1
|
Carrera A, Lettieri E, Lietti G, Martignoni S, Sgarbossa C, Cafazzo J. Therapies go digital. What drives physicians' acceptance? PLoS One 2024; 19:e0303302. [PMID: 38728346 PMCID: PMC11086840 DOI: 10.1371/journal.pone.0303302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
National healthcare systems face multiple challenges, including the increasing demand for care and decreasing availability of healthcare professionals. Digital health technologies represent opportunities that offer improved efficiency, accessibility, and patient care. In this scenario, Digital Therapeutics are technological advancements to treat or alleviate a disease and deliver a medical intervention with evidence-based therapeutic impacts and regulatory approval. Digital Therapeutics are a paradigm shift for physicians, who exercise caution in terms of trust and wide usage. Digital Therapeutics represents an opportunity and a challenge in healthcare system integration. The research investigates the factors explaining physicians' acceptance of Digital Therapeutics. A research model that combines organizational mechanisms derived from Institutional Theory and rational factors derived from the Technology Acceptance model was developed. The model was tested through 107 responses from a survey distributed to the members of the leading Italian scientific society in Diabetology. Literature-based hypotheses were empirically tested through Structural Equation Modelling. The analysis confirmed the influence of Perceived Ease of Use on Perceived Usefulness and Perceived Usefulness on the Intention To Use Digital Therapeutics. Rules and norms impact Perceived Usefulness when considering the influence of the scientific society. Culture and mindset towards innovation within the hospital positively affect Perceived Ease of Use. The readiness of hospital facilities enhances the extent to which physicians perceive the ease of employing Digital Therapeutics in their daily practice. Instead, esteemed colleagues' opinions and guidelines from the scientific society reveal to physicians the value of Digital Therapeutics in patients' care pathways. Institutions should prioritize cultural, normative, and regulative aspects to accelerate physicians' endorsement of Digital Therapeutics. Findings advance the theoretical knowledge around clinicians' adoption of innovative digital health technologies, unveiling the interaction between rational and institutional factors. The results highlight practical implications for healthcare institutions and Digital Therapeutics manufacturers willing to promote their adoption.
Collapse
Affiliation(s)
- Alessandro Carrera
- Department of Management Engineering, Politecnico di Milano, Milano, Italy
| | - Emanuele Lettieri
- Department of Management Engineering, Politecnico di Milano, Milano, Italy
| | - Gaia Lietti
- Department of Management Engineering, Politecnico di Milano, Milano, Italy
| | - Sara Martignoni
- Department of Management Engineering, Politecnico di Milano, Milano, Italy
| | - Chiara Sgarbossa
- Department of Management Engineering, Politecnico di Milano, Milano, Italy
| | - Joseph Cafazzo
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Carrera A, Manetti S, Lettieri E. Rewiring care delivery through Digital Therapeutics (DTx): a machine learning-enhanced assessment and development (M-LEAD) framework. BMC Health Serv Res 2024; 24:237. [PMID: 38395905 PMCID: PMC10885456 DOI: 10.1186/s12913-024-10702-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Digital transformation has sparked profound change in the healthcare sector through the development of innovative digital technologies. Digital Therapeutics offer an innovative approach to disease management and treatment. Care delivery is increasingly patient-centered, data-driven, and based on real-time information. These technological innovations can lead to better patient outcomes and support for healthcare professionals, also considering resource scarcity. As these digital technologies continue to evolve, the healthcare field must be ready to integrate them into processes to take advantage of their benefits. This study aims to develop a framework for the development and assessment of Digital Therapeutics. METHODS The study was conducted relying on a mixed methodology. 338 studies about Digital Therapeutics resulting from a systematic literature review were analyzed using descriptive statistics through RStudio. Machine learning algorithms were applied to analyze variables and find patterns in the data. The results of these analytical analyses were summarized in a framework qualitatively tested and validated through expert opinion elicitation. RESULTS The research provides M-LEAD, a Machine Learning-Enhanced Assessment and Development framework that recommends best practices for developing and assessing Digital Therapeutics. The framework takes as input Digital Therapeutics characteristics, regulatory aspects, study purpose, and assessment domains. The framework produces as outputs recommendations to design the Digital Therapeutics study characteristics. CONCLUSIONS The framework constitutes the first step toward standardized guidelines for the development and assessment of Digital Therapeutics. The results may support manufacturers and inform decision-makers of the relevant results of the Digital Therapeutics assessment.
Collapse
|
3
|
De Micco F, De Benedictis A, Lettieri E, Tambone V. Editorial: Equitable digital medicine and home health care. Front Public Health 2023; 11:1251154. [PMID: 38192562 PMCID: PMC10773581 DOI: 10.3389/fpubh.2023.1251154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/01/2023] [Indexed: 01/10/2024] Open
Affiliation(s)
- Francesco De Micco
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Anna De Benedictis
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Nursing Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Emanuele Lettieri
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Vittoradolfo Tambone
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| |
Collapse
|
4
|
Moglia A, Marsilio L, Rossi M, Pinelli M, Lettieri E, Mainardi L, Manzotti A, Cerveri P. Mixed Reality and Artificial Intelligence: A Holistic Approach to Multimodal Visualization and Extended Interaction in Knee Osteotomy. IEEE J Transl Eng Health Med 2023; 12:279-290. [PMID: 38410183 PMCID: PMC10896423 DOI: 10.1109/jtehm.2023.3335608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/16/2023] [Accepted: 11/17/2023] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Recent advancements in augmented reality led to planning and navigation systems for orthopedic surgery. However little is known about mixed reality (MR) in orthopedics. Furthermore, artificial intelligence (AI) has the potential to boost the capabilities of MR by enabling automation and personalization. The purpose of this work is to assess Holoknee prototype, based on AI and MR for multimodal data visualization and surgical planning in knee osteotomy, developed to run on the HoloLens 2 headset. METHODS Two preclinical test sessions were performed with 11 participants (eight surgeons, two residents, and one medical student) executing three times six tasks, corresponding to a number of holographic data interactions and preoperative planning steps. At the end of each session, participants answered a questionnaire on user perception and usability. RESULTS During the second trial, the participants were faster in all tasks than in the first one, while in the third one, the time of execution decreased only for two tasks ("Patient selection" and "Scrolling through radiograph") with respect to the second attempt, but without statistically significant difference (respectively [Formula: see text] = 0.14 and [Formula: see text] = 0.13, [Formula: see text]). All subjects strongly agreed that MR can be used effectively for surgical training, whereas 10 (90.9%) strongly agreed that it can be used effectively for preoperative planning. Six (54.5%) agreed and two of them (18.2%) strongly agreed that it can be used effectively for intraoperative guidance. DISCUSSION/CONCLUSION In this work, we presented Holoknee, the first holistic application of AI and MR for surgical planning for knee osteotomy. It reported promising results on its potential translation to surgical training, preoperative planning, and surgical guidance. Clinical and Translational Impact Statement - Holoknee can be helpful to support surgeons in the preoperative planning of knee osteotomy. It has the potential to impact positively the training of the future generation of residents and aid surgeons in the intraoperative stage.
Collapse
Affiliation(s)
- Andrea Moglia
- Department of ElectronicsInformation and BioengineeringPolitecnico di Milano20133MilanItaly
| | - Luca Marsilio
- Department of ElectronicsInformation and BioengineeringPolitecnico di Milano20133MilanItaly
| | - Matteo Rossi
- Department of ElectronicsInformation and BioengineeringPolitecnico di Milano20133MilanItaly
- Istituto Auxologico Italiano IRCCS20149MilanItaly
| | - Maria Pinelli
- Department of Management, Economics and Industrial EngineeringPolitecnico di Milano20133MilanItaly
| | - Emanuele Lettieri
- Department of Management, Economics and Industrial EngineeringPolitecnico di Milano20133MilanItaly
| | - Luca Mainardi
- Department of ElectronicsInformation and BioengineeringPolitecnico di Milano20133MilanItaly
| | | | - Pietro Cerveri
- Department of ElectronicsInformation and BioengineeringPolitecnico di Milano20133MilanItaly
- Istituto Auxologico Italiano IRCCS20149MilanItaly
| |
Collapse
|
5
|
Manetti S, Lettieri E, Ni MZ. Development and validation of Medical Device Key Evidence Tool ('MeDKET'): An evidence-based framework to explain success in selected European and US companies. PLoS One 2023; 18:e0288126. [PMID: 37440504 DOI: 10.1371/journal.pone.0288126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Innovating in Medical Device (MD) industry is challenging. This study aims to develop and validate an evidence-based framework that helps innovators of small and large enterprises (SEs and LEs) assess their readiness for successful MD development and deployment. We conducted a key-informant process (stage 1) where 25 international experts identified a list of emergent Health Technology Assessment (HTA) themes they believed were essential to company success. A sample of 22 European and US selected companies (13 SEs and 9 LEs) then reached a consensus on a list of key themes through a robust Delphi process (stage 2). Finally, we constructed (stage 3) and validated (stage 4) the checklist for SEs and LEs. The checklist for SEs and LEs included 21 and 15 items (i.e., fundamental Yes/No questions) with nine overlapping criteria for both SEs and LEs. In both groups, MD success was driven by three major item categories: (i) R&D assessment strategy; (ii) device-outcome measures; (iii) company profiling. Alongside the retrospective validation study, we collected 40 case studies on MDs (23 successes and 17 failures) across the selected enterprises. The retrospective validation provided the proportion of successful and failed case studies that met the 'MeDKET' criteria. We discovered that early HTA plays a pivotal role in MD industry success with different implications based on enterprise size. This study is the first of its kind to provide a holistic picture of the perceived role of early-stage HTA in MD industry success.
