Managing gaming phenomena in the Tuscan performance evaluation system.

The problem of gaming in performance evaluation systems is a known phenomenon (Bevan, 2006, Bevan Hood, 2006) that can take place especially when there are economic incentives related to specific targets. In all Tuscan Local Health Authorities (LHAs) and Teaching Hospitals (THs) a multidimensional performance evaluation system has been adopted since 2005, based on administrative and non-administrative data benchmarking. The goal of the Tuscany performance measurement system is to give a general outline for the management of the LHAs and THs, both for evaluating performance and for enhancing and promoting the results of the healthcare system. The performance evaluation system consists of 130 indicators classified in six dimensions: Population health assessment; Regional health system; Quality; Patient satisfaction; Staff satisfaction; Efficiency and financial performance After three years of the performance evaluation system’s adoption, integrated with an incentive system, improvements were achieved in most of the indicators monitored. The paper reports the effects of the performance evaluation system and how gaming phenomena were managed with a special focus on data manipulation. Methods The research team focused the analysis on the larger performance improvements during the years 2005-2007 to evaluate whether gaming phenomena have been taking place. The findings of this analysis were reported and discussed with top managers and professionals through individual interviews and group meetings in order to detect the determinants of the results obtained. In 2007 LHAs and THs whose indicators clearly show large improvement were highlighted during meetings with the top management asking them how his/her organization reaches its results. Results Gaming has been found in indicators concerning small and specific areas, such as the rate of hospitalization for heart failure, while indicators that concern larger phenomena, such as the pre-surgical length of stay, were less involved. The request of evidence to explain the improvement obtained has been a deterrent to gaming behaviors. Conclusions The results suggest that further development is needed to analyse suspicious cases. The public presentation of data and the request for evidence to explain large improvements in peer review meetings ease the accountability process. In addition these can be a deterrent for future activities.Gaming phenomena, Health service improvement, reputational level

How to re-allocate resources within services through data benchmarking: some evidence from the Tuscan Health System.

Background Tuscany Region has implemented a multidimensional system to assess the performance of all Local Health Authorities (LHAs), based on over 130 indicators classified in 6 dimensions in benchmarking. A study was carried out to use the results of the evaluation performance system to support health system decision makers to cope with resources scarcity. Objective To quantify the amount of resources LHAs can re-allocate, taking actions in different sectors, for services with more value for patients. Methods The analysis was based on the data benchmarking of all the indicators of the performance evaluation system with an impact on the level of resources used. For each indicator, the first step was to estimate the gap between the performance of each LHA and the best performance or the regional average. The second step was to measure this gap in terms of financial value. Results The results of the analysis put on evidence that at the regional level 6 to 10 percent of the budget for healthcare (6.100 ml Euros) can be re-allocated if all the institutions achieve the regional average or the best practice. Some LHAs are already efficient but others have large room for improvement: some of them, working on efficiency and appropriatness, can re-allocate up to the 13% of their total costs in services with more value for patients. Policy Implications The implications of this study can be extremely useful for policy makers and the top management of LHAs in a public system that bases its action on cooperation more that competition. Benchmarking makes the system capable to measure the financial impact of different types of actions which can effect efficiency.Disinvestment, setting priorities, healthcare

Evaluating Performance in the Tuscan Health Care System.

The Tuscan health care system strives to foster cooperation among the various organizations that provide services. Government authorities therefore believe it is important to plan and develop a transparent system capable of monitoring the economic results of the region’s 16 public health authorities and their ability to pursue and accomplish the aims of the regional health care plan. The principal aim of the Tuscan performance evaluation system is to give a general outline of the management of the region’s health care authorities. This outline is intended to be useful both for evaluating performance and for enhancing and promoting the results of the healthcare system.Performance evaluation system, benchmarking in healthcare.

Performance assessment in the maternity pathway in Tuscany Region

The paper describes the performance measurement system of the maternity pathway used in Tuscany by health care professionals, general managers and regional policy-makers. This system uses 19 indicators grouped in six dimensions: population’s state of health; compliance with regional guidelines; efficiency and financial performance; clinical and health assessment; patient satisfaction; and employees’ satisfaction. The results are represented on a spider diagram that summarizes the results on the different dimensions. The Tuscan performance measurement system of the maternity pathway has been used to identify best practice within, and their adoption throughout, the Tuscan public health care system

Making governance work in the healthcare sector: evidence from a “natural experiment” in Italy

