ACKnoWLEDGEMEntS - Clinical Research Centre

Transcription

NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010
HOSPITALS
ACKNOWLEDGEMENTS
The National Healthcare Statistics Initiative team would like to thank the Director General of Health Malaysia for his continuous support towards
this survey and permission to publish the report.
Also, our sincere appreciation to the following for their participation, assistance, support and contribution:
• Deputy Director General of Health (Research and Technical Support), MOH
• Deputy Director General of Health (Medical), MOH
• Deputy Director General of Health (Public Health), MOH
• Director, Clinical Research Centre (CRC), National Institutes of Health (NIH)
• Director, Medical Development Division, MOH
• Director, Medical Practice Division, MOH
• Health Informatics Centre, MOH
• Private Medical Practice Control Section (National level)
• Private Medical Practice Control Unit (State level)
• All participating public, private and university hospitals which provided or allowed access to their establishment and workforce data.
• KPJ Healthcare Berhad
• Pantai Holdings Berhad
• Malaysian Medical Council, Association of Private Hospitals of Malaysia, Obstetrical & Gynaecological Society of Malaysia, Malaysian
Paediatric Association, Malaysian Society of Anaesthesiologists, Malaysian Psychiatric Association, Malaysian Oncological Society
• Head of Clinical Services, MOH
• Members of NHEWS (Hospital) Expert Panels
• All medical doctors and support personnel who participated in the NHEWS (Hospital)
• All those who have supported or contributed to the success of the NHEWS (Hospital) and publication of this report
Thank you.
National Healthcare Statistics Initiative (NHSI)
Ministry of Health Malaysia
vii
HOSPITALS
MEMBERS OF NHEWS (HOSPITAL) PROJECT TEAM
Principal Investigator
Datuk Dr. Noor Hisham Abdullah
Principal Co-Investigator
DR. SHEAMINI SIVASAMPU
DR. GOH PIK PIN
Co-Investigators
DR. NOORAINI BABA
DR. MD KHADZIR SHEIKH AHMAD
MR. ZAMANE ABDUL RAHMAN
Project Liaison Officers
DR. AFIDAH ALI
DR. LAILI MURNI MOKHTAR
Project Manager
DR. TAHRANI PERIANA KOVINDEAR
DR. ARUNAH CHANDRAN (OCT 2011 – PRESENT)
Survey Coordinators
MS. FAIZAH AHMAD
MS. KAMILAH DAHIAN
MS. FATIHAH MAHMUD
MS. NORFADILAH HAMDAN (JAN 2011 – AUG 2011)
MS. MUNIRAH MOHAMED (JULY 2010 – JAN 2011)
Statistician
MS. LENA YEAP
Database Developers / Administrators
ALTUS SOLUTIONS SDN. BHD.
viii
HOSPITALS
MEMBERS OF NHEWS (HOSPITAL) EXPERT PANELS
HOSPITAL SERVICES
Expert Panels
Institutions
Datin Dr. Nor Akma Yusuf
Medical Development Division, Ministry of Health
Dr. Afidah Ali
Medical Practice Division, Ministry of Health
Dr. Laili Murni Mokhtar
Matron Faridah Omar
Nursing Division, Ministry of Health
Ms. Ruby Ng
Association of Private Hospitals of Malaysia
Dr. Sheamini Sivasampu
Clinical Research Centre, Ministry of Health
Ms. Fatihah Mahmud
MATERNITY SERVICES
Expert Panels
Institutions
Dato’ Dr. Ravindran Jegasothy
Hospital Kuala Lumpur
Dr. Ravichandran Jeganathan
Hospital Sultanah Aminah, Johor Bahru
Prof. Dr. Zaleha Abdullah Mahdy
Universiti Kebangsaan Malaysia Medical Centre
Dr. Sharmini Diana Parampalam
Hospital Seberang Jaya
Dr. Jumeah Shamsuddin
Dr. Arpah Ali
Dr. Arunah Chandran
Ms. Faizah Ahmad
PAEDIATRIC SERVICES
Expert Panels
Institutions
Dr. Lim Yam Ngo
Dato’ Dr. Teh Keng Hwang
