Occurrence of inflammatory bowel disease in central Italy: a study based on health information systems.

Background: The burden of inflammatory bowel diseases, including Crohn's disease and ulcerative colitis, has never been estimated in Italy using administrative data sources. Our objective was to measure the occurrence of inflammatory bowel diseases in the Lazio region (Italy) using administrative data and to test the sensitivity of the Crohn's disease case-finding algorithm with respect to clinical diagnosis.

Methods: We conducted a population-based cross-sectional study identifying prevalent and incident cases.

Pneumonia burden in elderly patients: a classification algorithm using administrative data.

Background: Pneumonia has traditionally been classified into two subtypes: community-acquired pneumonia (CAP) and nosocomial pneumonia (NP). Recently, a new entity has been defined, called healthcare-associated pneumonia (HCAP). Few studies have investigated the potential of population-based, electronic, healthcare databases to identify the incidences of these three subtypes of pneumonia.

Effect of evidence-based drug therapy on long-term outcomes in patients discharged after myocardial infarction: a nested case–control study in Italy.

Purpose: There are some methodological concerns regarding results from observational studies about the effectiveness of evidence-based (EB) drug therapy in secondary prevention after myocardial infarction. The present study used a nested case–control approach to address these major methodological limitations.

Methods: A cohort of 6880 patients discharged from hospital after acute myocardial infarction (AMI) in 2006–2007 was enrolled and followed-up throughout 2009.

[Definition and validation of a predictive model to identify patients with chronic obstructive pulmonary disease (COPD) from administrative databases].

Objective: To develop and validate a predictive model for the identification of patients with Chronic Obstructive Pulmonary Disease (COPD) among the resident population of the Lazio region, using information available in the regional administrative systems (SIS) as well as clinical data of a panel of COPD patients.

Setting And Participants: All residents in the Lazio region over 40 years of age in 2007 (2,625,102 inhabitants)

Main Outcome Measures: The predictive model was developed through record linkage of health care related consumption patterns among 428 panel patients with confirmed COPD diagnosis in 2006 and a control group of patients without COPD (selection from outpatients specialized health care registry, 1:4). Hospital admission for COPD was defined a priori to be sufficient to identify a COPD patient.

Definition of patients treated with evidence based drugs in absence of prescribed daily doses: the example of acute myocardial infarction.

Purpose: Define patients treated with evidence-based drugs in a cohort discharged after acute myocardial infarction (AMI) in absence of prescribed daily doses (PDD). To compare different drug use measures and analyze their impact on the effect estimate of risk factors related to drug use.

Methods: AMI patients discharged in Rome during 2006-2007 were selected from the Hospital Information System.

[Chronic obstructive pulmonary disease prevalence estimated using a standard algorithm based on electronic health data in various areas of Italy].

Aim: to estimate the prevalence of chronic obstructive pulmonary disease (COPD) by integrating various administrative health information systems.

Methods: prevalent COPD cases were defined as those reported in the hospital discharge registry (HDR) and cause of mortality registry (CMR) with codes 490*, 491*, 492*, 494* and 496* of the International diseases classification 9th revision. Annual prevalence was estimated in 35+ year-old residents in six Italian areas ofb different sizes, in the period 2002-2004.

[Introduction to risk adjustment methods in comparative evaluation of outcomes].

The increasing demand for comparative evaluation of outcomes requires the development and diffusion of epidemiologic research, the ability to correctly conduct analyses and to interpret results. When healthcare outcomes are used for comparing quality of care across providers, failure to use methods of risk adjustment to account for any variation in patient populations can lead to misinterpretation of the findings. The purpose of this paper is to provide a detailed but easy-reading review of different risk adjustment methodologies to compare health care outcomes.

Risk adjustment and outcome research. Part I.

Objective: The increasing demand for comparative evaluation of outcomes requires the development and diffusion of epidemiologic research, the ability to correctly formulate hypotheses, to conduct analyses and to interpret the results. The purpose of this paper is to provide a detailed but easy-reading review of epidemiologic methods to compare healthcare outcomes, particularly risk-adjustment methods.

Methods: The paper is divided into three parts.

Prognostic factors and determinants of fatal outcome due to bacterial meningitis in the Lazio region of Italy, 1996-2000.

Objectives: To estimate case fatality rates (CFR) of bacterial meningitis and analyze factors associated with mortality due to bacterial meningitis in the Italian region of Lazio.

Methods: Patients reported with bacterial meningitis during the period 1996-2000, who died within 30 days from hospitalization (cases), were compared with survivors (controls) for factors related to healthcare. Age, gender, residence, bacterial agent, co-morbidities, and signs of disease severity were also analyzed in the final model.

The Italian CABG Outcome Study: short-term outcomes in patients with coronary artery bypass graft surgery.

