Elena Berti

Objectives: To estimate the incidence of healthcare-associated infections (HAIs) in Italian long-term care facilities (LTCFs) and to evaluate whether an artificial intelligence (AI) approach, through unsupervised machine learning (ML), could stratify residents into clinically distinct groups with differing susceptibility to HAIs. Design: Prospective cohort study with 12-month follow-up. Setting: 24 LTCFs in Italy, participating in the European Centre for Disease Prevention and Control 12-month longitudinal study on HAIs in LTCFs, 2022–2023. Participants: 395 residents enrolled across the participating LTCFs. Methods: Incidence measures of HAIs (rate and ratio) were estimated, using generalized estimating equations. A hierarchical cluster analysis based on residents’ clinical and demographic characteristics was implemented as an unsupervised ML approach. Results: Overall, 75 HAIs per 100 residents (95% CI, 70.3–78.3) and 0.23 HAIs per 1,000 resident-days (95% CI, 0.11–0.76) were estimated. Respiratory tract infections (29.5%, 95% CI 24.2–31.1), COVID-19 (26.3%, 95% CI 22.1–28.4), and urinary tract infections (15%, 95% CI 11.0–35.4) were the most frequent. Clustering identified two reproducible resident groups: Group 1 (39%), more independent and cognitively preserved, with fewer comorbidities and lower infection incidence; and Group 2 (61%), more dependent and clinically complex, with higher incidence of HAIs. Cluster stability was high (mean ARI = 0.83). Conclusions: This study confirms the high burden of HAIs in Italian LTCFs and provides exploratory evidence that AI-based clustering can identify reproducible HAI susceptibility profiles in a setting where such approaches have been scarcely applied.

Background: Knowledge about the dynamics of transmission of SARS-CoV-2 and the clinical aspects of COVID-19 has steadily increased over time, although evidence of the determinants of disease severity and duration is still limited and mainly focused on older adult and fragile populations.Methods: The present study was conceived and carried out in the Emilia-Romagna (E-R) and Veneto Regions, Italy, within the context of the EU’s Horizon 2020 research project called ORCHESTRA (Connecting European Cohorts to increase common and effective response to SARS-CoV-2 pandemic) (www.orchestra-cohort.eu). The study has a multicenter retrospective population-based cohort design and aimed to investigate the incidence and risk factors of access to specific healthcare services (outpatient visits and diagnostics, drug prescriptions) during the post-acute phase from day-31 to day-365 after SARS-CoV-2 infection, in a healthy population at low risk of severe acute COVID-19. The study made use of previously recorded large-scale healthcare data available in the administrative databases of the two Italian Regions. The statistical analysis made use of methods for competing risks. Risk factors were assessed separately in the two Regions and results were pooled using random effects meta-analysis.Results: There were 35,128 subjects in E-R and 88,881 in Veneto who were included in the data analysis. The outcome (access to selected health services) occurred in a high percentage of subjects in the post-acute phase (25% in E-R and 21% in Veneto). Outpatient care was observed more frequently than drug prescriptions (18% vs. 12% in E-R and 15% vs. 10% in Veneto). Risk factors associated with the outcome were female sex, age greater than 40 years, baseline risk of hospitalization and death, moderate to severe acute COVID-19, and acute extrapulmonary complications.Conclusion: The outcome of interest may be considered as a proxy for long-term effects of COVID-19 needing clinical attention. Our data suggest that this outcome occurs in a substantial percentage of cases, even among a previously healthy population with low or mild severity of acute COVID-19. The study results provide useful insights into planning COVID-19-related services.

Background: The COVID-19 pandemic has had a relevant impact on mental health by influencing a series of well-known predictors: frequency and quality of socialization, income security, and physical activity. As society returns to normality, the potential mid-to-long term impact of such a major...

Background In Italy, there is scant evidence on the impact of Community Hospitals (CHs) on clinical outcomes. Aims To assess the effectiveness of CHs versus long-term care hospital or inpatient rehabilitation facilities on mortality, re-admission, institutionalization, and activation of a home care programme in the Emilia-Romagna Region (ERR-Italy) after acute hospitalisation. Methods We implemented a cohort study drawing upon the ERR Administrative Healthcare Database System and including hospital episodes of ERR residents subject ≥ 65 years, discharged from a public or private hospital with a medical diagnosis to a CH or to usual care between 2017 and 2019. To control for confounding, we applied a propensity score matching. Results Patients transferred to CHs had a significantly lower risk of dying but an increased risk of being readmitted to community or acute hospital within 30/90 days from discharge. The hazard of institutionalisation within 30/90 days was significantly lower in the whole population of the CH exposed group but not among patients with cardiac or respiratory chronic diseases or diabetes. The activation of a home care program within 90 days was slightly higher for those who were transferred to a CH. Discussion The findings of our study show mixed effects on outcomes of patients transferred to CHs compared to those who followed the post-acute usual care and should be taken with cautious as could be affected by the so-called ‘confounding by indication’. Conclusions The study contributes to the intermediate care available evidence from a region with a well-established care provision through CHs.

