1
|
Dealing with COVID-19 Epidemic in Italy: Responses from Regional Organizational Models during the First Phase of the Epidemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18095008. [PMID: 34065117 PMCID: PMC8125969 DOI: 10.3390/ijerph18095008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 11/23/2022]
Abstract
As the COVID-19 outbreak traveled through various Italian regions, all national and local administrations issued measures to counter the spread of the contagion and organize healthcare. The Italian healthcare system is, indeed, a decentralized system with 21 regional health systems (RHSs), with different models of healthcare service delivery and organization. This study investigates whether a different organization of RHSs would have led to different management of the COVID-19 epidemic, and evaluates the effect of different approaches in epidemic management on the COVID-19 epidemiological trend. A set of indicators is identified by conducting an online synchronous Focus Group, involving an experts panel. A Pearson’s correlation test was performed on the values assumed by the historical series of indicators investigate correlations among the trends represented by the indicators or between them and external factors. The comparison between the experiences of the different Italian regions, regarding the management of the epidemic, has helped to confirm and emphasize the importance of a community-based approach in health care—integrated with the hospital’s functions for the care of complex conditions and the need for specialized assistance.
Collapse
|
2
|
de Jong M, Peters SAE, de Ritter R, van der Kallen CJH, Sep SJS, Woodward M, Stehouwer CDA, Bots ML, Vos RC. Sex Disparities in Cardiovascular Risk Factor Assessment and Screening for Diabetes-Related Complications in Individuals With Diabetes: A Systematic Review. Front Endocrinol (Lausanne) 2021; 12:617902. [PMID: 33859615 PMCID: PMC8043152 DOI: 10.3389/fendo.2021.617902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Insight in sex disparities in the detection of cardiovascular risk factors and diabetes-related complications may improve diabetes care. The aim of this systematic review is to study whether sex disparities exist in the assessment of cardiovascular risk factors and screening for diabetes-related complications. Methods PubMed was systematically searched up to April 2020, followed by manual reference screening and citations checks (snowballing) using Google Scholar. Observational studies were included if they reported on the assessment of cardiovascular risk factors (HbA1c, lipids, blood pressure, smoking status, or BMI) and/or screening for nephropathy, retinopathy, or performance of feet examinations, in men and women with diabetes separately. Studies adjusting their analyses for at least age, or when age was considered as a covariable but left out from the final analyses for various reasons (i.e. backward selection), were included for qualitative analyses. No meta-analyses were planned because substantial heterogeneity between studies was expected. A modified Newcastle-Ottawa Quality Assessment Scale for cohort studies was used to assess risk of bias. Results Overall, 81 studies were included. The majority of the included studies were from Europe or North America (84%).The number of individuals per study ranged from 200 to 3,135,019 and data were extracted from various data sources in a variety of settings. Screening rates varied considerably across studies. For example, screening rates for retinopathy ranged from 13% to 90%, with half the studies reporting screening rates less than 50%. Mixed findings were found regarding the presence, magnitude, and direction of sex disparities with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, with some evidence suggesting that women, compared with men, may be more likely to receive retinopathy screening and less likely to receive foot exams. Conclusion Overall, no consistent pattern favoring men or women was found with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, and screening rates can be improved for both sexes.
