65 results on '"Francesco Taroni"'
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2. Attitude control for a combine harvester: a cascade scheme approach.
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Federico Dettù, Matteo Corno, Daniele D'Ambrosio, Andrea Acquistapace, Francesco Taroni, and Sergio Matteo Savaresi
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- 2022
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Catalog
3. Transmission control for power-shift agricultural tractors.
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Giulio Panzani, Mara Tanelli, Sergio M. Savaresi, Carlo Pirola, Giorgio Gavina, and Francesco Taroni
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- 2010
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4. On Transmission-Ratio Computation for the Control of a Continously Variable Transmission in Agricultural Tractors.
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Mara Tanelli, Fabio Codeca, Sergio M. Savaresi, Francesco Taroni, and Fabio Previdi
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- 2007
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5. Controllers tuning in a power-split continuously variable transmission.
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Sergio M. Savaresi, Francesco Taroni, Fabio Previdi, and Sergio Bittanti
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- 2003
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6. Modeling, control design and experimental automatic calibration of a leveling system for combine harvesters
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Federico Dettù, Matteo Corno, Daniele D’Ambrosio, Andrea Acquistapace, Francesco Taroni, and Sergio Matteo Savaresi
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Control and Systems Engineering ,Applied Mathematics ,Electrical and Electronic Engineering ,Computer Science Applications - Published
- 2023
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7. A Lost Decade
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Francesco Taroni
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- 2021
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8. Health in the Making of a Nation
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Francesco Taroni
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- 2021
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9. Postwar: Roads Not Taken
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Francesco Taroni
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- 2021
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10. New Issues at the Dawn of the Twenty-first Century
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Francesco Taroni
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- 2021
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11. The Rise and Fall of the Mutual Jungle
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Francesco Taroni
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- 2021
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12. The Creation of the Servizio Sanitario Nazionale
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Francesco Taroni
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- 2021
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13. Health and Healthcare Policy in Italy since 1861
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Francesco Taroni
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- 2021
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14. The Great War and the Spanish Flu
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Francesco Taroni
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- 2021
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15. Postscript
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Francesco Taroni
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- 2021
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16. Reinventing the SSN?
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Francesco Taroni
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- 2021
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17. Two Converging Crises
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Francesco Taroni
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- 2021
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18. Health and Healthcare in the Liberal State
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Francesco Taroni
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- 2021
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19. Health Under the Fascist State
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Francesco Taroni
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- 2021
- Full Text
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20. Il Servizio sanitario nazionale di fronte alla pandemia. Passato e futuro delle politiche per la salute
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Giorgi, Maria Chiara and Francesco, Taroni
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governo multilivello della salute ,pandermia ,SSN - Published
- 2020
21. I regionalismi sanitari in Italia nel contesto internazionale: lezioni dalla pandemia
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Francesco, Taroni and Giorgi, Maria Chiara
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regioni ,covid-19 ,Sanità - Published
- 2020
22. Espansione pubblica e riorganizzazione privata. Come sono cambiati i sistemi sanitari in Italia e in Europa
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Giorgi, Maria Chiara and Francesco, Taroni
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sanità ,NPM ,privatizzazione - Published
- 2020
23. Health and Healthcare Policy in Italy Since 1861 : A Comparative Approach
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Francesco Taroni and Francesco Taroni
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- Public health--Italy--History, Medical policy--Italy--History
- Abstract
Providing a historical overview of healthcare in Italy from its unification in 1861 to the present COVID-19 pandemic, this book analyses the political, social and cultural impact of Italian healthcare policy and medicine. The author examines the development of public health, hospitals, and primary care, and the building of healthcare systems across three political regimes in Italy: the liberal period (1861-1914), Fascism (1922-43), and the Italian Republic (1948 to the present day). By emphasising the embeddedness of health-related legislation in Italy's political and social background, this book offers a comparative account of Italian health policy, and contrasts this with developments in neighbouring European countries, Canada and the United States. The book focuses on the Italian government's reaction to the social and political impact of several diseases: pellagra; cholera; malaria; and tuberculosis, and explores the present-day response to the current COVID-19 pandemic. A timely and comprehensive read, this book will appeal to those teaching and researching Italian history and the history of medicine and healthcare more widely. more...
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- 2021
24. Un invito allo sviluppo Recensione al rapporto di ricerca 'Esiste un modello sanitario piemontese?'
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Francesco Taroni and Francesco Taroni
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regionalismo, politiche sanitarie, costituzione - Abstract
Il lavoro traccia il profilo della sanità del Piemonte, una delle regione italiane di più antiche italiane di più antiche tradizioni, attraverso l'analisi ravvicinata dei suoi più importanti provvedimneti legislativi e delle loro interazioni con la disciplina ed il contesto. more...
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- 2018
25. Control of power-shuttle motion-inverter.
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Sergio M. Savaresi, Mara Tanelli, Sergio Bittanti, Alberto Mangili, Francesco Taroni, and Fabio Previdi
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- 2005
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26. Media and Health
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Francesco Taroni and Taroni F.
