[Quality indicators of hospital care: evaluation of patient care in acute myocardial infarction]. / A kórházi ellátás minóségi indikátorai: az akut myocardialis infarctus kezelésének értékelése.

In the international hospital accreditation programs there is an increasing emphasis on involving performance indicators. The inpatient mortality rate of AMI patients and the usage of thrombolytic therapy are very common, evidence based indicators of these programs. The authors goal was to analyze the applicability of these indicators in the evaluation of the Hungarian hospital care. In Hungary, there is a data collection system on every inpatient case. This database was used to determine the above mentioned two indicators for 1997 and 1998. They calculated by hospital group level, by institutions and by geographic areas crude rates and rates adjusted for age and gender, and for severity using the different DRGs of AMI patients. In these two years the inpatient mortality rates of AMI patients were 20.4% and 21.7%, and the usage of thrombolytic therapy were 9.9% and 11.8%, respectively. Using indirect standardization methodology in the usage of thrombolytic therapy, they found high differences among the counties compared to the national average, the range was 51-199%, and among the institutions 0-306%, respectively. It is clear, that there are huge differences in the curative processes and in the inpatient mortality rates of AMI patients among the hospitals. The differences are developed by chance, there are no close connections either to hospital groups, or to geographical locations. Because of the difficulties of risk adjustment, they suggested that indicators were suitable for benchmarking. It is necessary to implement in the national quality criteria system different indicators for evaluating the patient care, to develop programs for auditing the best and worst hospitals and to introduce standards for assuring the validity of the basic data.

Physical exercise program for children with bronchial asthma.

A long-term physical exercise program was established for a large number of children with bronchial asthma. Asthmatic children were first taught to swim on their backs to prevent breathing problems customary for beginners using other strokes. They concurrently participated in gymnasium exercises, and the program was later completed with outdoor running. Program effectiveness was evaluated by monitoring asthmatic symptoms, changes in medication, and changes in the activity and physical fitness of the children. Data collected from 121 children showed that during the first year in the program the number of days with asthmatic symptoms decreased in a large majority of the patients while medication was decreased. School absenteeism and hospitalization dropped markedly. Parental evaluation of the children indicated much improvement in 51.2%, improvement in 40.5%, unchanged condition in 7.4%, and deterioration of general health was only reported in one child (0.8%). The same extent of improvement continued during the second year. The Cooper test was applied for the first time to such an exercise program and indicated that the participating asthmatic children performed as well as a control group of nonasthmatic children, and the cardiovascular efficiency of the asthmatics was actually better.

Diagnosis of food allergy through bronchial challenge.

Bronchial provocation tests were performed in 48 children whose skin tests were positive to food extracts or in cases in which anamnestic data suggested food allergy. In 20 cases a marked change of dynamic compliance, vital capacity or FEV1 could be demonstrated within 1--5 minutes after the inhalation of food extracts. Ten of them had bronchoconstriction after milk or egg; 5 among them had negative skin tests. Twenty patients were examined before and after 1--3 hours after the ingestion of 300 ml. of milk. Five of them showed definite decrease of FEV1, whereas the vital capacity did not change. It is concluded that food allergy can be established as the cause of bronchoconstriction in 5--10% of asthmatic children.