Collapse
Affiliation(s)
- Marit de Jong
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Sanne A. E. Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Rianneke de Ritter
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Carla J. H. van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Simone J. S. Sep
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, Netherlands
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Coen D. A. Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Rimke C. Vos
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department Public Health and Primary Care / LUMC-Campus The Hagua, Leiden University Medical Center, Hague, Netherlands
| |
Collapse
|
3
|
Salinas M, López-Garrigós M, Flores E, Lugo J, Leiva-Salinas C. Laboratory Computer-Based Interventions for Better Adherence to Guidelines in the Diagnosis and Monitoring of Type 2 Diabetes. Diabetes Ther 2019; 10:995-1003. [PMID: 30924078 PMCID: PMC6531594 DOI: 10.1007/s13300-019-0600-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The aim was to present two automated laboratory strategies designed to detect new cases of type 2 diabetes and prediabetes and improve their monitoring. METHODS To improve diabetes diagnosis, we automatically registered the glycated hemoglobin (HbA1c) levels of every primary care patient between 25 and 46 years old in case of abnormal lipid testing when an HbA1c test had not been requested in the current order or during the previous year and when fasting glucose was > 100 mg/dl. We counted the number of detected cases of diabetes and prediabetes and calculated the cost per identified patient. To improve diabetes monitoring, the levels of HbA1c, total cholesterol, high- and low-density lipoprotein cholesterol and triglycerides and the spot urinary albumin-to-creatinine ratios (ACRs) were automatically registered in patients with diabetes when not ordered according to guidelines. We calculated the total economic costs according to the total number of additional registered tests and reagent cost. RESULTS Of 103,425 requests, 224 (0.22%) met the inclusion criteria. Seventeen (7.6%) patients were identified as having new cases of diabetes and 149 (66.5%) of prediabetes, at a cost of €15.2 and €2.3, respectively, per case detected. From 13,874 requests in patients with diabetes, 91 HbA1c and 708 lipid tests and 862 ACRs were automatically registered to comply with guidelines, resulting in expenses of €1948.90. CONCLUSIONS Making use of laboratory technology, it is possible to detect new cases of type 2 diabetes and prediabetes and to improve disease monitoring.
Collapse
Affiliation(s)
- Maria Salinas
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain.
- Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain.
| | - Maite López-Garrigós
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain
| | - Emilio Flores
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain
- Department of Clinical Medicine, Universidad Miguel Hernandez, Elche, Spain
| | - Javier Lugo
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain
| | | |
Collapse
|
4
|
Tucker JL, Zoberi KA, Hooks-Anderson DR, Salas J, Scherrer JF. Race in Older but Not Younger Patients Associated With Greater Glycemic Burden in Primary Care Patients. DIABETES EDUCATOR 2018; 44:549-557. [PMID: 30328788 DOI: 10.1177/0145721718805691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study is to determine if race disparities in glycemic control differ in young vs older white and African American patients with diabetes. METHODS Electronic medical record data were gathered from 1431 primary care patients ≥18 years old, diagnosed with type 2 diabetes, who had ≥2 A1C measurements between July 1, 2008, and June 30, 2015. A1C values were used to compute the average monthly glycemic burden (AMGB). AMGB is the average monthly cumulative amount of A1C >7.5. Age-stratified (18-50 vs >50 years old) linear regression models were computed to measure the association between race and AMGB before and after adjusting for covariates. RESULTS Younger compared to older patients had significantly greater AMGB. In younger patients, AMGB was not significantly different in African American vs white patients. In older patients, African Americans had significantly greater AMGB compared to whites, and this association remained significant after adjusting for all covariates in a linear regression model. CONCLUSIONS Results narrow the known race disparity in glycemic control to older African American patients. Substantial AMGB in white and African American younger patients warrants aggressive clinical and public health interventions that could help patients manage their diabetes and reduce their risk for diabetes-related health conditions.
Collapse
Affiliation(s)
- Jane L Tucker
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, MO
| | - Kimberly A Zoberi
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, MO
| | - Denise R Hooks-Anderson
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, MO
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, MO
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, MO
| |
Collapse
|
5
|
Mapping the Gaps: Gender Differences in Preventive Cardiovascular Care among Managed Care Members in Four Metropolitan Areas. Womens Health Issues 2018; 28:446-455. [PMID: 29929865 DOI: 10.1016/j.whi.2018.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 03/21/2018] [Accepted: 04/20/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Prior research documents gender gaps in cardiovascular risk management, with women receiving poorer quality routine care on average, even in managed care systems. Although population health management tools and quality improvement efforts have led to better overall care quality and narrowing of racial/ethnic gaps for a variety of measures, we sought to quantify persistent gender gaps in cardiovascular risk management and to assess the performance of routinely used commercial population health management tools in helping systems narrow gender gaps. METHODS Using 2013 through 2014 claims and enrollment data from more than 1 million members of a large national health insurance plan, we assessed performance on seven evidence-based quality measures for the management of coronary artery disease and diabetes mellitus, a cardiac risk factor, across and within four metropolitan areas. We used logistic regression to adjust for region, demographics, and risk factors commonly tracked in population health management tools. FINDINGS Low-density lipoprotein (LDL) cholesterol control (LDL < 100 mg/dL) rates were 5 and 15 percentage points lower for women than men with diabetes mellitus (p < .0001), and coronary artery disease (p < .0001), respectively. Adjusted analyses showed women were more likely to have gaps in LDL control, with an odds ratio of 1.31 (95% confidence interval, 1.27-1.38) in diabetes mellitus and 1.88 (95% confidence interval, 1.65-2.10) in coronary artery disease. CONCLUSIONS Given our findings that gender gaps persist across both clinical and geographic variation, we identified additional steps health plans can take to reduce disparities. For measures where gaps have been consistently identified, we recommend that gender-stratified quality reporting and analysis be used to complement widely used algorithms to identify individuals with unmet needs for referral to population health and wellness behavior support programs.
Collapse
|
6
|
He M, Gao J, Liu W, Tang X, Tang S, Long Q. Case management of patients with Type 2 diabetes mellitus: a cross-sectional survey in Chongqing, China. BMC Health Serv Res 2017; 17:129. [PMID: 28187724 PMCID: PMC5303217 DOI: 10.1186/s12913-017-2039-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 01/19/2017] [Indexed: 11/29/2022] Open
Abstract
Background Type 2 diabetes mellitus has been identified as one of the priority diseases and included in the essential public health service package in China. This study investigated the frequency of follow-up visits and contents of care for case management of patients with Type 2 diabetes in Chongqing located in the western China, in terms of the regional practice guideline; and analyzed factors associated with the use of care. Methods A cross-sectional survey was conducted with patients diagnosed with Type 2 diabetes in two areas in Chongqing. Total 502 participants (out of 664 people eligible) completed the interview. The outcome measures included at least four follow-up visits in a year, annual HbA1c test, blood lipid test and diabetic screening for nephropathy and eyes. Logistic regression analysis was applied to examine the association between participants’ demographic and socio-economic characteristics and outcome measures. Results Over the one-year study period, 65% of participants had four or more follow-up visits. In light of the recommended tests, the proportions of having HbA1c test, blood lipid test and screening for nephropathy and eyes annually were 8, 54, 45 and 44%, respectively. After adjusting for study sites, age, sex, education, type of residence, level of income, the patients who were covered by Urban Employee Basic Medical Insurance, were enrolled in the targeted disease reimbursement program, and lived with diabetes more than five years were more likely to have regular follow-up visits and the recommended tests. Conclusions Case management for patients with Type 2 diabetes mellitus was not effectively implemented in terms of frequency of follow-up visits and recommended tests over one-year period, as indicated in the regional practice guideline.
Collapse
Affiliation(s)
- Miao He
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Research Center for Medicine and Social Development, Chongqing Medical University, No.1 Yixueyuan Road, Chongqing, Yuzhong district, 400016, People's Republic of China
| | - Jiaqi Gao
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Research Center for Medicine and Social Development, Chongqing Medical University, No.1 Yixueyuan Road, Chongqing, Yuzhong district, 400016, People's Republic of China
| | - Weiwei Liu
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Research Center for Medicine and Social Development, Chongqing Medical University, No.1 Yixueyuan Road, Chongqing, Yuzhong district, 400016, People's Republic of China
| | - Xiaojun Tang
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Research Center for Medicine and Social Development, Chongqing Medical University, No.1 Yixueyuan Road, Chongqing, Yuzhong district, 400016, People's Republic of China.
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Qian Long
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Global Health Research Center, Duke Kunshan University, Kunshan, China
| |
Collapse
|
7
|
Seghieri G, Policardo L, Profili F, Francesconi P, Anichini R, Del Prato S. Hospital incidental diagnosis of diabetes: A population study. J Diabetes Complications 2016; 30:457-61. [PMID: 26782024 DOI: 10.1016/j.jdiacomp.2015.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 12/06/2015] [Accepted: 12/09/2015] [Indexed: 01/30/2023]
Abstract
AIMS To identify incidental previously unrecognized diabetes (IPUD) among hospitalized patients and corresponding mortality risk in comparison with individuals with known diabetes (KDM). METHODS Out of 214,991 individuals discharged in year 2011 from all hospitals of Tuscany, Italy we retrospectively identified IPUD as individuals with no known diabetes and/or previous antidiabetic medication, receiving at least two prescriptions of glucose-lowering-drugs over the next 6months after discharge. Two-year (2012-2013) adjusted mortality risk was tested by a Cox-regression-analysis, comparing IPUD and KDM patients with at least one hospital admission in 2011. RESULTS 974 patients with IPUD (375.6×100,000 hospitalized people) have been identified. IPUD risk was associated with aging, male gender and greater burden of co-morbidities, was higher in migrants of non-Italian ancestry and was reduced among patients of family physicians adhering to guidelines resulting in a proactive model of care delivery. In IPUD patients alive at 1st January 2012, (n=865) the adjusted risk of two-year mortality was similar to that of KDM subjects (HR=1.08; 95% CI: 0.92-1.26; p=NS). CONCLUSIONS IPUD occurs more commonly in older male subjects, migrants of non-Italian ancestry, and among patients of physicians non-adhering to a shared diabetes care model. People with IPUD have similar two-year-mortality risk compared with KDM individuals.
Collapse
Affiliation(s)
| | | | | | | | - Roberto Anichini
- Diabetes Unit, Department of Internal Medicine, Azienda USL 3, Pistoia, Italy
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Pisa, Italy
| |
Collapse
|
8
|
Buja A, Solinas G, Visca M, Federico B, Gini R, Baldo V, Francesconi P, Sartor G, Bellentani M, Damiani G. Prevalence of Heart Failure and Adherence to Process Indicators: Which Socio-Demographic Determinants are Involved? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:238. [PMID: 26907316 PMCID: PMC4772258 DOI: 10.3390/ijerph13020238] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/22/2016] [Accepted: 02/03/2016] [Indexed: 11/19/2022]
Abstract
Interest in chronic conditions reflects their role as the first cause of death and disability in developed countries; improving the management of these conditions is a priority for health care services. The aim of this study was to establish which sociodemographic factors influence adherence to standards of care for chronic heart failure (CHF). A generalized multilevel structural equation model was developed and applied to a sample of patients with CHF obtained from administrative data flows in six Italian regions to ascertain any associations between adherence to standards of care for CHF and sociodemographic variables. Indicators of compliance were adherence to beta-blocker therapy (BB-A) and Angiotensin Convertin Enzime inhibitor/Angiotensin Receptor Blocker therapy (ACE-A), and creatinine and electrolyte testing (CNK-T). All indicators were computed over a one-year follow-up. Among a cohort of 24,997 patients, the BB-A rate was 40.4%, the ACE-A rate 61.1%, and the CNK-T rate 57.0%. Factors found associated with adherence were gender, age, and citizenship. Our study shows an inadequate adherence to standards of care for CHF, particularly associated with certain sociodemographic characteristics. This suggests the need to improve the role of primary care in managing this chronic condition. The measures considered only apply to patients with a reduced Left Ventricular Ejection Fraction, hence a limitation of this analysis is the lack of information on left ventricular ejection.
Collapse
Affiliation(s)
- Alessandra Buja
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padova, 35122 Padova, Italy.
| | - Giuliana Solinas
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy.
| | - Modesta Visca
- Agenas, National Agency for Health Services, 00187 Rome, Italy.
| | - Bruno Federico
- Department of Human Sciences, Social and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy.
| | - Rosa Gini
- Regional Health Agency of Tuscany, 50141 Firenze, Italy.
| | - Vincenzo Baldo
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padova, 35122 Padova, Italy.
| | | | - Gino Sartor
- Faculty of Medicine, University of Padova, 35122 Padova, Italy.
| | | | - Gianfranco Damiani
- Department of Public Health, Università Cattolica del Sacro Cuore in Rome, 00168 Rome, Italy.
| |
Collapse
|
9
|
Gini R, Schuemie M, Brown J, Ryan P, Vacchi E, Coppola M, Cazzola W, Coloma P, Berni R, Diallo G, Oliveira JL, Avillach P, Trifirò G, Rijnbeek P, Bellentani M, van Der Lei J, Klazinga N, Sturkenboom M. Data Extraction and Management in Networks of Observational Health Care Databases for Scientific Research: A Comparison of EU-ADR, OMOP, Mini-Sentinel and MATRICE Strategies. EGEMS 2016; 4:1189. [PMID: 27014709 PMCID: PMC4780748 DOI: 10.13063/2327-9214.1189] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Introduction: We see increased use of existing observational data in order to achieve fast and transparent production of empirical evidence in health care research. Multiple databases are often used to increase power, to assess rare exposures or outcomes, or to study diverse populations. For privacy and sociological reasons, original data on individual subjects can’t be shared, requiring a distributed network approach where data processing is performed prior to data sharing. Case Descriptions and Variation Among Sites: We created a conceptual framework distinguishing three steps in local data processing: (1) data reorganization into a data structure common across the network; (2) derivation of study variables not present in original data; and (3) application of study design to transform longitudinal data into aggregated data sets for statistical analysis. We applied this framework to four case studies to identify similarities and differences in the United States and Europe: Exploring and Understanding Adverse Drug Reactions by Integrative Mining of Clinical Records and Biomedical Knowledge (EU-ADR), Observational Medical Outcomes Partnership (OMOP), the Food and Drug Administration’s (FDA’s) Mini-Sentinel, and the Italian network—the Integration of Content Management Information on the Territory of Patients with Complex Diseases or with Chronic Conditions (MATRICE). Findings: National networks (OMOP, Mini-Sentinel, MATRICE) all adopted shared procedures for local data reorganization. The multinational EU-ADR network needed locally defined procedures to reorganize its heterogeneous data into a common structure. Derivation of new data elements was centrally defined in all networks but the procedure was not shared in EU-ADR. Application of study design was a common and shared procedure in all the case studies. Computer procedures were embodied in different programming languages, including SAS, R, SQL, Java, and C++. Conclusion: Using our conceptual framework we found several areas that would benefit from research to identify optimal standards for production of empirical knowledge from existing databases.an opportunity to advance evidence-based care management. In addition, formalized CM outcomes assessment methodologies will enable us to compare CM effectiveness across health delivery settings.
Collapse
Affiliation(s)
- Rosa Gini
- Agenzia Regionale di Sanità della Toscana; Erasmus MC University Medical Center
| | - Martijn Schuemie
- Janssen Research & Development, Epidemiology; Observational Health Data Sciences and Informatics (OHDSI)
| | | | - Patrick Ryan
- Janssen Research & Development, Epidemiology; Observational Health Data Sciences and Informatics (OHDSI)
| | - Edoardo Vacchi
- Università degli Studi di Milano, Dipartimento di Informatica
| | - Massimo Coppola
- Consiglio Nazionale delle Ricerche, Istituto di Scienza e Tecnologie dell'Informazione
| | - Walter Cazzola
- Università degli Studi di Milano, Dipartimento di Informatica
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Seghieri C, Policardo L, Francesconi P, Seghieri G. Gender differences in the relationship between diabetes process of care indicators and cardiovascular outcomes. Eur J Public Health 2015; 26:219-24. [DOI: 10.1093/eurpub/ckv159] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
11
|
Multimorbidity and Patient Safety Incidents in Primary Care: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0135947. [PMID: 26317435 PMCID: PMC4552710 DOI: 10.1371/journal.pone.0135947] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/29/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Multimorbidity is increasingly prevalent and represents a major challenge in primary care. Patients with multimorbidity are potentially more likely to experience safety incidents due to the complexity of their needs and frequency of their interactions with health services. However, rigorous syntheses of the link between patient safety incidents and multimorbidity are not available. This review examined the relationship between multimorbidity and patient safety incidents in primary care. METHODS We followed our published protocol (PROSPERO registration number: CRD42014007434). Medline, Embase and CINAHL were searched up to May 2015. Study design and quality were assessed. Odds ratios (OR) and 95% confidence intervals (95% CIs) were calculated for the associations between multimorbidity and two categories of patient safety outcomes: 'active patient safety incidents' (such as adverse drug events and medical complications) and 'precursors of safety incidents' (such as prescription errors, medication non-adherence, poor quality of care and diagnostic errors). Meta-analyses using random effects models were undertaken. RESULTS Eighty six relevant comparisons from 75 studies were included in the analysis. Meta-analysis demonstrated that physical-mental multimorbidity was associated with an increased risk for 'active patient safety incidents' (OR = 2.39, 95% CI = 1.40 to 3.38) and 'precursors of safety incidents' (OR = 1.69, 95% CI = 1.36 to 2.03). Physical multimorbidity was associated with an increased risk for active safety incidents (OR = 1.63, 95% CI = 1.45 to 1.80) but was not associated with precursors of safety incidents (OR = 1.02, 95% CI = 0.90 to 1.13). Statistical heterogeneity was high and the methodological quality of the studies was generally low. CONCLUSIONS The association between multimorbidity and patient safety is complex, and varies by type of multimorbidity and type of safety incident. Our analyses suggest that multimorbidity involving mental health may be a key driver of safety incidents, which has important implication for the design and targeting of interventions to improve safety. High quality studies examining the mechanisms of patient safety incidents in patients with multimorbidity are needed, with the goal of promoting effective service delivery and ameliorating threats to safety in this group of patients.
Collapse
|
12
|
Ricci-Cabello I, Violán C, Foguet-Boreu Q, Mounce LTA, Valderas JM. Impact of multi-morbidity on quality of healthcare and its implications for health policy, research and clinical practice. A scoping review. Eur J Gen Pract 2015; 21:192-202. [PMID: 26232238 DOI: 10.3109/13814788.2015.1046046] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The simultaneous presence of multiple conditions in one patient (multi-morbidity) is a key challenge facing healthcare systems globally. It potentially threatens the coordination, continuity and safety of care. In this paper, we report the results of a scoping review examining the impact of multi-morbidity on the quality of healthcare. We used its results as a basis for a discussion of the challenges that research in this area is currently facing. In addition, we discuss its implications for health policy and clinical practice. The review identified 37 studies focussing on multi-morbidity but using conceptually different approaches. Studies focusing on 'comorbidity' (i.e. the 'index disease' approach) suggested that quality may be enhanced in the presence of synergistic conditions, and impaired by antagonistic or neutral conditions. Studies on 'multi-morbidity' (i.e. multiplicity of problems) and 'morbidity burden' (i.e. the total severity of conditions) suggested that increasing number of conditions and severity may be associated with better quality of healthcare when measured by process or intermediate outcome indicators, but with worse quality when patient-centred measures are used. However, issues related to the conceptualization and measurement of multi-morbidity (inconsistent across studies) and of healthcare quality (restricted to evaluations for each separate condition without incorporating considerations about multi-morbidity itself and its implications for management) compromised the generalizability of these observations. Until these issues are addressed and robust evidence becomes available, clinicians should apply minimally invasive and patient-centred medicine when delivering care for clinically complex patients. Health systems should focus on enhancing primary care centred coordination and continuity of care.
Collapse
Affiliation(s)
- Ignacio Ricci-Cabello
- a Nuffield Department of Primary Care Health Sciences , University of Oxford , Oxford , UK
| | - Concepció Violán
- b Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain.,c Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès) , Spain
| | - Quinti Foguet-Boreu
- b Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain.,c Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès) , Spain.,d Department of Medical Sciences , School of Medicine, University of Girona , Girona , Spain
| | - Luke T A Mounce
- e Institute for Health Research, University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter , Exeter , UK
| | - Jose M Valderas
- a Nuffield Department of Primary Care Health Sciences , University of Oxford , Oxford , UK.,b Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain.,c Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès) , Spain.,e Institute for Health Research, University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter , Exeter , UK.,f CIBER en Epidemiologia y Salud P blica (CIBERESP) , Barcelona , Spain
| |
Collapse
|