8 results on '"Chiara Rossi"'
Search Results
2. Sex Disparities in the Quality of Diabetes Care: Biological and Cultural Factors May Play a Different Role for Different Outcomes
- Author
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Antonio Nicolucci, Maria Chiara Rossi, Angela Napoli, Carlo Giorda, Valeria Manicardi, Concetta Suraci, Maria Rosaria Cristofaro, Sandro Gentile, Giuseppe Lucisano, Fabio Pellegrini, Maria Franca Mulas, Rossi, Mc, Cristofaro, Mr, Gentile, Sandro, Lucisano, G, Manicardi, V, Mulas, Mf, Napoli, A, Nicolucci, A, Pellegrini, F, Suraci, C, and Giorda, C.
- Subjects
Advanced and Specialized Nursing ,Research design ,medicine.medical_specialty ,Cross-sectional study ,business.industry ,Endocrinology, Diabetes and Metabolism ,Medical record ,diabetes mellitus, gender medicine ,Odds ratio ,Type 2 diabetes ,medicine.disease ,Surgery ,Diabetes mellitus ,Internal Medicine ,medicine ,Observational study ,Disease management (health) ,business ,Demography - Abstract
OBJECTIVE To investigate the quality of type 2 diabetes care according to sex. RESEARCH DESIGN AND METHODS Clinical data collected during the year 2009 were extracted from electronic medical records; quality-of-care indicators were evaluated. Multilevel logistic regression analysis was applied to estimate the likelihood of women versus men to be monitored for selected parameters, to reach clinical outcomes, and to be treated with specific classes of drugs. The intercenter variability in the proportion of men and women achieving the targets was also investigated. RESULTS Overall, 415,294 patients from 236 diabetes outpatient centers were evaluated, of whom 188,125 (45.3%) were women and 227,169 (54.7%) were men. Women were 14% more likely than men to have HbA1c >9.0% in spite of insulin treatment (odds ratio 1.14 [95% CI 1.10–1.17]), 42% more likely to have LDL cholesterol (LDL-C) ≥130 mg/dL (1.42 [1.38–1.46]) in spite of lipid-lowering treatment, and 50% more likely to have BMI ≥30 kg/m2 (1.50 [1.50–1.54]). Women were less likely to be monitored for foot and eye complications. In 99% of centers, the percentage of men reaching the LDL-C target was higher than in women, the proportion of patients reaching the HbA1c target was in favor of men in 80% of the centers, and no differences emerged for blood pressure. CONCLUSIONS Women show a poorer quality of diabetes care than men. The attainment of the LDL-C target seems to be mainly related to pathophysiological factors, whereas patient and physician attitudes can play an important role in other process measures and outcomes.
- Published
- 2013
3. Quality of Diabetes Care Predicts the Development of Cardiovascular Events: Results of the AMD-QUASAR Study
- Author
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Carlo Coscelli, Antonio Nicolucci, Maria Chiara Rossi, Giuseppe Lucisano, Domenico Cucinotta, Patrizia Di Blasi, Fabio Pellegrini, Marco Comaschi, Umberto Valentini, Giacomo Vespasiani, and Giovanni Bader
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Research design ,Male ,medicine.medical_specialty ,National Health Programs ,Endocrinology, Diabetes and Metabolism ,Type 2 diabetes ,Predictive Value of Tests ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,medicine ,Electronic Health Records ,Humans ,Longitudinal Studies ,Epidemiology/Health Services Research ,Original Research ,Aged ,Quality of Health Care ,Advanced and Specialized Nursing ,business.industry ,Incidence (epidemiology) ,Medical record ,Incidence ,Middle Aged ,medicine.disease ,Diabetes Mellitus, Type 2 ,Italy ,Cardiovascular Diseases ,Predictive value of tests ,Quality Score ,Physical therapy ,Microalbuminuria ,Female ,business - Abstract
OBJECTIVE The QUASAR (Quality Assessment Score and Cardiovascular Outcomes in Italian Diabetes Patients) study aimed to assess whether a quality-of-care summary score predicted the development of cardiovascular (CV) events in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS In 67 diabetes clinics, data on randomly selected patients were extracted from electronic medical records. The score was calculated using process and outcome indicators based on monitoring, targets, and treatment of A1C, blood pressure, LDL cholesterol, and microalbuminuria. The score ranged from 0 to 40. RESULTS Overall, 5,181 patients were analyzed; 477 (9.2%) patients developed a CV event after a median follow-up of 28 months. The incidence rate (per 1,000 person-years) of CV events was 62.4 in patients with a score of 25. Multilevel analysis, adjusted for clustering and case-mix, showed that the risk to develop a new CV event was 84% higher in patients with a score of 25. Mean quality score varied across centers from 16.5 ± 7.5 to 29.1 ± 6.3. When the score was tested as the dependent variable, it emerged that 18% of the variance in the score could be attributed to setting characteristics. CONCLUSIONS Our study documented a close relationship between quality of diabetes care and long-term outcomes. A simple score can be used to monitor quality of care and compare the performance of different centers/physicians.
