90 research outputs found
Determinants of Prolonged Hospitalization in Children and Adolescents: A Retrospective Observational Study
No full textIntroduction: Ensuring an appropriate length of stay (LOS) is a primary goal for hospitals, as prolonged LOS poses clinical risks and organizational challenges. Children and adolescents are particularly susceptible to prolonged LOS due to frequent hospitalizations and unique vulnerabilities, including developmental disabilities that may necessitate additional care and monitoring. This study aims to describe the LOS of children and adolescent patients and identify the sociodemographic, organizational, clinical, and nursing care factors contributing to prolonged LOS in this population. Design: Observational, retrospective, monocentric study. Methods: A sequential sampling approach was used to select the clinical records of 1538 children and adolescent patients admitted to an Italian university hospital in 2022. The study included all children and adolescents aged 3–18 who were hospitalized for a minimum of 2 days. Patients from outpatient units and those with LOS shorter than 2 days were excluded. The Neonatal Pediatric Professional Assessment Instrument (PAIped) and the Hospital Discharge Register were used to collect sociodemographic, organizational, clinical, and nursing care patient data, including nursing diagnoses (NDs) and nursing actions (NAs). A forward stepwise regression approach was used to identify predictors of LOS among the selected variables. A mediation analysis was conducted to explore the role of nursing predictors, identified in the stepwise regression, as mediators between the number of medical diagnoses and LOS. Results: Positive correlations between the number of medical diagnoses, NDs, NAs, and LOS were discovered (rs = 0.262, p = < 0.001; rs = 0.114, p = < 0.001; rs = 0.384, p = < 0.001, respectively). Longer hospital stays were associated with an increased number of medical diagnoses, NDs, and NAs. The number of NAs emerged as an independent predictor of LOS (β = 0.516; p < 0.001). Other significant determinants of LOS included a higher number of NAs and medical diagnoses, the presence of a medical DRG category, increased DRG weight, emergency admissions, residency in rural areas, and older age (F = 122.222, p < 0.001, R2 = 0.361, adjusted R2 = 0.358). The mediation analysis showed that the number of medical diagnoses positively predicted the number of NAs (β = 2.774, p < 0.001), which, in turn, positively affected LOS (β = 0.162, p < 0.001). A significant indirect effect of the number of medical diagnoses on LOS through NAs was observed (β = 0.448, 95% CI [0.34, 0.55]), along with a significant direct effect of medical diagnoses on LOS, even with the mediator in the model (β = 0.633, p < 0.001), indicating partial mediation (F = 321.6892; R2 = 0.295; p < 0.001). These results highlight the influence of medical diagnoses on LOS through the mediating role of NAs. Conclusions: Our study highlights the significant interplay between determinants of LOS in children and adolescent patients, emphasizing the need for targeted interventions, resource planning, and the integration of clinical nursing information systems to enhance care quality and support evidence-based practices. Clinical Relevance: Optimizing resource distribution and implementing specific interventions for patients at risk of prolonged LOS could help mitigate this negative outcome and enhance the quality of care. Incorporating nursing data into DRG systems could improve reimbursement accuracy and benefit the nursing profession, which may result in better patient outcomes and lower hospital expanses
Incremental Net Benefit and Incremental Cost-Effectiveness Ratio of COVID-19 Vaccination Campaigns: Systematic Review of Cost-Effectiveness Evidence
No full textSARS-CoV-2 vaccination has been the most effective tool to prevent COVID-19, significantly reducing deaths and hospitalizations worldwide. Vaccination has played a huge role in bringing the COVID-19 pandemic under control, even as the inequitable distribution of vaccines still leaves several countries vulnerable. Therefore, organizing a mass vaccination campaign on a global scale is a priority to contain the virus spread. The aim of this systematic review was to assess whether COVID-19 vaccination campaigns are cost-effective with respect to no vaccination. A systematic literature search was conducted in the WHO COVID-19 Global literature database, PubMed, Web of Science, Embase, and Scopus from 2020 to 2022. Studies assessing the COVID-19 vaccination campaign cost-effectiveness over no vaccination were deemed eligible. The “Drummond’s checklist” was adopted for quality assessment. A synthesis of the studies was performed through the “dominance ranking matrix tool”. Overall, 10 studies were considered. COVID-19 vaccination was deemed cost-effective in each of them, and vaccination campaigns were found to be sustainable public health approaches to fight the health emergency. Providing economic evaluation data for mass vaccination is needed to support decision makers to make value-based and evidence-based decisions to ensure equitable access to vaccination and reduce the COVID-19 burden worldwide
Case della Comunità e presa in carico della persona. L’importanza dei modelli di integrazione dei servizi per lo sviluppo dell’Assistenza Primaria
No full textUna missione, due componenti, due riforme ed otto interventi
per un ammontare di 15.63 miliardi di euro sono i numeri che ca-
ratterizzano la Missione 6 Salute del Piano Nazionale di Ripresa e
Resilienza (PNRR). Un piano che dovrà traghettare il Servizio
Sanitario Nazionale (SSN) verso un cambiamento che garantisca,
nel corso degli anni, una risposta omogenea ai bisogni di cura in
tutte le aree del nostro Paese (Presidenza del Consiglio dei Mini-
stri, 2022
Moving forward: Cost-Effectiveness of PrEP in HIV prevention for Men Who Have Sex with Men in Italy
No full textGlobally, in 2018 1.7 million people contracted Human Immunodeficiency Virus (HIV) and 770,000 people died from AIDS-related illnesses. Men Who Have Sex with Men (MSM) have one of the highest probabilities of HIV transmission.