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business.industry ,Sensationalism ,Internalism and externalism ,Media relations ,Active audience ,Public relations ,Public opinion ,Press releases ,Framing (social sciences) ,Agenda setting ,Biocommunicability ,Political science ,Framing ,Audience reception ,business ,Health communication ,News media - Abstract
News media are the principal conduit of information about medicine and shape the attitudes of public opinion, physicians, researchers, and policy-makers. However, researchers and policy advocates deem media health with opposing attitudes: they are faulted as courting sensationalism and raising expectations but are also used for promoting behavioral changes from adopting healthier lifestyles to choosing health insurance plans. In fact, different media have different effects in communicating different issues to different audiences. This requires examining production, content, and audience reception of media messages in a common circuit of communication, starting from medical journals and scientists' press releases which are the principal sources of information for journalists writing about medicine. The article describes three broad models of health communication; engages with an internalist and an externalist view of the cozy relations at the interfaces between media and medicine; and examines its reception by active audiences. more...
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- 2016
27. The Jefferson Scale of Physician Empathy: Preliminary Psychometrics and Group Comparisons in Italian Physicians
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Mariangela Di Lillo, Francesco Taroni, Alessandra Lo Scalzo, Americo Cicchetti, Mohammadreza Hojat, Di Lillo M., Cicchetti A., Lo Scalzo A., Taroni F., and Hojat M.
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medicine.medical_specialty ,Validation study ,Medical staff ,Psychometrics ,media_common.quotation_subject ,PHYSICIAN EMPATHY ,ITALIANS PHYSICIANS ,Empathy ,General Medicine ,Professional competence ,Group comparison ,Education ,Multicenter study ,Scale (social sciences) ,Family medicine ,medicine ,Psychiatry ,Psychology ,JEFFERSON SCALE ,media_common - Abstract
PurposeTo examine the psychometrics of the Jefferson Scale of Physician Empathy (JSPE) among a sample of Italian physicians.MethodThe JSPE was translated into Italian using back-translation procedures to ensure the accuracy of the translation. The translated JSPE was administered to 778 phys more...
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- 2009
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28. Increasing appropriateness of hospital admissions in the Emilia-Romagna region of Italy
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Monica Fiorini, Daniel Z. Louis, Maria Vizioli, Carol Rabinowitz, Francesco Taroni, Rita Maria Melotti, and Joseph S. Gonnella
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Adult ,Adolescent ,Medical audit ,MEDLINE ,Young Adult ,Health services ,Financial incentives ,Humans ,Medicine ,Diagnosis-Related Groups ,Hospital use ,Health policy ,Aged ,Medical Audit ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Health Services ,Middle Aged ,medicine.disease ,Hospitalization ,Italy ,Needs assessment ,Medical emergency ,business ,Needs Assessment - Abstract
Objectives: The Emilia-Romagna region of Italy has reduced the number of available hospital beds and introduced financial incentives to curb hospital use. The goal of this study was to assess the impact of these policies on changes over time in the number of acute hospital admissions classified in diagnosis related groups (DRGs) that could be treated safely and effectively in alternative, less costly settings. Methods: The assessment of the appropriate site of care was based on analysis of hospital discharge data for all hospitals for the selected diagnosis related groups in the Emilia-Romagna region for 2001 to 2005. The necessity for acute hospital admission was based on the severity of a patient's principal diagnosis, co-morbid diseases and, for surgical admissions, procedure performed. Results: From 2001 to 2005, potentially inappropriate medical admissions of more than one day decreased from 20,076 to 11,580, a 42% decrease. Inappropriate admissions decreased in both public and private hospitals but there remained a higher rate of inappropriate admissions to private hospitals. Potentially inappropriate medical admissions accounted for 128,319 bed-days in 2001 and 68,968 bed-days in 2005, a reduction of 59,351 bed-days. Potentially inappropriate surgical admissions decreased from 7383 in 2001 to 4349 in 2005, a 41% decrease. Bed-days consumed by inappropriate surgical admissions decreased from 23,181 in 2001 to 13,660 in 2005. Conclusions: The Emilia-Romagna region has succeeded in reducing the use of acute hospital beds for patients in selected diagnosis related groups. However, there are still substantial numbers of admissions that could potentially be treated in less costly settings. more...
- Published
- 2008
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29. The fabbrica della penicillina in postwar Italy: an institutionalist approach
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Francesco, Taroni
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Italy ,Politics ,Penicillins ,History, 20th Century ,Anti-Bacterial Agents - Abstract
This paper focuses on the motives and long-term effects of the momentous decision to build a world-class biomedical research laboratory, the International Center for Chemical Microbiology, at the Istituto Superiore di Sanità in Rome, rather than develop domestic production of penicillin to meet the needs of a destitute postwar Italy. An institutionalist approach will provide a richer vision of the intersections of scientific and national political history in postwar Italy and the Cold War. The Center failed in its modernising mission due to an insular mentality producing an 'enclosure effect' against the State, the healthcare system and the pharmaceutical industry. The absence of a scientific base together with an economic policy of 'liberal protectionism' that placed premiums on import tariffs and the licensing of foreign products explains the path dependency of the pharmaceutical industry during the postwar years and its demise in the 1960s. more...
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- 2015
30. Using pharmacy data to identify those with chronic conditions in Emilia Romagna, Italy
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Carol Rabinowitz, Sabine Mall, Elaine J. Yuen, Francesco Taroni, Daniel Z. Louis, Andrea Donatini, Masahito Jimbo, Vittorio Maio, Maio V., Yuen EJ., Rabinowitz C., Louis DZ, Jimbo M., Donatini A., Mall S., and Taroni F. more...
