Comparison of Different Telemedicine Services to Pre-Evaluate Their Use in a New "Computational Hospital".

Future healthcare is transitioning toward a decentralization of patient care, in which personal care is increasingly moved at the patient home and surrounding areas, while hospitals concentrate primarily on procedures that cannot be performed elsewhere, such as surgeries or outpatient examinations. The healthcare system in the Liguria region (Italy) is currently developing a new Center for Computational and Technological Medicine (CMCT), which is intended to facilitate and support this transition. As a component of the strategic planning and design process, this study examines the development and organization of telemedicine services across a range of chosen Italian and European institutions that share similarities with CMCT in terms of scope and scale. We specifically focus on telemedicine services - how they are governed, their main fields of application. The analysis confirmed the growing importance of telemedicine as part of the new vision of medicine, in which the patient is at the center.

Criteria for the Evaluation of Italian Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS): Comparison with European Standards and Certification Models.

The definition of the title "Istituto di Ricovero e Cura a Carattere Scientifico" (IRCCS) and how this title is given by the Italian Ministry of Health is presented. Specifically, the first assessment of a commission concerning the essential information for the accreditation process is introduced. Moreover, the two years review process that aims to collect last updated information of the IRCCS, to identify level of excellence and critical aspects, is also explained. The present Italian forms and international manuals like Joint Commission, OECI and HCERES were schematized using UML diagrams. The current IRCCS accreditation forms are presented with the suggested updates organized in some levels of structuring. We compared the Italian forms with the manuals required to obtain international certifications (Joint Commission and OECI) and we analyzed the criteria for the evaluation of research units in France (the HCERES standards). Although it is a preliminary study, the use of UML diagrams allows to schematize a new accreditation model, in line with European guidelines and the most important international certifications.

The Impact of the Introduction of the Breast Unit Model in a Northwestern Italian Region.

Breast cancer is the most common tumor in middle-aged and older women. In 2003, the European Parliament recommended to Member States that all women with breast cancer should be treated by a multidisciplinary team and that a network of certified breast centers be organized (the centers have been called Breast Units (BUs)). With the present study, we aim to explore the impact of the introduction of the BU organizational model in the Liguria region, Italy, through different outcome indicators. An explorative retrospective analysis was conducted through the period from 2013 to 2019 to assess the impact of the introduction of the BU model in our region. We identified two periods: before (2014-2015) and after (2017-2018) the introduction of this organizational model to assess its value impact through the definition of six measurable outcome indicators. Length of hospitalization, repeated specialist outpatient diagnostic procedures and the rate of subjects who started radiotherapy treatment within 60 days improved after the introduction of BUs. The passive health migration rate only improved significantly for one local health unit (LHU), while reintervention and diagnosis-surgery time did not show any enhancement after the introduction of the BU model. The BU model seems to provide an increase in several aspects of the healthcare offered to breast cancer patients in Liguria, specifically in those areas where a shared guideline could assist healthcare workers. Future research, such as pilot studies, are needed to assess the impact of the introduction of the BU model in our reality.

EU-Funded Telemedicine Projects - Assessment of, and Lessons Learned From, in the Light of the SARS-CoV-2 Pandemic.

The SARS-CoV-2 health emergency has demonstrated the need for developing structured telemedicine systems to protect citizens from the spread of the virus. Thereby, their importance and the necessity to tailor their diffusion at large scale for providing services both at a distance and in time has been shown. For these reasons, the European Union advocates the digital transition of health systems for the next 5 years. The main aim of this work is to revisit the telemedicine research projects financed by European Community during the period 2000-2020 with particular respect to the results derived from their application. The analysis showed that some integration of tele-care and tele-health could be obtained with tele-monitoring systems and the implementation of Electronic Personal Record (EPR). Furthermore, telemedicine allows enhancing health care in critical environments, to protect health and life of the most vulnerable patients, and to encourage cross-border dialogue. The criteria of "from distance" and "timely delivered" are granted, but the effectiveness of the overall offered services highly depends on the availability and the quality of the input data. Unfortunately, this remains a relevant problem in the SARS-CoV-2 pandemic.

Molecular tests for SARS-CoV-2: data from Liguria Region (Italy).

