Faculty and staff of the Center continued work on a major series of projects being performed in collaboration with the regional health care system of Emilia-Romagna Region, Italy. Current projects include development of models to predict risk of hospitalization for patients with chronic disease, analyses of the distribution and outcomes of surgical services for patients with cancer; analyses of intra-regional variation in medical, surgical and pharmaceutical treatment, refinement of a method for assessing the timeliness and appropriateness of acute hospitalization, analyses of patterns and quality of care for women with breast cancer, development of "profiles" of care provided by primary care teams and studies of the integration of hospital and outpatient care.
Population-based Longitudinal Health Care Database
The Emilia-Romagna Region has developed a population-based longitudinal health care database for the roughly 5 million individuals who were residents of Emilia-Romagna between 2004 and 2014. The database includes encounter-based records of an individual's interaction with the healthcare system using administrative data. Since Italy has a National Health Service, all residents of the region are included, without limitations concerning age or insurance status. The value of the database has been increased by adding clinical classifications mapped from the hospital and pharmacy data. The Disease Staging classification, developed by Center faculty, has been used to classify the severity of primary diagnosis and co-morbidity for hospitalized patients and to identify individuals who may be at higher risk for using more extensive or expensive health services in the future. Another set of indicators (Chronic Condition Drug Groups – CCDGs) uses outpatient pharmacy data and the Italian national formulary to identify individuals with selected chronic diseases.
Development & Application of Risk Models
We have developed models to predict risk of hospitalization for patients with chronic disease. Details of these models, which perform as well or better than similar models in other countries, have recently been published in BMJ Open. A collaborative grant application submitted by the Regional Health Care Research Agency and Thomas Jefferson University to refine these models has been funded by the Italian Ministry of Health. Model results, along with profiles of patients identified as "high risk" are being provided to physicians and other health professionals associated with newly formed "medical homes" to assist in efforts toward proactive management of patients with chronic disease that may reduce the likelihood of preventable, high-cost hospitalization.
Analysis of the Distribution & Outcomes of Surgical Procedures Performed in the Hospitals of the Regione Emilia-Romagna
At the request of the director general of the regional healthcare system, we analyzed the distribution and outcomes of major surgery in the region focusing on the relationship between volume of procedures performed and patient outcomes. A study of follow-up care for breast cancer survivors was published in Tumori.
Analyses of Intraregional Variation in Utilization & Outcomes
The Center is collaborating with the Regional Agency for Health and Social Care of the Emilia-Romagna Region of Italy in the development of a series of analyses and reports focused on variation in utilization and outcomes for selected high frequency medical and surgical treatments. These reports, currently in the early stages of development, are designed to try to identify variation that is not explained by patient characteristics or patient preferences. Initial analyses include patients undergoing cholecystectomy for cholecystitis, men having a prostatectomy for benign prostatic hypertrophy, patterns of care for patients with congestive heart failure and using of selected pharmaceutical treatments in elderly patients and those with common chronic medical problems. The goal of initial analyses will be to provide the regions and local health authorities with information useful for improving the quality and efficiency of care in the region.
Assessment of Timeliness & Appropriateness of Acute Hospital Use
The Center has developed a method to identify potentially inappropriate acute hospital admissions (patients who could be effectively and safely treated in alternative, less costly settings) as well as “late” hospital admissions (patients who could have benefited from diagnosis and treatment at an earlier stage of their disease). This methodology uses standard hospital discharge abstract data to evaluate the severity of a patient’s principal diagnosis, using the Disease Staging classification, the presence and severity of co-morbid disease and the nature of surgical procedures performed. The method has been reviewed by a panel of Italian physicians which confirmed the validity of the approach. The revised criteria have been applied to hospital admissions for residents of the Emilia-Romagna Region and used by the region, local health units and hospitals as a part of the planning process designed to efficiently meet the health care needs of the population. Currently, the list of DRGs to be assessed is being expanded to include a total of 108 diagnostic groups.
Quality of End-of-Life Care
We are performing analysis using administrative data to measure quality of care at the end of life for patients with cancer. This project, performed in collaboration with the University of Bologna and the Emilia-Romagna Regional Health Care and Social Care Research Agency, evaluates key indicators such as use of chemotherpay, hospitalization, home health care, hospice care and use of pain medication on the last months of life.
Breast Cancer in the Emilia-Romagna Region: Patterns & Quality of Care
Center researchers collaborated with the Emilia-Romagna regional cancer care commission in an analysis of compliance with American Society of Clinical Oncology radiation and chemotherapy guidelines for women with breast cancer. This project used tumor registry data for women with breast cancer data merged with information from the Regione Emilia-Romagna administrative database. Our manuscript, “Using Administrative Data to Identify and Stage Breast Cancer Cases: Implications for Assessing Quality of Care” was published in Tumori. An additional study, “Variation among Local Health Units in Follow-up Care of Breast Cancer Patients in Emilia-Romagna-Italy” has been accepted for publication in the same journal. We have begun additional analyses of variation in compliance with radiation therapy guidelines and long term survival for women with breast cancer.