Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy

Background There is a growing interest in the factors that influence short-term mortality and readmission after hospitalization for acute myocardial infarction (AMI) since such outcomes are commonly considered as hospital performance measures. Socioeconomic status (SES) is one of the factors contributing to healthcare outcomes after hospitalization for AMI. However, no study has been published on education and 30-day readmission in Europe. The objective of this study is to examine the association between educational level and 30-day mortality and readmission among patients hospitalized for AMI in Tuscany (Italy). Methods A retrospective cohort study using data from hospital discharge records was conducted. The analysis included all patients discharged with a principal diagnosis of AMI between January 1, 2011, and November 30, 2014, from all hospitals in Tuscany. Educational level was categorized as low (no middle school diploma), mid (middle school diploma) and high (high school diploma or more). Three multilevel models were developed, sequentially controlling for patient-level socio-demographic and clinical variables and hospital-level variables. Patients were stratified by age (≤75 and >75 years). Results Mortality analysis included 23,402 patients, readmission analysis included 22,181 patients. In both unadjusted and full-adjusted models, patients with a high education had lower odds of 30-day mortality compared to those patients with low education (OR age ≤ 75 years 0.67, 95% CI:0.47–0.94; OR age > 75 years 0.72, 95% CI:0.54–0.95). With regard to 30-day readmission, only patients aged over 75 years with a high education had lower odds of short-term readmission compared to those patients with low education (OR age > 75 0.73, 95% CI:0.58–0.93). Conclusions Among patients hospitalized in Tuscany for AMI, low levels of education were associated with increased odds of 30-day mortality for both age groups and increased odds of 30-day readmission only for patients aged over 75 years. Our findings suggest that the educational component should not be underestimated in order to improve short-term outcomes, which are considered as performance measures at the hospital level. Hospital managers might consider strategies that are sensitive to patients with low SES, such as providing post-hospitalization support to less-educated patients and promoting a healthier lifestyle, to improve both health equity and performance 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

“Use of Scanner Data to Analyze the Table Wine Demand in the Italian Major Retailing Trade”

ABSTRACT While the utilization of scanner data for food demand analyses has become increasingly popular in the United States, few food demand studies, and in particular none on table wine, have been conducted using scanner data in Italy+ This paper presents a first attempt to estimate a demand system for selected brands of red tetra-packaged, plastic packaged, and bag-in-box table wine using scanner data providing new and useful insights into the marketing of Italian wine+ Price and expenditure elasticities of Italian red table wine demand drawn from a linear almost ideal demand system are provided+ Results suggest a partially loyal market of table wine, showing a tendency to substitution across brands and a degree of competition among the leading brands+ @EconLit citations: Q110, Q130#+ © 2006 Wiley Periodicals, Inc

Women's choices of hospital for breast cancer surgery in Italy: Quality and equity implications

: This paper employs mixed logit regression to investigate the effects of providers characteristics on women's choice of hospital for breast surgery. Patient level data are used to model choices in Tuscany region, Italy. In particular, we focus on the effects of travel time and hospital quality indicators including quality standard (volumes of breast surgery), measurement of process (waiting times) and quality of surgical procedures. Variation in preferences related to individual characteristics such as age, education and travel distance from the hospital are also considered. Findings show that, on average, women prefer closer hospital with longer waiting times and higher quality (high volumes of interventions). We found preference heterogeneity associated to education: travel distance affects choice especially among less educated women (regardless of age), while among younger women (<65 years), less educated ones prefer shorter waiting times. These results could be used to optimize the allocation of resources toward breast cancer units that meet quality and efficacy standards to increase the efficiency and responsiveness of breast cancer care

Organizational climate: Comparing private and public hospitals within professional roles

AbstractThis study compares the organizational climate differences within professional roles in private and public hospitals. We focused on how physicians, administrative, healthcare and non-healthcare staff either in the public or in the private perceived their work environment and each organizational climate dimension. Data came from organizational-climate questionnaires administered in 2010 and 2012 to 19616 and 1276 health employees in public and private hospitals in the Tuscany Region respectively. We applied exploratory factoranalysis to verify the validity and internal consistency between items in the questionnaire and t-test, one-way analysis of variance to compare mean perceptions regarding to the dimensions across different groups of respondents. We measured four dimensions: “training opportunities”, “managerial tools”, “organization” and “management & leadership style” and overall job satisfaction. Hospital status in the professional roles was found significant in the staff's perceptions (p≤0.05)

Heterogeneity in Preferences for Primary Care Consultations: Results from a Discrete Choice Experiment

Abstract: Purpose: The increasing importance of flexibility in the general practitioner (GP) -patient consultation approach in primary care requires healthcare managers and physicians to find a balance among all the potentially important characteristics of consultation. This study used a discrete choice experiment (DCE) to assess patients' preferences for different attributes of GP consultation and how the rate at which they traded between different attributes is affected by socio-demographic characteristics and past experiences with primary care services . Methods: A survey was conducted to a sample of 6970 residents in Tuscany region, Italy. Besides socio-demographic characteristics the survey collected information about participants' past experience with GP consultation in the last 12 months. Moreover, participants were asked to select their preferred option in a series of pairwise choices, defined by the following attributes: level of involvement in decision making, amount of information received from the GP and waiting time for the visit. Results: Results revealed that receiving information from the GP was more important than being involved in the decisions and that, approximately, a complete involvement had the same importance as a partial involvement. Participants' past experience with GP's consultation appeared to have the greatest influence on the involvement level. The amount of information required by the respondents was also influenced by a complex interplay of personal and contextual factors. Conclusions: This large-scale study extends the body of literature on DCE applications for different GP consultation approaches, providing new information about the influence that patients' socio-demographic characteristics and past experiences could have on consultation preferences.