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1. Cost-effectiveness of the adherence with recommendations for clinical monitoring of patients with diabetes

Author

Giovanni Corrao, Federico Rea, Giuseppe Mancia, Gianluca Perseghin, Luca Merlino, Nello Martini, Simona Carbone, Flavia Carle, Andrea Bucci, Marianxhela Dajko, Silvia Arcà, Donata Bellentani, Velia Bruno, Carla Ceccolini, Angela De Feo, Lucia Lispi, Rosanna Mariniello, Maurizio Masullo, Federica Medici, Paola Pisanti, Modesta Visca, Rinaldo Zanini, Teresa Di Fiandra, Natalia Magliocchetti, Giovanna Romano, Anna Cantarutti, Pietro Pugni, Marina Davoli, Mirko Di Martino, Adele Lallo, Patrizia Vittori, Giuliana Vuillermin, Alfonso Bernardo, Anna Fusciante, Laura Belotti, Rossana De Palma, Enza Di Felice, Roberta Chiandetti, Elena Clagnan, Stefania Del Zotto, Andrea Di Lenarda, Aldo Mariotto, Marisa Prezza, Loris Zanier, Danilo Fusco, Chiara Marinacci, Antonio Lora, Liana Spazzafumo, Simone Pizzi, Maria Simiele, Giuseppe Massaro, Ettore Attolini, Vito Lepore, Vito Petrarolo, Giovanni De Luca, Giovanna Fantaci, Sebastiano Pollina Addario, Salvatore Scondotto, Francesco Bellomo, Mario Braga, Valeria Di Fabrizio, Silvia Forni, Paolo Francesconi, Francesco Profili, Francesco Avossa, Matteo Corradin, Silvia Vigna, Letizia Dondi, Antonella Pedrini, Carlo Piccinni, Mimma Cosentino, Maria G. Marvulli, Aldo Maggioni, Corrao, G, Rea, F, Mancia, G, Perseghin, G, Merlino, L, Martini, N, Carbone, S, Carle, F, Bucci, A, Dajko, M, Arca, S, Bellentani, D, Bruno, V, Ceccolini, C, De Feo, A, Lispi, L, Mariniello, R, Masullo, M, Medici, F, Pisanti, P, Visca, M, Zanini, R, Di Fiandra, T, Magliocchetti, N, Romano, G, Cantarutti, A, Pugni, P, Davoli, M, Di Martino, M, Lallo, A, Vittori, P, Vuillermin, G, Bernardo, A, Fusciante, A, Belotti, L, De Palma, R, Di Felice, E, Chiandetti, R, Clagnan, E, Del Zotto, S, Di Lenarda, A, Mariotto, A, Prezza, M, Zanier, L, Fusco, D, Marinacci, C, Lora, A, Spazzafumo, L, Pizzi, S, Simiele, M, Massaro, G, Attolini, E, Lepore, V, Petrarolo, V, De Luca, G, Fantaci, G, Pollina Addario, S, Scondotto, S, Bellomo, F, Braga, M, Di Fabrizio, V, Forni, S, Francesconi, P, Profili, F, Avossa, F, Corradin, M, Vigna, S, Dondi, L, Pedrini, A, Piccinni, C, Cosentino, M, Marvulli, M, and Maggioni, A

Subjects
Diagnostic Screening Programs, Male, medicine.medical_specialty, Time Factors, Databases, Factual, National Health Programs, Cost effectiveness, Endocrinology, Diabetes and Metabolism, Cost-Benefit Analysis, Population, Medicine (miscellaneous), Audit, Diagnostic Techniques, Ophthalmological, Diabete, Kidney Function Tests, Cost Savings, Predictive Value of Tests, Diabetes mellitus, Health care, medicine, Diabetes Mellitus, Healthcare cost, Humans, education, Aged, Incremental cost-effectiveness ratio, education.field_of_study, Nutrition and Dietetics, medicine.diagnostic_test, business.industry, Periodic examination, Health Care Costs, Middle Aged, medicine.disease, Prognosis, Population-based cohort study, Real-world, Italy, Cost-effectivene, Emergency medicine, Patient Compliance, Female, Cardiology and Cardiovascular Medicine, business, Lipid profile, Complication, Blood Chemical Analysis, Cohort study
Abstract

Background and aims To validate a set of indicators for monitoring the quality of care of patients with diabetes in ‘real-life’ practice through its relationship with measurable clinical outcomes and healthcare costs. Methods and results A population-based cohort study was carried out by including the 20,635 patients, residents in the Lombardy Region (Italy), who in the year 2012 were newly taken-in-care for diabetes. Adherence with clinical recommendations (i.e., controls for glycated haemoglobin, lipid profile, urine albumin excretion and serum creatinine) was recorded during the first year after the patient was taken-in-care, and categorized according whether he/she complied with none or almost none (0 or 1), just some (2) or all or almost all (3 or 4) the recommendations, respectively denoted as poor, intermediate and high adherence. Short- and long-term complications of diabetes, and healthcare cost incurred by the National Health Service, were assessed during follow-up. Compared with patients with poor adherence, those with intermediate and high adherence respectively showed (i) a delay in outcome occurrence of 13 days (95% CI, -2 to 27) and 23 days (9 to 38), and (ii) a lower healthcare cost of 54 € and 77 €. In average, a gain of 18 Euros and 15 Euros for each day free from diabetic complication by increasing adherence respectively from poor to intermediate and from poor to high were observed. Conclusion Close control of patients with diabetes through regular clinical examinations must be considered the cornerstone of national guidance, national audits, and quality improvement incentive schemes.

