Anna Patrizia Barone - Academia.edu (original) (raw)
Papers by Anna Patrizia Barone
Giornale italiano di cardiologia, 2005
Il presente documento indica il percorso clinico assistenziale in emergenza (PCAE) per i pazienti... more Il presente documento indica il percorso clinico assistenziale in emergenza (PCAE) per i pazienti affetti da infarto miocardico acuto con sopraslivellamento persistente del tratto ST (STEMI) all’elettrocardiogramma (ECG). Obiettivo principale del PCAE per lo STEMI è quello di definire percorsi diagnostici e terapeutici appropriati e basati sulle evidenze, al fine di ottimizzare la diagnosi e il trattamento dei pazienti affetti da infarto acuto del miocardio. Il presente documento prevede una parte generale sulla metodologia utilizzata – per la cui lettura si rimanda al sito web dell’Agenzia di Sanità Pubblica (ASP) del Lazio (www.asplazio.it/home/Sistemi Informativi/Emergenza Sanitaria/Attività dell’Emergenza/PCAE/Parte Generale/Introduzione) – ed una parte specifica relativa allo STEMI. Il PCAE è stato redatto da un Gruppo Multidisciplinare di Esperti costituito da anestesisti-rianimatori, cardiologi, cardiologi emodinamisti, cardiochirurghi, direttori sanitari, epidemiologi, geria...
Acta cardiologica, 2010
Coronary revascularization methods are among the most common major medical procedures performed i... more Coronary revascularization methods are among the most common major medical procedures performed in industrialized countries. The short- and long-term comparative effectiveness of different techniques remains undetermined. The study population included all adult patients (94,864 subjects) admitted for acute myocardial infarction (AMI) in 2004 in Italy, as recorded in the National Hospital Discharge Records. Invasive reperfusion therapy (coronary artery bypass graft, percutaneous coronary intervention), and standard medical treatments were compared. End points were short-term (30-day) in-hospital mortality and any combination of new revascularizations, re-AMI, stroke, or death (MACCE) occurring within 6 and 12 months from initial treatment. Risk factors and comorbidities were used to define patients' health status. The Cox model was applied to evaluate risk-adjusted hazard ratios (HR) for different approaches. Medical treatment was used as the reference category. Propensity score ...
Epidemiologia e prevenzione
The increasing demand for comparative evaluation of outcomes requires the development and diffusi... more The increasing demand for comparative evaluation of outcomes requires the development and diffusion of epidemiologic research, the ability to correctly conduct analyses and to interpret results. When healthcare outcomes are used for comparing quality of care across providers, failure to use methods of risk adjustment to account for any variation in patient populations can lead to misinterpretation of the findings. The purpose of this paper is to provide a detailed but easy-reading review of different risk adjustment methodologies to compare health care outcomes. The paper is divided in two parts. Introduction describes the difference between experimental and observational studies, the role of confounding in observational studies and the ways confounding is identified and controlled (propensity adjustment and risk adjustment), Specific part on risk adjustment describes: (1) the methods for constructing the severity measures; (2) the methods that use the severity measures to obtain &q...
Italian heart journal : official journal of the Italian Federation of Cardiology, 2005
We present an evidence-based diagnostic and therapeutic pathway for the treatment of subjects wit... more We present an evidence-based diagnostic and therapeutic pathway for the treatment of subjects with suspected acute elevated ST-segment myocardial infarction (STEMI). The pathway was developed to aid the reorganization of the emergency service (ES) of the Lazio Region of Italy. Pathway development followed several phases: a) setting up of a multidisciplinary panel comprising all professional figures involved in the management of STEMI subjects; b) drafting of a list of important research questions with a particular focus on areas of clinical and organization uncertainty; c) systematic searches for relevant international scientific evidence to answer research questions; d) assessment, synthesis and classification of identified evidence according to the quality of evidence; e) formulation of management recommendations by their strength according to the methods used by the national guidelines program; f) presentation of draft findings and recommendations; g) external peer review of the ...
