# EASY-NET Program: Effectiveness of an Audit and Feedback Intervention in the Emergency Care for Acute Conditions in the Lazio Region

## TL;DR

A new audit and feedback strategy was tested in Italian hospitals to improve emergency care for heart attack and stroke patients, showing reduced readmissions for stroke but no significant changes in other areas.

## Contribution

This study provides the first evidence in Italy on the impact of audit and feedback interventions in emergency care settings using aggregated hospital data.

## Key findings

- The intervention reduced 30-day readmissions for ischemic stroke by 3.80 percentage points in the exposed group.
- No significant differences were observed in other indicators like appropriateness or timeliness of emergency interventions.
- The study used a quasi-experimental design comparing pre- and post-intervention periods with a control group.

## Abstract

The EASY-NET network program (NET-2016-02364191)—effectiveness of audit and feedback (A&F) strategies to improve health practice and equity in various clinical and organizational settings), piloted a novel and more structured A&F strategy. This study compared the effectiveness of the novel strategy against the sole periodic dissemination of indicators in enhancing the appropriateness and timeliness of emergency health interventions for patients diagnosed with acute myocardial infarction (AMI) and ischemic stroke in the Lazio Region. The efficacy of the intervention was assessed through a prospective quasi-experimental design employing a pre- and post-intervention (2021–2022) comparison with a control group. Participating hospitals in the Lazio Region, where professional teams voluntarily engaged in the intervention, constituted the exposed group, while the control group exclusively engaged in routine reporting activities. Effectiveness analysis was conducted at the patient level, utilizing regional health information systems to compute process and outcome indicators. The effectiveness of the intervention was evaluated using difference-in-difference models, comparing pre- and post-intervention periods between exposed and control groups. Estimates were calculated in terms of the difference in percentage points (PP) between absolute risks. Sixteen facilities for the AMI pathway and thirteen for the stroke pathway participated in the intervention. The intervention yielded a reduction in the proportion of 30-day readmissions following hospitalization for ischemic stroke by 0.54 pp in the exposed patients demonstrating a significant difference of −3.80 pp (95% CI: −6.57; −1.03; 5453 patients, 63.7% cases) in the exposed group compared to controls. However, no statistically significant differences attributable to the implemented A&F intervention were observed in other indicators considered. These results represent the first evidence in Italy of the impact of A&F interventions in an emergency setting, utilizing aggregated data from hospitals involved in the Lazio Region’s emergency network.