What drives hospital performance? The impact of comparative outcome evaluation of patients admitted for hip fracture in two Italian regions

Pinnarelli, Luigi; Nuti, Sabina; Sorge, Chiara; Davoli, Marina; Fusco, Danilo; Agabiti, Nera; Vainieri, Milena; Perucci, Carlo A.

doi:10.1136/bmjqs-2011-000218

Cited by 42 publications

(32 citation statements)

References 31 publications

(26 reference statements)

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“…This finding is especially true for hospitals entirely paid by the DRG system, as shown in a study that compared the quality improvement programs in Lazio and Toscana [16]. …”

Section: Discussionmentioning

confidence: 92%

“…The impact of pay-for-performance in the Lazio region can be related to the fact that the hospitals had plenty of room for improvement from baseline [17], given the low proportion of patients receiving surgery within 48 hours [16]. …”

Section: Discussionmentioning

confidence: 99%

“…The compensation system of a pay-for-performance needs to be linked with important clinical outcomes [19-21], in Lazio hospital remuneration was related to the proportion of hip surgery performed within 48 hours. The Lazio regional act was aimed at implementing the pay-for-performance model uniformly to all providers in the region so that its effects were not diluted [16], however it is noteworthy that the pay-for-performance model could have an impact at the hospital level rather than at the individual or team level [17,19,22]. Furthermore, healthcare providers could have affected the impact of pay-for-performance program as different ownership types might have implemented different incentives related to the uptake of the pay-for-performance model [23].…”

Section: Discussionmentioning

confidence: 99%

“…In 2007, P.Re.Val.E [5,6] was conducted with the aim of improving the quality of health care; in 2008, the Agency for Public Health of Lazio designed a clinical pathway for elderly patients with hip fracture. The impact of these programs on the quality of health care for orthopedic patients compared with other Italian regions was evaluated in a recent study [16]. Overall, there is no clear evidence regarding an association between public reporting and improved quality of care, even though some studies suggest that public reporting may motivate quality improvement activities [24,25].…”

Section: Discussionmentioning

confidence: 99%

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

Colais¹,

Pinnarelli²,

Fusco³

et al. 2013

BMC Health Serv Res

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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.

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“…This finding is especially true for hospitals entirely paid by the DRG system, as shown in a study that compared the quality improvement programs in Lazio and Toscana [16]. …”

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Colais¹,

Pinnarelli²,

Fusco³

et al. 2013

BMC Health Serv Res

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“…Although more and more authors in the healthcare literature raise increasing expectation on the public disclosure of data (Leatherman and McCarty 1999;Marshall et al 2000;Hibbard et al 2003;Rogowski et al 2004), this factor may be even more effective if associated with others. Indeed, Pinnarelli et al (2012) demonstrated that in Italy only two regions improved the percentage of femur fracture operated within 48 h: Lazio and Tuscany. Both of these two Regions decided to publicly disclose data, however improvement registered by Tuscany was significantly higher than Lazio because of the more comprehensive strategy implemented by Tuscany Region.…”

Section: The Critical Factors Leading To Successmentioning

confidence: 99%

Assessing the effectiveness of a performance evaluation system in the public health care sector: some novel evidence from the Tuscany region experience

2012

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Since 80's the introduction of New Public Management principles has promoted the use of performance measurement to drive a more efficient, effective and accountable public sector. The adoption of a sophisticated and comprehensive multidimensional performance measurement system, which looks beyond traditional financial measures, based on organization strategies, such as the balanced scorecard, has thus been suggested. This revolution in the public management came together with the devolution processes that involved most European public health systems. Set within this context, in the last decade, each of the twenty Italian regions developed its own management tools. Among others, the Tuscan performance evaluation system (PES) has been valued as a particularly innovative and comprehensive system. This paper reports the novel experience of the Tuscan PES; in particular, it measures PES effectiveness and discusses the critical factors that could have led to the PES success. Five are the critical success factors identified by researchers: the visual reporting system, the linkage between PES and CEO's reward system, the public disclosure of data, the high level of employees and managers involvement into the entire process and the strong political commitment. All those factors run together to achieve better results; however, the process of development of the system plays a pivotal role. Scholars suggest the use of a constructive approach in order to gain effective changes in human organization. According to this stream of literature, this paper contributes by the novel experience of the Tuscan PES in addressing as a further fruitful application of the constructivist approach in healthcare.

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Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

et al. 2022

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IMPORTANCE Longer time to surgery (TTS) for hip fractures has been associated with higher rates of postoperative complications and mortality. Given that more than 300 000 adults are hospitalized for hip fractures in the United States each year, various improvement programs have been implemented to reduce TTS with variable results, attributed to contextual patient-and systemlevel factors. OBJECTIVETo catalog TTS improvement programs, identify their results, and categorize program strategies according to Expert Recommendations for Implementing Change (ERIC), highlighting components of successful improvement programs within their associated contexts and seeking to guide health care systems in implementing programs designed to reduce TTS. EVIDENCE REVIEW A systematic review was conducted per the Preferred Reporting Items forSystematic Reviews and Meta-analyses guideline. Three databases (MEDLINE/PubMed, EMBASE, and Cochrane Trials) were searched for studies published between 2000 and 2021 that reported on improvement programs for hip fracture TTS. Observational studies in high-income country settings, including patients with surgical, low-impact, nonpathological hip fractures aged 50 years or older, were considered for review. Improvement programs were assessed for their association with decreased TTS, and ERIC strategies were matched to improvement program components.FINDINGS Preliminary literature searches yielded 1683 articles, of which 69 articles were included for final analysis. Among the 69 improvement programs, 49 were associated with significantly decreased TTS, and 20 programs did not report significant decreases in TTS. Among 49 successful improvement programs, the 5 most common ERIC strategies were (1) assess for readiness and identify barriers and facilitators, (2) develop a formal implementation blueprint, (3) identify and prepare champions, (4) promote network weaving, and (5) develop resource-sharing agreements. CONCLUSIONS AND RELEVANCEIn this systematic review, certain components (eg, identifying barriers and facilitators to program implementation, developing a formal implementation blueprint, preparing intervention champions) are common among improvement programs that were associated with reducing TTS and may inform the approach of hospital systems developing similar programs. Other strategies had mixed results, suggesting local contextual factors (eg, operating room availability) may affect their success. To contextualize the success of a given improvement program across different clinical settings, subsequent investigation must elucidate the association between interventional success and facility-level factors influencing TTS, such as hospital census and type, teaching status, annual surgical volume, and other factors.

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What drives hospital performance? The impact of comparative outcome evaluation of patients admitted for hip fracture in two Italian regions

Cited by 42 publications

References 31 publications

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

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

Assessing the effectiveness of a performance evaluation system in the public health care sector: some novel evidence from the Tuscany region experience

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

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