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Ilaria Massa  - - - 
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Riccardo Zucchi

189 shared publications

Department of Pathology, University of Pisa, Pisa, Italy

A. Rocca

145 shared publications

Pneumology, University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Bologna, Italy

Aldo Paolicchi

138 shared publications

Laboratory of Clinical Pathology; University of Pisa Medical School Hospital Pisa; Italy

Alessandro Saba

51 shared publications

Department of Surgical Pathology, Medicine, Molecular and Critical Area, University of Pisa, 56126 Pisa, Italy.

Maria Claudia Lucchetti

13 shared publications

Università di Roma Tre

12
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Distribution of Articles published per year 
(2013 - 2018)
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10
 
Publications See all
Article 1 Read 0 Citations The challenge of sustainability in healthcare systems: frequency and cost of diagnostic procedures in end-of-life cancer... Ilaria Massa, William Balzi, Mattia Altini, Raffaella Bertè,... Published: 01 February 2018
Supportive Care in Cancer, doi: 10.1007/s00520-018-4067-7
DOI See at publisher website ABS Show/hide abstract
Literature data on the overuse and misuse of diagnostic procedures leading to end-of-life aggressiveness are scarce due to the limited amount of estimated economic waste. This study investigated the potential overuse of diagnostic procedures in a population of end-of-life patients. This is a retrospective study on consecutive advanced patients admitted into two Italian hospices. Frequency and relative costs of X-ray imaging, CT scans, MRI, and interventional procedures prescribed in the 3 months before admission were collected in patient electronic charts and/or in administrative databases. We conducted a deeper analysis of 83 cancer patients with a diagnosis of at least 1 year before admission to compare the number of examinations performed at two distant time periods. Out of 541 patients, 463 (85.6%) had at least one radiological exam in the 3 months before last admission. The mean radiological exam number was 3.9 ± 3.2 with a relative mean cost of 278.60 ± 270.20 € per patient with a statistically significant (p < 0.001) rise near death. In the 86-patient group, a higher number of procedures was performed in the last 3 months of life than in the first quarter of the year preceding last admission (38.43 ± 28.62 vs. 27.95 ± 23.21, p < 0.001) with a consequent increase in cost. Patients nearing death are subjected to a high level of “diagnostic aggressiveness.” Further studies on the integration of palliative care into the healthcare pathway could impact the appropriateness of interventions, quality of care, and, ultimately, estimated costs.
Article 0 Reads 1 Citation Quantification of dehydroepiandrosterone in human serum on a routine basis: development and validation of a tandem mass ... Beatrice Campi, Sabina Frascarelli, Elisabetta Pietri, Ilari... Published: 06 November 2017
doi: 10.1007/s00216-017-0731-x
DOI See at publisher website PubMed View at PubMed
Article 0 Reads 1 Citation Androgen and oestrogen receptors as potential prognostic markers for patients with ductal carcinoma in situ treated with... Sara Ravaioli, Maria Maddalena Tumedei, Flavia Foca, Roberta... Published: 01 October 2017
International Journal of Experimental Pathology, doi: 10.1111/iep.12253
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Article 0 Reads 1 Citation The challenge of sustainability in healthcare systems: Frequency and cost of inappropriate patterns of breast cancer car... Ilaria Massa, William Balzi, Costanza Burattini, Nicola Gent... Published: 01 August 2017
The Breast, doi: 10.1016/j.breast.2017.05.007
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•We applied a method to identify wastages and associated costs in breast cancer care.•We developed techniques to link data from multiple routine healthcare data sources.•These resources may be redirected to higher-value interventions for patients.