Tracking the digital health gap in elderly: A study in Italian remote areas.

The Covid-19 pandemic has provided a major innovative thrust to public services regarding their digitization to continue providing an effective response to the population's needs and to reduce management costs. However, there has been a partial lack of those welfare policies that can provide an adequate response to the elderly segment of the population, which is most affected by the introduction of new technologies into the public sphere. This study analyses the digital gap in health in the elderly living in remote areas of Italy and investigates the use of digital devices for health purposes. It compares the use of digital solutions for health with people's common digital competencies and their willingness to use them. A descriptive analysis of the sample was constructed to verify the different responses of the elderly by age, gender, educational qualification, and geographic area. Furthermore, regression analyses have been conducted to test whether there is any dependent effect among the elderly's characteristics or geographic areas. The results highlight the existence of a potential digital health gap among the elderly in remote areas of Italy both due to infrastructural issues and the lack of digital skills. The latter are positively correlated with educational qualification, such that it is also possible to highlight differences between age groups analysed and shape future welfare policies to reduce digital inequality.

Analyzing the emotional impact of COVID-19 with Twitter data: Lessons from a B-VAR analysis on Italy.

The novel coronavirus 2019 revolutionized the way of living and the communication of people making social media a popular tool to express concerns and perceptions. Starting from this context we built an original database based on the Twitter users' emotions shown in the early weeks of the pandemic in Italy. Specifically, using a single index we measured the feelings of four groups of stakeholders (journalists, people, doctors, and politicians), in three groups of Italian regions (0,1,2), grouped according to the impact of the COVID-19 crises as defined by the Conte Government Ministerial Decree (8th March 2020). We then applied B-VAR techniques to analyze the sentiment relationships between the groups of stakeholders in every Region Groups. Results show a high influence of doctors at the beginning of the epidemic in the Group that includes most of Italian regions (Group 0), and in Lombardy that has been the region of Italy hit the most by the pandemic (Group 2). Our outcomes suggest that, given the role played by stakeholders and the COVID-19 magnitude, health policy interventions based on communication strategies may be used as best practices to develop regional mitigation plans for the containment and contrast of epidemiological emergencies.

Does the healthcare system know what to cut under the pandemic emergency pressure? An observational study on geographic variation of surgical procedures in Italy.

OBJECTIVES: During 2020 many countries reduced the number of elective surgeries to free up beds and cope with the COVID-19 outbreak. This situation led healthcare systems to prioritise elective interventions and reduce the overall volumes of treatments.The aim of this paper is to analyse whether the pandemic and the prioritisation policies on elective surgery were done considering the potential inappropriateness highlighted by the measurement of geographic variation. SETTING: The setting of the study is acute care with a focus on elective surgical procedures. Data were analysed at the Italian regional level. PARTICIPANTS: The study is observational and relies on national hospitalisation records from 2019 to 2020. The analyses refer to the 21 Italian regional health systems, using 48 917 records for 2019 and 33 821 for 2020. The surgical procedures analysed are those considered at high risk of unwarranted variation: coronary angioplasty, cholecystectomy, colectomy, knee replacement, hysterectomy, tonsillectomy, hip replacement and vein stripping. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary measures were the hospitalisation rate and its reduction per procedure, to understand the level of potential inappropriateness. Secondary measures were the SD and high/low ratio, to map the level of geographic variation. RESULTS: For some procedures, there is a linear negative relationship (eg, tonsillectomy: ρ = -0.92, p<0.01; vein stripping: ρ = -0.93, p<0.01) between the reduction in hospitalisation and its starting point. The only two procedures for which no significant differences were registered are cholecystectomy (ρ = -0.22, p=0.31) and hysterectomy (ρ = -0.22, p=0.33). In particular, in all cases, data show that regions with higher 2019 hospitalisation rates registered a larger reduction. CONCLUSIONS: The Italian data show that the pandemic seems to have led hospital managers and health professionals to cut surgical interventions more likely to be inappropriate. Hence, these findings can inform and guide the healthcare system to manage unwarranted variation when coming back to the new normal. This new starting point (lower volumes in some selected elective surgical procedures) should be used to plan elective surgical treatments that can be cancelled because of their high risk of inappropriateness.

The Italian interregional performance evaluation system

This contribution describes the Interregional Performance Evaluation System (IRPES) designed by MeS Lab of Sant’Anna School of Advanced Studies (Pisa—Italy), by highlighting its main characteristics and its evolution. Context: Since its creation in 2008, the IRPES has been developed by researchers from different backgrounds, with the involvement of practitioners and managers, so as to offer support to local, regional and national healthcare management. The IRPES is currently adopted by 12 Italian regions, which share a common performance evaluation system to assess the respective regional healthcare systems’ performance. Structure: The IRPES is currently composed of about 400 indicators, which monitor different dimensions of the health systems. About half of them are benchmarked against shared standards, to assess the healthcare systems’ performance. Indicators are grouped into around thirty composite indicators. Data visualization: MeS Lab designed innovative tools to deliver a clear representation of the performance of health systems, which in turn facilitate policymakers to gain a dynamic understanding of weaknesses and strengths of the systems they manage. In particular, the more traditional representation tools (such as maps or histograms) are accompanied by new visualisation instruments, such as “the dartboard” and “the stave”. Covid-19: With the outburst of COVID-19 pandemic emergency, assessing the resilience of healthcare systems has become the new challenge posed to the IRPES. Thus, 63 novel resilience indicators tailored for the pandemic were introduced, starting from the second semester of 2020. Continuous monitoring of the performance of health systems was equally implemented, which has been essential to policymakers during such a difficult time.

