[The use of procedures volume indicators in an Italian Teaching Hospital]. / L'utilizzo degli indicatori di volume legati alle prestazioni. Esperienza di un Policlinico Universitario.

In a context of continuous spread health technologies, in which particular intensive procedures are performed, the use of procedure volume indicators supports the decision making process in monitoring and improving the healthcare quality. The aim of our work focuses on the evaluation of the association between the volume of procedures performed by organizational units inside an Italian University Hospital and the results in terms of mortality and prolonged length of stay (LOS). Volume indicators concerning esophageal resection, pancreatic resection, abdominal aortic aneurysm repair, coronary artery bypass graft and percutaneous transluminal coronary angioplasty were analysed according to the Agency of Health Care Research and Quality's criteria. A retrospective observational study was conducted analysing hospital discharged databases and operating room records for the period 2000-2005. Descriptive and inferential statistical analysis were performed using SPSS software 13.0 version. Regarding prolonged LOS, a statistical significant difference emerged among high and low volume organizational units for pancreatic resections, bypass, and angioplasty with respectively adjusted OR at 2.4 (C.I. 95% 1.04-5.53); 1.67 (C.I. 95% 1.29-2.16) and 3.34 (CI 95% 2.60-4.28). For mortality, a statistical significant difference emerged for abdominal aortic aneurysm repair and bypass with respectively OR at 21.02 (C.I. 95% 2.22-199.64) and 26.55 (C.I. 95% 15.30 - 46.07). The use of procedure volume indicators could help hospital administrators and medical professionals balance competing values such as control of cost and continuous quality improvement.

[Evaluation of the appropriateness of hospital admissions using the iso-gravity classification systems APR-DRG and Disease Staging and the Italian version of Appropriateness Evaluation Protocol (AEP)]. / Valutazione dell'appropriatezza dei ricoveri in un policlinico universitario: analisi mediante l'uso comparativo dei sistemi di classificazione iso-gravità APR-DRG e disease staging e del PRUO.

Our main purpose was to evaluate the organizational appropriateness of admissions made in a university hospital, by comparing two iso-gravity classification systems, APR-DRG and Disease Staging, with the Italian version of AEP (PRUO). Our analysis focused on admissions made in 2001, related to specific Diagnosis Related Groups (DRGs), which, according an Italian Law, would be considered at high risk of inappropriateness, if treated as ordinary admissions. The results obtained by using the 2 classification systems did not show statistically significant differences with respect to the total number of admissions. On the other hand, some DRGs showed statistically significant differences due to different algorithms of attribution of the severity levels used by the two systems. For almost all of the DRGs studied, the AEP-based analysis of a sample of medical records showed an higher number of inappropriate admissions in comparison with the number expected by iso-gravity classification methods. The difference is possibly due to the percentage limits of tolerability fixed by the Law for each DRG. Therefore, the authors suggest an integrated use of the two methods to evaluate organizational appropriateness of hospital admissions.

Prevalence of and risk factors for Helicobacter pylori infection among healthcare workers at a teaching hospital in Rome: the Catholic University Epidemiological Study.

OBJECTIVES: To evaluate the prevalence of and the risk factors for Helicobacter pylori in a population of medical and non-medical workers at a teaching hospital in Rome, Italy. DESIGN: A cross-sectional study. METHODS: From January to October 1998, 655 subjects (65% of the total population) underwent a 13C-urea breath test to assess H. pylori infection. Subjects completed a questionnaire concerning sociodemographic characteristics, work departments and history of some gastrointestinal symptoms. Differences in means and proportions were evaluated and independent predictors of H. pylori infection status were assessed by multiple logistic regression analysis. RESULTS: Forty percent of the subjects were found to be H. pylori infected. The mean age of positive subjects was significantly higher than that of negative ones (38 +/- 14 versus 34 +/- 12 years; P < 0.01). No significant difference was found between males and females concerning the infection status (40.2% males versus 39.9% females). Lower years of father's education [odds ratio (OR), 3.1; 95% confidence interval (CI), 1.9-5.1] and age older than 35 years (OR, 2.0; 95% CI, 1.3-3.1) were the only independent predictors of the likelihood of H. pylori positivity. Prevalence of gastrointestinal symptoms was similar in infected and uninfected subjects. Physicians were significantly less infected than nurses and auxiliary personnel (26% versus 47% versus 55%, respectively); however, a loss of association was observed after adjustment by multiple logistic regression (OR, 1.8; 95% CI, 0.9-3.7). In all groups, some specific departments appear to be associated with a higher infection status. CONCLUSIONS: Among healthcare workers, H. pylori infection was associated with specific sociodemographic characteristics, such as age and level of father's education. The prevalence of H. pylori infection was not associated with different professional categories. However, some specific departments seem to increase infection risk.

