Online citations, reference lists, and bibliographies.
← Back to Search

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).

P. Colais, N. Agabiti, D. Fusco, L. Pinnarelli, C. Sorge, C. Perucci, M. Davoli
Published 2013 · Medicine

Save to my Library
Download PDF
Analyze on Scholarcy
Share
OBJECTIVE 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. SETTING 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.
This paper references
10.1093/OXFORDJOURNALS.AJE.A009673
Use of census-based aggregate variables to proxy for socioeconomic group: evidence from national samples.
A. Geronimus (1998)
Inequality in outcomes after hip fracture @BULLET Equity and access to care
10.5860/choice.43sup-0342
Agency for Healthcare Research and Quality (AHRQ)
Steve Bhimji (2015)
Morbidity and mortality after hip fracture: the impact of operative delay. Arch Orthop Trauma Surg 2004;124:334–40
M Gdalevich (2004)
10.1016/j.socscimed.2011.04.003
A Qualitative Comparative Analysis of factors associated with trends in narrowing health inequalities in England.
T. Blackman (2011)
Department of Health (DH) Tackling Health Inequalities: 2007 Status Report on the Programme for Action
(2008)
Equity in Canadian health care: does socioeconomic status affect waiting times for elective surgery?
S. Shortt (2003)
Poisson Regression Adjustment of Event Rates And Its Macro Procedure ADJ_POIS. SAS Conference Proceedings: SAS Users Group International
Dingyi Zhao (1999)
10.1093/INTQHC/MZM003
Does delay in surgery after hip fracture lead to worse outcomes? A multicenter survey.
V. Novack (2007)
10.1186/1472-6963-4-34
Differences in access to coronary care unit among patients with acute myocardial infarction in Rome: old, ill, and poor people hold the burden of inefficiency
C. Ancona (2004)
10.1136/bmj.38643.663843.55
Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study
J. W. Roche (2005)
10.1186/1471-2458-8-340
Socio-economic status and overall and cause-specific mortality in Sweden
M. Weires (2008)
10.1136/bmjqs-2011-000218
What drives hospital performance? The impact of comparative outcome evaluation of patients admitted for hip fracture in two Italian regions
L. Pinnarelli (2012)
10.1001/JAMA.296.1.72
Hospital quality for acute myocardial infarction: correlation among process measures and relationship with short-term mortality.
E. Bradley (2006)
[An index of socioeconomic position based on 2001 Census, Rome].
G. Cesaroni (2006)
Available at http
(2003)
10.1016/S0140-6736(05)17867-2
Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations
M. Huisman (2005)
10.1093/intqhc/mzq062
The impact of information disclosure on quality of care in HMO markets.
Kyoungrae Jung (2010)
10.1136/bmj.327.7418.771
Time trends and demography of mortality after fractured neck of femur in an English population, 1968–98: database study
S. Roberts (2003)
Resolution no. 301 published on 7 July 2008 in Supplement no. 77 to the Official Bulletin of the Lazio Region
Lazio Region
10.1002/ART.10682
The effect of education and income on need and willingness to undergo total joint arthroplasty.
G. Hawker (2002)
10.1037/e419652008-001
Tackling health inequalities: Status report on the Programme for Action
R. Earwicker (2005)
10.1093/INTQHC/MZL065
The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study.
N. Agabiti (2007)
21. National Institute of Statistics (ISTAT), Italy. Available at
(2010)
10.1001/JAMA.291.14.1738
Association of timing of surgery for hip fracture and patient outcomes.
Gretchen M. Orosz (2004)
10.1136/jech.2003.014928
The role of individual and contextual socioeconomic circumstances on mortality: analysis of time variations in a city of north west Italy
C. Marinacci (2004)
Care Disparities Report
AHRQ. National Healt (2010)
10.1097/MLR.0b013e318244e6b5
The Effect of Improving Processes of Care on Patient Outcomes: Evidence From the United Kingdom’s Quality and Outcomes Framework
A. Ryan (2012)
[Inequalities in health in Italy].
A. Caiazzo (2004)
Reducing the Risks to Health: The Role of Social Protection Report of the Social Protection Task Group for the Strategic Review of Health Inequalities in England Post 2010
H. Glennerster (2009)
Ministry of Health, Italy. Mattoni-outcomeproject. Available at
(2010)
Lazio Regional Health Service (RHS) Outcome Evaluation Program Available at
(2006)
10.1093/INTQHC/MZI012
Waiting for orthopaedic surgery: factors associated with waiting times and patients' opinion.
Sofia Löfvendahl (2005)
10.1308/1478708051838
Waiting time for primary hip replacement--a matter of priority.
D. Chakravarty (2005)
Strategic Review of Health Inequalities in England Post-2010. http://www.marmotreview.org (6 November 2010, date last accessed)
M. Marmot (2010)
10.1016/S0002-8703(03)00448-4
Universal health insurance coverage does not eliminate inequities in access to cardiac procedures after acute myocardial infarction.
L. Pilote (2003)
10.1097/01.sla.0000171031.08435.b9
Racial Disparity in Surgical Complications in New York State
K. Fiscella (2005)
10.1016/0167-6296(95)00036-4
What are the costs of queuing for hip fracture surgery in Canada?
B. H. Hamilton (1996)
Socioeconomic differences in
G Cesaroni (2009)
Fair society, healthy lives : the Marmot Review : strategic review of health inequalities in England post-2010.
M. Marmot (2010)
10.1370/afm.1213
Health Care Reform and Equity: Promise, Pitfalls, and Prescriptions
K. Fiscella (2011)
[Recommendations for quality control of cervico-vaginal cytology].
Gruppo Italiano Screening del Cervicocarcinoma GISCi (2004)
The effect of education and income on need and willingness to undergo total joint arthroplasty. Arthritis Rheum 2002;46:3331–9
GA Hawker (2002)
10.1007/s00038-010-0224-6
Decomposing income-related inequality in cervical screening in 67 countries
Brittany McKinnon (2010)
10.1136/jech.2004.028092
Indicators of socioeconomic position (part 2)
B. Galobardes (2006)
10.25011/CIM.V32I3.6113
Wait times for surgical and adjuvant radiation treatment of breast cancer in Canada and the United States: greater socioeconomic inequity in America.
K. Gorey (2009)
10.7326/0003-4819-127-8_Part_2-199710151-00048
Assessing Quality Using Administrative Data
L. Iezzoni (1997)
10.1136/jech.2004.023531
Indicators of socioeconomic position (part 1)
B. Galobardes (2006)
10.1161/STROKEAHA.108.542944
Socioeconomic Differences in Stroke Incidence and Prognosis Under a Universal Healthcare System
G. Cesaroni (2009)
Poisson Regression Adjustment of Event Rates And Its Macro Procedure ADJ_POIS
Dingyi Zhao (1999)
10.1136/bmj.38790.468519.55
Mortality associated with delay in operation after hip fracture: observational study
A. Bottle (2006)
10.7326/0003-4819-148-2-200801150-00006
Systematic Review: The Evidence That Publishing Patient Care Performance Data Improves Quality of Care
C. Fung (2008)
10.1007/s00402-004-0662-9
Morbidity and mortality after hip fracture: the impact of operative delay
M. Gdalevich (2004)
10.1093/intqhc/mzp046
Effects of socioeconomic position on 30-day mortality and wait for surgery after hip fracture.
A. P. Barone (2009)



