Public strategies for improving eHealth integration and long-term sustainability in public health care systems: Findings from an Italian case study

eHealth is expected to contribute in tackling challenges for health care systems. However, it also imposes challenges. Financing strategies adopted at national as well regional levels widely affect eHealth long-term sustainability. In a public health care system, the public actor is among the main "buyers" eHealth. However, public interventions have been increasingly focused on cost containment. How to match these 2 aspects? This article explores some central issues, mainly related to financial aspects, in the development of effective and valuable eHealth strategies in a public health care system: How can the public health care system (as a "buyer") improve long-term success and sustainability of eHealth solutions? What levers are available to match in the long period different interests of different stakeholders in the eHealth field? A case study was performed in the Region of Tuscany, Italy. According to our results, win-win strategies should be followed. Investments should take into account the need to long-term finance solutions, for sustaining changes in health care organizations for obtaining benefits. To solve the interoperability issues, the concept of the "platform approach" emerged, based on collaboration within and between organizations. Private sector as well as beneficiaries and final users of the eHealth solutions should participate in their design, provision, and monitoring. For creating value for all, the evidence gap and the financial needs could be addressed with a pull mechanism of funding, aimed at paying according to the outcomes produced by the eHealth solution, on the base of an ongoing monitoring, measurement, and evaluation of the outcomes

Basic ICT adoption and use by general practitioners: an analysis of primary care systems in 31 European countries

There is general consensus that appropriate development and use of information and communication technologies (ICT) are crucial in the delivery of effective primary care (PC). Several countries are defining policies to support and promote a structural change of the health care system through the introduction of ICT. This study analyses the state of development of basic ICT in PC systems of 31 European countries with the aim to describe the extent of, and main purposes for, computer use by General Practitioners (GPs) across Europe. Additionally, trends over time have been analysed

Incentivizing ICT in healthcare: A comparative analysis of incentive schemes in Italian Regions

Background: The use of Information and Communication Technologies (ICTs) in healthcare has been presented as a potential solution to the current challenges that healthcare systems have to face. The introduction of ICTs may need initial investments and, moreover, may produce changes in the routine practice of the healthcare system. Financial incentives are expected to be an effective managerial tool to communicate a strategic vision and a mandate, to improve the adherence to the strategy and to promote a consistent individual behaviour. In this perspective, financial incentives are assumed to accelerate the ICTs adoption and use in healthcare. The aim of this study was to investigate whether and how Italian Regional healthcare systems use the Chief Executive Officers’ (CEOs) reward scheme to stimuli the implementation of ICT in healthcare. Materials and methods: A content analysis was conducted on the Italian Regional acts on healthcare CEOs incentive schemes, that were approved in the period 2010–2012 and with a legal validity that ranged from 1 to 4 years (until 2014). The acts cover around 60% of the Italian Regions. ICT goals were identified, categorized, and compared using descriptive statistics. Results: This study identified two areas on which financial incentives related to ICTs were mainly focused: (i) ICT infrastructure and architecture; (ii) flows and processing of economic and financial data. The use of technology to better store and process medical data (i.e. EHR-like systems) were only marginally present. Use of e-Health and mHealth solutions for providing healthcare services, valorization of ‘health big data’ in a community care perspective, more advanced applications of technology for monitoring or preventing diseases were not incentivized for CEOs in Italy. Conclusion: The use of ICTs in healthcare appears to be of general interest in Italy: a great number of Italian Regions introduced specific goals into CEOs financial schemes. Efforts in this field seem to be not linked to the objectives of better care at sustainable cost, while it appears important to ensure a better and wider presence of enabling environments and to implement ICT-based control systems. Keywords: ICT, Financial incentives, Incentive scheme, Healthcare CEO, Italy, Region

Reverse compassion: value-in-use and value-in-context of healthcare services during crisis