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Medical Audit ,education.field_of_study ,Chronic condition ,Disease surveillance ,medicine.medical_specialty ,Pediatrics ,National Health Programs ,business.industry ,Health Policy ,Population ,Public Health, Environmental and Occupational Health ,Prevalence ,Pharmacy ,Chronic disease ,Italy ,Pharmaceutical Services ,Family medicine ,Claims data ,Chronic Disease ,Humans ,Medicine ,Formulary ,education ,business - Abstract
Background and objectives: Automated pharmacy data have been used to develop a measure of chronic disease status in the general population. The objectives of this project were to refine and apply a model of chronic disease identification using Italian automated pharmacy data; to describe how this model may identify patterns of morbidity in Emilia Romagna, a large Italian region; and to compare estimated prevalence rates using pharmacy data with those available from a 2000 Emilia Romagna disease surveillance study. Methods: Using the Chronic Disease Score, a list of chronic conditions related to the consumption of drugs under the Italian pharmaceutical dispensing system was created. Clinical review identified medication classes within the Italian National Therapeutic Formulary that were linked to the management of each chronic condition. Algorithms were then tested on pharmaceutical claims data from Emilia Romagna for 2001 to verify the applicability of the classification scheme. Results: Thirty-one chronic condition drug groups (CCDGs) were identified. Applying the model to the pharmacy data, approximately 1.5 million individuals (37.1%) of the population were identified as having one or more of the 31 CCDGs. The 31 CCDGs accounted for 77% (E556 million) of 2001 pharmaceutical expenditures. Cardiovascular diseases, rheumatological conditions, chronic respiratory illness, gastrointestinal diseases and psychiatric diseases were the most frequent chronic conditions. External validation comparing rates of the diseases found through using pharmacy data with those of a 2000 Emilia Romagna disease surveillance study showed similar prevalence of illness. Conclusions: Using Italian automated pharmacy data, a measure of population-based chronic disease status was developed. Applying the model to pharmaceutical claims from Emilia Romagna 2001, a large proportion of the population was identified as having chronic conditions. Pharmacy data may be a valuable alternative to survey data to assess the extent to which large populations are affected by chronic conditions. more...
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- 2005
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31. The Evolution of Health-Policy Making in Italy
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George France, Francesco Taroni, France G., and Taroni F.
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National Health Programs ,business.industry ,Health Policy ,Politics ,Public expenditure ,Special Interest Group ,Decentralization ,Organizational Innovation ,Regional Health Planning ,State Medicine ,Italy ,Health Care Reform ,Political science ,Health care ,Development economics ,Humans ,Policy Making ,business ,Decision Making, Organizational ,Health policy ,Universalism ,Pace - Abstract
An analysis of the dynamics of health care policy in Italy suggests that in recent years the pace of change in the health care system has accelerated. Although the basic features of universalism, comprehensiveness, and funding from general taxation have remained remarkably constant, the capacity to innovate policy tools and their settings and to take account of domestic and international experience seems to have increased. The political will and capacity to combat entrenched interests may also have increased, although implementation is still weak. The imperative to contain public expenditure has heavily conditioned health policy and will continue to do so. This has occurred mainly at the national level, but as the principal locus of health-policy making progressively shifts to the regions, so too will the constraining effect of this imperative move downward. If the decentralization process continues, problems could arise due to interregional differences in capacities to formulate and implement appropriate policies and to tackle special interest groups. more...
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- 2005
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32. Empirical assessment of the impact of drug-eluting stents on the rate of use of coronary revascularization procedures
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Francesco Taroni and Roberto Grilli
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Sirolimus ,medicine.medical_specialty ,Percutaneous ,business.industry ,Health Policy ,medicine.medical_treatment ,Psychological intervention ,Revascularization ,medicine.disease ,Coronary revascularization ,Surgery ,Coronary artery disease ,Empirical assessment ,Conventional PCI ,medicine ,Humans ,Stents ,Angioplasty, Balloon, Coronary ,Coronary Artery Bypass ,Stage (cooking) ,business ,Immunosuppressive Agents - Abstract
Objectives:To assess the impact of the availability of drug-eluting stents (DES) in April 2002 in Emilia-Romagna (a four-million resident Italian region), on the rate of use of revascularization procedures. DES are expected to influence the rate of use of coronary artery bypass graft (CABG) and percutaneous coronary interventions (PCI). However, to date, little empirical information is available on the actual impact of this innovation on clinical practice.Methods:A time series regression analysis of the monthly number of procedures (PCI and CABG) performed between January 1998 and March 2003.Results:DES availability was associated with statistically significant changes in the use of revascularization procedures, although the size of the effect was always small or moderate. PCI increased only by 0.36 more procedures per month (approximately four per year), whereas more evident was the concurrent reduction of isolated CABG (4.15 fewer per month, that is fifty fewer per year). Overall, considering all the surgical revascularizations (i.e., CAGB both isolated and associated with other interventions), there was a reduction of 2.52 procedures per month (thirty less per year).Conclusions:Despite DES being at a very early stage of their diffusion process, our results indicate that they are already having an impact, although moderate, on the use of revascularization procedures. If these findings will be confirmed, they will have a substantial influence on the patterns of care for patients with coronary artery disease and relevant policy implications for health services. more...
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- 2004
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33. Comparisons of American, Israeli, Italian and Mexican physicians and nurses on the total and factor scores of the Jefferson scale of attitudes toward physician–nurse collaborative relationships
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Gideon Alroy, Hana Geva, Antonio Torres-Ruiz, David Ibarra, Mohammadreza Hojat, Americo Cicchetti, Carlo Liva, Adelina Alcorta-Gonzalez, Sylvia K. Fields, Thomas J. Nasca, Gualtiero Ricciardi, Hanna Admi, Massimo Tangucci, Francesco Taroni, Tanya Mashiach, Joseph S. Gonnella, Alessandra Lo Scalzo, Anna Maria Vincenza Amicosante, Manuela M Macinati, and Schmuel Eidelman more...
