AHRQ prevention quality indicators to assess the quality of primary care of local providers: a pilot study from Italy

Abstract

Background: Outside the USA, Agency for Healthcare Research and Quality (AHRQ) prevention quality indicators (PQIs) have been used to compare the quality of primary care services only at a national or regional level. However, in several national health systems, primary care is not directly managed by the regions but is in charge of smaller territorial entities. We evaluated whether PQIs might be used to compare the performance of local providers such as Italian local health authorities (LHAs) and health districts.

Methods: We analysed the hospital discharge abstracts of 44 LHAs (and 11 health districts) of five Italian regions (including ≈18 million residents) in 2008-10. Age-standardized PQI rates were computed following AHRQ specifications. Potential predictors were investigated using multilevel modelling.

Results: We analysed 11 470 722 hospitalizations. The overall rates of preventable hospitalizations (composite PQI 90) were 1012, 889 and 988 (×100 000 inhabitants) in 2008, 2009 and 2010, respectively. Composite PQIs were able to differentiate LHAs and health districts and showed small variation in the performance ranking over years.

Conclusion: Although further research is required, our findings support the use of composite PQIs to evaluate the performance of relatively small primary health care providers (50 000-60 000 enrollees) in countries with universal health care coverage. Achieving high precision may be crucial for a structured quality assessment system to align hospitalization rate indicators with measures of other contexts of care (cost, clinical management, satisfaction/experience) that are typically computed at a local level.

Figure 1

PQIs: PQI 90—overall hospitalization rates for ambulatory care sensitive conditions in 44 LHAs from five Italian regions (Abruzzo: LHAs 201–204; Emilia-Romagna: E101–E113; Lazio: 101–112; Lombardy: 301–315; Trieste: T01); years 2008–10. Data of the local health units 101–105 of the Lazio region (City of Rome) for the year 2009 were not available

Figure 2

PQIs: PQI 90—overall hospitalization rates for ambulatory care sensitive conditions in 11 health districts from three Italian LHAs (LHA of Pescara: Pe01–Pe06; LHA of Lanciano-Vasto-Chieti: district of Francavilla; LHA of Trieste: Tr01-Tr04); years 2008–10