Journal Article

Inequality in 30-day mortality and the wait for surgery after hip fracture: the impact of the regional health care evaluation program in Lazio (Italy)

COLAIS, P., PERUCCI, C.A., PINNARELLI, L., DAVOLI, M., SORGE, C., AGABITI, N., FUSCO, D.

2013

Overview

Objectives. Interventions that address inequalities in health care are a priority for public health research. We evaluated the impact of the Regional Health Care Evaluation Program in the Lazio region, which systematically calculates and publicly releases hospital performance data, on socioeconomic differences in the quality of healthcare for hip fracture. Design. Retrospective cohort study. Settings and participants. We identified, in the hospital information system, elderly patients hospitalized for hip fracture between 01 January 2006 and 31 December 2007 (period 1) and between 01 January 2009 and 30 November 2010 (period 2). Main outcome measures. We used multivariate regression models to test the association between socioeconomic position index (SEP, level I well-off to level III disadvantaged) and outcomes: mortality within 30 days of hospital arrival, median waiting time for surgery and proportion of interventions within 48 h. Results. We studied 11 581 admissions. Lower SEP was associated with a higher risk of 30-day mortality in period 1 (relative risk (RR) = 1.42, P = 0.027), but not in period 2. Disadvantaged people were less likely to undergo intervention within 48 h than well-off persons in period 1 (level II: RR = 0.72, P < 0.001; level III: RR = 0.46, P<0.001) and period 2 (level II: RR = 0.88, P = 0.037; level III: RR = 0.63, P< 0.001). We observed a higher probability of undergoing intervention within 48 h in period 2 compared with the period 1 for each socioeconomic level. Conclusion. This study suggests that a systematic evaluation of health outcome approach, including public disclosure of results, could reduce socioeconomic differences in healthcare through a general improvement in the quality of care.

• Publisher: Oxford University Press,Pergamon Press
• Subject: Admission / Aged, 80 and over / Associations / Biological and medical sciences / Epidemiology / Equality / Female / General aspects / Health policy / Healthcare Disparities - organization & administration / Healthcare Disparities - statistics & numerical data / Hip Fractures - mortality / Hip Fractures - surgery / Hospitals / Humans / Indexes / Italy / Italy - epidemiology / Male / Medical sciences / Medical service / Mortality / Old age / Patients / Public health / Public health. Hygiene / Public health. Hygiene-occupational medicine / Quality of Health Care - organization & administration / Quality of Health Care - statistics & numerical data / Regional Medical Programs - organization & administration / Regional Medical Programs - standards / Regional Medical Programs - statistics & numerical data / Risk / Socioeconomic Factors / Socioeconomic status / Surgery / Waiting Lists - mortality