Objective: During the last decade, a worldwide growing interest in evaluating performance of health services through 'outcome studies' took place. This study started in early 2002 and represents the first National Health System (NHS) experience to evaluate adjusted performance indicators at national level. The aim of this study was to compare 30 days mortality after coronary artery bypass graft (CABG) between cardiac surgery centres, adjusting by confounding risk factors.

[Functional recovery in post-acute rehabilitation: patient characteristics and treatment effect].

Objective: Most studies on the effectiveness of rehabilitation consider only particular rehabilitation treatments for particular conditions, and do not give a global vision of the issue. This study evaluated the effectiveness of various types of post acute rehabilitative care in patients with different diagnoses by investigating the association between treatments and functional gain by type of impairment and severity on admission.

Design, Setting And Participants: Information on the characteristics of patients and the rehabilitative treatments was collected using an Italian version of the Minimum Data Set-Post Acute Care.

Toward a new payment system for inpatient rehabilitation. Part II: Reimbursing providers.

Background: The major fault with existing reimbursement systems lies in their failure to discriminate for the effectiveness of stay, both when paying per day and when paying per episode of treatment.

Objectives: We sought to define an average length of effective stay and recovery trends by impairment category, to design a prospective payment system that takes into account costs and expected recovery trends, and to compare the calculated reimbursement with the predicted costs estimated in a previous study (Saitto C, Marino C, Fusco D, et al. A new prospective payment system for inpatient rehabilitation.

Toward a new payment system for inpatient rehabilitation. Part I: Predicting resource consumption.

Background: The measures of clinical status used to predict costs must pay the most attention possible to medical conditions and clinical complexity. Length of stay (LOS), which has been used as a proxy for resource consumption, is not a direct measure of costs. Classification and regression trees, which are used in defining iso-resource groups, can be affected by overfitting and are based on a priori choices of the splitting attributes.

Differences in access to coronary care unit among patients with acute myocardial infarction in Rome: old, ill, and poor people hold the burden of inefficiency.

Background: Direct admission to Coronary Care Unit (CCU) on hospital arrival can be considered as a good proxy for adequate management in patients with acute myocardial infarction (AMI), as it has been associated with better prognosis. We analyzed a cohort of patients with AMI hospitalized in Rome (Italy) in 1997-2000 to assess the proportion directly admitted to CCU and to investigate the effect of patient characteristics such as gender, age, illness severity on admission, and socio-economic status (SES) on CCU admission practices.

Methods: Using discharge data, we analyzed a cohort of 9127 AMI patients.

Diabetes management by hospital-affiliated diabetes centres in Lazio, Italy.

Background: In Italy, diabetes centres are considered to provide adequate care but little is known about their performance.

Methods: Inpatient and outpatient administrative databases were used to select and study a cohort of 2,568 diabetic patients. Adherence to guidelines and effect of patient characteristics and diabetes centre on treatment was assessed.

A follow-up analysis of transient ischemic attack patients suggests unsatisfactory disease management and possible underutilization of carotid endarterectomy in Lazio, Italy.

We evaluated the disease management of transient ischemic attack in patients admitted to Lazio hospitals from July 1997 to June 1998. We assessed the effects of patient characteristics including chronic comorbidities on the use of diagnostic procedures, endarterectomy, and on the risk of adverse cerebrovascular outcome or death. There were 2,608 patients in the study who were followed up over a 18- to 30-month period.

Outcome of patients with cardiac diseases admitted to coronary care units: a report from Lazio, Italy.

Background: Coronary care units (CCUs) currently treat a variety of diseases, but little is known about the effectiveness of CCUs on heart conditions other than acute myocardial infarction.

Objectives: The objectives of this study were to evaluate the association between direct admission to CCUs and the risk of inhospital death in patients with heart disease, to investigate factors affecting direct admission to a CCU, and to assess the effect of CCU admission on the use of invasive procedures in patients with arrhythmias.

Research Design: We conducted a retrospective analysis of discharge-abstract data from Lazio, Italy, hospitals.

Evaluating outcomes of hospital care following coronary artery bypass surgery in Rome, Italy.

Objective: Monitoring health outcomes across hospitals has become a growing interest as a potential means to promote quality of care, but in Italy it is at the beginning stage. We aimed at comparing the performance of different cardiac surgery units and testing the utility of routinely collected data in this respect.

Methods: From the Lazio region hospital information system (HIS), we selected a cohort of 1603 individuals (84% males; mean age 63 years, SD 8) residing in Rome (2,685,890 inhabitants), who underwent isolated coronary artery bypass surgery (CABG, ICD-9-CM code: 36.

[Supply of outpatient care in the Lazio region: geographic distribution and characteristics of outpatient clinics].

Outpatient care accounts every year for a large share of the National Health Fund spending, however characteristics of supply have not been thoroughly investigated. Objective of the study is the description of the outpatient care system of Lazio region and of the main characteristics of outpatient clinics, through indicators obtained using data from the Outpatient Care Information System (SIAS) for 1999. Outpatient clinics were classified into three categories: ASL managed clinics, private clinics and hospital trusts.