Hospital Sultanah Bahiyah, Alor Setar
Prof. Dr. Zabidi Azhar Hussin
Malaysian Paediatrics Association
Dr. Neoh Siew Hong
Dr. Maznisah Mahmood
Dr. Jafanita Jamaluddin
Dr. Arunah Chandran
Ms. Kamilah Dahian
ix
HOSPITALS
SURGICAL
SERVICES
SURGICAL
Expert Panels
Institutions
Datuk (Mr.) Harjit Singh
Hospital Selayang
Mr. Andrew Gunn Kean Beng
Dato’ (Mr.) Abdul Jamil Abdullah
Hospital Sultanah Nur Zahirah
Dato’ (Mr.) Mohamed Yusof Abd. Wahab
Hospital Tengku Ampuan Rahimah, Klang
Dato’ (Mr.) Jiffre Din
Hospital Tengku Ampuan Afzan, Kuantan
Mr. Nik Azim Nik Abdullah
Hospital Umum Sarawak
Mr. Clement Edward Thaumanavar
Hospital Tuanku Fauziah, Kangar
Mr. Tan Wee Jin
Hospital Pulau Pinang
Mr. Chuah Jitt Aun
Hospital Queen Elizabeth, Kota Kinabalu
Mr. Azali Hafiz Yafee
Hospital Melaka
Mr. Nik Mohamad Shukri Nik Yahya
Hospital Raja Perempuan Zainab II, Kota Bharu
Mr. Khairun Nizam Mobin
Hospital Sultanah Bahiyah, Alor Setar
Ms. Jasiah Zakaria
Hospital Tuanku Jaafar, Seremban
Dr. Patimah Amin
Dr. Tahrani Periana Kovindear
Ms. Faizah Ahmad
EMERGENCY SERVICES
Expert Panels
Institutions
Dr. Teo Aik Howe
Dr. Mahathar Abd Wahab
Dr. Ahmad Tajuddin Mohamad Nor
Hospital Tengku Ampuan Rahimah, Klang
Dr. Khairi Kassim
Hospital Tengku Ampuan Afzan, Kuantan
Assoc. Prof. Dr. Mohd Idzwan Zakaria
Universiti Malaya Medical Centre
Assoc. Prof. Dr. Hj Ismail Mohd Saiboon
Dr. Al Zamani Mohammad Idrose
Dr. Shukruddeen Salleh
Hospital Kuala Krai
Dr. Kasuadi Hussin
Dr. Arunah Chandran
Ms. Faizah Ahmad
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HOSPITALS
ANAESTHESIOLOGY SERVICES
Expert Panels
Institutions
Datin Dr. V. Sivasakthi
Dr. Mary S. Cardosa
Hospital Selayang
Dato’ Dr. Jahizah Hassan
Dato’ Dr. Subrahmanyam Balan
Dr. Jenny Tong May Geok
Hospital Tuanku Jaafar, Seremban
Dr. Patimah Amin
Ms. Kamilah Dahian
ONCOLOGY SERVICES
Expert Panels
Institutions
Dr. Gerard Lim Chin Chye
Assoc. Prof. (K) Dato’ Dr. Fuad Ismail
Dr. Ros Suzanna Ahmad Bustaman
Dr. Hafizah Zaharah Ahmad
Dr. Lim Yeok Siew
Hospital Ampang
Dr. Nellie Cheah
Dr. Nik Muhd. Aslan bin Abdullah
Dr. Lau Kah Liew
Mdm. Sarah Lee Abdullah
Ms. Anisah Nanyan
Ms. Suryati Mustafar
Ms. Kamilah Dahian
PSYCHIATRIC SERVICES
Expert Panels
Institutions
Dr. Toh Chin Lee
Hospital Selayang
Dr. Lim Chong Hum
Hospital Ampang
Dr. Mazni Mat Junus
Hospital Serdang
Dr. Azizul Awaluddin
Hospital Putrajaya
Dr. Siti Nor Aizah Ahmad
Dr. Sheamini Sivasampu
Ms. Fatihah Mahmud
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HOSPITALS
SUMMARY OF STUDY PROCESS
CRF Development and Pilot Test
Survey Population
Hospital Induction and CRF Distribution
Q
U
Data Collection and Data Entry
E
R
Data Cleaning, Verification and Standardisation
I
E
S
Data Analysis
Report / Manuscript Writing
xii
HOSPITALS
Study Methodology
Introduction
The project is a collaboration of various divisions in the Ministry of Health (MOH) such as Medical Development Division, Medical Practice Division,
Planning and Development Division and Medical Device Bureau. The Healthcare Statistic Unit in Clinical Research Centre (CRC) is the project
management team for the NHEWS hospital survey. CRC developed the operation procedures, designed, printed, and distributed all field manuals and
Case Report Forms (CRF) for the survey. CRC was also responsible for the daily operations of the survey, the training of staff and troubleshooting.