In Italy, in 2018 2,847 new HIV cases were diagnosed, of which 39% among MSM. The MSM population accounts for 16,690 individuals whereof 50% already underwent the Highly Active Antiretroviral Therapy (HAART). The aim of this study is to evaluate the cost-effectiveness of daily Pre-Exposure Prophylaxis (PrEP) in the Italian MSM susceptible population.
A Markov transition model was calibrated to the HIV epidemic among MSM in Italy, comparing PrEP to naïve patients (NP). Model parameters were retrieved by querying scientific databases. Transition probabilities were adjusted for incidence of HIV while costs and benefits were discounted at an annual rate of 3%. The impact on results of critical parameters was explored through a Monte Carlo-based sensitivity analysis. The cost-effectiveness analysis results were reported as Incremental Cost-Effectiveness Ratio (ICER) express as € per Quality Adjusted Life Year (QALY) gained.
The introduction of such a PrEP program would result in a total cost of €822,398,199 million and lead to a gain of 70,762 discounted QALYs over an 85-year time horizon.
Assuming a 92% efficacy of PrEP therapy, the ICER for the PrEP program is €4,346.16/QALY gained. This value is definitively lower than acceptability NICE threshold (£20,000).
PrEP can reduce the infection rate up to 60% in a five-year period. The Monte Carlo simulation confirmed the robustness of the model results.
This analysis showed PrEP to be cost-effective when used in a susceptible population. Even if PrEP doesn't protect from other sex-related infectious diseases, it could prevent HIV transmission, thus breaking down HIV-infection incidence rate. Each country should reflect on the real possibility to implement a robust Public Health program pondering the adoption of PrEP.
Key messages
PrEP is very effective at reducing HIV infection when taken correctly. It is the backbone in the “combination prevention”, necessary to reach the SDG of ending the AIDS epidemic by 2030.
This preliminary analysis suggests that the introduction of a daily PrEP program for MSM in Italy is cost-effective and possibly cost saving in the long term
Health technology assessment of whole genome sequencing in the diagnosis of genetic disorders: a scoping review of the literature
No full textObjective: The aim of this scoping review is to map the available evidence about the use of health technology assessment (HTA) in the assessment of whole genome sequencing (WGS).Methods: A scoping review methodology was adopted. The population, concept, and context framework was used to build up the research question and to establish the eligibility criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was adopted to implement a comprehensive search strategy. Evidence was retrieved from scientific databases and HTA organizations Web sites. Reports were classified as full HTA, mini-HTA, rapid reviews or other.Results: The search strategy identified seven reports. Five HTA organizations from five countries elaborated the reports: one full HTA, four rapid reviews, and two classified as others. The reports were mainly focused on the evaluation of the clinical utility and cost-effectiveness of genome-wide sequencing as well as informing policy questions by providing analyses of organizational and ethical considerations.Conclusions: Few HTA organizations are drafting reports for WGS. It is essential to stimulate a critical reflection during the elaboration of HTA reports for WGS to steer choices of decision makers in the establishment of priorities for research and policy and reimbursement rates
Artificial Intelligence and Urban health: a step forward to the achievement of SDGs
No full textThe Sustainable Development Goals (SDGs) recognized the transformative power of urbanization with a dedicated goal (SDG11) focused on cities. This represents a pivotal first step to empower cities, also technologically, enabling new levels of intelligence and showing the need to become smarter. Artificial Intelligence (AI) and smart cities bring a multidisciplinary, integrated approach, examining how the digital and physical worlds are converging. The AI-based algorithms are overcoming the provision of urban services entering the realms of urban governance, planning, health, and safety. The aim of this study is to review how digital technologies and AI-based algorithms can influence and transform urban health. A scoping review of the literature was conducted using the Population, Concept, Context (PCC) framework to formulate the research question. A comprehensive search strategy will be implemented according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Major electronic databases were queried combining specific keywords. In addition, the search was completed by a snowball-search to identify missing articles. Out of a total of 1150 publications, 8 were identified as relevant to the research question. Among these articles, 43% and 35% reported findings from Europe and North America respectively. Evidence from the literature primarily focuses on the integration of smart city networks (sensor, people, business), based on AI, and urban health with different impacts on the health conditions of urban population over time. Public health plays major roles in urban planning sharing jointly common missions and perspectives. The advent of smart cities supported by AI can have an impact on public health, transforming urban life, with important consequences for physical, mental, and social well-being. AI applications in urban health could support public health activities of prevention and surveillance, and decision-making process, ushering a new era of public health
Formulazione di un questionario che indaga gli aspetti organizzativi nell’Health Technology Assessment della Whole Genome Sequencing in maniera accurata e praticabile
No full textObiettivi - Redigere un questionario volto ad indagare il dominio degli aspetti organizzativi (ORG) legati all’implementazione e all’utilizzo della tecnologia diagnostica di Whole Ge- nome Sequencing (WGS).
