Massa Ilaria, Balzi William, Burattini Costanza, Gentili Nicola, Bucchi Lauro, Nanni Oriana, Gallegati Davide, Pierini Andrea, Amadori Dino, Falcini Fabio, Altini Mattia
Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, FC, Italy.
Healthcare Administration, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, FC, Italy.
Breast. 2017 Aug;34:103-107. doi: 10.1016/j.breast.2017.05.007. Epub 2017 May 27.
In a context of decreasing economic health resources and a rise in health needs, it is urgent to face this sustainability crisis through the analysis of healthcare expenditures. Wastages, deriving from inappropriate interventions, erode resources which could be reallocated to high-value activities. To identify these areas of wastages, we developed a method for combining and analyzing data from multiple sources. Here we report the preliminary results of a retrospective cohort study evaluating the performance of breast cancer (BC) care at IRST, an Italian cancer institute.
Four data sources gathered in a real-world setting (a clinical database, two administrative databases and a cancer registry) were linked. Essential Key Performance Indexes (KPIs) in the pattern of BC diagnosis (KPI 1 and 2) and treatment (KPI 3 and 4) based on current guidelines were developed by a board of professionals. The costs of inappropriate examinations were associated with the diagnostic KPIs.
We found that 2798 patients treated at IRST from January 2010 to June 2016 received a total of 2516 inappropriate examinations accounting for € 573,510.80. Linkage from multiple routine healthcare data sources is feasible: it allows the measurement of important KPIs specifically designed for BC care, and the identification of areas of low-value use of the resources.
If systematically applied, this method could help provide a complete picture of inappropriateness and waste, redirect these resources to higher-value interventions for patients, and fill the gap between proper use of the resources and the best clinical results.
在经济卫生资源减少而卫生需求增加的背景下，迫切需要通过分析医疗保健支出来应对这一可持续性危机。因不适当干预产生的浪费侵蚀了可重新分配用于高价值活动的资源。为了确定这些浪费领域，我们开发了一种整合和分析来自多个来源数据的方法。在此，我们报告一项回顾性队列研究的初步结果，该研究评估了意大利癌症研究所IRST的乳腺癌（BC）护理绩效。
将在真实环境中收集的四个数据源（一个临床数据库、两个行政数据库和一个癌症登记处）进行关联。由专业人员委员会根据当前指南制定了BC诊断模式（关键绩效指标1和2）和治疗（关键绩效指标3和4）中的基本关键绩效指标。不适当检查的费用与诊断关键绩效指标相关联。
我们发现，2010年1月至2016年6月在IRST接受治疗的2798例患者共接受了2516次不适当检查，费用为573,510.80欧元。从多个常规医疗保健数据源进行关联是可行的：它能够衡量专门为BC护理设计的重要关键绩效指标，并确定资源低价值使用的领域。
如果系统应用这种方法，有助于全面了解不适当和浪费情况，将这些资源重新导向为患者提供的更高价值干预措施，并填补资源合理使用与最佳临床结果之间的差距。
