Reporting of Quality Indicators and Improvement in Hospital Performance: The P.Re.Val.E. Regional Outcome Evaluation Program
Department of Epidemiology, Lazio Regional Health Service, Italy. Health Services Research
(Impact Factor: 2.78).
10/2012; 47(5):1880-901. DOI: 10.1111/j.1475-6773.2012.01401.x
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.
Available from: Zackary Berger
[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE: Recent US healthcare reforms aim to improve quality and access. We synthesized evidence assessing the impact that public reporting (PR), which will be extended to the outpatient setting, has on patient outcomes and disparities. METHODS: A systematic review using PRISMA guidelines identified studies addressing the impact of PR on patient outcomes and disparities. RESULTS: Of the 1970 publications identified, 25 were relevant, spanning hospitals (16), nursing homes (5), emergency rooms (1), health plans (2), and home health agencies (1). Evidence of effect on patient outcomes was mixed, with 6 studies reporting a favorable effect, 9 a mixed effect, 9 a null effect, and 1 a negative effect. One study found a mixed effect of PR on disparities. CONCLUSION: The evidence of the impact of PR on patient outcomes is lacking, with limited evidence that PR has a favorable effect on outcomes in nursing homes. There is little evidence supporting claims that PR will have an impact on disparities or in the outpatient setting. PRACTICE IMPLICATIONS: Health systems should collect information on patient-relevant outcomes. The lack of evidence does not necessarily imply a lack of effect, and a research gap exists regarding patient-relevant outcomes and PR.
Available from: Ulla Wienhues-Thelen
[Show abstract] [Hide abstract]
ABSTRACT: Purpose: The fibroblast growth factor-23 (FGF-23) is a key player in the regulation of calcium-phosphate and vitamin D metabolism and has a causal role in the pathogenesis of LV hypertrophy, a major determinant of cardiovascular events. We evaluated the association between circulating levels of FGF-23 / vitamin D, slight abnormalities in LV mass and mortality in elderly people.
Methods: The relationship between plasma levels of FGF-23 (ELISA, Immutopics), total 25-hydroxyvitamin D (ECLIA, Roche Diagnostics), 2 cardiac markers (hs-cTnT and NT-proBNP) and elevated LV mass/BSA (>95 g/m2 for women, >115 for men) was examined in 2001 elderly people (mean age 73±5 years, 48% women), resident in central Italy, and enrolled in the epidemiological study PREDICTOR. Data on all-cause mortality were available for a subgroup of 1200 subjects after a median follow-up of 47 months.
Results: In the 25% of the subjects with elevated LV mass (mean 121±21 g/m2), median concentrations of FGF-23 (80.8 [61.2-105.6] vs. 70.2 [55.9-91.9] RU/mL), hs-cTnT (6.6 [3.5-11.5] vs. 4.6 [3.0-8.1] ng/L), NT-proBNP (147 [64-296] vs. 79 [41-151] ng/L) were higher, and vitamin D was lower (10.3 [5.8-17.9] vs. 13.3 [7.6-21.2] ng/mL) than in those with normal LV mass (all p<0.0005). FGF-23 and vitamin D were significantly associated with elevated LV mass, independently of troponin levels or clinical risk factors. Higher circulating levels of FGF-23 (HR 1.88 [1.40-2.54], p<0.0001) and lower concentrations of vitamin D (HR 0.68 [0.50-0.93], p=0.02) were associated with all-cause mortality (86 deaths, 7.2%), after adjustment for demographical and clinical variables and for benchmark cardiac biomarkers (NT-proBNP or hs-cTnT).
Conclusions: In the present population of elderly people at low risk, elevated levels of FGF-23 and low levels of vitamin D identify individuals with mild LV hypertrophy and predict all-cause mortality.
[Show abstract] [Hide abstract]
ABSTRACT: Public disclosure is increasingly a requirement of accrediting agencies and governments. There are few published empirical evaluations of disclosure interventions that inform evidence-based implementation or policy. This study investigated the practices associated with the public disclosure of healthcare accreditation information, in addition to multi-stakeholder perceptions of key challenges and opportunities for improvement. We conducted a mixed methods study comprising analysis of disclosure practices by accreditation agencies, and 47 semi-structured individual or group interviews involving 258 people. Participants were diverse stakeholders associated with Australian primary, acute and residential aged care accreditation programmes. Four interrelated issues were identified. First, there was broad agreement that accreditation information should be publicly disclosed, although the three accreditation agencies differed in the information they made public. Second, two implementation issues emerged: the need to educate the community about accreditation information, and the practical question of the detail to be provided. Third, the impact, both positive and negative, of disclosing accreditation information was raised. Fourth, the lack of knowledge about the impact on consumers was discussed. Public disclosure of accreditation information is an idea that has widespread support. However, translating the idea into practice, so as to produce appropriate, meaningful information, is a challenge.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.