Purpose Using data from a continuous and ongoing cross-sectional web survey on hospitalisation service experiences in two Italian regions, the authors used multilevel and multivariate logistic regression models to identify factors related to users' demographics, emotional and informative support, technical and physical aspects of the provision, influencing satisfaction and willingness-to-recommend, before and during a crisis. Design/methodology/approach The value-in-use, defined in terms of a positive or negative value given by the experience with services, can be evaluated by users and influenced by the context of provision. The authors tested whether and how the value-in-use of services changed in a context of crisis. This study is applied to the healthcare sector during the coronavirus disease 2019 (COVID-19) epidemic, by evaluating the impact of the pandemic on hospitalisation experience. Findings Overall, analyses of 8,712 questionnaires found a greater value after the pandemic spread. In a time of crisis, technical and informative aspects of care were found to be most valued by patients that may recognise the extraordinary professionalism of workers during the crisis. Research limitations/implications This study empirically suggests that context can affect the evaluation of value-in-use by patients during unprecedented circumstances, producing additional value-in-context. Practical implications These findings imply that during critical periods where there is less scope for expressions of gratitude and appreciation towards front-line workers, user-reported data can be used for motivating professionals and increase resilience. These results reiterate the need to continue collecting and reporting the service users' voices, including as activity within plans for managing challenging situations. Social implications The level of healthcare system distress, due to the COVID-19 epidemic, positively affects patients' propensity to recommend, which the authors suggest is driven by healthcare services' feelings of reverse compassion. These findings imply that during critical periods where there is less scope for expressions of gratitude and appreciation towards front-line workers, user-reported data can be used for motivating professionals and increase resilience, which can have positive social implications. These results reiterate the need to continue collecting and reporting the service users' voices, including as activity within plans for managing challenging situations. Originality/value Research based on the intersection of theoretical and empirical research regarding value-in-use, value-in-context and service quality measured through user experience is scarce, in particular in the healthcare sector. The authors' findings set the direction for future research on the influence of context on value creation and value creation's perception by users, on the concept of reverse compassion and on reverse compassion's impact on organisational well-being, particularly in times of crisis

Healthy Living and Co-Production: Evaluation of Processes and Outcomes of a Health Promotion Initiative Co-Produced with Adolescents

Co-production is an approach to designing, delivering, and evaluating public services through strict collaboration among professionals and the people using services with an equal and reciprocal relationship. Health promotion initiatives that include education services rarely use the co-production approach. Nevertheless, the value of co-production is widely recognized, although it is considered a normative good, and scarce and mixed evidence is available in literature. The purpose of this paper is to provide evidence supporting the hypothesis that a co-production approach, applied to an intervention for preventing obesity, can be effective and efficient. To this end, an evaluation of the processes, outputs meant as intermediate results, and behavioral and economic outcomes of a public health-promotion initiative co-produced and co-delivered with adolescents (beFood) was conducted. Mixed methods were used, including field-observations, two self-reported questionnaires, and an opportunity–cost analysis that compared beFood to traditional approaches of public health promotion. The co-production model was successfully implemented and appears to be effective—more than 5000 adolescents were reached by only 49 co-producer adolescents, who reported behavioral changes (e.g., eating better and practicing more physical activity). The cost analysis showed that the co-production approach was also efficient, producing relevant savings and potentially making available more than 3000 h of professionals’ time. This research can support a re-thinking of public institutions’ organization, public initiatives’ design, and public servants’ rol

A m-health intervention in the maternal care pathway: protocol for the impact evaluation of hAPPyMamma (Preprint)

Background: M-health has a great potentiality in both improving quality and efficiency of care, and in increasing health literacy and empowerment of patients-users. There are several studies related to the introduction on m-health tools for supporting pregnancy and the post-natal period, with promising but not still rigorously evaluated impacts. This article contributes to the literature, by presenting an m-health intervention (the mobile app called “hAPPyMamma”) applied in the maternal and child care of a high-income country (in a pilot area of Tuscany Region, Italy) and the methods adopted for evaluating its impact. Objective: The final aim of the introduction of this m-health app in the maternal care pathway is to promote the health of pregnant women and of their children and to improve their experience of care. Methods: This study is based on a quasi-experimental design that compares two groups: women who use the app (intervention group) and women who do not use the app (control group). The data concerning the measures of the maternal health literacy and the empowerment are collected prospectively in order to be able to perform a difference in difference analysis. In the post-partum period also data on women’s experience in the maternal care pathway are collected from both groups and data on the experience of the hAPPyMamma use are collected only within the intervention group. The organisational impact is evaluated through a quantitative and qualitative survey addressing professionals and managers of the maternal care pathway involved in the intervention. Results: The recruitment of the two samples was carried out with the same procedure in 2017, and was subsequent: first, the control group, and after some months, the intervention group. 177 women were enrolled in the control group; out of them, 170 answered to the first web questionnaire and 114 to second one. 150 women were enrolled in the intervention group; out of them, 100 women answered the first web questionnaire and 90 the second one. Data collection was completed in April 2018. Data analysis is underway. Conclusions: This study evaluates the implementation of the m-health intervention hAPPyMamma and describes its impact at individual and organisational level, in terms of the improvement of maternal health literacy, the access to and the utilisation of healthcare services during the maternal care pathway. This study contributes to define the potential role of this m-health tool in maternal care pathway in Tuscany Region and consequently in the Italian context, and the possible extension of its implementation

