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Objectives: To compare the accuracy of the INTERGROWTH-21st (IG-21) with the Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG) abdominal circumference (AC) standards in the detection of small-for-gestational-age (SGA) fetuses in a high-risk population. Material and Methods: Our study included all pregnant patients with an increased risk of placental insufficiency that were seen in two Italian university hospitals between 2014 and 2015. The accuracy of IG-21 and SIEOG AC standards in the detection of SGA neonates was analyzed by means of the area under the receiver operating characteristic curve (ROC-AUC) at 4 gestational age intervals (24-27, 28-31, 32-35, >35 weeks). Results: We enrolled 428 patients (278 Italians). There was no significant difference between the ROC-AUC of AC according to IG-21 and SIEOG standards for all birthweight thresholds and gestational intervals that were considered. The diagnostic performance was similar in Italian and non-Italian patients. The accuracy was, however, limited, with values of ROC-AUC ranging between 0.80 and 0.89. Conclusions: The IG-21 and SIEOG AC standards are interchangeable for the diagnosis of SGA fetuses. The diagnostic accuracy is, however, limited. We provide figures that can be used to stratify the probability that an infant will be SGA in an obstetric population at increased risk of growth restriction.

BACKGROUND: Recent studies have reported declines in incidence, prevalence and mortality for abdominal aortic aneurysms (AAAs) in various countries, but evidence from Mediterranean countries is lacking. The aim of this study is to examine the trend of hospitalization and post-operative mortality rates for AAAs in Italy during the period 2000-2011, taking into account the introduction of endovascular aneurysm repair (EVAR) in 1990s. METHODS: This retrospective cohort study was carried out in Emilia-Romagna, an Italian region with 4.5 million inhabitants. A total of 19,673 patients hospitalized for AAAs between 2000 and 2011, were identified from the hospital discharge records (HDR) database. Hospitalization rates, percentage of OSR and EVAR and 30-day mortality rates were calculated for unruptured (uAAAs) and ruptured AAAs (rAAAs). RESULTS: Adjusted hospitalization rates decreased on average by 2.9% per year for uAAAs and 3.2% for rAAAs (p

In Italia, il processo di de-istituzionalizzazione e di implementazione di modelli di assistenza per la salute mentale sono caratterizzati da carenza di valutazione. In particolare, non sono state intraprese iniziative per monitorare le attività relative all’assistenza dei pazienti con disturbi psichiatrici. Pertanto, l’obiettivo della tesi è effettuare una valutazione comparativa dei percorsi di cura nell’ambito della salute mentale nei Dipartimenti di Salute Mentale e Dipendenze Patologiche della regione Emilia-Romagna utilizzando indicatori ottenuti dai flussi amministrativi correnti.. I dati necessari alla costruzione degli indicatori sono stati ottenuti attraverso un data linkage dei flussi amministrativi correnti regionali delle schede di dimissione ospedaliera, delle attività territoriali dei Centri di Salute Mentale e delle prescrizioni farmaceutiche, con riferimento all’anno 2010. Gli indicatori sono stati predisposti per tutti i pazienti con diagnosi principale psichiatrica e poi suddivisi per categoria diagnostica in base al ICD9-CM. . Il set di indicatori esaminato comprende i tassi di prevalenza trattata e di incidenza dei disturbi mentali, i tassi di ospedalizzazione, la ri-ospedalizzazione a 7 e 30 giorni dalla dimissione dai reparti psichiatrici, la continuità assistenziale ospedale-territorio, l’adesione ai trattamenti ed il consumo e appropriatezza prescrittiva di farmaci. Sono state rilevate alcune problematiche nella ricostruzione della continuità assistenziale ospedale-territorio ed alcuni limiti degli indicatori relativi alle prescrizioni dei farmaci. Il calcolo degli indicatori basato sui flussi amministrativi correnti si presenta fattibile, pur con i limiti legati alla qualità, completezza ed accuratezza dei dati presenti. L’implementazione di questi indicatori su larga scala (regionale e nazionale) e su base regolare può essere una opportunità per impostare un sistema di sorveglianza, monitoraggio e valutazione dell’assistenza psichiatrica nei DSM., In Italy, the process of de-institutionalisation and implementation of a community-based model in mental health care has been characterized by a lack of evaluation. In particular, no activity is or has been in place to develop or maintain standards of quality of care. Aim of this dissertation is to compare the care pathways in mental health services in Emilia Romagna Region using process and outcome indicator obtained from administrative databases. Process and outcome indicators of mental health care for Local Health Authorities of Emilia-Romagna Region (3,724,388 adult inhabitants in 2010) were obtained through linkage of hospital discharge records, community mental health service database and drug prescription database. The study cohorts include patients with a primary ICD-9-CM diagnosis code 290.xx-319 hospitalized or treated in community mental health services in 2010. The set of indicators explores treated prevalence and incidence rates by disorders and settings, continuity between hospital and community care, retention in treatment, re-hospitalizations, antidepressant drug and mood stabilizer prescriptions. Hospitalization rates varied from 159,0 to 290,3 per 100.000 inhabitants. Treated prevalence in the study area was 15‰ and incidence was 6‰. Of the patients treated by community mental health services, about 37% had a severe mental illness. The proportion of patients re-hospitalized within 30 days from discharge was 12%. Less than 6% of patients with severe mental illness discontinued treatment with community mental health services. Calculation of the selected indicators proved to be feasible, conditional on quality checks for completeness and accuracy of the primary diagnosis. Implementation of these indicators on a larger scale and on a regular basis may provide a unique opportunity to set up a mental health surveillance system and monitor treated prevalence and incidence of mental disorders as well as continuity of care and treatment outcomes at the patient level.