This paper is referenced by
10.1093/pubmed/fdy033
The relationship between socioeconomic status and trauma outcomes
M. Abedzadeh-Kalahroudi (2018)
10.1136/bmjopen-2017-016939
Patient and system factors of time to surgery after hip fracture: a scoping review
K. Sheehan (2017)
10.1007/s00198-019-05143-y
Socio-economic inequalities in fragility fracture outcomes: a systematic review and meta-analysis of prognostic observational studies
G. Valentin (2019)
10.1007/s00198-016-3853-7
Socioeconomic inequality in clinical outcome among hip fracture patients: a nationwide cohort study
P. K. Kristensen (2016)
10.1186/s12889-016-3019-8
Socioeconomic differences in one-year survival after ischemic stroke: the effect of acute and post-acute care-pathways in a cohort study
V. Belleudi (2016)
10.2106/JBJS.15.00676
Racial and Socioeconomic Disparities in Hip Fracture Care.
C. Dy (2016)
10.1016/j.rmed.2017.02.016
Reducing socioeconomic inequalities in COPD care in the hospital outpatient setting - A nationwide initiative.
S. S. Tøttenborg (2017)
10.1371/journal.pone.0194972
Regional Outcome Evaluation Program (P.Re.Val.E.): Reduction of inequality in access to effective health care in the Lazio region of Italy (2012–2015)
M. Ventura (2018)
10.1177/1403494818807831
Educational inequalities in fracture-related mortality using multiple cause of death data in the Skåne region, Sweden
M. Lindéus (2018)
10.4081/monaldi.2017.839
Age-related prevalence of non-cardiac surgery indications.
Nera Agabiti (2017)
10.1186/1472-6963-13-393
The impact of a pay-for-performance system on timing to hip fracture surgery: experience from the Lazio Region (Italy)
P. Colais (2013)
10.1016/j.healthpol.2018.01.003
Socioeconomic status and waiting times for health services: An international literature review and evidence from the Italian National Health System.
S. Landi (2018)
10.1186/s12939-017-0706-8
Socioeconomic inequalities of outpatient and inpatient service utilization in China: personal and regional perspectives
Da-wei Zhu (2017)
Hip Fractures in the Elderly: Frequency of Surgery and Trends in its Timeliness before and after the Introduction of Performance Indicator
Buja Saia M (2018)
10.1093/eurpub/cku253
Are hospital process quality indicators influenced by socio-demographic health determinants.
A. Buja (2015)
Hip Fractures in the Elderly: Frequency of Surgery and Trendsin its Timeliness before and after the Introduction ofPerformance Indicator
Aless (2018)
10.1097/JHQ.0000000000000091
Effect of Socioeconomic Status on Surgery Waiting Times and Mortality After Hip Fractures in Italy
A. Petrelli (2018)
10.3390/ijerph15091980
Impact of the Regional Network for AMI in the Management of STEMI on Care Processes, Outcomes and Health Inequities in the Veneto Region, Italy
M. Saia (2018)
10.3390/ijerph15020352
Socioeconomic Inequality in One-Year Mortality of Elderly People with Hip Fracture in Taiwan
I-Lin Hsu (2018)
Semantic Scholar Logo Some data provided by SemanticScholar