Development of a Novel Coding Scheme to Explore Interactions in the Co-Production of Public Services with Priority Populations

This study focuses on the development of a reliable coding scheme (CP-CODER) for studying interaction dynamics during the co-production of a public service involving priority communities. CP-CODER addresses the need to involve priority populations in the development of public services, an approach that has been recognized as difficult because of the high possibility of their experiencing negative health, social, and economic outcomes. The coding scheme was designed to capture group dynamics and forms of public engagement by adopting and integrating existing theoretical frameworks in the public service management and qualitative method literature. Coding was conducted on the transcripts of four co-production workshops, which included 26 family caregivers, three local health and social care service provider representatives, and five researchers involved in the coproduction of new community-based services. One category was added to the two theoretical frameworks. The kappa ranged from 0.70–1.00 for the eight variables and the 26 individual items. The overall kappa was 0.91, while the overall percentage of agreement was 91.16%. The results of the pilot test showed the importance of integrating and managing three dimensions in coproducing with a priority population: the turn-taking, the content, and the level of abstraction of the discussion. The findings of this study have enhanced and supported both practitioners and researchers in co-producing services, ensuring the equal contribution of all participants, even those whose voices are rarely heard

Studying the Experience of Care Through Latent Class Analysis: An Application to Italian Neonatal Intensive Care Units

Though many data on the experience of care of patients and caregivers are collected, they are rarely used to improve the quality of health care delivery. One of the main causes is the widespread struggle in interpreting and enhancing these data, requiring the introduction of new techniques to extract intelligible, meaningful, and actionable information. This research explores the potentiality of the latent class analysis (LCA) statistical model in studying experience data. A cross-sectional survey was administered to 482 parents of infants hospitalized in several Italian neonatal intensive care units. Through a 3-step LCA, four subgroups of parents with specific experience profiles, sociodemographic characteristics, and levels of satisfaction were identified. These were composed of parents who reported (1) a positive experience (36%), (2) problematic communication with unit staff (30%), (3) limited access to the unit and poor participation in their baby's care (26%), and (4) a negative experience (8%). Through its explorative segmentation, LCA can provide valuable information to design quality improvement interventions tailored to the specific needs and concerns of each subgroup

Implementation of eunethta core model (R) in lombardia: the VTS Framework

Objectives: This study describes the health technology assessment (HTA) framework introduced by Regione Lombardia to regulate the introduction of new technologies. The study outlines the process and dimensions adopted to prioritize, assess and appraise the requests of new technologies. Methods: The HTA framework incorporates and adapts elements from the EUnetHTA Core Model and the EVIDEM framework. It includes dimensions, topics, and issues provided by EUnetHTA Core Model to collect data and process the assessment. Decision making is instead supported by the criteria and Multi-Criteria Decision Analysis technique from the EVIDEM consortium. Results: The HTA framework moves along three process stages: (i) prioritization of requests, (ii) assessment of prioritized technology, (iii) appraisal of technology in support of decision making. Requests received by Regione Lombardia are first prioritized according to their relevance along eight dimensions (e.g., costs, efficiency and efficacy, organizational impact, safety). Evidence about the impacts of the prioritized technologies is then collected following the issues and topics provided by EUnetHTA Core Model. Finally, the Multi-Criteria Decision Analysis technique is used to appraise the novel technology and support Regione Lombardia decision making. Conclusions: The VTS (Valutazione delle Tecnologie Sanitarie) framework has been successfully implemented at the end of 2011. From its inception, twenty-six technologies have been processed

Implementation of eunethta core model (R) in lombardia: the VTS Framework

Objectives: This study describes the health technology assessment (HTA) framework introduced by Regione Lombardia to regulate the introduction of new technologies. The study outlines the process and dimensions adopted to prioritize, assess and appraise the requests of new technologies. Methods: The HTA framework incorporates and adapts elements from the EUnetHTA Core Model and the EVIDEM framework. It includes dimensions, topics, and issues provided by EUnetHTA Core Model to collect data and process the assessment. Decision making is instead supported by the criteria and Multi-Criteria Decision Analysis technique from the EVIDEM consortium. Results: The HTA framework moves along three process stages: (i) prioritization of requests, (ii) assessment of prioritized technology, (iii) appraisal of technology in support of decision making. Requests received by Regione Lombardia are first prioritized according to their relevance along eight dimensions (e.g., costs, efficiency and efficacy, organizational impact, safety). Evidence about the impacts of the prioritized technologies is then collected following the issues and topics provided by EUnetHTA Core Model. Finally, the Multi-Criteria Decision Analysis technique is used to appraise the novel technology and support Regione Lombardia decision making. Conclusions: The VTS (Valutazione delle Tecnologie Sanitarie) framework has been successfully implemented at the end of 2011. From its inception, twenty-six technologies have been processed

