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Angelici L, Angioletti C, Pinnarelli L, Colais P, de Belvis AG, Melnyk A, La Gatta E, Farchi S, Davoli M, Agabiti N, Acampora A. EASY-NET Program: Effectiveness of an Audit and Feedback Intervention in the Emergency Care for Acute Conditions in the Lazio Region. Healthcare (Basel) 2024; 12:733. [PMID: 38610155 PMCID: PMC11012083 DOI: 10.3390/healthcare12070733] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
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.
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Affiliation(s)
- Laura Angelici
- Department of Epidemiology, Regional Health Service–Lazio, Via Cristoforo Colombo, 112, 00147 Rome, Italy; (L.P.); (P.C.); (M.D.); (N.A.); (A.A.)
| | - Carmen Angioletti
- Management and Health Laboratory, Institute of Management, Department Embeds, Sant’Anna School of Advanced Studies, Scuola Superiore Sant’Anna, 56127 Pisa, Italy;
| | - Luigi Pinnarelli
- Department of Epidemiology, Regional Health Service–Lazio, Via Cristoforo Colombo, 112, 00147 Rome, Italy; (L.P.); (P.C.); (M.D.); (N.A.); (A.A.)
| | - Paola Colais
- Department of Epidemiology, Regional Health Service–Lazio, Via Cristoforo Colombo, 112, 00147 Rome, Italy; (L.P.); (P.C.); (M.D.); (N.A.); (A.A.)
| | - Antonio Giulio de Belvis
- Critical Pathways and Evaluation Outcome Unit, Fondazione Policlinico Universitario “A. Gemelli”—IRCCS, 00168 Rome, Italy;
| | - Andriy Melnyk
- Faculty of Economics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.); (E.L.G.)
| | - Emanuele La Gatta
- Faculty of Economics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.); (E.L.G.)
| | - Sara Farchi
- Area Rete Ospedaliera E Specialistica, Direzione Regionale Salute E Integrazione Sociosanitaria Regione Lazio, 00168 Rome, Italy;
| | - Marina Davoli
- Department of Epidemiology, Regional Health Service–Lazio, Via Cristoforo Colombo, 112, 00147 Rome, Italy; (L.P.); (P.C.); (M.D.); (N.A.); (A.A.)
| | - Nera Agabiti
- Department of Epidemiology, Regional Health Service–Lazio, Via Cristoforo Colombo, 112, 00147 Rome, Italy; (L.P.); (P.C.); (M.D.); (N.A.); (A.A.)
| | - Anna Acampora
- Department of Epidemiology, Regional Health Service–Lazio, Via Cristoforo Colombo, 112, 00147 Rome, Italy; (L.P.); (P.C.); (M.D.); (N.A.); (A.A.)
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Mercurio G, Gottardelli B, Lenkowicz J, Patarnello S, Bellavia S, Scala I, Rizzo P, de Belvis AG, Del Signore AB, Maviglia R, Bocci MG, Olivi A, Franceschi F, Urbani A, Calabresi P, Valentini V, Antonelli M, Frisullo G. A novel risk score predicting 30-day hospital re-admission of patients with acute stroke by machine learning model. Eur J Neurol 2024; 31:e16153. [PMID: 38015472 DOI: 10.1111/ene.16153] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/29/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The 30-day hospital re-admission rate is a quality measure of hospital care to monitor the efficiency of the healthcare system. The hospital re-admission of acute stroke (AS) patients is often associated with higher mortality rates, greater levels of disability and increased healthcare costs. The aim of our study was to identify predictors of unplanned 30-day hospital re-admissions after discharge of AS patients and define an early re-admission risk score (RRS). METHODS This observational, retrospective study was performed on AS patients who were discharged between 2014 and 2019. Early re-admission predictors were identified by machine learning models. The performances of these models were assessed by receiver operating characteristic curve analysis. RESULTS Of 7599 patients with AS, 3699 patients met the inclusion criteria, and 304 patients (8.22%) were re-admitted within 30 days from discharge. After identifying the predictors of early re-admission by logistic regression analysis, RRS was obtained and consisted of seven variables: hemoglobin level, atrial fibrillation, brain hemorrhage, discharge home, chronic obstructive pulmonary disease, one and more than one hospitalization in the previous year. The cohort of patients was then stratified into three risk categories: low (RRS = 0-1), medium (RRS = 2-3) and high (RRS >3) with re-admission rates of 5%, 8% and 14%, respectively. CONCLUSIONS The identification of risk factors for early re-admission after AS and the elaboration of a score to stratify at discharge time the risk of re-admission can provide a tool for clinicians to plan a personalized follow-up and contain healthcare costs.
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Affiliation(s)
- Giovanna Mercurio
- Department of Emergency Science, Anesthesiology and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Benedetta Gottardelli
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jacopo Lenkowicz
- Gemelli Generator RWD, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Patarnello
- Gemelli Generator RWD, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simone Bellavia
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Irene Scala
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Pierandrea Rizzo
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Antonio Giulio de Belvis
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
- Clinical Pathways and Outcome Evaluation Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anna Benedetta Del Signore
- Department of Emergency Science, Anesthesiology and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Global Medical Department-Primary Care Unit, Angelini Pharma, Rome, Italy
| | - Riccardo Maviglia
- Department of Emergency Science, Anesthesiology and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Grazia Bocci
- Department of Emergency Science, Anesthesiology and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Olivi
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Franceschi
- Department of Emergency Science, Anesthesiology and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Andrea Urbani
- Catholic University of Sacred Heart, Rome, Italy
- Department of Laboratory and Infectious Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paolo Calabresi
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Vincenzo Valentini
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Massimo Antonelli
- Department of Emergency Science, Anesthesiology and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Frisullo
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Cummings JR, Zhang X, Gandré C, Morsella A, Shields-Zeeman L, Winkelmann J, Allin S, Augusto GF, Cascini F, Cserháti Z, de Belvis AG, Eriksen A, Fronteira I, Jamieson M, Murauskienė L, Palmer WL, Ricciardi W, Samuel H, Scintee SG, Taube M, Vrangbæk K, van Ginneken E. Challenges facing mental health systems arising from the COVID-19 pandemic: Evidence from 14 European and North American countries. Health Policy 2023; 136:104878. [PMID: 37611521 DOI: 10.1016/j.healthpol.2023.104878] [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: 10/04/2022] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 08/25/2023]
Abstract
We assessed challenges that the COVID-19 pandemic presented for mental health systems and the responses to these challenges in 14 countries in Europe and North America. Experts from each country filled out a structured questionnaire with closed- and open-ended questions between January and June 2021. We conducted thematic analysis to investigate the qualitative responses to open-ended questions, and we summarized the responses to closed-ended survey items on changes in telemental health policies and regulations. Findings revealed that many countries grappled with the rising demand for mental health services against a backdrop of mental health provider shortages and challenges responding to workforce stress and burnout. All countries in our sample implemented new policies or initiatives to strengthen mental health service delivery - with more than two-thirds investing to bolster their specialized mental health care sector. There was a universal shift to telehealth to deliver a larger portion of mental health services in all 14 countries, which was facilitated by changes in national regulations and policies; 11 of the 14 participating countries relaxed regulations and 10 of 14 countries made changes to reimbursement policies to facilitate telemental health care. These findings provide a first step to assess the long-term challenges and re-organizational effect of the COVID-19 pandemic on mental health systems in Europe and North America.
