Co-production in healthcare services: What we know, how we can evaluate it

Background In times of increasing population aging, higher incidence of chronic diseases and higher expectations regarding public service provision, healthcare services are under increasing strain to cut costs while keeping quality. In this context, debates on the importance of promoting systems of co-produced health between stakeholders have gained considerable traction both in the literature and in policy debates of the public sector (Dunston et al., 2009, Voorberg et al. 2015; European Commission 2010). Co-production occurs \u201cwhen public service organizations partner with external entities, including other public organizations, third sector, or service user, to jointly produce services that they previously produced on their own\u201d (Thomas, 2013, p. 788). In this perspective, co-production is not only a patient involvement tool, but mainly a managerial tool, where partner in the production process could influence the methods used to organise and manage the service delivery (Sorrentino et al., 2015; Brandsen and Honingh, 2015; Gilardi et al., 2016). Despite this widespread acceptance, minimal consensus exists on the mechanisms for evaluating the actual impacts of the co-production in healthcare sector. More specifically, little has been produced on how the results of these changing structures, practices and goals in healthcare management and provision can be monitored and evaluated (Hardyman et al., 2015; Gilardi et al., 2016; Palumbo, 2016). Objectives The study aims at filling this gap by developing a conceptual framework for assessing co-production in healthcare. Specifically, drawing on existing literature on co-production in healthcare, we develop an original analytical evaluation framework with respect to: i) the multidimensional perspectives to be taken into consideration; ii) the dimensions to be analysed; iii) the methods that allow implementing our framework in practice. Methodolody First of all, a quantitative bibliometric analysis, using Bibliometrix software (Aria and Cuccurullo, 2017), is carried out. The reference database chosen is WoS and the inclusion criterion is \u201cco-production AND heath* OR coproduction AND health*\u201d in topic. Moreover, the search is refined by language, i.e. English, and type of publication, i.e. journal academic article. No time limitation is selected. After deleting non-inherent papers, our final sample was made up of 213 papers. As second stage, a qualitative content analysis based on PRISMA protocol is developed, focusing on those papers targeting evaluation issues. Finally, a preliminary co-production evaluation model proposal is proposed and discussed. Main results The study shows an increasing attention on the co-production topic, as highlighted by an annual percentage growth rate of about 26% and the big increase in the last 5 years in number of publications. The countries with a highest number of publications and collaborations are UK (mainly England), Netherlands, Australia and USA. As expected, the most repeated keyword is co-production, however, it is interesting to underline the presence of \u201cmental health\u201d and \u201cpublic health\u201d, that can be assumed as the main topic of studies analyzed. Nonetheless, only few studies focus on the evaluation of outcomes. Among them, the content analysis has revealed a predominantly mono-dimensional and mono-stakeholder approach. Specifically, clinical, economic or psychological-social - mainly in terms of patient satisfaction \u2013 impacts (i.e. Lwembe et al., 2016; Harvey et al., 2017) are assessed. The analysis reveals that one of the main challenges of assessing co-production lies in its multi-dimensional nature; thus a multiple perspectives framework has to be adopted. To contribute filling this gap, we developed a preliminary multidimensional (i.e. performance indicators) and multi-stakeholder (i.e. different actors involved) evaluation model (Figure 1). Specifically, the framework takes into account the three main outcome domains \u2013 i) economic, ii) managerial/organisational and iii) clinical \u2013 and three main stakeholders involved \u2013 i) hospital, ii) healthcare professionals, iii) patients and their families. The economic and efficiency measures concerning direct and indirect cost for hospital and patients/family, should be integrated with clinical and managerial measures for each stakeholder: 1. Hospital: administrative efficiency, activating capacity, inclusiveness of decision making, stability/flexibility of rules, conflict resolution and collaboration climate, frequency of interaction. 2 Patient (and caregiver or family): objective (i.e. compliance) and subjective (i.e. quality of life, quality of care perception, patient satisfaction) indicators. 3. Healthcare professional and staff: objective (e.g. turnover rate, absences, injuries and work-related ill health) and subjective (e.g. burnout, satisfaction, healthcare professional engagement, occupational health, risk perception) indicators

Complex ruptures of the quadriceps tendon: a systematic review of surgical procedures and outcomes.

