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Papers by Pietro Giorgio Lovaglio
The goal of transforming the EU into the most competitive and dynamic knowledge-based economy in ... more The goal of transforming the EU into the most competitive and dynamic knowledge-based economy in the world within the year 2010 relies on the development of educational and training systems from both a worldwide perspective as well as from the perspective of lifelong learning. In October 2001, the European Commission recommended the development of composite indicators
Effectiveness of University Education in Italy
In this paper, we propose a method for the evaluation of relative and impact external efficiency ... more In this paper, we propose a method for the evaluation of relative and impact external efficiency of university studies as effects of education on the long-term income of graduates. In order to evaluate the "ceteris paribus" levels and growth we applied a multilevel longitudinal model with random effects. The variables used in our analysis refer to Human Capital studies. The Bank of Italy has collected the data used for the analysis in the years 1998, 2000 and 2002.
Econometric Reviews, 2007
Dagum and Slottje (2000) estimated household human capital (HC) as a latent variable (LV) and pro... more Dagum and Slottje (2000) estimated household human capital (HC) as a latent variable (LV) and proposed its monetary estimation by means of an actuarial approach. This paper introduces an improved method for the estimation of household HC as an LV by means of formative and reflective indicators in agreement with the accepted economic definition of HC. The monetary value of HC is used in a recursive causal model to obtain short-and long-term multipliers that measure the direct and total effects of the variables that determine household HC. The new method is applied to estimate US household HC for year 2004.
Computational Statistics & Data Analysis, 2007
A new approach for the estimation and the validation of a Structural Equation Model with a format... more A new approach for the estimation and the validation of a Structural Equation Model with a formative-reflective scheme is presented. The basis of the paper is a proposal for overcoming a potential deficiency of PLS Path Modeling. In the PLS approach the reflective scheme assumed for the endogenous latent variables is inverted; moreover, the model errors are not explicitly taken into account for the estimation of the endogenous latent variables. The proposed approach utilizes all the relevant information in the formative manifest variables providing solutions which respect the causal structure of the model. The estimation procedure is based on the optimization of the redundancy criterion. The new approach, entitled Redundancy Analysis approach to Path Modeling is compared with both traditional PLS Path Modeling and LISREL methodology, on the basis of real and simulated data.
The Lancet Infectious Diseases, 2013
Objective Although the incidence of meningococcal disease has been declining over the past decade... more Objective Although the incidence of meningococcal disease has been declining over the past decade in Portugal MenB meningococci is still an important cause of meningitis and sepsis. The aim of this study was to estimate the strain coverage of the 4CMenB vaccine in Portugal in order to support health policies for prevention and control of meningococcal disease. Methods Since 2002 the clinical and laboratory notification of meningococcal disease is mandatory in Portugal. National database includes since then all confirmed cases notified to the reference laboratory or to the Directorate of Health. Strains included in this study were all the invasive MenB isolated from the 1 st July 2011 to the 30 th June 2015, sent to the reference laboratory. To predict the vaccine strain coverage of the 4CMenB the expression and cross-reactivity of the surface antigens fHbp, NadA, NHBA were assessed by the Meningococcal Antigen Typing System (MATS) whereas PorA typing was performed by sequencing. The presence of at least one antigen with a Relative Potency (RP) greater than its MATS-positive bactericidal threshold RP value or the presence of PorA VR2 = 4 was considered to be predictive for a strain to be covered by the 4CMenB vaccine. Results The estimated 4CMenB strain coverage in Portugal was 67.9%. The percentage of strain coverage in each of the four epidemiological years ranged from 63.9% to 73.7%. Strains covered by one antigen represent 32.1% of the total of isolates, 29.2% of strains were covered by two antigens and 6.6% by three antigens. No strain had all the four antigens. Antigens that most contributed for coverage were NHBA and fHbp. Data from Portugal is in accordance with the MATS predicted strain coverage in five European countries (England and Wales, France, Germany, Italy and Norway) that pointed to 78% coverage for strains collected in the epidemiological year 2007-2008.
Over the last few years, increasing attention has been directed toward the problems inherent to m... more Over the last few years, increasing attention has been directed toward the problems inherent to measuring the quality of healthcare and implementing benchmarking strategies. Besides offering accreditation and certification processes, recent approaches measure the performance of healthcare institutions in order to evaluate their effectiveness, defined as the capacity to provide treatment that modifies and improves the patient's state of health. This paper, dealing with hospital effectiveness, focuses on research methods for effectiveness analyses within a strategy comparing different healthcare institutions. The paper, after having introduced readers to the principle debates on benchmarking strategies, which depend on the perspective and type of indicators used, focuses on the methodological problems related to performing consistent benchmarking analyses. Particularly, statistical methods suitable for controlling case-mix, analyzing aggregate data, rare events, and continuous ou...
Response management to the SARS-CoV-2 outbreak requires to answer several forecasting tasks. For ... more Response management to the SARS-CoV-2 outbreak requires to answer several forecasting tasks. For hospital managers, a major one is to anticipate the likely needs of beds in intensive care in a given catchment area one or two weeks ahead, starting as early as possible in the evolution of the epidemic. This paper proposes to use a bivariate Error Correction model to forecast the needs of beds in intensive care, jointly with the number of patients hospitalised with Covid-19 symptoms. Error Correction models are found to provide reliable forecasts that are tailored to the local characteristics both of epidemic dynamics and of hospital practice for various in Europe in Italy, France and Scotland, both at the onset and at later stages of the spread of the disease. The forecast performance is encouraging for all analysed regions, suggesting that the present approach may be useful also beyond the analysed cases.
From the economical point of view Human capital (HC) can be defined as the flow of Income accumul... more From the economical point of view Human capital (HC) can be defined as the flow of Income accumulation throughout the life span generated by investment in education and working experience whereas from the statistical point of view is typically considered a Latent Variable (LV). A situation well known in literature is a LV linked to its observed Variables both in a reflective block and a formative block, where a block is said to be formative if the observed variables cause the latent variables, whereas the block is said to be reflective if the latent variables cause manifest variables. The approaches proposed with the aim to estimate HC are recent and start from the economic theory specified in the Dagum’s recursive model (Dagum, 1994; Dagum and Slottje, 2000; Dagum et al., 2003; Vittadini et al., 2003) purporting to explain the determination and the distribution of Income, net and gross wealth, debt and HC. The importance of HC for the determination and the accumulation of Income ju...
Riassunto. Secondo la maggior parte dei recenti contributi, i processi di accreditamento dell'... more Riassunto. Secondo la maggior parte dei recenti contributi, i processi di accreditamento dell'universita oltre a valutare i requisiti ex-ante, hanno come primario scopo quello di verificarne i risultati. La valutazione dell’efficacia del sistema universitario dovrebbe essere basata sull'investimento nell'istruzione superiore che determina un flusso stabile di reddito da lavoro nel ciclo vitale, piu precisamente sul capitale umano (CU) definito come l’investimento in formazione che incide sulla capacita di produrre reddito nel ciclo vitale. In questo paper vengono delineate le linee guida per un processo di valutazione dell'universita basato sul capitale umano potenziale ed in particolare vengono affrontati i temi della stima del HC con un'applicazione alle famiglie italiane nel 2000 e l'esplorazione delle basi di dati disponibili per una valutazione del CU generato dalle Universita ai loro laureati. Parole chiave: Capitale umano, Efficacia, Efficienza, Valuta...
Since 2001, the region of Lombardy has accreditated nursing homes named R.S.A. “Residenza Sanitar... more Since 2001, the region of Lombardy has accreditated nursing homes named R.S.A. “Residenza Sanitario-Assistenziale”, which make up Italy’s principal RSA network with the annual turnover of approximately 60,000 people. The most noteworthy element of the reform introduced is a concentration on resident’s frailty rather than disability. This is assessed by using SOSIA, a form for intermediate observation of assistance. Residents are classified into eight classes of frailty, called isofrailty classes of SOSIA, which are differentiated by how compromised their motor and cognitive skills are, and by the presence of comorbidity. The study presents the methodology used to identify and estimate cut-offs of three indicators employed in SOSIA classification. It also discusses their characteristics versus other evaluation systems, such as Resource Utilization Group RUG-III and Autonomie Gerontologique – Groupes Iso-Resources AGGIR.
The Balanced Scorecard represents a technique used to translate an organization’s mission and str... more The Balanced Scorecard represents a technique used to translate an organization’s mission and strategy into a comprehensive set of performance measures that provide the framework for the implementation of strategic management. The original contribution of this article deals with the exploration of available indicators and statistical methodologies that may facilitate the diffusion of the BSC framework in a hospital setting within the Lombardy Region Health sector. Specifically, the present paper describes an approach to designing and implementing a Balanced Scorecard system for measuring the performance and productivity of Health structures, suggesting regional stakeholders how the information dimensions of BSC can assist in developing competitive strategic outcomes. The empirical assessment of causal relationships among four BSC dimensions in Lombardy Region Hospitals was performed by Partial Least Square Path Modelling approach within a multilevel perspective (taking into account ...
PLOS ONE
The spread of COVID-19 implied a large and fast increase of demand for intensive care services. T... more The spread of COVID-19 implied a large and fast increase of demand for intensive care services. To face this increase in demand, health care systems need to adapt their response by increasing hospital beds, intensive care unit (ICU) capacity and by (re-)deploying doctors and other personnel. This paper proposes a forecast approach based on the Vector Error Correction model for the daily counts of hospitalized patients with symptoms and of patients in ICU, using publicly available data on the current COVID-19 outbreak in Italy, Switzerland and Spain. The level of analysis is the local government managing the health care system response, which corresponds to regions for Italy. The one-week-ahead forecasts are validated with out-of-sample data over successive weeks; they are found to provide timely and robust prediction of ICU capacity needs in Lombardy, the most-affected Italian region, starting from the sample of the first 2 weeks of data. The same methodology is successfully validated on other Italian regions, Switzerland and Spain. This approach may be used in other countries/regions/provinces to help adapt the health care system response to COVID-19 (or other similar disease); for this purpose, the open-source software code to produce the forecasts is provided with the paper.
The goal of transforming the EU into the most competitive and dynamic knowledge-based economy in ... more The goal of transforming the EU into the most competitive and dynamic knowledge-based economy in the world within the year 2010 relies on the development of educational and training systems from both a worldwide perspective as well as from the perspective of lifelong learning. In October 2001, the European Commission recommended the development of composite indicators
Effectiveness of University Education in Italy
In this paper, we propose a method for the evaluation of relative and impact external efficiency ... more In this paper, we propose a method for the evaluation of relative and impact external efficiency of university studies as effects of education on the long-term income of graduates. In order to evaluate the "ceteris paribus" levels and growth we applied a multilevel longitudinal model with random effects. The variables used in our analysis refer to Human Capital studies. The Bank of Italy has collected the data used for the analysis in the years 1998, 2000 and 2002.
Econometric Reviews, 2007
Dagum and Slottje (2000) estimated household human capital (HC) as a latent variable (LV) and pro... more Dagum and Slottje (2000) estimated household human capital (HC) as a latent variable (LV) and proposed its monetary estimation by means of an actuarial approach. This paper introduces an improved method for the estimation of household HC as an LV by means of formative and reflective indicators in agreement with the accepted economic definition of HC. The monetary value of HC is used in a recursive causal model to obtain short-and long-term multipliers that measure the direct and total effects of the variables that determine household HC. The new method is applied to estimate US household HC for year 2004.
Computational Statistics & Data Analysis, 2007
A new approach for the estimation and the validation of a Structural Equation Model with a format... more A new approach for the estimation and the validation of a Structural Equation Model with a formative-reflective scheme is presented. The basis of the paper is a proposal for overcoming a potential deficiency of PLS Path Modeling. In the PLS approach the reflective scheme assumed for the endogenous latent variables is inverted; moreover, the model errors are not explicitly taken into account for the estimation of the endogenous latent variables. The proposed approach utilizes all the relevant information in the formative manifest variables providing solutions which respect the causal structure of the model. The estimation procedure is based on the optimization of the redundancy criterion. The new approach, entitled Redundancy Analysis approach to Path Modeling is compared with both traditional PLS Path Modeling and LISREL methodology, on the basis of real and simulated data.
The Lancet Infectious Diseases, 2013
Objective Although the incidence of meningococcal disease has been declining over the past decade... more Objective Although the incidence of meningococcal disease has been declining over the past decade in Portugal MenB meningococci is still an important cause of meningitis and sepsis. The aim of this study was to estimate the strain coverage of the 4CMenB vaccine in Portugal in order to support health policies for prevention and control of meningococcal disease. Methods Since 2002 the clinical and laboratory notification of meningococcal disease is mandatory in Portugal. National database includes since then all confirmed cases notified to the reference laboratory or to the Directorate of Health. Strains included in this study were all the invasive MenB isolated from the 1 st July 2011 to the 30 th June 2015, sent to the reference laboratory. To predict the vaccine strain coverage of the 4CMenB the expression and cross-reactivity of the surface antigens fHbp, NadA, NHBA were assessed by the Meningococcal Antigen Typing System (MATS) whereas PorA typing was performed by sequencing. The presence of at least one antigen with a Relative Potency (RP) greater than its MATS-positive bactericidal threshold RP value or the presence of PorA VR2 = 4 was considered to be predictive for a strain to be covered by the 4CMenB vaccine. Results The estimated 4CMenB strain coverage in Portugal was 67.9%. The percentage of strain coverage in each of the four epidemiological years ranged from 63.9% to 73.7%. Strains covered by one antigen represent 32.1% of the total of isolates, 29.2% of strains were covered by two antigens and 6.6% by three antigens. No strain had all the four antigens. Antigens that most contributed for coverage were NHBA and fHbp. Data from Portugal is in accordance with the MATS predicted strain coverage in five European countries (England and Wales, France, Germany, Italy and Norway) that pointed to 78% coverage for strains collected in the epidemiological year 2007-2008.
Over the last few years, increasing attention has been directed toward the problems inherent to m... more Over the last few years, increasing attention has been directed toward the problems inherent to measuring the quality of healthcare and implementing benchmarking strategies. Besides offering accreditation and certification processes, recent approaches measure the performance of healthcare institutions in order to evaluate their effectiveness, defined as the capacity to provide treatment that modifies and improves the patient's state of health. This paper, dealing with hospital effectiveness, focuses on research methods for effectiveness analyses within a strategy comparing different healthcare institutions. The paper, after having introduced readers to the principle debates on benchmarking strategies, which depend on the perspective and type of indicators used, focuses on the methodological problems related to performing consistent benchmarking analyses. Particularly, statistical methods suitable for controlling case-mix, analyzing aggregate data, rare events, and continuous ou...
Response management to the SARS-CoV-2 outbreak requires to answer several forecasting tasks. For ... more Response management to the SARS-CoV-2 outbreak requires to answer several forecasting tasks. For hospital managers, a major one is to anticipate the likely needs of beds in intensive care in a given catchment area one or two weeks ahead, starting as early as possible in the evolution of the epidemic. This paper proposes to use a bivariate Error Correction model to forecast the needs of beds in intensive care, jointly with the number of patients hospitalised with Covid-19 symptoms. Error Correction models are found to provide reliable forecasts that are tailored to the local characteristics both of epidemic dynamics and of hospital practice for various in Europe in Italy, France and Scotland, both at the onset and at later stages of the spread of the disease. The forecast performance is encouraging for all analysed regions, suggesting that the present approach may be useful also beyond the analysed cases.
From the economical point of view Human capital (HC) can be defined as the flow of Income accumul... more From the economical point of view Human capital (HC) can be defined as the flow of Income accumulation throughout the life span generated by investment in education and working experience whereas from the statistical point of view is typically considered a Latent Variable (LV). A situation well known in literature is a LV linked to its observed Variables both in a reflective block and a formative block, where a block is said to be formative if the observed variables cause the latent variables, whereas the block is said to be reflective if the latent variables cause manifest variables. The approaches proposed with the aim to estimate HC are recent and start from the economic theory specified in the Dagum’s recursive model (Dagum, 1994; Dagum and Slottje, 2000; Dagum et al., 2003; Vittadini et al., 2003) purporting to explain the determination and the distribution of Income, net and gross wealth, debt and HC. The importance of HC for the determination and the accumulation of Income ju...
Riassunto. Secondo la maggior parte dei recenti contributi, i processi di accreditamento dell'... more Riassunto. Secondo la maggior parte dei recenti contributi, i processi di accreditamento dell'universita oltre a valutare i requisiti ex-ante, hanno come primario scopo quello di verificarne i risultati. La valutazione dell’efficacia del sistema universitario dovrebbe essere basata sull'investimento nell'istruzione superiore che determina un flusso stabile di reddito da lavoro nel ciclo vitale, piu precisamente sul capitale umano (CU) definito come l’investimento in formazione che incide sulla capacita di produrre reddito nel ciclo vitale. In questo paper vengono delineate le linee guida per un processo di valutazione dell'universita basato sul capitale umano potenziale ed in particolare vengono affrontati i temi della stima del HC con un'applicazione alle famiglie italiane nel 2000 e l'esplorazione delle basi di dati disponibili per una valutazione del CU generato dalle Universita ai loro laureati. Parole chiave: Capitale umano, Efficacia, Efficienza, Valuta...
Since 2001, the region of Lombardy has accreditated nursing homes named R.S.A. “Residenza Sanitar... more Since 2001, the region of Lombardy has accreditated nursing homes named R.S.A. “Residenza Sanitario-Assistenziale”, which make up Italy’s principal RSA network with the annual turnover of approximately 60,000 people. The most noteworthy element of the reform introduced is a concentration on resident’s frailty rather than disability. This is assessed by using SOSIA, a form for intermediate observation of assistance. Residents are classified into eight classes of frailty, called isofrailty classes of SOSIA, which are differentiated by how compromised their motor and cognitive skills are, and by the presence of comorbidity. The study presents the methodology used to identify and estimate cut-offs of three indicators employed in SOSIA classification. It also discusses their characteristics versus other evaluation systems, such as Resource Utilization Group RUG-III and Autonomie Gerontologique – Groupes Iso-Resources AGGIR.
The Balanced Scorecard represents a technique used to translate an organization’s mission and str... more The Balanced Scorecard represents a technique used to translate an organization’s mission and strategy into a comprehensive set of performance measures that provide the framework for the implementation of strategic management. The original contribution of this article deals with the exploration of available indicators and statistical methodologies that may facilitate the diffusion of the BSC framework in a hospital setting within the Lombardy Region Health sector. Specifically, the present paper describes an approach to designing and implementing a Balanced Scorecard system for measuring the performance and productivity of Health structures, suggesting regional stakeholders how the information dimensions of BSC can assist in developing competitive strategic outcomes. The empirical assessment of causal relationships among four BSC dimensions in Lombardy Region Hospitals was performed by Partial Least Square Path Modelling approach within a multilevel perspective (taking into account ...
PLOS ONE
The spread of COVID-19 implied a large and fast increase of demand for intensive care services. T... more The spread of COVID-19 implied a large and fast increase of demand for intensive care services. To face this increase in demand, health care systems need to adapt their response by increasing hospital beds, intensive care unit (ICU) capacity and by (re-)deploying doctors and other personnel. This paper proposes a forecast approach based on the Vector Error Correction model for the daily counts of hospitalized patients with symptoms and of patients in ICU, using publicly available data on the current COVID-19 outbreak in Italy, Switzerland and Spain. The level of analysis is the local government managing the health care system response, which corresponds to regions for Italy. The one-week-ahead forecasts are validated with out-of-sample data over successive weeks; they are found to provide timely and robust prediction of ICU capacity needs in Lombardy, the most-affected Italian region, starting from the sample of the first 2 weeks of data. The same methodology is successfully validated on other Italian regions, Switzerland and Spain. This approach may be used in other countries/regions/provinces to help adapt the health care system response to COVID-19 (or other similar disease); for this purpose, the open-source software code to produce the forecasts is provided with the paper.