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Abstract
Objectives The quality of ambulatory care in Switzerland is widely unknown. Therefore, this study aimed to evaluate the recently proposed quality indicators (QIs) based on a nationwide healthcare claims database and determine their association with the risk of subsequent hospitalisation at patient-level.
Design Retrospective cohort study.
Setting Inpatient and outpatient claims data of a large health insurance in Switzerland covering all regions and population strata.
Participants 520 693 patients continuously insured during 2015 and 2016.
Measures A total of 24 QIs were obtained by adapting the existing instruments to the Swiss national context and measuring at patient-level. The association between each QI and hospitalisation in the subsequent year was assessed using multiple logistic regression models.
Results The proportion of patients with good adherence to QIs was high for the secondary prevention of diabetes and myocardial infarction (glycated haemoglobin (HbA1c) control, 89%; aspirin use, 94%) but relatively low for polypharmacy (53%) or using potentially inappropriate medications (PIMs) in the elderly (PIM, 33%). Diabetes-related indicators such as the HbA1c control were significantly associated with a lower risk of hospitalisation (OR, 0.87; 95% CI, 0.80 to 0.95), whereas the occurrence of polypharmacy and PIM increased the risk of hospitalisation in the following year (OR, 1.57/1.08; 95% CI, 1.51 to 1.64/1.05 to 1.12).
Conclusions This is the first study to evaluate the recently presented QIs in Switzerland using nationwide real-life data. Our study suggests that the quality of healthcare, as measured by these QIs, varied. The majority of QIs, in particular QIs reflecting chronic care and medication use, are considered beneficial markers of healthcare quality as they were associated with reduced risk of hospitalisation in the subsequent year. Results from this large practical test on real-life data show the feasibility of these QIs and are beneficial in selecting the appropriate QIs for healthcare implementation in general practice.
- primary care
- quality indicators
- clinical guidelines
- quality in health care
- internal medicine
- public health
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Footnotes
Collaborators The Swiss Quality Indicator for Primary Care (SQIPRICA) Working Group members were: Dr med Felix Huber, Medical Director, MediX Group Practices Zürich, Zürich, Switzerland; Rahel Meier, MSc, Research Associate, Institute of Primary Care, University of Zürich, Switzerland; Dr med Jan von Overbeck, Cantonal Physician, Canton of Bern, Bern, Switzerland; Dr Oliver Reich, Head of Santé24, Swica Insurance, Winterthur, Switzerland; Professor Dr med Thomas Rosemann, Director, Institute of Primary Care, University of Zürich, Switzerland; Felix Schneuwly, Head of Public Affairs Swiss Online Comparative Service Comparis, Zürich, Switzerland; Professor Dr Martin Scherer, Director Department of General Practice/PrimaryCare, Hamburg University Medical School, Hamburg-Eppendorf, Hamburg, Germany; Professor Dr med Oliver Senn, Institute of Primary Care, University of Zürich, Zürich, Switzerland; Med Pract Daniel Tapernoux, Medical Advisor, Swiss Patient Organisation (SPO), Zürich, Switzerland.
Contributors All authors were involved in the study design. CAH, EB and MS conceived and designed the study. RR analysed the data. CAH drafted the manuscript. EB, RR, MS and the members of the Quality Indicator for Primary Care Working Group revised the manuscript. All authors participated in the interpretation of data, critically reviewed for important intellectual contents and gave the final approval of the version to be published.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval According to the national ethical and legal regulation (the Swiss Federal Law of data protection), an ethical approval and patient consent were not required. Analyses were based on anonymised data.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. The data sets analysed in the study are not publicly available because they are part of the confidential Helsana health insurance claims database. Additional information not included in the paper is available from the corresponding author on reasonable request.