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Cross-Cultural Comparison ,Male ,Psychometrics ,Attitude of Health Personnel ,media_common.quotation_subject ,MEDLINE ,Physician-Nurse Relations ,Nurses ,Nursing Methodology Research ,Nurse's Role ,Nursing ,Physicians ,Surveys and Questionnaires ,Humans ,Professional Autonomy ,Cooperative Behavior ,Israel ,Physician's Role ,Mexico ,General Nursing ,media_common ,Analysis of Variance ,Teamwork ,Nursing research ,Role theory ,Cross-cultural studies ,United States ,Italy ,Female ,Power, Psychological ,Psychological Theory ,Psychology ,Autonomy - Abstract
This cross-cultural study was designed to compare the attitudes of physicians and nurses toward physician-nurse collaboration in the United States, Israel, Italy and Mexico. Total participants were 2522 physicians and nurses who completed the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (15 Likert-type items, (Hojat et al., Evaluation and the Health Professions 22 (1999a) 208; Nursing Research 50 (2001) 123). They were compared on the total scores and four factors of the Jefferson Scale (shared education and team work, caring as opposed to curing, nurses, autonomy, physicians' dominance). Results showed inter- and intra-cultural similarities and differences among the study groups providing support for the social role theory (Hardy and Conway, Role Theory: Perspectives for Health Professionals, Appelton-Century-Crofts, New York, 1978) and the principle of least interest (Waller and Hill, The Family: A Dynamic Interpretation, Dryden, New York, 1951) in inter-professional relationships. Implications for promoting physician-nurse education and inter-professional collaboration are discussed. more...
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- 2003
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34. Healthcare Reform and Disease Management in Italy
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Francesco Taroni, Roberto Grilli, and Andrea Donatini
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Clinical governance ,Economic growth ,Leadership and Management ,business.industry ,Health Policy ,Pharmacy ,Health administration ,Competition (economics) ,Pharmacoeconomics ,Nursing ,Health care ,Medicine ,Disease management (health) ,business ,General Nursing ,Health policy - Abstract
The 1999 reform of the Italian healthcare system has softened the effects of the 1992 shift to market mechanisms and competition within healthcare by promoting cooperation and partnerships among providers and Local Health Units (LHUs). In addition, it has facilitated the completion of transfering organizational and financial responsibility to the regional governments. more...
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- 2001
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35. Il rimpianto di una conversazione mancata
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Francesco Taroni
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Health (social science) ,Health Policy ,Short paper ,Tribute ,Psychology ,Digital divide ,Humanities - Abstract
This is a tribute and a lasting memory of Achille Ardigň as a scholar, an academic an administrator and a politician. On a personal note, the short paper touches upon the intermingling of his personalities and the latitude of his knowlodge, which he always generously shared.Keywords: tribute, e-health, digital divide, participation, responsibility, inequalities.Parole chiave: tributo, e-health, digital divide, partecipazione, responsabilitÀ, disuguaglianze. more...
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- 2009
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36. Health care policy and politics in Italy in hard times
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Francesco Taroni and Taroni, Francesco
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Politics ,Italy ,business.industry ,Health Policy ,Political science ,Health care ,Public Health, Environmental and Occupational Health ,Humans ,Public administration ,business ,Health policy - Abstract
This time is different. According to Pierson, welfare states emerged virtually unscathed from the strains of the economic crises of the 1970s and the 1980s and that they bounced back thanks to their enduring popularity and powerful constituencies. By contrast, the current financial crisis is one of those unexpected and rare emergencies (the prototypical ‘black swan’) capable of producing powerful short-time effects and long-lasting political and institutional change. Even health care systems, the most immovable objects of the ‘frozen’ landscapes of welfare states, are on the move to a destination unknown. Italy is the poster child for creeping corruption of the basic principles of its Servizio sanitario nazionale (SSN), established in 1978 along the lines of the UK National Health Service (NHS). Although there is no direct assault on the SSN and its universalism, the unprecedented cutbacks in health care expenditure are not just transient ‘haircuts’ but convenient avenues for reductions in social rights. In this respect, the Italian case bears watching by other countries. more...
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- 2015
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37. Variation in Hospital Use and Avoidable Patient Morbidity
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Elaine J. Yuen, Francesca Repetto, Maria Luisa Moro, Daniel Z. Louis, Francesco Taroni, and Joseph S. Gonnella
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medicine.medical_specialty ,Population ,Disease ,Severity of Illness Index ,Hospitals, Private ,Patient Admission ,Catchment Area, Health ,0504 sociology ,0502 economics and business ,Severity of illness ,medicine ,Humans ,Hernia ,Intensive care medicine ,education ,education.field_of_study ,Geography ,Hospitals, Public ,business.industry ,Data Collection ,Health Policy ,05 social sciences ,Public Health, Environmental and Occupational Health ,Bacterial pneumonia ,050401 social sciences methods ,medicine.disease ,Appendicitis ,Italy ,Acute Disease ,Chronic Disease ,Emergency medicine ,Diverticular disease ,Standardized rate ,Morbidity ,business ,050203 business & management - Abstract
Objectives: To determine whether geographical areas with relatively low overall hospitalization rates have higher population-based rates of admission of patients with advanced stages of disease. Methods: Age- and sex-standardized hospital admission rates were calculated for the residents of the 80 Local Health Units in Lombardia, Italy. Using the Disease Staging classification, advanced stage admissions were identified for six common medical and surgical conditions, which it was presumed would reflect untimely hospital admission. Standardized rates of advanced stage admissions were compared in areas with overall high hospitalization rates (high-use areas) and low hospitalization rates (low-use areas). Results: Hospitalization at advanced stages of disease in the low-use areas were significantly higher for the six conditions combined (55.9 vs 43.0 per 100 000; P=0.005), and for external hernia, appendicitis and uterine fibroma, but not for bacterial pneumonia, diverticular disease and peptic ulcer. For the six study conditions combined, residents of overall low-use areas were 30% more likely to be admitted with advanced stages of disease. Conclusion: Low overall hospitalization rates were found to be associated with greater severity of illness at hospitalization and potentially avoidable morbidity for some conditions. Policies aimed at curbing unnecessary hospital admission should consider preserving access for appropriate treatment. more...
- Published
- 1997
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38. Estimation of survival after AIDS diagnosis: CD4 T lymphocyte count versus clinical severity
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Barbara J. Turner, Francesco Taroni, and Leona E. Markson
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Adult ,CD4-Positive T-Lymphocytes ,Male ,medicine.medical_specialty ,Epidemiology ,AIDS Epidemiology ,Severity of Illness Index ,Zidovudine ,T-Lymphocyte Count ,Risk Factors ,Internal medicine ,Severity of illness ,medicine ,Humans ,Survival rate ,Survival analysis ,Proportional Hazards Models ,Acquired Immunodeficiency Syndrome ,Proportional hazards model ,business.industry ,AIDS Serodiagnosis ,CD4 Lymphocyte Count ,Surgery ,Survival Rate ,Italy ,Quartile ,Female ,business ,medicine.drug - Abstract
We compared the relative contribution to estimating survival after AIDS diagnosis of a clinical severity measure, the Severity Index for Adults with AIDS (SIAA), and laboratory values at AIDS diagnosis that are often used prognostically. Three SIAA categories were defined from the first AIDS-defining condition and the most severe complication within 3 months. We studied 421 Italian patients surviving > or = 3 months after AIDS diagnosis. Survival curves for laboratory measures grouped by quartile showed poorest survival for CD4 count more...
- Published
- 1996
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39. The risk of adenomatous polyps in asymptomatic first-degree relatives of persons with colon cancer
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Francesco Taroni, Enrico Roda, S. Fossi, Maria Cristina Morelli, S. Sottili, Franco Bazzoli, Rocco Maurizio Zagari, and Paolo Pozzato
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medicine.medical_specialty ,Hepatology ,medicine.diagnostic_test ,business.industry ,Colorectal cancer ,Gastroenterology ,Colonoscopy ,Odds ratio ,medicine.disease ,digestive system diseases ,Relative risk ,Internal medicine ,Medicine ,First-degree relatives ,Risk factor ,Family history ,business ,Mass screening - Abstract
Background & Aims: Increasing evidence indicates that inherited susceptibility is important in the pathogenesis of colorectai neoplasia. The aim of this study was to clarify whether having only one first-degree relative with colorectal cancer increases the risk of developing adenomatous polyps and whether total colonoscopy is an appropriate screening measure in these patients. Methods: The frequency of such a history was evaluated in 397 asymptomatic patients who underwent total colonoscopy. Of these patients, 155 had colorectal polyps and the remaining 242 did not have polyps. Results: Among polyp cases, 27 of 155 (17.4%) had a positive history; among those without polyps, 12 of 242 (5.0%) had a positive history. Alternatively expressed, 27 of 39 patients (69%) with family history and 128 of 358 patients (36%) without family history had adenomas. The estimated risk for polyps associated with family history was 1.9. Among polyp cases, 14 of 27 patients (51.9%) with family history and 32 of 128 patients (25.0%) without family history had only proximal polyps ( χ 2 test; P = 0.006; odds ratio, 3.2). In the same groups, frequency of high-grade dysplasia was 8 of 27 patients (29.6%) and 16 of 128 patients (12.5%), respectively ( χ 2 test; P = 0.04; odds ratio, 2.9). Conclusions: Relative to subjects with no family history, asymptomatic patients with one first-degree relative with colorectal cancer had nearly double the risk of developing adenomatous polyps, greater frequency of severely dyspiastic lesions, and significantly higher frequency of proximal polyp location. This suggests that total colonoscopy screening is indicated in these subjects. more...
- Published
- 1995
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40. An Analysis of Health Services Using Disease Staging: A Pilot Study in the Emilia‐Romagna Region of Italy
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Elaine J. Yuen, Daniel Z. Louis, and Francesco Taroni
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medicine.medical_specialty ,business.industry ,Mortality rate ,General Medicine ,medicine.disease ,Appendicitis ,Coronary artery disease ,Severity of illness ,Emergency medicine ,Health care ,Cholecystitis ,Medicine ,media_common.cataloged_instance ,Myocardial infarction ,Medical emergency ,European union ,business ,media_common - Abstract
The European Community is currently experimenting with the use of Diagnosis Related Groups (DRGs) and other patient classification systems. Disease Staging is a clinically based classification system which focuses on the dimensions of severity of illness and can be implemented using the same data required for the DRGs. Reports a pilot study in the Emilia‐Romagna region of Italy, where data were analysed from three hospitals for patients hospitalized in 1988 with four diseases: coronary artery disease/acute myocardial infarction, cholecystitis, appendicitis, and diabetes mellitus. The same patients were classified using DRGs and Disease Staging, and the Disease Staging methodology was used to analyse issues of timeliness of hospital admission, length of stay patterns, and in‐hospital mortality rates. more...