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Affiliation(s)
- Janet R Cummings
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States.
| | - Xinyue Zhang
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Coralie Gandré
- Institut de recherche et documentation en économie de la santé (IRDES), Paris, France; AP-HP, Hôpital Robert Debré, Paris, France
| | | | - Laura Shields-Zeeman
- Department of Public Mental Health, Trimbos Institute, Utrecht, the Netherlands; Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | | | - Sara Allin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Gonçalo Figueiredo Augusto
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | | | - Zoltán Cserháti
- Semmelweis University, Health Services Management Training Centre, Budapest, Hungary
| | - Antonio Giulio de Belvis
- Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Astrid Eriksen
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Inês Fronteira
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, CHRC, NOVA University Lisbon, Lisbon, Portugal; Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Margaret Jamieson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Liubovė Murauskienė
- Department of Public Health, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | - Hadar Samuel
- Myers-JDC-Brookdale Institute, Jerusalem, Israel
| | | | - Māris Taube
- Department of Psychiatry and Narcology, Rīga Stradiņš University, Riga, Latvia
| | - Karsten Vrangbæk
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ewout van Ginneken
- European Observatory on Health Systems and Policies, Technische Universität Berlin, Berlin, Germany
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de Belvis AG. Editorial: Value-based healthcare in oncology. Front Public Health 2023; 11:1274409. [PMID: 37780437 PMCID: PMC10534953 DOI: 10.3389/fpubh.2023.1274409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Affiliation(s)
- Antonio Giulio de Belvis
- Fondazione Policlinico Universitario “A. Gemelli”, Università Cattolica del Sacro Cuore, Italian National Institute of Care and Research (IRCCS), Italian National Scientific Association of Quality on Health and Social Care (ASIQUAS) National Board, Rome, Italy
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Papavero SC, Fracasso A, Ramaglia P, Cicchetti A, de Belvis AG, Ferrara FM. Telemedicine Has a Social Impact: An Italian National Study for the Evaluation of the Cost-Opportunity for Patients and Caregivers and the Measurement of Carbon Emission Savings. Telemed J E Health 2023; 29:1252-1260. [PMID: 36637858 DOI: 10.1089/tmj.2022.0333] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Indexed: 01/14/2023] Open
Abstract
Background: Owing to COVID-19, all stakeholders have recognized the advantages of telehealth and they were available for its permanent implementation, both from the normative and economic point of view. It is, therefore, necessary to understand what were the real benefits created in society through telehealth. Objective: Develop a method to identify a social impact of telemedicine in Italy, considering the reduction on the patient moves with a consequent travel cost, time (opportunity costs), and carbon emission savings. Methods: Since March 2020, we have conducted a quality improvement study in 17 centers, collecting sociodemographic variables. To assess the social impact, we transform the data into outcome measures. The protocol used "Telemedicina Subito" allows the rapid implementation of telemedicine, using operating manual, structured according Health Technology Assessment approach. Results: We collected data related to 2,091 televisits, analyzing three different perspectives. First, one patient with a televisit had a saving equal to the median of EUR 97.16 (interquartile range [IQR]: 64.29-159.69), USD 113.88; considering that the median cost for the visit in presence was EUR 105.91 (p-value <0.05) and after the use of telehealth had a median of EUR 0 (mean: EUR 14.70; p-value <0.05). Second, informal caregivers have a median savings of EUR 65.06 (IQR: 55.52-89.21), USD 76.26. Finally, for one single telemedicine visits we can contribute with a median carbon emission savings of ∼13 kg (IQR: 6-24). Conclusions: The evaluation of the social impact on telemedicine facilitated the creation of an important framework for decision-makers.
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Affiliation(s)
- Sara Consilia Papavero
- ALTEMS: High School of Economics and Management of Health Systems, Catholic University of Sacred Hearth, Rome, Italy
| | - Andrea Fracasso
- ALTEMS: High School of Economics and Management of Health Systems, Catholic University of Sacred Hearth, Rome, Italy
| | - Pietro Ramaglia
- ALTEMS: High School of Economics and Management of Health Systems, Catholic University of Sacred Hearth, Rome, Italy
| | - Americo Cicchetti
- ALTEMS: High School of Economics and Management of Health Systems, Catholic University of Sacred Hearth, Rome, Italy
| | - Antonio Giulio de Belvis
- Hygiene Section, Department of Life Sciences and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Fabrizio Massimo Ferrara
- ALTEMS: High School of Economics and Management of Health Systems, Catholic University of Sacred Hearth, Rome, Italy
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Angioletti C, Pinnarelli L, Colais P, Angelici L, de Mattia E, Davoli M, de Belvis AG, Agabiti N, Acampora A. Audit and Feedback in the Hospitals of the Emergency Networks in the Lazio Region, Italy: A Cross-Sectional Evaluation of the State of Implementation. Healthcare (Basel) 2022; 11:healthcare11010024. [PMID: 36611484 PMCID: PMC9818902 DOI: 10.3390/healthcare11010024] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Audit and Feedback (A&F) is an effective multidimensional strategy for improving the quality of care. The optimal methods for its implementation remain unclear. This study aimed to map the state of art of A&F strategies in the hospitals involved in a time-dependent emergency network. For these purposes, a structured questionnaire was defined and discussed within the research group. This consists of 29 questions in three sections: (1) characteristics of the structure, (2) internal feedback systems, and (3) external feedback systems. All structures involved in the network were invited to participate in the e-survey by indicating a Health Management representative and a clinical representative for the Cardiovascular (CaV) and/or for the Cerebrovascular area (CeV). Of 20 structures invited, a total of 13 (65%) responded to the survey, 11 for the CaV area and 8 for the CeV area. A total of 10 of 11 (91%) facilities for the CaV area and 8/11 (75%) for the CeV area reported that they perform A&F activities. All facilities perform at least one of the activities defined as "assimilating A&F procedures." The most frequent is the presentation and discussion of clinical cases (82% CaV and 88% CeV) and the least is the identification of responsible for improvement actions (45% CaV and 38% CeV). In 4/10 (40%) facilities for the CaV area and 4/8 (50%) for the CEV area, corrective actions are suggested or planned when the feedback is returned. These results confirm the need to define, in a synergistic way with the relevant stakeholders, an effective and agreed A&F intervention to improve the level of implementation of A&F strategies.
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Affiliation(s)
- Carmen Angioletti
- Department of Epidemiology, Regional Health Service Lazio Region, 00147 Rome, Italy
- Critical Pathways and Evaluation Outcome Unit, Fondazione Policlinico Universitario “A. Gemelli”—IRCCS, 00168 Rome, Italy
- Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence:
| | - Luigi Pinnarelli
- Department of Epidemiology, Regional Health Service Lazio Region, 00147 Rome, Italy
| | - Paola Colais
- Department of Epidemiology, Regional Health Service Lazio Region, 00147 Rome, Italy
| | - Laura Angelici
- Department of Epidemiology, Regional Health Service Lazio Region, 00147 Rome, Italy
| | - Egidio de Mattia
- Critical Pathways and Evaluation Outcome Unit, Fondazione Policlinico Universitario “A. Gemelli”—IRCCS, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Regional Health Service Lazio Region, 00147 Rome, Italy
| | - Antonio Giulio de Belvis
- Critical Pathways and Evaluation Outcome Unit, Fondazione Policlinico Universitario “A. Gemelli”—IRCCS, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology, Regional Health Service Lazio Region, 00147 Rome, Italy
| | - Anna Acampora
- Department of Epidemiology, Regional Health Service Lazio Region, 00147 Rome, Italy
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de Mattia E, Angioletti C, Perilli A, Guajardo Rios LS, Garganese G, Tagliaferri L, Scambia G, Fragomeni SM, de Belvis AG. Gov➔Value: How to combine reported quality experiences and patient-reported outcome measures. First results on vulvar cancer patients in an Italian Research Hospital. Front Public Health 2022; 10:1014651. [PMID: 36605234 PMCID: PMC9807601 DOI: 10.3389/fpubh.2022.1014651] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Vulvar cancer (VC) accounts for <1% of cancers affecting the female gender. Clinical Pathways (CP) and Clinical Outcomes Monitoring are useful for providing high-quality care to these patients. However, it is essential to integrate them with the patient's perspective according to Value-Based Healthcare paradigms. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are tools for assessing outcomes and experiences with health care from the patient's perspective. The aim of this paper is to collect and synthesize PROMs and main stakeholders' experience on the VC CP, according to a value-based approach. Materials and methods To select the most appropriate instrument, a review was conducted on the main databases and official websites of specific institutions and organizations. In the second phase, a 2-round Delphi survey was conducted to assess the Reported Experience Measures (REMs) tool. Questions were evaluated according to four criteria (general relevance, evidence-based, measurability, actionability) and included if strong agreement was reached. A Principal Component Analysis (PCA) was executed. Cronbach's alpha and McDonald's omega were computed. Fisher's exact test and Wilcoxon rank sum test were used to compare ratings between groups. Descriptive statistics were performed for both PROMs and REMs instruments. Results For PROMs assessment, EORTC QLQ-C30 questionnaire was selected and administered to 28 patients. Global Health Status/Quality of Life and Functional Scales Scores were high or very high, while symptoms scale reported low or medium scores. The final REMs consists of 22 questions for professionals and 16 for patients and caregivers. It was administered to 22 patients, 11 caregivers, 5 physicians, 2 nurses and 1 clinical senior manager. PCA identified 4 components. Scale reliability was acceptable (α = 0.75 95% CI: 0.61-0.85; ω = 0.69; 95% CI: 0.54, 0.82). A statistically significant difference between the patient/caregiver group and the professionals was found for items 8 (follow-up), 10 (perceived quality), 12 (safety), and 16 (climate) (p = 0.02; p = 0.03; p < 0.001; p < 0.001, respectively). Discussion PROMs could provide new ways of intercepting patients' needs and feedback, thus acting on them. The proposed REMs tool would allow to detect information not available elsewhere, which, through Audit and feedback strategies, could lead to enhancement of healthcare experience, according to a value-based approach.