Published
2021

2. Definition of fibromyalgia severity: findings from a cross-sectional survey of 2339 Italian patients

Author

Maurizio Masullo, A. Capacci, Roberto Giacomelli, Fabio Fischetti, Mariateresa Cirillo, Giuliana Guggino, Giovanni Biasi, Lorenzo Dagna, Manuela Di Franco, Marco Ghini, Maurizio Cutolo, Daniele Santilli, Sara Bonazza, F. Mozzani, Carlo Salvarani, Elisa Gremese, Ilenia Riccucci, Gianluigi Bajocchi, Alberto Batticciotto, Laura Bazzichi, Giulio Cavalli, Marco Di Carlo, Florenzo Iannone, Stefano Barbagli, Sonia Farah, Serena Guiducci, Roberto Gerli, Marcello Govoni, Francesca Nacci, Francesco Carubbi, Piercarlo Sarzi-Puttini, Mario Bentivegna, Bianca Maria Polizzi, Luigi Sinigaglia, Fabiola Atzeni, Valeria Giorgi, Chiara Gioia, Fausto Salaffi, Salaffi, Fausto, Di Carlo, Marco, Bazzichi, Laura, Atzeni, Fabiola, Govoni, Marcello, Biasi, Giovanni, Di Franco, Manuela, Mozzani, Flavio, Gremese, Elisa, Dagna, Lorenzo, Batticciotto, Alberto, Fischetti, Fabio, Giacomelli, Roberto, Guiducci, Serena, Guggino, Giuliana, Bentivegna, Mario, Gerli, Roberto, Salvarani, Carlo, Bajocchi, Gianluigi, Ghini, Marco, Iannone, Florenzo, Giorgi, Valeria, Farah, Sonia, Cirillo, Mariateresa, Bonazza, Sara, Barbagli, Stefano, Gioia, Chiara, Santilli, Daniele, Capacci, Annunziata, Cavalli, Giulio, Carubbi, Francesco, Nacci, Francesca, Riccucci, Ilenia, Sinigaglia, Luigi, Masullo, Maurizio, Polizzi, Bianca Maria, Cutolo, Maurizio, Sarzi-Puttini, Piercarlo, Salaffi F., Di Carlo M., Bazzichi L., Atzeni F., Govoni M., Biasi G., Di Franco M., Mozzani F., Gremese E., Dagna L., Batticciotto A., Fischetti F., Giacomelli R., Guiducci S., Guggino G., Bentivegna M., Gerli R., Salvarani C., Bajocchi G., Ghini M., Iannone F., Giorgi V., Farah S., Cirillo M., Bonazza S., Barbagli S., Gioia C., Santilli D., Capacci A., Cavalli G., Carubbi F., Nacci F., Riccucci I., Sinigaglia L., Masullo M., Polizzi B.M., Cutolo M., Sarzi-Puttini P., and Maria Polizzi, Bianca

Subjects
Male, Percentile, Settore MED/16 - REUMATOLOGIA, Fibromyalgia, Cross-sectional study, severity, Disease, Severity of Illness Index, Economica, 0302 clinical medicine, modified, Interquartile range, Retrospective Studie, Surveys and Questionnaires, Surveys and Questionnaire, Pharmacology (medical), 030212 general & internal medicine, cut-off points, Pain Measurement, Fibromyalgia Assessment Status, fibromyalgia, polysymptomatic distress scale, revised Fibromyalgia Impact Questionnaire, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Incidence, Italy, Middle Aged, Prognosis, Retrospective Studies, Quality of Life, Distress, Human, medicine.medical_specialty, Prognosi, Revised Fibromyalgia Impact Questionnaire, Follow-Up Studie, 03 medical and health sciences, Rheumatology, Internal medicine, Severity of illness, cut-off point, medicine, 030203 arthritis & rheumatology, Cross-Sectional Studie, business.industry, medicine.disease, Fibromyalgia Assessment Statu, fibromyalgia assessment status, revised fibromyalgia impact questionnaire, business
Abstract