The experiences of 33 national COVID-19 dashboard teams during the first year of the pandemic in the World Health Organization European Region: A qualitative study.

Background: Governments across the World Health Organization (WHO) European Region have prioritised dashboards for reporting COVID-19 data. The ubiquitous use of dashboards for public reporting is a novel phenomenon. Objective: This study explores the development of COVID-19 dashboards during the first year of the pandemic and identifies common barriers, enablers and lessons from the experiences of teams responsible for their development. Methods: We applied multiple methods to identify and recruit COVID-19 dashboard teams, using a purposive, quota sampling approach. Semi-structured group interviews were conducted from April to June 2021. Using elaborative coding and thematic analysis, we derived descriptive and explanatory themes from the interview data. A validation workshop was held with study participants in June 2021. Results: Eighty informants participated, representing 33 national COVID-19 dashboard teams across the WHO European Region. Most dashboards were launched swiftly during the first months of the pandemic, February to May 2020. The urgency, intense workload, limited human resources, data and privacy constraints and public scrutiny were common challenges in the initial development stage. Themes related to barriers or enablers were identified, pertaining to the pre-pandemic context, pandemic itself, people and processes and software, data and users. Lessons emerged around the themes of simplicity, trust, partnership, software and data and change. Conclusions: COVID-19 dashboards were developed in a learning-by-doing approach. The experiences of teams reveal that initial underpreparedness was offset by high-level political endorsement, the professionalism of teams, accelerated data improvements and immediate support with commercial software solutions. To leverage the full potential of dashboards for health data reporting, investments are needed at the team, national and pan-European levels.

Changes in Acute Myocardial Infarction, Stroke, and Heart Failure Hospitalizations During COVID-19 Pandemic in Tuscany-An Interrupted Time Series Study.

Objectives: We evaluate the impact of the COVID-19 pandemic on unplanned hospitalization rates for patients without COVID-19, including their length of stay, and in-hospital mortality, overall, and for acute myocardial infarction (AMI), stroke, and heart failure in the Tuscany region of Italy. Methods: We carried out a population-based controlled interrupted time series study using segmented linear regression with an autoregressive error term based on admissions data from all public hospitals in Tuscany. The primary outcome measure was weekly hospitalization rates; secondary outcomes included length of stay, and in-hospital mortality. Results: The implementation of the pandemic-related mitigation measures and fear of infection was associated with large decreases in inpatient hospitalization rates overall (-182 [-234, -130]), unplanned hospitalization (-39 [-51, -26]), and for AMI (-1.32 [-1.98, -0.66]), stroke (-1.51 [-2.56, -0.44]), and heart failure (-8.7 [-11.1, -6.3]). Average length of stay and percent in-hospital mortality for select acute medical conditions did not change significantly. Conclusion: In Tuscany, Italy, the COVID-19 pandemic was associated with large reductions in hospitalization rates overall, as well as for heart failure, and the time sensitive conditions of AMI and stroke during the months January to July 2020.

Changes in Acute Myocardial Infarction, Stroke, and Heart Failure Hospitalizations During COVID-19 Pandemic in Tuscany—An Interrupted Time Series Study

Objectives: We evaluate the impact of the COVID-19 pandemic on unplanned hospitalization rates for patients without COVID-19, including their length of stay, and in-hospital mortality, overall, and for acute myocardial infarction (AMI), stroke, and heart failure in the Tuscany region of Italy. Methods: We carried out a population-based controlled interrupted time series study using segmented linear regression with an autoregressive error term based on admissions data from all public hospitals in Tuscany. The primary outcome measure was weekly hospitalization rates;secondary outcomes included length of stay, and in-hospital mortality. Results: The implementation of the pandemic-related mitigation measures and fear of infection was associated with large decreases in inpatient hospitalization rates overall (−182 [−234, −130]), unplanned hospitalization (−39 [−51, −26]), and for AMI (−1.32 [−1.98, −0.66]), stroke (−1.51 [−2.56, −0.44]), and heart failure (−8.7 [−11.1, −6.3]). Average length of stay and percent in-hospital mortality for select acute medical conditions did not change significantly. Conclusion: In Tuscany, Italy, the COVID-19 pandemic was associated with large reductions in hospitalization rates overall, as well as for heart failure, and the time sensitive conditions of AMI and stroke during the months January to July 2020.