Approval for the NHEWS hospital protocol was granted by the MOH Medical Research and Ethics Committee (MREC) in 2010.
Data Security
The NHEWS hospital data collection was authorised under the Private Healthcare Facilities and Services Act 1998. However, participation was
voluntary. Data collected in the NHEWS hospitals are consistent with the Personal Data Protection Act 2010. All information collected is held in the
strictest confidence, according to legal and research ethics guidelines.
CRF Development and Pilot Test
The CRF was developed and designed by the NHEWS team in consultation with the respective NHEWS hospital expert panel. The survey form is
comprised of 8 sections, namely:
1. Hospital Establishments Survey
2. Obstetrics Services Survey
3. Paediatric Services Survey
4. Anaesthesiology Services Survey
5. Emergency Services Survey
6. General Surgery & Subspecialty Services Survey
7. Psychiatric Services Survey
8. Oncology Services Survey
Variables in each section were grouped by subsections such as facilities, activities & services, workforce, trainee doctors’ details and medical devices.
The CRFs were developed in printed and electronic versions so as to provide options in mode of data submission and as a means to increase
respondents’ participation.
The CRFs were pilot-tested by 2 public hospitals, namely Hospital Selayang and Hospital Serdang before being rolled out. Representatives from
these 2 hospitals were briefed on the objectives of the survey, the datasets required and the mode of data submission available. They were then
given hands-on training using the electronic version of the CRF. Revisions and improvements were made to the survey form where necessary and
corrections were made, taking into account comments and responses received during the pilot tests. List of data definitions used in this survey
are included in Appendix 1.
Survey Population
The determination of total population for the survey was finalised prior to the initiation of data collection. The procedure involved record matching of
hospitals in current NHEWS hospital databases against independent databases of the Ministry’s Private Medical Practice Control Section, Department
of Statistics (DOS) and Medical Development Division. Both matched and unmatched records were then reviewed by the NHEWS hospital team while
the verification procedure was conducted by contacting each site to confirm operational status. The review and verification processes were repeated
until the dataset was cleaned of inconsistencies and finalised. All hospitals that had cleaned datasets were included in the NHEWS hospital survey.
The NHEWS hospital survey collected data from all hospitals in Malaysia. Only hospitals that met the following eligibility criteria were included:
• General hospitals, maternity centres, specialised institutions i.e. cardiology, eye and children’s general hospitals
• Hospitals providing acute (curative) care
• Orang Asli hospital
Excluded hospitals are:
• Hospitals with zero beds
• Military hospitals as well as hospital units of institutions, such as prison hospitals.
• Hospitals and hospital beds available for chronic or long-term care
(e.g. rehabilitation and palliative care, nursing homes, leprosy centres and psychiatric institutions)
• Hospitals converted into maternity homes
• Hospitals operational in year 2011
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HOSPITALS
The hospital sampling frame was constructed from multiple sources including the following:
• Public hospital listings from MOH’s division
• Private hospital register from Private Medical Practice Control Section
There were a total of 347 hospitals in Malaysia in 2010.