Objective To establish optimal cut-off values for the scores of the revised Fibromyalgia Impact Questionnaire (FIQR), the modified Fibromialgia Assessment Scale (FAS 2019mod), and the Polysymptomatic Distress Scale (PDS) in order to distinguish five levels of FM disease severity. Methods Consecutive FM patients were evaluated with the three clinimetric indices, and each patient was required to answer the anchor question: ‘In general, would you say your health is 1 = very good, 2 = good, 3 = fair, 4 = poor, or 5 = very poor?’—which represented the external criterion. Cut-off points were established through the interquartile reconciliation approach. Results The study sample consisted of 2181 women (93.2%) and 158 men (6.8%), with a mean age of 51.9 (11.5) years, and mean disease duration was 7.3 (6.9) years. The overall median FIQR, FAS 2019 mod and PDS scores (25th–75th percentiles) were respectively 61.16 (41.16–77.00), 27.00 (19.00–32.00) and 19.0 (13.00–24.00). Reconciliation of the mean 75th and 25th percentiles of adjacent categories defined the severity states for FIQR: 0–23 for remission, 24–40 for mild disease, 41–63 for moderate disease, 64–82 for severe disease and >83 for very severe disease; FAS 2019 mod: 0–12 for remission, 13–20 for mild disease, 21–28 for moderate disease, 29–33 for severe disease and >33 for very severe disease; PDS: 0–5 for remission, 6–15 for mild disease, 16–20 for moderate disease, 21–25 for severe disease and >25 for very severe disease. Conclusions Disease severity cut-offs can represent an important improvement in interpreting FM.

Published
2021

3. Measuring multimorbidity inequality across Italy through the multisource comorbidity score: A nationwide study

Author

Pietro Pugni, Enza Di Felice, Rossana De Palma, Donata Bellentani, Giovanna Romano, Stefania Del Zotto, Mario Braga, Liana Spazzafumo, Luca Merlino, Maria Grazia Marvulli, Federica Medici, Carlo Piccinni, Giuseppe Massaro, Teresa Di Fiandra, Lucia Bisceglia, Chiara Marinacci, Mirko Di Martino, Giovanni Corrao, Giuseppe Sechi, Angela De Feo, Antonio Lora, Andrea Di Lenarda, Mauro Agnello, Nello Martini, Matteo Corradin, Flavia Carle, Patrizia Vittori, Aldo P. Maggioni, Modesta Visca, Natalia Magliocchetti, Marianxhela Dajko, Lucia Lispi, Letizia Dondi, Francesco Bellomo, Sebastiano Pollina Addario, Silvia Arcà, Giuseppe Montagano, Danilo Fusco, Rinaldo Zanini, Paolo Francesconi, Marina Davoli, Adele Lallo, Carlo Alberto Scirè, Paola Pisanti, Elena Clagnan, Donatella Garau, Simona Carbone, Mimma Cosentino, Salvatore Scondotto, Laura Belotti, Loris Zanier, Giovanna Fantaci, Vito Petrarolo, Valeria Di Fabrizio, Francesco Avossa, Silvia Forni, Maria Simiele, E. Attolini, Roberta Chiandetti, Carla Ceccolini, Aldo Mariotto, Rosanna Mariniello, Federico Rea, Antonella Pedrini, Francesco Profili, Andrea Bucci, Anna Cantarutti, Maurizio Masullo, Velia Bruno, Vito Lepore, Corrao, G, Rea, F, Carle, F, Di Martino, M, De Palma, R, Francesconi, P, Lepore, V, Merlino, L, Scondotto, S, Garau, D, Spazzafumo, L, Montagano, G, Clagnan, E, Martini, N, and Scire', C

Subjects
Male, Inequality, multimorbidity, media_common.quotation_subject, Population, Demographic transition, Distribution (economics), State Medicine, NO, Prognostic Score, 03 medical and health sciences, 0302 clinical medicine, inequalities, medicine, Prevalence, Multimorbidity, Humans, score, Administrative Database, 030212 general & internal medicine, education, Health policy, media_common, education.field_of_study, business.industry, 030503 health policy & services, Healthcare, Public Health, Environmental and Occupational Health, Middle Aged, medicine.disease, Comorbidity, comorbidity, multimorbidity, inequalities, score, comorbidity, Geography, Cross-Sectional Studies, Italy, Population study, Female, 0305 other medical science, business, Demography
Abstract

Background Multimorbidity is a growing concern for healthcare systems, with many countries experiencing demographic transition to older population profiles. A simple multisource comorbidity score (MCS) has been recently developed and validated. A very large real-world investigation was conducted with the aim of measuring inequalities in the MCS distribution across Italy. Methods Beneficiaries of the Italian National Health Service aged 50–85 years who in 2018 were resident in one of the 10 participant regions formed the study population (15.7 million of the 24.9 million overall resident in Italy). MCS was assigned to each beneficiary by categorizing the individual sum of the comorbid values (i.e. the weights corresponding to the comorbid conditions of which the individual suffered) into one of the six categories denoting a progressive worsening comorbidity status. MCS distributions in women and men across geographic partitions were compared. Results Compared with beneficiaries from northern Italy, those from centre and south showed worse comorbidity profile for both women and men. MCS median age (i.e. the age above which half of the beneficiaries suffered at least one comorbidity) ranged from 60 (centre and south) to 68 years (north) in women and from 63 (centre and south) to 68 years (north) in men. The percentage of comorbid population was lower than 50% for northern population, whereas it was around 60% for central and southern ones. Conclusion MCS allowed of capturing geographic variability of multimorbidity prevalence, thus showing up its value for addressing health policy in order to guide national health planning.

Published
2020

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