Department of Epidemiology, Lazio RegionalHealth Service, Rome, Italy.
BMJ Qual Saf. 2012 Feb;21(2):127-34. doi: 10.1136/bmjqs-2011-000218. Epub 2011 Oct 19.
From 2006 to 2007 Lazio and Tuscany, two Italian regions, released data about hospital performance and implemented strategic programmes aimed at improving the quality of hospital care. Furthermore, different pay-for-performance systems were introduced: the hospital's performance determined the DRG (Diagnosis-Related Group) reimbursement rate for Lazio providers while in Tuscany the chief executive officer's compensation was linked to the hospital's performance. The authors evaluated the impact of the Lazio and Tuscany programmes on quality of healthcare for orthopaedic patients compared with other Italian regions.
The proportion of older patients admitted with hip fractures who had surgery within 48 h and the median waiting time for surgical treatment of fractures of the tibia or fibula were estimated separately for Lazio, Tuscany and other Italian regions for two periods: 2006-2007 and 2008-2009. Risk-adjusted proportions were obtained using the direct standardisation method and a multivariate logistic regression was performed taking into account age, gender and comorbidity status.
The proportion of hip operations performed within 48 h was increased by 34% for Lazio (p<0.001) and 46% for Tuscany (p<0.001) and reduced by 3% in other Italian regions (p<0.001). To assess for possible adverse consequences, such as increased waiting times for other orthopaedic procedures, the authors monitored time to surgery for tibia or fibula fractures. There were no significant differences in the median time to surgery for tibia or fibula fractures between the two periods.
The Lazio and Tuscany programmes appeared to have a positive impact on quality of care for older patients admitted with hip fracture without having a negative impact on other orthopaedic interventions. The results highlight the need for continuous quality improvement by repeating the evaluation process and by combining the performance system with a management strategy.
2006 年至 2007 年，意大利的拉齐奥和托斯卡纳两个地区公布了医院绩效数据，并实施了旨在提高医院护理质量的战略计划。此外，还引入了不同的按绩效付费系统：拉齐奥地区的医院绩效决定了 DRG（诊断相关分组）的报销率，而在托斯卡纳，首席执行官的薪酬与医院绩效挂钩。作者评估了拉齐奥和托斯卡纳计划对与其他意大利地区的骨科患者的医疗质量的影响。
分别估计 2006-2007 年和 2008-2009 年期间，拉齐奥、托斯卡纳和其他意大利地区髋部骨折老年患者入院后 48 小时内接受手术的比例以及胫骨或腓骨骨折手术治疗的中位等待时间。使用直接标准化法获得风险调整后的比例，并采用多元逻辑回归考虑年龄、性别和合并症状态。
拉齐奥的髋部手术比例增加了 34%（p<0.001），托斯卡纳增加了 46%（p<0.001），而其他意大利地区减少了 3%（p<0.001）。为了评估可能的不良后果，例如其他骨科手术的等待时间增加，作者监测了胫骨或腓骨骨折的手术时间。两个时期之间胫骨或腓骨骨折的中位手术时间没有显著差异。
拉齐奥和托斯卡纳的计划似乎对髋部骨折老年患者的护理质量产生了积极影响，而对其他骨科干预措施没有产生负面影响。结果强调了通过重复评估过程并将绩效系统与管理策略相结合来持续改进质量的必要性。