Collapse
Affiliation(s)
- Stefania Manetti
- Department of Management Engineering, Politecnico di Milano, Milano, Italy
| | - Emanuele Lettieri
- Department of Management Engineering, Politecnico di Milano, Milano, Italy
| | - Melody Zhifang Ni
- London In-Vitro Diagnostics (LIVD) Cooperative, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| |
Collapse
|
6
|
Vettoretto N, Foglia E, Gerardi C, Lettieri E, Nocco U, Botteri E, Bracale U, Caracino V, Carrano FM, Cassinotti E, Giovenzana M, Giuliani B, Iossa A, Milone M, Montori G, Peltrini R, Piatto G, Podda M, Sartori A, Allocati E, Ferrario L, Asperti F, Songia L, Garattini S, Agresta F. High-energy devices in different surgical settings: lessons learnt from a full health technology assessment report developed by SICE (Società Italiana di Chirurgia Endoscopica). Surg Endosc 2023; 37:2548-2565. [PMID: 36333498 PMCID: PMC9638482 DOI: 10.1007/s00464-022-09734-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The present paper aims at evaluating the potential benefits of high-energy devices (HEDs) in the Italian surgical practice, defining the comparative efficacy and safety profiles, as well as the potential economic and organizational advantages for hospitals and patients, with respect to standard monopolar or bipolar devices. METHODS A Health Technology Assessment was conducted in 2021 assuming the hospital perspective, comparing HEDs and standard monopolar/bipolar devices, within eleven surgical settings: appendectomy, hepatic resections, colorectal resections, cholecystectomy, splenectomy, hemorrhoidectomy, thyroidectomy, esophago-gastrectomy, breast surgery, adrenalectomy, and pancreatectomy. The nine EUnetHTA Core Model dimensions were deployed considering a multi-methods approach. Both qualitative and quantitative methods were used: (1) a systematic literature review for the definition of the comparative efficacy and safety data; (2) administration of qualitative questionnaires, completed by 23 healthcare professionals (according to 7-item Likert scale, ranging from - 3 to + 3); and (3) health-economics tools, useful for the economic evaluation of the clinical pathway and budget impact analysis, and for the definition of the organizational and accessibility advantages, in terms of time or procedures' savings. RESULTS The literature declared a decrease in operating time and length of stay in using HEDs in most surgical settings. While HEDs would lead to a marginal investment for the conduction of 178,619 surgeries on annual basis, their routinely implementation would generate significant organizational savings. A decrease equal to - 5.25/-9.02% of operating room time and to - 5.03/-30.73% of length of stay emerged. An advantage in accessibility to surgery could be hypothesized in a 9% of increase, due to the gaining in operatory slots. Professionals' perceptions crystallized and confirmed literature evidence, declaring a better safety and effectiveness profile. An improvement in both patients and caregivers' quality-of-life emerged. CONCLUSIONS The results have demonstrated the strategic relevance related to HEDs introduction, their economic sustainability, and feasibility, as well as the potentialities in process improvement.
Collapse
Affiliation(s)
- Nereo Vettoretto
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Chirurgia, V.le Ciotti 154, 25018, Montichiari, BS, Italy.
| | - Emanuela Foglia
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Chiara Gerardi
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Emanuele Lettieri
- Dipartimento di Ingegneria Gestionale, Politecnico di Milano, Milan, Italy
| | - Umberto Nocco
- S.C. Ingegneria Clinica, ASST Grande Ospedale Metropolitano Niguarda and Associazione Italiana Ingegneri Clinici, Milan, Italy
| | - Emanuele Botteri
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Chirurgia, V.le Ciotti 154, 25018, Montichiari, BS, Italy
| | - Umberto Bracale
- U.O.C. Chirurgie Generale e Oncologica Mini Invasiva, A.O.U. Policlinico Federico II, Naples, Italy
| | - Valerio Caracino
- U.O.C. Chirurgia Generale e d'Urgenza, AUSL Pescara, Pescara, Italy
| | | | - Elisa Cassinotti
- Chirurgia Generale, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Giovenzana
- Unit of HepatoBilioPancreatic and Digestive Surgery, Ospedale San Paolo, University of Milan, Milan, Italy
| | - Beatrice Giuliani
- Unit of HepatoBilioPancreatic and Digestive Surgery, Ospedale San Paolo, University of Milan, Milan, Italy
| | - Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, University of Rome Sapienza Polo Pontino, Rome, Italy
| | - Marco Milone
- U.O.C. Chirurgia Generale, Azienda Ospedaliera Universitaria Federico II di Napoli, Naples, Italy
| | - Giulia Montori
- U.O.C. Chirurgia Generale, Ospedale di Vittorio Veneto, Treviso, Italy
| | - Roberto Peltrini
- U.O.C. Chirurgie Generale e Oncologica Mini Invasiva, A.O.U. Policlinico Federico II, Naples, Italy
| | - Giacomo Piatto
- UOC Chirurgia Generale e d'Urgenza, Ospedale di Montebelluna (TV), AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Mauro Podda
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Cagliari, Cagliari, Italy
| | - Alberto Sartori
- UOC Chirurgia Generale e d'Urgenza, Ospedale di Montebelluna (TV), AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Eleonora Allocati
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Lucrezia Ferrario
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Federica Asperti
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Letizia Songia
- S.C. Ingegneria Clinica, ASST Grande Ospedale Metropolitano Niguarda and Associazione Italiana Ingegneri Clinici, Milan, Italy
- SC Ingengeria Clinica, ASST di Lecco, Lecco, Italy
| | - Silvio Garattini
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | | |
Collapse
|
7
|
Pinelli M, Manetti S, Lettieri E. Assessing the Social and Environmental Impact of Healthcare Technologies: Towards an Extended Social Return on Investment. Int J Environ Res Public Health 2023; 20:5224. [PMID: 36982131 PMCID: PMC10049561 DOI: 10.3390/ijerph20065224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
Stroke is the third leading cause of death and disability overall worldwide. Upper limb impairment is a common consequence for stroke survivors, having negative impact on their quality of life. Robotic rehabilitation, through repetitive and monitored movements, can improve their status. Developed by a team of researchers at Politecnico di Milano, AGREE is an exoskeleton for upper limb rehabilitation at the stage gate between translational research and clinical validation. Since the cost of this device is particularly high, the present study aimed to provide a framework for assessing its value. The Social Return on Investment (SROI) method, able to grasp the economic, social and environmental impact of an activity, was applied, using expert opinions of a pool of clinical engineers and healthcare professionals from different Italian hospitals to obtain information. Environmental impacts were estimated through Life Cycle Assessment in terms of CO2 emissions and incorporated in the analysis. Considering a 5-year period, the SROI for a single exoskeleton was 3.75:1, and the SROI for the number of exoskeletons projected to be sold was 2.868:1, thus resulting largely in value for money. This study provides a model for combining economic, social and environmental outcomes that, besides contributing to theory, could be useful for decision-making.
Collapse
|
8
|
Carrera A, Zoccarato F, Mazzeo M, Lettieri E, Toletti G, Bertoli S, Castelnuovo G, Fresa E. What drives patients' acceptance of Digital Therapeutics? Establishing a new framework to measure the interplay between rational and institutional factors. BMC Health Serv Res 2023; 23:145. [PMID: 36765410 PMCID: PMC9921481 DOI: 10.1186/s12913-023-09090-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The rising incidence of chronic diseases among the population, further exacerbated by the phenomenon of aging, is a primary concern and a serious challenge for the healthcare systems worldwide. Among the wide realm of health digital technologies, the rise of Digital Therapeutics (DTx), which are medical devices able to deliver evidence-based treatments to manage and treat diseases, opens new opportunities. However, their diffusion and usage are still fragmented among countries. As the diffusion results from the adoption of technology from a social system and individual acceptance, this study aims to design and test a theoretical model that investigates the intention to use DTx, with a particular focus on the treatment of obesity, as a widespread and burdensome chronic condition. METHODS This research is built on 336 answers coming from a survey to test the proposed model, which consists of a combination of organizational mechanisms, derived from Institutional Theory, and rational factors, derived from the Technology Acceptance Model (TAM). The survey has been delivered to patients and former patients of Istituto Auxologico Italiano, a hospital with several locations in northern Italy, recognized as a center of excellence for the treatment of obesity. RESULTS The analyses of the answers, performed through the Structural Equation Modelling (SEM) technique, confirmed the influence of the Perceived Usefulness on Intention To Use, and of the Perceived Ease Of Use on the Perceived Usefulness, confirming the validity of the assumptions derived from the TAM. On the other hand, institutional factors were introduced as antecedents of the Perceived Usefulness, and the Perceived Ease Of Use. Results show that the Regulative Pillar influences both the TAM constructs, the Normative Pillar (peer influence) has a positive effect only on the Perceived Usefulness, and finally, the Cultural Pillar impacts the Perceived Ease Of Use. CONCLUSION This study allows filling the knowledge gap regarding the usage of the Institutional as a means to predict individuals' intentions. Moreover, managerial contributions are available as the results have been operationalized into practical advice to managers and healthcare professionals to foster the adoption, and thus the diffusion, of Digital Therapeutics.