BACKGROUND: Chronic ruptures, ruptures following total knee arthroplasty (TKA), and re-ruptures of the quadriceps tendon (QT) are rare. A systematic review of the current literature was conducted on their treatment and outcome to provide evidence-based indications for their management. METHODS: We searched published articles in English on chronic ruptures of QT, QT ruptures that occurred after TKA, and re-ruptures in PubMed, Scopus, and Google Scholar up to January 2021. Twenty-five articles were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Data from 25 articles (97 patients) with a mean age of 57 were retrieved. Patients were classified into three groups depending on the type of rupture: 16 patients suffered chronic QTR, 78 a QTR after a TKA, and 9 patients reported a re-rupture. The most frequent surgical approaches were different for each group: Codivilla's Y-V technique and end-to-end sutures were the most commonly used in the chronic tears group (62.5%), synthetic MESH was the most frequent choice in QTR after a TKA group (38 patients, 53%), while end-to-end sutures were the first choice in the re-rupture group (4 patients, 44%). CONCLUSIONS: Complex ruptures of the QT can be chronic ruptures, re-ruptures, or ruptures occurring after TKA. The choice of the best surgical technique depends on the macroscopic quality of the tendon stumps rather than the timing of intervention. Evidence-based preventive and therapeutic strategies should be developed

Co-production in healthcare services: What we know, how we can evaluate it

Purpose The implementation of co-production in healthcare provision is not only spreading rapidly but also being increasingly appraised as a more sustainable model for the future. Despite this widespread acceptance, minimal consensus exists, however, on the co-production\u2019s definition and on the mechanisms for evaluating the actual impacts of the implementation of co-production in healthcare. This study aims to define the current state of art of the healthcare service co-production research field with a specific focus on evaluation issues. Methodolody First of all, a quantitative bibliometric analysis, using Bibliometrix software (Aria and Cuccurullo, 2017), was carried. The reference database chosen is WoS and the inclusion criterion was \u201cco-production AND heath* OR coproduction AND health*\u201d in topic. As second stage, a qualitative content analysis based on PRISMA protocol is developed, focusing on those papers targeting evaluation issues. Results The bibliometric analysis shows an annual percentage growth rate of about 26% with the biggest increase in the last 5 years in number of publications. The co-citation analysis highlights two main intellectual areas: a public administration and management cluster and a service management cluster. Nonetheless, only few studies focus on the evaluation of outcomes. Among them, the content analysis has revealed a predominantly mono-dimensional and mono-stakeholder approach. Specifically, clinical, economic or psychological-social - mainly in terms of patient satisfaction \u2013 impacts are assessed. Practical implications The study offers the base to develop a systematic analytical framework for the evaluation of co-production of healthcare. Originality The study represents the first bibliometric analysis on co-production in healthcare

Aetiology of canine infectious respiratory disease complex and prevalence of its pathogens in Europe

