scholarly journals Measuring Regional Performance in the Italian NHS: Are Disparities Decreasing?

2021 ◽  
Author(s):  
Silvia Bruzzi ◽  
Enrico Ivaldi ◽  
Marta Santagata
Keyword(s):  
Health Care ◽  
Health Systems ◽  
Health Care Quality ◽  
Health Care Systems ◽  
Care Quality ◽  
Regional Disparities ◽  
Future Research ◽  
Regional Health ◽  
Regional Health Care ◽  
Composite Indexes

AbstractGiven the regional disparities that historically characterize the Italian context, in this paper we propose a framework to evaluate the regional health care systems’ performance in order to contribute to the debate on the relationship between decentralisation of health care and equity. To investigate the regional health systems performance, we refer to the OECD Health Care Quality Indicators project to construct of a set of five composite indexes. The composite indexes are built on the basis of the non-compensatory Adjusted Mazziotta-Pareto Index, that allows comparability of the data across units and over time. We propose three indexes of health system performance, namely Quality Index, Accessibility Index and Cost-Expenditure Index, along with a Health Status Index and a Lifestyles Index. Our framework highlights that regional disparities still persist. Consistently with the evidence at the institutional level, there are regions, particularly in Southern Italy, which record lower levels of performance with high levels of expenditure. Continuous research is needed to provide policy makers with appropriate data and tools to build a cohesive health care system for the benefit of the whole population. Even if future research is needed to integrate our framework with new indicators for the calculation of the indexes and with the identification of new indexes, the study shows that a scientific reflection on decentralisation of health systems is necessary in order to reduce inequalities.

Quality improvement in large healthcare organizations

2016 ◽  
Vol 30 (1) ◽  
pp. 133-153 ◽  
Author(s):  
Elisabet Höög ◽  
Jack Lysholm ◽  
Rickard Garvare ◽  
Lars Weinehall ◽  
Monica Elisabeth Nyström
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Care Quality ◽  
Health Care Systems ◽  
Care Quality ◽  
Care Organization ◽  
Longitudinal Case Study ◽  
Systematic Analysis ◽  
Content Type

Purpose – The purpose of this paper is to investigate the obstacles and challenges associated with organizational monitoring and follow-up (M & F) processes related to health care quality improvement (QI) and development. Design/methodology/approach – A longitudinal case study of a large health care organization during a system-wide QI intervention. Content analysis was conducted of repeated interviews with key actors and archival data collected over a period of four years. Findings – The demand for improved M & F strategies, and what and how to monitor were described by the respondents. Obstacles and challenges for achieving M & F strategies that enables system-wide and coherent development were found in three areas: monitoring, processing, and feedback and communication. Also overarching challenges were found. Practical implications – A model of important aspects of M & F systems is presented that can be used for analysis and planning and contribute to shared cognition of such systems. Approaches for systematic analysis and follow-up of identified problems have to be developed and fully incorporated in the organization’s measurement systems. A systematic M & F needs analytic and process-oriented competence, and this study highlights the potential in an organizational function with capacity and mandate for such tasks. Originality/value – Most health care systems are flooded with a vast amount of registers, records, and measurements. A key issue is how such data can be processed and refined to reflect the needs and the development process of the health care system and how rich data can be used for improvement purposes. This study presents key organizational actor’s view on important factors to consider when building a coherent organizational M & F strategy.

scholarly journals Financing of Health Care in the Conditions of Pandemic Threats

Federalism ◽  
2020 ◽  
pp. 110-116
Author(s):  
A. G. Kolomiets
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Social Groups ◽  
Regional Health ◽  
Free Riders ◽  
Regional Health Care ◽  
Care Systems ◽  
The Usa ◽  
Using Data ◽  
Excess Profit

The author, using data of health care systems and COVID in the USA, Italy and other countries makes a conclusion that effective parrying of pandemic threats demands correction of a health care system and its financing. In particular, expansion of access for «marginal» social groups to services of out-patient and polyclinic institutions including non-payable services on a constant basis is necessary. Situation when involvement of the low-paid migrants who are actually excluded from regional health care systems allows to get excess profit for employers, creates for society not only additional expenses, but also risks of catastrophic development of epidemiological situations. Such employers are a kind of «free-riders» too expensive for society.

