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European Journal of Public Health, Vol. 23, Supplement 1, 2013
Clinical Assessment of Risk Management: an INtegrated Approach (CARMINA) Pierfrancesco Tricarico P Tricarico1, A Cambieri2, A Campo3, P Cantaro3, A Costa4, S Fiore2, L Marazzi2, A Marcolongo5, M Monturano6, I Mura7, D Pascu8, G Privitera4, O Rinaldi6, G Romano9, G Sotgiu7, S Tardivo9, D Zanardo5, T Zerman8, S Brusaferro1 1 Dipartimento di Scienze Mediche e Chirurgiche, Universita` degli Studi di Udine, Udine, Italy 2 Policlinico Universitario ‘‘A. Gemelli’’, Rome, Italy 3 Azienda Sanitaria Provinciale di Caltanissetta, Caltanissetta, Italy 4 Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Universita` degli Studi di Pisa, Pisa, Italy 5 Azienda ULSS 18, Rovigo, Italy 6 Istituto Europeo di Oncologia, Milano, Italy 7 Dipartimento di Scienze Biomediche, Universita` degli Studi di Sassari, Sassari, Italy 8 Azienda ULSS 20, Verona, Italy 9 Dipartimento di Medicina e Sanita` Pubblica, Universita` degli Studi di Verona, Verona, Italy Contact:
[email protected]
Background The European Union frame in public health calls for common and openly known safety standards for crossing-border patients; Clinical Risk Management (CRM) is essential to minimize and control healthcare associated risks and spread the results within the organizations and to external stakeholders. Our objective was to develop a system of indicators able to represent the performance of healthcare organizations on CRM and guide their improvement over time. Methods After a literature review, a self-evaluation tool was developed by experienced risk managers from 8 Italian leader organizations. Once the basic structure of the tool was processed, it was tested in 16 satellite organizations scattered on national territory, in two different pilot studies. The tool in its final form was then validated by 17 external risk management experts with Delphi methodology. Results The self-assessment tool for clinical risk management, named CARMINA (Clinical Assessment of Risk Management: an INtegrated Approach) is composed of seven areas: 1) Governance, awareness and measurement, 2) Communication, 3) Knowledge and skills, 4) Safe and environment context 5) Care processes, 6) Adverse event management 7) Learning from experience. The tool, in total, is made of 52 standards, each one built on four progressive quality improvement steps: 1) organizational setup, 2) activity monitoring, 3) outcomes, 4) improvement actions. This tool allows organizations to assess their processes compared to minimum standards, to analyze and monitor their performance over time, to benchmark with other realities and also to spread the results to various stakeholders. Conclusions The adoption of CARMINA can be useful as a starting point for achieving minimum standards on CRM as well as an instrument for monitoring improvement over time and benchmarking with other organizations. Even if it was developed in Italy, most of its standards can be easily adopted in other countries. Key messages We developed a flexible self-evaluation tool for minimum standards on Clinical Risk Management that allows performance monitoring and benchmarking with other realities. Our self-evaluation tool can be adopted in any country. Evaluation of the endorsement of the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement on the quality of published systematic review and meta-analyses Stefania Boccia N Panic1,2,3, E Leoncini1, G de Belvis1, W Ricciardi1, S Boccia1 1 Department of Public Health, Universita` Cattolica del Sacro Cuore, Rome, Italy 2 Faculty of Medicine, University of Belgrade, Belgrade, Serbia
3 University Clinical-Hospital Center ‘‘Dr Dragisa Misovic-Dedinje, Belgrade, Serbia Contact:
[email protected]
Introduction PRISMA statement was developed in order set standards in the reporting of systematic reviews and meta-analyses. The aim of this study was to evaluate the impact of PRISMA endorsement on the methodological quality and the quality of reporting of systematic reviews and meta-analyses, published in scientific journals in the field of gastroenterology and hepatology (GH). Methods After identifying the GH journals which endorsed PRISMA in instructions for authors (IA), we appraised: 15 papers published in 2012 explicitly adopting PRISMA in full text, in journals whose IA suggested PRISMA use l (Group A); 15 papers from the same journals not explicitly reporting PRISMA in the full text (Group B); 30 papers from the same journals published in the year preceding PRISMA endorsement (Group C); 30 papers published in 2012 from 10 higher impact factor journals which did not endorse PRISMA. Papers were evaluated by estimating compliance to AMSTAR and adherence to PRISMA