Measuring and benchmarking the quality of two different organizational ways in delivering infant vaccination.

The aim of this study was the quality of service evaluation of two different organizational ways in delivering infant vaccination according to a Regional Vaccination Plan. Eleven vaccination centres were selected in two Local Health Units (ASLs) belonging to the Regional Health Service of the Lazio Region, Italy. The services offering paediatric vaccinations for children under three years of age, delivered without an appointment (VACP) or with the need for an appointment (VACL), were investigated. The quality aspects under evaluation were communicational efficiency, organisational efficiency and comfort. Subjective data were collected from different stakeholders and involve the elicitation of best and worst feasible performance conditions for the ASLs when delivering VACP/VACL services. Objective data consists in the observation of current performances of the selected vaccination centres. Quality scorecards were obtained from the combination of all data. Benchmarking between VACP and VACL, i.e., two different organisational ways in delivering infant vaccination, can be performed as a result of the probabilistic meaning of the evaluated scores. An expert of vaccination services, i.e., a virtual combination of patients, doctors and nurses, claims the quality of service delivery of the ASLs under investigation with probability 78.03% and 69.67% for VACP and VACL, respectively. In other words, for short, the quality scores of the ASLs were 78.03% for VACP and 69.67% for VACL. Furthermore our results show how to practically improve the current service delivery. The QuaVaTAR approach can result in improvements of the quality of the ASLs for the two different ways of delivering paediatric vaccinations in a simple and intuitive way.

Measles outbreak in the Lazio region of Italy: surveillance and impact on emergency departments and hospitalizations.

BACKGROUND: The World Health Organization's (WHO) Regional Office for Europe had committed to 2015 as the year to eliminate measles from the region but several outbreaks have been reported recently from several areas of the continent. Here we describe an outbreak that occurred in 2010-2011 in Lazio region, Central Italy, and its impact on some health care services (i.e., Emergency Departments (EDs) and hospital clinics). METHODS: We analyzed cases of measles reported to the infectious diseases surveillance system and accesses to EDs and hospitalizations for measles in the Lazio Region (central Italy, population of about 5,730,000 people). RESULTS: In 2010-2011, 2,956 cases were reported to the surveillance system (incidence rate: 18.4 and 33.3 per 100,000 in 2010 and 2011, respectively). The incidence rates varied greatly with the territory. The outbreak occurred mainly among children <1 year old and among adolescents, most unvaccinated and did not seem to be related to cases imported from Eastern Europe. Complications were reported in 37.4% of the cases. The epidemic was mainly related to an accumulation of adolescents susceptible to measles due to unsatisfactory vaccination coverage in the early nineties. The outbreak had a strong impact on the health system with 2,881 ED visits and 1,168 hospitalizations. Outbreak-associated costs were considerable. CONCLUSIONS: An additional intervention should be considered aimed at improving routine immunization coverage in children and at planning catch-up vaccination of 6-18 year olds not previously vaccinated. Further, timely surveillance is needed and specific protocols should be implemented to limit secondary cases.

[Multicentric study to evaluate the quality of discharge abstract coding of admissions in which the treatment was not performed and to identify a possible appropriateness indicator]. / Studio multicentrico sulla valutazione della qualità della codifica della scheda di dimissione ospedaliera relativamente ai ricoveri per acuti in cui non è stato eseguito il trattamento. Individuazione di un possibile indicatore di appropriatezza organizzativa.

The aim of this study was to assess the quality of discharge abstract data regarding admissions in which the planned treatment was not performed, in 4 hospitals in the Rome metropolitan area. The main objective was to evaluate the appropriateness of admissions through use of the Italian version of the Appropriateness Evaluation Protocol (AEP/PRUO). Inconsistencies between discharge abstract forms and hospital records were found in 95/142 (66,9%) of examined records. These were subsequently evaluated through the Appropriateness Evaluation Protocol and overall , 95,6% of inconsistent records were found to be inappropriate admissions. Monitoring V64 codes may represent an indirect indicator of appropriateness.