The total number in the population, inclusion and exclusion criteria with the number of establishments included and excluded in the study, and
response rates are summarised in the following table:
Total Number
in the Population
Number of Hospitals
Included in the Study
Total Number that
Responded (Response Rate)
Ministry of Health
136
130
130 (100%)
University
Orang Asli
3
1
207
347
3
1
203
337
3 (100%)
1 (100%)
120 (59.1%)
254 (75.4%)
Hospital Category
Public
Private
Total
Note: Details of hospitals that participated in NHEWS hospital survey are available in Appendix 2
Hospital Induction & CRF Distribution
The first task of the NHEWS hospital field operations consisted of briefing all hospitals in the survey population. It is a process of introducing the
survey to the hospitals and getting them to participate voluntarily.
This process began with the distribution of invitation letters to the hospital administrators or directors to attend briefing sessions conducted in 13
states at specified venues and dates.
The hospital induction was conducted at the following locations and dates:
No
1
2
3
4
5
6
7
8
9
10
11
12
13
Location
WP Kuala Lumpur
Serdang, Selangor
Melaka
Seremban, Negeri Sembilan
Kuantan, Pahang
Ipoh, Perak
Johor Bharu, Johor
Georgetown, Pulau Pinang
Kuching, Sarawak
Kota Kinabalu, Sabah
Alor Setar, Kedah
Tumpat, Kelantan
Kuala Terengganu, Terengganu
Targeted Hospitals
From WP Kuala Lumpur & WP Putrajaya
From Selangor
From Melaka
From Negeri Sembilan
From Pahang
From Perak
From Johor
From Pulau Pinang
From Sarawak
From Sabah & WP Labuan
From Kedah & Perlis
From Kelantan
From Terengganu
Date
25 March 2011
31 March & 1 April 2011
6 April 2011
11 April 2011
13 April 2011
14 April 2011
20 April 2011
21 April 2011
25 April 2011
28 April 2011
9 May 2011
16 May 2011
19 May 2011
A compilation of the following documents were distributed to hospital representatives who attended the induction session:
• NHEWS information brochure
• Survey instruction manual
• An endorsement letter from the State Health Director
• Username and password access details for electronic CRF
• NHEWS 2008-2009 hospital report
The induction session began with a PowerPoint slide presentation by a NHEWS hospital team member with a brief overview on the project and
the aims of the NHEWS hospital survey. This was followed by demonstrations on how to fill in the paper and electronic CRFs. Hospitals that were
not represented during the induction meeting were contacted on a later date in an effort to include their participation and to provide them with the
relevant documents by post.
Hospital representatives were given 2 weeks duration to submit the completed CRFs. Non respondents after this duration were contacted in order
to remind and to track the distributed CRFs.
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HOSPITALS
Data Collection
For the purpose of easy data entry at respondent site, the cleaned dataset on human workforce was pre uploaded into the NHEWS hospital
database in order to minimize the need for manual typing of names and related information. The cleaned dataset was obtained by conducting
record matching of human workforce information in current NHEWS hospital database against databases from Malaysian Medical Council, National
Specialist Register and Medical Development Division. The cleaned list was then sent to the corresponding heads of services in the MOH or other
related authorised personnel for final verification.
Respondents had the option to choose between 2 modes of data submission which are:
1. Paper data submission via hardcopy Case Report Form (CRF)
2. Electronic data submission via web application (eCRF)
Data Entry
Data received via paper submission was thoroughly checked and reviewed for completeness and consistency prior to data entry into the NHEWS
hospital database. Data entry was then performed by trained NHEWS hospital team members. Data entry from participant’s site through electronic
CRF was submitted directly into the NHEWS hospital database and monitored in real-time basis by NHEWS hospital team. Quality of data entry
was constantly checked and maintained by several built-in features in the data entry module such as a compulsory data checking function,
inconsistency checks, auto calculations and auto default data from the previous year’s survey. Every activity in NHEWS hospital database was
recorded in a real-time tracking system.
Data Cleaning, Verification and Standardisation
Data cleaning was performed in parallel with data entry based on the results of edit checks. An edit check is a data checking procedure for tracing
doubtful data being entered and was performed by NHEWS team members who were familiar with hospital settings. Queries that arose were then
attended to by contacting the data entry personnel at the participant’s site or other authorised representatives to seek further clarification.