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Affiliation(s)
- Egidio de Mattia
- Clinical Pathways and Outcomes Evaluation Unit, Fondazione Policlinico Universitario ‘A. Gemelli’—IRCCS, Rome, Italy
| | - Carmen Angioletti
- Clinical Pathways and Outcomes Evaluation Unit, Fondazione Policlinico Universitario ‘A. Gemelli’—IRCCS, Rome, Italy
| | - Alessio Perilli
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy,*Correspondence: Alessio Perilli, ✉
| | - Linda Stella Guajardo Rios
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario ‘A. Gemelli’—IRCCS, Rome, Italy
| | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy,Section of Gynecology and Obstetrics, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Tagliaferri
- Unit of Oncological Radiotherapy, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario ‘A. Gemelli’—IRCCS, Rome, Italy
| | - Giovanni Scambia
- Section of Gynecology and Obstetrics, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy,Unit of Cancer Gynecology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario ‘A. Gemelli’—IRCCS, Rome, Italy
| | - Simona Maria Fragomeni
- Unit of Cancer Gynecology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario ‘A. Gemelli’—IRCCS, Rome, Italy
| | - Antonio Giulio de Belvis
- Clinical Pathways and Outcomes Evaluation Unit, Fondazione Policlinico Universitario ‘A. Gemelli’—IRCCS, Rome, Italy,Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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Giulio de Belvis A, Meregaglia M, Morsella A, Adduci A, Perilli A, Cascini F, Solipaca A, Fattore G, Ricciardi W, Maresso A, Scarpetti G. Italy: Health System Review. Health Syst Transit 2022; 24:1-236. [PMID: 36951263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
This analysis of the Italian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Italy has a regionalized National Health Service (SSN) that provides universal coverage largely free of charge at the point of delivery, though certain services and goods require a co-payment. Life expectancy in Italy is historically among the highest in the EU. However, regional differences in health indicators are marked, as well as in per capita spending, distribution of health professionals and in the quality of health services. Overall, Italy's health spending per capita is lower than the EU average and is among the lowest in western European countries. Private spending has increased in recent years, although this trend was halted in 2020 during the coronavirus disease 2019 (COVID-19) pandemic. A key focus of health policies in recent decades was to promote a shift away from unnecessary inpatient care, with a considerable reduction of acute hospital beds and stagnating overall growth in health personnel. However, this was not counterbalanced by a sufficient strengthening of community services in order to cope with the ageing population's needs and related chronic conditions burden. This had important repercussions during the COVID-19 emergency, as the health system felt the impact of previous reductions in hospital beds and capacity and underinvestment in community-based care. Reorganizing hospital and community care will require a strong alignment between central and regional authorities. The COVID-19 crisis also highlighted several issues pre-dating the pandemic that need to be addressed to improve the sustainability and resilience of the SSN. The main outstanding challenges for the health system are linked to addressing historic underinvestment in the health workforce, modernizing outdated infrastructure and equipment, and enhancing information infrastructure. Italy's National Recovery and Resilience Plan, underwritten by the Next Generation EU budget to assist with economic recovery from the COVID-19 pandemic, contains specific health sector priorities, such as strengthening the country's primary and community care, boosting capital investment and funding the digitalization of the health care system.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Anna Maresso
- European Observatory on Health Systems and Policies
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9
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Waitzberg R, Hernández-Quevedo C, Bernal-Delgado E, Estupiñán-Romero F, Angulo-Pueyo E, Theodorou M, Kantaris M, Charalambous C, Gabriel E, Economou C, Kaitelidou D, Konstantakopoulou O, Vildiridi LV, Meshulam A, de Belvis AG, Morsella A, Bezzina A, Vincenti K, Figueiredo Augusto G, Fronteira I, Simões J, Karanikolos M, Williams G, Maresso A. Early health system responses to the COVID-19 pandemic in Mediterranean countries: A tale of successes and challenges. Health Policy 2021; 126:465-475. [PMID: 34711444 PMCID: PMC8507573 DOI: 10.1016/j.healthpol.2021.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/24/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022]
Abstract
This paper conducts a comparative review of the (curative) health systems' response taken by Cyprus, Greece, Israel, Italy, Malta, Portugal, and Spain during the first six months of the COVID-19 pandemic. Prior to the COVID-19 pandemic, these Mediterranean countries shared similarities in terms of health system resources, which were low compared to the EU/OECD average. We distill key policy insights regarding the governance tools adopted to manage the pandemic, the means to secure sufficient physical infrastructure and workforce capacity and some financing and coverage aspects. We performed a qualitative analysis of the evidence reported to the 'Health System Response Monitor' platform of the European Observatory by country experts. We found that governance in the early stages of the pandemic was undertaken centrally in all the Mediterranean countries, even in Italy and Spain where regional authorities usually have autonomy over health matters. Stretched public resources prompted countries to deploy "flexible" intensive care unit capacity and health workforce resources as agile solutions. The private sector was also utilized to expand resources and health workforce capacity, through special public-private partnerships. Countries ensured universal coverage for COVID-19-related services, even for groups not usually entitled to free publicly financed health care, such as undocumented migrants. We conclude that flexibility, speed and adaptive management in health policy responses were key to responding to immediate needs during the COVID-19 pandemic. Financial barriers to accessing care as well as potentially higher mortality rates were avoided in most of the countries during the first wave. Yet it is still early to assess to what extent countries were able to maintain essential services without undermining equitable access to high quality care.
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Affiliation(s)
- Ruth Waitzberg
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel; Department of Health Care Management, Faculty of Economics & Management, Technical University Berlin, Germany.
