Zoltan Balogh PhD MSc RN PT

Quality Measurement Quality Measurement of of Long Term Care Long Term Care in Hungaryin Hungary

21st May 2010, London School of Economics - United Kingdom

Semmelweis University Faculty of Health Sciences

Department of Nursing Science

Council of the Hungarian Health Paramedical Professionals

WHO, 1997

DEMOGRAPHIC CHANGES DEMOGRAPHIC CHANGES IN THE WORLD 1IN THE WORLD 1

proportion of the population proportion of the population aged 65 years and overaged 65 years and over in 1996 in 1996

2

WHO, 1997

DEMOGRAPHIC CHANGES DEMOGRAPHIC CHANGES IN THE WORLD 2IN THE WORLD 2

proportion of the population proportion of the population aged 65 years and overaged 65 years and over in 2020 in 2020

3

POPOULATION BY SEXPOPOULATION BY SEX1890-1941-20081890-1941-2008

1941

500000 400000 300000 200000 100000 0 100000 200000 300000 400000 500000

0–45–9

10–1415–1920–2425–2930–3435–3940–4445–4950–5455–5960–6465–6970–7475–7980–8485–X

korocsoport

fő

Férfiak Férfi-többlet Nők Női-többlet

2004

500000 400000 300000 200000 100000 0 100000 200000 300000 400000 500000

0–45–9

10–1415–1920–2425–2930–3435–3940–4445–4950–5455–5960–6465–6970–7475–7980–8485–X

korcsoport

fő

Férfiak Férfi-többlet Nők Női-többlet

1890

500000 400000 300000 200000 100000 0 100000 200000 300000 400000 500000

0–45–9

10–1415–1920–2425–2930–3435–3940–4445–4950–5455–5960–6465–6970–7475–7980–8485–X

korcsoport

fő

Férfiak Férfi-többlet Nők Női-többlet

Hungarian Central Statistical Office

1890 1941 2008

MEN MENMENWOMEN WOMENWOMEN

4

27%

24%

20%

20%

19%

19%

59%

62%

63%

61%

60%

59%

55%

14%

15%

16%

18%

20%

22%

26%

21%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1995 2000 2010 2020 2030 2040 2050

Year

prop

orti

on (

%)

65< years20-64 years0-19 years

o

Estimates and projections of the Estimates and projections of the proportion of the population proportion of the population

aged 65 years and over in Hungaryaged 65 years and over in Hungary1995-20501995-2050

László Hablicsek, Pál Péter Tóth, 1999.5

MILESTONES IN THE HISTORY MILESTONES IN THE HISTORY OF LONG TERM CAREOF LONG TERM CARE

Foundation of home nursing and hospice care (1991-Foundation of home nursing and hospice care (1991-95)95)

Reducing the number of hospital bed (1995/1996)Reducing the number of hospital bed (1995/1996) Introducing the new concept for home nursing Introducing the new concept for home nursing

(1995/1996)(1995/1996) New Health Act (1997)New Health Act (1997) Introducing the Nursing Departments/ Nursing Introducing the Nursing Departments/ Nursing

Institutes (1998)Institutes (1998) Introducing Hospice Home Care teams (Introducing Hospice Home Care teams (11999)999) Minimum human and material resources (2003)Minimum human and material resources (2003) New professional requirementNew professional requirement (2009)(2009) New professional standards in home careNew professional standards in home care (2010) (2010)

6

QUALITY MEASUREMENT OF LTC 1QUALITY MEASUREMENT OF LTC 1

Clinical auditsClinical audits

Professional guidelines and standardsProfessional guidelines and standards

Nursing protocolsNursing protocols

7

QUALITY MEASUREMENT OF LTC 2QUALITY MEASUREMENT OF LTC 2

Clinical audits organised by Clinical audits organised by NPHMNPHMOS:OS: PersonPersonnnel working conditions:el working conditions:

Prescribed specialised trainingPrescribed specialised training Employment contractsEmployment contracts Liability insuranceLiability insurance

Retrospective analysis of nursing documentationRetrospective analysis of nursing documentation Examination of patent’s rightsExamination of patent’s rights Material working conditions:Material working conditions:

Existence of equipmentsExistence of equipments

8

QUALITY MEASUREMENT OF LTC 3QUALITY MEASUREMENT OF LTC 3

Professional guidelines and standards by Professional guidelines and standards by Ministry ofMinistry of