In Italia, il processo di de-istituzionalizzazione e di implementazione di modelli di assistenza per la salute mentale sono caratterizzati da carenza di valutazione. In particolare, non sono state intraprese iniziative per monitorare le attività relative all’assistenza dei pazienti con disturbi psichiatrici. Pertanto, l’obiettivo della tesi è effettuare una valutazione comparativa dei percorsi di cura nell’ambito della salute mentale nei Dipartimenti di Salute Mentale e Dipendenze Patologiche della regione Emilia-Romagna utilizzando indicatori ottenuti dai flussi amministrativi correnti.. I dati necessari alla costruzione degli indicatori sono stati ottenuti attraverso un data linkage dei flussi amministrativi correnti regionali delle schede di dimissione ospedaliera, delle attività territoriali dei Centri di Salute Mentale e delle prescrizioni farmaceutiche, con riferimento all’anno 2010. Gli indicatori sono stati predisposti per tutti i pazienti con diagnosi principale psichiatrica e poi suddivisi per categoria diagnostica in base al ICD9-CM. . Il set di indicatori esaminato comprende i tassi di prevalenza trattata e di incidenza dei disturbi mentali, i tassi di ospedalizzazione, la ri-ospedalizzazione a 7 e 30 giorni dalla dimissione dai reparti psichiatrici, la continuità assistenziale ospedale-territorio, l’adesione ai trattamenti ed il consumo e appropriatezza prescrittiva di farmaci. Sono state rilevate alcune problematiche nella ricostruzione della continuità assistenziale ospedale-territorio ed alcuni limiti degli indicatori relativi alle prescrizioni dei farmaci. Il calcolo degli indicatori basato sui flussi amministrativi correnti si presenta fattibile, pur con i limiti legati alla qualità, completezza ed accuratezza dei dati presenti. L’implementazione di questi indicatori su larga scala (regionale e nazionale) e su base regolare può essere una opportunità per impostare un sistema di sorveglianza, monitoraggio e valutazione dell’assistenza psichiatrica nei DSM., In Italy, the process of de-institutionalisation and implementation of a community-based model in mental health care has been characterized by a lack of evaluation. In particular, no activity is or has been in place to develop or maintain standards of quality of care. Aim of this dissertation is to compare the care pathways in mental health services in Emilia Romagna Region using process and outcome indicator obtained from administrative databases. Process and outcome indicators of mental health care for Local Health Authorities of Emilia-Romagna Region (3,724,388 adult inhabitants in 2010) were obtained through linkage of hospital discharge records, community mental health service database and drug prescription database. The study cohorts include patients with a primary ICD-9-CM diagnosis code 290.xx-319 hospitalized or treated in community mental health services in 2010. The set of indicators explores treated prevalence and incidence rates by disorders and settings, continuity between hospital and community care, retention in treatment, re-hospitalizations, antidepressant drug and mood stabilizer prescriptions. Hospitalization rates varied from 159,0 to 290,3 per 100.000 inhabitants. Treated prevalence in the study area was 15‰ and incidence was 6‰. Of the patients treated by community mental health services, about 37% had a severe mental illness. The proportion of patients re-hospitalized within 30 days from discharge was 12%. Less than 6% of patients with severe mental illness discontinued treatment with community mental health services. Calculation of the selected indicators proved to be feasible, conditional on quality checks for completeness and accuracy of the primary diagnosis. Implementation of these indicators on a larger scale and on a regular basis may provide a unique opportunity to set up a mental health surveillance system and monitor treated prevalence and incidence of mental disorders as well as continuity of care and treatment outcomes at the patient level.

