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Di Pilla A, Nero C, Specchia ML, Ciccarone F, Boldrini L, Lenkowicz J, Alberghetti B, Fagotti A, Testa AC, Valentini V, Sala E, Scambia G. A cost-effectiveness analysis of an integrated clinical-radiogenomic screening program for the identification of BRCA 1/2 carriers (e-PROBE study). Sci Rep 2024; 14:928. [PMID: 38195911 PMCID: PMC10776619 DOI: 10.1038/s41598-023-51031-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024] Open
Abstract
Current approach to identify BRCA 1/2 carriers in the general population is ineffective as most of the carriers remain undiagnosed. Radiomics is an emerging tool for large scale quantitative analysis of features from standard diagnostic imaging and has been applied also to identify gene mutational status. The objective of this study was to evaluate the clinical and economic impact of integrating a radiogenomics model with clinical and family history data in identifying BRCA mutation carriers in the general population. This cost-effective analysis compares three different approaches to women selection for BRCA testing: established clinical criteria/family history (model 1); established clinical criteria/family history and the currently available radiogenomic model (49% sensitivity and 87% specificity) based on ultrasound images (model 2); same approach used in model 2 but simulating an improvement of the performances of the radiogenomic model (80% sensitivity and 95% specificity) (model 3). All models were trained with literature data. Direct costs were calculated according to the rates currently used in Italy. The analysis was performed simulating different scenarios on the generation of 18-year-old girls in Italy (274,000 people). The main outcome was to identify the most effective model comparing the number of years of BRCA-cancer healthy life expectancy (HLYs). An incremental cost-effectiveness ratio (ICER) was also derived to determine the cost in order to increase BRCA carriers-healthy life span by 1 year. Compared to model 1, model 2 increases the detection rate of BRCA carriers by 41.8%, reduces the rate of BRCA-related cancers by 23.7%, generating over a 62-year observation period a cost increase by 2.51 €/Year/Person. Moreover, model 3 further increases BRCA carriers detection (+ 68.3%) and decrease in BRCA-related cancers (- 38.4%) is observed compared to model 1. Model 3 increases costs by 0.7 €/Year/Person. After one generation, the estimated ICER in the general population amounts to about 3800€ and 653€ in model 2 and model 3 respectively. Model 2 has a massive effect after only one generation in detecting carriers in the general population with only a small cost increment. The clinical impact is limited mainly due to the current low acceptance rate of risk-reducing surgeries. Further multicentric studies are required before implementing the integrated clinical-radiogenomic model in clinical practice.
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Affiliation(s)
- A Di Pilla
- Dipartimento di Scienze della Vita e Sanità Pubblica - Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Nero
- UOC Ginecologia Oncologica, Dipartimento per le Scienze della salute della donna, del Bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - M L Specchia
- Dipartimento di Scienze della Vita e Sanità Pubblica - Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy.
- Università Cattolica del Sacro Cuore, Rome, Italy.
| | - F Ciccarone
- UOC Ginecologia Oncologica, Dipartimento per le Scienze della salute della donna, del Bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Boldrini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Radiomics Research Core Facility, Gemelli Science and Technology Park, Rome, Italy
| | - J Lenkowicz
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Radiomics Research Core Facility, Gemelli Science and Technology Park, Rome, Italy
| | - B Alberghetti
- UOC Ginecologia Oncologica, Dipartimento per le Scienze della salute della donna, del Bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Fagotti
- UOC Ginecologia Oncologica, Dipartimento per le Scienze della salute della donna, del Bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - A C Testa
- UOC Ginecologia Oncologica, Dipartimento per le Scienze della salute della donna, del Bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - V Valentini
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Radiomics Research Core Facility, Gemelli Science and Technology Park, Rome, Italy
| | - E Sala
- Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Radiologia, Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Scambia
- UOC Ginecologia Oncologica, Dipartimento per le Scienze della salute della donna, del Bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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2
