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6 Art. 15 comma 25 bis. L.135/2012 For the purpose of National Outcome Ai fini della attivazione dei programmi nazionali di valutazione sull'applicazione delle norme Evaluation di cui presente programs, articolo, the il Ministry Ministeroof della salute provvede alla modifica ed integrazione di tutti i sistemi informativi Health modifies and integrates all NHS del Servizio sanitario nazionale, anche quando gestiti da diverse amministrazioni dello Stato, informations ed alla interconnessione systems on a livello an individual nazionale di tutti i flussi informativi basis.the su base National individuale. Agency Il complesso for Regional delle informazioni e dei dati individuali Healthcosì Services ottenuti has e' reso access disponibile to the per le attività di valutazione esclusivamente in anonima ai sensi interconnected information systems dell'articolo 35 del decreto legislativo 23 giugno 2011, n Il Ministero della salute si avvale dell'agenas per lo svolgimento delle funzioni di valutazione degli esiti delle prestazioni assistenziali e delle procedure medico chirurgiche nell'ambito del Servizio sanitario nazionale. A tal fine, AGENAS accede, in tutte le fasi della loro gestione, ai sistemi informativi interconnessi del Servizio sanitario nazionale di cui al presente comma in modalità anonima.

7 it provides «warnings» for The National Outcome Evaluation Programme «relevant» measures differences the in outcome variability among providers and/or outcomes.art.12 National regulation on health care local units in Italy Health agreement /2014 Outcome measures by Hospital/ Local Health Unit Audit tools Report Card ER Information by Hospital/ System Local Health Unit Pilot studies

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9 Distance Learning programme PNE Participants (12 months online)

10 Coronary artery bypass graft (CABG): 30-day mortality. Italy

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12 Coronary artery bypass graft (CABG): 30-day mortality >5% Audit ongoing on quality of data

13 Coronary artery bypass graft (isolated): 30-day mortality

14 Clinical audit on heart surgery based on Outcome Data, Tuscany Riccardo Tartaglia, MD, Eur-Erg Tommaso Bellandi, PhD, Eur-Erg

15 Valvuloplasty: 30-day mortality. 2013

16 Valvuloplasty: 30-day mortality. 2013

17 Valvuloplasty: 30-day mortality - Italy Information for patients??? the risk of dying in the month following valvuloplasty in the Fazzi hospital is about 11 times higher than the nearby clinic

18 Distance 5km 10 min

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20 Coronary artery bypass graft (CABG):; Volume of care and 30 days mortality Italy 2011

21 Valvuloplasty: Volume of admissions 2013 HOSPITAL PROVIN CE REGION N Italia ITALIA Osp. V. Fazzi LE PUGLIA 114 A.O.SSN Consorziale Policlinico BA PUGLIA 195 CCA S. Maria BA PUGLIA 307 CCA Anthea BA PUGLIA 396 CCA CBH Villa Bianca BA PUGLIA 310 CCA Città di Lecce LE PUGLIA 321 CCA Villa Verde SNC TA PUGLIA 136

22 Coronary artery bypass graft (CABG):; Volume of admissions. Italy /112 hospitals >200/year

23 30 day mortality after surgery for stomach cancer by volume of interventions

24 30 DAY MORTALITY AFTER SURGERY FOR STOMACH CANCER:VOLUME OF INTERVENTIONS 108 / 662 hospitals (16%) > 20

25 Health impact assessment volume of surgery by ward- 30 day mortality. PNE 2011 Surgery for stomach cancer by ward N % Ϯ Total > 10/year <= 10 /year * 2.7 = deaths Surgery for colon cancer by ward N % Ϯ Total > 25 /year <= 25/year * 3.2 = deaths

26 30 DAY MORTALITY AFTER SURGERY FOR STOMACH CANCER:VOLUME OF INTERVENTIONS Information for policy makers??? 108 / 662 hospitals (16%) > 20

27 REGULATORY DOCUMENT ON QUALITATIVE, STRUCTURAL, TECNOLOCICAL AND QUANTITATIVE STANDARD OF HOSPITAL CARE

28 VOLUME OF ADMISSIONS

29 OUTCOME

30 Laparoscopic cholecystectomy : complications within 30 days. Italy 2013

31 OUTCOME EVALUATION PROGRAMMES Education and training of healthcare professionals Patient empowerment The outcome measures represent assessment tools to support clinical and organizational audit programs aimed at improving both effectiveness, and safety in the NHS. Outcome measures Audit Report Card ER Information Reporting and by Hospital/ learning tools by Hospital/ systems System Local Health Unit Local Health Unit Pilot studies Policies and programmes on patient safety