Improving discharge summary quality in Cyprus’ general health system: a national evaluation framework

Abstract Background Cyprus’ General Health System (GHS) recently completed its first five years of implementation, during which the Health Insurance Organization (HIO) prioritized improving the quality of services provided by contracted hospitals. As part of this effort, performance-based reimbursement criteria were introduced, including the completeness of discharge summaries (DS), which are essential for clinical communication and continuity of care. This study assessed the evolving quality of DS issued within the GHS through structured sampling and feedback. Methods Four rounds of random DS sampling were conducted across GHS hospitals during 2023 and 2024. Evaluation followed structured HIO-issued guidelines. DS were anonymized and scored: 0 (missing), 0.5 (partially completed), and 1 or 2 (fully completed), depending on each field's maximum score. Each hospital received a composite score (0-5) based on the proportion of DS exceeding a 75% completeness threshold. Feedback was provided to hospitals after the first two rounds in 2023 to encourage improvements. Results In the four rounds, a total of 2,196, 2,201, 2,367, and 2,425 DS were evaluated from 58, 58, 61, and 62 hospitals, respectively. The proportion of DS exceeding the 75% completeness threshold increased substantially, from 33.8% and 33.6% in the first two rounds (2023), to 62.2% (June 2024) and 65.0% (December 2024). Concurrently, the percentage of hospitals achieving the maximum quality score (5) rose from 12-13% in 2023 to 41% in mid-2024 and 48% by year-end. The mean hospital-level quality score improved from 2.2 in 2023 to 3.6 (June 2024) and 3.8 (Dec 2024). Median scores also increased, from 2.0 in 2023 to 4.0 in 2024. Conclusions The implementation of clear guidelines, structured evaluation, and targeted feedback led to substantial improvements in the quality of DS across GHS hospitals. This data-driven approach offers a transferable model for enhancing clinical documentation in national health systems. Key messages • Structured audit and feedback mechanisms led to measurable improvements in discharge documentation quality across Cyprus’ national health system. • The applied scoring framework demonstrates an evidence-based model for enhancing clinical communication and health data quality in hospital settings.