| | | | - Enrique Bernal-Delgado
- Data Sciences for Health Services and Policy Research. Institute for Health Sciences in Aragon (IACS), Spain
| | - Francisco Estupiñán-Romero
- Data Sciences for Health Services and Policy Research. Institute for Health Sciences in Aragon (IACS), Spain
| | - Ester Angulo-Pueyo
- Data Sciences for Health Services and Policy Research. Institute for Health Sciences in Aragon (IACS), Spain
| | | | - Marios Kantaris
- American University of Cyprus, Larnaca, Health Services Research Centre
| | | | | | - Charalampos Economou
- Department of Sociology, Panteion University of Social and Political Sciences, Athens, Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Greece
| | - Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Greece
| | | | - Amit Meshulam
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel
| | - Antonio Giulio de Belvis
- Department of Life and Public Health Sciences, Catholic University of the Sacred Heart, Rome, Italy; Critical Pathways and Outcomes Evaluation Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Alisha Morsella
- Department of Life and Public Health Sciences, Catholic University of the Sacred Heart, Rome, Italy; Critical Pathways and Outcomes Evaluation Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | | | | | - Gonçalo Figueiredo Augusto
- NOVA National School of Public Health, Universidade NOVA de Lisboa; Comprehensive Health Research Center, Universidade NOVA de Lisboa; Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa
| | - Inês Fronteira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa
| | - Jorge Simões
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa
| | | | - Gemma Williams
- European Observatory on Health Systems and Policies, Spain
| | - Anna Maresso
- European Observatory on Health Systems and Policies, Spain
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10
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Waitzberg R, Gerkens S, Dimova A, Bryndová L, Vrangbæk K, Jervelund SS, Birk HO, Rajan S, Habicht T, Tynkkynen LK, Keskimäki I, Or Z, Gandré C, Winkelmann J, Ricciardi W, de Belvis AG, Poscia A, Morsella A, Slapšinskaitė A, Miščikienė L, Kroneman M, de Jong J, Tambor M, Sowada C, Scintee SG, Vladescu C, Albreht T, Bernal-Delgado E, Angulo-Pueyo E, Estupiñán-Romero F, Janlöv N, Mantwill S, Van Ginneken E, Quentin W. Balancing financial incentives during COVID-19: A comparison of provider payment adjustments across 20 countries. Health Policy 2021; 126:398-407. [PMID: 34711443 PMCID: PMC8492384 DOI: 10.1016/j.healthpol.2021.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 12/20/2022]
Abstract
Provider payment mechanisms were adjusted in many countries in response to the COVID-19 pandemic in 2020. Our objective was to review adjustments for hospitals and healthcare professionals across 20 countries. We developed an analytical framework distinguishing between payment adjustments compensating income loss and those covering extra costs related to COVID-19. Information was extracted from the Covid-19 Health System Response Monitor (HSRM) and classified according to the framework. We found that income loss was not a problem in countries where professionals were paid by salary or capitation and hospitals received global budgets. In countries where payment was based on activity, income loss was compensated through budgets and higher fees. New FFS payments were introduced to incentivize remote services. Payments for COVID-19 related costs included new fees for out- and inpatient services but also new PD and DRG tariffs for hospitals. Budgets covered the costs of adjusting wards, creating new (ICU) beds, and hiring staff. We conclude that public payers assumed most of the COVID-19-related financial risk. In view of future pandemics policymakers should work to increase resilience of payment systems by: (1) having systems in place to rapidly adjust payment systems; (2) being aware of the economic incentives created by these adjustments such as cost-containment or increasing the number of patients or services, that can result in unintended consequences such as risk selection or overprovision of care; and (3) periodically evaluating the effects of payment adjustments on access and quality of care.
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Affiliation(s)
- Ruth Waitzberg
- Department of Health Care Management, Faculty of Economics & Management, Technische Universität Berlin, Germany; The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel.
| | | | - Antoniya Dimova
- Faculty of Public Health, Medical University - Varna, Bulgaria.
| | - Lucie Bryndová
- Center for Social and Economic Strategies, Faculty of Social Science, Charles University, Czechia.
| | - Karsten Vrangbæk
- University of Copenhagen, Department of Public Health, Section for Health Services Research, Copenhagen, Denmark.
| | - Signe Smith Jervelund
- University of Copenhagen, Department of Public Health, Section for Health Services Research, Copenhagen, Denmark.
| | - Hans Okkels Birk
- University of Copenhagen, Department of Public Health, Section for Health Services Research, Copenhagen, Denmark.
| | - Selina Rajan
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Triin Habicht
- WHO Barcelona Office for Health Systems Financing, Spain.
| | | | - Ilmo Keskimäki
- Finnish Institute for Health and Welfare and Tampere University, Faculty of Social Sciences, Finland
| | - Zeynep Or
- Institute for Research and Information in Health Economics, France.
| | - Coralie Gandré
- Institute for Research and Information in Health Economics, France.
| | - Juliane Winkelmann
- Department of Health Care Management, Faculty of Economics & Management, Technische Universität Berlin, Germany.
| | - Walter Ricciardi
- Section of Hygiene, University Department of Life Sciences and Public Health-Università Cattolica del Sacro Cuore, Italy.
| | - Antonio Giulio de Belvis
- Section of Hygiene, University Department of Life Sciences and Public Health-Università Cattolica del Sacro Cuore, Italy.
| | - Andrea Poscia
- UOC ISP Prevention and Surveillance of Infectious and Chronic Diseases-Department of Prevention-Local Health Authority (ASUR-AV2), Jesi, Italy.
| | - Alisha Morsella
- Section of Hygiene, University Department of Life Sciences and Public Health-Università Cattolica del Sacro Cuore, Italy.
| | - Agnė Slapšinskaitė
- Faculty of Public Health, Health Research Institute, Medical Academy, Lithuanian University of Health Sciences, Lithuania.
| | - Laura Miščikienė
- Faculty of Public Health, Health Research Institute, Medical Academy, Lithuanian University of Health Sciences, Lithuania.
| | - Madelon Kroneman
- Netherlands Institute of Health Services Research, Utrecht, the Netherlands.
| | - Judith de Jong
- Netherlands Institute of Health Services Research, Utrecht, the Netherlands.
| | - Marzena Tambor
- Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Cracow, Poland.
| | - Christoph Sowada
- Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Cracow, Poland.
| | - Silvia Gabriela Scintee
- National School of Public Health, Management and Professional Development Bucharest, Romania.
| | - Cristian Vladescu
- National School of Public Health, Management and Professional Development Bucharest, Faculty of Medicine, University Titu Maiorescu, Romania.
| | - Tit Albreht
- National Institute of Public Health of Slovenia, Department of Public Health, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
| | - Enrique Bernal-Delgado
- Data Sciences for Health Services and Policy Research. Institute for Health Sciences in Aragon (IACS), Spain.
| | - Ester Angulo-Pueyo
- Data Sciences for Health Services and Policy Research. Institute for Health Sciences in Aragon (IACS), Spain.
| | - Francisco Estupiñán-Romero
- Data Sciences for Health Services and Policy Research. Institute for Health Sciences in Aragon (IACS), Spain.
| | - Nils Janlöv
- Swedish Agency for Health and Care Services Analysis.
| | - Sarah Mantwill
- University of Lucerne Department of Health Sciences and Medicine, Switzerland.
| | | | - Wilm Quentin
- Department of Health Care Management, Faculty of Economics & Management, Technische Universität Berlin, Germany; European Observatory on Health Systems and Policies, Belgium.
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11
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Morsella A, Cadeddu C, Castagna C, Hoxhaj I, Sassano M, Wang CM, Wang L, Klessova S, de Belvis AG, Boccia S, Ricciardi W. "Integrating China in the International Consortium for Personalized Medicine": The Coordination and Support Action to Foster Collaboration in Personalized Medicine Development between Europe and China. Public Health Genomics 2021; 24:310-314. [PMID: 34392247 DOI: 10.1159/000516264] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/26/2021] [Indexed: 11/19/2022] Open
Abstract
"Integrating China in the International Consortium for Personalized Medicine" (IC2PerMed) is a coordination and support action funded within the Horizon 2020 work program. Following the guidance of the International Consortium for Personalized Medicine (ICPerMed), the project's overarching aim is to align the European Union and China's research agendas in the field of personalized medicine (PM) to enable a swift development of PM approaches in the EU with strong leverage upon EU-Chinese collaboration. Living in the CO-VID-19 era, we are witnessing how the challenges imposed by the pandemic all around the globe have been acting as a catalyst for collaborations and knowledge sharing among national health systems worldwide. Given the strong interest on behalf of both Europe and China in the advancement of PM approaches, now more than ever, a cross-border collaboration between the 2 powers can accelerate the effective translation of such innovation to healthcare systems, advance research, and ensure that such change follows the directions toward the path of sustainability. IC2PerMed developments will be led by European and Chinese experts equally assembled into 3 Working Groups: (1) people and organization, (2) innovation and market, and (3) research and clinical studies in PM. This complex and dynamic network of actions thrives on dialog, cooperation, and alignment of research at national and global levels; work in the direction taken by IC2PerMed shall pave the way toward the realization of PM's full potential, prevent it from becoming a burden for healthcare systems, and, rather, prove that it provides an essential and irreplaceable contribution to their effectiveness, efficiency, and sustainability.