•This method helps to fill the gap between appropriateness and best clinical results. ObjectivesIn a context of decreasing economic health resources and a rise in health needs, it is urgent to face this sustainability crisis through the analysis of healthcare expenditures. Wastages, deriving from inappropriate interventions, erode resources which could be reallocated to high-value activities. To identify these areas of wastages, we developed a method for combining and analyzing data from multiple sources. Here we report the preliminary results of a retrospective cohort study evaluating the performance of breast cancer (BC) care at IRST, an Italian cancer institute. In a context of decreasing economic health resources and a rise in health needs, it is urgent to face this sustainability crisis through the analysis of healthcare expenditures. Wastages, deriving from inappropriate interventions, erode resources which could be reallocated to high-value activities. To identify these areas of wastages, we developed a method for combining and analyzing data from multiple sources. Here we report the preliminary results of a retrospective cohort study evaluating the performance of breast cancer (BC) care at IRST, an Italian cancer institute. Materials and methodsFour data sources gathered in a real-world setting (a clinical database, two administrative databases and a cancer registry) were linked. Essential Key Performance Indexes (KPIs) in the pattern of BC diagnosis (KPI 1 and 2) and treatment (KPI 3 and 4) based on current guidelines were developed by a board of professionals. The costs of inappropriate examinations were associated with the diagnostic KPIs. Four data sources gathered in a real-world setting (a clinical database, two administrative databases and a cancer registry) were linked. Essential Key Performance Indexes (KPIs) in the pattern of BC diagnosis (KPI 1 and 2) and treatment (KPI 3 and 4) based on current guidelines were developed by a board of professionals. The costs of inappropriate examinations were associated with the diagnostic KPIs. ResultsWe found that 2798 patients treated at IRST from January 2010 to June 2016 received a total of 2516 inappropriate examinations accounting for € 573,510.80. Linkage from multiple routine healthcare data sources is feasible: it allows the measurement of important KPIs specifically designed for BC care, and the identification of areas of low-value use of the resources. We found that 2798 patients treated at IRST from January 2010 to June 2016 received a total of 2516 inappropriate examinations accounting for € 573,510.80. Linkage from multiple routine healthcare data sources is feasible: it allows the measurement of important KPIs specifically designed for BC care, and the identification of areas of low-value use of the resources. ConclusionIf systematically applied, this method could help provide a complete picture of inappropriateness and waste, redirect these resources to higher-value interventions for patients, and fill the gap between proper use of the resources and the best clinical results. If systematically applied, this method could help provide a complete picture of inappropriateness and waste, redirect these resources to higher-value interventions for patients, and fill the gap between proper use of the resources and the best clinical results. 1. IntroductionJump to Section1. Introduction2. Methods 2.1. Setting 2.2. KPIs 2.3. Data sources 2.4. Case series3. Results4. DiscussionEthical approvalConflict of interestRole of the funding sourceAcknowledgementsAppendix. ReferencesIn developed countries, oncology represents an increasing burden on the healthcare budget. Major determinants of healthcare expenditures include the increase in cancer incidence, closely linked to population aging, and the use of new high-cost drugs and technologies, especially in patients with advanced disease. These innovations have led to an improvement in survival rate, but challenge the sustainability of health systems. It is estimated, for example, that in the USA the costs of cancer care will increase by an average of 20% per year in the period 1990–2020 [[1], [2]].Breast cancer (BC) is the most common cancer among women in western countries [3][3], and the second leading cause of cancer-related death [4][4]. It is a clinically complex condition, which requires a coordinated multidisciplinary approach and is susceptible to different treatment solutions due to its heterogeneity [5][5]. The increasing trend towards the centralization of BC care in multidisciplinary breast units has probably promoted a greater adherence to practice guidelines, but the patterns of care actually provided and the associated costs have seldom been evaluated [6][6].The funding of the Italian health system will not increase significantly in coming years [7][7]. By implication, it is plausible to assume that no new resources will be allocated to oncology, even if the needs will increase. In Italy, where budget constraints are threatening the sustainability of the healthcare system, a thorough analysis of healthcare expenditures has shown that waste accounts for about 20–30% of global health costs [8][8]. Wastages derive from inappropriate interventions, i.e. actions that are not recommended by national and international guidelines and do not add significant therapeutic advantages. Avoiding this loss of resources is imperative. In addition, wastages can ultimately damage patients and affect the quality of