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PLoS One. 2014 May 9;9(5):e95419. doi: 10.1371/journal.pone.0095419. eCollection 2014.

Can Italian healthcare administrative databases be used to compare regions with respect to compliance with standards of care for chronic diseases?

Author information

1
Agenzia regionale di sanità della Toscana, Florence, Italy; Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands.
2
Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands.
3
Agenzia regionale di sanità della Toscana, Florence, Italy.
4
Società italiana di medicina generale, Florence, Italy.
5
Genomedics, Florence, Italy.
6
Unità Locale Socio Sanitaria Padova, Padua, Italy.
7
Azienda Sanitaria Provinciale Ragusa, Ragusa, Italy.
8
Assessorato Politiche per la Salute, Bologna, Italy.
9
Zona Territoriale Senigallia, Senigallia, Italy.
10
Università Cattolica del Sacro Cuore, Rome, Italy.
11
Agenzia Nazionale per il Servizi Sanitari Regionali, Rome, Italy.
12
Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Abstract

BACKGROUND:

Italy has a population of 60 million and a universal coverage single-payer healthcare system, which mandates collection of healthcare administrative data in a uniform fashion throughout the country. On the other hand, organization of the health system takes place at the regional level, and local initiatives generate natural experiments. This is happening in particular in primary care, due to the need to face the growing burden of chronic diseases. Health services research can compare and evaluate local initiatives on the basis of the common healthcare administrative data.However reliability of such data in this context needs to be assessed, especially when comparing different regions of the country. In this paper we investigated the validity of healthcare administrative databases to compute indicators of compliance with standards of care for diabetes, ischaemic heart disease (IHD) and heart failure (HF).

METHODS:

We compared indicators estimated from healthcare administrative data collected by Local Health Authorities in five Italian regions with corresponding estimates from clinical data collected by General Practitioners (GPs). Four indicators of diagnostic follow-up (two for diabetes, one for IHD and one for HF) and four indicators of appropriate therapy (two each for IHD and HF) were considered.

RESULTS:

Agreement between the two data sources was very good, except for indicators of laboratory diagnostic follow-up in one region and for the indicator of bioimaging diagnostic follow-up in all regions, where measurement with administrative data underestimated quality.

CONCLUSION:

According to evidence presented in this study, estimating compliance with standards of care for diabetes, ischaemic heart disease and heart failure from healthcare databases is likely to produce reliable results, even though completeness of data on diagnostic procedures should be assessed first. Performing studies comparing regions using such indicators as outcomes is a promising development with potential to improve quality governance in the Italian healthcare system.

PMID:
24816637
PMCID:
PMC4015953
DOI:
10.1371/journal.pone.0095419
[Indexed for MEDLINE]
Free PMC Article
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