The impact of a pay-for-performance system on timing to hip fracture surgery: experience from the Lazio Region (Italy)

Abstract

BackgroundA tariff modulation mechanisms has been introduced in some Italian regions with the aim of reducing inappropriate admissions and improving quality of care. In response to a regional act, hospitals in Lazio adopted a clinical pathway for elderly patients with hip fracture and introduced a compensation system based on the quality of health care, as in a pay-for-performance model. The objective of the present study was to compare the proportion of surgery for hip fracture performed within 48 hours of admission among Lazio hospitals according to different payment systems, before and after the implementation of the regional act.MethodsA retrospective cohort study of patients aged 65 years and over, residing in the Lazio region and admitted to an acute care hospital for hip fracture before (1 July 2008 - 30 June 2009) and after (1 July 2010 - 30 June 2011) the pay-for-performance act. The proportion of surgeries performed within 48 h of hospital arrival was calculated. An adjusted multivariate regression analysis was applied to assess the effect of hospital payment type on the likelihood of surgery within 48 h of hospital arrival.ResultsThe share of patients with hip fracture that had surgery within 48 hours was 11.7% before the introduction of the pay-for-performance act and 22.2% after. The proportion of early hip fracture operations increased after the pay-for-performance act, regardless of hospital payment type. The largest increase of surgery within 48 h occurred in private hospitals (adjusted Relative Risk = 2.80, p < 0.001).ConclusionsThe introduction of a compensation system based on health care quality is associated with improved quality of care for elderly patients with hip fracture, especially in hospitals that only use the Diagnosis Related Group system.

Racial and Socioeconomic Disparities in Hip Fracture Care

“…Nonwhite patients are at significantly greater risk of undergoing surgery at low-quality hospitals 31,32 . Investigators from Italy demonstrated that 2 policybased adjustments-public reporting of outcomes 33 and pay-forperformance compensation-significantly improved the quality of care for patients with hip fractures 34 . Both of these principles are present in the United States Affordable Care Act, indicating that strategic implementation of these policies could address disparities in care for patients with hip fractures.…”

Characteristics of rehabilitation services in high-FIM efficiency hospitals after hip fracture

“…Pay-for-performance was found to improve quality and efficiency of cardiac rehabilitation (12). Also, a pay-for-performance model was associated with improved quality of care for older patients with hip fracture (13). Thus, rehabilitation characteristics of this study could be used as quality indicators and assessment criteria for pay-for-performance.…”

The Current State of Validation of Administrative Healthcare Databases in Italy: A Systematic Review

“…Debates on the use of administrative databases routinely occur [12] and algorithms have been proposed to assess the disease status of large populations in Italy [52,53]. In general, Italian administrative databases have the potential to address important questions in post-marketing surveillance [8,54], epidemiology [12], quality performance and health services research [55]. In its annual review of drug utilization, the Italian Medicines Agency (AIFA), reported a list of 103 peer-reviewed publications of drug utilization studies performed in Italy [56].…”