Abstract
The study of impact of the autonomization of a public hospital on health services (The third section) Year 2 – 3 is a section of the study series of the Health Systems Research Institute to evaluate the impact of the autonomization of Banpaew Hospital (Public organization). The first-part objective is to assess the impact of the autonomization of Banpaew Hospital on quality of health services by medical record review, comparing processes and outcomes of care during the one-year period before the autonomization—the “before” period—and the year after the autonomization—the “after” period—in five disease groups. The outpatient setting includes diabetes mellitus (DM), hypertension (HT) and tuberculosis (TB). The inpatient setting includes appendicitis (AP) and acute myocardial infarction (AMI). The second-part objective is to develop a set of system performance indicators of an autonomous hospital, and to try to evaluate the performance of Banpaew Hospital using the indicator set, by studying in Banpaew and two other community hospitals. The findings in the first part of the study are mixed. There are certain differences in processes and outcomes of care in the five diseases between the before and the after period in both directions—better and worse results. In the DM group, there is a tendency for better process of care, whereas patients during the after period show a slight increase in short-term complication. However, the changes are not statistically significant (p’s >0.05). In the HT group, there is significant reduction in completeness of physical examination records while there are more information on recommended laboratory investigations (p’s <0.01). In the TB group, there are evidences of deterioration in recording processes of care and outcome of treatment (p’s <0.05). In the appendicitis group, there is a slight reduction in completeness of progress notes, but there is no change in outcomes. In the AMI group, there is no overall difference in processes and outcome of care. In the second part of the study, we identify the indicator set for monitoring the autonomous hospital with respect to the conceptual framework of health care reform to have two levels—the organizational and the district levels—and consists of 67 indicators in seven dimensions