Assessment and analysis of territorial experiences in digital tele-echocardiography

Nowadays digital ultrasound-cardiovascular devices are able to send out directly digital images and films. Thanks to the large adoption of such devices, the echocardiographic world is facing new ways of exchanging images and collaborating. What we present in this paper is a review of the experimental projects carried in Lombardy, meant to support the work of specialists by means of second opinion and telemedicine services. On the medical point of view echocardiography is a widely used activity where operators are perfectly accustomed to do repetitive operations and steps. Tele-echocardiography (T-E) introduces new methods and technologies into stable and everyday medical practice, causing disruptions either on the side of the specialists' way of working or on the new opportunities and service. Introducing such a service means to properly model it in order to reduce the changes in the operators' way of working while maximizing the benefits. A proper method of modelling the operators' needs is then a key factor which must be correctly addressed. This paper will present some successful projects and the assessment procedure but it will also discuss a possible service modelling method, which has been adopted for the described experiences

Diuretic Resistance in Cardio-Nephrology: Role of Pharmacokinetics, Hypochloremia, and Kidney Remodeling

Background: Diuretic resistance is among the most challenging problems that the cardio-nephrologist must address in daily clinical practice, with a considerable burden on hospital admissions and health care costs. Indeed, loop diuretics are the first-line therapy to overcome fluid overload in heart failure patients. The pathophysiological mechanisms of fluid and sodium retention are complex and depend on several neuro-hormonal signals mainly acting on sodium reabsorption along the renal tubule. Consequently, doses and administration modalities of diuretics must be carefully tailored to patients in order to overcome under- or overtreatment. The frequent and tricky development of diuretic resistance depends in part on post-diuretic sodium retention, reduced tubular secretion of the drug, and reduced sodium/chloride sensing. Sodium and chloride depletions have been recently shown to be major factors mediating these processes. Aquaretics and high-saline infusions have been recently suggested in cases of hyponatremic conditions. This review discusses the limitations and strengths of these approaches. Summary: Long-term diuretic use may lead to diuretic resistance in cardio-renal syndromes. To overcome this complication intravenous administration of loop diuretics and a combination of different diuretic classes have been proposed. In the presence of hyponatremia, high-saline solutions in addition to loop diuretics might be beneficial, whereas aquaretics require caution to avoid overcorrection. Key Messages: Diuretic resistance is a central theme for cardio-renal syndromes. Hyponatremia and hypochloremia may be part of the mechanisms for diuretic resistance. Aquaretics and high-saline solutions have been proposed as possible new therapeutic solutions