checklists. Results PRISMA statement was referred in the IA in 9 out of 70 GH journals (12.9%). We found significant difference in the overall compliance to AMSTAR checklist, with higher mean compliance recorded in groups A (85.0%) and B (85.6%), respect to C (74.6%) and D (76.9%) (p = 0.022). Overall adherence to PRISMA checklist was significantly higher in groups A (90.1%) and B (91.1%) compared to C (83.1%) and D (85.3%) (p = 0.001). Conclusions The endorsement of PRISMA resulted in increase of both methodological quality and quality of reporting. It is advised that an increasing number of scientific medical journals include PRISMA in instructions for authors. Key messages The endorsement of PRISMA resulted in increase of both methodological quality and quality of reporting. is advised that an increasing number of scientific medical journals include PRISMA in instructions for authors. Quality of medical records and appropriate hospital stay: two faces of the same coin Andrea Poscia A Poscia1, C Tucceri2, A Cambieri2, AG De Belvis1,2, W Ricciardi, M Volpe2 1 Institute of Public Health – Catholic University ‘‘Sacro Cuore’’, Rome, Italy 2 Teaching Hospital ‘‘A. Gemelli’’, Rome,Italy Contact:
[email protected]
Medical record is an important tool in the patient diagnostic and therapeutic path, but it’s becoming more and more essential for the administrative reporting. In several country, such as Italy, medical records are used by the third payer also for evaluation of the health care facilities appropriateness. Aim of this study was assess the relationship between the medical records quality and the appropriateness of hospital stay in a third level Italian teaching hospital. An evaluation team, consisting of one doctor and one nurse trained ad hoc, carried out independently between July 2012 and February 2013 a retrospective assessment of quality and appropriateness of a random sample of medical records. 1460 medical records (representative of 3% of the hospitalizations in 2012) were examined. The quality assessment was performed using a 26-item evaluation grid validated at the national level according to international standards (Joint Commission). The appropriateness of each days was assessed using the Italian version of Appropriateness Evaluation Protocol (AEP) - 2002 edition. Hospitalization was defined appropriate according to the law 40/2012 of the Lazio Region.
6th European Public Health Conference: Thursday 14 November 2013, 14:00–15:30
The average score for quality, in line with studies already published, was 14% higher for the hospitalization classified as appropriate (p < 0.01). Moreover, the quality of medical records shows a direct correlation with the percentage of appropriate days (rho = 0.23, p < 0.01). This association was confirmed through a multiple regression analysis adjusted for age, type of DRG (surgical/medical), length of hospital stay, type of admission (elective/urgent) and appropriateness of admission (R-squared = 0.75). This study have shown a significant correlation between the quality of health records and organizational appropriateness of hospital stay. The identification of the major deficiencies in the health records, through a standardized and repeatable evaluation of quality, allows to trigger a virtuous process that can potentially result in an economic benefit for the hospital. Key message Hospital management should encourage a better quality in clinical documentation to improve accountability and appropriateness of hospital stay. Effective approach to improve the value of out-patient care in hypertensive patients Gena Grancharova T Vekov, S Aleksandrova-Yankulovska, G Grancharova, N Veleva, M Draganova Department of Medical Ethics, Health Management and Information Technologies, Medical University, Faculty of Public Health, Pleven, Bulgaria Contact:
[email protected]
Background The general practitioners (GPs) in Bulgaria, as in many other countries, are rewarded on the per capita basis. This does not motivate them to take responsibility for the outcomes of care and control of chronic diseases. Some studies underlined that the value in health care should be measured mainly by the therapeutic results and the physician should be paid accordingly. This improves the value for patients, financing institutions, and health care providers, and to economic stability of health system as a whole. The aim of this study was to prove how the changes in GPs behaviour to hypertensive patients’ treatment may influence the value for patients and the remuneration of physicians. Methods The study was conducted in January-December 2012, including 112 GPs and 2240 patients (20 patients per GP; 62.6% women and 37.4% men) with arterial hypertension (AH) without other co-morbidity. Each