Using patient-reported measures to drive change in healthcare: the experience of the digital, continuous and systematic PREMs observatory in Italy

BACKGROUND: The use of Patient Reported Experience Measures (PREMs) has great potential in healthcare service improvement, but a limited use. This paper presents an empirical case of PREMs innovation in Italy, to foster patient data use up to the ward level, by keeping strengths and addressing weaknesses of previous PREMs survey experiences. The paper reports key lessons learned in this ongoing experience of action research, directly involving practitioners. METHODS: The aim of this paper is to present the results of an ongoing action research, encompassing the innovation of PREMs collection, reporting and use, currently adopted by 21 hospitals of two Italian regions. The continuous and systematic PREMs collection has been implemented between 2017 and 2019 and includes: a continuous web-based administration, using web-services; an augmented and positive questionnaire matching standard closed-ended questions with narrative sections; the inclusion and benchmarking of patient data within a shared performance evaluation system; public disclosure of aggregated anonymized data; a multi-level and real-time web-platform for reporting PREMs to professionals. The action research was carried out with practitioners in a real-life and complex context. The authors used multiple data sources and methods: observations, feedback of practitioners, collected during several workshops and meetings, and analysis of preliminary data on the survey implementation. RESULTS: A continuous and systematic PREMs observatory was developed and adopted in two Italian regions. PREMs participation and response rates tend to increase over time, reaching stable percentages after the first months. Narrative feedback provide a 'positive narration' of episodes and behaviours that made the difference to patients and can inform quality improvement actions. Real-time reporting of quantitative and qualitative data is enabling a gratifying process of service improvement and people management at all the hospitals' levels. CONCLUSIONS: The PREMs presented in this paper has been recognized by healthcare professionals and managers as a strategic and positive tool for improving an actual use of PREMs at system and ward levels, by measuring and highlighting positive deviances, such as compassionate behaviours

E-patient (r)evolution: quando è il paziente a coinvolgere il medico.

Lo scopo di questo studio è fornire un contribuito al framework teorico di riferimento, con evidenze sui comportamenti di scelta della popolazione della Regione Toscana riguardo l’uso di internet quale strumento per reperire informazioni sulla salute. Dai risultati emerge che sono i più giovani e istruiti, con una insoddisfazione del sistema sanitario e con cattive esperienze con le Asl in termini di burocrazia e prontezza del front-office a consultare più internet, ma coloro i quali hanno un buon rapporto con il proprio medico di famiglia sono più propensi a condividere tali informazioni derivanti dalla rete con il medico stesso

Do Patient Preferences Change in a Pandemic? Exploring Italian Patient Reported Experience DATA during the COVID-19 Crisis (PNS245)

Objectives Patient experience is an important metric of hospital performance, both in its own right and due to its association with good processes and a range of positive outcomes. Little is known about the impact of crisis situations on patient experience, such as in the COVID-19 pandemic, where extraordinary measures were necessary to maintain healthcare provision. Methods We performed multilevel and multivariate regression to evaluate the differences in hospitalisation experience before and during the COVID-19 outbreak in Tuscany and Veneto, regions differently affected by the pandemic. Experience was measured by continuously collected online Patient-Reported Experience Measures (PREMs), with 8,712 questionnaires collected from January-April 2020. Results Almost all PREM scores increased in the COVID-19 period compared to the two months preceding. Multilevel analysis showed very low, nonsignificant variation in overall satisfaction and Willingness-to-Recommend (WOM) between hospitals in the same region, controlling for health status, sex, age, and first incidence of COVID-19 in the region. Multivariate regression models, including demographic factors only, found increased WOM in the worse affected region. By including relevant PREM items, we found the items most predictive of WOM changed during pandemic situations, with a greater effect and significance for items associated with emotional support and communication (e.g. having fears and anxieties addressed by clinicians [0.25, p=0.07; 0.46 p=0.03]) alongside reduced effect sizes and higher p-values for items most affected by pandemic control processes (e.g. ward silence [0.47, p=0.04; 0.14, p=0.45], communication with relatives [0.3, p=0.02; 0.005, p=0.98). Conclusions Hospitals in Tuscany and Veneto were able to provide a positive patient experience in the COVID-19 pandemic, despite operating challenges. Patient expectations of their hospitalisation may have changed through awareness of the wider health crisis. The different factors most predictive of WOM during the pandemic may be explained by patient recognition and understanding of the great efforts and professionalism of healthcare professionals

