Monitoring the performance of local health authorities in start of long term care program in Toscana

Background The prompt recognition of needs for long term care (LTC) and management of the elderly disable patients remains a challenge among health organizations. An evaluation process requires time and good organizational approach. This study explores the relationship between the evaluation process and hospitalization before the start of a LTC program, comparing different local health authorities (LHAs). Methods Data from administrative flows in Toscana, Italy, were used. The observation period was January 1, 2012 and December 31, 2013. Inclusion criteria were age >65 years. Poisson regression analysis was performed to estimate the Rate Ratio (RR) of hospitalization before the start of the LTC, adjusting for age, sex, disease severity, presence of chronic conditions, number of drugs and care network. Deviation from means coding was used to create a dummy variable for each LHA. Thus, RR compares the rate of hospitalization of each unit compared to the regional average. Results In this study 12 LHAs with 11498 patients were included. There is a wide variation in the rate of hospitalization among LHAs, with RR ranging from 0.30 (CI95% 0.22-2.39) to 2.26 (CI95% 1.83-2.79). Results suggest that there are five LHAs in which patients have significantly higher RRs of acute hospital admission than the baseline. On the contrary there is one LHA that has significantly smaller RR of acute hospital admission than the regional average in Toscana. Conclusions The results showed wide differences among LHAs in the rate of hospitalization of patients destined to LTC. These findings can encourage the application of this methodology for public reporting in the assessment for entry in a LTC program. Key message: Monitoring the performance of local health authorities is giving us possibility to understand if evaluation procedure for start of long term care program is effective or needs to be improved