Developing a new predictor of health expenditure: preliminary results from a primary healthcare setting.

OBJECTIVES: Risk adjustment is a widely used tool for health expenditure prediction and control. Early approaches for estimating health expenditure were based on patient demographic variables alone, whereas more recent models incorporate patient information, such as chronic medical conditions, clinical diagnoses, and self-reported health status. Many studies have investigated the health expenditure predictive capacity of single demographic, morbidity, or health-related quality of life measures, but the best models prove to be those that include them all. The aim of this study was to develop an index that combines measures of perceived health and disease severity and to compare its efficacy in predicting health expenditure with that of the measures taken individually. STUDY DESIGN: This is a linked cross-sectional study. METHODS: In 2009 and 2010, the health-related quality of life questionnaire SF-36 (8 scales, two indices: Physical Component Summary [PCS] and Mental Component Summary [MCS]) was distributed to 886 patients of general practitioners in the Province of Siena, Italy. Severity of diseases was calculated for each patient using the Charlson Index (CH-I) and Cumulative Illness Rating Scale Severity Index (CIRS-SI). Siena Local Health Unit 2012 data on health expenditure were obtained for each patient. Multivariate linear regression was applied to test the performance of severity (CH-I, CIRS-SI) and perceived health (PCS and MCS) measures in predicting health expenditure. The indexes that predicted health expenditure best were then combined in a new tool, and its expenditure predictive capacity was tested. RESULTS: The best health expenditure predictors proved to be PCS and SI (R2 = 0.15 and R2 = 0.17, respectively). When combined in a new index (PCS-SI), better predictive capacity of health expenditure was obtained than with the two single measures separately (R2 = 0.19). CONCLUSIONS: A multidimensional indicator proved to be a better predictor of healthcare expenditure than single health measures.

Effects of anticoagulation therapy with vitamin K antagonists on hospitalizations and emergency room accesses in Grosseto (Italy).

INTRODUCTION: A lot of drug groups are associated with preventable drug-related admissions. Coumarin derivatives, prescribed for the treatment and prevention of deep vein thrombosis or pulmonary embolism or prevention of systemic embolism or stroke in patients with prosthetic heart valves or atrial fibrillation, are often associated with bleeding. The aim of our study was to analyze how the anticoagulant therapy with VKAs could affects the hospitalizations and the visits to emergency room in the elderly population (> 65 years old). METHODS: In 2013 we conducted a cross sectional study analyzing the database of all pharmaceutical prescriptions, selecting patients living in Grosseto (Italy), which received at least two prescriptions of coumarin derivatives in 2012. We analyzed the admissions to hospital and the accesses to the emergency rooms (ERs) made by each patient, focusing especially on those related to bleeding. For each access to ER we recorded the date, time of stay, diagnosis and outcome. For each hospitalization the information we recorded were the date of admission and discharge diagnosis. RESULTS: 3684 patients were included in our study. 261 (7.1%) patients visited the emergency room for bleeding; 37 (1%) for intracranial bleeding. The accesses made by men were higher than those made by women. The average time of stay in ER was 349 minutes. The admissions to hospital were 96 (2.6%); 42 (1.1%) were admitted to hospital with a diagnosis of major vascular event. 53 patients (20.3%), accessed to the ER more than one time. The 11.5% was admitted to the hospital more than one time. CONCLUSIONS: Our study showed that VKAs are responsible of an increase of the accesses to ER and of the admissions to hospital. However, it would be interesting to enlarge the sample size including patients living in other provinces or in other regions, with a lower age and treated also with TSOACs, in order to evaluate the real cost-effectiveness of anticoagulant therapy.

Italian medical students quality of life: years 2005-2015.

BACKGROUND: Quality of Life (QoL) is a concept used to indicate the general wellness of persons or societies. University students report a low quality of life and a worse perception of their health status, because of a situation of greater discomfort in which they live during the course of the study, especially in faculties with an important emotional burden, such as medical schools. The aim of the study was to evaluate the perceived health status of first year medical students. METHODS: We conducted a cross sectional study in the time span 2005-2015, administering the questionnaire Short Form 36 (SF-36) to first-year students of the School of Medicine of the University of Siena, Italy. In addition to demographic information such as gender and the age we investigated the region of residence, marital status, employment status, and smoking habits; height and weight were required to calculate the body mass index (BMI) to evaluate a possible physical discomfort connected with the perception of health status. The data from the questionnaires were organized and processed by software Stata® SE, version 12.1. RESULTS: 1,104 questionnaires were collected. Medical students reported lower SF-36 scores, compared to the Italian population of the same age. Female gender and smoking habits influence negatively the score of several scales. Body Mass Index is positively correlated with the Physical Activity, while Age is negatively correlated with Social Activities. CONCLUSIONS: The perceived quality of life of the Italian medical students is lower when compared to the general population. This confirms that the condition of student implies additional problems, as other studies reports. It would be better to improve it, developing students' resilience. It would be interesting to extend this research to students of other years, from other faculties and other locations, to gain a broader view about the QoL of the Italian students.

Cyst of seminal vesicle with ectopic ureter and ipsilateral renal dysplasia: case report.

A case of ectopic ureter in a cystic seminal vesicle associated to a microkidney is presented. The diagnosis was established by history, physical examination, CT and direct contrastography by perineal access. Treatment consisted of excision of the cystic seminal vesicle with the ectopic ureter and dysplasic kidney.