Business intelligence and the leverage of information in healthcare organizations from a managerial perspective: a systematic literature review and research agenda.

PURPOSE: Business intelligence (BI) systems and tools are deemed to be a transformative source with the potential to contribute to reshaping the way different healthcare organizations' (HCOs) services are offered and managed. However, this emerging field of research still appears underdeveloped and fragmented. Hence, this paper aims to reconciling, analyzing and synthesizing different strands of managerial-oriented literature on BI in HCOs and to enhance both theoretical and applied future contributions. DESIGN/METHODOLOGY/APPROACH: A literature-based framework was developed to establish and guide a three-stage state-of-the-art systematic literature review (SLR). The SLR was undertaken adopting a hybrid methodology that combines a bibliometric and a content analysis. FINDINGS: In total, 34 peer-review articles were included. Results revealed significant heterogeneity in theoretical basis and methodological strategies. Nonetheless, the knowledge structure of this research's stream seems to be primarily composed of five clusters of interconnected topics: (1) decision-making, relevant capabilities and value creation; (2) user satisfaction and quality; (3) process management, organizational change and financial effectiveness; (4) decision-support information, dashboard and key performance indicators; and (5) performance management and organizational effectiveness. ORIGINALITY/VALUE: To the authors' knowledge, this is the first SLR providing a business and management-related state-of-the-art on the topic. Besides, the paper offers an original framework disentangling future research directions from each emerged cluster into issues pertaining to BI implementation, utilization and impact in HCOs. The paper also discusses the need of future contributions to explore possible integrations of BI with emerging data-driven technologies (e.g. artificial intelligence) in HCOs, as the role of BI in addressing sustainability challenges.

Randomized controlled trial on occupational graduated compression clinical and cost-effectiveness.

BACKGROUND: Subjects exposed to occupational standing are at risk of developing chronic venous disease. Graduated compression stockings (GCS) counteract venous hypertension. Aim of the present investigation was to assess GCS clinical and cost effectiveness in prolonged standing up workers. METHODS: Randomized controlled trial involving 75 healthy healthcare professionals working in 6 hours standing up shifts without or with GCS (group A and B, respectively). Outcome measures were performed before and after the shift, at baseline (T0), at 1 (T1), 6 (T6) and 12 (T12) months and included lower limb volume, air plethysmography (APG), quality of life, and dedicated cost-effectiveness questionnaires. RESULTS: Seventy-two subjects completed the data collection. Leg volume increased in group A and decreased in B at all assessment points (T0, 1, 6, 12) (P<0.0001). Venous filling index did not change within the 12 months, but, after every shift, its value was lower in B compared to A (P<0.0001). At 12 months, VVSymQ worsened in A and improved in B (P<0.0001) and CIVIQ significantly worsened in A (P<0.0001), while in B it significantly improved (P<0.0001). Perceived disability was higher in A at 12 months (P<0.001) and the cost calculation revealed a saving of 1510 euro per year in B. CONCLUSIONS: GCS counteracted occupational oedema and positively influenced venous filling index, while improving vein specific quality of life measurements in addition to cost savings.

[Economic impact of kidney patients with sepsis in hospital setting].

Introduction: Over the last decades, sepsis has become a real medical emergency, with a high mortality rate and often requiring admission to an intensive care unit. An increasing number of CKD patients contracts sepsis due to several clinical risk factors (use of catheters, immunosuppressive therapy, comorbidity, etc.) and is treated in Nephrology wards, generating additional costs that are not covered by hospital Diagnosis Related Groups (DRG) reimbursement. The aim of the study is to evaluate the costs of sepsis in one Nephrology Unit and to detect the mortality rate of CKD patients with sepsis. Methods: We conducted a retrospective study on a cohort of CKD patients admitted into one Nephrology Unit in 2017. CKD inpatients were divided in two groups: patients with sepsis (SP) and without (control group). Socio-demographic, clinical and therapeutic data, as well as routine biochemistry, were collected through a "sepsis form". SP were identified thanks to hospital discharge records (HDR). The hospital-related costs of a SP were obtained by summing up: (1) the average cost of an inpatient day of care for the average length of stay in the Nephrology Unit; (2) the average cost of the antimicrobial therapy, as recorded on the clinical folder. Results: Among the 408 CKD inpatients, 61 were septic. The overall average cost of a SP was 23.087,57 €; the average cost of the hospital stay and of the antimicrobial therapy was 19.364,98 € and 3.722,60 € respectively. The average length of stay in the Nephrology Unit was 16.7 days. The in-hospital mortality rate was 41.7%, with a 312% additional mortality rate. Conclusions: SP had an overall average cost three times higher than CKD inpatients without sepsis (9.290,79 €). This additional cost was due to a longer hospital stay (8.7 days more on average) and a higher cost of antimicrobial therapy per case (€ 221,24). A national multi-centre study is needed to confirm our data and to promote an adjustment of reimbursement tariff for DRG-sepsis, which is now applicable only to an ICU setting.

Moderating healthcare costs through an assisted physical activity programme.

