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The outcome in hospitalization for geriatric wards: is this a real issue for multilevel model? An Italian case study

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In the Italian national health system, each care unit is allowed to establish its own effectiveness criterion, within a well defined law frame. On the other hand, the central health authority dictates the criteria for hospitalization. The relationship between the combination of effectiveness and appropriateness is here investigated with respect to geriatric wards, belonging to the national health system, within a specific region in Central Italy. In particular, our attention focuses on the evaluation of the healthcare outcome, the outcome itself relying on the patient well-being, where the latter is the result of a complex system of reciprocal relations between patients and healthcare agents. These outcomes can be modeled taking into account both patients traits and wards/hospital settings apt to preserve the inner dynamics of the sets of relations. To this purpose, under a methodological point of view, the evaluation of the healthcare outcome is modeled in terms of risk, where the inclusion of risk adjustments with respect to covariates has been advanced by Goldstein and Spiegelhalter in 1996.The adoption of this model allowed us to differentiate among outcomes, as explicitated by the aforementioned authors, shows how certain outcomes are related to the healthcare structure and others are not. Therefore, multilevel modeling applies to the former case only. When justified, multilevel models in terms of risk adjustments lead to a ranking between wards.

Keywords: well-being, healthcare outcome, multilevel models, geriatric wards, risk, risk adjustment, ranking