Cremona Beside Caregivers: una ricerca per assistere chi assiste

Stato dell’arte In Europa la fascia di popolazione over 65 rappresenta il 19% della popolazione, mentre In Italia ha già superato il 22%. Tuttavia, la distribuzione di queste persone non è omogenea sul territorio, ma presenta una maggiore presenza nelle aree rurali dove tale fascia di popolazione ha un alto rischio di esclusione sociale e fragilità (Burholt & Dobbs, 2012). Sebbene siano stati posti per molto tempo in secondo piano, i bisogni delle persone anziane nelle aree rurali sono di primario interesse, soprattutto per la diversità di richieste e di necessità che ci si aspetta di trovare in queste aree rispetto a zone con buona presenza di servizi. In questi contesti, infatti, un ruolo cruciale nell’assistenza agli anziani viene svolto dai caregiver, che si trovano largamente caricati del supporto all’invecchiamento (Sixsmith et al., 2014). Nel 2009 è stato infatti rilevato che in Italia due terzi delle cure necessarie alle persone anziane venivano assicurate da loro parenti (Troisi & Knodratowitz, 2013), anche per garantire c alle persone anziane di poter continuare a vivere nei contesti a loro cari, attraverso pratiche di “aging in place” - cioè di invecchiamento attivo nel proprio contesto comunitario di vita (Rodríguez-Rodríguez & Sánchez-González, 2016). In questo scenario, la provincia di Cremona rappresenta per sue caratteristiche territoriali e sociali un osservatorio privilegiato per studiare le necessità della popolazione anziana e di chi li assiste, anche nell’ottica di promuovere una rappresentazione propositiva e partecipe di questa fase della popolazione alla co-definizione dei servizi e dei prodotti ad essi dedicati. Date queste premesse, l’obiettivo di questo progetto di ricerca è di condurre una mappatura degli stakeholders sul territorio Cremonese, delle risorse presenti e dei bisogni scoperti, al fine di orientare attività di supporto dedicate prioritariamente al target dei caregiver. Approccio metodologico A copertura dei suddetti obiettivi si è definito un disegno di ricerca multi-fase e multi-metodo così composto: Fase 1 - analisi sistematica dei database statistici Istat, volta a descrivere le caratteristiche socio-demografiche della popolazione anziana cremonese, sia attuale che in trend storico, comparandola con quella nazionale; Fase 2 - Desk analysis per identificare i servizi sanitari, socio-sanitari e sociale attivi sul territorio a favore dell’anziano fragile che vive a casa, in termini di ruoli e i professionisti coinvolti, le collaborazioni formali e informali tra professionisti e tra Enti; regimi dietetici proposti agli anziani (i.e. in famiglia nelle RSA, nelle cooperative, nell’ADI…); Fase 3 - Interviste qualitative biografiche a stakeholders locali (i.e. rappresentanti Fondazioni, Cooperative, Comuni, RSA, associazioni di volontariato…) riconosciuti per la loro centralità nel rapporto con anziani e caregiver, al fine di approfondire le loro esperienze, l’analisi delle priorità e delle necessità presenti sul territorio. Principali risultati I dati demografici confermano la tendenza alla senilizzazione della provincia di Cremona: è la seconda provincia con la percentuale di over 65 della Regione Lombardia, dopo Pavia (Elaborazione Ires L. Morosini su dati Istat, 2019). Negli ultimi venti anni, tale percentuale è cresciuta dal 23,7% nel 2002 al 26,8% di oggi (Istat, 2021). La durata di vita attesa degli anziani cremonesi oltre i 65 anni resta inferiore a quella media lombarda: 22,1 anni nelle donne e 18,4 negli uomini, di cui la maggior parte trascorsi “senza limitazioni funzionali” (Elaborazione Ires L. Morosini su dati Istat, 2019). Tuttavia, nel 2016 il 10,8% degli ultrasessantacinquenni residenti nella Provincia di Cremona beneficiava di un’indennità di accompagnamento, il 13,8% tra le donne e il 6,9% tra gli uomini di quella fascia di età. Dalla mappatura degli stakeholders sono stati identificati 36 enti del settore sanitario, 35 del terzo settore e 7 istituzioni chiave per lo studio del fenomeno degli anziani e dei loro caregiver. Dalle prime interviste biografiche condotte emerge la necessità di dotarsi di strumenti di mappatura sistematica della fragilità senile; inoltre gli stakeholder sottolineano l’importanza di creare spazi di lavoro multidisciplinari che possano operare nelle diverse aree di ci la fragilità senile si compone (sanitaria, sociale, alimentare, economica, …). Conclusioni I primi risultati confermano il bisogno del territorio cremonese nell’ambito dell’assistenza agli anziani fragili: le attività e le risorse finora messe in campo necessitano di essere orchestrate per operare in maniera efficace e sostenibile per il territorio stesso e per le persone che lo vivono

Methodological issues on the use of administrative data in healthcare research: the case of heart failure hospitalizations in Lombardy region, 2000 to 2012

BACKGROUND: Administrative data are increasingly used in healthcare research. However, in order to avoid biases, their use requires careful study planning. This paper describes the methodological principles and criteria used in a study on epidemiology, outcomes and process of care of patients hospitalized for heart failure (HF) in the largest Italian Region, from 2000 to 2012. METHODS: Data were extracted from the administrative data warehouse of the healthcare system of Lombardy, Italy. Hospital discharge forms with HF-related diagnosis codes were the basis for identifying HF hospitalizations as clinical events, or episodes. In patients experiencing at least one HF event, hospitalizations for any cause, outpatient services utilization, and drug prescriptions were also analyzed. RESULTS: Seven hundred one thousand, seven hundred one heart failure events involving 371,766 patients were recorded from 2000 to 2012. Once all the healthcare services provided to these patients after the first HF event had been joined together, the study database totalled about 91 million records. Principles, criteria and tips utilized in order to minimize errors and characterize some relevant subgroups are described. CONCLUSIONS: The methodology of this study could represent the basis for future research and could be applied in similar studies concerning epidemiology, trend analysis, and healthcare resources utilization