Background Quality of care monitoring is an important aspect in healthcare and depends on the availability of valid quality indicators (QI), easily obtainable from available data sources. This is important particularly for benzodiazepines and Z-drugs (BZD) given their important side effects, so good QIs are needed.
Purpose To develop QIs for BZD use in general and mental health hospitals, based on available reimbursement data (RD).
Material and methods First, QI were selected through a literature review and expert meetings within the network for healthcare institutions (Zorgnet-ICURO). Next, these QIs were assessed for content validity in two separate datasets. The first dataset was obtained from national RD (year 2017, collected from all Belgian health care insurers). The second dataset comprised facturation data (FD) from two test hospitals: one general hospital psychiatry ward (GHP) and one mental health hospital (MHH).
Results Four QIs were selected allowing in-depth evaluation of BZD use (Table). For the MHH, reimbursement data corresponded well with local facturation data (719 vs. 710 patients with ≥1 BZD use) but not in the GHP (161 vs. 206 patients). Upon analysis, it emerged that three-quarters of QIs could not be calculated as RD does not provide for a valid nominator at different times during hospitalisation. A subsequent survey among hospitals showed high variability in how RD are reported to insurers, explaining information loss.
Conclusion Current RD are not sufficiently detailed to evaluate BZD use within/between hospitals. However, high use of electronic prescribing in Belgian hospitals allows the use of actual prescription and administration data for this purpose but will need additional effort from hospitals.1 A uniform structure is currently under development to allow standardised data extraction and comparison.
References and/or acknowledgements 1. Kadri, B. et al. Can clinical practice indicators relating to long-acting benzodiazepine use in the elderly be easily generated in a hospital setting?Eur J Clin Pharmacol2018;74:233.
No conflict of interest.