- Published
- 1992
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41. Hospital comparisons using a Euro Health Data Base for resource management and strategic planning
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Francis H. Roger France, Anita Alban, Barry Barber, Claire Beguin, Steve Bruster, Marie-Christine Closon, Ulises Ruiz, Francesco Taroni, Karl Uberla, and Richard van den Heuvel
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SQL ,Databases, Factual ,Abstracting and Indexing ,International Cooperation ,Population ,Case mix index ,Medicine ,Operations management ,Resource management ,education ,Diagnosis-Related Groups ,computer.programming_language ,Strategic planning ,education.field_of_study ,business.industry ,Health Policy ,Comparability ,Planning Techniques ,Models, Theoretical ,Reference Standards ,Europe ,Data set ,Utilization Review ,Hospital Information Systems ,business ,computer ,Test data - Abstract
A European approach for resource management and strategic planning has been implemented in the HOSCOM project of AIM by defining information standards needed across countries, as well as a methodology to measure resources and costs at the institutional and interinstitutional level. A Euro Health Data Base (EHDB) has been obtained in order to test data availability and comparability as well as to validate models through macrocomparisons using case-mix (DRG's, refined grouping, disease staging) and microcomparisons based on three diseases (cardiac valve replacement, diabetes mellitus and hip fracture). The EHDB's presently based on 274 164 medical record summaries sampled from 7 countries allowed us to build prototypes (using Clipper, Prolog and SQL) in order to export uniform aggregates in the different countries, with standard software tools for statistical comparisons. It showed the present feasibility of using case-mix based on the European Minimum Basic Data Set (MBDS) and the difficulty of obtaining uniform data on resources and costs other than length of stay across countries. Medical data confidentiality was assured but not yet population-based representativity. Given the present state of the EHDB, problems have been clearly identified in order to be solved by international research and development projects in the near future. more...
- Published
- 1991
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42. Mass Media Interventions
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Francesco Taroni and Roberto Grilli
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medicine.medical_specialty ,business.industry ,Public health ,media_common.quotation_subject ,Target audience ,Media relations ,Public relations ,Public good ,Social issues ,Political science ,medicine ,Quality (business) ,business ,News media ,media_common ,Mass media - Abstract
Mass public health campaigns aim at channeling the power of the media toward the public good, ensuring adequate exposure of the target audience. Public health practitioners should learn how to harness the power of the different media and to successfully compete in a contested environment. The quality of news reporting in medicine is largely determined by medical journals, research, and health-care institutions as well as by individual scientists competing for visibility, funding, and profits. Audiences, however, are more active than usually assumed and mass campaigns should be appropriately used as legitimate spaces for debate of social issues at the science–policy interface. more...
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- 2008
- Full Text
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43. Italy
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Francesco Taroni, George France, Andrea Tramarin, Emma Conti, Andrea Donatini, and Fernando Antonio Compostella
- Abstract
This chapter reviews Italy's response to its HIV epidemic. More than twenty years after the diagnosis of the first case of AIDS, the pattern of the HIV epidemic in Italy has significantly changed. A particular feature of the Italian case is that heterosexual transmission has been increasing, mainly as a result of sexual contact with injecting drug users (IDUs). This reflects the fact that, despite a number of local success stories, Italy has not been successful in preventing the spread of HIV infection both among and from IDUs. more...
- Published
- 2007
- Full Text
- View/download PDF
44. Prevalence of long-term care acquired infections in nursing and residential homes in the Emilia-Romagna Region
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M. Mongardi, Francesco Taroni, M. Marchi, M. L. Moro, Moro M.L., Mongardi M., and Taroni F.
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Male ,Microbiology (medical) ,Activities of daily living ,Cross-sectional study ,Population ,MEDLINE ,Nursing ,Prevalence ,Homes for the Aged ,Humans ,Medicine ,education ,Aged ,Aged, 80 and over ,Cross Infection ,education.field_of_study ,business.industry ,Infection prevalence ,General Medicine ,Long-Term Care ,Nursing Homes ,Stratified sampling ,Long-term care ,Cross-Sectional Studies ,Infectious Diseases ,Italy ,Female ,Nursing homes ,business - Abstract
Hardly any data on the occurrence of infection in Italian nursing homes have been published; yet Italy has the second oldest population in the world. The objective of the study was to assess the frequency of infections in a sample of Italian nursing homes. A 1-day prevalence survey was conducted in three local health authorities (LHAs) of the Emilia-Romagna region in Italy, aimed at describing the prevalence of patients with long-term care facilityassociated infections and their associated factors among residents of nursing and residential facilities. All nursing homes (NHs) and a stratified random sample of residential homes (RHs) in the three LHAs were included in the study, for a total of 1,926 elderly people in 49 facilities. The following data were recorded: infections, medical condition, activities of daily living (ADL), use of antibiotics. The main outcome of the study was infection prevalence. The prevalence of patients with long-term care facility-associated infection was 8.4/100 residents overall (CI 95% 7.9–9.0), 14.6/100 in NHs and 7.5/100 in RHs (CI 95% 6.8–8.1). The prevalence of infection significantly varied with LHA and facility. It was associated with level of dependency and exposure to invasive procedures, such as urinary catheterization and parenteral procedures. Six percent of residents received a systemic antimicrobial on the day of the study, and in 22% of cases there was no evidence of suspected or diagnosed infections. The prevalence study identified a high prevalence of infected patients in nursing homes in Italy, consistent with observation in other geographic areas. more...