Introduction: Integration between primary care and mental health care is critical for health-care systems. Some years ago, the Emilia-Romagna Region undertook a project (the "Leggieri Project") aimed at rationalizing pathways to care and improving the quality of treatments for common psychiatric disorders. The aim of this study was to monitor and assess local implementation of the stepped care model outlined by the regional project. Materials and methods: We examined all new cases referred to Bologna Mental Health Centers (MHCs) from 2007 through 2009 (N = 15,534). Data on patients, referrals and treatments were collected from Department of Mental Health's Adult Psychiatry database. Standardized incidence rates, rates of referrals from general practitioners (GPs), and stepped care levels were investigated. We compared patient characteristics and treatments of cases referred by GPs and all other cases. A similar analysis was carried out for groups defined by stepped care level. Results: The annual incidence of MHC referral ranged from 64.7 to 65.8 per 10,000 adult inhabitants. On the whole, 52% of the new cases were referred to the MHCs by GPs: this rate increased over time from 48% to 54%. As for stepped care, MHC care was planned for 55% of the patients referred by GPs, 14% were managed with joint GP and MHC care, and 31% of the new cases were back-referred after a psychiatric consultation. The differences between these levels of care narrowed over the three-year period: cases managed with psychiatric consultations or joint GP-MHC care increased, while those managed exclusively by the MHC decreased. Almost 50% of all cases involving non-Italian immigrants were referred by GPs, although this rate was lower than that observed among Italian patients. These trends were evident in each departmental area. Patients referred by GPs were more likely to be elderly women with common psychiatric disorders. Among these, the cases managed in MHCs had the most severe diagnoses and received the most intensive and long-lasting treatments. Conclusions: Integration of primary care and mental health care is increasing and seems to be appropriate. In accordance with the recommendations of the regional project, integrated care is used above all for patients with common psychiatric disorders. Collaborative care for severe disorders requires further investigation. For these disorders, which often affect young patients and are frequently associated with comorbidity and a high risk of chronicity evolution, early detection and integrated care are crucial goals for the immediate future.