All queries were resolved before the database was locked from any further data entry activities to maintain data quality and integrity. A final checking
was performed prior to database locking to ensure that the data was acceptable for statistical analysis. The dataset was then standardised by
performing data deduplication procedure for removing duplicate records and checking of range and consistency to detect outliers and deviate data.
Verification of outliers and deviate data was done with the source data providers via verbal and written communication and the data were cross
checked against other data sources such as the Health Information Management System reports, Malaysian Medical Council Doctor Database,
professional societies, National Specialist Register and Registry Central Surveys. Most of the missing or out-of-range mandatory variables and
auxiliary variables were resolved
Statistical Analysis
In this report, the outcomes such as establishments, services, facilities, workforce and devices of hospitals and specialist services were expressed
as an absolute count by state, sector and year while the activities were expressed as an absolute count and mean by state, sector and year. The
turnover interval (TOI) was calculated using the following formula:
TOI = ( B x 365.25 ) - ALOS
N
Where: B is number of inpatient beds
N is number of inpatient admissions
ALOS is average length of stay
The number of hospitals and specialist services details per 10,000 population and per million population were calculated as follows:
T
× 10,000
P
T
× 1,000,000
Number of hospitals and specialist services details /million population =
P
Number of hospitals and specialist services details /10,000 population =
Where: T is an estimate of the total quantity of the variable available in the country in the year under consideration.
P is the mid year population of Malaysia or the relevant geographic region where the survey was conducted.
For maternity services chapter, the number of hospitals and specialist services details per 10,000 population and per million population was
calculated as follows:
Number of hospitals and specialist services details /10,000 female population = T
× 10,000
P
P is the mid year female population of Malaysia or the relevant geographic region where the survey was conducted.
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HOSPITALS
T
×
Number of hospitals and specialist services details /100 deliveries = P
100
T
× 1,000
Number of hospitals and specialist services details /1000 deliveries = P
P is the total obstetric deliveries of Malaysia or the relevant geographic region where the survey was conducted.
For paediatric services chapter, the number of hospitals and specialist services details per 10,000 population and per million population was
calculated as follows:
Number of hospitals and specialist services details /1,000 children population =
T
×
P 1,000
P is the mid-year children age below 15 years old population of Malaysia or the relevant geographic region where the survey was conducted.
T
×
Number of hospitals & specialist services details /1,000 deliveries = P 1,000
P is the total deliveries of Malaysia or the relevant geographic region where the survey was conducted.
An estimate of the total quantity of the device/service/facility, T =
∑W T
i i
,
Where: Ti is the value of the quantity of device/service/ facility available in the i th facility in the year,
Wi is the sampling weight of the i th facility
1
Wi = p
Please refer to details on the Malaysian population statistics for 2010 by state in Appendix 3.
The statistical estimation of the totals varies depending on the survey methods and the sampling design employed to the collected data, and if
necessary, with adjustment for incomplete data.
Survey
Sampling weight and adjustment
Hospital and specialist services
Response propensity stratification
Adjust base weight in each class (formed by cross-classification of a few auxiliary variables) by
inverse of weighted response rate in each class.
Auxiliary variables to form weighting class could also be selected by logistic regression to model
response status.
As the response rate of the survey was less than 100%, the procedures described above incorporated the sampling weight of the sampling unit when
making estimates in order that the weighted sample is representative of the population.
The sampling weight for each sampling unit or units of analysis has the following components:
1. Probability of selection
The basic weight is obtained by multiplying the reciprocals of the probability of the selection at each step of the sampling design.
2. Adjustment for non response
The response rate was less than 100% for some of the chapters in the surveys; thus an adjustment to the sampling weight is required. The
non response adjustment weight was a ratio with the number of units in the population as the numerator and the number of responding
sampling unit as the denominator. The adjustment was made to reduce the bias in our estimation to the extent of non responding units sharing
the same characteristics as the responding units. Where this was unlikely, some adjustments were done taking into account the differences
in some relevant characteristics between responding and non responding units that may influence the outcome, such as bed strength, staff
strength, scope of services for hospitals etc.
