A novel stream of collaborative National portals to enhance preparedness and informed choices : Fabrizio Carinci

Issue/problem AGENAS supports the implementation of health policies in direct collaboration with Italian Regions and Autonomous Provinces. To improve public reporting, we aimed to complement the production of technical reports with new forms of timely communication, using National Portals. Description of the problem Between October-December 2020, we designed and implemented the Covid-19 National Portal, including a suite of targeted indicators, fully automated via ad hoc scripts written in php and R on top of a relational database using internal and external data sources. Targeted information was widely communicated and continuously updated. Dedicated sections on forecasting and resilience were delivered in collaboration with specialised academic institutions. In 2021, we deployed the Portal for the Transparency of Health Services, broadly oriented towards health issues, the location of services and performance indicators. Results Pre-post comparisons of web analytics for Jan-Apr 2020-2022 showed clear advantages of Covid-19 Portal. By Apr 2020, Italy had introduced national lockdown, while AGENAS covered the topic traditionally, recording 48,122 users overall, with daily peaks below 5,000 sessions. In 2021-2022, the number of users skyrocketed at 436,280, with daily peaks of 100,000 sessions, and 421,123 respectively, with daily peaks of 150,000 sessions. Visits to the Transparency Portal were considerably more limited. Lessons To be widely used, public health information needs to be relevant (responding to personal need close to home), understandable, accurate and timely. National Portals can gain efficiency through the mediation of search engines, enhanced by: targeted naming (url), coherent semantic perimeter (third level domain in a highly referenced institutional website), continuous updating, and impact factor (linked by authoritative websites). The Transparency Portal will take stock of these lessons to succeed in a new funded program of NextGenerationEU. Key messages • Relevant, understandable, accurate and timely dissemination for different types of audience may be effectively organised through National Portals. • Productive collaboration between health specialists and communication experts can enhance usability and actionability of National Portals for public health.

A novel plot for the early alert of epidemic growth using regional targets: the doubling plot : Fabrizio Carinci

Background During the pandemic, restrictions set by the Italian Government were primarily based on the regional level of key parameters including hospitalization and incidence rates. We aimed to build a specific plot to monitor trends and trigger early alerts, with daily updates publicly available on a National Portal. Methods A multidisciplinary team conceived and implemented a new composite plot, developing ad hoc R scripts on top of a specialised database, built in collaboration with the Ministry of Health. We calculated the doubling time Td as log(2)/log(1+r/100), where r is the daily change of target parameters and Td ranges between (0,+-infinity), and not determined for constant or missing values. We calculated Td daily, as either doubling (growth) or halving (decrease) time. To visualize trends, we assembled two different types of graphs: a bivariate plot showing the path of each point (Td, target parameter) over time, and a line plot of Td over time. The Y axis was inverted for doubling times, as lower Td indicate higher alert in this case. The two graphs were arranged in lines, using cutoffs for excessive high values for doubling times and low values for halving times. A third line was included to display trends of the target parameter over time. Results The plot was successfully realized and published on the Portal for all regions in February 2021 (https://www.agenas.gov.it/covid19/web/index.php?r=english%2Fdoubling&q=ITA&t=0). Since July 2021, we used the doubling plot to monitor the three main parameters adopted to set restrictions for Covid-19: a) occupancy rates in intensive care;b) occupancy rates in medical wards;c) weekly incidence rates. The plot highlighted growth trends and early alerts, particularly in the initial phases of growth. Conclusions The doubling plot can provide useful information to trigger early responses for pandemic control in decentralised governance. R code is available open source from AGENAS for free use. Key messages • The doubling plot was conceived and implemented on a National Portal to trigger early alerts of Covid-19 progression in Italian Regions and Autonomous Provinces. • The plot could be rapidly adapted to legislative parameters and can be useful in different situations to monitor epidemic growth and support public health policies.

Managing COVID-19 within and across health systems: why we need performance intelligence to coordinate a global response.

BACKGROUND: The COVID-19 pandemic is a complex global public health crisis presenting clinical, organisational and system-wide challenges. Different research perspectives on health are needed in order to manage and monitor this crisis. Performance intelligence is an approach that emphasises the need for different research perspectives in supporting health systems' decision-makers to determine policies based on well-informed choices. In this paper, we present the viewpoint of the Innovative Training Network for Healthcare Performance Intelligence Professionals (HealthPros) on how performance intelligence can be used during and after the COVID-19 pandemic. DISCUSSION: A lack of standardised information, paired with limited discussion and alignment between countries contribute to uncertainty in decision-making in all countries. Consequently, a plethora of different non-data-driven and uncoordinated approaches to address the outbreak are noted worldwide. Comparative health system research is needed to help countries shape their response models in social care, public health, primary care, hospital care and long-term care through the different phases of the pandemic. There is a need in each phase to compare context-specific bundles of measures where the impact on health outcomes can be modelled using targeted data and advanced statistical methods. Performance intelligence can be pursued to compare data, construct indicators and identify optimal strategies. Embracing a system perspective will allow countries to take coordinated strategic decisions while mitigating the risk of system collapse.A framework for the development and implementation of performance intelligence has been outlined by the HealthPros Network and is of pertinence. Health systems need better and more timely data to govern through a pandemic-induced transition period where tensions between care needs, demand and capacity are exceptionally high worldwide. Health systems are challenged to ensure essential levels of healthcare towards all patients, including those who need routine assistance. CONCLUSION: Performance intelligence plays an essential role as part of a broader public health strategy in guiding the decisions of health system actors on the implementation of contextualised measures to tackle COVID-19 or any future epidemic as well as their effect on the health system at large. This should be based on commonly agreed-upon standardised data and fit-for-purpose indicators, making optimal use of existing health information infrastructures. The HealthPros Network can make a meaningful contribution.

Oxygen-ozone therapy as adjuvant in the current emergency in SARS-COV-2 infection: a clinical study.

The aim of the multicentre study promoted by Nuova FIO is to evaluate the beneficial effects of the systemic Oxygen-Ozone (O2O3) therapy in patients suffering from SARS COV-2 disease in the early phases of the disease, before worsening, up to the need of tracheal intubation. The study is based on the rationale on that the systemic oxygen-ozone treatment could be effective, positively influencing the disease evolution and/or being able to mitigate the onset of the cytokine storm syndrome at least partially.