Reproductive health of immigrant women in the Lazio region of Italy

The number of legal immigrant women living in the Lazio region of Italy has increased in recent years; there were 69,320 "permessi di soggiorno" (temporary residence permits) issued in 1992 but 119,778 issued in 2000. This analysis concerns women who left hospital after having a live birth, an induced abortion or a spontaneous abortion. The foreign women were compared with all (Italian and foreign) women living in Lazio. The general fertility rate is slightly higher among all women resident in Lazio than among the foreign women, but the latter have a higher rate at ages 18-24 years. The risk of induced abortion is higher (34.8/1000 women) among the foreigners than among all residents (10.5/1000 women). The spontaneous abortion ratio was also higher among the foreigners (213.8/1000 live births) than the residents (154.6/1000 live births). There is clear evidence of an increase in the demand from foreign women for medical services for reasons associated with reproduction. The provision of these services needs to be modified to take account of their particular needs.     

经济欠发达地区农村产前保健项目中间结果评价

目的:对经济欠发达地区农村开展的产前保健项目的中间结果进行评价.方法:由县卫生局组织有关产前保健专家对乡镇卫生院产科医务人员进行业务培训;由县卫生局和乡镇领导协调卫生与计划生育部门开展农村社区产前保健的健康教育;由乡镇卫生院产科助产士负责开展产前检查.应用整群随机分组的设计及做干预前后测量的方法进行评价.评价的指标包括初次产前检查孕周、产前检查次数和产前检查率.结果:干预使孕妇初次产前检查的时间提前.干预提高了产前检查率.干预提高了高危妊娠妇女的产前检查次数.结论:卫生与计划生育部门合作开展产前保健是促进经济欠发过地区农村母婴保健工作可行与有效的途径.     

Reporting of Quality Indicators and Improvement in Hospital Performance: The P.Re.Val.E. Regional Outcome Evaluation Program

Objective

To evaluate whether reporting of hospital performance was associated with a change in quality indicators in Italian hospitals.

Data Sources/Study Setting

Nationwide Hospital Information System for 2006–2009.

Study Design

We performed a pre-post evaluation in Lazio (before and after disclosure of the Regional Outcome Evaluation Program P.Re.Val.E.) and a comparative evaluation versus Italian regions without comparable programs. We analyzed risk-adjusted proportions of percutaneous coronary intervention (PCI), hip fractures operated on within 48 hours, and cesarean deliveries.

Data Collection/Extraction Methods

Using standardized ICD-9-CM coding algorithms, we selected 381,053 acute myocardial infarction patients, 250,712 hip fractures, and 1,736,970 women who had given birth.

Principal Findings

In Lazio PCI within 48 hours changed from 22.49 to 29.43 percent following reporting of the P.Re.Val.E results (relative increase, 31 percent; p < .001). In the other regions this proportion increased from 22.48 to 27.09 percent during the same time period (relative increase, 21 percent; p < .001). Hip fractures operated on within 48 hours increased from 11.73 to 15.78 percent (relative increase, 34 percent; p < .001) in Lazio, and not in other regions (29.36 to 28.57 percent). Cesarean deliveries did not decrease in Lazio (34.57–35.30 percent), and only slightly decreased in the other regions (30.49–28.11 percent).

Conclusions

Reporting of performance data may have a positive but limited impact on quality improvement. The evaluation of quality indicators remains paramount for public accountability.     

Process versus outcome indicators in the assessment of quality of health care.

This paper reviews the relative strengths and weaknesses of outcome and process measures as performance indicators in health care. Differences in outcome may be due to case mix, how the data were collected, chance, or quality of care. Health care is only one determinant of health and other factors have important effects on health outcomes, such as nutrition, environment, lifestyle and poverty. The advantages of process measures are that they are more sensitive to differences in the quality of care and they are direct measures of quality. However, outcome measures are of greater intrinsic interest and can reflect all aspects of care, including those that are otherwise difficult to measure such as technical expertise and operator skill. Outcome indicators can be improved if efforts are made to standardize data collection and case mix adjustment systems are developed and validated. It is argued that this is worth doing only where it is likely that variations in health care might lead to significant variations in health outcome and where the occurrence of the outcome is sufficiently common that the outcome indicator will have the power to detect real differences in quality. If these conditions are not met, then alternative strategies such as process measurement and risk management techniques may be more effective at protecting the public from poor quality care.     

The changing distribution of HIV infection: HIV surveillance in Lazio, Italy, 1985 through 1994. Lazio HIV Surveillance Collaborative Group.