The canine infectious respiratory disease complex (CIRDC) is an endemic worldwide syndrome involving multiple viral and bacterial pathogens. Traditionally, Bordetella bronchiseptica (Bb), canine adenovirus type 2 (CAV-2), canine distemper virus (CDV), canine herpesvirus (CHV) and canine parainfluenza virus (CPiV) were considered the major causative agents. Lately, new pathogens have been implicated in the development of CIRDC, namely canine influenza virus (CIV), canine respiratory coronavirus (CRCoV), canine pneumovirus (CnPnV), Mycoplasma cynos and Streptococcus equi subspecies zooepidemicus. To better understand the role of the different pathogens in the development of CIRDC and their epidemiological relevance in Europe, prevalence data were collected from peer-reviewed publications and summarized. Evidence of exposure to Bb is frequently found in healthy and diseased dogs and client-owned dogs are as likely to be infected as kennelled dogs. Co-infections with viral pathogens are common. The findings confirm that Bb is an important cause of CIRDC in Europe. CAV-2 and CDV recovery rates from healthy and diseased dogs are low and the most likely explanation for this is control through vaccination. Seroconversion to CHV can be demonstrated following CIRDC outbreaks and CHV has been detected in the lower respiratory tract of diseased dogs. There is some evidence that CHV is not a primary cause of CIRDC, but opportunistically re-activates at the time of infection and exacerbates the disease. The currently available data suggest that CIV is, at present, neither a prevalent nor a significant pathogen in Europe. CPiV remains an important pathogen in CIRDC and facilitates co-infection with other viral and bacterial pathogens. CnPnV and CRCoV are important new elements in the aetiology of CIRDC and spread particularly well in multi-dog establishments. M. cynos is common in Europe and is more likely to occur in younger and kennelled dogs. This organism is frequently found together with other CIRDC pathogens and is significantly associated with more severe respiratory signs. S. zooepidemicus infection is not common and appears to be a particular problem in kennels. Protective immunity against respiratory diseases is rarely complete, and generally only a reduction in clinical signs and excretion of pathogen can be achieved through vaccination. However, even vaccines that only reduce and do not prevent infection carry epidemiological advantages. They reduce spread, increase herd immunity and decrease usage of antimicrobials. Recommending vaccination of dogs against pathogens of CIRDC will directly provide epidemiological advantages to the population and the individual dog

Molecular Survey on Kobuviruses in Domestic and Wild Ungulates From Northwestern Italian Alps

Since the first identification in 1989 in humans, kobuviruses (KoVs) have been identified from a wide range of animal species including carnivores, rodents, birds, ungulates, rabbits, and bats. Several studies have described the identification of genetically related KoVs in the fecal virome of domestic and wild animals suggesting a mutual exchange of viruses. By screening a total of 231 fecal samples from wild and domestic ungulates, KoVs RNA was detected in wild boars (3.2%; 2/63), chamois (4.6%; 2/43), and goats (2.6%; 2/77). On phylogenetic analysis of the partial RdRp sequence, the wild boar strains clustered within the species Aichivirus C whilst the strains identified in domestic and wild ruminants grouped into the species Aichivirus B. The complete VP1 gene was obtained for chamois and goat KoVs. Interestingly, upon phylogenetic analysis the strains grouped together with a KoV of ovine origin within a distinct genetic type (B3) of the species Aichivirus B

Molecular identification and characterization of a genotype 3 hepatitis e virus (HEV) strain detected in a wolf faecal sample, Italy

Hepatitis E virus (HEV) infection is a major health problem worldwide. In developed countries, zoonotic transmission of HEV genotypes (Gt) 3 and 4 is caused by the ingestion of raw or undercooked meat of infected pigs and wild boars, the main reservoirs of HEV. However, additional animals may harbour HEV or HEV-related strains, including carnivores. In this study, we investigated the molecular epidemiology of orthohepeviruses in wild canids by screening a total of 136 archival faecal samples, collected from wolves (42) and red foxes (94) in Northwestern Italy. Orthohepevirus RNA was identified in a faecal specimen, collected from a wolf carcass in the province of La Spezia (Liguria Region, Italy). The nearly full-length (7212 nucleotides) genome of the strain HEV/81236/Wolf/2019/ITA (GenBank accession no. MZ463196) was determined by combining a sequence-independent single-primer amplification (SISPA) approach with the Oxford Nanopore Technologies sequencing platform. Upon phylogenetic analysis, the HEV detected in wolf was segregated into clade HEV-3.1, displaying the highest nucleotide (nt) identity (89.0–93.3%) to Gt3 strains belonging to subtype c. Interestingly, the wolf faecal sample also contained porcine astrovirus sequences, endorsing the hypothesis of a dietary origin of the HEV strain due to preying habits

P216 Comparative Assessment C-reactive Protein Between a Point-of-Care Testing and Current Standard of Care (Immunonephelometric testing)