scholarly journals A Study of Community and Health Clinic Approaches to Addressing Toxic Stress and Promoting Protective Factors among Families with Infants

2020 ◽  
Author(s):  
Julie S. McCrae ◽  
JoAnn L Robinson ◽  
Angeline K Spain ◽  
Kaela Byers ◽  
Jennifer L Axelrod
Keyword(s):  
Health Care ◽  
Chronic Stress ◽  
Health Care Quality ◽  
Health Care Systems ◽  
Community Services ◽  
Care Quality ◽  
Health Clinic ◽  
Toxic Stress ◽  
Early Life Adversity ◽  
Design Elements

Abstract BackgroundHealth care administrators must promote effective partnerships with community agencies to address social determinants of health, including reducing exposure to chronic stress in early childhood. Important targets for mitigating “toxic” levels of young child exposures are through reducing parents’ experiences of chronic stress as well as protecting children from direct experiences of harm such as physical or sexual abuse. Conducting screening to identify when parents and children are exposed to early life adversity is a first step; bringing in or referring out families to needed support services is an essential component. This paper describes a multi-modal investigation of health care systems innovations to engage and support parents to prevent and mitigate children’s toxic stress exposures through pediatric primary care and community services partnerships.MethodsKey study features include: 1) multi-component, multi-site study in five U.S. communities of pediatric health care clinics and the families they serve, 2) a developmental evaluation approach that describes how systems innovations are experienced over time at three levels (community systems, pediatric providers, and families), and 3) rapid cycle feedback in partnership with communities, clinics and families to co-interpret data and findings. The methodology includes: 1) focus groups and interviews with community stakeholders, clinic staff, and families, 2) electronic health record and Medicaid services data extracted to assess health care quality, and 3) clinic-recruitment of 908 parents of newborns in a longitudinal survey.ResultsThe sample is briefly characterized based on responses to the enrollment phase of the parent survey.ConclusionsWe discuss the study design elements’ contribution to generate evidence needed by innovators, communities, and clinics to modify and sustain investments in these innovations.

scholarly journals 6.H. Workshop: Quality strategies in European health systems: assessing their nature, use and effectiveness

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Cost Effectiveness ◽  
Health Systems ◽  
Health Care Quality ◽  
Care Quality ◽  
Lessons Learned ◽  
Potential Contribution ◽  
Policy Makers

Abstract Quality of care is one of the most frequently quoted principles of health policy, and is currently high up on the agenda of policy-makers at national, European, and international levels. However, the understanding of the term and what it encompasses varies. Many organizations and movements, such as evidence-based medicine, health technology assessment, provider accreditation, clinical practice guidelines and patient safety, play an important role in improving quality of health care. However, this broad field of quality-related initiatives is fragmented, and there is often a lack of awareness about parallel activities because of different labels. Evidence on the effectiveness and cost-effectiveness of different quality strategies is not always readily available for policy-makers, who have to struggle with prioritizing initiatives for investment. To provide a solid foundation for addressing these challenges, the European Observatory on Health Systems and Policies in collaboration with the OECD has put together a comprehensive study on health care quality, its interpretation and the evidence on different strategies aiming to assure or improve it. Drawing on this 2019 study, the workshop has the following objectives: Provide an understanding of the multidimensional concept of quality of care and its relation to health system performance as well as a comprehensive framework for looking at different strategies and their potential contribution to improving health care quality;Introduce key components of international and European governance for quality of care;Highlight the effectiveness, cost-effectiveness and implementation of selected quality strategies, with a focus on the European context:Health professional regulation, including education, licensing and registration, continuous professional development and mechanisms to ensure fitness to practice;External institutional strategies for health care organizations, including accreditation, certification and supervision;“Pay for Quality”, wherein financial incentives are paid to providers or professionals for achieving quality-related targets within a specific timeframe.Discuss and refine lessons learned through audience participation, and identify further areas for research and action. Key messages Quality of care is a political priority and an important contributor to population health. Within an overall strategic framework, understanding the potential of different quality strategies is key. Evidence on the (cost-)effectiveness of different quality strategies is variable but largely inconclu-sive. Maintaining an overview and identifying areas for action is paramount for policy-makers.

