title: AHRQ prevention quality indicators to assess the quality of primary care of local providers: a pilot study from Italy.
abstract: BACKGROUND
  Outside the USA, Agency for Healthcare Research and Quality (AHRQ) prevention quality indicators (PQIs) have been used to compare the quality of primary care services only at a national or regional level. However, in several national health systems, primary care is not directly managed by the regions but is in charge of smaller territorial entities. We evaluated whether PQIs might be used to compare the performance of local providers such as Italian local health authorities (LHAs) and health districts.
  
  
  METHODS
  We analysed the hospital discharge abstracts of 44 LHAs (and 11 health districts) of five Italian regions (including ≈18 million residents) in 2008-10. Age-standardized PQI rates were computed following AHRQ specifications. Potential predictors were investigated using multilevel modelling.
  
  
  RESULTS
  We analysed 11 470 722 hospitalizations. The overall rates of preventable hospitalizations (composite PQI 90) were 1012, 889 and 988 (×100 000 inhabitants) in 2008, 2009 and 2010, respectively. Composite PQIs were able to differentiate LHAs and health districts and showed small variation in the performance ranking over years.
  
  
  CONCLUSIONS
  Although further research is required, our findings support the use of composite PQIs to evaluate the performance of relatively small primary health care providers (50 000-60 000 enrollees) in countries with universal health care coverage. Achieving high precision may be crucial for a structured quality assessment system to align hospitalization rate indicators with measures of other contexts of care (cost, clinical management, satisfaction/experience) that are typically computed at a local level.
authors.affiliation: 1 Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy lmanzoli@post.harvard.edu.
authors.forename: Lamberto
authors.initials: L
authors.lastname: Manzoli
authors.affiliation: 1 Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Flacco
authors.affiliation: 2 Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: De Vito
authors.affiliation: 3 General Directorate for Health Planning, Ministry of Health, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Arcà
authors.affiliation: 3 General Directorate for Health Planning, Ministry of Health, Rome, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Carle
authors.affiliation: 1 Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capasso
authors.affiliation: 2 Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: Marzuillo
authors.affiliation: 4 Regional Healthcare Agency of Abruzzo, Pescara, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Muraglia
authors.affiliation: 5 General Direction Local Health Unit no. 1, Trieste, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Samani
authors.affiliation: 2 Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Villari
mesh_terms: D000293:Adolescent; D000328:Adult; D003695:Delivery of Health Care / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008297:Male; D009313:National Health Programs / Q000592:standards / Q000706:statistics & numerical data; D010351:Patient Discharge; D010865:Pilot Projects; D011320:Primary Health Care / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult