Search

In a randomized control trial mid-regional proadrenomedullin (MR-proADM)-guided decision-making has been proven to safely reduce hospital admissions based on an accurate assessment of disease severity in the Emergency Department (ED). This study aimed to assess the impact of a MR-proADM-Guided Triage (MR-GT) versus standard Hospital Triage (HT) on clinical and economic outcomes in ED patients with suspected infection in Spain, Italy, Germany, and the UK, using Patient-Level Data (PLD) from two observational studies. PLD was collected from patients enrolled at a Spanish hospital during two observational studies. Logistic regression was used to identify predictors of hospitalization. A patient-level simulation model was subsequently developed to evaluate the clinical and economic impact of MR-GT versus HT using results from the statistical analysis and country-specific cost data from the published literature. Probabilistic and deterministic sensitivity analyses were carried out. Four hundred seventy-three patients were enrolled in this study. MR-proADM had the strongest association with hospital admission, followed by age and National Early Warning Score (NEWS). In the simulation model, MR-GT was associated with an overall reduction in unnecessary hospitalization relative to HT, equal to 22.6 percentage points (40.9% vs 63.5%). In addition, the use of MR-GT would reduce the total hospital cost per patient presenting to the ED with suspected infection by roughly 30%, with a mean cost saving per patient of €626, €1,484, €1,154, and £1,113 in Spain, Italy, Germany, and the UK respectively. The robustness of these findings was confirmed by sensitivity analyses. The statistical analyses were not performed on the same population simulated in the model. Clinical input parameters were assumed to be the same for all countries. MR-proADM showed to be the main predictor of hospitalization. A MR-proADM decision algorithm provides cost savings in Spain, Italy, Germany, and the UK.

Over the past 20 years, the prevalence of diabetes in Italy has been growing, up to the current estimated proportion of about 8.5%, which accounts also for undiagnosed patients. As most of these subjects are >65 years of age, the probability of having comorbidities is high. In addition, diabetes itself exposes patients to a wide spectrum of complications, that cover several therapeutic areas. This is why the optimal management of diabetes necessarily involves a multidisciplinary team.Several models of integrated care of chronic diseases may be set: for instance, the role assigned to GPs and specialists may differ among models. Indeed, a disequilibrium between GPs and specialists is deemed to be the main cause of the low patients’ participation in Progetto Cronicità (chronic diseases project), which started in Lombardia (a Northern region in Italy) in 2018.A help to understand how to build a proper integrated care model in diabetes comes from the experience of the Authors, that describe in detail their experience in IRCCS MultiMedica (Sesto San Giovanni, MI, Italy).This Supplement ends with a review of the evidence found in literature about the advantages of a multidisciplinary management of diabetes in terms of outcomes, costs, and patients’ satisfaction.

Additional file 1 A pdf file providing more information on the usage of the proposed framework, in particular the whole Pertussis analysis is showed. Furthermore, a simpler example of analysis is exploited as a step by step guide of the EPIMOD package.

Additional file 1: Complete input parameters, included studies details and additional results and analyses.

This file gives additional information on the characteristics of all studies included in the primary meta-analysis. (DOCX 134 kb)

This file provides a summary of effect estimates for primary and secondary outcomes including subgroups of all RCTs. (DOCX 36 kb)

This file explains the methodology of the meta-analysis and systematic review in more detail. (DOCX 48 kb)