- Published
- 2011
4. Diabetes Interactive Diary: A New Telemedicine System Enabling Flexible Diet and Insulin Therapy While Improving Quality of Life
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Daniela Bruttomesso, Antonio Nicolucci, Fabio Pellegrini, Antonio Ceriello, Angela Girelli, Paolo Di Bartolo, David Kerr, Carmen De La Questa Mayor, Giacomo Vespasiani, David Horwitz, Francisco J. Ampudia, and Maria Chiara Rossi
- Subjects
Advanced and Specialized Nursing ,Type 1 diabetes ,medicine.medical_specialty ,business.industry ,Diet therapy ,Endocrinology, Diabetes and Metabolism ,Blood sugar ,medicine.disease ,law.invention ,Surgery ,Carbohydrate counting ,Randomized controlled trial ,Quality of life ,law ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,medicine ,medicine.symptom ,business ,Weight gain - Abstract
OBJECTIVE Widespread use of carbohydrate counting is limited by its complex education. In this study we compared a Diabetes Interactive Diary (DID) with standard carbohydrate counting in terms of metabolic and weight control, time required for education, quality of life, and treatment satisfaction. RESEARCH DESIGN AND METHODS Adults with type 1 diabetes were randomly assigned to DID (group A, n = 67) or standard education (group B, n = 63) and followed for 6 months. A subgroup also completed the SF-36 Health Survey (SF-36) and World Health Organization-Diabetes Treatment Satisfaction Questionnaire (WHO-DTSQ) at each visit. RESULTS Of 130 patients (aged 35.7 ± 9.4 years; diabetes duration 16.5 ± 10.5 years), 11 dropped out. Time for education was 6 h (range 2–15 h) in group A and 12 h (2.5–25 h) in group B (P = 0.07). A1C reduction was similar in both groups (group A from 8.2 ± 0.8 to 7.8 ± 0.8% and group B from 8.4 ± 0.7 to 7.9 ± 1.1%; P = 0.68). Nonsignificant differences in favor of group A were documented for fasting blood glucose and body weight. No severe hypoglycemic episode occurred. WHO-DTSQ scores increased significantly more in group A (from 26.7 ± 4.4 to 30.3 ± 4.5) than in group B (from 27.5 ± 4.8 to 28.6 ± 5.1) (P = 0.04). Role Physical, General Health, Vitality, and Role Emotional SF-36 scores improved significantly more in group A than in group B. CONCLUSIONS DID is at least as effective as traditional carbohydrate counting education, allowing dietary freedom for a larger proportion of type 1 diabetic patients. DID is safe, requires less time for education, and is associated with lower weight gain. DID significantly improved treatment satisfaction and several quality-of-life dimensions.