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- 2007
45. Effect of hospital ownership status and payment structure on the adoption and use drug-eluting stents for percutaneous coronary interventions
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Paolo Guastaroba, Francesco Taroni, Roberto Grilli, Grilli R., Guastaroba P., and Taroni F.
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medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,Stent ,Retrospective cohort study ,General Medicine ,Confidence interval ,Surgery ,Cardiac surgery ,surgical procedures, operative ,Emergency medicine ,Conventional PCI ,Medicine ,cardiovascular diseases ,business ,Adverse effect - Abstract
Background: The impact of the use of drug-eluting stents in percutaneous coronary intervention (PCI) on cardiac care is still uncertain. We examined the influence of systemic factors, such as hospital ownership status, organizational characteristics and payment structure, on the use of drug-eluting stents in PCI and the effect on cardiac surgery volume. Methods: We conducted a cross-sectional analysis of drug-eluting stent use in 12 993 patients undergoing PCI with stenting (drug-eluting or bare-metal) and time-series regression analyses of the monthly number of cardiac surgery and PCI procedures performed using data collected from 1998 to 2004 at 13 public and private hospitals in the Emilia-Romagna region of Italy. Results: Public hospitals used drug-eluting stents more selectively than private hospitals, targeting the new device to patients at high risk of adverse events. The time-series regression analyses showed that the number of PCI procedures performed per year increased during this period, both in public (slope coefficient 36.4, 95% confidence interval [CI] 30.2 to 43.1) and private centres (slope coefficient 6.4, 95% CI 3.1 to 9.2 ). Concurrently, there was a reduction in the number of isolated coronary artery bypass graft (CABG) surgeries, although the degree of change was higher in public than in private hospitals (coefficient –16.1 v. –6.2 respectively ). The number of CABG procedures associated with valve surgery decreased in public hospitals (coefficient –5.0, 95% CI –6.1 to –3.8) but increased in private hospitals (coefficient 4.1, 95% CI 2.0 to 6.1). Interpretation: Public and private hospitals behaved differently in adopting drug-eluting stents and in using PCI with drug-eluting stents as a substitute for surgical revascularization. more...
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- 2007
46. Managing the introduction of expensive medical procedures: use of a registry
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Francesco Taroni, Roberto Grilli, Grilli R., and Taroni F.
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Male ,medicine.medical_specialty ,Cost Control ,National Health Programs ,medicine.medical_treatment ,Psychological intervention ,Coronary Artery Disease ,Administration, Cutaneous ,Policy decision ,Medicine ,Bare metal ,Humans ,cardiovascular diseases ,Myocardial infarction ,Registries ,Intensive care medicine ,Randomized Controlled Trials as Topic ,Sirolimus ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Stent ,Middle Aged ,medicine.disease ,Clinical trial ,Clinical Practice ,Italy ,Female ,Stents ,Diffusion of Innovation ,business ,Healthcare system - Abstract
Objectives: To explore how the adoption of medical innovations challenges tax-financed health systems, drawing from the case of sirolimus eluting stents, a promising and costly innovation for percutaneous coronary interventions. Methods: The coverage decisions for the new stents adopted in Emilia-Romagna, an Italian region, are described. The innovation was adopted through a process combining the development of clinical guidelines targeting their use to selected clinical indications, negotiation with the manufacturer for reducing price, and the organization of a registry for monitoring its patterns of utilization and assessing its effectiveness. Results: Overall, 17% of the 6276 patients included in the registry over a 12-month period had the new stent. Wide differences between published trials on sirolimus eluting stents and actual clinical practice emerged. The new stents were frequently (23%) used in combination with traditional bare metal stents, and for indications (acute myocardial infarction and multivessel coronary disease) never included in clinical experiments (25% and 8% of the cases, respectively). Patients' outcomes were also different, the overall rate of major adverse cardiac events being relatively higher (12%) than that shown in clinical trials. Conclusions: The actions undertaken for the new stents allowed a timely, and at the same time targeted and monitored, adoption of the innovation. This experience highlights how policy decisions related to new medical products could benefit from the availability of clinical databases providing key information on how innovations are actually used and on their impact on clinical practice. more...
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- 2006
47. The Italian health-care system
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George France, Francesco Taroni, Andrea Donatini, France G., Taroni F., and Donatini A.
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Male ,Economic growth ,Financial Management ,National Health Programs ,Quality Assurance, Health Care ,Waiting Lists ,media_common.quotation_subject ,MEDLINE ,Primary care ,Gross domestic product ,Health Services Accessibility ,Reimbursement Mechanisms ,Health care ,Outcome Assessment, Health Care ,Economics ,Humans ,Lower income ,media_common ,Motivation ,Equity (economics) ,Health Care Rationing ,business.industry ,Health Policy ,Payment ,Italy ,Central government ,Health Care Reform ,Female ,Health Expenditures ,business - Abstract
Italy's national health service is statutorily required to guarantee the uniform provision of comprehensive care throughout the country. However, this is complicated by the fact that, constitutionally, responsibility for health care is shared between the central government and the 20 regions. There are large and growing differences in regional health service organisation and provision. Public health-care expenditure has absorbed a relatively low share of gross domestic product, although in the last 25 years it has consistently exceeded central government forecasts. Changes in payment systems, particularly for hospital care, have helped to encourage organisational appropriateness and may have contributed to containing expenditure. Tax sources used to finance the Servizio Sanitario Nazionale (SSN) have become somewhat more regressive. The limited evidence on vertical equity suggests that the SSN ensures equal access to primary care but lower income groups face barriers to specialist care. The health status of Italians has improved and compares favourably with that in other countries, although regional disparities persist. more...