BACKGROUND: During the last decades, physical inactivity has become increasingly important due to its effects on health; in the medical field, it has been highlighted that physical inactivity is one of the leading cause of death. Moreover, the increasing trend in a sedentary lifestyle has also led to economic concerns; for this reason, the need to develop healthcare programmes to raise awareness of the benefits of physical exercise among the global population has arisen. OBJECTIVE: This paper analyses the relationship between moderate physical activity, cost of pharmaceuticals and health services utilization with regard to a primary care community programme based on moderate exercise intervention. The study highlights the effect of an exercise programme for people in sheltered accommodation in terms of effects on their quality of life and in terms of economic sustainability. METHODOLOGY: A randomized controlled trial of an exercise programme was designed. A total of 150 patients were randomized in two groups. The intervention group was recruited from Centro Esercizio Vita whereas the participants of the control group were recruited from general practitioners. RESULTS: At 9 months after randomization, the exercise-based group presented a lower average cost for drugs (p-value 0.039), an overall better health status perception (p-value 0.0019) and accessed general practitioners less frequently (p-value 0.058). CONCLUSIONS: Our study shows that assisted physical activity practiced on the basis of an exercise programme, over a period of nine months, has overall positive consequences in terms of reduction in health expenditure and quality of life.

Impact of a colorectal enhanced recovery program implementation on clinical outcomes and institutional costs: A prospective cohort study with retrospective control.

BACKGROUND: The enhanced recovery program for perioperative care of the surgical patient reduces postoperative metabolic response and organ dysfunction, accelerating functional recovery. The aim of this study was to determine the impact on postoperative recovery and cost-effectiveness of implementing a colorectal enhanced recovery program in an Italian academic centre. MATERIALS AND METHODS: A prospective series of consecutive patients (N = 100) undergoing elective colorectal resection completing a standardized enhanced recovery program in 2013-2015 (ERP group) was compared to patients (N = 100) operated at the same institution in 2010-2011 (Pre-ERP group) before introducing the program. The exclusion criteria were: >80 years old, ASA score of IV, a stage IV TNM, and diagnosis of inflammatory bowel disease. The primary outcome was hospital length of stay which was used as a proxy of functional recovery. Secondary outcomes included: postoperative complications, 30-day readmission and mortality, protocol adherence, nursing workload, cost-effectiveness, and factors predicting prolonged hospital stay. The ERP group patient satisfaction was also evaluated. RESULTS: Hospital stay was significantly reduced in the ERP versus the Pre-ERP group (4 versus 8 days) as well as nursing workload, with no increase in postoperative complications, 30-day readmission or mortality. ERP group protocol adherence (81%) and patient satisfaction were high. Conventional perioperative protocol was the only independent predictor of prolonged hospital stay. Total mean direct costs per patient were significantly higher in the Pre-ERP versus the ERP group (6796.76 versus 5339.05 euros). CONCLUSIONS: Implementing a colorectal enhanced recovery program is feasible, efficient for functional recovery and hospital stay reduction, safe, and cost-effective. High patient satisfaction and nursing workload reduction may also be expected, but high protocol adherence is necessary.

Economic and organizational impact of a clinical decision support system on laboratory test ordering.

BACKGROUND: We studied the impact of a clinical decision support system (CDSS) implemented in a few wards of two Italian health care organizations on the ordering of redundant laboratory tests under different perspectives: (1) analysis of the volume of tests, (2) cost analysis, (3) end-user satisfaction before and after the installation of the CDSS. METHODS: (1) and (2) were performed by comparing the ordering of laboratory tests between an intervention group of wards where a CDSS was in use and a second (control) group where a CDSS was not in use; data were compared during a 3-month period before (2014) and a 3-month period after (2015) CDSS installation. To measure end-user satisfaction (3), a questionnaire based on POESUS was administered to the medical staff. RESULTS: After the introduction of the CDSS, the number of laboratory tests requested decreased by 16.44% and costs decreased by 16.53% in the intervention group, versus an increase in the number of tests (+3.75%) and of costs (+1.78%) in the control group. Feedback from practice showed that the medical staff was generally satisfied with the CDSS and perceived its benefits, but they were less satisfied with its technical performance in terms of slow response time. CONCLUSIONS: The implementation of CDSSs can have a positive impact on both the efficiency of care provision and health care costs. The experience of using a CDSS can also result in good practice to be implemented by other health care organizations, considering the positive result from the first attempt to gather the point of view of end-users in Italy.

TQM implementation for the healthcare sector.

Purpose The purpose of this paper is to enlarge the debate on total quality management (TQM) implementation in the healthcare sector and to evaluate how and whether leadership can affect TQM implementation. Design/methodology/approach This paper is based on findings from a literature review of TQM and leadership. The authors analysed these findings to categorise causes of a lack of leadership in TQM programme implementations. Findings The authors propose three categories of causes of a lack of leadership in TQM programme implementation. The first cause is well-known: a lack of senior managers' involvement and commitment. The second category is the "combined leadership" that occurs in large healthcare organisations; and the third category is the influence of an external "political leadership" on public healthcare. Research limitations/implications This paper presents researchers with three categories of causes of failure of leadership in TQM implementation that can be investigated. It also encourages reflections from practitioners concerning TQM leadership in the healthcare sector. Practical implications The authors request that practitioners reflect on ways to create or sustain a "monolithic" leadership, especially in large organisations, to ensure a common vision, values and attitude for unitary TQM governance. Originality/value In an original way, this paper analyses and proposes three categories of causes linked to a lack of TQM leadership in the healthcare sector.