Decision-Making Algorithm and Predictive Model to Assess the Impact of Infectious Disease Epidemics on the Healthcare System: The COVID-19 Case Study in Italy.

To improve decision-making strategies and prediction based on epidemiological data, so far biased by highly-variable criteria, algorithms using unbiased morbidity parameters, i.e. Intensive Care Units (ICU) and Ordinary Hospitalizations (OH), are proposed. ICU/OH acceleration and velocities are mathematically modeled using available and official data to derive two thresholds, alerting on 30 % ICU and 40 % OH of COVID-19 daily occupancy settled by the Italian Minister of Health, as a case of study. A predictive model is also proposed to estimate the daily occupancy of ICU and OH in hospitals for each region, using a Susceptible-Infected-Recovered-Death (SIRD) epidemic model to further extend occupancy prediction in each regional district. Computed data validated the proposed models in Italy after almost two years of pandemic, obtaining agreements with the Italian Presidential Decree regardless of the different regional trends of epidemic waves. Therefore, the decision-making algorithm and prediction model resulted valuable tools, retrospectively, to be tested prospectively in sustainable strategies to curb the impact of COVID-19, or of any other pandemic threats with any aggregate of data, on local healthcare systems.

Response to COVID-19: was Italy (un)prepared?

On 31st January 2020, the Italian cabinet declared a 6-month national emergency after the detection of the first two COVID-19 positive cases in Rome, two Chinese tourists travelling from Wuhan. Between then and the total lockdown introduced on 22nd March 2020 Italy was hit by an unprecedented crisis. In addition to being the first European country to be heavily swept by the COVID-19 pandemic, Italy was the first to introduce stringent lockdown measures. The SARS-CoV-2 outbreak and related COVID-19 pandemic have been the worst public health challenge endured in recent history by Italy. Two months since the beginning of the first wave, the estimated excess deaths in Lombardy, the hardest hit region in the country, reached a peak of more than 23,000 deaths. The extraordinary pressures exerted on the Italian Servizio Sanitario Nazionale (SSN) inevitably leads to questions about its preparedness and the appropriateness and effectiveness of responses implemented at both national and regional levels. The aim of the paper is to critically review the Italian response to the COVID-19 crisis spanning from the first early acute phases of the emergency (March-May 2020) to the relative stability of the epidemiological situation just before the second outbreak in October 2020.

Corona-regionalism? Differences in regional responses to COVID-19 in Italy.

The paper discusses the responses to the COVID-19 crisis in the acute phase of the first wave of the pandemic (February-May 2020) by different Italian regions in Italy, which has a decentralised healthcare system. We consider five regions (Lombardy, Veneto, Emilia-Romagna, Umbria, Apulia) which are located in the north, centre and south of Italy. These five regions differ both in their healthcare systems and in the extent to which they were hit by the first wave of COVID-19 pandemic. We investigate their different responses to COVID-19 reflecting on seven management factors: (1) monitoring, (2) learning, (3) decision-making, (4) coordinating, (5) communicating, (6) leading, and (7) recovering capacity. In light of these factors, we discuss the analogies and differences among the regions and their different institutional choices.

Research protocol for the validation of a new portable technology for real-time continuous monitoring of Early Warning Score (EWS) in hospital practice and for an early-stage multistakeholder assessment.

INTRODUCTION: The real-time continuous monitoring of vital parameters in patients affected by multiple chronic conditions and/or COVID-19 can lead to several benefits to the Italian National Healthcare System (IT-NHS). The UBiquitous Integrated CARE (UBICARE) technology is a novel health digital platform at the validation stage in hospital setting. UBICARE might support the urgent need for digitalisation and early intervention, as well as minimise the face-to-face delivery of care in both hospital and community-based care settings. This research protocol aims to design an early-stage assessment of the multidimensional impact induced by UBICARE within the IT-NHS alongside technology validation in a hospital ward. METHODS AND ANALYSIS: The targeted patients will be medium/high-risk hypertensive individuals as an illustrative first example of how UBICARE might bring benefits to susceptible patients. A mixed-method study will be applied to incorporate to the validation study a multistakeholder perspective, including perceived patient experiences and preferences, and facilitate technology adoption. First, semistructured interviews will be undertaken with a variety of stakeholders including clinicians, health managers and policy-makers to capture views on the likely technology utility, economic sustainability, impact of adoption in hospital practice and alternative adoption scenarios. Second, a monocentric, non-randomised and non-comparative clinical study, supplemented by the administration of standardised usability questionnaires to patients and health professionals, will validate the use of UBICARE in hospital practice. Finally, the results of the previous stages will be discussed in a multidisciplinary-facilitated workshop with IT-NHS relevant stakeholders to reconcile stakeholders' perspectives. Limitations include a non-random recruitment strategy in the clinical study, small sample size of the key stakeholders and potential stakeholder recruitment bias introduced by the research technique. ETHICS AND DISSEMINATION: The Ethics Committee for Clinical Experimentation of Tuscany Region approved the protocol. Participation in this study is voluntary. Study results will be disseminated through peer-reviewed publications and academic conferences.