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Affiliation(s)
- Alisha Morsella
- Critical Pathway and Outcome Evaluation Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Cadeddu
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carolina Castagna
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ilda Hoxhaj
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Sassano
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Lili Wang
- BGI Research, Beijing Genomics Institute BGI Group, Beijing, China
| | - Svetlana Klessova
- University Côte d'Azur, CNRS, GREDEG, Nice, France.,G.A.C., Innovation Department., G.A.C. Group, Issy-les-Moulineaux, France
| | - Antonio Giulio de Belvis
- Critical Pathway and Outcome Evaluation Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Woman and Child Health and Public Health-Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Walter Ricciardi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.,Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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12
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de Belvis AG, Pellegrino R, Castagna C, Morsella A, Pastorino R, Boccia S. Success Factors and Barriers in Combining Personalized Medicine and Patient Centered Care in Breast Cancer. Results from a Systematic Review and Proposal of Conceptual Framework. J Pers Med 2021; 11:654. [PMID: 34357121 PMCID: PMC8306768 DOI: 10.3390/jpm11070654] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 02/06/2023] Open
Abstract
Breast Cancer (BC) is the leading cause of death due to cancer in women. Ensuring equitable, quality-assured and effective care has increased the complexity of BC management. This systematic review reports on the state-of-the art of available literature investigating the enactment of personalized treatment and patient-centered care models in BC clinical practice, building a framework for the delivery of personalized BC care within a Patient-Centered model. Databases were searched for articles (from the inception to December 2020) reporting on Patient-Centered or Personalized Medicine BC management models, assessing success factors or limits. Out of 1885 records, 25 studies were included in our analysis. The main success factors include clearly defined roles and responsibilities within a multi-professional collaboration, appropriate training programs and adequate communication strategies and adopting a universal genomic language to improve patients' involvement in the decision-making process. Among detected barriers, delays in the use of genetic testing were linked to the lack of public reimbursement schemes and of clear indications in timing and appropriateness. Overall, both care approaches are complementary and necessary to effectively improve BC patient management. Our framework attempts to bridge the gap in assigning a central role played by shared decision-making, still scarcely investigated in literature.
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Affiliation(s)
- Antonio Giulio de Belvis
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (A.G.d.B.); (A.M.); (R.P.); (S.B.)
- Clinical Pathways and Outcome Evaluation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Via della Pineta Sacchetti 217, 00168 Rome, Italy
| | - Rossella Pellegrino
- Clinical Pathways and Outcome Evaluation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Via della Pineta Sacchetti 217, 00168 Rome, Italy
| | - Carolina Castagna
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (A.G.d.B.); (A.M.); (R.P.); (S.B.)
| | - Alisha Morsella
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (A.G.d.B.); (A.M.); (R.P.); (S.B.)
- Clinical Pathways and Outcome Evaluation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Via della Pineta Sacchetti 217, 00168 Rome, Italy
| | - Roberta Pastorino
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (A.G.d.B.); (A.M.); (R.P.); (S.B.)
| | - Stefania Boccia
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (A.G.d.B.); (A.M.); (R.P.); (S.B.)
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13
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D'Ambrosio F, de Belvis AG, Morsella A, Castellini G, Graffigna G, Laurenti P. Life After COVID-19: Rethinking the Healthcare System and Valuing the Role of Citizens' Engagement in Health Prevention. Front Psychol 2020; 11:589249. [PMID: 33192925 PMCID: PMC7658406 DOI: 10.3389/fpsyg.2020.589249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/25/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Floriana D'Ambrosio
- Section of Hygiene, University Department of Health Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Giulio de Belvis
- Section of Hygiene, University Department of Health Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Critical Pathways and Outcomes Evaluation Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alisha Morsella
- Section of Hygiene, University Department of Health Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Critical Pathways and Outcomes Evaluation Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Greta Castellini
- Department of Psychology, EngageMinds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Guendalina Graffigna
- Department of Psychology, EngageMinds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Patrizia Laurenti
- Section of Hygiene, University Department of Health Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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14
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de Belvis AG, Lohmeyer FM, Barbara A, Giubbini G, Angioletti C, Frisullo G, Ricciardi W, Specchia ML. Ischemic stroke: clinical pathway impact. Int J Health Care Qual Assur 2019; 32:588-598. [PMID: 31018795 DOI: 10.1108/ijhcqa-05-2018-0111] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Indexed: 12/19/2022]
Abstract
PURPOSE A clinical pathway for patients with acute ischemic stroke was implemented in 2014 by one Italian teaching hospital multidisciplinary team. The purpose of this paper is to determine whether this clinical pathway had a positive effect on patient management by comparing performance data. DESIGN/METHODOLOGY/APPROACH Volume, process and outcome indicators were analyzed in a pre-post retrospective observational study. Patients' (admitted in 2013 and 2015) medical records with International Classification of Diseases, ICD-9 code 433.x (precerebral artery occlusion and stenosis), 434.x (cerebral artery occlusion) and 435.x (transient cerebral ischemia) and registered correctly according to hospital guidelines were included. FINDINGS An increase context-sensitive in-patient numbers with more severe cerebrovascular events and an increase in patient transfers from the Stroke to Neurology Unit within three days (70 percent, p=0.25) were noted. Clinical pathway implementation led to an increase in patient flow from the Emergency Department to dedicated specialized wards such as the Stroke and Neurology Unit (23.7 percent, p<0.001). Results revealed no statistically significant decrease in readmission rates within 30 days (5.7 percent, p=0.85) and no statistically significant differences in 30-day mortality. RESEARCH LIMITATIONS/IMPLICATIONS The pre-post retrospective observational study design was considered suitable to evaluate likely changes in patient flow after clinical pathway implementation, even though this design comes with limitations, describing only associations between exposure and outcome. ORIGINALITY/VALUE Clinical pathway implementation showed an overall positive effect on patient management and service efficiency owing to the standardized application in time-dependent protocols and multidisciplinary/integrated care implementation, which improved all phases in acute ischemic stroke care.
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Affiliation(s)
- Antonio Giulio de Belvis
- Department for Evaluation of Clinical Pathways and Outcomes, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy
- Università Cattolica del Sacro Cuore , Rome, Italy
| | | | - Andrea Barbara
- Institute of Public Health/Hygiene Section, Università Cattolica del Sacro Cuore , Rome, Italy
| | - Gabriele Giubbini
- Institute of Public Health/Hygiene Section, Università Cattolica del Sacro Cuore , Rome, Italy
| | - Carmen Angioletti
- Department for Evaluation of Clinical Pathways and Outcomes, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy
| | - Giovanni Frisullo
- Università Cattolica del Sacro Cuore , Rome, Italy
- Department of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy
| | - Walter Ricciardi
- Institute of Public Health/Hygiene Section, Università Cattolica del Sacro Cuore , Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy
- Italian National Health Institute , Rome, Italy
| | - Maria Lucia Specchia
- Institute of Public Health/Hygiene Section, Università Cattolica del Sacro Cuore , Rome, Italy
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15
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de Belvis AG, Barbara A, Giubbini G, Traglia S, Angioletti C, Ianiro G, Masucci L, Sanguinetti M, Laurenti P, Cambieri A, Gasbarrini A, Ricciardi W, Cammarota G. Impact evaluation of a Critical Pathway for patients with Clostridium difficile infection: A pre-post analysis in a Third Level Referral Center. Int J Infect Dis 2019; 80:105-110. [PMID: 30682499 DOI: 10.1016/j.ijid.2019.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/16/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Clostridium Difficile Infections (CDIs) have been increasing both in incidence and in severity, representing a big public health concern. AIM The aim of this study was to evaluate the impact of a recently implemented Critical Pathway (CP) focused on patients with CDI in an Italian Teaching Hospital. METHODS The CP implementation consisted of intervention aimed to faster diagnosis and appropriateness in admission and discharge point of care; activation of a multidisciplinary team; staff training; information to patients and caregivers. In a pre-post retrospective observational study, volume, process and outcome indicators were analyzed. FINDINGS A total of 228 patients (128 in 2013 and 100 in 2016) were included. A decrease in the absolute number of access to the Emergency Department (p=0.02) and an increase in hospitalization in more appropriate ward (ie gastroenterology ward, p<0.001) were found. The median hospital length of stay decreased from 20.5 (12.5-31) days in 2013 to 16.5 (7-31) days in 2016 (p=0.05). With regards to outcome indicators, an increase of discharge to home and a decrease of discharge to long term facilities were showed (p=0.01 both). Despite a reduction, no statically significant differences in mortality between 2013 and 2016 were revealed by the analysis. CONCLUSION In conclusion, we found quality improvement in patient hospital management. Our experience confirms that the implementation of the CP increases the appropriateness in hospital quality of care.
