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PATH events


A brief report on the PATH'09 related activities performed to date in Croatia


After the National Conference held on February 13, 2009, three workshops with hospital coordinators have been organized (April 8, May 8 and June 16). At these workshops we have vividly and interactively discussed the infrastructure that is necessary for PATH'09 program implementation in the Republic of Croatia and how to organize data collection to acquire optimal, high quality information. A brief summary follows below.

  • A total of 25 hospitals have been registered, including 8 university hospitals, 10 general hospitals and 7 special hospitals (psychiatry and rehabilitation).
  • In Croatia, some data on the indicators kept at the central national database in the National Institute of Public Health, regional institutes of public health or Croatian Institute of Health Insurance may require quite a complex procedure to acquire since they cannot be extracted individually; the more so, the data thus obtained would require additional validation for quality and accuracy. Therefore, we have decided not to use the central national database in this phase of the program. Instead, we consider it more appropriate to develop the culture of quality measurement at the hospitals and to be in touch with our own data and to use the results of their analysis for improvement.
  • Of the set of phase 1 indicators proposed, we have adopted the following ones: C-section rate, Case fatality for stroke and AMI, Postoperative pulmonary embolism, Length of stay, Day surgery, Needle injury, and Smoke free hospital audit.
  • We have considered the possibilities of including sub-indicators and related indicators, adjustment/stratification, and actions for improvement for all indicators. We have chosen only those for which data can be collected, so far. It should be noted that currently hospital information system is not available in 95% of Croatian hospitals (computerization has just been under way).
  • As ICD-10 classification has been used in Croatia, whereas ICD-9 classification is mostly cited in indicator drafts and conversion from one to another classification is by no means a simple task, we kindly ask for both classifications to be allocated in parallel in indicator drafts for all indicators as it has already been done for the Case fatality for stroke indicator.
  • We received phase 1 indicator drafts at the end of May 2009 (i.e. later than previously planned), therefore there may be some delay due to objective reasons in the deadline for data collection, the more so as the holiday season (June, July) is approaching. Yet, all our hospital coordinators have generally accepted July 30 as the deadline for data collection on phase 1 indicators. I would like to note again that in addition to all the activities related to the choice of indicators and making all those involved understand what has to be performed and how to do it in the best way possible, we also had to have the indicator drafts translated into Croatian language and Excel forms for data collection developed.
  • We have established a mailing list for hospital coordinators included in PATH'09, for all communication and a tool for discussion, continuous questions and answers during the process of data collection.
  • Excel forms (that have been defined together) are expected to be distributed to all hospitals participating in PATH'09 by the end of June 2009; to each form (indicator) will be attached detailed instructions how to fill it out, and continuous help will be available by e-mail, if needed.

In parallel with the establishment of phase 1 indicators, we have been active in preparing phase 2 indicators. The proposals for phase 2 indicators will be thoroughly discussed at our next workshop anticipated to take place on September 17, 2009. At this workshop, we plan to present preliminary results of the analysis of phase 1 indicators. Unfortunately, despite our efforts and enthusiasm, the preparation of phase 2 indicators cannot be completed by the end of July 2009 (holidays).

We have decided the indicator of antibiotic prophylaxis to be included as a phase 2 indicator. Respective proposal has been developed in collaboration with a relevant professional in the field and will be discussed at the next workshop on September 17.

Considering financial indicator, we have prepared a proposal which I will send until the end of June.

As for the indicator of breastfeeding and WHO inquiry, in Croatia there are 14 Friendly Hospital Network hospitals. The project leader will be contacted and definitive proposal on the issue can only be submitted thereafter.

Considering the new indicator "blood component transfused by type of surgery" draft, which I have accepted to develop, this task required due consideration of all the relevant conditions to make the indicator feasible in practice and to discuss it with the surgeons, anesthesiologists and transfusiologists. It took time to do and it was impossible to complete by the preset draft deadline (June 15). Now I have collected all relevant information from the routine and will submit this indicator draft along with the existing evidence based data by July 5.


Jasna Mesaric

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