The Italian Health Care System is a public health system which provides universal coverage for comprehensive and essential health services through general taxation. Since the early 1990s, a strong decentralization policy has taken place in Italy and the State has gradually ceded its jurisdiction to the 20 Italian Regions. These Regions now have the political, administrative, and financial responsibility for the provision of health care to their residents. This shift of power has created some interregional differences in the quality of healthcare services. However, eight Italian Regions have adopted the same Performance Evaluation System (PES) since 2008. It was designed and implemented to monitor about 160 indicators. The Regional Network has offered valuable information and the opportunity to adopt managerial tools that can be used to drive performance improvement and achieve equity. This paper firstly describes the methodology followed by the eight Regions in defining their priorities and setting their targets, relying on the multidimensional data the Inter-Regional Performance Evaluation System provides. It secondly enquires how some Regions have applied and adapted this methodology to their characteristics and strategies

Mouse and rat ultrasonic vocalizations in neuroscience and neuropharmacology: State of the art and future applications

Mice and rats emit ultrasonic vocalizations (USVs), which may express their arousal and emotional states, to communicate with each other. There is continued scientific effort to better understand the functions of USVs as a central element of the rodent behavioral repertoire. However, studying USVs is not only important because of their ethological relevance, but also because they are widely applied as a behavioral readout in various fields of biomedical research. In mice and rats, a large number of experimental models of brain disorders exist and studying the emission of USVs in these models can provide valuable information about the health status of the animals and the effectiveness of possible interventions, both environmental and pharmacological. This review (i) provides an updated overview of the contexts in which ultrasonic calling behaviour of mice and rats has particularly high translational value, and (ii) gives some examples of novel approaches and tools used for the analysis of USVs in mice and rats, combining qualitative and quantitative methods. The relevance of age and sex differences as well as the importance of longitudinal evaluations of calling and non-calling behaviour is also discussed. Finally, the importance of assessing the communicative impact of USVs in the receiver, that is, through playback studies, is highlighted

Orofacial Esthetic Scale and Psychosocial Impact of Dental Aesthetics Questionnaire: Development and psychometric properties of the Finnish version

To develop the Finnish version of the Orofacial Esthetic Scale (OES-Fi) and the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ-Fi) and estimate the psychometric properties of these instruments applied to adult Finns.info:eu-repo/semantics/publishedVersio

Nuclear Factor \u3baB-Dependent Neurite Remodeling Is Mediated by Notch Pathway

In this study, we evaluated whether a cross talk between nuclear factor \u3baB (NF-\u3baB) and Notch may take place and contribute to regulate cell morphology and/or neuronal network in primary cortical neurons. We found that lack of p50, either induced acutely by inhibiting p50 nuclear translocation or genetically in p50(-/-) mice, results in cortical neurons characterized by reduced neurite branching, loss of varicosities, and Notch1 signaling hyperactivation. The neuronal morphological effects found in p50(-/-) cortical cells were reversed after treatment with the \u3b3-secretase inhibitor DAPT (N-[N-(3,5-difluorophenacetyl)-1-alanyl 1]-S-phenylglycine t-butyl ester) or Notch RNA interference. Together, these data suggested that morphological abnormalities in p50(-/-) cortical neurons were dependent on Notch pathway hyperactivation, with Notch ligand Jagged1 being a major player in mediating such effect. In this line, we demonstrated that the p50 subunit acts as transcriptional repressor of Jagged1. We also found altered distribution of Notch1 and Jagged1 immunoreactivity in the cortex of p50(-/-) mice compared with wild-type littermates at postnatal day 1. These data suggest the relevance of future studies on the role of Notch/NF-\u3baB cross talk in regulating cortex structural plasticity in physiological and pathological conditions

Cortical Structure Alterations and Social Behavior Impairment in p50-Deficient Mice

Alterations in genes that regulate neurodevelopment can lead to cortical malformations, resulting in malfunction during postnatal life. The NF-κB pathway has a key role during neurodevelopment by regulating the maintenance of the neural progenitor cell pool and inhibiting neuronal differentiation. In this study, we evaluated whether mice lacking the NF-κB p50 subunit (KO) present alterations in cortical structure and associated behavioral impairment. We found that, compared with wild type (WT), KO mice at postnatal day 2 present an increase in radial glial cells, an increase in Reelin protein expression levels, in addition to an increase of specific layer thickness. Moreover, adult KO mice display abnormal columnar organization in the somatosensory cortex, a specific decrease in somatostatin- and parvalbumin-expressing interneurons, altered neurite orientation, and a decrease in Synapsin I protein levels. Concerning behavior, KO mice, in addition to an increase in locomotor and exploratory activity, display impairment in social behaviors, with a reduction in social interaction. Finally, we found that risperidone treatment decreased hyperactivity of KO mice, but had no effect on defective social interaction. Altogether, these data add complexity to a growing body of data, suggesting a link between dysregulation of the NF-κB pathway and neurodevelopmental disorders pathogenesis