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Affiliation(s)
- Antonio Giulio de Belvis
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Roma, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
| | - Andrea Barbara
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gabriele Giubbini
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Serena Traglia
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Gianluca Ianiro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Department of Internal Medicine, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luca Masucci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Institute of Microbiology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maurizio Sanguinetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Institute of Microbiology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Patrizia Laurenti
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Roma, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Andrea Cambieri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Department of Internal Medicine, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Walter Ricciardi
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Roma, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giovanni Cammarota
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Department of Internal Medicine, Università Cattolica del Sacro Cuore, Roma, Italy
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Poscia A, Azzolini E, Cacciatore P, de Belvis AG, Volpe M, Cambieri A, Damiani G, Ricciardi W, Specchia ML. Does Clinical Governance influence the quality of medical records? Ann Ist Super Sanita 2018; 54:104-108. [PMID: 29916414 DOI: 10.4415/ann_18_02_05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Clinical Governance (CG) is a validated framework for continuous quality improvement in health care settings. Quality medical records may reflect the quality of care delivered and are a viable tool to implement CG skills. AIM Aim of this study is to investigate the correlation between the level of implementation of CG dimensions and the quality of medical records. MATERIAL AND METHODS A cross-sectional study was carried out in an Italian Teaching Hospital. CG implementation levels were quantified through a systematic methodology (OPTIGOV©). The overall quality of medical records was measured through a revised version of a National-validated scale. A multiple linear regression model was used to test the likely influence of all the variables constituting the OPTIGOV evaluation on the quality of medical records. 47 hospital wards and 1458 medical records were assessed. RESULTS A significant and positive association between the quality of medical records and the accountability score (β = 0.15; p < 0.01) and the clinical audit score (b = 0.11; p = 0.02), was found. Conversely, the risk management score shown a negative and significant correlation (b = -0.17; p < 0.01). This study confirms that CG plays a central role in driving quality improvement and advocates a systematic implementation of such an approach within healthcare organizations.
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Affiliation(s)
- Andrea Poscia
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, IRCCS Fondazione Policlinico "Agostino Gemelli", Rome, Italy
| | - Elena Azzolini
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, IRCCS Fondazione Policlinico "Agostino Gemelli", Rome, Italy
| | - Pasquale Cacciatore
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, IRCCS Fondazione Policlinico "Agostino Gemelli", Rome, Italy
| | - Antonio Giulio de Belvis
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, IRCCS Fondazione Policlinico "Agostino Gemelli", Rome, Italy
| | - Massimo Volpe
- Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Andrea Cambieri
- Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Gianfranco Damiani
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, IRCCS Fondazione Policlinico "Agostino Gemelli", Rome, Italy
| | | | - Maria Lucia Specchia
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, IRCCS Fondazione Policlinico "Agostino Gemelli", Rome, Italy
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Lohmeyer FM, Commers MJ, Leoncini E, Specchia ML, Boccia S, Ricciardi WG, de Belvis AG. Community-based Mental Healthcare: A Case Study in a Cross-border Region of Germany and the Netherlands. Gesundheitswesen 2018; 81:e58-e63. [PMID: 30273940 DOI: 10.1055/a-0664-0579] [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: 10/28/2022]
Abstract
BACKGROUND Community-based mental healthcare (CBMH) aims at supplying psychiatric patients with rehabilitative care outside the hospital. The aim of this study was to compare the organization of CBMH in a cross-border region of Germany and the Netherlands. METHOD Semi-structured interviews gave insight into characteristics of CBMH approaches applied in the German region of Aachen (IHP) and the Dutch Province of Limburg (FACT). We applied a Delphi technique to select a performance indicator (PI) set for CBMH, which served as a conceptual model to allow comparison. RESULTS Both approaches are flexible, patient-centred and include the evaluation of quality. Both provide financial and administrative support for the access. CONCLUSION CBMH approaches appear to be equally valid from several perspectives even if they revealed, at the same time, important differences related to scope, integration with non-CBMH care resources and geographic coverage. Secondarily, the study provides a contribution to the development of a PI set to compare and evaluate CBMH approaches.
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Affiliation(s)
| | - Matthew J Commers
- International Health, Maastricht University, Maastricht, The Netherlands
| | | | - Maria Lucia Specchia
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefania Boccia
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Walter Gualtiero Ricciardi
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Italian National Institute of Health, President, Rome, Italy
| | - Antonio Giulio de Belvis
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Maged D, Ferrelli RM, Zorayan A, Di Pietro ML, de Belvis AG, Ricciardi W, Boccia S, Teleman AA, Sanguinetti M. Cooperating to improve healthcare in Arab countries. Ann Ist Super Sanita 2018; 53:330-333. [PMID: 29297863 DOI: 10.4415/ann_17_04_09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This brief note presents a few examples of successful health collaboration to improve healthcare in Arab countries. Considerable growth has been noticed in the past years in the health sector of the Middle East and North Africa region countries due to the need to address health service capacity gaps and improve the quality of health infrastructure. The rising population coupled with the aging demographic is expected to drive healthcare demand in the Arab region, augmenting its demand. In order to meet this demand, a lot of progress within the public sector has been made and several initiatives have taken place to create awareness of the most common diseases affecting the region. Among the steps undertaken in order to face the shortage of experience of medical personnel and the rising cost of the delivery of health services, the most noticeable ones relate to major investments within the realm of healthcare provision. However, country-specific drivers of disease burden should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. Moreover, health gains will need to be sustained by supporting interventions on income, education, and fertility as drivers of health improvement.
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Affiliation(s)
- Davide Maged
- Italian Hospital Umberto Primo, Cairo, Egypt - Centro Studi e Ricerche sulla Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rita Maria Ferrelli
- Servizio Relazioni Esterne e Centro Rapporti Internazionali, Istituto Superiore di Sanità, Rome, Italy
| | | | - Maria Luisa Di Pietro
- Centro Studi e Ricerche sulla Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Giulio de Belvis
- Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Stefania Boccia
- Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Adele Anna Teleman
- Centro Studi e Ricerche sulla Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Sanguinetti
- Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
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Vrijhoef HJ, de Belvis AG, de la Calle M, de Sabata MS, Hauck B, Montante S, Moritz A, Pelizzola D, Saraheimo M, Guldemond NA. IT-supported integrated care pathways for diabetes: A compilation and review of good practices. Int J Care Coord 2017; 20:26-40. [PMID: 28690856 PMCID: PMC5476194 DOI: 10.1177/2053434517714427] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction Integrated Care Pathways (ICPs) are a method for the mutual decision-making and organization of care for a well-defined group of patients during a well-defined period. The aim of a care pathway is to enhance the quality of care by improving patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. To describe this concept, different names are used, e.g. care pathways and integrated care pathways. Modern information technologies (IT) can support ICPs by enabling patient empowerment, better management, and the monitoring of care provided by multidisciplinary teams. This study analyses ICPs across Europe, identifying commonalities and success factors to establish good practices for IT-supported ICPs in diabetes care. Methods A mixed-method approach was applied, combining desk research on 24 projects from the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) with follow-up interviews of project participants, and a non-systematic literature review. We applied a Delphi technique to select process and outcome indicators, derived from different literature sources which were compiled and applied for the identification of successful good practices. Results Desk research identified sixteen projects featuring IT-supported ICPs, mostly derived from the EIP on AHA, as good practices based on our criteria. Follow-up interviews were then conducted with representatives from 9 of the 16 projects to gather information not publicly available and understand how these projects were meeting the identified criteria. In parallel, the non-systematic literature review of 434 PubMed search results revealed a total of eight relevant projects. On the basis of the selected EIP on AHA project data and non-systematic literature review, no commonalities with regard to defined process or outcome indicators could be identified through our approach. Conversely, the research produced a heterogeneous picture in all aspects of the projects’ indicators. Data from desk research and follow-up interviews partly lacked information on outcome and performance, which limited the comparison between practices. Conclusion Applying a comprehensive set of indicators in a multi-method approach to assess the projects included in this research study did not reveal any obvious commonalities which might serve as a blueprint for future IT-supported ICP projects. Instead, an unexpected high degree of heterogeneity was observed, that may reflect diverse local implementation requirements e.g. specificities of the local healthcare system, local regulations, or preexisting structures used for the project setup. Improving the definition of and reporting on project outcomes could help advance research on and implementation of effective integrated care solutions for chronic disease management across Europe.