The current Covid-19 pandemic makes necessary to identify people affected by SARS-CoV-2. To do this, the most reliable method is the use of the molecular test that is the gold standard to detect positive peoples.Here, we provide a comprehensive review on the diagnostic processes through molecular tests for SARS-CoV-2 infection. First, we have obtained information about the testing technologies in the Liguria region's hospitals to find and describe the most common technologies used and to calculate the molecular test's average cost. Second, we have evaluated the sensitivity, the specificity, the safety with respect to the data reported on scientific literature (Real Word Data VS Registrative Studies) and the organizational aspects of the molecular tests.Clinical Relevance- This study aims to provide support to the decision makers on clinical, economic, organizational, social and ethical issues related to the use of molecular test for SARS-CoV-2.

Use of Electronic Administrative Databases to Measure Quality Indicators of Breast Cancer Care: Experience of Five Regional Oncology Networks in Italy.

PURPOSE: Assuring quality of care, while maintaining sustainability, in complex conditions such as breast cancer (BC) is an important challenge for health systems. Here, we describe a methodology to define a set of quality indicators, assess their computability from administrative data, and apply them to a large cohort of BC cases. MATERIALS AND METHODS: Clinical professionals from the Italian Regional Oncology Networks identified 46 clinically relevant indicators of BC care; 22 were potentially computable using administrative data. Incident cases of BC diagnosed in 2016 in five Italian regions were identified using administrative databases from regional repositories. Each indicator was calculated through record linkage of anonymized individual data. RESULTS: A total of 15,342 incident BC cases were identified. Nine indicators were actually computable from administrative data (two structure and seven process indicators). Although most indicators were consistent with guidelines, for one indicator (blood tumor markers in the year after surgery, 44.2% to 64.5%; benchmark ≤ 20%), deviation was evident throughout the five regions, highlighting systematic overlooking of clinical recommendations. Two indicators (radiotherapy within 4 months after surgery if no adjuvant chemotherapy; 42% to 83.8%; benchmark ≥ 90%; and mammography 6 to 18 months after surgery, 55.1% to 72.6%; benchmark ≥ 90%) showed great regional variability and were lower than expected, possibly as result of an underestimation in indicator calculation by administrative data. CONCLUSION: Despite highlighting some limitations in the use of administrative data to measure health care performance, this study shows that evaluating the quality of BC care at a population level is possible and potentially useful for guiding quality improvement interventions.

Witnessing ischemia or proofing coronary atherosclerosis: two different windows on the same or on different pathways precipitating cardiovascular events?

Risk stratification and prevention of future cardiac events is an extremely relevant part of the daily medical practice in the large population of asymptomatic or scarcely symptomatic patients. The strategies available to this purpose encompass programs intended either to reduce progression and complications of atherosclerosis, and revascularization procedures aimed to reduce total ischemic burden. The former represents a primary prevention approach and fights the substrate of ischemic heart disease. The latter, instead, is used to reduce the total ischemic burden and thus implies to identify those patients in whom ischemia can be life threatening because of its severity and extension. Today, at least two imaging methods are available for this task: coronary calcium scoring by x-ray CT and ischemia assessment by myocardial perfusion imaging. Although both approaches can accurately estimate cardiovascular risk, from a theoretical point of view, the assessment of ischemia evaluates the functional consequences of coronary obstructions and thus the target of revascularization procedure, while estimating the total atherosclerotic burden represents an indirect index of it. This difference might appear academic in its nature, given the current model of ischemic heart disease pathophysiology that assumes and predicts a very tight correlation between the severity of a coronary stenosis and its capability to cause ischemia. However, the majority of studies focused on the combined risk assessment with both approaches confirm the relevance of this issue. In fact, among 7785 patients reported in the literature, coronary calcium scoring most often resulted in positive findings (78%). However, this sign of atherosclerosis was associated with inducible ischemia in only one-fifth of patients. In the near future, coronary calcium scoring will be easily and immediately completed by the noninvasive definition of coronary stenoses. At that time we will face a still largely unknown risk: the presence of a stenosis in the absence of symptoms and of ischemia. Evaluating the effectiveness of different protocols will thus be needed to improve our capability to help these patients.