Giornale italiano di cardiologia (2006), 2011
Observational outcome studies represent a valid approach to evaluating comparative treatment effe... more Observational outcome studies represent a valid approach to evaluating comparative treatment effectiveness in real populations. The main objective of outcome research is to underline what works and what does not work in the field of health assistance. In 2004 the Italian Ministry of Health launched the Project "Mattone Misura dell'Outcome" aimed at assessing the introduction of procedures and methods for the systematic evaluation of outcomes in the national health system. A new experience, the PROGRESSI program (PROGRamma ESiti per SIVeAS e LEA), started in 2008 with the aim to further develop the methodologies for outcome evaluation. In this Supplement the final results from four clinical studies named "Sperimentazioni dell'area cardiovascolare del Progetto Mattoni" are presented. These studies started between 2005 and 2007 and their main objectives were to evaluate: --the contribution of information from current informative systems and clinical studies ...
Journal of Cardiovascular Medicine, 2006
Objective The increasing demand for comparative evaluation of outcomes requires the development a... more Objective The increasing demand for comparative evaluation of outcomes requires the development and diffusion of epidemiologic research, the ability to correctly formulate hypotheses, to conduct analyses and to interpret the results. The purpose of this paper is to provide a detailed but easy-reading review of epidemiologic methods to compare healthcare outcomes, particularly riskadjustment methods. Methods The paper is divided into three parts. Part I describes confounding in observational studies, the ways confounding is identified and controlled (propensity adjustment and risk adjustment), and the methods for constructing the severity measures in risk-adjustment procedures. Conclusions It is becoming increasingly important for policy makers and planners to identify which factors may improve or worsen the effectiveness of treatments and services and to compare the performances of providers. Politicians, managers, epidemiologists, and clinicians should make their decisions based on the validity and precision of study results, by using the best scientific knowledge available. The statistical methods described in this review cannot measure 'reality' as it 'truly' is, but can produce 'images' of it, defining limits and uncertainties in terms of validity and precision. Studies that use credible risk-adjustment strategies are more likely to yield reliable and applicable findings.
Journal of Epidemiology & Community Health, 2011
Conclusion The algorithm showed good performance to identify COPD patients among those individual... more Conclusion The algorithm showed good performance to identify COPD patients among those individuals registered in the regional healthcare system confirming the strength of administrative data for monitoring chronic diseases.
Journal of Clinical Pharmacy and Therapeutics, 2011
What is known and Objective: Adherence to evidence-based drug therapy after acute myocardial infa... more What is known and Objective: Adherence to evidence-based drug therapy after acute myocardial infarction has increased over the last decades, but is still unsatisfactory. Our objectives are to set out to analyse patterns of evidence-based drug therapy after acute myocardial infarction (AMI), and evaluating socio-demographic differences. Methods: A cohort of 3920 AMI patients discharged from hospital in Rome (2006-2007) was selected. Drugs claimed during the 12 months after discharge were retrieved. Drug utilization was defined as density of use (boxes claimed/individual follow-up; chronic use = 6+ boxes/365 days) and therapeutic coverage, calculated through Defined Daily Doses (chronic use: ‡80% of individual follow-up). Patterns of use of single drugs and their combination were described. The association between poly-therapy and gender, age and socioeconomic position (small-area composite index based on census data) was analysed through logistic regression, accounting for potential confounders. Results and Discussion: Most patients used single drugs: 90AE5% platelet aggregation inhibitors (antiplatelets), 60AE0% b-blockers, 78AE1% agents acting on the renin-angiotensin system (ACEIs/ARBs), 77AE8% HMG CoA reductase inhibitors (statins). Percentages of patients with ‡80% of therapeutic coverage were 81AE9% for antiplatelets, 17AE8% for b-blockers, 64AE4% for ACEIs/ARBs and 76AE1% for statins. The multivariate analysis showed gender and age differences in adherence to poly-therapy (females: OR = 0AE84; 95% CI 0AE72-0AE99; 71-80 years age-group: OR = 0AE82; 95% CI 0AE68-0AE99). No differences were observed with respect to socioeconomic position. What is new and Conclusion: The availability of information systems offers the opportunity to monitor the quality of care and identify weaknesses in public health-care systems. Our results identify specific factors contributing to non-adherence and hence define areas for more targeted
Journal of Clinical Epidemiology, 2011
Comparative evaluations of clinical outcomes (e.g., in-hospital mortality, complications after a ... more Comparative evaluations of clinical outcomes (e.g., in-hospital mortality, complications after a surgical procedure) or health care processes involve the definition of several indicators for each study unit. Graphical displays are best suited for highlighting the main patterns in the data. The aim of this study was to compare different graphical techniques, including target plots, radar plots, and "spie" charts, for comparing the performances of different health care providers. Thirteen indicators were calculated and combined in eight composite indices for eight clinical categories of interest. The indices were displayed with target plots, radar plots, and "spie" charts. All the three techniques had an immediate interpretation and were easy to implement. However, target plots failed to highlight small differences between indicators, whereas radar plots were strongly influenced by the order in which the indicators were displayed. Both target and radar plots assumed equal weights for the indicators, and did not allow predetermined judgments on the relative importance of the indicators. "Spie" charts overcame the primary limitations of the other two techniques. Furthermore, they are well suited to summarize the overall performance of a health care provider with a single score. "Spie" charts represented the best graphical tool for displaying multivariate health care data in comparative evaluations of clinical outcomes and processes of care among health care providers.
International Journal for Quality in Health Care, 2009
Objective. In countries where the National Health Service provides universal health coverage, soc... more Objective. In countries where the National Health Service provides universal health coverage, socioeconomic position should not influence the quality of health care. We examined whether socioeconomic position plays a role in short-term mortality and waiting time for surgery after hip fracture. Design. Retrospective cohort study. Settings and participants. From the Hospital Information System database, we selected all patients, aged at least 65 years and admitted to acute care hospitals in Rome for a hip fracture between 1 January 2006 and 30 November 2007. The socioeconomic position of each individual was obtained using a city-specific index of socioeconomic variables based on the individual's census tract of residence. Main outcome measures. Three different outcomes were defined: waiting times for surgery, mortality within 30 days and intervention within 48 h of hospital arrival for hip fracture. We used a logistic regression to estimate 30-day mortality and a Cox proportional hazard model to calculate hazard ratios of intervention within 48 h. Median waiting times were estimated by adjusted Kaplan-Meyer curves. Analyses were adjusted for age, gender and coexisting medical conditions. Results. Low socioeconomic level was significantly associated with higher risk of mortality [adjusted relative risk (RR) ¼ 1.51; P , 0.05] and lower risk of early intervention (adjusted RR ¼ 0.32; P , 0.001). Socioeconomic level had also an effect on waiting times within 30 days. Conclusions. Individuals living in disadvantaged census tracts had poorer prognoses and were less likely than more affluent people to be treated according to clinical guidelines despite universal healthcare coverage.
Giornale italiano di …, 2008
Citation: Seccareccia F, D'Errigo P, Rosato S, Maraschini A, Badoni G, Perucci CA, Fusco D, ... more Citation: Seccareccia F, D'Errigo P, Rosato S, Maraschini A, Badoni G, Perucci CA, Fusco D, Colais P, D'Ovidio M, Barone AP, Gruppo di ricerca del Progetto Mattoni del SSN--Misura dell'Outcome, Gruppo di ricerca dello studio IN-ACS Outcome-Italian Network on Acute ...
BMC Health Services Research, 2012
Background: P.Re.Val.E. is the most comprehensive comparative evaluation program of healthcare ou... more Background: P.Re.Val.E. is the most comprehensive comparative evaluation program of healthcare outcomes in Lazio, an Italian region, and the first Italian study to make health provider performance data available to the public. The aim of this study is to describe the P.Re.Val.E. and the impact of releasing performance data to the public. Methods: P.Re.Val.E. included 54 outcome/process indicators encompassing many different clinical areas. Crude and adjusted rates were estimated for the 2006-2009 period. Multivariate regression models and direct standardization procedures were used to control for potential confounding due to individual characteristics. Variable life-adjusted display charts were developed, and 2008-2009 results were compared with those from 2006-2007. Results: Results of 54 outcome indicators were published online at http://www.epidemiologia.lazio.it/prevale10/ index.php. Public disclosure of the indicators' results caused mixed reactions but finally promoted discussion and refinement of some indicators. Based on the P.Re.Val.E. experience, the Italian National Agency for Regional Health Services has launched a National Outcome Program aimed at systematically comparing outcomes in hospitals and local health units in Italy. Conclusions: P.Re.Val.E. highlighted aspects of patient care that merit further investigation and monitoring to improve healthcare services and equity.
Epidemiologia e prevenzione
Giornale italiano di cardiologia, 2005
Il presente documento indica il percorso clinico assistenziale in emergenza (PCAE) per i pazienti... more Il presente documento indica il percorso clinico assistenziale in emergenza (PCAE) per i pazienti affetti da infarto miocardico acuto con sopraslivellamento persistente del tratto ST (STEMI) all’elettrocardiogramma (ECG). Obiettivo principale del PCAE per lo STEMI è quello di definire percorsi diagnostici e terapeutici appropriati e basati sulle evidenze, al fine di ottimizzare la diagnosi e il trattamento dei pazienti affetti da infarto acuto del miocardio. Il presente documento prevede una parte generale sulla metodologia utilizzata – per la cui lettura si rimanda al sito web dell’Agenzia di Sanità Pubblica (ASP) del Lazio (www.asplazio.it/home/Sistemi Informativi/Emergenza Sanitaria/Attività dell’Emergenza/PCAE/Parte Generale/Introduzione) – ed una parte specifica relativa allo STEMI. Il PCAE è stato redatto da un Gruppo Multidisciplinare di Esperti costituito da anestesisti-rianimatori, cardiologi, cardiologi emodinamisti, cardiochirurghi, direttori sanitari, epidemiologi, geria...
Acta cardiologica, 2010
Coronary revascularization methods are among the most common major medical procedures performed i... more Coronary revascularization methods are among the most common major medical procedures performed in industrialized countries. The short- and long-term comparative effectiveness of different techniques remains undetermined. The study population included all adult patients (94,864 subjects) admitted for acute myocardial infarction (AMI) in 2004 in Italy, as recorded in the National Hospital Discharge Records. Invasive reperfusion therapy (coronary artery bypass graft, percutaneous coronary intervention), and standard medical treatments were compared. End points were short-term (30-day) in-hospital mortality and any combination of new revascularizations, re-AMI, stroke, or death (MACCE) occurring within 6 and 12 months from initial treatment. Risk factors and comorbidities were used to define patients' health status. The Cox model was applied to evaluate risk-adjusted hazard ratios (HR) for different approaches. Medical treatment was used as the reference category. Propensity score ...
Epidemiologia e prevenzione
The increasing demand for comparative evaluation of outcomes requires the development and diffusi... more The increasing demand for comparative evaluation of outcomes requires the development and diffusion of epidemiologic research, the ability to correctly conduct analyses and to interpret results. When healthcare outcomes are used for comparing quality of care across providers, failure to use methods of risk adjustment to account for any variation in patient populations can lead to misinterpretation of the findings. The purpose of this paper is to provide a detailed but easy-reading review of different risk adjustment methodologies to compare health care outcomes. The paper is divided in two parts. Introduction describes the difference between experimental and observational studies, the role of confounding in observational studies and the ways confounding is identified and controlled (propensity adjustment and risk adjustment), Specific part on risk adjustment describes: (1) the methods for constructing the severity measures; (2) the methods that use the severity measures to obtain &q...
Italian heart journal : official journal of the Italian Federation of Cardiology, 2005
We present an evidence-based diagnostic and therapeutic pathway for the treatment of subjects wit... more We present an evidence-based diagnostic and therapeutic pathway for the treatment of subjects with suspected acute elevated ST-segment myocardial infarction (STEMI). The pathway was developed to aid the reorganization of the emergency service (ES) of the Lazio Region of Italy. Pathway development followed several phases: a) setting up of a multidisciplinary panel comprising all professional figures involved in the management of STEMI subjects; b) drafting of a list of important research questions with a particular focus on areas of clinical and organization uncertainty; c) systematic searches for relevant international scientific evidence to answer research questions; d) assessment, synthesis and classification of identified evidence according to the quality of evidence; e) formulation of management recommendations by their strength according to the methods used by the national guidelines program; f) presentation of draft findings and recommendations; g) external peer review of the ...
Giornale italiano di cardiologia (2006), 2011
Observational outcome studies represent a valid approach to evaluating comparative treatment effe... more Observational outcome studies represent a valid approach to evaluating comparative treatment effectiveness in real populations. The main objective of outcome research is to underline what works and what does not work in the field of health assistance. In 2004 the Italian Ministry of Health launched the Project "Mattone Misura dell'Outcome" aimed at assessing the introduction of procedures and methods for the systematic evaluation of outcomes in the national health system. A new experience, the PROGRESSI program (PROGRamma ESiti per SIVeAS e LEA), started in 2008 with the aim to further develop the methodologies for outcome evaluation. In this Supplement the final results from four clinical studies named "Sperimentazioni dell'area cardiovascolare del Progetto Mattoni" are presented. These studies started between 2005 and 2007 and their main objectives were to evaluate: --the contribution of information from current informative systems and clinical studies ...
Journal of Cardiovascular Medicine, 2006
Objective The increasing demand for comparative evaluation of outcomes requires the development a... more Objective The increasing demand for comparative evaluation of outcomes requires the development and diffusion of epidemiologic research, the ability to correctly formulate hypotheses, to conduct analyses and to interpret the results. The purpose of this paper is to provide a detailed but easy-reading review of epidemiologic methods to compare healthcare outcomes, particularly riskadjustment methods. Methods The paper is divided into three parts. Part I describes confounding in observational studies, the ways confounding is identified and controlled (propensity adjustment and risk adjustment), and the methods for constructing the severity measures in risk-adjustment procedures. Conclusions It is becoming increasingly important for policy makers and planners to identify which factors may improve or worsen the effectiveness of treatments and services and to compare the performances of providers. Politicians, managers, epidemiologists, and clinicians should make their decisions based on the validity and precision of study results, by using the best scientific knowledge available. The statistical methods described in this review cannot measure 'reality' as it 'truly' is, but can produce 'images' of it, defining limits and uncertainties in terms of validity and precision. Studies that use credible risk-adjustment strategies are more likely to yield reliable and applicable findings.
Journal of Epidemiology & Community Health, 2011
Conclusion The algorithm showed good performance to identify COPD patients among those individual... more Conclusion The algorithm showed good performance to identify COPD patients among those individuals registered in the regional healthcare system confirming the strength of administrative data for monitoring chronic diseases.
Journal of Clinical Pharmacy and Therapeutics, 2011
What is known and Objective: Adherence to evidence-based drug therapy after acute myocardial infa... more What is known and Objective: Adherence to evidence-based drug therapy after acute myocardial infarction has increased over the last decades, but is still unsatisfactory. Our objectives are to set out to analyse patterns of evidence-based drug therapy after acute myocardial infarction (AMI), and evaluating socio-demographic differences. Methods: A cohort of 3920 AMI patients discharged from hospital in Rome (2006-2007) was selected. Drugs claimed during the 12 months after discharge were retrieved. Drug utilization was defined as density of use (boxes claimed/individual follow-up; chronic use = 6+ boxes/365 days) and therapeutic coverage, calculated through Defined Daily Doses (chronic use: ‡80% of individual follow-up). Patterns of use of single drugs and their combination were described. The association between poly-therapy and gender, age and socioeconomic position (small-area composite index based on census data) was analysed through logistic regression, accounting for potential confounders. Results and Discussion: Most patients used single drugs: 90AE5% platelet aggregation inhibitors (antiplatelets), 60AE0% b-blockers, 78AE1% agents acting on the renin-angiotensin system (ACEIs/ARBs), 77AE8% HMG CoA reductase inhibitors (statins). Percentages of patients with ‡80% of therapeutic coverage were 81AE9% for antiplatelets, 17AE8% for b-blockers, 64AE4% for ACEIs/ARBs and 76AE1% for statins. The multivariate analysis showed gender and age differences in adherence to poly-therapy (females: OR = 0AE84; 95% CI 0AE72-0AE99; 71-80 years age-group: OR = 0AE82; 95% CI 0AE68-0AE99). No differences were observed with respect to socioeconomic position. What is new and Conclusion: The availability of information systems offers the opportunity to monitor the quality of care and identify weaknesses in public health-care systems. Our results identify specific factors contributing to non-adherence and hence define areas for more targeted
Journal of Clinical Epidemiology, 2011
Comparative evaluations of clinical outcomes (e.g., in-hospital mortality, complications after a ... more Comparative evaluations of clinical outcomes (e.g., in-hospital mortality, complications after a surgical procedure) or health care processes involve the definition of several indicators for each study unit. Graphical displays are best suited for highlighting the main patterns in the data. The aim of this study was to compare different graphical techniques, including target plots, radar plots, and "spie" charts, for comparing the performances of different health care providers. Thirteen indicators were calculated and combined in eight composite indices for eight clinical categories of interest. The indices were displayed with target plots, radar plots, and "spie" charts. All the three techniques had an immediate interpretation and were easy to implement. However, target plots failed to highlight small differences between indicators, whereas radar plots were strongly influenced by the order in which the indicators were displayed. Both target and radar plots assumed equal weights for the indicators, and did not allow predetermined judgments on the relative importance of the indicators. "Spie" charts overcame the primary limitations of the other two techniques. Furthermore, they are well suited to summarize the overall performance of a health care provider with a single score. "Spie" charts represented the best graphical tool for displaying multivariate health care data in comparative evaluations of clinical outcomes and processes of care among health care providers.
International Journal for Quality in Health Care, 2009
Objective. In countries where the National Health Service provides universal health coverage, soc... more Objective. In countries where the National Health Service provides universal health coverage, socioeconomic position should not influence the quality of health care. We examined whether socioeconomic position plays a role in short-term mortality and waiting time for surgery after hip fracture. Design. Retrospective cohort study. Settings and participants. From the Hospital Information System database, we selected all patients, aged at least 65 years and admitted to acute care hospitals in Rome for a hip fracture between 1 January 2006 and 30 November 2007. The socioeconomic position of each individual was obtained using a city-specific index of socioeconomic variables based on the individual's census tract of residence. Main outcome measures. Three different outcomes were defined: waiting times for surgery, mortality within 30 days and intervention within 48 h of hospital arrival for hip fracture. We used a logistic regression to estimate 30-day mortality and a Cox proportional hazard model to calculate hazard ratios of intervention within 48 h. Median waiting times were estimated by adjusted Kaplan-Meyer curves. Analyses were adjusted for age, gender and coexisting medical conditions. Results. Low socioeconomic level was significantly associated with higher risk of mortality [adjusted relative risk (RR) ¼ 1.51; P , 0.05] and lower risk of early intervention (adjusted RR ¼ 0.32; P , 0.001). Socioeconomic level had also an effect on waiting times within 30 days. Conclusions. Individuals living in disadvantaged census tracts had poorer prognoses and were less likely than more affluent people to be treated according to clinical guidelines despite universal healthcare coverage.
Giornale italiano di …, 2008
Citation: Seccareccia F, D'Errigo P, Rosato S, Maraschini A, Badoni G, Perucci CA, Fusco D, ... more Citation: Seccareccia F, D'Errigo P, Rosato S, Maraschini A, Badoni G, Perucci CA, Fusco D, Colais P, D'Ovidio M, Barone AP, Gruppo di ricerca del Progetto Mattoni del SSN--Misura dell'Outcome, Gruppo di ricerca dello studio IN-ACS Outcome-Italian Network on Acute ...
BMC Health Services Research, 2012
Background: P.Re.Val.E. is the most comprehensive comparative evaluation program of healthcare ou... more Background: P.Re.Val.E. is the most comprehensive comparative evaluation program of healthcare outcomes in Lazio, an Italian region, and the first Italian study to make health provider performance data available to the public. The aim of this study is to describe the P.Re.Val.E. and the impact of releasing performance data to the public. Methods: P.Re.Val.E. included 54 outcome/process indicators encompassing many different clinical areas. Crude and adjusted rates were estimated for the 2006-2009 period. Multivariate regression models and direct standardization procedures were used to control for potential confounding due to individual characteristics. Variable life-adjusted display charts were developed, and 2008-2009 results were compared with those from 2006-2007. Results: Results of 54 outcome indicators were published online at http://www.epidemiologia.lazio.it/prevale10/ index.php. Public disclosure of the indicators' results caused mixed reactions but finally promoted discussion and refinement of some indicators. Based on the P.Re.Val.E. experience, the Italian National Agency for Regional Health Services has launched a National Outcome Program aimed at systematically comparing outcomes in hospitals and local health units in Italy. Conclusions: P.Re.Val.E. highlighted aspects of patient care that merit further investigation and monitoring to improve healthcare services and equity.
Epidemiologia e prevenzione