OBJECTIVES: This study sought to describe the human immunodeficiency virus (HIV) surveillance system in Lazio, Italy, and to analyze exposure patterns and time trends of HIV serodiagnoses from January 1985 to December 1994. METHODS: A linkage procedure made it possible to identify newly diagnosed HIV cases. Anonymous information was collected on demographic and exposure factors for each individual. RESULTS: Of 35,425 reports, 13,660 were newly diagnosed HIV cases, 70.9% of them in men. The proportion of women increased at the beginning of the study period (the male:female ratio declined from 3.5 in 1985 to 2.6 in 1986) and then remained stable. The proportion of subjects reporting heterosexual exposure, in men and women, respectively, increased from 1.5% and 2.0% in 1985 to 21.2% and 60.8% in 1994. Starting in 1992, heterosexual contact has become the main transmission route for women. CONCLUSIONS: A changing pattern in the HIV epidemic is emerging, with a shift in the incidence of HIV diagnosis from "core" high-risk groups (drug injectors) to the large low-risk population (the general population) exposed through heterosexual transmission. This is probably occurring in other areas (e.g., large urban centers in the United States) with a similar epidemiological situation.     

P.S.R.O., quality of care, and research.

A necessary condition for achieving the legislative goals of Public Law 92-603, which created the Professional Standards Review Organizations, is the proper evaluation of the system of providing medical care. Peer review as currently constituted does not provide a proper evaluation. This article shows why present practices are not satisfactory, presents an outline of a minimally satisfactory evaluation system, and concludes by showing that many of the criticisms made of P.S.R.O.s are deficient, and that peer review has the potential for resulting in some improvement in the quality of medical care.     

A program of evaluation and research for hospital based home care

A program of evaluation and research has been developed and initiated in a large Hospital Based Home Care Program which principally serves chronically-ill, elderly veterans. Program evaluation is based on data from an automated home care information system developed for this purpose. The information system is based on the Long-Term Health Care Minimum Data Set, a nationally-recommended data set which describes patient demographics and physical and mental health status, and health services provided. Home care and related costs per visit and per patient day have been identified. A proposed, experimental research protocol identifies health status outcomes and health care costs of home care and alternative modes of long-term health care.     

The evaluation of the quality of health care. A lay perspective

The careful selection of a physician or hospital is important to the quality of health care received. Unfortunately, our present medical/health system does not provide laypeople with the opportunity to take active, informed roles in choosing their own medical care. In order to make such decisions, laypeople need to have more useful information concerning the quality of their medical providers. Nonprofessional users of the system should become more actively involved in the evaluation of hospitals and physicians. In doing so, people will not only improve their health, but also help to restructure the medical system into one that is more efficient and responsive to their needs.     

Electronic health records: turning research into decision support for quality care

Much has been written and discussed about low clinical and decision-support tools can help providers deliver quality care to their patients. But there are theories--and then there are realities--about what will actually work in the real world and how useful they will be. When incorporating decision-support tools into electronic health records, the results may not always be predictable.     

Primary health care, basic health care, and family health program: synergies and singularities in the Brazilian context

This article analyzes the concepts of primary health care, basic health care, and family health care as used in official documents by the Brazilian Ministry of Health, final reports of the National Conferences on Health and Human Resources, the Basic Operational Ruling on Human Resources, and texts accessed on-line by BIREME. The data analysis, through double-entry matrices, showed a lack of these references in Brazilian health policy formulation and implementation. Basic Operational Ruling 96 (NOB/96) plays a distinct role in this regard; the national conference reports show an important gap in this debate, and most of the published articles present the concepts of primary care and basic care with the meaning of health unit or local service. Articles on the Family Health Program refer to it more as a program than a strategy, and the articles analyzing such concepts show the influence of rationalities underlying the different strategies for organization of health services in the Brazilian scenario, namely Health Surveillance and Programmatic Actions in Health and in Defense of Life.     

Expert evaluation of the quality of ambulatory health care for rural population

The paper outlines the issues related to expert evaluation of medical consultation quality provided at out-patient departments of central regional hospitals (CRH). The algorithm and programme of expertise were included into the special "Expert Assessment Schedule for Ambulatory Consultations" containing an assessment of eight major items. An expert assessment was carried out of 447 patients who made ambulatory visits to CRH, with a view of studying the reasons for failures, searching for the possibilities to overcome them and for the reserves of raising the quality of medical care for rural population. The findings of assessing the quality of ambulatory consultations at the CRH level showed that the physician's performance is in need of improvement taking into account the information acquired and shortcomings at each stage of medical consultation delivery.