.
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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.
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High accuracy
and reliability
Reporting
frequency
Biannually or
annually
Indicator
No. 10
Efficiency of
use of operating rooms
Applicable
areas
Surgery
Quality
property
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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
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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
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
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
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
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
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
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
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
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
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
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
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
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
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
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
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
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.
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
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
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
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
...
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
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
...
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
Reporting
frequency
Biannually or
annually
Indicator
No. 15
Rate of
patients' satisfaction of healthcare services
Applicable
areas
The whole
hospital
Quality
property
Patients’ satisfaction
...
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
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
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
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.
...
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
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
...
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...
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
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
...
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
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
...
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ĐT: (028) 3930 3279 DĐ: 0906 22 99 66