Item non response or missing data were imputed to reduce bias using the following method:
• Logical imputation
• Conditional imputation
• Regression imputation
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HOSPITALS
CONSORT DIAGRAM NHEWS (HOSPITAL) 2010
Total number of hospitals in all 16
N = 355
Losses, n = 8
Establishments closed operations *
Number of hospitals
N = 347
Ministry of Health
University
Private
N = 137
N=3
N = 207
Excluded, n = 6
Losses, n = 8
1. Zero beds, n = 1
a.Hospital Tuaran
2. Chronic (curative) care, n = 5
a.Leprosy, n = 1
i.Rajah Charles Brooke
Memorial Hospital
1. Specialised institution, n = 1
a. TMC Women’s Specialist
(Kuantan) Sdn. Bhd.
(Fertility Centre)
Included
Included
Included
n = 131
N=3
N = 203
b. Psychiatry, n = 4
i. Hospital Mesra Bukit Padang
ii. Hospital Bahagia Ulu Kinta
iii.Hospital Permai
iv.Hospital Sentosa
Total included hospitals
N = 337
Analysis
* List of establishments that have closed operations:
1.
2.
3.
4.
5.
6.
7.
8.
Appollo TTDI Medical Centre
Kim Fung Medical Centre Sdn. Bhd.
Hospital Taj/Polyclinic Taj (GRFL)
Pusat Pakar Perbidanan, Sakit Puan dan Kanak-kanak
Pusat Perubatan Darul Ehsan
Damansara Women’s Specialist Centre Sdn. Bhd.
Kajang Medical Centre Sdn. Bhd.
Kajang Specialist Maternity & Surgery Sdn.Bhd.
xvii
2. Chronic (curative) care, n = 1
a. Nursing care & Rehab
i.Columbia Asia Extended
Care Hospital
3. Establishment changed to
maternity home, n = 1
a. Poliklinik Kotaraya &
Klinik Pakar Wanita
4. Licensed as hospital started
year 2011, n = 1
a. Bintulu Medical Centre
HOSPITALS
ABBREVIATIONS
ABG
Arterial Blood Gas
ALOS
Average Length of Stay
APS
Acute Pain Services
BOR
Bed Occupancy Rate
CCU
Coronary Care Unit
CDR
Cytotoxic Drugs Reconstitution
CRC
Clinical Research Centre
CRF
Case report form
CS
Caesarean Section
CT
Computed Tomography
DOS
Department of Statistics
ECT
Electroconvulsive Therapy
FBC
Full Blood Count
GA
General Anaesthesia
GICU
General Intensive Care Unit
HDU
High Dependency Unit
IGRT
Image-Guided Radiotherapy
IMRT
Intensity Modulated Radiotherapy
LA
Local Anaesthesia
MMA
Malaysian Medical Association
MNNR
Malaysian Neonatal Registry
MOH
Ministry of Health
MREC
MOH Medical Research And Ethics Committee
MRG
Malaysian Research Grant
MRI
Magnetic Resonance Imaging
NHEWS
National Healthcare Establishments And Workforce Survey
NHSI
National Healthcare Statistics Initiatives
NICU
Neonatal Intensive Care Unit
NMRR
National Medical Research Register
OECD
Organisation For Economic Co-operation And Development
OPD
Outpatient Department
OR
Operating Room
OSCC
One Stop Crisis Centre
OT
Operating Theatre
OCA
Patient-controlled Analgesia Pump
PET
Positron Emission Tomography
PHDW
Paediatric High Dependency Ward
PICU
Paediatric Intensive Care Unit
PMP
Per Million Population
PPH
Post Partum Haemorrhage
SCN
Special Care Nursery
SDP
Source Data Provider
SVD
Spontaneous Vertex Deliveries
TOI
Turnover Interval
WPKL
Wilayah Persekutuan Kuala Lumpur
WP
Wilayah Persekutuan
xviii

ACKnoWLEDGEMEntS - Clinical Research Centre

Transcription

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