patient was checked by his GP at least 6 times per year. The variables monitored include: heart frequency, systolic and diastolic blood pressure, lipid profile, smoking, diet, physical activity and hospitalization. The value for patients was considered in two parts: value in treatment and value in prevention of consequent heart diseases and incidents. The variables were monitored over one year period. The statistical significance of differences has been assessed at pHo < 0.05. Results The results showed that if the therapeutic targets were well determined, and the physicians well-motivated, patients received significantly higher value of treatment. By the end of the study, 63.1% of patients had well-controlled blood pressure, serum cholesterol levels were within the reference range in 90.2%, and heart frequency was normal in 91.5%. An increase in physicians’ salaries was associated with better treatment outcomes for the patients. The effectiveness of this approach for treatment and control of AH in out-patient care, measured by the relative change in patient’s value, increased over three times despite the raise of health care expences. Conclusions Achievement of higher value for patients should be a prevailing target in health care delivery. The value should be understood
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as therapeutic result. Health care providers’ remuneration should be based on patient’s value. Key messages The value in out-patient care should be measured by the therapeutic results. This will improve the value for all participants in health care and the economic stability of health system. The value for patient should be understood as therapeutic result. Achievement of patients’ higher value should be a prevailing target in health care delivery. Hospital patients mobility trends among the Italian regions: 1998-2008 Gabriele Messina G Messina1,2, G Prisco2, L Gialluca1, C Bedogni3, F Moirano4, N Nante1,2 1 Health Services Research Laboratory, University of Siena, Siena, Italy 2 Post Graduate School of Public Health, University of Siena, Siena, Italy 3 Local Health Authority 3 of Liguria Region, Genova, Italy 4 Agency for the Regional Health Systems, Rome, Italy Contact:
[email protected]
Background The health mobility is an increasingly debated issue in the European arena under the European Union directive on crossborder patients migration. The Italian health system, due to its characteristics of administrative and fiscal federalism, is well suited to the analysis of the dynamics of interregional flows of patients. Our study aims to analyze time series patients’mobility among the 21 among Italian regions. Methods We used hospital discharge data obtained from the Ministry of Health, ranging from 1998 to 2008. The information collected for each of the 19 Italian regions and the two autonomous provinces of Bolzano and Trento were: admission of residents in their regional hospitals (R); admission to hospitals of patients ‘‘attracted’’ from other regions (A); admission of residents ‘‘escaped’’ in other regions (E). The data were grouped into two time series: from 1998 to 2002 and from 2003 to 2008 (1 regional administrative mandate is 5 years long). For the statistical analysis of time trends we used the non-parametric test of Cuzick. Significance was set at P < 0.05. Results 13/21 Regions changed their R trends: only some, placed in North Italy (Piedmont, V.Aosta, Trento, Friuli, Marche) had an increase. 12/21 Regions changed the A trend but only Calabria had a reduction one. 11/21 Regions changed the E trend: in 4 there was an increase. Conclusions The reduction of E could be read as a regain of the loses (increase demand satisfaction and/or improvement of health care performances) which were previously experienced. An increase of A could be read as a better offer; an increase of R identifies a regain in satisfying the inner demand of regional residents and/or improvements of the health care system. More significant is the jointly interpretation of R, E and A which made possible to identify several scenarios, for example good policy is when we found attractiveness ability trend, without the loss of inner residents. This scenario seems to have generally occurred in Northern Italy (for example Piedmont, V.Aosta, Trento, Friuli). Other Regions showed an increase of E and a reduction of R (Veneto, Tuscany, Umbria and Abruzzo). This condition was more critical. Apulia and Sardinia did not show significant variations. Key messages Patients’ mobility is a proxy of health policy. The European microcosm of the italian regions showed that areas mainly located in Northern increased local health care demand’satisfaction, while others increased escapes and decreased attractions.