In 2020, the number of deaths increased in Italy, mainly because of the COVID-19 pandemic; mortality was among the highest in Europe, with a clear heterogeneity among regions and socio-demographic strata. The present work aims to describe trends in mortality and to quantify excess mortality variability over time and in relation to demographics, pre-existent chronic conditions and care setting of the Emilia-Romagna region (Northern Italy). This is a registry-based cross-sectional study comparing the 2020 observed mortality with figures of the previous five years by age, sex, month, place of death, and chronicity. It includes 300,094 deaths in those 18 years of age and above resident in the Emilia-Romagna region. Excess deaths were higher during the first pandemic wave, particularly among men and in March. Age-adjusted risk was similar among both men and women (Mortality Rate Ratio 1.15; IC95% 1.14–1.16). It was higher among females aged 75+ years and varied between sub-periods. Excluding COVID-19 related deaths, differences in the risk of dying estimates tended to disappear. Metabolic and neuropsychiatric diseases were more prevalent among those that deceased in 2020 compared to the deaths that occurred in 2015–2019 and therefore can be confirmed as elements of increased frailty, such as being in long-term care facilities or private homes as the place of death. Understanding the impact of the pandemic on mortality considering frailties is relevant in a changing scenario.

Healthcare administrative databases are a valuable tool to assess the frequency of multimorbidity and its impact on healthcare resources. Patients belonging to the four common patterns of multimorbidity identified in this study explained a high proportion of multimorbidity prevalence and healthcare resources use.

Background: Hip fracture (HF) requires an intensive healthcare resources utilization. Long-term morbidity related to poor fracture management is associated with a significant increase in healthcare costs. Many factors may affect the costs and outcomes in patients with HF. Using a definition of integrated Continuum-Care Episode (CCE) that encompasses the hospital phase and the post-acute rehabilitation after a surgical procedure for HF, we investigated the costs of CCEs for HF and their determinants, with particular regard to the contribution of different rehabilitation settings. Methods: We conducted a retrospective observational cohort study using data extracted from administrative databases of 5094 consecutive patients hospitalized for HF in 2017, aged ≥65 years, and resident in Emilia Romagna, Italy. To evaluate the overall costs of the CCE, we calculated the acute and post-acute costs from the date of the first hospital admission to the end of the integrated CCE. The determinants of costs were investigated using generalized linear regression models. Results: After adjusting for demographic and clinical characteristics, type of surgery (b=-0.340, p<0.001), and hospital bed-based rehabilitation in public or private healthcare facilities either followed by rehabilitation in a community hospital/temporary nursing home beds (b=0.372, p<0.001) or not (b=0.313, p<0.001) were the strongest determinants of costs, while rehabilitation in intermediate care facilities alone was associated with lower costs (0.163, p<0.001). Conclusions: Our findings suggest that CCE cost and its variability is mainly related to the rehabilitation settings. Cost-wise, intermediate care resulted to be an appropriate setting for providing post-acute rehabilitation for HF, representing the one associated with the lower cost of the overall CCE. Therefore, intermediate care settings should be privileged when planning HF rehabilitation pathways.

Background: The service strategy (same-day transfer between spoke hospital and hub centre with catheterisation laboratory (cath-lab) facility to perform invasive procedures) has been suggested to improve the management of patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) admitted to spoke hospitals. We used data from a large prospective Italian registry to describe application, performance and outcome of the service strategy in the daily clinical practice. Methods: This study was based on an observational, post-hoc analysis of all consecutive NSTEACS patients admitted to spoke non-invasive hospitals of the Emilia-Romagna regional network and receiving coronary artery angiography (CAA)±percutaneous coronary intervention (PCI). We evaluated: application of service strategy, time to cath-lab access, hospital stay length, 30-days occurrence of adverse events. Results: From January 2011–December 2012, 2952 NSTEACS consecutive patients were admitted to spoke non-invasive hospitals and received CAA. Overall, 1765 (60%) patients were managed with a service strategy. After multivariable analysis, service strategy emerged as independent predictor of faster access to cath-lab (within 72 h: hazard ratio (HR) 2.3, 95% confidence interval (CI) 1.9–2.7, pppConclusions: In our daily clinical practice, a service strategy seems to be an effective approach to optimise the invasive management of NSTEACS patients admitted to spoke hospitals.