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Affiliation(s)
- Hubertus Jm Vrijhoef
- Department of Patient & Care, Maastricht University Medical Center, The Netherlands.,Vrije Universiteit Brussels, Belgium.,Panaxea b.v., Amsterdam, The Netherlands
| | | | | | | | | | - Sabrina Montante
- Fondazione Policlinico A. Gemelli - Università Cattolica S. Cuore, Italy
| | | | | | | | - Nick A Guldemond
- Institute of Health Policy & Management, Department of Health Services Management & Organisation, Erasmus University Rotterdam, The Netherlands
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Murri R, de Belvis AG, Fantoni M, Tanzariello M, Parente P, Marventano S, Bucci S, Giovannenze F, Ricciardi W, Cauda R, Sganga G. Impact of antibiotic stewardship on perioperative antimicrobial prophylaxis. Int J Qual Health Care 2016; 28:502-7. [DOI: 10.1093/intqhc/mzw055] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2016] [Indexed: 01/30/2023] Open
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Specchia ML, de Belvis AG, Parente P, Avolio M, Ricciardi W, Damiani G. "Wind of change": the role of human centered healthcare factors in the implementation of clinical governance in an Italian University teaching hospital. Ann Ist Super Sanita 2016; 52:281-288. [PMID: 27364405 DOI: 10.4415/ann_16_02_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Clinical governance (CG) is an approach to quality improvement in healthcare aimed at achieving a patient-centered health care system. The main objective of this study was to highlight human centered healthcare latent factors underlying the results of a CG assessment performed in the teaching hospital "A. Gemelli" of Rome, Italy. MATERIALS AND METHODS CG implementation levels were assessed through OPTIGOV© (OPTimizing healthcare GOVernance), a CG scorecard methodology. In order to identify the variables generating latent factors that can influence the governance of the Hospital, the multiple correspondence analysis (MCA) was applied. RESULTS The application of OPTIGOV© showed a good CG implementation level in the Gemelli Hospital. By applying MCA, the variables aggregated so as to define 3 latent factors (F1: assessment for people oriented improvement strategy; F2: assessment for people targeted management; F3: tracking for timely accountable people) explaining as a whole 82.68% of the total variance and respectively 48.09% (F1), 24.95% (F2) and 9.64% (F3). CONCLUSIONS The heuristic interpretation of the three latent factors could bring back to the concept of humanization in healthcare. This study shows that in the teaching hospital "A. Gemelli" humanization in healthcare is the driver of health care quality improvement.
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Affiliation(s)
- Maria Lucia Specchia
- Istituto di Sanità Pubblica, Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Giulio de Belvis
- Istituto di Sanità Pubblica, Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Parente
- Istituto di Sanità Pubblica, Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Avolio
- Istituto di Sanità Pubblica, Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Gianfranco Damiani
- Istituto di Sanità Pubblica, Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
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Petitti T, Candela ML, Ianni A, de Belvis AG, Ricciardi W, De Marinis MG. [Validation of the Italian version of the GHAA-9 m questionnaire on patient satisfaction in digestive Endoscopy]. Ig Sanita Pubbl 2015; 71:465-476. [PMID: 26722824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND There isn't a validated questionnaire in Italian language to evaluate the quality perceived by the patient in Digestive Endoscopy. OBJECTIVE validation of the translation of a questionnaire from English to Italian language to measure the level of patient satisfaction. MATERIALS AND METHODS we conducted a prospective study on validation in Italian of a short questionnaire adapted for Endoscopy by the American Society of Gastrointestinal Endoscopy, the GHAA-9m. It's been tested with the technique of the questionnaire/interview on 80 outpatients who underwent in the month of September 2014 to endoscopic examinations of the gastrointestinal tract. The patients were divided into 2 groups of 40 patients: group 1 was administered before the questionnaire and subsequently the interview was conducted, on the contrary on the group 2 was administered before the interview and subsequently the questionnaire. The results of the two groups were compared using the inter-rater agreement. It was also evaluated the internal consistency of the questions. RESULTS The results show that the instrument is experienced as simple and quick to use for patients. Data analysis allowed us to conclude that the Italian translation is valid and consistent. In the phase of the interview there were some aspects that suggest, in a development of this tool, some changes that could increase the accuracy and informational content. CONCLUSIONS The Italian version of the questionnaire GHAA-9m has good validity, reliability, and shows property valuation comparable to those of the American version and can therefore be used in daily practice Digestive Endoscopy.
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Affiliation(s)
- Tommasangelo Petitti
- Unità di Ricerca in Igiene, Sanità Pubblica e Statistica, Università Campus Biomedico di Roma, Italia
| | | | - Andrea Ianni
- Unità di Ricerca in Igiene, Sanità Pubblica e Statistica, Università Campus Biomedico di Roma, Italia
| | - Antonio Giulio de Belvis
- Dipartimento di Sanità Pubblica, Sezione di Igiene, Università Cattolica del S. Cuore di Roma, Italia
| | - Walter Ricciardi
- Unità di Ricerca in Scienze Infermieristiche, Università Campus Biomedico di Roma, Italia
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Ferre F, de Belvis AG, Valerio L, Longhi S, Lazzari A, Fattore G, Ricciardi W, Maresso A. Italy: health system review. Health Syst Transit 2014; 16:1-168. [PMID: 25471543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Italy is the sixth largest country in Europe and has the second highest average life expectancy, reaching 79.4 years for men and 84.5 years for women in 2011. There are marked regional differences for both men and women in most health indicators, reflecting the economic and social imbalance between the north and south of the country. The main diseases affecting the population are circulatory diseases, malignant tumours and respiratory diseases. Italy's health care system is a regionally based national health service that provides universal coverage largely free of charge at the point of delivery. The main source of financing is national and regional taxes, supplemented by copayments for pharmaceuticals and outpatient care. In 2012, total health expenditure accounted for 9.2 percent of GDP (slightly below the EU average of 9.6 percent). Public sources made up 78.2 percent of total health care spending. While the central government provides a stewardship role, setting the fundamental principles and goals of the health system and determining the core benefit package of health services available to all citizens, the regions are responsible for organizing and delivering primary, secondary and tertiary health care services as well as preventive and health promotion services. Faced with the current economic constraints of having to contain or even reduce health expenditure, the largest challenge facing the health system is to achieve budgetary goals without reducing the provision of health services to patients. This is related to the other key challenge of ensuring equity across regions, where gaps in service provision and health system performance persist. Other issues include ensuring the quality of professionals managing facilities, promoting group practice and other integrated care organizational models in primary care, and ensuring that the concentration of organizational control by regions of health-care providers does not stifle innovation.
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Affiliation(s)
| | | | - Luca Valerio
- Universita Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | | | - Anna Maresso
- European Observatory on Health Systems and Policies
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Specchia ML, de Belvis AG, Capizzi S, Veneziano MA, Kheiraoui F, Morelli L, Ferriero AM, Cadeddu C, Ricciardi W. Building successful collaborations between Public Health and Primary Health Care. Ig Sanita Pubbl 2013; 69:427-444. [PMID: 24091844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Public Health (PH) and Primary Health Care (PHC) need to be better integrated, at different levels of the healthcare system, in order to improve health and social outcomes. The aim of this study was to review international models and approaches supporting the integration of PH and PHC and to classify these according to their main focus. A literature search was performed using the main scientific databases, to identify national and international journal publications regarding models to support integration between PH and PHC. The final set of the documents provided a broad coverage of the topic. Four models of integration were identified: general integration, chronic disease prevention, targeted prevention or care delivery and infection control. Models differed in their levels of implementation, stages of development and focus. This review, by classifying the main characteristics and results of the experiences retrieved, indicates a relatively scarce use of integration models in the global health care landscape, with the exception of Canada. In fact, Canada has been a leader in developing models of integrated health systems that combine tailored approaches to influence personal health behaviour and community-oriented approaches to influence the health of the population. The review also revealed a general lack of experience in evaluating the sustainability of integration between PH and PHC, not only in terms of cost-effectiveness, but also in terms of better health and work conditions and self-perceived quality of care in the population. Collaboration between PH and PHC seems to be an important strategy for achieving principles of equity and access in health care and for ensuring a more equal distribution of health care services.
