Audit&Feedback in emergency care: a pre-post intervention study in Lazio (Italy)

BACKGROUND: Within EASY-NET Italian Programme (NET-2016-02364191), we evaluated the effectiveness of a structured Audit & Feedback (A&F) intervention in improving care quality for ST Elevation Myocardial Infarction (STEMI). METHODS: A&F intervention involved sending periodic reports via e-mail to participating hospitals in Lazio Region (about 5 million inhabitans). Volume, process and outcome indicators were calculated by hospital through Health Information System, compared with regional mean and target values. Health managers and clinicians were feedback recipients. Study design: pre-post intervention with control group (web-based regional periodic publication of indicators). Proportion of STEMI treated within 90 minutes with Percutaneous Transluminal Coronary Angioplasty (PTCA) was calculated in 2021 (pre) and in 2022 (post). Patients level adjusted Difference-in-Difference model (DID, 95% CI) was applied. Stepwise procedure identified individual (e.g. age, sex, clinical conditions) and hospital (e.g. hospital type) covariates entering in the model. RESULTS: A total of 19 hospitals were evaluated, 8 as controls. The number of analysed STEMI was 5084 (2651 in 2022) of which 3272 (1731 in 2022) in exposed hospitals. Overall, mean age 66 years, males 74.7%. Proportion treated with PTCA within 90 minutes in 2021 was 55.1% in exposed hospitals, and 57.9% in controls; in 2022 60.0% in exposed hospitals 66.4% in controls. Adjusted percentage difference in post/pre change between exposed and non-exposed hospitals was not significant in univariate and multivariate model (-3.6%, p = 0.218 and -4.4% p = 0.126). CONCLUSIONS: These results cannot demonstrate a difference between exposed and not exposed hospitals. Possible explanations could be the short follow-up evaluated and the influence of covid-19 pandemic. In fact, several hospitals in both exposed and control group still had entire hospital wards dedicated to covid-19 management in 2021. KEY MESSAGES: • A&F methodology designed and implemented in EASY-NET project represents a challenging instrument to promote quality of care. • Monitoring hospital performance through periodical reporting allows continuous quality improvement.