Piloting a web-based systematic collection and reporting of patient-reported outcome measures and patient-reported experience measures in chronic heart failure

OBJECTIVES: To evaluate the feasibility of a digital and continuous collection and reporting of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) for chronic heart failure (CHF). DESIGN: A single-site pilot study was settled for evaluating the feasibility of the intervention, both using qualitative and quantitative data (ie, workshop, surveys). SETTING: The pilot has been implemented in a Tuscan specialised hospital (Italy). PARTICIPANTS: 162 patients were involved. Inclusion criteria were: a previous diagnosis of HF, age ≥18 years, absence of cognitive impairment or active tumours, ability to provide informed consent to study participation. INTERVENTION: The continuous collection and reporting of PROMs and PREMs has been designed and implemented in 2018. PREMs questionnaires for patients were developed, while Kansas City Cardiomyopathy Questionnaire-12 was used for assessing PROMs. Questionnaires are administered at specific time points: discharge; 30 days, 7 and 12 months after the discharge. Enrolment of patients, administration and real-time reporting of questionnaires are carried on through a digital platform. OUTCOME MEASURES: Enrolment, response and drop-out rates were considered to assess the feasibility of the intervention. Qualitative data were collected during meetings and workshops with health workers. The representativeness of the recruited sample with respect to the population characteristics was also evaluated. RESULTS: The system has been successfully implemented during 2018. Response rates have been consistently above 50%, demonstrating patients' transversal willingness to participate. All the involved stakeholders acknowledged the feasibility of the design. The recruited sample is significantly different in terms of age and educational level compared with the overall population characteristics. CONCLUSION: It is possible to run a web-based systematic collection and reporting system for CHF patient-reported data. Systematic collection and reporting of PROMs and PREMs data allows professionals to increasingly assume CHF patient perspective in their daily work. Limitations will be used to improve the system

Including patient-reported measures in performance evaluation systems: Patient contribution in assessing and improving the healthcare systems

In healthcare, the introduction of quality standards and indicators to assess performance triggered the development of multidimensional Performance Management Systems (PMSs). The concept of performance in healthcare has recently evolved and broadened its scope. One of the current challenges of PMSs is measuring and integrating the patient perspective into traditional measures. In the regional healthcare system of Tuscany (Italy), a PMS has been implemented and used since 2005. The PMS counts on the systematic involvement of clinicians and managers. Furthermore, the PMS also includes patients' perspective. Moreover, Tuscany has recently implemented the first regional permanent Patient-Reported Outcome and Experience Measures (PROMs and PREMs) Observatory in Italy. This paper presents the results of an action research aimed at analysing the integration of patient-reported outcome and experience indicators into a consolidated PMS. The study describes the process of identifying and discussing of patient-reported indicators with practitioners and categorising findings into three domains: design of patient-reported indicators, integration process into the PMS, and goal of adoption of the patient-related indicators. The paper also describes facilitators, challenges, and lessons learnt with respect to organisational, methodological, cultural, and responsibility-linked factors. The study discusses the ability to agree on how to transform patient data, especially PROMs, into effective performance indicators. The integration of patient-reported indicators into the PMS poses two main challenges: one in terms of sustainability of the performance system itself, and another regarding the attribution of the responsibility for patient outcomes between care settings and providers. This paper provides initial insights on how the integration of patient-reported indicators can make PMSs more inclusive and focussed on the patient-centred perspective

Promoting healthy eating habits among youth according to their preferences: Indications from a discrete choice experiment in Tuscany

Abstract Introduction The incidence of overweight among youth in Western Countries requires the implementation of initiatives to promote healthy lifestyles. Although under particular conditions obesity is not preventable, drawing attention on factors affecting teenagers' preferences can ameliorate the efficacy of public interventions designed for health promotion. Methods This study aims at eliciting teenagers' food preferences through a discrete choice experiment, conducted in Tuscany using a webAPP survey, with the participation of more than 4,700 teenagers. Respondents expressed their preferences for breakfast food based on three attributes: food quality, packaging and claim. The survey also collected information on respondents' socio-demographic characteristics, social influence and media use for food information. Results Teenagers' preferences for healthy foods seem positively related with their own level of food literacy. The tendency of respondents to read labels and nutritional facts is positively associated with preferences for healthier foods. Peers' influence is not significant, while family influence has a positive impact on teenagers' healthy choices. Internet usage is associated with unhealthy choices with a healthy aspect. Conclusion The results can be useful in defining effective actions for the promotion of healthy behaviors among teenagers, either in communication and awareness campaigns or in education and activation initiatives, with respect to the reading and interpretation of nutritional facts and labels, the role of family and friends, and the use of media