Metodologia - Successivamente all’estrazione dei risultati delle analisi delle corrispon- denze multiple relative alle tecnologie diagnostiche effettuata da Cacciatore et al., sono state identificate le quattro issue EUnetHTA alle quali far riferimento, secondo l’autore, per studiare il dominio ORG (G0004, G0005, G0006, D0023). Seguendo le indicazioni del Core Model 3.0 di EUnetHTA, con particolare attenzione rivolta alle Assessment element card delle sopracitate issue, ed in seguito allo studio della letteratura e dei report HTA che descrivono gli aspetti organizzativi della WGS, è stato redatto un questionario mediante l’applicazione web Google Forms. Per progettare il questionario è stata inoltre seguita la guida di Boparai et al. Il questionario sarà distribuito a mezzo posta elettronica ai centri clinici italiani che fanno uso della WGS.
Risultati - Le domande risultanti a risposta aperta e a risposta multipla sono distribuite in 6 sezioni, di cui le ultime 4 derivanti in maniera univoca dalle 4 issue predeterminate, ed indagano le seguenti aree concettuali: le caratteristiche del partecipante al questionario (4 domande) e del centro presso cui lavora (2 domande), le attività e le risorse associate all’impiego della WGS (1 domanda), gli attori con i quali il partecipante si interfaccia e le azioni che intercorrono affinché i processi relativi alla WGS (1 domanda) e alla Whole Exo- me Sequencing (WES) (1 domanda) siano eseguiti, i rapporti di cooperazione e/o comuni- cazione con altri centri che ricorrono alla WGS (2 domande), le opinioni sulle facilitazioni o limitazioni nell’accesso alla tecnologia derivanti dalla centralizzazione (2 domande) della stessa, le opinioni sui vantaggi e svantaggi economici e qualitativi derivanti dalla decen- tralizzazione della tecnologia (2 domande), i costi legati alla WGS (1 domanda), l’influenza della WGS sul ricorso ad altri test genetici (1 domanda), le opinioni sulla semplificazione dei percorsi diagnostici derivante da una diffusione di utilizzo della WGS (2 domande), l’utilizzo di WGS come esame genetico di primo livello e le opinioni sulle popolazioni eleg- gibili (2 domande). I destinatari del questionario sono professionisti che lavorano presso centri che fanno uso della WGS: biologi, medici, informatici, tecnici di laboratorio, infer- mieri, consulenti genetici
Ranking Nursing Diagnoses by Predictive Relevance for Intensive Care Unit Transfer Risk in Adult and Pediatric Patients: A Machine Learning Approach with Random Forest
No full textIngles
Analisi costi-efficacia dell’adozione dei pacemaker leadless rispetto ai pacemaker tradizionali
No full textObiettivi - Stimare la costo-efficacia dei pacemaker leadless (PL) rispetto ai pacemaker tradizionali (PT) nella popolazione eleggibile per l’impianto di PL e PT dalla prospettiva del Servizio Sanitario Nazionale (SSN).
