title: Can Italian healthcare administrative databases be used to compare regions with respect to compliance with standards of care for chronic diseases?
abstract: BACKGROUND
  Italy has a population of 60 million and a universal coverage single-payer healthcare system, which mandates collection of healthcare administrative data in a uniform fashion throughout the country. On the other hand, organization of the health system takes place at the regional level, and local initiatives generate natural experiments. This is happening in particular in primary care, due to the need to face the growing burden of chronic diseases. Health services research can compare and evaluate local initiatives on the basis of the common healthcare administrative data.However reliability of such data in this context needs to be assessed, especially when comparing different regions of the country. In this paper we investigated the validity of healthcare administrative databases to compute indicators of compliance with standards of care for diabetes, ischaemic heart disease (IHD) and heart failure (HF).
  
  
  METHODS
  We compared indicators estimated from healthcare administrative data collected by Local Health Authorities in five Italian regions with corresponding estimates from clinical data collected by General Practitioners (GPs). Four indicators of diagnostic follow-up (two for diabetes, one for IHD and one for HF) and four indicators of appropriate therapy (two each for IHD and HF) were considered.
  
  
  RESULTS
  Agreement between the two data sources was very good, except for indicators of laboratory diagnostic follow-up in one region and for the indicator of bioimaging diagnostic follow-up in all regions, where measurement with administrative data underestimated quality.
  
  
  CONCLUSIONS
  According to evidence presented in this study, estimating compliance with standards of care for diabetes, ischaemic heart disease and heart failure from healthcare databases is likely to produce reliable results, even though completeness of data on diagnostic procedures should be assessed first. Performing studies comparing regions using such indicators as outcomes is a promising development with potential to improve quality governance in the Italian healthcare system.
authors.affiliation: Agenzia regionale di sanità della Toscana, Florence, Italy; Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Rosa
authors.initials: R
authors.lastname: Gini
authors.affiliation: Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Martijn J
authors.initials: MJ
authors.lastname: Schuemie
authors.affiliation: Agenzia regionale di sanità della Toscana, Florence, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Francesconi
authors.affiliation: Società italiana di medicina generale, Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Lapi
authors.affiliation: Genomedics, Florence, Italy.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Cricelli
authors.affiliation: Genomedics, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pasqua
authors.affiliation: Unità Locale Socio Sanitaria Padova, Padua, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Gallina
authors.affiliation: Unità Locale Socio Sanitaria Padova, Padua, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Donato
authors.affiliation: Azienda Sanitaria Provinciale Ragusa, Ragusa, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.affiliation: Assessorato Politiche per la Salute, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Donatini
authors.affiliation: Zona Territoriale Senigallia, Senigallia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marini
authors.affiliation: Società italiana di medicina generale, Florence, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Cricelli
authors.affiliation: Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Damiani
authors.affiliation: Agenzia Nazionale per il Servizi Sanitari Regionali, Rome, Italy.
authors.forename: Mariadonata
authors.initials: M
authors.lastname: Bellentani
authors.affiliation: Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Johan
authors.initials: J
authors.lastname: van der Lei
authors.affiliation: Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Miriam C J M
authors.initials: MC
authors.lastname: Sturkenboom
authors.affiliation: Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Niek S
authors.initials: NS
authors.lastname: Klazinga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D016208:Databases, Factual / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005843:Geography; D062306:Geography, Medical / Q000379:methods / Q000706:statistics & numerical data; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000628:therapy*; D011320:Primary Health Care / Q000706:statistics & numerical data; D059039:Standard of Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D055815:Young Adult