Landscapes on Prevention Quality Indicators: A Spatial Analysis of Diabetes Preventable Hospitalizations in Portugal (2016–2017)

Preventable hospitalizations due to complications of diabetes mellitus (DM), represented by the related prevention quality indicators (PQI), are ambulatory care-sensitive conditions that can be prevented and controlled through effective primary health care (PHC) treatment. It is important to reduce mortality and promote the quality of life to diabetic patients in regions with higher hospitalization rates. The study aims to analyze the results of the DM age-sex-adjusted PQI, by groups of health centers (ACES), distributed in the Portuguese territory. The most representative PQI at a national level were identified, and the trends were mapped and analyzed. Also, it presents the ACES with the highest age-adjusted rates of avoidable hospitalizations for DM. The absolute number of preventable hospitalizations for all DM complications in Portugal has decreased by 20%, thus passing from the rate of 79 in 2016 to 65.2/100,000 inhabitants in 2017. Despite the improvement in results for PQI 03, 20 of 48 ACES that were above the national 2017 median rate in 2016, achieved better results the following year, and for the overall preventable diabetes hospitalizations (PQI 93) only 11 out 39, revealing the need for further studies and PHC actions to improve the diabetic quality of life.

Time trends of primary care quality across Portuguese regions: using prevention quality indicators

Background Primary care quality is one of the main dimensions of primary care performance and can be evaluated by several methods, e.g. studying hospitalizations for conditions that could be treated, or less severe, if appropriately managed in primary care. Accordingly, the Agency for Healthcare Research and Quality (AHRQ) developed prevention quality indicators (PQIs). In this study, we aimed to compare PQIs and their time trends across Portuguese regions. Methods We performed a retrospective study, using all adult public hospital discharges in mainland Portugal, between 2011 and 2015. PQI rates for the overall (PQI 90) and composite indicators (i.e. 91 - acute, 92 - chronic, 93 - diabetes) were computed using AHRQ specifications. These rates were compared between the 5 Portuguese NUTS 2 regions of residence. Results From the total of 407,792 hospital discharges in mainland Portugal (2011-2015) 11.9% comprised the selected PQIs, the majority related the acute composite PQI, followed by the chronic composite PQI. The hospitalization rate of the overall PQI increased from 999.5 hospitalizations (2011) to 1231,0 hospitalizations/100,000 inhabitants (2015), with an increase in all NUTS 2 regions. In 2015, while Algarve and North had the lowest PQI rates, Centro and Alentejo showed the highest ones. Conclusions Between 2011 and 2015, there was an increasing trend of overall and composite PQI rates. Also, important differences between Portuguese regions were found that must be further studied. The authors thank the support given by the Project ’POCI-01-0145-FEDER-030766’ (1st.IndiQare - Quality indicators in primary health care: validation and implementation of quality indicators as an assessment and comparison tool), funded by Fundação para a Ciência e a Tecnologia (FCT) and co-funded by Fundo de Desenvolvimento Regional (FEDER) through Operacional Competitividade e Internacionalização (COMPETE 2020). Key messages Between 2011 and 2015, overall prevention quality indicator rate increased in Portugal. There are great differences between Portuguese NUTS 2 regions regarding prevention quality indicators.