care. In such a challenging context, policy makers and healthcare providers are striving to create performance measurement systems.Measuring performance in healthcare is a challenging and debated issue, centered on the value of healthcare, defined as the health outcome achieved at the population level per amount of expenditure [9][9]. This entails accessing, processing, combining, and analyzing a variety of data from multiple and heterogeneous sources.In the current paper, we report the preliminary results of a retrospective cohort study in which we evaluated the performance of BC care by connecting information gathered from four data sources in a real-world setting. Our rationale was two-fold: first, to develop a method for identifying areas of wastages with the aim to reallocate these resources into high-value activities; second, to fulfill the gap between health management and clinical practice, i.e. between proper use of the resources and the best clinical results. In detail, our objectives were: i) to verify the possibility of data linkage between different sources, each with a different level of validation, completion and timeliness; ii) to measure Key Performance Indexes (KPIs), based on international guidelines on BC care and identified in the Economic Appropriateness of an Integrated Care Pathway (Appropriatezza Economica del Percorso Integrato di Cura, E.Pic.A.) study and iii) to determine their associated costs in order to identify areas of low-value use of the resources.2. MethodsJump to Section1. Introduction2. Methods 2.1. Setting 2.2. KPIs 2.3. Data sources 2.4. Case series3. Results4. DiscussionEthical approvalConflict of interestRole of the funding sourceAcknowledgementsAppendix. References2.1. SettingJump to Section1. Introduction2. Methods 2.1. Setting 2.2. KPIs 2.3. Data sources 2.4. Case series3. Results4. DiscussionEthical approvalConflict of interestRole of the funding sourceAcknowledgementsAppendix. ReferencesThe study was conducted at the Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRST of Meldola, Forlì, Italy.2.2. KPIsJump to Section1. Introduction2. Methods 2.1. Setting 2.2. KPIs 2.3. Data sources 2.4. Case series3. Results4. DiscussionEthical approvalConflict of interestRole of the funding sourceAcknowledgementsAppendix. ReferencesUsing a new approach for performance evaluation, as proposed in the E.Pic.A. study, a board of professionals identified 7 KPIs in the pattern of BC diagnosis and treatment (local and systemic), on the basis of the current guidelines from the Italian Association of Medical Oncology (Associazione Italiana di Oncologia Medica, AIOM) [10][10] and the National Comprehensive Cancer Network (NCCN) [11][11]. These KPIs were defined in consideration of what could be retrieved from administrative databases. In the current paper we show the preliminary results of 4 of the KPIs comprised in the E.Pic.A. study.KPI 1, pre-surgery, was defined as the proportion of patients with stage I or II disease (defined through the tumor, node, metastasis [TNM] staging of the pathology report obtained at surgery) who underwent one of the following examinations: hepatic ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) (except for the thorax), positron emission tomography (PET), bone scan, within two distinct timeframes. Since the reasons for performing examinations are generally not indicated in clinical databases, we hypothesized two scenarios: the first was based on the assumption that each test was related to BC, and the second scenario was based on the assumption that patients could have undergone a specific examination for reasons unrelated to cancer, such as the presence of comorbidities and/or the patients' attitude and socio-economic context. In the first scenario, in rigorous adherence to current guidelines, each of the above-mentioned exams was considered as inappropriate if performed within 2 months before breast surgery. In the second scenario, one of the above-mentioned examinations was considered as inappropriate only if it had been performed more than once within 6 months before breast surgery, except for bone scan which was considered as inappropriate in any case. In
Article 5 Reads 4 Citations Modeling Social Life Cycle Assessment framework for the Italian wine sector Gabriella Arcese, Maria Claudia Lucchetti, Ilaria Massa Published: 01 January 2017
Journal of Cleaner Production, doi: 10.1016/j.jclepro.2016.06.137
DOI See at publisher website
Article 0 Reads 13 Citations Androgen receptor signaling pathways as a target for breast cancer treatment Elisabetta Pietri, Vincenza Conteduca, Daniele Andreis, Ilar... Published: 15 August 2016
Endocrine-Related Cancer, doi: 10.1530/ERC-16-0190
DOI See at publisher website
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