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- 2009
5. Longitudinal Assessment of Quality of Life in Patients With Type 2 Diabetes and Self-Reported Erectile Dysfunction
- Author
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Maurizio Belfiglio, Giorgia De Berardis, Gianni Tognoni, Maria Chiara Rossi, Monica Franciosi, Sheldon Greenfield, Miriam Valentini, Barbara Di Nardo, Michele Sacco, Sherrie H. Kaplan, Antonio Nicolucci, and Fabio Pellegrini
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Male ,Gerontology ,Research design ,medicine.medical_specialty ,Longitudinal study ,Time Factors ,Endocrinology, Diabetes and Metabolism ,Context (language use) ,Type 2 diabetes ,Erectile Dysfunction ,Quality of life ,Surveys and Questionnaires ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Longitudinal Studies ,Depression (differential diagnoses) ,Aged ,Advanced and Specialized Nursing ,Chi-Square Distribution ,business.industry ,Middle Aged ,medicine.disease ,Health Surveys ,Erectile dysfunction ,Diabetes Mellitus, Type 2 ,Italy ,Quality of Life ,business ,Chi-squared distribution - Abstract
OBJECTIVE—In the context of the QuED (Quality of Care and Outcomes in Type 2 Diabetes) project, we evaluated the longitudinal changes over 3 years in quality of life (QoL) in patients with type 2 diabetes according to the presence or the development of erectile dysfunction (ED). RESEARCH DESIGN AND METHODS—Patients were requested to fill in a questionnaire investigating the presence of ED and QoL (SF-36 Health Survey, depression symptoms [Center for Epidemiologic Studies–Depression], and quality of sexual life) every 6 months for 3 years. The analyses were based on multilevel models, adjusted for patient clinical and sociodemographic characteristics. RESULTS—The study involved 1,456 patients, of whom 34% reported frequent erectile problems at baseline; 192 developed ED during the follow-up. No changes in QoL measures were detected in patients without ED; in those with ED at baseline, a worsening in all SF-36 scales was observed, reaching statistical significance for physical functioning (P = 0.03). Among patients who developed ED during the study, a deterioration in all SF-36 dimensions and a worsening in depressive symptoms preceded the development of ED. The onset of ED was associated with a further marked worsening in physical functioning (P = 0.0008), general health perception (P = 0.02), and social functioning (P = 0.04) on SF-36 subscales, as well as in the summary physical and mental components scores (P = 0.04 and P = 0.07, respectively). The development of ED was also associated with a highly significant increase in depressive symptoms (P = 0.001) and a marked decrease in quality of sexual life (P < 0.0001). CONCLUSIONS—This longitudinal study documents for the first time the impact of ED onset on several aspects of QoL in patients with type 2 diabetes. The study also shows that QoL tended to further decrease during 3 years in patients with ED at baseline but not in those without this condition.
- Published
- 2005
6. Baseline Quality-of-Care Data From a Quality-Improvement Program Implemented by a Network of Diabetes Outpatient Clinics
- Author
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Gualtiero De Bigontina, Antonio Nicolucci, Carlo Giorda, Illidio Meloncelli, Giacomo Vespasiani, Fabio Pellegrini, Maria Chiara Rossi, Adolfo Arcangeli, Antonino Cimino, and Umberto Valentini
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Research design ,Male ,medicine.medical_specialty ,Quality management ,Quality Assurance, Health Care ,Endocrinology, Diabetes and Metabolism ,Blood Pressure ,Type 2 diabetes ,Ambulatory Care Facilities ,Diabetes mellitus ,Internal Medicine ,medicine ,Diabetes Mellitus ,Outpatient clinic ,Albuminuria ,Humans ,Epidemiology/Health Services Research ,Aged ,Quality Indicators, Health Care ,Advanced and Specialized Nursing ,Glycated Hemoglobin ,business.industry ,Medical record ,Benchmarking ,Middle Aged ,medicine.disease ,Lipids ,Surgery ,Treatment Outcome ,Emergency medicine ,Female ,business ,Quality assurance - Abstract
OBJECTIVE—To describe patterns of diabetes care and implement benchmarking activities at the national level. RESEARCH DESIGN AND METHODS—A total of 86 clinics participated, all using electronic medical records. Quality indicators were identified, and software was developed, enabling the extraction of the information needed for quality-of-care profiling. RESULTS—Overall, 114,249 patients with type 2 diabetes were seen during 2004. A1C was measured at least once in 88.0% of the patients, lipid profile in 64.6%, blood pressure in 77.2%, and microalbuminuria in 48.1%. Overall, 43.1% of individuals had A1C ≤7.0%, 36.6% had blood pressure ≤130/85 mmHg, and 29.8% had LDL cholesterol CONCLUSIONS—This study is the first step of a nationwide quality-improvement effort and documents the possibility of obtaining standardized information to be used for diabetes care profiling and benchmarking activities.