Health and Hungarian Scientific College of Health and Hungarian Scientific College of NursingNursing

Role of GPs and District and Home NurseRole of GPs and District and Home Nurse Patient’ admissionsPatient’ admissions Process of home and palliative careProcess of home and palliative care Hungarian Healthcare Service StandardsHungarian Healthcare Service Standards

9

QUALITY MEASUREMENT OF LTC 4QUALITY MEASUREMENT OF LTC 4

Protocols in the field of home care nursingProtocols in the field of home care nursing Nursing and rehabilitation of stroke patientsNursing and rehabilitation of stroke patients Nursing and rehabilitation of MSNursing and rehabilitation of MS Dietotherapy of chronic cardiac failuresDietotherapy of chronic cardiac failures Physiotherapy of hip joint endoprothesisPhysiotherapy of hip joint endoprothesis Incontinence managementIncontinence management Wound managementWound management

7

QUALITY MEASUREMENT OF LTC 5QUALITY MEASUREMENT OF LTC 5

ISO StandardsISO Standards Activities of managementActivities of management Resources managementResources management Process controlProcess control Measurement, analyMeasurement, analyssis and improvementis and improvement

Ministry of Health published the recommendation of Ministry of Health published the recommendation of

application of the ISO 9001:2000 standards in the home application of the ISO 9001:2000 standards in the home

and hospice health care servicesand hospice health care services..

7

INTERNATIONAL CONCEPTS

10

Thank you for your kind attention!

„For health and for the sick with representing our profession”

11

REFERNCESREFERNCES

Balázs E. Interjú Boldogné Csurik Magdolnával az Országos Tisztiorvosi Balázs E. Interjú Boldogné Csurik Magdolnával az Országos Tisztiorvosi Hivatal Ápolási Szakfelügyeleti Osztálynak vezetőjével. Otthonápolás. Hivatal Ápolási Szakfelügyeleti Osztálynak vezetőjével. Otthonápolás. 2005;1(5):5-9. 2005;1(5):5-9.

Balogh Z, Borbas I, Lako E. Balogh Z, Borbas I, Lako E. Nursing in Hungary. Nursing in Hungary. Budapest: Institute for Basic Budapest: Institute for Basic and Continuing Education of Health Workers; 2008.and Continuing Education of Health Workers; 2008.

Hajnal MP. Minőségfejlesztés – egy korszak kezdete – tovább egy megkezdett Hajnal MP. Minőségfejlesztés – egy korszak kezdete – tovább egy megkezdett úton. Otthonápolás. 2005;1(5):14-16. úton. Otthonápolás. 2005;1(5):14-16.

Hegedűs K. HPPA: the rise of Hungarian hospice and palliative care. European Hegedűs K. HPPA: the rise of Hungarian hospice and palliative care. European Journal of Palliative Care 2010;17(2):98-100.Journal of Palliative Care 2010;17(2):98-100.

ICN. Delivering quality, serving communities: ICN. Delivering quality, serving communities: Nurses leading chronic careNurses leading chronic care. . Geneve, 2010. p. 2-42.Geneve, 2010. p. 2-42.

Modly D, Zanotti R, Poletti P, Fitzpatrick JJ. Modly D, Zanotti R, Poletti P, Fitzpatrick JJ. Home Care Nursing ServicesHome Care Nursing Services. In: . In: Balogh Z, Modly D.: Home-Based Health Care in Hungary. (Chapter 12) New Balogh Z, Modly D.: Home-Based Health Care in Hungary. (Chapter 12) New York, USA Springer Publishing Company, Inc.; 1997. p. 127-132.York, USA Springer Publishing Company, Inc.; 1997. p. 127-132.

Richard B, Figueras S & J. Richard B, Figueras S & J. Europen Health Care Reform.Europen Health Care Reform. WHO Regional Office WHO Regional Office for Europe, Coppenhagen, 1997. p. 22-28.for Europe, Coppenhagen, 1997. p. 22-28.

Stubnya G, Balogh Z., Csetneki J. Zur beruflichen Situation von Stubnya G, Balogh Z., Csetneki J. Zur beruflichen Situation von Pflegefachkräften und Geburtshelfern in Ungarn. Pflegerecht 2009;9:428-434.Pflegefachkräften und Geburtshelfern in Ungarn. Pflegerecht 2009;9:428-434. 7