Marina Davoli Department of Epidemiology Lazio Region/Italian National Agency for Regional Health Services

Transcription

1 Marina Davoli Department of Epidemiology Lazio Region/Italian National Agency for Regional Health Services

2 Main objectives of the PNE include: comparative evaluation among healthcare providers; comparative evaluation among subgroups of patients - stratified, for example, for socioeconomic level or area of residence - in order to promote equity in the delivery of health services identification of the variables of healthcare Outcome measures by Hospital/ Local Health Unit The National Outcome Evaluation Programme measures the outcome variability among providers and/or health care local units in Italy Audit tools Report Card ER Information by Hospital/ System Local Health Unit Pilot studies pathways that influence outcomes -for example, the estimate of thresholds of volume activity associated with an improved outcome and its use as a criterion in the process of accreditation of facilities Internal and External Auditing

3 Overview of systematic reviews Search strategy febr 2012

4 Positive Association between hospital volume in trahospital /30 days mortality (N=25) 1 AIDS 14 Chirurgia CA prostata 2 Aneurisma aorta addominale non 15 Chirurgia CA rene rotto 3 Aneurisma aorta addominale rotto 16 Chirurgia CA stomaco 4 Angioplastica coronarica 17 Chirurgia CA vescica 5 Artroplastica ginocchio 18 Chirurgia cardiaca pediatrica 6 Bypass aorto-coronarico 19 Colecistectomia 7 Chirurgia CA colon retto 20 Emorragia sub aracnoidea 8 Chirurgia CA colon 21 Endoarterectomia carotidea 9 Chirurgia CA esofago 22 Frattura femore 10 Chirurgia CA fegato 23 Infarto del miocardio 11 Chirurgia CA mammella 24 Rivascolarizzazione arti inferiori 12 Chirurgia CA pancreas 25 Terapia intensiva neonatale 13 Chirurgia CA polmone

5 e&panno 37 (2-3) marzo-giugno 2013

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8 1. Ogni breast unit deve effettuare almeno 150 interventi chirurgici all anno (si intendono solo casi di tumore diagnosticati presso il centro). 2. Ogni chirurgo, specializzato nella cura delle neoplasie benigne e maligne della mammella, deve effettuare almeno 50 interventi all anno. E auspicabile che i chirurghi appartenenti alla breast unit effettuino soltanto interventi alla mammella

9 HOSPITAL/UNIT VOLUME Author N. patients outcome Volume threshold Heil J et al ,863 mastectomy 150 Mc Dermott et al Siesling S et al ,000 BCS SLD 10 yrs surveillance 70

10 SURGEON VOLUME Author N. patients outcome Volume threshold Peltomieni et al 2012 BCS SLD 100 Mc Dermott et al Taben et al ,000 BCS SLD SLD, quality of care score 50 5

11 Breast Cancer. Proportion of new resection surgery within 120 days since conservative surgery. PNE 2014

12 Breast Cancer. Immediate Breast reconstruction. PNE 2014

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14 REGULATORY DOCUMENT ON QUALITATIVE, STRUCTURAL, TECNOLOCICAL AND QUANTITATIVE STANDARD OF HOSPITAL CARE

15 VOLUME OF INTERVENTIONS

16 Surgical intervention for breast cancer : Volume of admissions. Italy hospitals > % of hospitals> 10 70% of women

17 Surgical intervention for breast cancer : % surgery in UU.OO and hospitals with case load > 135. ITALIA 2014.

18 Surgical intervention for breast cancer: Hospitals with case load > 400. Analysis by ward of discharge. ITALIA Specialità chirurgia gen/pla/tor Altre specialità.

19 % Surgical intervention for breast cancer in high volume wards (=>135) - ITALIA 2014 REGIONE % Piemonte 57.5 Valle d'aosta 0 Lombardia 67.6 PA Bolzano 38.5 PA Trento 96.1 Veneto 59.2 FVG 62.4 Liguria 61.9 Emilia Romagna 74.7 Toscana 68.9 Umbria 67 Marche 56.1 Lazio 51.2 Abruzzo 70.6 Molise 0 Campania 58.6 Puglia 68 Basilicata 86 Calabria 48.1 Sicilia 61.2 Sardegna 64.2

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22 Surgical intervention for breast cancer in high volume wards/ hospitals (=>135).

23 National Health Service (NHS) universal coverage -By central government -By regions -By local health authorities

24 BOLZANO

25 TRENTO

26 TM Mammella. Lazio 2014 LAZIO Centri di senologia + Osp San Giuseppe Marino

27 Centri di senologia TM Mammella. Roma 2014

28 Breast Cancer Proportion of new resection surgery within 120 days since conservative surgery. Italy 12,3% 9,6%

29 Proportion of new resection surgery within 120 days since conservative surgery by hospital. Italy 2014

30 Proportion of new resection surgery within 120 days since conservative surgery by hospital and Region. PNE 2014

31 Breast Cancer. Reconstructive surgery in the index admission. Italy 35,5% 44,6%

32 Breast Cancer. Immediate Breast Reconstrucion by hospital, Italy 2014

33 Breast Cancer. Immediate Breast Reconstruction by hospital and Region, Italy 2014

34 National Health Service (NHS) universal coverage -By central government -By regions -By local health authorities Additional clinical variables and surgeons ID registered on hospital discharge record nationally starting jan 2017

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38 CONCLUSIONS The available evidence shows a positive association between hospital/unit/phisican volume of care and better outcomes There is no clear threshold for unit/surgeon volume Case load may be considered as a proxy indicator of quality measure of care necessary but not sufficent. Quality of health care information systems should be improved in order to allow more comprehensive outcome evaluation