[Assessment of the adequacy of health services in day hospital care: experience of an endocrine surgery day care unit at a university polyclinic]. / Valutazione di appropriatezza delle prestazioni sanitarie effettuate in regime di Day Hospital: l'esperienza di una unità di DH di chirurgia endocrina in un Policlinico Universitario.

The aim of the study was to assess the appropriateness of the provision of surgical treatment in the day hospital setting and at the same time to evaluate the efficacy of the service provided. The study was conducted on admissions to a day care unit operating in conjunction with the surgery division of a university hospital. The evaluation of appropriateness was carried out using explicit criteria, based on regional regulations and on guidelines drawn up by the Agency for Regional Health Services. The criteria related to the hospital bed equivalent Rotation Index and to the types of DRGs treated and services provided. Efficacy was assessed using the following para-meters: number of US-guided fine needle aspiration biopsies; techniques used; age, sex and nodule size; patient distribution by results of diagnostic examination; cytological classification; percentage of patients with complications. We also evaluated the possibility of transferring short-term (2-3 days) surgical admissions from ordinary regimens to the day care setting. The results of this study yield useful synthetic indicators for assessing the appropriateness both of the day care function as a whole and of individual operating units, providing both administrative and medical staff with a useful frame of reference for the planning of health-care management.

Practical aspects in drawing up a quality handbook in radiotherapy.

The quality and dimensions of the Quality Handbook in healthcare are shortly defined. Particular emphasis is put on the role of the quality of compliance and on certification (ISO 9000). The role of quality assessment in healthcare processes is described. It is not conceived as an inspection but rather as an incentive to a continuous quality improvement in healthcare processes. Within the quality of compliance, the role of the Quality Handbook and its modalities of definition, organization and implementation are illustrated.

Management process reengineering of the "Policlinico A. Gemelli": outcomes of testing.

Monitoring and outcomes of experimental solutions adopted in management process reengineering of a teaching hospital ("Policlinico A. Gemelli") of approximately 1550 beds are reported. All monitored processes are considered. For each process, information flows are analyzed, specifying indicators used for monitoring of adopted organizational solutions. Different testing outcomes have shown that pre-established objectives have been attained, while corrections required for their improvement, are indicated.

Phase 1: identifying critical success factors.

Health care processes and services of the "Policlinico" are analyzed with respect to their performance. Possible improvement is identified in reducing the process overall time at the process-service interface.

[Hospitals and immigration: analysis of a case series]. / L'ospedale di fronte all'immigrazione: analisi di una casistica.

The "immigrants problem", with the inevitable social aspects which this new phenomenon involves, has grown lately into a matter of primary interest to the public opinion of our country. The hospital too, in its capacity as leader among the sociosanitary institutions, has witnessed a change to some extent of the demand for services resulting from this reality. The Authors intend therefore to re-define here the whole body of a large metropolitan hospital patients, referring to an extensive statistical information and analyzing with special attention the statistics about foreign citizens. To this purpose they have considered all the cases of hospitalization occurred during a five-year period, from 1985 to 1989. The gathered data have been elaborated and analyzed from a more strictly demographic standpoint and (in particular) from the epidemiological point of view, comparing the data resulting among the immigrants with those regarding the whole body of hospitalized people during the same period. The data so obtained show, in spite of some significant differences due almost certainly to social differences, a superimposition on the italian reality, reproducing on a smaller scale its distinctive features. Even if this research is restricted to a specific situation, the results obtained can be considered a basis to make further similar studies within other hospital structures, in order to point out the different and variable demands for hospital services originating from this new social reality.

Heart failure and adverse drug reactions among hospitalized older adults.

The aim of this study was to assess whether heart failure (HF) could be a risk factor for adverse drug reactions (ADRs) among hospitalized older adults. This study included 19,496 patients admitted to community- and university-based hospitals in Italy (mean age 70 +/- 14 years; 49.7% female). ADRs were identified in 207 of the 2,413 (8.6%) patients with HF and in 855 (5.0%) of the 17,083 patients without HF (P < 0.001). After adjusting for potential confounders, HF was shown to be associated with an increased likelihood of experiencing an ADR (odds ratio (OR) 1.29; 95% confidence interval (CI) 1.06-1.56). After stratifying the sample by gender, the association continued to be seen in the women (OR 1.58; 95% CI 1.22-2.05) but not in the men (OR 0.99; 95% CI 0.74-1.34). In conclusion, HF appears to be associated with a higher rate of ADRs among hospitalized patients. Gender may influence the effect of HF on the risk of ADRs.