Collapse
Affiliation(s)
| | - Francesca Zoccarato
- grid.4643.50000 0004 1937 0327Polytechnic University of Milan, School of Management, Milan, Italy
| | - Margherita Mazzeo
- grid.4643.50000 0004 1937 0327Polytechnic University of Milan, School of Management, Milan, Italy
| | - Emanuele Lettieri
- grid.4643.50000 0004 1937 0327Polytechnic University of Milan, School of Management, Milan, Italy
| | - Giovanni Toletti
- grid.4643.50000 0004 1937 0327Polytechnic University of Milan, School of Management, Milan, Italy
| | - Simona Bertoli
- grid.418224.90000 0004 1757 9530IRCCS Istituto Auxologico Italiano, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Food, Environmental and Nutritional Sciences, University of Milan, Milan, Italy
| | - Gianluca Castelnuovo
- grid.418224.90000 0004 1757 9530IRCCS Istituto Auxologico Italiano, Milan, Italy ,grid.8142.f0000 0001 0941 3192Department of Psychology, Catholic University, Milan, Italy
| | - Emanuele Fresa
- grid.418224.90000 0004 1757 9530IRCCS Istituto Auxologico Italiano, Milan, Italy
| |
Collapse
|
9
|
Manetti S, Cumetti M, De Benedictis A, Lettieri E. Adoption of novel biomarker test parameters with machine learning-based algorithms for the early detection of sepsis in hospital practice. J Nurs Manag 2022; 30:3754-3764. [PMID: 36125938 PMCID: PMC10092467 DOI: 10.1111/jonm.13807] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/29/2022] [Accepted: 09/14/2022] [Indexed: 12/30/2022]
Abstract
AIMS We aim (i) to redesign sepsis's clinical pathway and fit the organizational requirements of a novel machine-learning algorithm incorporating a novel biomarker test and (ii) to assess adoption drivers of the new combined technology. BACKGROUND There is an urgent need to achieve sepsis' early detection and diagnostic excellence. METHODS A qualitative study based on semi-structured interviews conducted at the target site and across other Italian hospitals. A content analysis was undertaken, emergent themes were selected and categorized, and interviews were conducted until saturation was reached. RESULTS Sixteen nurses (10 at the target site and six across other hospitals) and nine non-nursing professionals (seven at the target site and two across other hospitals) were interviewed. An organizational redesign was identified as the primary adoption driver. Even though nurses perceived workload increase related to the machine-learning component, technology acceptability was relatively high, as the standardization of tasks was perceived as crucial to improving professional satisfaction. CONCLUSIONS A novel business-oriented solution based on machine learning requires interprofessional integration, new professional roles, infrastructure improvement, and data integration to be effectively implemented. IMPLICATIONS FOR NURSING MANAGEMENT Lessons learned from this study suggest the need to involve nurses in the early stages of the design of new machine-learning technologies and the importance of training nurses on sepsis management through the support of disruptive technological innovation.
Collapse
Affiliation(s)
- Stefania Manetti
- Management and Health Laboratory, Institute of Management, EMbeDS Department, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Michele Cumetti
- Management and Health Laboratory, Institute of Management, EMbeDS Department, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Anna De Benedictis
- Department of Healthcare Professions, Campus Bio-Medico of Rome University Hospital, Rome, Italy
| | - Emanuele Lettieri
- Department of Management Engineering, Politecnico di Milano, Milan, Italy
| |
Collapse
|
10
|
Pinelli M, Lettieri E, Boaretto A, Casile C, Citro G, Zazzaro B, Ravazzoni A. Glucometer Usability for 65+ Type 2 Diabetes Patients: Insights on Physical and Cognitive Issues. Sensors (Basel) 2022; 22:6202. [PMID: 36015970 PMCID: PMC9416294 DOI: 10.3390/s22166202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
Background: Self-monitoring of blood glucose (SMBG) is of paramount relevance for type 2 diabetes mellitus (T2DM) patients. However, past evidence shows that there are physical and cognitive issues that might limit the usage of glucometers by T2DM patients aged 65 years and over. Objective: Our aim was to investigate the physical and cognitive issues related to the usage of glucometers by T2DM patients aged 65 years and over. Materials and Methods: The extant literature was analysed to define an original framework showing the logical nexus between physical and cognitive issues and quality of life. Then we collected evidence addressing the specific case of the Accu-Chek® Instant glucometer produced by Roche Diabetes Care GmbH, which implements new features claiming to improve usability. We conducted 30 interviews with T2DM patients aged 65 years and over, three interviews with senior nurses, and a focus group with three senior physicians and three senior nurses. Results: From the interviews, both patients and nurses declared that they were generally satisfied with the Accu-Chek® Instant glucometer's characteristics. In the focus group, the results were commented on and, in the light of some diverging answers, improvements have been set up for future implementation. Conclusions: Our study produces evidence and future suggestions about the usage of glucometers by type 2 diabetes patients aged 65 years and over.
Collapse
Affiliation(s)
- Maria Pinelli
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Via Lambruschini 4/B, 20156 Milan, Italy
| | - Emanuele Lettieri
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Via Lambruschini 4/B, 20156 Milan, Italy
| | | | - Carlo Casile
- Azienda Ospedaliera Papardo, Contrada Papardo, 98158 Messina, Italy
| | | | - Bernardino Zazzaro
- Presidio Ospedaliero Umberto I° UOS Endocrinologia, Via Testaferrata 1, 96100 Siracusa, Italy
| | - Adriana Ravazzoni
- Presidio Ospedaliero Umberto I° UOS Endocrinologia, Via Testaferrata 1, 96100 Siracusa, Italy
| |
Collapse
|
11
|
Buffoli M, Gola M, Mosca EI, Ugolini M, Lettieri E, Capolongo S. Community Health Centers for Resilient Communities in the post-COVID-19 era. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The synergy between territorial services and hospital organizations plays a crucial role for health promotion. Starting from the recent pandemic, the Community Health Centers (CHCs) could turn out particularly efficient in cases of high emergencies, avoiding the overflow of users in the hospital thanks to health home care management or low and medium-care facilities. The aim of the research is to identify evidence based experiences that supports the efficacy of design and management of CHCs, also during pandemics.
Methods
The methodology is based on the analysis of several European case studies, selected by an extensive analysis of the main EU countries, through a comparative matrix with different criteria related to: a) general information; b) urban relationship with the healthcare territorial network; c) number of inhabitants and population basins; d) building typology, dimensions, flexibility and layout issues; e) healthcare staff involved, the number of workers and volumes of activities; f) sanitary and not sanitary functions before and during the COVID-19 pandemic, and transformations applied.
Results
The analysis gives rise to several correlations due the localization of CHCs and the healthcare territorial network, dimensions and staff involved, sanitary and not sanitary functions -before and during the pandemic- and the flexibility of the CHCs, that permits to list experience based best practices for the design and management of resilient CHCs, as useful strategic lines for professionals in public health and healthcare design. The survey highlights the strategic role of CHCs for the healthcare territorial network with particular evidence during pandemics.
Conclusions
The strategies aim to encourage the introduction of CHCs for the access to care for the population. The outcomes of the analysis are related to the research project Cities and Health Community Centers for Resilient Communities funded by PoliSocial Award 2020 of Politecnico di Milano.
Key messages
definition of design and organizational strategies for Community Health Centers for Resilient Communities in the post-COVID-19 era. qualitative and quantitative data analysis of European Community Health Centers before and during the COVID-19 pandemic.
Collapse
Affiliation(s)
- M Buffoli
- Design & Health LAB, DABC, Politecnico di Milano, Milan, Italy
| | - M Gola
- Design & Health LAB, DABC, Politecnico di Milano, Milan, Italy
| | - EI Mosca
- Design & Health LAB, DABC, Politecnico di Milano, Milan, Italy
| | - M Ugolini
- DAStU, Politecnico di Milano, Milan, Italy
| | - E Lettieri
- DIG, Politecnico di Milano, Milan, Italy
| | - S Capolongo
- Design & Health LAB, DABC, Politecnico di Milano, Milan, Italy
| |
Collapse
|
12
|
Vettoretto N, Foglia E, Ferrario L, Gerardi C, Molteni B, Nocco U, Lettieri E, Molfino S, Baiocchi GL, Elmore U, Rosati R, Currò G, Cassinotti E, Boni L, Cirocchi R, Marano A, Petz WL, Arezzo A, Bonino MA, Davini F, Biondi A, Anania G, Agresta F, Silecchia G. Could fluorescence-guided surgery be an efficient and sustainable option? A SICE (Italian Society of Endoscopic Surgery) health technology assessment summary. Surg Endosc 2021; 34:3270-3284. [PMID: 32274626 DOI: 10.1007/s00464-020-07542-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Indocyanine green fluorescence vision is an upcoming technology in surgery. It can be used in three ways: angiographic and biliary tree visualization and lymphatic spreading studies. The present paper shows the most outstanding results from an health technology assessment study design, conducted on fluorescence-guided compared with standard vision surgery. METHODS A health technology assessment approach was implemented to investigate the economic, social, ethical, and organizational implications related to the adoption of the innovative fluorescence-guided view, with a focus on minimally invasive approach. With the support of a multidisciplinary team, qualitative and quantitative data were collected, by means of literature evidence, validated questionnaires and self-reported interviews, considering the dimensions resulting from the EUnetHTA Core Model. RESULTS From a systematic search of literature, we retrieved the following studies: 6 on hepatic, 1 on pancreatic, 4 on biliary, 2 on bariatric, 4 on endocrine, 2 on thoracic, 11 on colorectal, 7 on urology, 11 on gynecology, 2 on gastric surgery. Fluorescence guide has shown advantages on the length of hospitalization particularly in colorectal surgery, with a reduction of the rate of leakages and re-do anastomoses, in spite of a slight increase in operating time, and is confirmed to be a safe, efficacious, and sustainable vision technology. Clinical applications are still presenting a low evidence in the literature. CONCLUSION The present paper, under the patronage of Italian Society of Endoscopic Surgery, based on an HTA approach, sustains the use of fluorescence-guided vision in minimally invasive surgery, in the fields of general, gynecologic, urologic, and thoracic surgery, as an efficient and economically sustainable technology.