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de Belvis AG, Marino M, Avolio M, Pelone F, Basso D, Dei Tos GA, Cinquetti S, Ricciardi W. Wait watchers: the application of a waiting list active management program in ambulatory care. Int J Qual Health Care 2013; 25:205-12. [PMID: 23407820 DOI: 10.1093/intqhc/mzt015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
OBJECTIVE This study describes and evaluates the application of a waiting list management program in ambulatory care. DESIGN Waiting list active management survey (telephone call and further contact); before and after controlled trial. SETTING Local Health Trust in Veneto Region (North-East of Italy) in 2008-09. PARTICIPANTS Five hundred and one people on a 554 waiting list for C Class ambulatory care diagnostic and/or clinical investigations (electrocardiography plus cardiology ambulatory consultation, eye ambulatory consultation, carotid vessels Eco-color-Doppler, legs Eco-color-Doppler or colonoscopy, respectively). INTERVENTION Active list management program consisting of a telephonic interview on 21 items to evaluate socioeconomic features, self-perceived health status, social support, referral physician, accessibility and patients' satisfaction. A controlled before-and-after study was performed to evaluate anonymously the overall impact on patients' self-perceived quality of care. MAIN OUTCOME MEASURES The rate of patients with deteriorating healthcare conditions; rate of dropout; interviewed degree of satisfaction about the initiative; overall impact on citizens' perceived quality of care. RESULTS 95.4% patients evaluated the initiative as useful. After the intervention, patients more likely to have been targeted with the program showed a statistically significant increase in self-reported quality of care. CONCLUSIONS Positive impact of the program on some dimensions of ambulatory care quality (health status, satisfaction, willingness to remain in the queue), thus confirming the outstanding value of 'not to leave people alone' and 'not to leave them feeling themselves alone' in healthcare delivery.
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Affiliation(s)
- Antonio Giulio de Belvis
- Department of Public Health and Preventive Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
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De Feo E, de Belvis AG, Silenzi A, Specchia ML, Gallì P, Ricciardi W. Patient-centeredness and e-health among Italian hospitals: results of a cross-sectional web-based survey. Telemed J E Health 2012; 18:791-6. [PMID: 23082793 DOI: 10.1089/tmj.2011.0234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
OBJECTIVES Given the growing recognition of patient-centeredness as a healthcare quality indicator and its limited implementation in practice, our study evaluated how the Italian hospitals (ItHs), including research hospitals (IRCCSs), research teaching hospitals (THs), and independent public hospital trusts (AOs), address the dimension of online data access through their institutional Web sites to promote a patient-centered care. MATERIALS AND METHODS To address patient-centeredness and e-health, eight specific indicators adapted from the Euro Health Consumer Index were evaluated from 169 ItHs: online booking of healthcare services; access to medical records; register of legitimate doctors; waiting times for most commonly delivered healthcare services; transport information; centralized booking; public relations office; and pain management hospital committee. Univariate and bivariate statistics and a logistic regression analysis have been performed. RESULTS The majority of the ItHs were under public ownership, and half of them are located in Northern Italy. From the logistic regression analysis, AOs appeared to be more likely to develop a patient-centered healthcare approach (odds ratio [OR]=3.69; 95% confidence interval [CI] 1.14-11.89) compared with IRCCSs or THs. In addition, when grouped together, all public hospitals show more than threefold higher implementation of patient-centeredness strategies (OR=3.60; 95% CI 1.49-8.72) with respect to private ones. Northern hospitals are more likely to ensure wider implementation of a patient-centered approach to healthcare (OR=3.37; 95% CI 1.49-7.62). CONCLUSIONS According to our results, most of the ItHs are under public ownership, and half of them are located in the northern regions of Italy. The higher implementation of patient-centeredness strategies observed for Northern hospitals highlights interregional disparity in healthcare that needs a coordinated effort at both the hospital and policymaker levels to ensure a widespread implementation of patient-centered care among all Italian regions.
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Affiliation(s)
- Emma De Feo
- Institute of Hygiene and Public Health, Catholic University of Sacred Heart, Rome, Italy.
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de Belvis AG, Ferrè F, Specchia ML, Valerio L, Fattore G, Ricciardi W. The financial crisis in Italy: Implications for the healthcare sector. Health Policy 2012; 106:10-6. [DOI: 10.1016/j.healthpol.2012.04.003] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/10/2012] [Accepted: 04/02/2012] [Indexed: 11/24/2022]
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Rosano A, Loha CA, Falvo R, van der Zee J, Ricciardi W, Guasticchi G, de Belvis AG. The relationship between avoidable hospitalization and accessibility to primary care: a systematic review. Eur J Public Health 2012; 23:356-60. [PMID: 22645236 DOI: 10.1093/eurpub/cks053] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Avoidable hospitalization (AH) has been widely studied as a possible measure of the performance of primary health care (PHC). However, studies examining the relationship between the efficiency and quality of PHC and AH have found mixed results. Our study aims at highlighting those factors related to the relationship between AH and accessibility to PHC in different countries. METHODS We conducted a systematic search for peer-reviewed studies published between 1990 and October 2010 in English, German, French, Italian or Spanish and indexed primary electronic databases. RESULTS The final analysis was conducted on the basis of 51 papers. Of them, 72.5% revealed a significant inverse association between the indicator of PHC accessibility and rates of AH. Indicators of PHC calculated at individual level are more likely to reveal contradictory aspects of the relationship between rates of AH and indicators of quality and PHC accessibility. CONCLUSIONS Most studies confirmed the expected relationship between indicators of PHC accessibility and hospitalization for ambulatory care sensitive conditions (ACSCs), showing lower hospitalization rates for ACSC in areas with greater access to PHC. The findings support the use of ACSC hospitalization as an indicator of primary care quality, with the precaution of applying appropriate adjustment factors.
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Affiliation(s)
- Aldo Rosano
- Agency for Public Health, Lazio Region, Rome, Italy.
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Ricciardi W, de Belvis AG, Marino M, Santoro A, Silenzi A. [Inequalities in Public Health development in Italy, an evolving-to-federalism country]. Epidemiol Prev 2011; 35:45-49. [PMID: 22166864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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de Belvis AG, Avolio M, Sicuro L, Rosano A, Latini E, Damiani G, Ricciardi W. Social relationships and HRQL: a cross-sectional survey among older Italian adults. BMC Public Health 2008; 8:348. [PMID: 18834511 PMCID: PMC2569037 DOI: 10.1186/1471-2458-8-348] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 10/03/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study is to investigate the association between social relationships and Health Related Quality of Life (HRQL) among the elderly in Italy. METHODS A sample of 33,744 Italian residents, representing the non-institutionalised population aged 60 years and over was extracted from the national ISTAT cross-sectional survey during 1999-2000. HRQL was measured with the SF-12, from which the Physical Component Score (PCS) and Mental Component Score (MCS) were obtained. Data were subjected to descriptive analysis and multiple logistic regression models with adjustment for the main confounders. RESULTS Our analysis shows a gradient in PCS and MCS among the terziles in seeing/meeting "friends" and "family" and, for PCS, a North-South gradient among the Italian regions. Females, the elderly who reported a lower household income, those who spent less time in recreational and religious activities, who lived too far from their relatives and had few relationships with friends and relatives, were significantly less likely to have an MCS above the median value. For PCS, an increase in HRQL was likely to be associated with a higher educational level, while lower PCS scores were associated with: age 75+, inadequate household income, unmarried status, infrequency of seeing/meeting friends, too high a mean distance from own home to relatives' homes, lack of leisure time spent in recreational activities, living in the Centre-South of Italy, chronic diseases, reduced autonomy, and use of drugs during the previous two days. Significant interactions between suffering from one chronic disease and the use of drugs were also found for both MCS and PCS. CONCLUSION Some dimensions of social relationships were significantly associated with HRQL. These findings are crucial for devising welfare strategies at both the regional and the European level, i.e. in countries such as Italy where the primacy of family support of the elderly has declined in recent years.
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Affiliation(s)
- Antonio Giulio de Belvis
- Department of Public Health and Preventive Medicine, Catholic University Sacro Cuore, Rome, Italy.
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