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Specchia ML, Specchia ML, Arcuri G, Di Pilla A, Limongelli P, Salgarello M, Masetti R, Bellantone RDA, Bellantone RDA. Insights on DRGs, guideline compliance and economic sustainability. The case of mastectomy with immediate breast reconstruction. Ann Ig 2023; 35:240-249. [PMID: 35603973 DOI: 10.7416/ai.2022.2524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Immediate breast reconstruction is recommended for eligible patients undergoing mastectomy, raising the issue of economic sustainability of both mastectomy and breast reconstruction performed within the same hospitalization, as opposed to two surgical procedures in two different hospitalizations. Study design A retrospective analysis was conducted to compare economic sustainability of mastectomies with or without immediate breast reconstruction. Methods Economic data on hospitalizations for mastectomy in a Teaching Hospital between 1 January 2019 and 31 March 2021 were analyzed to assess their sustainability. Results 338 admissions were selected (63.9% with immediate breast reconstruction (CI 99%: 57.2% to 70.6%). Compared to mastectomy alone, mastectomy with immediate breast reconstruction had higher cost of € 2,245 (p < 0.001), with operating rooms and devices as main cost drivers. Current reimbursements rates (which are the same for mastectomy alone and for mastectomy with immediate breast reconstruction) led to an average loss of € 1,719 for each mastectomy with immediate breast reconstruction. Conclusion Current DRGs reimbursement rates for hospital admissions for breast cancer surgery do not guarantee immediate breast reconstruction's economic sustainability. DRGs system should be revised, or other solutions as bundled payment should be implemented in the light of the costs of innovation in healthcare, considering mastectomy and breast reconstruction steps in a path of linked actions aimed at improving patients' health.
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Affiliation(s)
- M L Specchia
- Clinical Governance Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - M L Specchia
- Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Roma, Italy
| | - G Arcuri
- Health Technologies and Innovation Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - A Di Pilla
- Clinical Governance Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Roma, Italy
| | - P Limongelli
- Health Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - M Salgarello
- Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Roma, Italy.,Woman, Child and Public Health Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - R Masetti
- Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Roma, Italy.,Woman, Child and Public Health Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - R D A Bellantone
- Clinical Governance Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - R D A Bellantone
- Translational Medicine and Surgery Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Roma, Italy
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Specchia ML, Arcuri G, Di Pilla A, La Gatta E, Osti T, Limongelli P, Scambia G, Bellantone RDA. The value of uterine oncological surgery in a University Hospital. Results of a break-even analysis. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Robotic surgery has many clinical advantages but high costs, raising the issue of healthcare sustainability. This study aims to a comparative analysis of the value, in terms of costs and outcomes, of robotic, laparoscopic, and laparotomy surgery for uterine cancer in a University Hospital.
Methods
An observational retrospective study was carried out on hospitalizations between 1 Jan 2019 and 31 Oct 2021 for uterine cancer surgery. DRG amount, costs, economic margins and 30-days readmissions percentage (mean values and 95% CIs) were calculated for robotic, laparoscopic and laparotomy surgery. Student’s t and Chi-square tests were used to assess differences and the break-even point was calculated.
Results
1336 hospitalizations were analyzed, 366 with robotic, 591 with laparoscopic, and 379 with laparotomy surgery. Robotic surgery compared to laparoscopic and laparotomy ones showed a significant difference (p < 0,001) for economic margin, which was largely negative (-1069.18 €; 95%CI: -1240.44 - -897.92 €) mainly due to devices cost (3549.37 €; 95%CI: 3459.32 € - 3639.43 €), and a lower 30-days readmissions percentage (1.4%; 95%CI: 0.2% - 2.6%) with a significant difference only versus laparotomy (p = 0.029). Laparoscopic compared to laparotomy surgery showed a significantly (p < 0,001) more profitable economic margin (1692.21 €; 95%CI: 1531.75 € - 1852.66 €) without a significant difference for 30-days readmissions. The break-even analysis showed that, on average, for every uterine cancer laparoscopic elective surgery, 1.58 elective robotic surgeries are sustainable for the hospital (95% CI: 1.23 - 2.06).
Conclusions
The systematic application of the break-even analysis will allow defining over time the right distribution of robotic, laparoscopic and laparotomy surgeries’ volumes to perform in order to ensure both quality and economic-financial balance and therefore value of uterine oncological surgery in the University Hospital.
Key messages
• The value-based healthcare approach, defined as the measured improvement in a patient’s health outcomes in relation to its cost, finds effective application in uterine cancer surgery.
• The use of the break-even approach allows to promote the value-based view by identifying a useful criterion for the planning and governance of interventions for uterine malignancies.
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Affiliation(s)
- ML Specchia
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
- Università Cattolica del Sacro Cuore , Rome, Italy
| | - G Arcuri
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
| | - A Di Pilla
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
- Università Cattolica del Sacro Cuore , Rome, Italy
| | - E La Gatta
- Università Cattolica del Sacro Cuore , Rome, Italy
| | - T Osti
- Università Cattolica del Sacro Cuore , Rome, Italy
| | - P Limongelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
| | - G Scambia
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
- Università Cattolica del Sacro Cuore , Rome, Italy
| | - RDA Bellantone
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
- Università Cattolica del Sacro Cuore , Rome, Italy
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4
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Gasparini L, Di Guglielmo F, Borgia M, Nuzzo M, Ursini L, Di Pilla A, Caravatta L, Genovesi D. PO-1455 Oncogeriatric assessment in elderly breast cancer patients: a monoistitutional experience. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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5
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Gasparini L, Borgia M, Trignani M, Di Pilla A, Porreca A, Di Nicola M, Genovesi D. PO-1073 NLR and PLR ratio as predictive markers of outcomes in head and neck squamous cell carcinoma. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Rosa C, Di Tommaso M, Seccia B, Delli Pizzi A, Cianci R, Basilico R, Di Pilla A, Taraborrelli M, Caravatta L, Genovesi D. PO-1093: Defecography for sphincter evaluation in rectal cancer patients irradiated with dose intensification. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01110-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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7
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Zace D, Specchia ML, Di Pilla A, Carini E, Cacciatore P, Frisicale E, Silano M, Ricciardi W, Sassi F. Implementation level of best practice policies by Italian government for healthier food environments. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Government actions play a critical role in shaping healthy food environments, which can improve population's diet and decrease the burden of disease. This study aims to determine and compare the level of policy implementation for healthy food environments in Italy with reference to international benchmarks and make prioritized recommendations based on the identified implementation gaps.
Methods
The Healthy Food Environment Policy Index (Food-EPI) tool from the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) was adapted for the Italian context. This tool includes two components, thirteen domains and fifty good practice indicators, which were verified with experts from National Health Institute (NHI). Evidence for implementation was gathered and summarized for all fifty indicators from data sources such as governmental websites, non-government organizations publications and websites and via direct contact with government officials. After collecting all evidence, experts from the NHI verified the completeness and accuracy of it. The evidence document will be presented to stakeholders, aiming to seek consensus on the priority actions to be implemented by the Italian Government to improve food environments.
Results
The evidence for policy implementation concerning Italy varied among domains and indicators. We found the highest level of evidence within three domains: Food Composition (2/2 indicators), Food Labelling (3/4 indicators) and Food Promotion (4/5 indicators). The domains with less identified evidence were Food Prices (1/4 indicators), Food Retail (0/4 indicators), Food Trade and Investment (0/2 indicators) and Platforms and Interaction (1/4 indicators).
Conclusions
The evidence summarization and the upcoming stakeholders' meeting to rate the level of implementation for each indicator in Italy, have the potential to improve government commitment to shape healthier food environments.
Key messages
Food environment policies, implemented by the government, play a key role in the health of the population, decreasing the burden of disease. Several food environment policies have been implemented and supported by the Italian government but there are still some priority actions to be taken towards healthier food environments.
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Affiliation(s)
- D Zace
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - M L Specchia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Di Pilla
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Carini
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Cacciatore
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Frisicale
- Local Health Authority, ASL ROMA 1, Rome, Italy
| | - M Silano
- National Institute of Health, Italy, Rome, Italy
| | - W Ricciardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Sassi
- Imperial College of Science, Technology and Medicine, London, UK
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8
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Di Serafino F, Pascucci D, Sassano M, Di Pilla A, Carini E, Specchia ML, Ricciardi W, Damiani G. Systematic review on multidisciplinarity and management of multimorbid chronic patients in hospital. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Multimorbidity requires that many physicians shift the focus of the care they provide towards the management of multiple chronic conditions such as heart diseases, diabetes, chronic obstructive pulmonary disease and mental illness. The aim of this systematic review is to summarize the scientific evidence on the effects of Multidisciplinary Teams (MDT) on chronic patients' management in hospital settings, evaluating outcomes, costs and workload.
Medline, Scopus and Ovid were queried for relevant articles using the Population-Intervention-Context-Outcome (PICO) model. Selected articles were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were analyzed using descriptive statistics, and comparison among comorbid patients with at least one mental illness versus those without was performed using Chi-square test (p < 0,05).
Out of 7332 records, 7 studies met the inclusion criteria and 85 indicators were identified: 52% improved significantly, 46% did not show any variation and 2% (nausea and delirium) worsened. In particular, in-hospital mortality was significantly reduced in 65% of the studies describing such indicator. The presence of a mental illness showed a statistically significant increase of length of stay (p < 0,05), hence related to a lower bed-day saving, while no statistically significant effect was observed on 30-day readmissions (p = 0,13). In addition, few studies highlighted that a higher workload leads to greater burn-out rates.
MDT meetings represent a fundamental step in a complex path care. They are useful to discuss clinical cases to define their diagnosis and to formulate shared treatment plans in order to deliver personalized treatment options and appropriate follow-up. These findings should stimulate decision makers to invest in the development of MDT and further research should be conducted to evaluate team efficacy.
Key messages
Successful management of chronic diseases can be enhanced by Multidisciplinary Teams. Caregivers can be involved in this relational process to ensure a better path care.
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Affiliation(s)
| | - D Pascucci
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Sassano
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Di Pilla
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Carini
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - M L Specchia
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico A. Gemelli, Rome, Italy
| | - W Ricciardi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico A. Gemelli, Rome, Italy
| | - G Damiani
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico A. Gemelli, Rome, Italy
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Specchia ML, Cozzolino MR, Carini E, Di Pilla A, Ricciardi W, Damiani G. Leadership styles and job satisfaction. Results of a systematic review. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Healthcare organizations are social systems in which human resources are generally the most important factor for the provision of care. In these contexts, leadership plays a key role in providing effective and efficient care and results in positive outcomes for professionals, patients and work environment. The aim of this review was to identify and analyze the knowledge present to date in literature concerning the correlation between leadership styles and nurses' job satisfaction.
Methods
A systematic review of the literature was carried out on Medline and CINAHL databases between June and October 2019 by using a specific search algorithm. The following inclusion criteria were set: focus on the impact of different leadership styles on nurses' job satisfaction; secondary care; nursing setting; full-text available; English or Italian language.
Results
6681 titles, 410 abstracts and 57 full texts were analyzed. The 12 selected studies considered 7 leadership styles: Transformational, Transactional, Passive-Avoidant, Laissez-Faire, Resonant, Authentic and Servant. Four studies (33%) considered only 1 style, 3 studies (25%) 2 styles, 4 studies (33%) 3 styles and only one study (9%) considered 4 styles. Transformational and Transactional styles were the most represented (75% and 67% respectively). Most of the studies conducted (88%) showed a significant correlation, both positive and negative, between the adopted Leadership style and the nurses' job satisfaction.
Conclusions
In a complex and constantly evolving context, healthcare organizations need to guarantee not only technical and professional competence, but also satisfaction as a motivational lever for health workers. It is therefore necessary to identify and fill the gaps in leadership abilities as a present and future objective in order to positively affect health professionals' job satisfaction and therefore healthcare quality indicators.
Key messages
Job satisfaction plays a key role in healthcare and nursing as a motivational lever for health workers. Leadership styles directly impact on nurses' job satisfaction which in turn affects healthcare quality and patient outcomes.
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Affiliation(s)
- M L Specchia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - E Carini
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Di Pilla
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - W Ricciardi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Damiani
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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10
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Carini E, Bruno S, Di Pilla A, Beccia V, Di Pumpo M, Damiani G, Carducci B, Masini L, Lanzone A, Laurenti P. Influenza vaccination among pregnant women: increasing awareness and coverage. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Influenza is a serious public health issue and pregnant women are one of the categories at higher risk of complications. Vaccination represents a safe and effective tool for prevention but the importance is not well perceived and the coverage is low (ECDC: 25% median in 2016/17). A program of education and free vaccination has been proposed to pregnant women following birthing classes. The aim was to increase pregnant awareness and to increase vaccination coverage of both parents. Classes about vaccinations, their timing and efficacy were given and a dedicated ambulatory operating twice a month during the flu season was set up. After the classes, the women were addressed to the ambulatory to be vaccinated. Vaccination was offered to the partners of the pregnant as well. General data, anamnesis and data about previous vaccinations were asked and then entered into a database.
The number of women participating to the birthing classes from October 2019 to January 2020 was 119. Of those, from the beginning of the vaccination sessions on November 14th 2019 until January 16th 2020, 46 were vaccinated in the dedicated ambulatory (plus 2 in the resident ambulatory of the hospital). The compliance to vaccination was 40.34%. An additional number of 39 partners was also vaccinated. November was the month with the highest number of people vaccinated (20 women and 14 partners), while January had the lowest (7 women and 8 partners).
As expected a higher number of people got vaccinated at the beginning of the flu season. A considerable number of partners decided to vaccinate, showing the parents understanding of the importance of herd immunity. Sensitising the women towards vaccination and increasing their awareness is crucial to improve women and new-borns' health status. Even though the compliance was considerable, a lot of work has to be done to improve vaccination coverage and to make the importance of vaccination clear.
Key messages
Providing a programme of sensitisation could improve influenza vaccination coverage. The compliance, although satisfactory, can be further improved providing different and steady educational strategies.
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Affiliation(s)
- E Carini
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Bruno
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Di Pilla
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - V Beccia
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Di Pumpo
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Damiani
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - B Carducci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Masini
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Lanzone
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - P Laurenti
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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11
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Di Pilla A, Specchia ML, Perilli A, Tofani N, Carini E, Ricciardi W, Damiani G. Impact of clinical risk management in pediatric intensive care units: a systematic review. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Clinical risk is the probability that a patient is the victim of an adverse event attributable to medical care, albeit unintentionally; clinical risk management is therefore a key area for the quality of healthcare, especially in care-intensive settings; even more for pediatric patients. The objective of this review is to assess the impact of the application of tools and methodologies for clinical risk management in pediatric care-intensive settings.
Methods
Pubmed and Web of Science were queried to carry out a systematic review, using the PICO methodology to formulate the research strategy and query (June 2019). Application experiences of clinical risk management that had quantitative and qualitative impacts in pediatric intensive care units were included.
Results
A total of 1178 papers were reviewed and 22 articles were included, most of them from the US (8). Out of the 22 experiences described, 11 were related to reactive management tools, 7 to proactive tools; 4 experiences reported the use of both reactive and proactive tools; 11 articles made explicit a reduction in adverse events following the intervention in the study (29.8%-78.8%, p < 0.001); 8 articles made explicit organizational changes triggered by the intervention; 2 proactive tools were also used in order to specifically assess the economical savings related to the changes that occurred as a result of the intervention; 1 article compared two reactive clinical risk management systems in the same context, underlining that a more innovative system tended to highlight more systemic errors, while a more traditional one focused on errors that were less common but potentially more dangerous; 14 studies were specifically dedicated to risk in drug management.
Conclusions
The application of clinical risk management tools made changes in pediatric intensive care units; the integrated use of different methodologies, both proactive and passive, for the management of clinical risk is highlighted in many studies.
Key messages
Methodologies for clinical risk management can have significant impacts on organizational processes and outcomes of pediatric intensive care units, improving safety of patient and operators. The simultaneous use of several clinical risk management tools, both proactive and reactive, is increasingly widespread.
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Affiliation(s)
- A Di Pilla
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - M L Specchia
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario, Rome, Italy
| | - A Perilli
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - N Tofani
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario, Rome, Italy
| | - E Carini
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - W Ricciardi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario, Rome, Italy
| | - G Damiani
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario, Rome, Italy
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Castrini F, Specchia ML, Spina F, Carini E, Di Pilla A, Grieco A, Frisicale E, Ricciardi W, Damiani G. The impact of Multidisciplinary Tumor Boards on breast cancer care: results of a systematic review. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
A Multidisciplinary Tumor Board (MTB) is a group of professionals from different clinical areas that meets to examine oncological patients to face multiple aspects of the pathology. MTBs represent an effective way for clinical decision making and management of complex diseases like cancer that needs an integrated approach. They have the potential to implement patient's care optimizing both evaluation and treatment. The aim of this study was to evaluate the clinical and organizational impact and benefits of MTBs on breast cancer cases.
The databases investigated to carry out the research were Pubmed and Web of Science. Only Italian and English articles focused on breast cancer patients evaluated through MTB approach were included. No time restriction was adopted. Articles about other types of cancer were not included; systematic reviews and non-peer reviewed papers such as editorial and commentaries were excluded from the study.
The research found 5163 publications; duplicated records were omitted. 5086 articles were excluded through the analysis of title and abstract; after full text reading 52 studies were excluded. Only 25 publications fulfilled the inclusion and exclusion criteria. Two articles considered the impact of MTB on overall survival; 1 publication studied the effect of diagnostic changes; 7 articles examined the impact of MTBs on cancer treatment; 2 studies analysed the effects on clinical performance. Other publications examined secondary outcomes and indicators.
MTB has been described to have a positive impact on breast cancer. It improves overall survival (substantial results for over 65), diagnostic accuracy (up to 65%) and treatment scheme making it more adherent to guidelines (28%-93,1%). Furthermore, MTB makes patient's management more functional and avoids inappropriate interventions.
Further studies are needed to deepen on some topics such as the economic aspects and the importance of the participation of general practitioners to MTBs.
Key messages
MTB could improve patient’s care and clinical management of cancer. It is necessary to study if greater accuracy in patient’s management could have economic impact as it avoids inappropriate procedures.
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Affiliation(s)
- F Castrini
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - M L Specchia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Spina
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Carini
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Di Pilla
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Grieco
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Frisicale
- Università Cattolica del Sacro Cuore, Rome, Italy
- Local Health Authority, ASL Roma 1, Rome, Italy
| | - W Ricciardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Damiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Di Pilla A, Bruno S, Carini E, Beccia V, Quaranta G, La Milia D, Masini L, Carducci B, Lanzone A, Laurenti P. Vaccination attitude assessment among attendees the birthing preparation course: a pre-post study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Vaccinations are among the most effective and safe ways to prevent the spreading and the complications of infectious diseases. In order to reduce risks and to protect children from the early beginning of their life, most vaccinations are recommended within the 15th month of life. In Italy, the law provides 10 compulsory vaccinations to the 0-16 age group. A training program was carried on by a Public Health specialist during the birthing preparation course, aimed at increasing the attitude to vaccination in maternal-child age.
Methods
A training session in the birthing preparation course was specifically carried out to raise awareness about vaccination during both pregnancy and puerperium and in early childhood; a questionnaire on vaccination awareness was administered before and after the training session.
Results
Out of 119 pregnant women attended the birthing preparation course from October 2019 to January 2020. As a result of the interventions, the percentage of the participants who consider the preparatory course a useful tool to obtain information about vaccines increases significantly from 30.34% pre-intervention to 64.56% post-intervention (p < 0.001). There is a significant increase in the mean number of vaccinations that the participants want their children to get, out of the 12 vaccinations proposed in the questionnaire: 9.68/12 pre-intervention versus 10.57/12 post-intervention (p = 0.021). Participants supporting the mandatory vaccinations are 96.04% pre-intervention and rise to 98.73% post-intervention.
Conclusions
Attitude and knowledge related to vaccination are crucial values for maternal-child health: they significantly increased after a training session dedicated to vaccination as a part of the pregnant pre-birth course, whose aim can be therefore extended to the management of the health of the child, well beyond the period of pregnancy, labor and childbirth, according the life-course approach to health, from the Public Health perspective.
Key messages
The childbirth preparation courses for pregnant should be valuable as a precious opportunity to raise parents’ awareness and their attitude to vaccinations, if dedicated sessions are included in them. The mandatory nature of vaccines is very well received by pregnant women.
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Affiliation(s)
- A Di Pilla
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Bruno
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario, Rome, Italy
| | - E Carini
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - V Beccia
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Quaranta
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario, Rome, Italy
| | - D La Milia
- Fondazione Policlinico Universitario, Rome, Italy
| | - L Masini
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario, Rome, Italy
| | - B Carducci
- Fondazione Policlinico Universitario, Rome, Italy
| | - A Lanzone
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario, Rome, Italy
| | - P Laurenti
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario, Rome, Italy
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14
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Carini E, Pezzullo AM, Frisicale EM, Cacciatore P, Pilla AD, Grossi A, Gabutti I, Cicchetti A, Boccia S, Specchia ML. Measuring organizational performance. A review of the dimensions of hospital performance indicators. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Patients’ increasing needs and expectations demand for an overall assessment of hospital performances. Several Agencies described sets of performance indicators and there is not a unanimous classification. The ImpactHTA Horizon2020 Project wants to address this aspect, developing a toolkit of key indicators to measure hospital organizational performance. The aim of this review is to identify the dimensions of quality in which hospital performance indicators are grouped, and to assess if there has been an evolution over time of the above-mentioned dimensions.
Following the PRISMA statement, PubMed, Ovid and Web of Science databases were queried to perform an umbrella review. Articles focusing on secondary care settings, published January 2000-May 2018 were considered. The study design included was systematic review.
3680 records were screened and 6 systematic reviews ranging 2002-2014 were included. The following dimensions were described in at least 50% of the studies: 6 studies classified efficiency (53 indicators analyzed); 5 studies classified effectiveness (12 indicators), patient centeredness (10 indicators) and safety (8 indicators); 3 studies responsive governance (2 indicators), staff orientation (8 indicators) and timeliness (4 indicators). 3 reviews did not specify the indicators related to the dimensions listed, 1 gave a complete definition of the meaning of each dimension and related indicators.
The research shows steady awareness of the importance of patient centeredness, effectiveness, efficiency, and safety dimensions; apparently, there is still not much attention to sustainability, appropriateness and accessibility in terms of indicators measuring, although those dimensions are described in one of the latest review. Another review described a new dimension, resources and capacity, which focuses on the availability of new technologies, underlining the growing importance of the adoption of digitalization in healthcare.
Key messages
Main dimensions of performance indicators: efficiency, effectiveness, patient centeredness, safety. More emphasis to sustainability and appropriateness to align with today’s healthcare challenges.
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Affiliation(s)
- E Carini
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A M Pezzullo
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E M Frisicale
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- ASL Roma 1, Rome, Italy
| | - P Cacciatore
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Di Pilla
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Grossi
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Gabutti
- Alta Scuola di Economia e Management dei Sistemi Sanitari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Cicchetti
- Alta Scuola di Economia e Management dei Sistemi Sanitari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Boccia
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M L Specchia
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Specchia ML, Arcuri G, Di Pilla A, Ricciardi G, Bellantone R. Healthcare costs and outcomes: a value-based assessment tool for Clinical Governance. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue/problem
Health systems sustainability is a critical public health issue. A value-based approach is essential to improve patient-centeredness, appropriateness, quality and funding allocation in healthcare.
Description of the problem
This project was aimed to develop an innovative transferable tool to assess value-based activities in Hospital by monitoring care pathways costs and outcomes. Main questions were to: assess cost and outcome variance in homogeneous groups of patients; evaluate clinical activities contribution to the hospital budget; identify and monitor critical points. In 2018 a Business Intelligence system fed by different Hospital datasets was developed and tested in a Teaching Hospital in Rome to quantify and integrate data on pathways efficacy and costs. It was based on an algorithm of 20 indicators related to Women and Child Care Pathways.
Results
Preliminary results showed a great variance for the same intervention/procedure concerning length of stay (3-8 days), waiting times (1-4 days), innovative technologies costs (2000-6000€) and obsolete reimbursement rates (2000-5000€) that do not guarantee adequate economic contribution margins. Improvement actions were defined concerning pathways’ workflow and organizational appropriateness. The need for negotiations with Ministry of Health was highlighted, aimed to update reimbursement rates.
Lessons
The tool, built on a value-based process view, allowed analyzing online outcomes and costs data aggregated by path, benchmarking results, identifying critical issues and providing improvement solutions. It turned out to be an innovative methodology - also applicable in other settings/countries - to trigger changes in health management and pursue quality and efficiency in healthcare.
Key messages
Value-based healthcare is the new public health paradigm. Assessing simultaneously Hospital costs and outcomes is a valuable way to derive overall healthcare value, improve quality and rationalize resources allocation.