Collapse
Affiliation(s)
- N Vettoretto
- Chirurgia Montichiari, Azienda Socio Sanitaria Territoriale Degli Spedali Civili, V.le Ciotti 154, Montichiari, 25018, Brescia, Italy.
| | - E Foglia
- LIUC - Università Cattaneo, Castellanza, VA, Italy
| | - L Ferrario
- LIUC - Università Cattaneo, Castellanza, VA, Italy
| | - C Gerardi
- Centro di Politiche Regolatorie, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Milan, Italy
| | - B Molteni
- Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy
| | - U Nocco
- Ingegneria Clinica, Azienda Socio Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - E Lettieri
- School of Management, Department of Management, Economics and Industrial Engineering, Politecnico, Milano, Italy
| | - S Molfino
- Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy
| | - G L Baiocchi
- Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy
| | - U Elmore
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - R Rosati
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - G Currò
- Department of Human Pathology of Adult and Evolutive Age, University Hospital of Messina, Messina, Italy
| | - E Cassinotti
- Chirurgia Generale, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico - University of Milan, Milan, Italy
| | - L Boni
- Chirurgia Generale, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico - University of Milan, Milan, Italy
| | - R Cirocchi
- Department of Surgical Sciences, University of Perugia, Perugia, Italy
| | - A Marano
- Chirurgia Generale ed Oncologica, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - W L Petz
- Chirurgia, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - A Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - M A Bonino
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - F Davini
- Centro multidisciplinare Chirurgia Robotica, Chirurgia Toracica mini-invasiva e Robotica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - A Biondi
- Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - G Anania
- Chirurgia Generale, University of Ferrara, Ferrara, Italy
| | - F Agresta
- Chirurgia Generale, Azienda ULSS 5 "Polesana", Hospital of Adria, Adria, RO, Italy
| | - G Silecchia
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome-Polo Pontino, Rome, Italy
| |
Collapse
|
13
|
Massi MC, Ieva F, Lettieri E. Data mining application to healthcare fraud detection: a two-step unsupervised clustering method for outlier detection with administrative databases. BMC Med Inform Decis Mak 2020; 20:160. [PMID: 32664923 PMCID: PMC7362640 DOI: 10.1186/s12911-020-01143-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The healthcare sector is an interesting target for fraudsters. The availability of a great amount of data makes it possible to tackle this issue with the adoption of data mining techniques, making the auditing process more efficient and effective. This research has the objective of developing a novel data mining model devoted to fraud detection among hospitals using Hospital Discharge Charts (HDC) in Administrative Databases. In particular, it is focused on the DRG upcoding practice, i.e., the tendency of registering codes for provided services and inpatients health status so to make the hospitalization fall within a more remunerative DRG class. METHODS We propose a two-step algorithm: the first step entails kmeans clustering of providers to identify locally consistent and locally similar groups of hospitals, according to their characteristics and behavior treating a specific disease, in order to spot outliers within this groups of peers. An initial grid search for the best number of features to be selected (through Principal Feature Analysis) and the best number of local groups makes the algorithm extremely flexible. In the second step, we propose a human-decision support system that helps auditors cross-validating the identified outliers, analyzing them w.r.t. fraud-related variables, and the complexity of patients' casemix they treated. The proposed algorithm was tested on a database relative to HDC collected by Regione Lombardia (Italy) in a time period of three years (2013-2015), focusing on the treatment of Heart Failure. RESULTS The model identified 6 clusters of hospitals and 10 outliers among the 183 units. Out of those providers, we report the in depth the application of Step Two on three Hospitals (two private and one public). Cross-validating with the patients' population and the hospitals' characteristics, the public hospital seemed justified in its outlierness, while the two private providers were deemed interesting for a further investigation by auditors. CONCLUSIONS The proposed model is promising in identifying anomalous DRG coding behavior and it is easily transferrable to all diseases and contexts of interest. Our proposal contributes to the limited literature regarding behavioral models for fraud detection, identifying the most 'cautious' fraudsters. The results of the first and the second Steps together represent a valuable set of information for auditors in their preliminary investigation.
Collapse
Affiliation(s)
- Michela Carlotta Massi
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, Via Bonardi 9, Milan, Italy. .,CADS - Center for Analysis, Decisions and Society, Human Technopole, Palazzo Italia, Via Cristina Belgioioso 28, Milan, 20157, Italy.
| | - Francesca Ieva
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, Via Bonardi 9, Milan, Italy.,CADS - Center for Analysis, Decisions and Society, Human Technopole, Palazzo Italia, Via Cristina Belgioioso 28, Milan, 20157, Italy.,CHRP-National Center for Healthcare Research and Pharmacoepidemiology, Università degli Studi di Milano-Bicocca, via Bicocca degli Arcimboldi 8, Milan, 20126, Italy
| | - Emanuele Lettieri
- Department of Management Engineering, Politecnico di Milano, Via Lambruschini 4/c, Milan, 20100, Italy
| |
Collapse
|
14
|
Roshanghalb A, Mazzali C, Lettieri E. Composite Outcomes of Mortality and Readmission in Patients with Heart Failure: Retrospective Review of Administrative Datasets. J Multidiscip Healthc 2020; 13:539-547. [PMID: 32612362 PMCID: PMC7322138 DOI: 10.2147/jmdh.s255206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/22/2020] [Indexed: 12/22/2022] Open
Abstract
Background Controlling the quality of care through readmissions and mortality for patients with heart failure (HF) is a national priority for healthcare regulators in developed countries. In this longitudinal cohort study, using administrative data such as hospital discharge forms (HDFs), emergency departments (EDs) accesses, and vital statistics, we test new covariates for predicting mortality and readmissions of patients hospitalized for HF and discuss the use of combined outcome as an alternative. Methods Logistic models, with a stepwise selection method, were estimated on 70% of the sample and validated on the remaining 30% to evaluate 30-day mortality, 30-day readmissions, and the combined outcome. We followed an extraction method for any-cause mortality and unplanned readmission within 30 days after incident HF hospitalization. Data on patient admission and previous history were extracted by HDFs and ED dataset. Results Our principal findings demonstrate that the model’s discriminant ability is consistent with literature both for mortality (AUC=0.738, CI (0.729–0.748)) and readmissions (AUC=0.578, CI (0.562–0.594)). Additionally, the discriminant ability of the composite outcome model is satisfactory (AUC=0.675, CI (0.666–0.684)). Conclusion Hospitalization characteristics and patient history introduced in the logistic models do not improve their discriminant ability. The composite outcome prediction is led more by mortality than readmission, without improvements for the comprehension of the readmission phenomenon.
Collapse
Affiliation(s)
- Afsaneh Roshanghalb
- Department of Management, Economics & Industrial Engineering, Politecnico di Milano, Milan, Italy
| | | | - Emanuele Lettieri
- Department of Management, Economics & Industrial Engineering, Politecnico di Milano, Milan, Italy
| |
Collapse
|
15
|
De Benedictis A, Lettieri E, Gastaldi L, Masella C, Urgu A, Tartaglini D. Electronic Medical Records implementation in hospital: An empirical investigation of individual and organizational determinants. PLoS One 2020; 15:e0234108. [PMID: 32497058 PMCID: PMC7272094 DOI: 10.1371/journal.pone.0234108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 05/19/2020] [Indexed: 01/04/2023] Open
Abstract
The implementation of hospital-wide Electronic Medical Records (EMRs) is still an unsolved quest for many hospital managers. EMRs have long been considered a key factor for improving healthcare quality and safety, reducing adverse events for patients, decreasing costs, optimizing processes, improving clinical research and obtaining best clinical performances. However, hospitals continue to experience resistance from professionals to accepting EMRs. This study combines institutional and individual factors to explain which determinants can trigger or inhibit the EMRs implementation in hospitals, and which variables managers can exploit to guide professionals' behaviours. Data have been collected through a survey administered to physicians and nurses in an Italian University Hospital in Rome. A total of 114 high-quality responses had been received. Results show that both, physicians and nurses, expect many benefits from the use of EMRs. In particular, it is believed that the EMRs will have a positive impact on quality, efficiency and effectiveness of care; handover communication between healthcare workers; teaching, tutoring and research activities; greater control of your own business. Moreover, data show an interplay between individual and institutional determinants: normative factors directly affect perceived usefulness (C = 0.30 **), perceived ease of use (C = 0.26 **) and intention to use EMRs (C = 0.33 **), regulative factors affect the intention to use EMRs (C = -0.21 **), and perceived usefulness directly affect the intention to use EMRs (C = 0.33 **). The analysis carried out shows that the key determinants of the intention to use EMRs are the normative ones (peer influence) and the individual ones (perceived usefulness), and that perceived usefulness works also as a mediator between normative factors and intention to use EMRs. Therefore, Management can leverage on power users to motivate, generate and manage change.