Three-dimensional central-moments-based lattice Boltzmann method with external forcing: A consistent, concise and universal formulation

The cascaded or central-moments-based lattice Boltzmann method (CM-LBM) is a robust alternative to the more conventional BGK-LBM for the simulation of high-Reynolds number flows. Unfortunately, its original formulation makes its extension to a broader range of physics quite difficult. To tackle this issue, a recent work [A. De Rosis, Phys. Rev. E 95, 013310 (2017)] proposed a more generic way to derive concise and efficient three-dimensional CM-LBMs. Knowing the original model also relies on central moments that are derived in an adhoc manner, i.e., by mimicking those of the Maxwell-Boltzmann distribution to ensure their Galilean invariance a posteriori, a very recent effort [A. De Rosis and K. H. Luo, Phys. Rev. E 99, 013301 (2019)] was proposed to further generalize their derivation. The latter has shown that one could derive Galilean invariant CMs in a systematic and a priori manner by taking into account high-order Hermite polynomials in the derivation of the discrete equilibrium state. Combining these two approaches, a compact and mathematically sound formulation of the CM-LBM with external forcing is proposed. More specifically, the proposed formalism fully takes advantage of the D3Q27 discretization by relying on the corresponding set of 27 Hermite polynomials (up to the sixth order) for the derivation of both the discrete equilibrium state and the forcing term. The present methodology is more consistent than previous approaches, as it properly explains how to derive Galilean invariant CMs of the forcing term in an a priori manner. Furthermore, while keeping the numerical properties of the original CM-LBM, the present work leads to a compact and simple algorithm, representing a universal methodology based on CMs and external forcing within the lattice Boltzmann framework.Comment: Published in Phys. Fluids as Editor's Pic

A longitudinal assessment of chronic care pathways in real-life: self-care and outcomes of chronic heart failure patients in Tuscany

Background: Worldwide healthcare systems face challenges in assessing and monitoring chronic care pathways and, even more, the value generated for patients. Patient-reported outcomes measures (PROMs) represent a valid Real-World Evidence (RWE) source to fully assess health systems’ performance in managing chronic care pathways. Methods: The originality of the study consists in the chance of adopting PROMs, as a longitudinal assessment tool for continuous monitoring of patients’ adherence to therapies and self-care behavior recommendations in clinical practice and as a chance to provide policy makers insights to improve chronic pathways adopting a patient perspective. The focus was on PROMs of patients with chronic heart failure (CHF) collected in the Gabriele Monasterio Tuscan Foundation (FTGM), a tertiary referral CHF centre in Pisa, Italy. During the hospital stay, CHF patients were enrolled and received a link (via SMS or email) to access to the first questionnaire. Follow-up questionnaires were sent 1, 7 and 12 months after the index hospitalisation. Professionals invited 200 patients to participate to PROMs surveys. 174 answers were digitally collected at baseline from 2018 to 2020 and analysed. Quantitative and qualitative analyses were conducted, using Chi2, t-tests and regression models together with narrative evidence from free text responses. Results: Both quantitative and qualitative results showed FTGM patients declared to strongly adhere to the pharmacological therapy across the entire pathway, while seemed less careful to adhere to self-care behavior recommendations (e.g., physical activity). CHF patients that performed adequate Self-Care Maintenance registered outcome improvements. Respondents declared to be supported by family members in managing their adherence. Conclusions: The features of such PROMs collection model are relevant for researchers, policymakers and for managers to implement interventions aimed at improving pathway adherence dimensions. Among those, behavioral economics interventions could be implemented to increase physical activity among CHF patients since proven successful in Tuscany. Strategies to increase territorial care and support patients’ caregivers in their daily support to patients’ adherence should be further explored. Systematic PROMs collection would allow to monitor changes in the whole pathway organization. This study brings opportunities for extending such monitoring systems to other organizations to allow for reliable benchmarking opportunities

COVID-19 vaccinations: An overview of the Italian national health system's online communication from a citizen perspective