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Affiliation(s)
- M L Specchia
- Direzione Governo Clinico, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Arcuri
- Direzione Governo Clinico, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Di Pilla
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Ricciardi
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento Scienze Salute Donna, Bambino e Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - R Bellantone
- Direzione Governo Clinico, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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16
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Cacciatore P, Kannengiesser P, Carini E, Di Pilla A, Pezzullo AM, Hoxhaj I, Gabutti I, Cicchetti A, Boccia S, Specchia ML. Balanced Scorecard for performance assessment in healthcare settings: a review of literature. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The Balanced-Scorecard (BSC) is a management tool developed in the early 1990s to balance the impact of financial and non-financial parameters and analyse the organisational performance in private companies according to four determinants. The original BSC has spread to different sectors in the last decades, including healthcare services, in numerous amended versions. The aim of our project was to identify potential indicators of BSC for performance evaluation in general hospitals.
Methods
We performed a systematic review of literature on Pubmed and Web of Science using the search string “balanced scorecard AND healthcare AND indicators”. We found 102 papers; 80 papers were removed for irrelevance, absence of full text or performance indicators. We only considered articles that followed the classic structure of BSC (Customer, Internal Processes, Financial, and Learning and Growth). The indicators listed in them were classified according to the four determinants of organisational performance.
Results
Eight articles out of 22 followed the classic structure of the BSC. The most represented category was Internal Processes (59 indicators), followed by Learning and Growth (52), Customer (40) and Financial (33). The number of common/overlapping indicators was low (5 for Internal Processes and 4 for the three other categories).
Conclusions
While BSC has spread to different settings, the list of indicators used in the classic four determinants for performance evaluation is heterogeneous. While common points can be identified between indicators, our review highlighted that every BSC is developed in a unique way which makes it difficult to identify a general framework adaptable to different hospital settings.
Key messages
The use of the Balanced Scorecard as management tool has spread to healthcare settings in the last decade. Indicators in BSC for healthcare settings are heterogeneous and only a limited number follow the standard structure of BSC.
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Affiliation(s)
- P Cacciatore
- Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Kannengiesser
- Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Carini
- Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Di Pilla
- Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A M Pezzullo
- Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Hoxhaj
- Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Gabutti
- Alta scuola di Economia e Management dei Sistemi Sanitari (A, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Cicchetti
- Alta scuola di Economia e Management dei Sistemi Sanitari (A, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Boccia
- Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M L Specchia
- Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Allajbej A, Patani F, Di Biase S, Fasciolo D, Di Carlo C, Rosa C, Gasparini L, Di Francesco M, Falcone G, Quaternato G, Croce A, Di Pilla A, Trignani M, Caravatta L, Genovesi D. PO-0727 Voice outcome following radiotherapy or laser microsurgery in patients with early glottic cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31147-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Allajbei A, Patani F, Trignani M, Di Pilla A, Bagalà P, Vinciguerra A, Augurio A, Caravaggio G, Falco M, Genovesi D. PO-129 Set-up errors in head and neck cancer patients undergoing IGRT. Relationship to BMI and weight loss. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30295-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Altaibej A, Patani F, Di Biase S, Fasciolo D, Di Carlo C, Rosa C, Gasparini L, Di Francesco M, Falcone G, Quaternato G, Croce A, Di Pilla A, Trignani M, Genovesi D. PO-145 Voice outcome in patients with early glottic cancer following radiotherapy versus laser microsurgery. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30311-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Allajbej A, Patani F, Trignani M, Di Pilla A, Bagalà P, Vinciguerra A, Caravaggio G, Falco M, Genovesi D. EP-1156: Set-up errors in head and neck cancer patients undergoing IGRT. Relationship to BMI and weight loss. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31466-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Di Biase M, Trignani M, Caponigro G, Di Pilla A, Perrotti F, Augurio A, Giancaterino S, Bagalà P, Falco M, Genovesi D. EP-1783: Translational and rotational set-up uncertainties in Head and Neck cancer treatments using CBCT. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33034-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Trignani M, Di Pilla A, Taraborrelli M, Campitelli G, Santarelli G, De Nicola M, Croce A, Genovesi D. PO-126: Early percutaneous endoscopic gastrostomy and nutritional supplementation in H&N cancer: an Italian survey. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)34886-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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