Department of Quantitative Methods, University of Milan Bicocca, Milan, Italy.
Health Care Manag Sci. 2013 Sep;16(3):245-57. doi: 10.1007/s10729-013-9227-1. Epub 2013 Mar 27.
In recent years, governments and other stakeholders have increasingly used administrative data for measuring healthcare outcomes and building rankings of health care providers. However, the accuracy of such data sources has often been questioned. Starting in 2002, the Lombardy (Italy) regional administration began monitoring hospital care effectiveness on administrative databases using seven outcome measures related to mortality and readmissions. The present study describes the use of benchmarking results of risk-standardized mortality from Lombardy regional hospitals. The data usage is part of a general program of continuous improvement directed to health care service and organizational learning, rather than at penalizing or rewarding hospitals. In particular, hierarchical regression analyses - taking into account mortality variation across hospitals - were conducted separately for each of the most relevant clinical disciplines. Overall mortality was used as the outcome variable and the mix of the hospitals' output was taken into account by means of Diagnosis Related Group data, while also adjusting for both patient and hospital characteristics. Yearly adjusted mortality rates for each hospital were translated into a reporting tool that indicates to healthcare managers at a glance, in a user-friendly and non-threatening format, underachieving and over-performing hospitals. Even considering that benchmarking on risk-adjusted outcomes tend to elicit contrasting public opinions and diverging policymaking, we show that repeated outcome measurements and the development and dissemination of organizational best practices have promoted in Lombardy region implementation of outcome measures in healthcare management and stimulated interest and involvement of healthcare stakeholders.
近年来，政府和其他利益相关者越来越多地使用行政数据来衡量医疗保健结果，并对医疗保健提供者进行排名。然而，这些数据源的准确性经常受到质疑。自 2002 年以来，意大利伦巴第（Lombardy）行政区开始在行政数据库中使用与死亡率和再入院率相关的七个结果衡量标准来监测医院的护理效果。本研究描述了使用伦巴第地区医院风险标准化死亡率的基准测试结果。数据的使用是旨在改善医疗服务和组织学习的一般持续改进计划的一部分，而不是为了惩罚或奖励医院。特别是，分别针对每个最相关的临床学科进行了考虑医院间死亡率差异的分层回归分析。总体死亡率被用作因变量，通过疾病诊断相关分组数据考虑了医院的输出组合，同时还调整了患者和医院的特征。每家医院的年度调整死亡率被转换为一种报告工具，以用户友好且非威胁性的格式，直观地向医疗保健管理人员显示表现不佳和表现出色的医院。即使考虑到基于风险调整结果的基准测试往往会引起公众意见的分歧和政策制定的分歧，我们也表明，反复的结果测量以及最佳组织实践的制定和传播，已经促进了伦巴第地区在医疗保健管理中实施结果衡量标准，并激发了医疗保健利益相关者的兴趣和参与。
