Measuring the quality of care in small countries: the empirical analysis of 30-day mortality following acute myocardial infarction and ischaemic stroke in Latvia. Issue 7 (July 2020)

• Record Type: Journal Article
• Authors: Lenzi, Jacopo; Noto, Guido; Corazza, Ilaria; Lepiksone, Jana; Fantini, Maria Pia
• Is Part Of: Health policy. Volume 124:Issue 7(2020)
• Page Start: 695
• Page End: 700
• Publication Date: 2020-07
• Subjects: Quality of care -- Performance -- Small Countries -- Health System Governance -- Hospital; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2020.05.017
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: Evaluating the quality of care in small countries is a challenge and an opportunity. A tailored approach was built to compare hospital performance within Latvia. The funnel plot allows to benchmark small providers against the state average. Correlating hospital rates and structural indicators can foster quality improvement. Cath labs and large caseloads are structural determinants of hospital performance. Abstract: The evaluation of quality of care is a complex task that, over the last decades, has been performed using the Donabedian model as its main conceptual framework. Small countries are an ideal setting in which to make innovative, empirical evaluations of the quality of care. In this research, we discussed the challenges and opportunities of assessing hospital performance in Latvia, a small country in the Baltic region of Northern Europe. The study outcomes were 30-day acute myocardial infarction mortality and 30-day ischaemic stroke mortality. We described how indicator specifications, risk-adjustment, data reliability assessment and graphical representations were tailored to the geographic and institutional context of Latvia. By looking at the impact of structural characteristics on hospital performance, we found that cath labs and large caseloads were significantly associated with lower mortality. This approach allows decision-makers at different governance levels to design and implement actions aimed at improving the quality of care. At the health system level, it may help policy-makers adopt proper strategies to tackle poor outcomes; at the hospital level, it may help managers intervene on structural determinants of performance. Because small countries face some relevant issues that have implications for health care, these analyses might be relevant also for larger countries to improve the design of their health-care services