Abstract
The study of quality indicators of administrative data and hospital characteristic aims to test the 45 indicators of quality assessment of the administrative data in the US whether they can be applied with the existing administrative data in Thailand.Can they use and compare the result of the services in various aspects such as year,region comparison. Will they be possibility of using some indicators to monitor the quality of services in Universal Coverage of health care scheme (UC) in the future? The methodology is cross sectional study of reimbusement data from 2000-2003.It is two parts of analysis.First,the data is assesed by sampling from year 2001 hospital data to audit the chart with central data.Second,administrative data of three years are test with 45 HCUP(Health care cost and utilization project) indicators.There are two groups of those indicators provider level and area level indicaor.The provider level consist of 6 Volume, 5 Utilization, 6 inpatient condition mortality and 7 inhospital procidural mortality indicators. While the area level consist of 4 Utilization and 16 Avoidable hospitalizations and Ambulatory care sensitive condition (ACSC) indicators.The comparison between the various characteristics are studied in this research. The result of this study showed that the 70% of data was corrected in diagnosis and 62% in procedural coding.The data can rather use for analysis of indicator.For the volume indicator,it can not be evaluated from data because those operations are less in Thailand,Thus,the mortality form them can not be compared as well. The utilization indicator which can be analysed in this study was Caesarean section rate while incidental appendectomy among elderly and Laparoscopic cholecystectomy can be used by combining data from three years due to the small number of cases.The useful inpatient condition mortality were Acute myocardial infarction mortality,Congestive heart failure mortality,Pneumonia mortality and Stroke mortality while another two indicators, Hip fracture mortality and GI hemorhage mortality were required to use the total data of several years for assessment. For the area level indicators, the service rate of Hysterectomy and Laminectomy can be used while CABG and PTCA cannot because of the inadequacy of data. Most of the Avoidable hospitalizations and Ambulatory care sensitive condition indicators can be used except for uncontrolled diabetes mellitus since there is no coding in ICD 10. However,some provinces had few data compare to area population so the indicators cannot be evaluated. Because they are no composite index of indicator,each of them can be applied separately,Using various years of data makes the reliable result of assessment especially mortality indicators. Some of indicators are main indicators for presenting the result of hospital services for example; Caesarean section rate because there were adequate data in each year and such result of services can be used for comparison. For the area level indicators, this study showed that some provincial area might have less population so the reliability of the indicators might be questionable. This can be solved by expanding area into regional area. Applying these indicators in Universal Coverage scheme presently is not likely to be possible because of two factors;the correctness of data and the suitability of the indicators in Thailand data.Moreover, there are many factors involved. For example, cause of illness, treatment or operation and health service system between Thailand and other countries are different. In order to tell which province or which hospital is good quality in inpatient services providing, there must be the development of indicators for Thailand, particularly, the standard of selection of indicators using statistic method. Besides, low standard of care caused by the monitoring organization would make the result of indicator assessment for comparison more meaningful.
