Reporting of quality indicators and improvement in hospital performance: the p.re.val.e. Regional outcome evaluation program.
ABSTRACT To evaluate whether reporting of hospital performance was associated with a change in quality indicators in Italian hospitals.
Nationwide Hospital Information System for 2006-2009.
We performed a pre-post evaluation in Lazio (before and after disclosure of the Regional Outcome Evaluation Program P.Re.Val.E.) and a comparative evaluation versus Italian regions without comparable programs. We analyzed risk-adjusted proportions of percutaneous coronary intervention (PCI), hip fractures operated on within 48 hours, and cesarean deliveries.
Using standardized ICD-9-CM coding algorithms, we selected 381,053 acute myocardial infarction patients, 250,712 hip fractures, and 1,736,970 women who had given birth.
In Lazio PCI within 48 hours changed from 22.49 to 29.43 percent following reporting of the P.Re.Val.E results (relative increase, 31 percent; p < .001). In the other regions this proportion increased from 22.48 to 27.09 percent during the same time period (relative increase, 21 percent; p < .001). Hip fractures operated on within 48 hours increased from 11.73 to 15.78 percent (relative increase, 34 percent; p < .001) in Lazio, and not in other regions (29.36 to 28.57 percent). Cesarean deliveries did not decrease in Lazio (34.57-35.30 percent), and only slightly decreased in the other regions (30.49-28.11 percent).
Reporting of performance data may have a positive but limited impact on quality improvement. The evaluation of quality indicators remains paramount for public accountability.
- SourceAvailable from: Carlo A Perucci[Show abstract] [Hide abstract]
ABSTRACT: Despite extensive studies on exposure and disease misclassification, few studies have investigated misclassification of confounders. This study aimed to identify differentially misclassified confounders in a comparative evaluation of hospital care quality and to quantify their impact on hospital-specific risk-adjusted estimates, focusing on the appropriateness of caesarean sections (CS).BMC Public Health 10/2014; 14(1):1049. · 2.32 Impact Factor
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ABSTRACT: /st>To evaluate whether public reporting of performance data was associated with a change over time in quality indicators for acute myocardial infarction (AMI) in Italian hospitals. /st>Pre-post evaluation of AMI indicators in the Lazio region, before and after disclosure of the Regional Outcome Evaluation Program, and a comparative evaluation versus other Italian regions not participating in the program. /st>Nationwide Hospital Information System and vital status records. /st>24 800 patients treated for AMI in Lazio and 39 350 in the other regions. /st>Public reporting of the Regional Outcome Evaluation Program in the Lazio region. /st>Risk-adjusted indicators for AMI. /st>The proportion of ST-segment elevation myocardial infarction (STEMI) patients treated with percutaneous coronary interventions (PCI) within 48 h in Lazio changed from 31.3 to 48.7%, before and after public reporting, respectively (relative increase 56%; P < 0.001). In the other regions, the proportion increased from 51.5 to 58.4% (relative increase 13%; P < 0.001). Overall 30-day mortality and 30-day mortality for patients treated with PCI did not improve during the study period. The 30-day mortality for STEMI patients not treated with PCI in Lazio was significantly higher in 2009 (29.0%) versus 2006/07 (24.0%) (P = .002). /st>Public reporting may have contributed to increasing the proportion of STEMI patients treated with timely PCI. The mortality outcomes should be interpreted with caution. Changes in AMI diagnostic and coding systems should also be considered. Risk-adjusted quality indicators represent a fundamental instrument for monitoring and potentially enhancing quality of care.International Journal for Quality in Health Care 04/2014; · 1.79 Impact Factor
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ABSTRACT: Objectives Fibroblast growth factor-23 (FGF-23) and vitamin D are hormones involved in phosphate homeostasis. They also directly influence cardiomyocyte hypertrophy. We examined if the relationships between levels of vitamin D or FGF-23, cardiac phenotype and outcome were independent of established cardiac biomarkers in a large cohort of community-dwelling elderly subjects. Design and SettingPlasma levels of FGF-23 and vitamin D were measured in 1851 men and women (65–84 years) resident in the Lazio region of Italy. Participants were referred to eight cardiology centers for clinical examination, electrocardiography, comprehensive Doppler echocardiography, and blood sampling. All-cause mortality or hospitalization were available after a median follow-up of 47 months with record-linkage of administrative data. ResultsVitamin-D deficiency (<20 ng/mL) was found in 72.3% of subjects butFGF-23 levels were normal (74 [58–97] RU/mL). After adjustment for cardiovascular risk factors and morbidities, low concentrations of vitamin D and high levels of FGF-23 were associated with a higher left ventricular (LV) mass index. Levels of FGF-23 (hazard ratio (HR) [95% confidence interval (CI)] 1.71 [1.28–2.28], p<0.0001) but not vitamin D (0.76 [0.57–1.01], p=0.08) were independently associated with mortality after adjustment for clinical risk factors and two cardiac markers together (N-terminal pro-brain natriuretic peptide and high-sensitivity cardiac troponin T), but did not predict hospital admission. People with above-median values of FGF-23 and below-median values of vitamin D had greater LV hypertrophy and higher mortality. Conclusions In community-dwelling elderly individuals with highly prevalent vitamin-D deficiency, FGF-23 levels were associated with LV hypertrophy and predicted mortality independently of two robust cardiac biomarkers. A causal relationship was not demonstrated, but the hormones involved in mineral metabolism emerged as non-traditional risk factors, and may affect cardiovascular risk.Journal of Internal Medicine 03/2014; · 5.79 Impact Factor