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- 2005
48. Impact of regionalization of cardiac surgery in Emilia-Romagna, Italy
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Daniela Fortuna, Francesco Taroni, Paolo Guastaroba, L. Nobilio, Elena Berti, M. Vizioli, Roberto Grilli, Nobilio L., Fortuna D., Vizioli M., Berti E., Guastaroba P., Taroni F., and Grilli R.
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Male ,medicine.medical_specialty ,Pediatrics ,Quality management ,Heart Diseases ,Waiting Lists ,Epidemiology ,Specialty ,Psychological intervention ,Regional Medical Programs ,Case mix index ,medicine ,Humans ,Hospital Mortality ,Cardiac Surgical Procedures ,Referral and Consultation ,Aged ,Quality Indicators, Health Care ,Aged, 80 and over ,business.industry ,Mortality rate ,Public health ,Public Health, Environmental and Occupational Health ,Thoracic Surgery ,Regionalisation ,Italy ,Cardiothoracic surgery ,Models, Organizational ,Emergency medicine ,Female ,Cardiology Service, Hospital ,business ,Evidence Based Public Health Policy and Practice - Abstract
Assessment of the impact of the regionalisation of cardiac surgery through the organisational form of a hubspoke model introduced in the year 2000.Case mix adjusted before (1998-1999)-after (2000-2002) comparison of: (a) in-hospital and 30 days mortality rates; (b) proportion of patients timely (within one day) referred for surgery from spoke to hub centres; (c) patients' waiting times to surgery.Emilia-Romagna, an Italian region with four million residents.16,512 patients agedor =18 years and referred to cardiac surgery over the period 1998-2002.Overall, taking into account differences in case mix across the whole study period, the implementation of the regionalisation policy was associated with a 22% reduction (OR: 0.79, 95%CI: 0.66 to 0.93) in in-hospital mortality rate. The corresponding figure for 30 day mortality was 18% (OR: 0.82: 95%CI: 0.69 to 0.98). The individual centres' volume of cases changed over the study period for all hospitals but two, and the biggest reduction in mortality was seen at the centre with the largest increase in caseload.This study provides additional evidence on the benefit of regionalisation of cardiac surgery interventions. The system allowed each centre to reach the minimum caseload required to assure good quality of care. These findings suggest that policies aimed at increasing cooperation rather than competition among health service providers have a positive impact on quality of care. Timely referrals for surgery increased by 21% (95%CI: 1.12 to 1.31), and mean waiting times were reduced by 7.5 average days (95%CI: -10.33 to -4.71). more...
- Published
- 2004
49. Roemer's effect reconsidered
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Francesco Taroni
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Health Services Needs and Demand ,Certificate of Need ,Health Policy ,Public Health, Environmental and Occupational Health ,Health services research ,MEDLINE ,Certificate of need ,Utilization review ,Bed Occupancy ,United States ,Nursing ,Hospital Bed Capacity ,Political science ,Utilization Review ,Humans ,Health Services Research - Published
- 2001
50. Patterns of hospital care and physician perspectives from an Italian, Japanese, and USA hospital
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Elaine J. Yuen, Joseph S. Gonnella, Daniel Z. Louis, Francesco Taroni, and Yoshimasa Umesato
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Adult ,medicine.medical_specialty ,Attitude of Health Personnel ,Severity of Illness Index ,Patient care ,03 medical and health sciences ,0504 sociology ,Japan ,Physicians ,Health care ,Severity of illness ,medicine ,Macro level ,Cholecystitis ,Diabetes Mellitus ,Humans ,Practice Patterns, Physicians' ,Hospitals, Teaching ,Quality of Health Care ,030505 public health ,business.industry ,Health Policy ,05 social sciences ,050401 social sciences methods ,Patient mix ,Length of Stay ,medicine.disease ,Appendicitis ,Hospital care ,United States ,Italy ,Emergency medicine ,Health Services Research ,0305 other medical science ,business ,Hospital stay - Abstract
Many studies have compared different countries' health care systems at the macro level. Less has been done to analyze care provided for patients with specific diseases and to compare physician attitudes concerning factors that influence patient care. This study compares severity of illness and length of hospital stay for patients admitted for diabetes mellitus, cholecystitis, or appendicitis at three teaching hospitals in Italy, Japan, and the United States. Physicians caring for patients with these diseases were surveyed to assess their opinions of the adequacy of resources available at their hospital, perceived administrative pressures concerning resource use, and interactions with patients and their families that relate to admission and discharge decisions. The severity of the patient mix was consistently higher in the U.S. hospital than in the Italian or Japanese hospitals. Controlling for diagnosis, severity of illness, surgery, age, and presence of co-morbid conditions, the U.S. hospital consistently had the shortest stays and the Japanese hospital the longest. Japanese physicians were more likely than U.S. or Italian physicians to report insufficient resources, such as nurses, to provide quality care, but less likely to report administrative pressures interfering with patient care. Differences in hospital utilization may reflect variation in clinical practices, availability of resources, barriers to access to care, organizational differences at the national and hospital level, and patient and family preferences. more...
- Published
- 1996
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