Collapse
Affiliation(s)
- Anna De Benedictis
- Department of Healthcare Professions, University Hospital Campus Bio-Medico, Rome, Italy
- Faculty of Medicine & Surgery, University Campus Bio-Medico, Rome, Italy
- * E-mail:
| | - Emanuele Lettieri
- Department of Economics, Management and Industrial Engineering, Politecnico of Milan, Milan, Italy
| | - Luca Gastaldi
- Department of Economics, Management and Industrial Engineering, Politecnico of Milan, Milan, Italy
| | - Cristina Masella
- Department of Economics, Management and Industrial Engineering, Politecnico of Milan, Milan, Italy
| | - Alessia Urgu
- Department of Healthcare Professions, University Hospital Campus Bio-Medico, Rome, Italy
| | - Daniela Tartaglini
- Department of Healthcare Professions, University Hospital Campus Bio-Medico, Rome, Italy
- Faculty of Medicine & Surgery, University Campus Bio-Medico, Rome, Italy
| |
Collapse
|
16
|
Mosconi P, Radrezza S, Lettieri E, Santoro E. Use of Health Apps and Wearable Devices: Survey Among Italian Associations for Patient Advocacy. JMIR Mhealth Uhealth 2019; 7:e10242. [PMID: 30664455 PMCID: PMC6350090 DOI: 10.2196/10242] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Technological tools such as Web-based social networks, telemedicine, apps, or wearable devices are becoming more widespread in health care like elsewhere. Although patients are the main users, for example, to monitor symptoms and clinical parameters or to communicate with the doctor, their perspective is seldom analyzed, and to the best of our knowledge, no one has focused on the patients' health care advocacy associations' point of view. OBJECTIVE The objective of this study was to assess patients' health care advocacy associations' opinions about the use, usefulness, obstacles, negative aspects, and impact of health apps and wearable devices through a Web-based survey. METHODS We conducted a Web-based survey through SurveyMonkey over nearly 3 months. Participants were contacted via an email explaining the aims of the survey and providing a link to complete the Web-based questionnaire. All the 20 items were mandatory, and the anonymized data were collected automatically into a database. Only fully completed questionnaires were considered for analysis. RESULTS We contacted 1998 patients' health care advocacy associations; a total of 258 questionnaires were received back (response rate 12.91%), and 227 of the received questionnaires were fully completed (completion rate 88.0%). Informative apps, hospital apps for viewing medical reports or booking visits, and those for monitoring physical activity are the most used. They are considered especially useful to improve patients' engagement and compliance with treatment. Wearable devices to check physical activity and glycemia are the most widespread considering, again, their benefits in increasing patients' involvement and treatment compliance. For health apps and wearable devices, the main obstacles to their use are personal and technical reasons; the risk of overmedicalization is considered the most negative aspect of their constant use, while privacy and confidentiality of data are not rated a limitation. No statistical difference was found on stratifying the answers by responders' technological level (P=.30), age (P=.10), and the composition of the association's advisory board (P=.15). CONCLUSIONS According to responders, health apps and wearable devices are sufficiently known and used and are considered potential supports for greater involvement in health management. However, there are still obstacles to their adoption, and the developers need to work to make them more accessible and more useful. The involvement of patients and their associations in planning services and products based on these technologies (as well as others) would be desirable to overcome these barriers and boost awareness about privacy and the confidentiality of data.
Collapse
Affiliation(s)
- Paola Mosconi
- Laboratory for Medical Research and Consumer Involvement, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Silvia Radrezza
- Laboratory for Medical Research and Consumer Involvement, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Emanuele Lettieri
- Department of Management, Economics and Industrial Engineering, Politecnico of Milan, Milan, Italy
| | - Eugenio Santoro
- Laboratory of Medical Informatics, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
17
|
De Benedictis A, Lettieri E, Masella C, Gastaldi L, Macchini G, Santu C, Tartaglini D. WhatsApp in hospital? An empirical investigation of individual and organizational determinants to use. PLoS One 2019; 14:e0209873. [PMID: 30633754 PMCID: PMC6329505 DOI: 10.1371/journal.pone.0209873] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/12/2018] [Indexed: 11/18/2022] Open
Abstract
The increasing use of messaging applications such as WhatsApp for both social and personal purposes has determined an increase in the widespread use of these technologies, even in healthcare. A growing number of healthcare professionals have adopted WhatsApp in their daily work in order to share information with peers and patients. Past research has highlighted the advantages and disadvantages of WhatsApp usage in healthcare settings; in particular two positions appear to coexist in the scientific debate: those that expose and underline all of the positive aspects of the phenomenon, and those which also highlight the negative aspects, linked in particular to the clinical risks for patients, data security and privacy protection. The main objective of this study was to assess if and how individual and organizational determinants can trigger or inhibit the use of WhatsApp in a hospital setting, and which variables managers can exploit to guide professionals’ behaviors. Data were collected through a survey administered to physicians and nurses in an Italian University Hospital in Rome; a total of 191 high-quality responses were received. The results show that WhatsApp is widely used in the Hospital, and that its use is mainly due to the perception of numerous advantages and benefits reported in clinical practice. Moreover, an interplay exists between organizational and individual factors in determining the use of WhatsApp between healthcare professionals and with patients. In particular, individual factors play a key role as determinants of the use of WhatsApp; healthcare professionals use this technology mainly based on its perceived usefulness. Instead, organizational factors play a secondary role; they do not have a direct influence on the use of WhatsApp, but always act through individual factors. This study is the first to analyses the influence of individual and organizational determinants of WhatsApp usage in the hospital setting, and provides hospital managers with important information in order to manage this phenomenon and implement adequate strategies to exploit its potential increase.
Collapse
Affiliation(s)
- Anna De Benedictis
- Department of Healthcare Professions, Hospital General Management, University Hospital Campus Bio-Medico, Rome, Italy
- Faculty of Medicine & Surgery, University Campus Bio-Medico, Rome, Italy
- * E-mail:
| | - Emanuele Lettieri
- Department of Economics, Management and Industrial Engineering, Politecnico of Milan, Milan, Italy
| | - Cristina Masella
- Department of Economics, Management and Industrial Engineering, Politecnico of Milan, Milan, Italy
| | - Luca Gastaldi
- Department of Economics, Management and Industrial Engineering, Politecnico of Milan, Milan, Italy
| | - Giordana Macchini
- Faculty of Medicine & Surgery, University Campus Bio-Medico, Rome, Italy
| | - Camilla Santu
- Department of Economics, Management and Industrial Engineering, Politecnico of Milan, Milan, Italy
| | - Daniela Tartaglini
- Department of Healthcare Professions, Hospital General Management, University Hospital Campus Bio-Medico, Rome, Italy
- Faculty of Medicine & Surgery, University Campus Bio-Medico, Rome, Italy
| |
Collapse
|
18
|
Cutti AG, Lettieri E, Verni G. Health Technology Assessment as Theoretical Framework to Assess Lower-Limb Prosthetics—Issues and Opportunities from an International Perspective. ACTA ACUST UNITED AC 2019. [DOI: 10.1097/jpo.0000000000000235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Uçar HN, Eray Ş, Kocael Ö, Uçar L, Kaymak M, Lettieri E, Vural AP. Big Data in Adolescent Psychiatry: Do Patients Share Their Psychiatric Symptoms on Social Networking Sites? Psychiatr Danub 2018; 30:395-403. [PMID: 30439799 DOI: 10.24869/psyd.2018.395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Fascinating developments in big data technologies and unprecedented diffusion of social networking sites (SNSs) generate unseen opportunities for scientific fields, including psychiatry. This study focuses on the use of SNSs by adolescent psychiatric patients and the potential use of SNS-generated data to help medical practitioners diagnose and treat patients' mental health. Our objective is to understand and measure the psychiatric and individual conditions in which symptom-sharing occurs on SNSs and the frequency of these conditions. Based on literature, we hypothesized that the perceived value of social network sites positively affects adolescents' sharing of symptoms on these sites. SUBJECTS AND METHODS An empirical test of this hypothesis was conducted with a survey of 224 adolescents admitted to a psychiatry clinic in Turkey. The hypothesis was tested using a hierarchical multiple regression analysis. RESULTS The perceived value of SNSs explained an additional 37.8% of variation in symptom sharing on SNSs above and beyond the control variables, which are gender, age, type of disorder, and amount of internet and SNS use. The findings suggested that adolescents share symptoms on SNSs only if they attribute value to the SNSs that they use. We also found that 72% of adolescents in our sample shared their symptoms on SNSs. CONCLUSIONS There is an attractive opportunity for information technology companies to develop, together with health professionals; data analytics that are able to detect symptoms to support psychiatric diagnoses and pave the way for big-data enabled personalized medicine.