scholarly journals Semi-Automated Visualization and ANalysis of Trends: A “SAVANT” for Facilitating Antimicrobial Stewardship Using Antistaphylococcal Resistance and Consumption as a Prototype

2018 ◽  
Vol 5 (4) ◽  
Author(s):  
Robert J Clifford ◽  
Uzo Chukwuma ◽  
Michael E Sparks ◽  
Douglas Richesson ◽  
Charlotte V Neumann ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
Large Scale ◽  
Moving Average ◽  
Health Care Systems ◽  
Care Quality ◽  
Mandatory Reporting ◽  
Outpatient Prescription ◽  
Care Systems ◽  
Prescription Rates

Abstract Background Governments and health care regulators now require hospitals and nursing homes to establish programs to monitor and report antimicrobial consumption and resistance. However, additional resources were not provided. We sought to develop an approach for monitoring antimicrobial resistance and consumption that health care systems can implement with minimal added costs or modifications to existing diagnostic and informatics infrastructure. Methods Using (1) the electronic laboratory information system of a nationwide managed care network, (2) the 3 most widely used commercial microbiology diagnostic platforms, and (3) Staphylococcus aureus, one of the most common causes of infections worldwide, as a prototype, we validated the approach dubbed “SAVANT” for Semi-Automated Visualization and ANalysis of Trends. SAVANT leverages 3 analytical methods (time series analysis, the autoregressive integrated moving average, and generalized linear regression) on either commercial or open source software to report trends in antistaphylococcal use and resistance. Results All laboratory results from January 2010 through December 2015 from an annual average of 9.2 million health care beneficiaries were queried. Inpatient and outpatient prescription rates were calculated for 8 key antistaphylococcal compounds. Trends and relationships of antistaphylococcal consumption and resistance among 81 840 unique S. aureus isolates from >6.5 million cultures were revealed. Conclusions Using existing or freely available resources, SAVANT was successfully implemented across a complex and geographically dispersed 280-hospital network, bridging a critical gap between medical informatics, large-scale data analytics, and mandatory reporting of health care quality metrics.

Health Care Transparency in Organizational Perspective

2016 ◽  
Author(s):  
Charlotta Levay
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
Health Care Organizations ◽  
Economic Incentives ◽  
Care Quality ◽  
Future Research ◽  
Health Care Market ◽  
Quality Reporting ◽  
Organizational Perspective ◽  
Health Care Transparency

Health care organizations are under increasing pressure to account for their performance to outside constituencies. This chapter reviews the background, nature, and consequences of organized efforts to enhance transparency in health care. Market reforms and quality concerns create mounting demands for public transparency, but health care quality is difficult to assess in a way that is both fair and accessible to a general audience. Public quality reporting has not been shown to improve quality of care, and there is a risk that it produces nominal rather than effective transparency. Especially when combined with economic incentives, transparency regimes tend to breed gaming, which is repeatedly ignored by systems designers. Health professionals typically react negatively, even if they also participate in and derive some benefits from transparency efforts. Future research needs to explore systematically the strategies that professionals, patients, and organizations engage in when creating and receiving public quality information.

scholarly journals The National Practice Benchmark for Oncology: 2015 Report for 2014 Data

2016 ◽  
Vol 12 (4) ◽  
pp. e437-e475 ◽  
Author(s):  
Carla Balch ◽  
John D. Ogle ◽  
James L. Senese
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Business Practices ◽  
Competitive Advantages ◽  
Regional Health ◽  
Regional Health Care ◽  
Community Oncology ◽  
Care Systems ◽  
National Practice ◽  
Business Structure

The National Practice Benchmark (NPB) is a unique tool used to measure oncology practices against others across the country in a meaningful way despite variations in practice demographics, size, and setting. In today’s challenging economic environment, each practice positions service offerings and competitive advantages to attract patients. Although the data in the NPB report are primarily reported by community oncology practices, the business structure and arrangements with regional health care systems are also reflected in the benchmark report. The ability to produce detailed metrics is an accomplishment of excellence in business and clinical management. With these metrics, a practice should be able to measure and analyze its current business practices and make appropriate changes, if necessary. In this report, we build on the foundation initially established by Oncology Metrics (acquired by Flatiron Health in 2014) over years of data collection and refine definitions to deliver the NPB, which is uniquely meaningful in the oncology market.

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