- Published
- 2008
7. Physician Attitudes Toward Foot Care Education and Foot Examination and Their Correlation With Patient Practice
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Sherrie H. Kaplan, Antonio Nicolucci, Monica Franciosi, Barbara Di Nardo, Sheldon Greenfield, Giorgia De Berardis, Fabio Pellegrini, Gianni Tognoni, Michele Sacco, Miriam Valentini, Maria Chiara Rossi, and Maurizio Belfiglio
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medicine.medical_specialty ,Attitude of Health Personnel ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Physical examination ,Context (language use) ,Patient Education as Topic ,Physicians ,Diabetes mellitus ,Internal Medicine ,medicine ,Humans ,Outpatient clinic ,Physical Examination ,Advanced and Specialized Nursing ,medicine.diagnostic_test ,Foot ,business.industry ,medicine.disease ,Diabetic foot ,Diabetic Foot ,Diabetes Mellitus, Type 2 ,Amputation ,Physical therapy ,Outcomes research ,Family Practice ,business ,Foot (unit) - Abstract
Foot complications are one of the most serious causes of morbidity, disability, poor quality of life, and resource use among diabetic people (1). The adoption of preventive strategies to reduce the rate of foot problems thus represents an important priority. In fact, a strategy that includes prevention, patient and staff education, multidisciplinary treatment of foot complications, and close monitoring has been demonstrated to be very effective in reducing amputation rate (2). In the context of a nationwide outcomes research program (the QuED project), we investigated several aspects related to foot care in 3,564 patients with type 2 diabetes enrolled by 125 diabetes outpatient clinics and …
- Published
- 2004
8. Sex disparities in the quality of diabetes care: biological and cultural factors may play a different role for different outcomes: a cross-sectional observational study from the AMD Annals initiative.
- Author
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Rossi MC, Cristofaro MR, Gentile S, Lucisano G, Manicardi V, Mulas MF, Napoli A, Nicolucci A, Pellegrini F, Suraci C, and Giorda C
- Subjects
- Aged, Blood Pressure physiology, Cholesterol, HDL blood, Cholesterol, LDL blood, Cross-Sectional Studies, Disease Management, Female, Humans, Male, Middle Aged, Sex Factors, Triglycerides blood, Diabetes Mellitus, Type 2 blood
- Abstract
Objective: To investigate the quality of type 2 diabetes care according to sex., Research Design and Methods: Clinical data collected during the year 2009 were extracted from electronic medical records; quality-of-care indicators were evaluated. Multilevel logistic regression analysis was applied to estimate the likelihood of women versus men to be monitored for selected parameters, to reach clinical outcomes, and to be treated with specific classes of drugs. The intercenter variability in the proportion of men and women achieving the targets was also investigated., Results: Overall, 415,294 patients from 236 diabetes outpatient centers were evaluated, of whom 188,125 (45.3%) were women and 227,169 (54.7%) were men. Women were 14% more likely than men to have HbA1c>9.0% in spite of insulin treatment (odds ratio 1.14 [95% CI 1.10-1.17]), 42% more likely to have LDL cholesterol (LDL-C)≥130 mg/dL (1.42 [1.38-1.46]) in spite of lipid-lowering treatment, and 50% more likely to have BMI≥30 kg/m2 (1.50 [1.50-1.54]). Women were less likely to be monitored for foot and eye complications. In 99% of centers, the percentage of men reaching the LDL-C target was higher than in women, the proportion of patients reaching the HbA1c target was in favor of men in 80% of the centers, and no differences emerged for blood pressure., Conclusions: Women show a poorer quality of diabetes care than men. The attainment of the LDL-C target seems to be mainly related to pathophysiological factors, whereas patient and physician attitudes can play an important role in other process measures and outcomes.
- Published
- 2013
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