Background In Italy and in other European countries, both at local and national level, the process of de-institutionalisation and implementation of a community-based model in mental health care has been characterized by a lack of evaluation. In particular, no activity is or has been in place to develop or maintain standards of quality of care. The aim of this study is to investigate the feasibility of the calculation of process and outcome indicators using administrative databases. Methods Process and outcome indicators of mental health care for 2 Local Health Authorities of Emilia-Romagna Region (Italy, 1.298.103 adult inhabitants) were obtained through linkage of hospital discharge records, the community mental health service database (year 2009) and the drug prescription database (years 2009 and 2010). The study cohorts include patients with a primary ICD-9-CM diagnosis code 290.xx-319 hospitalized or treated in the community mental health services in the year 2009. The set of indicators explore treated prevalence and incidence rates by disorder and setting, continuity between hospital and community care, retention in treatment, rehospitalizations, antidepressant drug and mood stabilizer prescriptions. Results Hospitalization rates varied by diagnosis (from 19 to 160 per 100.000 inhabitants) and increased with age. Treated prevalence in the two study areas was 2% and incidence was 0.7%. Of the patients treated by community mental health services, about 2% had a non-defined or a non-psychiatric diagnosis. The proportion of patients rehospitalized within 30 days from discharge was 19%. Less than 10% of patients with severe mental illness discontinued treatment with community mental health services. Conclusions Calculation of the selected indicators proved to be feasible, conditional on quality checks for completeness and accuracy of the primary diagnosis. Implementation of these indicators on a larger scale (regional or national) and on a regular basis may provide a unique opportunity to set up a mental health surveillance system and monitor treated prevalence and incidence of mental disorders as well as continuity of care and treatment outcomes at the patient level.

Background there is a wide debate in the literature about whether concentrating surgical procedure for colon cancer in larger hospitals could improve quality of care and outcomes. The aim of our study is to assess if there is an association between volume and surgical outcomes such as: reintervention in the index hospitalization, 30 day readmission and 30 day inhospital mortality in patients with a diagnosis of colon cancer in the surgical wards in Emilia-Romagna Region, Italy. Methods 14,200 colon cancer interventions performed from January 1st 2005 to December 31st 2010 were considered for analysis. Gender, age, comorbidities, presence of metastases, admission status and type of intervention were collected from hospital discharge records and considered as potential risk factors. We categorized ward volume as low (< 50 interventions per year) and high (50 interventions per year). We then performed a random intercept multilevel logistic regression with three levels (patients, surgical wards and hospitals). In the multilevel logistic regression model only the factors selected by using a stepwise procedure (p-entry = 0.05 and p-stay = 0.05) were included. Results preliminary results in the final model showed a significant association between volume and each of the three outcomes. The adjusted ORs of reintervention and 30-day readmission in high compared to low volume wards were 0.64 (95% CI = 0.450.93) and 0.83 (95% CI = 0.720.96), respectively. The adjusted ORs of 30 day in-hospital mortality in high compared to low volume wards were 0.45 (95% CI = 0.270.72) for elective patients and 0.82 (95% CI = 0.55–1.24) for urgent patients.

Background Recent guidelines recommend early surgical treatment of hip fractures in the elderly. Understanding the factors that delay surgical intervention is essential in order to facilitate early treatment. The aim of the present study is to determine the factors delaying surgical treatment of hip fractures in elderly patients for more than 2 days. Methods Assessment of hospital discharge records and chart review of 1733 consecutive patients undergoing surgery for hip fractures between 2004-2007 at the two Italian wards of Sant�Orsola-Malpighi Hospital, Bologna (N=1286) and S. Maria della Scaletta Hospital, Imola (N=447). Logistic regression models were used to examine potential predictors of surgery delay including gender, age, ward, comorbidity, type of intervention (partial or total hip replacement, reduction and internal fixation), International Normalized Ratio (INR), Haemoglobin (Hb), American Society of Anaesthesiologists (ASA) score, and day of admission (categorized as Monday to Wednesday, Thurday-Friday, Saturday-Sunday). Results 923 (53.3%) patients were operated within 2 days of admission to the hospital. Age, arrhythmia, type of intervention (partial or total hip replacement), INR score>1.5 and an ASA score of 4 compared to 1-2, admission on Thurdays-Friday or Saturday-Sunday and ward significantly predicted a surgery delay of more than 2 days. The Hosmer-Lemeshow test denoted a good model fit (χ�=12.2, p=0.14). Conclusions Both organization and medical problems accounted for delays of surgical treatment of hip fractures. A multidisciplinary approach, with early input by medical and anaesthetic teams, is needed for managing elderly patients with hip fracture. The availability of the operating theater during the weekend and established protocols aimed to optimize the patient flow logistics may be crucial to make hospitals more patient-centered and to improve patient outcomes