Evidence-based quality indicators for primary healthcare in association with the risk of hospitalisation: a population-based cohort study in Switzerland

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.

Keywords: clinical guidelines; internal medicine; primary care; public health; quality in health care; quality indicators.

Figure 1

Quality indicators (QI.2–7), general aspects. ATC, anatomical therapeutic chemical; ATII, angiotensin II; DDD, defined daily dose; PPI, proton pump inhibitor.

Figure 2

Quality indicators (QI.8–24), specific aspects. All regression models were controlled for: age, sex, region of residence (rural/urban), Latin-speaking area (yes/no), deductible class (low/high), supplementary/private insurance (yes/no), number of chronic conditions, healthcare costs in the previous year (in cost classes). ASS, aspirin; HbA1c, glycated haemoglobin; NSAIDs, non-steroidal anti-inflammatory drugs; PIM, potentially inappropriate medication.