Abstract Background C-reactive protein (CRP) is widely used as a biomarker of inflammatory disease activity in hospitalized and non-hospitalized patients. In particular, CRP is commonly used in patients suspected to have an inflammatory bowel disease (IBD) or with a confirmed diagnosis of IBD diagnosis in order to drive the diagnostic approach, to monitor disease activity and to guide therapeutic adjustments. However, standard laboratory CRP testing (Immunonephelometric assays) present some drawbacks, including a turnaround time of 1–2 hours, and the need of specialized equipment, offices and laboratory personnel. Because of that, point-of care testing (POCT) was recently developed in order to provide results within 2 minutes from blood collection, enabling a rapid response to clinical condition. Aim To determine the degree of analytical correlation between a recently developed POCT (ProciseDx) using capillary whole blood and the comparative Immunonephelometric assay using serum samples. Methods From October to November 2020, consecutive patients hospitalized at Gastroenterology Unit, Padua University Hospital, aged > 18 years and with clinical evidence of active inflammatory disease or infection, who underwent to a standard of care CRP test (Dimension Vista – Siemens Healthineers) were included in the study (range 2.9–340 g/L). Within 1 hour from blood collection, in each patient, CRP quantitation from capillary whole blood collected by finger stick was performed using the ProciseDx CRP assay, with reportable range between 3.6–100 g/L. A Deming regression test was used to identify the correlation between the two methods. Results Eighty-three patients were enrolled (62.5% males with mean age ± SD: 60±18). The most common indications for hospitalisation were liver disease (34.9%), pancreatic disturbance (27.7%) and suspicious or recurrence of IBD (16.7%). ProciseDx POCT with finger prick samples required a turnaround time of 2±0.2 minutes, whereas serum samples analyzed in clinical laboratory with the reference method required a turnaround time of about 180±15 minutes (p<0.001). Overall, the correlation between the two tests was high (R squared of 0.899 (95% CI 0.916–0.968)). In particular, the correlation between the methods was even higher with CRP values between 0–100 g/L with R squared of 0.961 (95% CI 0.958–0.986). Conclusion The ProciseDx POCT allows a more rapid and comparable accuracy of CRP assessment in hospitalized patients as compared to the standard laboratory measurement. Moreover, the ProciseDx POCT does not require specialised personnel to be performed. The use of ProciseDx POCT may improve and accelerate the decision-making approach, further reducing the resources required for CRP assessment

Co-production in healthcare services: the evaluation of economic and organizational impacts

In times of increasing population aging, higher incidence of chronic diseases and higher expectations regarding public service provision, healthcare services are under increasing strain to cut costs while keeping quality. In this context, debates on the importance of promoting systems of co-produced health between stakeholders have gained considerable traction both in the literature and in policy debates of the public sector. (Gilardi et al. 2016; European Commission 2010; UK Department of Health 2006) The implementation of co-production in healthcare provision is not only spreading rapidly but also being increasingly appraised as a more sustainable model for the future. Despite this widespread acceptance, minimal consensus exists, however, on the mechanisms for evaluating the actual impacts of the implementation of co-production in healthcare provision. More specifically, little has been produced on how the results of these changing structures, practices and goals in healthcare management and provision can be monitored and evaluated. Aiming at the reduction of this gap, this article proposes a discussion on the challenges and limitations of assessing co-production\u2019s impacts going beyond more traditionally used clinical criteria (that currently dominate evaluation activities in the field) towards analyses that take into consideration broader organizational and economic aspects of co-production activities. Finally, the article sketches the initial contours of an original and alternative evaluation model which highlights the importance of organizational and economic aspects for the effective implementation of co-production in healthcare

Molecular detection of canine bufaviruses in wild canids

Novel protoparvoviruses genetically related to human and non-human primate bufaviruses (BuVs) have been detected recently in respiratory and enteric specimens collected from dogs and cats. In this study, by molecular screening of archival collections of faecal samples from wolves and foxes, we detected BuVs with a rate of 17.1% (7/41) and 10.5% (9/86), respectively. Sequence analysis of a portion of the ORF2 gene region of nine positive samples showed that the viruses in these samples were closely related to BuVs (97.5–99.0% nucleotide sequence identity) found in domestic carnivores