Analysis and clinical determinants of post-COVID-19 syndrome in the Lombardy region: evidence from a longitudinal cohort study.

Objective: To define macro symptoms of long COVID and to identify predictive factors, with the aim of preventing the development of the long COVID syndrome.

Design: A single-centre longitudinal prospective cohort study conducted from May 2020 to October 2022.

Setting: The study was conducted at Luigi Sacco University Hospital in Milan (Italy).

Surfactant protein D (SP-D) as a biomarker of SARS-CoV-2 infection.

Background: Surfactant protein-D (SP-D) is a lung-resident protein that has emerged as a potential biomarker for COVID-19. Previous investigations on acute respiratory distress syndrome patients demonstrated a significant increment of SP-D serum levels in pathological conditions. Since SP-D is not physiologically permeable to alveoli-capillary membrane and poorly expressed by other tissues, this enhancement is likely due to an impairment of the pulmonary barrier caused by prolonged inflammation.

The impact of COVID-19 pandemic on AMI and stroke mortality in Lombardy: Evidence from the epicenter of the pandemic.

Background: The first Covid-19 epidemic outbreak has enormously impacted the delivery of clinical healthcare and hospital management practices in most of the hospitals around the world. In this context, it is important to assess whether the clinical management of non-Covid patients has not been compromised. Among non-Covid cases, patients with Acute Myocardial Infarction (AMI) and stroke need non-deferrable emergency care and are the natural candidates to be studied.

How have casemix, cost and hospital stay of inpatients in the last year of life changed over the past decade? Evidence from Italy.

Healthcare utilisation and expenditure are highly concentrated in hospital inpatient services, in particular in end-of-life care with the peak occurring in the very last year of life, regardless of patient age. Few scientific studies have investigated hospital costs and stays of patients at the end of life, and even fewer studies have analysed their evolution over time. In this paper, we exploit hospitalisation data for the Lombardy region of Italy with the aim of studying the evolution of hospital casemix, costs and stays of chronic patients, and compare the last year of life of two cohorts of patients who died in 2005 and 2014.

A bivariate prediction approach for adapting the health care system response to the spread of COVID-19.

The spread of COVID-19 implied a large and fast increase of demand for intensive care services. To face this increase in demand, health care systems need to adapt their response by increasing hospital beds, intensive care unit (ICU) capacity and by (re-)deploying doctors and other personnel. This paper proposes a forecast approach based on the Vector Error Correction model for the daily counts of hospitalized patients with symptoms and of patients in ICU, using publicly available data on the current COVID-19 outbreak in Italy, Switzerland and Spain.

Monitoring the Italian Home Palliative Care Services.

Background: In Italy, there currently is a lack of reliable and consistent data on home palliative care provided to people near death.

Objectives: Monitoring the activities of the Italian Home Palliative Care Services, according to the 2014 national data collection program entitled "Observatory of Best Practices in Palliative Care" and providing process/outcome measures on a subsample (Best Practice Panel), on regulatory standards and on complete/reliable activity data.

Design: A data collection web portal using two voluntary internet-based questionnaires in order to retrospectively identify the main care activity data provided within the year 2013 by Home care units.

The "ARIANNA" Project: An Observational Study on a Model of Early Identification of Patients with Palliative Care Needs through the Integration between Primary Care and Italian Home Palliative Care Units.

Objective: The aim of this study was to illustrate the characteristics of patients with palliative care (PC) needs, early identified by general practitioners (GPs), and to analyze their care process in home PC services.

Background: Early identification and service integration are key components to providing quality palliative care (PC) services ensuring the best possible service for patients and their families. However, in Italy, PC is often provided only in the last phase of life and for oncological patients, with a fragmented service.

Quality assessment of palliative home care in Italy.

Rationale: The complexity of end-of-life care, represented by a large number of units caring for dying patients, of different types of organizations motivates the importance of measure the quality of provided care. Despite the law 38/2010 promulgated to remove the barriers and provide affordable access to palliative care, measurement, and monitoring of processes of home care providers in Italy has not been attempted.

Aims And Objectives: Using data drawn by an institutional voluntary observatory established in Italy in 2013, collecting home palliative care units caring for people between January and December 2013, we assess the degree to which Italian home palliative care teams endorse a set of standards required by the 38/2010 law and best practices as emerged from the literature.

Structural Equation Models in a Redundancy Analysis Framework With Covariates.

A recent method to specify and fit structural equation modeling in the Redundancy Analysis framework based on so-called Extended Redundancy Analysis (ERA) has been proposed in the literature. In this approach, the relationships between the observed exogenous variables and the observed endogenous variables are moderated by the presence of unobservable composites, estimated as linear combinations of exogenous variables. However, in the presence of direct effects linking exogenous and endogenous variables, or concomitant indicators, the composite scores are estimated by ignoring the presence of the specified direct effects.

Patient safety analysis linking claims and administrative data.

Purpose: The purpose of this paper is to provide international data on the occurrence (and rates) of clinical errors, identified by type and consequence in the Lombardy region, and to assess empirically the association between hospital accreditation-type measures and clinical error rates by merging hospital discharge records and medical malpractice claim data in the Lombardy region (Italy).

Design/methodology/approach: Data were drawn from the regional database collecting claims and demands for reimbursement declared by patients hospitalized in regional healthcare structures and regional archives collecting hospital discharge records. To model the variability of clinical errors rates, binomial negative regression models were applied.

Benchmarking strategies for measuring the quality of healthcare: problems and prospects.

Over the last few years, increasing attention has been directed toward the problems inherent to measuring the quality of healthcare and implementing benchmarking strategies. Besides offering accreditation and certification processes, recent approaches measure the performance of healthcare institutions in order to evaluate their effectiveness, defined as the capacity to provide treatment that modifies and improves the patient's state of health. This paper, dealing with hospital effectiveness, focuses on research methods for effectiveness analyses within a strategy comparing different healthcare institutions.

Health of the nation outcome scales evaluation in a community setting population.

Purpose: To explore the internal structure of the health of the nation outcome scales (HoNOS-12), proposing a shorter one-dimensional version for routine use in community-oriented mental heath services.

Methods: A validation study involving four mental health departments, located in the province of Milan (Italy). Eligible patients were outpatients and residential inpatients rated on three occasions during the year 2009, with a range of mental illnesses and diagnoses.

Patient safety analyses using Lombardy administrative archives.

Purpose: The purpose of this paper is to discuss strategies for benchmarking patient safety using Lombardy region administrative archives. Patient safety indicators and statistical methods are presented that allow risk adjustment. The analysis benchmarks regional health structures, focusing on two patient safety indicators: failure to rescue; and death in low mortality diagnostic related group.