Collapse
Affiliation(s)
- Halit Necmi Uçar
- Department of Child and Adolescent Psychiatry, Van Education and Research Hospital, Van, Turkey,
| | | | | | | | | | | | | |
Collapse
|
20
|
Roshanghalb A, Mazzali C, Lettieri E, Paganoni AM. Chapter 10 Performance Measurement in Health Care: The Case of Best/Worst Performers Through Administrative Data. Performance Measurement and Management Control: The Relevance of Performance Measurement and Management Control Research 2018. [DOI: 10.1108/s1479-351220180000033010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
21
|
Burgun A, Bernal-Delgado E, Kuchinke W, van Staa T, Cunningham J, Lettieri E, Mazzali C, Oksen D, Estupiñan F, Barone A, Chène G. Health Data for Public Health: Towards New Ways of Combining Data Sources to Support Research Efforts in Europe. Yearb Med Inform 2017; 26:235-240. [PMID: 29063571 PMCID: PMC6239221 DOI: 10.15265/iy-2017-034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Indexed: 12/21/2022] Open
Abstract
Objectives: To present the European landscape regarding the re-use of health administrative data for research. Methods: We present some collaborative projects and solutions that have been developed by Nordic countries, Italy, Spain, France, Germany, and the UK, to facilitate access to their health data for research purposes. Results: Research in public health is transitioning from siloed systems to more accessible and re-usable data resources. Following the example of the Nordic countries, several European countries aim at facilitating the re-use of their health administrative databases for research purposes. However, the ecosystem is still a complex patchwork, with different rules, policies, and processes for data provision. Conclusion: The challenges are such that with the abundance of health administrative data, only a European, overarching public health research infrastructure, is able to efficiently facilitate access to this data and accelerate research based on these highly valuable resources.
Collapse
Affiliation(s)
- A. Burgun
- Inserm, UMR 1138, Centre de Recherche des Cordeliers, AP-HP, Paris Descartes University, Paris, France
| | - E. Bernal-Delgado
- Institute for Health Sciences in Aragon (IACS), BridgeHealth Consortium, Zaragoza, Spain
| | - W. Kuchinke
- University of Dusseldorf, Dusseldorf, Germany
| | - T. van Staa
- Health eResearch Centre, Farr Institute, University of Manchester, Manchester, United Kingdom
| | - J. Cunningham
- Health eResearch Centre, Farr Institute, University of Manchester, Manchester, United Kingdom
| | | | | | - D. Oksen
- Public Health Institute, Inserm, AVIESAN, Paris, France
| | - F. Estupiñan
- Institute for Health Sciences in Aragon (IACS), BridgeHealth Consortium, Zaragoza, Spain
| | - A. Barone
- Lombardia Informatica, Milano, Italy
| | - G. Chène
- Inserm, UMR 1219, CIC1401-EC, Univ. Bordeaux, ISPED, CHU Bordeaux, Bordeaux, France
| |
Collapse
|
22
|
Cutti AG, Lettieri E, Del Maestro M, Radaelli G, Luchetti M, Verni G, Masella C. Stratified cost-utility analysis of C-Leg versus mechanical knees: Findings from an Italian sample of transfemoral amputees. Prosthet Orthot Int 2017; 41:227-236. [PMID: 27025244 DOI: 10.1177/0309364616637955] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The fitting rate of the C-Leg electronic knee (Otto-Bock, D) has increased steadily over the last 15 years. Current cost-utility studies, however, have not considered the patients' characteristics. OBJECTIVES To complete a cost-utility analysis involving C-Leg and mechanical knee users; "age at the time of enrollment," "age at the time of first prosthesis," and "experience with the current type of prosthesis" are assumed as non-nested stratification parameters. STUDY DESIGN Cohort retrospective. METHODS In all, 70 C-Leg and 57 mechanical knee users were selected. For each stratification criteria, we evaluated the cost-utility of C-Leg versus mechanical knees by computing the incremental cost-utility ratio, that is, the ratio of the "difference in cost" and the "difference in utility" of the two technologies. Cost consisted of acquisition, maintenance, transportation, and lodging expenses. Utility was measured in terms of quality-adjusted life years, computed on the basis of participants' answers to the EQ-5D questionnaire. RESULTS Patients over 40 years at the time of first prosthesis were the only group featuring an incremental cost-utility ratio (88,779 €/quality-adjusted life year) above the National Institute for Health and Care Excellence practical cost-utility threshold (54,120 €/quality-adjusted live year): C-Leg users experience a significant improvement of "mobility," but limited outcomes on "usual activities," "self-care," "depression/anxiety," and reduction of "pain/discomfort." CONCLUSION The stratified cost-utility results have relevant clinical implications and provide useful information for practitioners in tailoring interventions. Clinical relevance A cost-utility analysis that considered patients characteristics provided insights on the "affordability" of C-Leg compared to mechanical knees. In particular, results suggest that C-Leg has a significant impact on "mobility" for first-time prosthetic users over 40 years, but implementation of specific low-cost physical/psychosocial interventions is required to retun within cost-utility thresholds.
Collapse
Affiliation(s)
| | | | | | | | | | - Gennero Verni
- 1 Centro Protesi INAIL, Vigorso di Budrio (BO), Italy
| | | |
Collapse
|
23
|
Ghezzi A, Gastaldi L, Lettieri E, Martini A, Corso M. A role for startups in unleashing the disruptive power of social media. International Journal of Information Management 2016. [DOI: 10.1016/j.ijinfomgt.2016.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
24
|
Burgun A, Oksen DV, Kuchinke W, Prokosch HU, Ganslandt T, Buchan I, van Staa T, Cunningham J, Gjerstorff ML, Dufour JC, Gibrat JF, Nikolski M, Verger P, Cambon-Thomsen A, Masella C, Lettieri E, Bertele P, Salokannel M, Thiebaut R, Persoz C, Chêne G, Ohmann C. Linking health and administrative data for maternal, child and young adult health. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw168.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
25
|
Abstract
Purpose
The purpose of this paper is to provide arguments and empirical evidence that different knowledge sharing behaviours – i.e. sharing best practices, sharing mistakes, seeking feedbacks – are promoted and enabled by different types of knowledge assets, and differently affect employees’ innovative work behaviours.
Design/methodology/approach
The research framework includes four sets of constructs: employees’ innovative work behaviour, knowledge sharing, knowledge assets, psychological safety. The literature-grounded hypotheses were tested collecting data from healthcare professionals from three hospice and palliative care organisations in Italy. In all, 195 questionnaires were analysed using structural equations modelling technique.
Findings
First, findings show that the linkage between knowledge assets and knowledge sharing is both direct and indirect with psychological safety as relevant mediating construct. The linkage between relational and structural social capital and seeking feedbacks and sharing mistakes is fully mediated by psychological safety. Second, findings show that each dimension of knowledge sharing affects the different dimensions of employees’ innovative work behaviour – i.e. idea generation, idea promotion, idea implementation – in a distinct manner. While sharing of best practices influences all of them, seeking feedbacks affects idea promotion and sharing mistakes influences idea implementation.
Practical implications
The results provide operations managers with a clearer picture of how to pursue improvements of current operations by leveraging on knowledge sharing among employees through the creation of numerous, high-quality interpersonal relationships among employees, based on rich and cohesive network ties.
Originality/value
This study, by adopting a micro-level perspective, offers an original perspective on how knowledge assets and knowledge sharing initiatives may contribute to the engagement of innovative work behaviour by employees.
Collapse
|
26
|
Rebecchi A, Gola M, Kulkarni M, Lettieri E, Paoletti I, Capolongo S. Healthcare for all in emerging countries: a preliminary investigation of facilities in Kolkata, India. Ann Ist Super Sanita 2016; 52:88-97. [PMID: 27033623 DOI: 10.4415/ann_16_01_15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION India is one of the five countries with the lowest public health spending levels: the private medical services are one of the most developed fields, meanwhile public health ones are totally inadequate with the most number of health facilities concentrated in cities, where only the 25% of the population lives. Public facilities are mainly made up of primary level and not well distributed on the territories, so they do not guarantee accessibility to a wide sample of population, who live in rural areas of India. METHODOLOGY Starting from the analysis of three different health care levels in the Indian context, the research team developed a meta-project that considers all the current criticisms and the Indian customs through a flexible layout that responds to the healthcare needs of population. RESULT AND DISCUSSION The research work is aimed to develop a meta-project that considers all the current criticisms and the Indian customs through flexible layouts that responds to the healthcare needs of population. CONCLUSION The innovation of the research work is to develop the hygienic aspects, the layout and the distribution, the sub-division of the medical functions through the Indian culture and the needs of the country. The choice of lowly technologies permits to promote the usage of local materials, their maintenance and skills for creating a virtuous economic system.
