EASY-NET Program: Methods and Preliminary Results of an Audit and Feedback Intervention in the Emergency Care for Acute Myocardial Infarction in the Lazio Region, Italy

Abstract

Within the EASY-NET network program (NET-2016-02364191), Work Package 1 Lazio evaluates the effectiveness of a structured audit and feedback (A&F) intervention compared with the web-based regional periodic publication of indicators in improving the appropriateness and timeliness of emergency healthcare for acute myocardial infarction (AMI). This work describes the A&F methodology and presents the results of the first feedback delivered. The intervention involves sending periodic reports via e-mail to participating hospitals. The feedback reports include a set of volume and quality (process and outcome) indicators, calculated by facility through the health information system of the Lazio Region and compared with regional mean, target values and values calculated for hospitals with similar volumes of activity. Health managers and clinicians of each participating hospital represent the “feedback recipients”. They are invited to organize clinical and organizational audit meetings to identify possible critical issues in the care pathway and define, where necessary, improvement actions. A total of 16 facilities are involved. Twelve facilities present high volumes in all volume indicators, while three facilities present low volumes for each indicator. Concerning the quality indicators, four facilities do not present critical indicators or had average results, three facilities do not present critical indicators but show average results in at least one of the indicators and six facilities present a critical value for at least one of the indicators. The first report highlighted some critical issues in some facilities on several indicators. During the audit meetings, each facility analyzes these issues, defining appropriate improvement actions. The outcome of these actions will be monitored through subsequent reporting to support the continuous care quality improvement process.

EASY-NET Program: Effectiveness of an Audit and Feedback Intervention in the Emergency Care for Acute Conditions in the Lazio Region

“…Further specifics regarding the implementation of the A&F intervention can be found in Angelici et al [17].…”

“…The effectiveness of the intervention was assessed using difference-in-difference (DID) models [16][17][18][19][20] to compare changes in outcomes from pre-to post-intervention periods between exposed and control groups. These models accounted for changes in secular trends and controlled for measured and unmeasured confounding factors.…”

“…As part of the EASY-NET project (NET-2016-02364191) [17,18], Work Package 1 (WP1) Lazio Emergency, led by the Department of Epidemiology of the Regional Health Service (RHS)-known as DEP Lazio-conducted a comparative analysis of the effectiveness in enhancing the appropriateness and timeliness of emergency healthcare interventions for acute myocardial infarction (AMI) and ischemic stroke. This comparison was between a structured A&F strategy and the voluntary consultation of numerous process and outcome indicators, updated annually (referred to as the "standard strategy"), facilitated through a dedicated regional web platform named P. Re.Val.E (Programma Regionale Valutazione Esiti-Regional Program for Outcomes and Processes Evaluation) [2].…”