Environmental sustainability in European public healthcare.

Purpose - The purpose of this paper is to enlarge the debate concerning the influence of leadership on environmental sustainability implementation in European public healthcare organisations. Design/methodology/approach - This paper is a viewpoint. It is based on preliminary analysis of European standards dedicated to environmental sustainability and their spread across Europe in public healthcare organisations. Viewpoints concerning leadership are then discussed and asserted. Findings - This paper found a limited implementation of standards such as Green Public Procurement criteria, Eco-Management and Audit Scheme and ISO 14001 in public healthcare. Some clues indicate that the lack of implementation is related to leadership and management commitment. Originality/value - For the first time, this paper investigates relationships between leadership and environmental sustainability in European public healthcare opening further avenues of research on the subject.

Poor adherence to guidelines for long-term oxygen therapy (LTOT) in two Italian university hospitals.

Long-term oxygen therapy (LTOT) improves survival in patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemia. Adherence to LTOT guidelines is problematic, both because efficacy has been demonstrated only in specific groups of COPD patients, and because it implies high costs. Introduces treatment high costs. The aim of our study was to examine retrospectively the adherence to LTOT guidelines in a sample of medical records of patients prescribed LTOT between January 2005 and December 2006 in two Italian university hospitals (Ferrara and Modena). Out of a total of 191 medical records of patients prescribed LTOT, only 157 had adequate clinical data considering the three main criteria for appropriateness (arterial blood gas and/or pulse oximetry measurement, oxygen administration, smoking status). Out of these 157 patients, only 73 (46.5 %) fulfilled all three criteria recommended by the guidelines. Adherence was higher for LTOT prescribed by pulmonologists compared to internists. This survey showed that the adherence to LTOT guidelines in a sample of medical records of patients prescribed LTOT is poor. Considering the high costs and the impact on the patients' quality of life of LTOT, these results suggest that the adherence should be carefully monitored.

Evaluation of patient compliance, quality of life impact and cost-effectiveness of a "test in-train out" exercise-based rehabilitation program for patients with intermittent claudication.

BACKGROUND: Patients with intermittent claudication (IC) could benefit from low-cost, effective rehabilitative programs. This retrospective study evaluates compliance, impact on Quality of Life (QoL) and cost-effectiveness of a hospital prescribed, at-home performed (Test-in/Train-out) rehabilitative program for patients with IC. METHODS AND RESULTS: Two-hundred and eighty-nine patients with IC (71 ± 10.1 years, M = 210) were enrolled for a 2-year period. Two daily 10-min home walking sessions at maximal asymptomatic speed were prescribed, with serial check-ups at the hospital. Compliance with the program was assessed by assigning a score of 1 (lowest compliance) to 4 (highest compliance). The SF-36 questionnaire and a constant-load treadmill test were used to evaluate QoL and Initial/Absolute Claudication Distance, respectively. Both direct and indirect costs of the program were considered for cost-effectiveness analysis. Two-hundred and fifty patients (70.5 ± 9.2 years, M = 191), at Fontaine's II-B stage (86%), were included in the study. No adverse events were reported. The average compliance score was 3.1. At discharge, both SF-36 domains and walking performance significantly increased (P < 0.0001). A total of 1,839 in-hospital check-ups (7.36 /patient) were performed. Direct and indirect costs represented 93% and 7% of the total costs, respectively. The average costs of a visit and of a therapy cycle were C68.93 and C507.20, respectively. The cost to walk an additional meter before stopping was C9.22. CONCLUSIONS: A Test-in/Train-out program provided favourable patient compliance, QoL impact and cost-effectiveness in patients with IC.

Screenee perception and health-related quality of life in colorectal cancer screening: a review.

Screening for colorectal cancer (CRC) has become established to varying degrees in several Western countries for the past 30 years. Because of its effectiveness, screening has been adopted or is planned in a number of other countries. In most countries, the screening method (e.g., fecal occult blood test [FOBT], sigmoidoscopy) is followed by colonoscopy, for verification. In other countries (e.g., United States, Germany), colonoscopy is the preferred first-line investigation method. However, because colonoscopy is considered to be invasive, might be poorly tolerated, and can be associated with complications, the idea of adopting colonoscopy as the primary screening method suffers. Negative effects of screening methods can reduce participation in programs and thereby negate the desired effect on individual and societal health. At present, there is no generally accepted method either to assess the perception and satisfaction of patients screened or the outcome of the screening procedures in CRC. In this review, we discuss the past development and present availability of instruments to measure health-related quality of life (HRQoL), the scarce studies in which such instruments have been used in screening campaigns, and the findings. We suggest the creation of a specific instrument for the assessment of HRQoL in CRC screening.