Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
Institute of Primary Care, University of Zürich, University Hospital Zürich, Zürich, Switzerland.
BMJ Open. 2020 Apr 23;10(4):e032700. doi: 10.1136/bmjopen-2019-032700.
The quality of ambulatory care in Switzerland is widely unknown. Therefore, this study aimed to evaluate the recently proposed quality indicators (QIs) based on a nationwide healthcare claims database and determine their association with the risk of subsequent hospitalisation at patient-level.
Retrospective cohort study.
Inpatient and outpatient claims data of a large health insurance in Switzerland covering all regions and population strata.
520 693 patients continuously insured during 2015 and 2016.
A total of 24 QIs were obtained by adapting the existing instruments to the Swiss national context and measuring at patient-level. The association between each QI and hospitalisation in the subsequent year was assessed using multiple logistic regression models.
The proportion of patients with good adherence to QIs was high for the secondary prevention of diabetes and myocardial infarction (glycated haemoglobin (HbA1c) control, 89%; aspirin use, 94%) but relatively low for polypharmacy (53%) or using potentially inappropriate medications (PIMs) in the elderly (PIM, 33%). Diabetes-related indicators such as the HbA1c control were significantly associated with a lower risk of hospitalisation (OR, 0.87; 95% CI, 0.80 to 0.95), whereas the occurrence of polypharmacy and PIM increased the risk of hospitalisation in the following year (OR, 1.57/1.08; 95% CI, 1.51 to 1.64/1.05 to 1.12).
This is the first study to evaluate the recently presented QIs in Switzerland using nationwide real-life data. Our study suggests that the quality of healthcare, as measured by these QIs, varied. The majority of QIs, in particular QIs reflecting chronic care and medication use, are considered beneficial markers of healthcare quality as they were associated with reduced risk of hospitalisation in the subsequent year. Results from this large practical test on real-life data show the feasibility of these QIs and are beneficial in selecting the appropriate QIs for healthcare implementation in general practice.
瑞士的门诊医疗质量普遍不为人知。因此，本研究旨在根据全国医疗保健索赔数据库评估最近提出的质量指标 (QI)，并确定其与患者水平后续住院风险的关联。
回顾性队列研究。
瑞士一家大型医疗保险的住院和门诊索赔数据，涵盖所有地区和人口阶层。
2015 年和 2016 年连续投保的 520693 名患者。
通过适应现有工具以适应瑞士国家背景并在患者水平上进行测量，共获得 24 个 QI。使用多项逻辑回归模型评估每个 QI 与下一年住院之间的关联。
在糖尿病和心肌梗死的二级预防方面，患者对 QI 的良好依从性比例较高（糖化血红蛋白 (HbA1c) 控制率为 89%；阿司匹林使用率为 94%），但在老年人中药物使用过多（53%）或使用潜在不适当药物（PIM）的比例相对较低（PIM 为 33%）。与糖尿病相关的指标，如 HbA1c 控制，与较低的住院风险显著相关（OR，0.87；95%CI，0.80 至 0.95），而药物使用过多和 PIM 的发生增加了下一年住院的风险（OR，1.57/1.08；95%CI，1.51 至 1.64/1.05 至 1.12）。
这是第一项使用全国真实数据评估瑞士最近提出的 QI 的研究。我们的研究表明，这些 QI 衡量的医疗保健质量参差不齐。大多数 QI，特别是反映慢性病护理和药物使用的 QI，被认为是医疗保健质量的有益指标，因为它们与下一年住院风险降低相关。这项针对真实数据的大型实际测试的结果表明这些 QI 的可行性，并有助于选择一般实践中实施医疗保健的适当 QI。
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