Filippo Paoletti

Chronic viral hepatitis remains a critical public health concern, a key focus of WHO’s 2030 elimination targets. High-risk populations, especially migrants often facing significant healthcare barriers, are disproportionately affected globally by this condition. Community-based interventions are crucial for enhancing access to screening, vaccination, and linkage to care. This scoping review, a foundational step within the EU co-funded VH-COMSAVAC project, identifies and analyses how these interventions map to the Quadruple Aim framework of value-based medicine. This scoping review adhered to PRISMA-ScR guidelines. Five scientific databases (MEDLINE, Embase, GlobalHealth, Scopus, Web of Science) were systematically searched up to July 30, 2023. Titles and abstracts of studies focusing on community-based HBV interventions, primarily targeting migrants and refugees while also encompassing other underserved populations, were independently screened by five reviewers using the Rayyan platform. Data extraction was conducted using a structured Excel spreadsheet, mapping reported outcomes to the Quadruple Aim framework (patient experience, population health, cost reduction, care team wellbeing) and intervention types (prevention, linkage to care, treatment). Of 34 included publications, 94% (n = 32) focused on prevention, 29% (n = 10) on linkage to care, and 6% (n = 2) on treatment strategies. Patient experience was the most reported value domain (56%, n = 19 studies), followed by population health (50%, n = 17 studies). Cost reduction (9%, n = 3 studies) and care team wellbeing (3%, n = 1 study) were considerably less represented. Point-of-care (PoC) testing demonstrated significantly higher linkage to care (86% vs. 34% for venepuncture) and 76.5% lower costs (€12.7 vs. €54.0 per screened person). Screening uptake in targeted intervention groups (19.5%) was also significantly higher than in control groups (1.7%; p = 0.014). Major reported barriers included language (62%), cultural/religious issues (50%), and lack of knowledge (32%). The review reveals a significant gap in the comprehensive, value-based evaluation of existing community-based interventions, with no established framework existing. The VH-COMSAVAC project seeks to bridge this by developing a value-based assessment tool, leveraging the Quadruple Aim, to systematically assess its prevention and linkage-to-care interventions and guide evidence-based optimization.

Background/Objectives: The principles of value-based healthcare (VBHC) have received widespread endorsement, leading healthcare organizations worldwide to shift their strategies towards them. However, despite growing recognition and acceptance, the actual implementation of value-based approaches varies widely. This research aims to identify studies that address the implementation of VBHC at different levels (healthcare policymakers, hospital administrators, and healthcare providers), focusing on each level’s relative strategies. Methods: To this end, a scoping review was conducted in accordance with the PRISMA extension for the scoping reviews checklist. The electronic databases of Web of Science, PubMed, MEDLINE, and Scopus were searched to identify relevant publications in English from January 2006 to 31 July 2023. Results: We identified 30 eligible studies. Findings are organized into four main macro strategic levels, each comprising specific dimensions and operational approaches. Fourteen articles analyzed the role of government commitment in VBHC implementation, while six articles focused on regional integrated care systems. The role of hospitals was described in sixteen records. Conclusions: Our study suggests that a comprehensive approach is necessary for the successful implementation of VBHC. Hospitals emerge as pivotal in this shift, requiring organizational and attitudinal changes among healthcare professionals. However, a complete transition towards VBHC that ensures seamless patient management throughout the entire care delivery value chain necessitates government involvement in terms of state legislation, reimbursement methods, and hospital networking.

Background/Objectives: The principles of value-based Healthcare (VBHC) have received widespread endorsement, lead-ing healthcare organizations worldwide to shift their strategies towards them. However, despite growing recognition and acceptance, the actual implementation of value-based approaches varies widely. This research aims to identify studies that address the implementation of VBHC at dif-ferent levels (healthcare policymakers, hospital administrators, and healthcare providers), fo-cusing on each level’s relative strategies; Methods: To this end, a scoping review was conducted in accordance with the PRISMA extension for Scoping Reviews checklist. The electronic databases of Web of Science, PubMed, MEDLINE and Scopus were searched to identify relevant publica-tions in English from January 2006 to 31 July 2023; Results: We identified 30 eligible studies. Findings are organized into four main macro strategic levels, each comprising specific dimen-sions and operational approaches. Fourteen articles analyzed the role of government commitment in VBHC implementation, while six articles focused on regional integrated care systems. The role of hospitals was described in sixteen records; Conclusions: Our study suggests that a compre-hensive approach is necessary for the successful implementation of VBHC. Hospitals emerge as pivotal in this shift, requiring organizational and attitudinal changes among healthcare profes-sionals. However, a complete transition towards VBHC that ensures a seamless patient manage-ment throughout the entire care delivery value chain, necessitates government involvement in terms of state legislation, reimbursement methods, and hospital networking.

Article: Bariatric surgery in prospective obese living kidney donors: scoping review and management decision algorithm - Minerva Surgery 2023 Dec 21 - Minerva Medica - Journals

Rising incidence and prevalence of end-stage renal disease is a worldwide concern for sustainability of healthcare systems and societies. Living donor renal transplant [LDRT] provides highest health achievements and cost containment than any alternative form of renal replacement therapy. Nonetheless, about 25% of potential LDRTs are missed for causes directly related with inadequate timing in donor assessment. Our quality improvement (QI) project implement process control tools and strategy aiming at reducing total evaluation time for donor candidates and minimizing dialysis exposure for intended recipients, which are the two main determinants of clinical outcomes and costs. The study includes patients who underwent donor nephrectomy between January 1, 2017 and December 31, 2021. Six Sigma DMAIC approach was adopted to assess Base Case performance (Jan2017-Jun2019) and to design and implement our QI project. Study of current state analysis focused on distribution of time intervals within the assessment process, analysis of roles and impacts of involved healthcare providers and identification of targets of improvement. Improved Scenario (Jul2019-Dec2021) was assessed in terms of total lead time reduction, total pre-transplantation dialysis exposure and costs reduction, and increase in pre-emptive transplantations. The study was reported following SQUIRE 2.0 Guidelines for QI projects. Study population includes 63 patients, 37 in Base Case and 26 in Improved Scenario. Total lead time reduced from a median of 293 to 166 days and this in turn reduced pre-transplantation dialysis exposure and costs by 45%. Rate of potential pre-emptive donors’ loss changes from 44% to 27%. Lean methodology is an effective tool to improve quality and efficiency of healthcare processes, in the interest of patients, healthcare professionals and payers.