Metodologia - Un albero decisionale Bayesiano è stato calibrato per una coorte ipotetica di pazienti divisi equamente nel braccio PL e nel braccio PT, adottando la prospettiva del SSN. Dopo che il paziente è stato impiantato, può incorrere con probabilità prede- terminate in una complicanza. La popolazione target consisteva di pazienti eleggibili per l’impianto di PL e PT e ai quali viene impiantato uno dei due tipi di device. I parametri del modello sono stati ottenuti dalla letteratura scientifica. In particolare, i costi dei device, il costo medio delle complicanze ad essi associate e le probabilità di transizione sono stati derivati rispettivamente da un report statale statunitense [1], uno studio economico nazionale francese [2] e una revisione sistematica con meta-analisi [3]. I costi e i bene- fici sono stati scontati a un tasso annuo del 3%. Per orientare il processo decisionale su quale alternativa supportare è stato scelto il threshold dell’Eurozona, che varia da € 30.000 a € 50.000. L’impatto dell’incertezza sui parametri del modello è stato esplorato attraverso un’analisi di sensibilità probabilistica (PSA), calcolando la curva di accettabilità della costo-efficacia (CEAC) e la frontiera di accettabilità della costo-efficacia (CEAF), e un’analisi del valore dell’informazione (VOI), stimando invece il valore atteso dell’informa- zione perfetta (EVPI). L’inferenza Bayesiana è stata supportata da una serie di algoritmi noti come Markov Chain Monte Carlo (MCMC), tra cui il Gibbs sampler. È stata inoltre valutata la performance dell’algoritmo selezionato attraverso l’impiego di alcune tecni- che diagnostiche (i.e., traceplot, grafici di densità, diagnostica di Gelman-Rubin, funzioni di autocorrelazione della catena). I risultati dell’analisi costi-efficacia sono stati espres- si come costi ed efficacia assoluti e come rapporto incrementale di costo-efficacia per complicanza evitata.
Risultati - L’adozione dei PL nella popolazione eleggibile all’impianto di PL e PT risulte- rebbe in un costo assoluto per il SSN di € 341.662.460, rispetto a € 247.187.180 risultanti dall’adozione dei PT. L’efficacia assoluta dei LP risulterebbe in 12.767 complicanze evi- tate, contro 9.606 per i PT. Nello scenario iniziale, rispetto ai PT, i PL hanno evidenziato un ICER di € 29.882 per complicanza evitata. La PSA ha confermato la robustezza dei risultati del caso base per il threshold scelto. Il grafico a contorno ha evidenziato che il 64% delle simulazioni si trova nel quadrante nord-est del piano di costi-efficacia, in cui i PL apportano maggiori benefici a fronte di costi superiori rispetto ai PT. La CEAC e la CEAF hanno evidenziato che i PL hanno una probabilità del 60% di essere costo-efficaci rispetto ai PT. L’EVPI ammonta a € 5.862 per paziente. Infine, le tecniche diagnostiche hanno indicato che il MCMC ha prodotto risultati robusti, con catene convergenti, elevate dimensioni effettive del campione e distribuzioni posteriori ben stimate, garantendo robu- stezza nella validità e nell’affidabilità dei risultati ottenuti
Analisi di minimizzazione dei costi dell'ablazione transcatetere della fibrillazione atriale eseguita mediante TactiFlex o TactiCath
No full textIntroduzione
L’ablazione transcatetere è una terapia efficace per il controllo del ritmo nella fibrillazione atriale
(FA). L’obiettivo dello studio è confrontare i costi dell’ablazione transcatetere della FA eseguita
rispettivamente con TactiFlex e TactiCath in uno scenario ospedaliero reale.
Metodi
Assunta la medesima efficacia e sicurezza cliniche per le due alternative, è stata effettuata un'analisi
di minimizzazione dei costi per valutarne l’impatto economico. Le durate medie delle due proce-
dure sono state calcolate su un campione di pazienti trattati presso un ospedale italiano. Le analisi
dei costi medici diretti e non medici diretti sono state effettuate adottando la prospettiva dell'ospe-
dale. È stata condotta un'analisi di sensibilità univariata per valutare l’incertezza nei parametri
scelti.
Risultati
Dalla prospettiva dell'ospedale, si stima preliminarmente che la procedura con TactiFlex costi €168
in più rispetto all'alternativa, con un guadagno medio di 57.3±9.5 minuti nella disponibilità della
sala operatoria impiegata e del personale coinvolto nell’ablazione. I parametri maggiormente deter-
minanti l’incertezza nei risultati sono i salari orari del personale e i costi dei cateteri ablatori.
Conclusioni
L’adozione del catetere TactiFlex può aumentare l'efficienza nell’impiego delle sale operatorie e del
personale coinvolto nelle ablazioni della FA, e ridurre il rischio di complicanze attribuibile alla
maggior durata dell’anestesia
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