COVID-19 vaccine hesitancy is still widespread. During the pandemic, the internet has been the preferred channel for health-related information, especially for less-educated citizens who tend to be the most hesitant about vaccination. A well-structured web communication strategy could help both to overcome vaccine hesitancy and to ensure equity in healthcare service access. This study investigated how the various regional and local health authorities in Italy used their institutional websites to inform users about COVID-19 vaccinations between March and April 2021. We browsed 129 institutional websites, checking the availability, quality and quantity, actionability and readability of information using a literature-based common grid. Descriptive statistics and statistical tests were performed. The online public dissemination of COVID-19 vaccination information in Italy was fragmented, both across and within regions. The side effects of vaccinations, were often not reported on the websites, thus missing an opportunity to enhance vaccination uptake. More focus should also be placed on readability, since readability indexes showed that they were difficult to understand. Our research revealed that several actions could be implemented to enhance online communication on COVID-19 vaccination. For instance, simplifying texts can make them more understandable and the information reported actionable

A numerical framework for simulating fluid-structure interaction phenomena

In this paper, a numerical tool able to solve fluid-structure interaction problems is proposed. The lattice Boltzmann method is used to compute fluid dynamics, while the corotational finite element formulation together with the Time Discontinuous Galerkin method are adopted to predict structure dynamics. The Immersed Boundary method is used to account for the presence of an immersed solid in the lattice fluidbackground and to handle fluid-structure interface conditions, while a Volume-of-Fluid-based method isadopted to take trace of the evolution of the free surface. These ingredients are combined through a partitioned staggered explicit strategy, according to an efficient and accurate algorithm recently developed by the authors. The effectiveness of the proposed methodology is tested against two different cases. The former investigates the dam break phenomenon, involving the modeling of the free surface. The latter involves the vibration regime experienced by two highly deformable flapping flags obstructing a flow. A wide numerical campaign is carried out by computing the error in terms of interface energy artificially introduced at the fluid-solid interface. Moreover, the structure behavior is dissected by simulating scenarios characterized by different values of the Reynolds number. Present findings are compared to literature results, showing a very close agreement.&nbsp

A numerical framework for simulating fluid-structure interaction phenomena

In this paper, a numerical tool able to solve fluid-structure interaction problems is proposed. The lattice Boltzmann method is used to compute fluid dynamics, while the corotational finite element formulation together with the Time Discontinuous Galerkin method are adopted to predict structure dynamics. The Immersed Boundary method is used to account for the presence of an immersed solid in the lattice fluid background and to handle fluid-structure interface conditions, while a Volume-of-Fluid-based method is adopted to take trace of the evolution of the free surface. These ingredients are combined through a partitioned staggered explicit strategy, according to an efficient and accurate algorithm recently developed by the authors. The effectiveness of the proposed methodology is tested against two different cases. The former investigates the dam break phenomenon, involving the modeling of the free surface. The latter involves the vibration regime experienced by two highly deformable flapping flags obstructing a flow. A wide numerical campaign is carried out by computing the error in terms of interface energy artificially introduced at the fluid-solid interface. Moreover, the structure behavior is dissected by simulating scenarios characterized by different values of the Reynolds number. Present findings are compared to literature results, showing a very close agreement

Lattice Boltzmann modeling and simulation of forced-convection boiling on a cylinder

When boiling occurs in a liquid flow field, the phenomenon is known as forced-convection boiling. We numerically investigate such a boiling system on a cylinder in a flow at saturated conditions. To deal with the complicated liquid–vapor phase-change phenomenon, we develop a numerical scheme based on the pseudopotential lattice Boltzmann method (LBM). The collision stage is performed in the space of central moments (CMs) to enhance numerical stability for high Reynolds numbers. The adopted forcing scheme, consistent with the CM-based LBM, leads to a concise yet robust algorithm. Furthermore, additional terms required to ensure thermodynamic consistency are derived in a CM framework. The effectiveness of the present scheme is successfully tested against a series of boiling processes, including nucleation, growth, and departure of a vapor bubble for Reynolds numbers varying between 30 and 30 000. Our CM-based LBM can reproduce all the boiling regimes, i.e., nucleate boiling, transition boiling, and film boiling, without any artificial input such as initial vapor phase. We find that the typical boiling curve, also known as the Nukiyama curve, appears even though the focused system is not the pool boiling but the forced-convection system. Also, our simulations support experimental observations of intermittent direct solid–liquid contact even in the film-boiling regime. Finally, we provide quantitative comparison with the semi-empirical correlations for the forced-convection film boiling on a cylinder on the Nu-Ja diagram