Evidence-based quality indicators for primary healthcare in association with the risk of hospitalisation: a population-based cohort study in Switzerland
Objectives The quality of ambulatory care in Switzerland is widely unknown. Therefore, this study aimed to evaluate the recently proposed quality indicators (QIs) based on a nationwide healthcare claims database and determine their association with the risk of subsequent hospitalisation at patient-l...
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BMJ Publishing Group
2020-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/4/e032700.full |
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| author | Oliver Reich Thomas Rosemann Oliver Senn Eva Blozik Rahel Meier Martin Scherer Carola A Huber Roland Rapold Felix Huber Jan von Overbeck Felix Schneuwly Daniel Tapernoux |
| author_facet | Oliver Reich Thomas Rosemann Oliver Senn Eva Blozik Rahel Meier Martin Scherer Carola A Huber Roland Rapold Felix Huber Jan von Overbeck Felix Schneuwly Daniel Tapernoux |
| author_sort | Oliver Reich |
| collection | DOAJ |
| description | Objectives The quality of ambulatory care in Switzerland is widely unknown. Therefore, this study aimed to evaluate the recently proposed quality indicators (QIs) based on a nationwide healthcare claims database and determine their association with the risk of subsequent hospitalisation at patient-level.Design Retrospective cohort study.Setting Inpatient and outpatient claims data of a large health insurance in Switzerland covering all regions and population strata.Participants 520 693 patients continuously insured during 2015 and 2016.Measures A total of 24 QIs were obtained by adapting the existing instruments to the Swiss national context and measuring at patient-level. The association between each QI and hospitalisation in the subsequent year was assessed using multiple logistic regression models.Results The proportion of patients with good adherence to QIs was high for the secondary prevention of diabetes and myocardial infarction (glycatedhaemoglobin (HbA1c) control, 89%; aspirin use, 94%) but relatively low for polypharmacy (53%) or using potentially inappropriate medications (PIMs) in the elderly (PIM, 33%). Diabetes-related indicators such as the HbA1c control were significantly associated with a lower risk of hospitalisation (OR, 0.87; 95% CI, 0.80 to 0.95), whereas the occurrence of polypharmacy and PIM increased the risk of hospitalisation in the following year (OR, 1.57/1.08; 95% CI, 1.51 to 1.64/1.05 to 1.12).Conclusions This is the first study to evaluate the recently presented QIs in Switzerland using nationwide real-life data. Our study suggests that the quality of healthcare, as measured by these QIs, varied. The majority of QIs, in particular QIs reflecting chronic care and medication use, are considered beneficial markers of healthcare quality as they were associated with reduced risk of hospitalisation in the subsequent year. Results from this large practical test on real-life data show the feasibility of these QIs and are beneficial in selecting the appropriate QIs for healthcare implementation in general practice. |
| format | Article |
| id | doaj-art-8323def38d0a4739a41c7dee93ec3f12 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-8323def38d0a4739a41c7dee93ec3f122025-08-20T02:30:31ZengBMJ Publishing GroupBMJ Open2044-60552020-04-0110410.1136/bmjopen-2019-032700Evidence-based quality indicators for primary healthcare in association with the risk of hospitalisation: a population-based cohort study in SwitzerlandOliver ReichThomas RosemannOliver SennEva Blozik0Rahel MeierMartin Scherer1Carola A Huber2Roland Rapold3Felix HuberJan von OverbeckFelix SchneuwlyDaniel TapernouxInstitute of Primary Care, University of Zurich, Zurich, SwitzerlandDepartment of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Health Sciences, Helsana Group, Zurich, SwitzerlandDepartment of Health Sciences, Helsana Insurance Group, Zürich, SwitzerlandObjectives The quality of ambulatory care in Switzerland is widely unknown. Therefore, this study aimed to evaluate the recently proposed quality indicators (QIs) based on a nationwide healthcare claims database and determine their association with the risk of subsequent hospitalisation at patient-level.Design Retrospective cohort study.Setting Inpatient and outpatient claims data of a large health insurance in Switzerland covering all regions and population strata.Participants 520 693 patients continuously insured during 2015 and 2016.Measures A total of 24 QIs were obtained by adapting the existing instruments to the Swiss national context and measuring at patient-level. The association between each QI and hospitalisation in the subsequent year was assessed using multiple logistic regression models.Results The proportion of patients with good adherence to QIs was high for the secondary prevention of diabetes and myocardial infarction (glycatedhaemoglobin (HbA1c) control, 89%; aspirin use, 94%) but relatively low for polypharmacy (53%) or using potentially inappropriate medications (PIMs) in the elderly (PIM, 33%). Diabetes-related indicators such as the HbA1c control were significantly associated with a lower risk of hospitalisation (OR, 0.87; 95% CI, 0.80 to 0.95), whereas the occurrence of polypharmacy and PIM increased the risk of hospitalisation in the following year (OR, 1.57/1.08; 95% CI, 1.51 to 1.64/1.05 to 1.12).Conclusions This is the first study to evaluate the recently presented QIs in Switzerland using nationwide real-life data. Our study suggests that the quality of healthcare, as measured by these QIs, varied. The majority of QIs, in particular QIs reflecting chronic care and medication use, are considered beneficial markers of healthcare quality as they were associated with reduced risk of hospitalisation in the subsequent year. Results from this large practical test on real-life data show the feasibility of these QIs and are beneficial in selecting the appropriate QIs for healthcare implementation in general practice.https://bmjopen.bmj.com/content/10/4/e032700.full |
| spellingShingle | Oliver Reich Thomas Rosemann Oliver Senn Eva Blozik Rahel Meier Martin Scherer Carola A Huber Roland Rapold Felix Huber Jan von Overbeck Felix Schneuwly Daniel Tapernoux Evidence-based quality indicators for primary healthcare in association with the risk of hospitalisation: a population-based cohort study in Switzerland BMJ Open |
| title | Evidence-based quality indicators for primary healthcare in association with the risk of hospitalisation: a population-based cohort study in Switzerland |
| title_full | Evidence-based quality indicators for primary healthcare in association with the risk of hospitalisation: a population-based cohort study in Switzerland |
| title_fullStr | Evidence-based quality indicators for primary healthcare in association with the risk of hospitalisation: a population-based cohort study in Switzerland |
| title_full_unstemmed | Evidence-based quality indicators for primary healthcare in association with the risk of hospitalisation: a population-based cohort study in Switzerland |
| title_short | Evidence-based quality indicators for primary healthcare in association with the risk of hospitalisation: a population-based cohort study in Switzerland |
| title_sort | evidence based quality indicators for primary healthcare in association with the risk of hospitalisation a population based cohort study in switzerland |
| url | https://bmjopen.bmj.com/content/10/4/e032700.full |
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