Collapse
Affiliation(s)
- Andrea Rebecchi
- Dipartimento di Architettura, Ingegneria delle Costruzioni e Ambiente Costruito (ABC), Politecnico di Milano, Milan, Italy
| | - Marco Gola
- Dipartimento di Architettura, Ingegneria delle Costruzioni e Ambiente Costruito (ABC), Politecnico di Milano, Milan, Italy
| | | | - Emanuele Lettieri
- Dipartimento di Ingegneria Gestionale (DIG), Politecnico di Milano, Milan, Italy
| | - Ingrid Paoletti
- Dipartimento di Architettura, Ingegneria delle Costruzioni e Ambiente Costruito (ABC), Politecnico di Milano, Milan, Italy
| | - Stefano Capolongo
- Dipartimento di Architettura, Ingegneria delle Costruzioni e Ambiente Costruito (ABC), Politecnico di Milano, Milan, Italy
| |
Collapse
|
27
|
Lettieri E, Fumagalli LP, Radaelli G, Bertele' P, Vogt J, Hammerschmidt R, Lara JL, Carriazo A, Masella C. Empowering patients through eHealth: a case report of a pan-European project. BMC Health Serv Res 2015; 15:309. [PMID: 26242863 PMCID: PMC4526304 DOI: 10.1186/s12913-015-0983-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background This paper crystallises the experience developed by the pan-European PALANTE Consortium in dealing with the generation of relevant evidence from heterogeneous eHealth services for patient empowerment in nine European Regions. The European Commission (EC) recently funded a number of pan-European eHealth projects aimed at empowering European patients/citizens thus transforming the traditional patient/citizen role in the management of their health (e.g., PALANTE, SUSTAIN, CARRE, HeartCycle, Empower). However, the heterogeneity of the healthcare systems, of the implemented services and of the target patients, the use of ad-hoc definitions of the salient concepts and the development of small-size experiences have prevented the dissemination of “global” results and the development of cumulative knowledge. The main challenge has been the generation of large-scale evidence from heterogeneous small-size experiences. Discussion Three lessons have been collectively learnt during the development of the PALANTE project, which involves 9 sites that have implemented different eHealth services for empowering different typologies of patients. These lessons have been refined progressively through project meetings, reviews with the EC Project Officer and Reviewers. The paper illustrates the ten steps followed to develop the three lessons. The first lesson learnt is about how EC-funded projects should develop cumulative knowledge by avoiding self-crafted measures of outcome and by adopting literature-grounded definitions and scales. The second lesson learnt is about how EC-funded projects should identify ambitious, cross-pilot policy and research questions that allow pooling of data from across heterogeneous experiences even if a multi-centre study design was not agreed before. The third lesson learnt is about how EC-funded projects should open their collections of data and make them freely-accessible to the scientific community shortly after the conclusion of the project in order to guarantee the replicability of results and conclusions. Summary The three lessons might provide original elements for fuelling the ongoing debate about the capability of the EC to develop evidence-based policies by pooling evidence from heterogeneous, local experiences.
Collapse
Affiliation(s)
- Emanuele Lettieri
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, 4/B Lambruschini Street, Milan, 20156, Italy.
| | - Lia P Fumagalli
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, 4/B Lambruschini Street, Milan, 20156, Italy.
| | | | - Paolo Bertele'
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, 4/B Lambruschini Street, Milan, 20156, Italy.
| | - Jess Vogt
- Empirica Gesellschaft für Kommunikations- und Technologieforschung mbH, 2 Oxfordstr, Bonn, D-53111, Germany.
| | - Reinhard Hammerschmidt
- Empirica Gesellschaft für Kommunikations- und Technologieforschung mbH, 2 Oxfordstr, Bonn, D-53111, Germany.
| | - Juan L Lara
- Fundación Pública Andaluza Progreso y Salud (FPS), 13 Avda. Américo Vespucio, Sevilla, 41071, Spain.
| | - Ana Carriazo
- Andalusian Health Service/Regional Ministry of Equality, Health and Social Policies of Andalusia, 14 Av. Hytasa, Sevilla, 41071, Spain.
| | - Cristina Masella
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, 4/B Lambruschini Street, Milan, 20156, Italy.
| |
Collapse
|
28
|
Burgun A, Oksen DV, Kuchinke W, Prokosch HU, Ganslandt T, Buchan I, van Staa T, Cunningham J, Gjerstorff ML, Dufour JC, Gibrat JF, Nikolski M, Verger P, Cambon-Thomsen A, Masella C, Lettieri E, Bertele P, Salokannel M, Thiebaut R, Persoz C, Chêne G, Ohmann C. Proposal for a European Public Health Research Infrastructure for Sharing of health and Medical administrative data (PHRIMA). Stud Health Technol Inform 2015; 216:1005. [PMID: 26262306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In Europe, health and medical administrative data is increasingly accumulating on a national level. Looking further than re-use of this data on a national level, sharing health and medical administrative data would enable large-scale analyses and European-level public health projects. There is currently no research infrastructure for this type of sharing. The PHRIMA consortium proposes to realise the Public Health Research Infrastructure for Sharing of health and Medical Administrative data (PHRIMA) which will enable and facilitate the efficient and secure sharing of healthcare data.
Collapse
Affiliation(s)
- Anita Burgun
- Institut Thématique Multi-organisme - Santé Publique, AVIESAN, Paris, France
| | - Dina V Oksen
- Institut Thématique Multi-organisme - Santé Publique, AVIESAN, Paris, France
| | | | - Hans-Ulrich Prokosch
- Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Thomas Ganslandt
- Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Iain Buchan
- Health e-Research Centre/Farr Institute, University of Manchester, Manchester, United Kingdom
| | - Tjeerd van Staa
- Health e-Research Centre/Farr Institute, University of Manchester, Manchester, United Kingdom
| | - James Cunningham
- Health e-Research Centre/Farr Institute, University of Manchester, Manchester, United Kingdom
| | | | - Jean-Charles Dufour
- UMR912 SESSTIM (AMU-INSERM-IRD-AMSE), Aix-Marseille University, Marseille, France
| | | | | | - Pierre Verger
- UMR912 SESSTIM (AMU-INSERM-IRD-AMSE), Aix-Marseille University, Marseille, France
| | | | - Cristina Masella
- Politecnico di Milano, Department of Management, Economics and Industrial Engineering, Milano, Italy
| | - Emanuele Lettieri
- Politecnico di Milano, Department of Management, Economics and Industrial Engineering, Milano, Italy
| | - Paolo Bertele
- Politecnico di Milano, Department of Management, Economics and Industrial Engineering, Milano, Italy
| | | | | | - Charles Persoz
- Institut Thématique Multi-organisme - Santé Publique, AVIESAN, Paris, France
| | - Geneviève Chêne
- Institut Thématique Multi-organisme - Santé Publique, AVIESAN, Paris, France
| | - Christian Ohmann
- European Clinical Research Infrastructures Network (ECRIN), Duesseldorf, Germany
| |
Collapse
|
29
|
Radaelli G, Lettieri E, Mura M, Spiller N. Knowledge Sharing and Innovative Work Behaviour in Healthcare: A Micro-Level Investigation of Direct and Indirect Effects. Creativity and Innovation Management 2014. [DOI: 10.1111/caim.12084] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
30
|
Piccoli M, Agresta F, Trapani V, Nigro C, Pende V, Campanile FC, Vettoretto N, Belluco E, Bianchi PP, Cavaliere D, Ferulano G, La Torre F, Lirici MM, Rea R, Ricco G, Orsenigo E, Barlera S, Lettieri E, Romano GM, Ferulano G, Giuseppe F, La Torre F, Filippo LT, Lirici MM, Maria LM, Rea R, Roberto R, Ricco G, Gianni R, Orsenigo E, Elena O, Barlera S, Simona B, Lettieri E, Emanuele L, Romano GM, Maria RG. Clinical competence in the surgery of rectal cancer: the Italian Consensus Conference. Int J Colorectal Dis 2014; 29:863-75. [PMID: 24820678 DOI: 10.1007/s00384-014-1887-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM The literature continues to emphasize the advantages of treating patients in "high volume" units by "expert" surgeons, but there is no agreed definition of what is meant by either term. In September 2012, a Consensus Conference on Clinical Competence was organized in Rome as part of the meeting of the National Congress of Italian Surgery (I Congresso Nazionale della Chirurgia Italiana: Unità e valore della chirurgia italiana). The aims were to provide a definition of "expert surgeon" and "high-volume facility" in rectal cancer surgery and to assess their influence on patient outcome. METHOD An Organizing Committee (OC), a Scientific Committee (SC), a Group of Experts (E) and a Panel/Jury (P) were set up for the conduct of the Consensus Conference. Review of the literature focused on three main questions including training, "measuring" of quality and to what extent hospital and surgeon volume affects sphincter-preserving procedures, local recurrence, 30-day morbidity and mortality, survival, function, choice of laparoscopic approach and the choice of transanal endoscopic microsurgery (TEM). RESULTS AND CONCLUSION The difficulties encountered in defining competence in rectal surgery arise from the great heterogeneity of the parameters described in the literature to quantify it. Acquisition of data is difficult as many articles were published many years ago. Even with a focus on surgeon and hospital volume, it is difficult to define their role owing to the variability and the quality of the relevant studies.
