4
• Art. 15 comma 25 bis. L.135/2012
For the purpose
• Ai fini della attivazione
dei programmiof National Outcome
nazionali di valutazione
sull'applicazione delle norme
di cui al presente articolo, il Ministero of della
Evaluation programs, the Ministry
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
ottenuti e' reso
disponibile
Healthcosì
Services has
access
to the per le
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
Outcome
Evaluation
…it National
provides
«warnings»
for
Programme
the in
outcome
«relevant» measures
differences
variability
and/or
….art.12providers
National regulation on
outcomesamong
health
care local
Health
agreement
/2014 units in Italy
Outcome measures
by Hospital/
Local Health Unit
Audit tools Report Card ER Information
by Hospital/
System
Local Health Unit
Pilot studies
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
[email protected]
www.regione.toscana.it/rischioclinico
Valvuloplasty: 30-day mortality. 2013
Valvuloplasty: 30-day
mortality. 2013
Information
Valvuloplasty: 30-day mortality
- Italyfor
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
HOSPITAL
PROVIN
CE
REGION N
Italia
ITALIA
26645
Osp. V. Fazzi
A.O.SSN Consorziale
Policlinico
LE
PUGLIA
114
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
cancer by ward
N
Total
7650 5.4
> 10/year
4729 2.7
<= 10 /year
2921 9.7
Surgery for colon cancer by ward
N
% Ϯ
% Ϯ
Total
30231 5.0
> 25 /year
21466 3.2
<= 25/year
8765 9.6
283
2921 * 2.7 = 80
203 deaths
842
8765 * 3.2 = 278
564 deaths
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 andThe
training
of measures
healthcare
professionals
outcome
represent
assessment tools to support clinical and
organizational audit programs aimed at
Patient empowerment
improving both effectiveness, and safety
Outcome measures
Audit Report Card ER Information
Pilot in the
NHS.
Reporting and learning systems
by Hospital/
Local Health Unit
tools by Hospital/
Local Health Unit
System
studies
Policies and programmes on patient safety