Objectives

• To outline improved methods for measuring performance in secondary care settings, which are central to hospital quality improvement, linking performance measurement with related organizational models

• To identify which and to which extent organizational/contextual factors impact the benefit generated by health technologies

• To produce a standardized method to measure the clinical variability with respect to the different organizational models in secondary care settings based on evidence from a selection of therapeutic areas

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Methodology

• Based on a prior extensive literature review, multiple case studies and quantitative methods (e.g. regression analysis) will be applied to identify a minimum set of indicators capturing variability in hospital performance

• A pilot study involving a network of collaborating hospitals will validate the methodology and the tool developed through a multiple case study approach

• Based on this, and building on AdHopHTA (www.adhophta.eu), a standard approach to assess organizational factors affecting health technologies’ effectiveness and the subsequent variability in the cost of care will be inferred

• Literature research and analysis on relationship between clinical decision making and organizational factors

• Analysis of two case studies: (1) Diagnostic use of high sensitivity troponin and its impact on NSTEMI myocardial infarction (Non-ST elevation myocardial infarction) diagnosis and treatment; (2) Use of robotic surgery with Da Vinci Robot

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Outputs​

• Deliverable D8.1: Toolkit including a list of relevant indicators to capture hospital performance variability and Toolkit to assess the transferability of evidence produced in other jurisdictions and decision-making levels [PDF]
   

• Analysis of economic evaluation methods for hospital-based assessment – Questionnaire [excel document]
   

• List of Indicators [PDF]
   

• Toolkit to capture hospital performance variability [excel document]
   

• Toolkit to assess transferability of evidence produced in other jurisdictions https://altems.unicatt.it/altems-ricerca-a-toolkit-to-assess-the-transferability-of-evidence-produced-in-other-jurisdictions
   

• Deliverable D8.2: Toolkit of instruments to identify the clinical variability and its impact on the use of health technology [PDF]
   

• Efficiency evaluation model for the assessment of clinical variation – Hip replacement [xslm document zip]
   

• Efficiency evaluation model for the assessment of clinical variation – Knee replacement [xslm document zip]

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Publications

• Carini E, Gabutti I, Frisicale EM, Di Pilla A, Pezzullo AM, De Waure C, Cicchetti A, Boccia S, Specchia ML (2020) Assessing hospital performance indicators. What dimensions? Evidence from an umbrella review. BMC Health Services Research. https://doi.org/10.1186/s12913-020-05879-y
   

• Grossi A, Hoxhaj I, Gabutti I, Specchia ML, Cicchetti A, Boccia S, De Waure C (2021) Hospital contextual factors affecting the implementation of health technologies: a systematic review. BMC Health Services Research. https://doi.org/10.1186/s12913-021-06423-2
   

• Gabutti I (2021). Driving health technologies towards performance: a contextualisation within the hospital setting. International Journal of Technology, Policy and Management. [https://doi.org/10.1504/IJTPM.2021.10043140]