Collapse
|
31
|
Sessa A, Esposito A, Iavicoli G, Lettieri E, Ragosta G, Rossano R, Capuano M. Cardiovascular Risk Factors in Renal Transplant Patients after Switch From Standard Tacrolimus to Prolonged-Release Tacrolimus. Transplant Proc 2012; 44:1901-6. [DOI: 10.1016/j.transproceed.2012.05.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
32
|
Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M, Cocorullo G, Corradi A, Franzato B, Lupo M, Mandalà V, Mirabella A, Pernazza G, Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D, Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Fingerhut A, Uranüs S, Garattini S. Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 2012; 26:2134-64. [PMID: 22736283 DOI: 10.1007/s00464-012-2331-3] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 04/16/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND In January 2010, the SICE (Italian Society of Endoscopic Surgery), under the auspices of the EAES, decided to revisit the clinical recommendations for the role of laparoscopy in abdominal emergencies in adults, with the primary intent being to update the 2006 EAES indications and supplement the existing guidelines on specific diseases. METHODS Other Italian surgical societies were invited into the Consensus to form a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other stakeholders involved in abdominal emergencies were invited along with a patient's association. In November 2010, the panel met in Rome to discuss each chapter according to the Delphi method, producing key statements with a grade of recommendations followed by commentary to explain the rationale and the level of evidence behind the statements. Thereafter, the statements were presented to the Annual Congress of the EAES in June 2011. RESULTS A thorough literature review was necessary to assess whether the recommendations issued in 2006 are still current. In many cases new studies allowed us to better clarify some issues (such as for diverticulitis, small bowel obstruction, pancreatitis, hernias, trauma), to confirm the key role of laparoscopy (such as for cholecystitis, gynecological disorders, nonspecific abdominal pain, appendicitis), but occasionally previous strong recommendations have to be challenged after review of recent research (such as for perforated peptic ulcer). CONCLUSIONS Every surgeon has to develop his or her own approach, taking into account the clinical situation, her/his proficiency (and the experience of the team) with the various techniques, and the specific organizational setting in which she/he is working. This guideline has been developed bearing in mind that every surgeon could use the data reported to support her/his judgment.
Collapse
Affiliation(s)
- Ferdinando Agresta
- Department of General Surgery, Presidio Ospedaliero di Adria, Piazza degli Etruschi, 9, 45011 Adria, RO, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Zanaboni P, Lettieri E. Institutionalizing telemedicine applications: the challenge of legitimizing decision-making. J Med Internet Res 2011; 13:e72. [PMID: 21955510 PMCID: PMC3222171 DOI: 10.2196/jmir.1669] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 05/19/2011] [Accepted: 05/18/2011] [Indexed: 12/26/2022] Open
Abstract
During the last decades a variety of telemedicine applications have been trialed worldwide. However, telemedicine is still an example of major potential benefits that have not been fully attained. Health care regulators are still debating why institutionalizing telemedicine applications on a large scale has been so difficult and why health care professionals are often averse or indifferent to telemedicine applications, thus preventing them from becoming part of everyday clinical routines. We believe that the lack of consolidated procedures for supporting decision making by health care regulators is a major weakness. We aim to further the current debate on how to legitimize decision making about the institutionalization of telemedicine applications on a large scale. We discuss (1) three main requirements--rationality, fairness, and efficiency--that should underpin decision making so that the relevant stakeholders perceive them as being legitimate, and (2) the domains and criteria for comparing and assessing telemedicine applications--benefits and sustainability. According to these requirements and criteria, we illustrate a possible reference process for legitimate decision making about which telemedicine applications to implement on a large scale. This process adopts the health care regulators' perspective and is made up of 2 subsequent stages, in which a preliminary proposal and then a full proposal are reviewed.
Collapse
Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
| | | |
Collapse
|
34
|
Sessa A, Esposito A, Iavicoli GD, Lettieri E, Dente G, Costa C, Bergallo M, Rossano R, Capuano M. Immunosuppressive agents and bone disease in renal transplant patients with hypercalcemia. Transplant Proc 2010; 42:1148-55. [PMID: 20534247 DOI: 10.1016/j.transproceed.2010.03.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Renal transplantation is the definitive treatment for many metabolic abnormalities of uremic patients, although it is only partially effective for renal osteodystrophy, which may interact with posttransplant renal osteopathy. Osteopenic-osteoporotic syndrome represents, together with fractures secondary to osteoporosis and osteonecrosis, the bone complication most related to renal transplantation. Several factors contribute to the pathogenesis of posttransplantation osteoporosis, particularly immunosuppressive treatment. In this study, we evaluated the prevalence of factors related to posttransplant renal osteopathy and the clinical impact of immunosuppressive protocols. We studied 24 renal transplant recipients with hypercalcemia. Glomerular filtration rate was >50 mL/min. Mean age, time on dialysis, and time from transplantation were 49.6, 5.4, and 6.9 years, respectively. We evaluated serum and urine calcium and phosphorus, calcitonin, parathormone, bone-specific alkaline phosphatase, osteocalcin, urine deoxypyridinoline, telopeptide of type 1 procollagen, 1,25-(OH)(2) and 25-OH vitamin D, parathyroid ultrasound, and computerized bone mineralometry. The combination of sirolimus and steroids resulted in the most disadvantageous outcomes regarding alkaline phosphatase and mineralometry. Calcineurin inhibitors did not significantly influence bone metabolism markers; mycophenolate mofetil evidenced no effect on bone. According to the literature, steroids account for the abnormalities found in our patients and in severe osteopenia. Several factors may contribute to the development of osteoporosis and fractures in transplantation patients, although they are overcome by the prominent effect of steroids. In patients at high risk of osteoporosis, steroid-free therapy should be considered. Everolimus is indicated for diseases with bone loss. Combined therapy with everolimus and mycophenolic acid without cyclosporine and steroids, seemed to be particularly indicated. Prophylactic treatments should be commenced early. No single marker was useful to diagnose posttransplant renal osteopathy. The definitive diagnosis should be made by bone biopsy during transplantation, and noninvasive procedures, such as densitometry and evaluation of biologic markers, may be useful during follow-up.
Collapse
Affiliation(s)
- A Sessa
- Day Hospital, Post Trapianto Rene UOC, Nefrologia e Dialisi PO Dei Pellegrini, Napoli, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Lettieri E. Uncertainty inclusion in budgeting technology adoption at a hospital level: evidence from a multiple case study. Health Policy 2009; 93:128-36. [PMID: 19651458 DOI: 10.1016/j.healthpol.2009.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 07/03/2009] [Accepted: 07/06/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The shortage of resources for healthcare has risen the quest for more rational models and practices for technology selection at a hospital level. Uncertainty is a critical issue. This paper aims to shed first light on this issue through an investigation on the content and the process of budgeting technology adoption with respect to uncertainty. METHODS An exploratory multi-case study was carried out to gain a better understanding of the current practice of technology assessment at a hospital level. Five Italian hospitals were selected. Key informants from the budget committees have been interviewed with a structured questionnaire based on the results of an electronic literature search. RESULTS Five domains of uncertainty have been identified. They have been deployed in a list of 15 relevant issues that should be reviewed during the budget process. The hospitals in the sample cope with these issues in a peculiar manner. Organisational uncertainty is broadly overcome. Reporting about technology performance after the adoption is missing. CONCLUSION Policy makers should facilitate hospitals: (a) to develop a multi-disciplinary and evidence based practice for technology selection, (b) to assess and manage uncertainty, and (c) to build a reporting system regarding technology performance in order to build fair practices for technology selection and support continuous learning.
Collapse
Affiliation(s)
- Emanuele Lettieri
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133 Milan, Italy.
| |
Collapse
|
36
|
Sessa A, Esposito A, Giliberti A, Iavicoli G, Costa C, Bergallo M, Lettieri E, Rossano R, Capuano M. Immunosuppressive Agents and Metabolic Factors of Cardiovascular Risk in Renal Transplant Recipients. Transplant Proc 2009; 41:1178-82. [DOI: 10.1016/j.transproceed.2009.02.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
37
|
Lettieri E, Masella C. Priority setting for technology adoption at a hospital level: Relevant issues from the literature. Health Policy 2009; 90:81-8. [DOI: 10.1016/j.healthpol.2008.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Revised: 07/15/2008] [Accepted: 07/16/2008] [Indexed: 11/30/2022]
|
38
|
Sessa A, Esposito A, Giliberti A, Bergallo M, Costa C, Rossano R, Lettieri E, Capuano M. BKV Reactivation in Renal Transplant Recipients: Diagnostic and Therapeutic Strategy—Case Reports. Transplant Proc 2008; 40:2055-8. [DOI: 10.1016/j.transproceed.2008.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
39
|
|
40
|
Lettieri E, Masella C. [Health-care costs and health technology assessment]. G Ital Nefrol 2007; 24 Suppl 40:s22-s36. [PMID: 18034409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This paper is made up of four sections: a) an overview of the relationship between health-care costs and health technology assessment; b) the state of art of the research into health technology assessment with details on the main fields of research, the results obtained, and the gaps to be bridged; c) an analysis of the techniques for assessing health-care technology (cost-minimization analysis [CMA]; cost-effectiveness analysis [CEA]; cost-utility analysis [CUA]; cost-benefit analysis [CBA]); and d) an overview of the use of the four assessment techniques between 1980 to 2006 in nephrology, with special emphasis on dialysis.
Collapse
Affiliation(s)
- E Lettieri
- Politecnico di Milano, Dipartimento di Ingegneria Gestionale, Milano.
| | | |
Collapse
|
41
|
|
42
|
|
43
|
|