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• Art. 15 comma 25 bis. L.135/2012 For the purpose of National Outcome • Ai fini della attivazione dei programmi nazionali di valutazione sull'applicazione delle norme di cui al presente articolo, il Ministero della Evaluation programs, the Ministry of salute provvede alla modifica ed integrazione di tutti i sistemi informativi Health modifies and integrates all NHS del Servizio sanitario nazionale, anche quando gestiti da diverse informations systems on an individual amministrazioni dello Stato, ed alla interconnessione a livello nazionale di basis….the National Agency for Regional tutti i flussi informativi su base individuale. Il complesso delle informazioni e dei dati individuali così ottenuti e' reso disponibile per le Health Services has access to the attività di valutazione esclusivamente in forma anonima ai sensi interconnected information systems dell'articolo 35 del decreto legislativo 23 giugno 2011, n. 118. • Il Ministero della salute si avvale dell'AGENAS per lo svolgimento delle funzioni di valutazione degli esiti delle prestazioni assistenziali e delle procedure medico ‐ chirurgiche nell'ambito del Servizio sanitario nazionale. A tal fine, AGENAS accede, in tutte le fasi della loro gestione, ai sistemi informativi interconnessi del Servizio sanitario nazionale di cui al presente comma in modalità anonima.
The National Outcome Evaluation … it provides «warnings» for Programme measures the outcome «relevant» differences in variability among providers and/or outcomes …. art.12 National regulation on health care local units in Italy Health agreement /2014 Outcome measures Audit Report Card ER Information Pilot by Hospital/ tools by Hospital/ System studies Local Health Unit Local Health Unit
Distance Learning programme– PNE 65.322 Participants (12 months online)
Coronary artery bypass graft (CABG): 30-day mortality. Italy 2012-13
Coronary artery bypass graft (CABG): 30-day mortality 2012-13 >5% Audit ongoing on quality of data
Coronary artery bypass graft (isolated): 30-day mortality
Clinical audit on heart surgery based on Outcome Data, Tuscany Riccardo Tartaglia, MD, Eur-Erg Tommaso Bellandi, PhD, Eur-Erg rischio.clinico@regione.toscana.it www.regione.toscana.it/rischioclinico
Valvuloplasty: 30-day mortality. 2013
Valvuloplasty: 30-day mortality. 2013
Information for Valvuloplasty: 30-day mortality - Italy 2012-2013 patients??? “the risk of dying in the month following valvuloplasty in the Fazzi hospital is about 11 times higher than the nearby clinic”
Distance 5km 10 min
Coronary artery bypass graft (CABG): ; Volume of care and 30 days mortality Italy 2011
Valvuloplasty: Volume of admissions 2013 PROVIN HOSPITAL CE REGION N Italia ITALIA 26645 Osp. V. Fazzi LE PUGLIA 114 A.O.SSN Consorziale Policlinico BA PUGLIA 195 CCA S. Maria BA PUGLIA 307 CCA Anthea BA PUGLIA 396 CCA CBH Villa Bianca BA PUGLIA 310 CCA Città di Lecce LE PUGLIA 321 CCA Villa Verde SNC TA PUGLIA 136
Coronary artery bypass graft (CABG): ; Volume of admissions. Italy 2013 26/112 hospitals >200/year
30 day mortality after surgery for stomach cancer by volume of interventions
30 DAY MORTALITY AFTER SURGERY FOR STOMACH CANCER:VOLUME OF INTERVENTIONS 108 / 662 hospitals (16%) > 20
Health impact assessment volume of surgery by ward- 30 day mortality. PNE 2011 Surgery for stomach 283 cancer by ward N % Ϯ Total 7650 5.4 2921 * 2.7 = 80 > 10/year 4729 2.7 203 deaths <= 10 /year 2921 9.7 Surgery for colon cancer by 842 ward N % Ϯ Total 30231 5.0 8765 * 3.2 = 278 > 25 /year 21466 3.2 564 deaths <= 25/year 8765 9.6
30 DAY MORTALITY AFTER SURGERY FOR STOMACH CANCER:VOLUME OF INTERVENTIONS Information for policy makers??? 108 / 662 hospitals (16%) > 20
REGULATORY DOCUMENT ON QUALITATIVE, STRUCTURAL, TECNOLOCICAL AND QUANTITATIVE STANDARD OF HOSPITAL CARE
VOLUME OF ADMISSIONS
OUTCOME
Laparoscopic cholecystectomy : complications within 30 days. Italy 2013
OUTCOME EVALUATION PROGRAMMES Education and training of healthcare professionals The outcome measures represent assessment tools to support clinical and Patient empowerment organizational audit programs aimed at improving both effectiveness, and safety in the NHS. Reporting and learning systems Outcome measures Audit Report Card ER Information Pilot by Hospital/ tools by Hospital/ System studies Local Health Unit Local Health Unit Policies and programmes on patient safety
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