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Promoting Innovation in Health Systems

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 30824

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Special Issue Editors

Dr. Carlo Giacomo Leo

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Guest Editor

Institute of Clinical Physiology, National Research Council, 73100 Lecce, Italy
Interests: public health; health economics; health technology assessment

Dr. Pierpaolo Mincarone

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Guest Editor

Institute for Research on Population and Social Policies, National Research Council, 73100 Lecce, Italy
Interests: healthcare process modelling; health technology assessment

Special Issue Information

Dear Colleagues,

We are witnessing rapid changes in healthcare systems, with a considerable acceleration during the recent pandemic period, driven both by the application of innovative technologies, in their broadest sense of medicines, devices, vaccines, procedures and systems, and by the growing awareness of citizens on their own health. In the first case a predominant role has been played by digitalization and integration of health data (Big data, Artificial Intelligence) and virtualization (patient-specific modelling to support medical decisions, personalized health status forecasting, virtual trials) both bringing to a sort dematerialization of part of healthcare. Innovation is also driven by constant attention to anticipating intervention time (risk assessment, screening and prompt diagnosis) but, obviously, also to increasing the capacity for intervention (e.g., through non-invasive technologies or to address unmet needs). The growing awareness refers to the fully active role of citizens, since the adoption of healthy life styles, that aims to the “physical, mental and social well-being”. In this context social determinants of health become critical especially in terms of empowerment and health literacy in order to lower the barriers to accessing digitalized opportunities (e.g., remote visits, searching for health information online).

In this complex and dynamic of innovation scenario, decision makers rely on comprehensive evaluations of the impact of technologies on different stakeholders such as those framed in the multidisciplinary process of Health Technology Assessment.

For this Special Issue on “Promoting innovation in health systems”, we welcome submissions of novel works that examine demands of health (e.g., emerging determinants of health and related unmet needs), new technologies (devices and processes) to address the emerging determinants and unmet needs (e.g., Digital Twin, virtual trials, eHealth), How to assess and support the match between demand and supply (e.g., modelling for economic evaluations, progresses in value assessment, social equity, resource optimization, organizational issues, accessibility, empowerment of citizens).

Submissions should include original articles or brief reports.

Dr. Carlo Giacomo Leo
Dr. Pierpaolo Mincarone
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

information needs
participation
digital health
modeling
ehealth
health processes
health information technology
health technologies
health technology assessment
economic evaluation

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Published Papers (10 papers)

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Research

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25 pages, 2746 KiB

Open AccessArticle

Online Health Information Seeking: An Italian Case Study for Analyzing Citizens’ Behavior and Perception

by Alessia D’Andrea, Patrizia Grifoni and Fernando Ferri

Int. J. Environ. Res. Public Health 2023, 20(2), 1076; https://doi.org/10.3390/ijerph20021076 - 7 Jan 2023

Cited by 3 | Viewed by 1878

Abstract

This study aims to understand people’s behavior when searching for online health information (and COVID-19 information) and their perception of the trustworthiness and credibility of the searched information, the actors, and sources used to obtain it. A questionnaire addressed to people who permanently live in Italy between ages 19 and 60 has been used to collect data. Data extracted from the analysis are reassuring from the point of view of trust and credibility both in the actors and in the sources used to obtain information on health and COVID-19. A correlation between the analyzed individual features, the online health information-seeking behavior, and perception resulted from the analysis. The study also underlined a positive correlation between the perception of the influence of information on the knowledge of health problems and the ability to identify false online health information, and between the experience in detecting false health online information and the ability to detect it. Finally, a positive correlation also resulted between the experience in finding online health information and the experience in finding false COVID-19 information. Full article

(This article belongs to the Special Issue Promoting Innovation in Health Systems)

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14 pages, 2014 KiB

Open AccessArticle

Using Unified Modeling Language to Analyze Business Processes in the Delivery of Child Health Services

by Fabrizio Pecoraro and Daniela Luzi

Int. J. Environ. Res. Public Health 2022, 19(20), 13456; https://doi.org/10.3390/ijerph192013456 - 18 Oct 2022

Cited by 3 | Viewed by 3384

Abstract

Business Process Management (BPM) has been increasingly used in recent years in the healthcare domain to analyze, optimize, harmonize and compare clinical and healthcare processes. The main aim of this methodology is to model the interactions between medical and organizational activities needed to deliver health services, measure their complexity, variability and deviations to improve the quality of care and its efficiency. Among the different tools, languages and notations developed in the decades, UML (Unified Modeling Language) represents a widely adopted technique to model, analyze and compare business processes in healthcare. We adopted its diagrams in the MOCHA project to compare the different ways of organizing, coordinating and delivering child care across 30 EU/EEA countries both from an organization and control-flow perspectives. This paper provides an overview of the main components used to represent the business process using UML diagrams, also highlighting how we customized them to capture the specificity of the healthcare domain taking into account that processes are reconstructed on the basis of country experts’ responses to questionnaires. The benefits of the application of this methodology are demonstrated by providing examples of comparing different aspects of child care. Full article

(This article belongs to the Special Issue Promoting Innovation in Health Systems)

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11 pages, 619 KiB

Open AccessArticle

Supporting and Enabling the Process of Innovation in Public Health: The Framework for Public Health Innovation

by Whitney R. Garney, Kelly L. Wilson, Kristen M. Garcia, Daenuka Muraleetharan, Christi H. Esquivel, Mandy N. Spadine, Sonya Panjwani and Kobi V. Ajayi

Int. J. Environ. Res. Public Health 2022, 19(16), 10099; https://doi.org/10.3390/ijerph191610099 - 16 Aug 2022

Cited by 4 | Viewed by 3082

Abstract

This manuscript introduces a new framework for creating innovations in public health—the Framework for Public Health Innovation. The framework was developed through a longitudinal qualitative research study that investigated the process of creating innovative adolescent health programs. Interviews were conducted with a national sample of 26 organizations over two time points. Data collection focused on the process of innovative program development; organizational capacity; training; and technical assistance needs, successes, and barriers. The framework was developed and modified based on interview findings and expert advice; then, the final framework was validated with content experts. The framework illustrates a dynamic process of innovation that begins with dissatisfaction with the status quo, and then, illustrates three necessary components for innovation—space, process, and partnerships. Four categories of innovation, which range in complexity, are proposed: (1) creating a new component to an existing program, (2) adapting an existing program to meet new needs, (3) taking an alternative approach to addressing an existing program, and (4) reframing a health problem from a new perspective. As illustrated by a feedback loop, the resulting innovations disrupt the status quo. This model can be applied to any content area in public health and is useful for both research and practitioners. Full article

(This article belongs to the Special Issue Promoting Innovation in Health Systems)

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10 pages, 2478 KiB

Open AccessArticle

Healthcare Providers’ Knowledge of Value-Based Care in Germany: An Adapted, Mixed-Methods Approach

by Axel Kuck, Kristian Kinscher, Leonard Fehring, Helmut Hildebrandt, Johannes Doerner, Jonas Lange, Hubert Truebel, Philip Boehme, Celina Bade and Thomas Mondritzki

Int. J. Environ. Res. Public Health 2022, 19(14), 8466; https://doi.org/10.3390/ijerph19148466 - 11 Jul 2022

Cited by 4 | Viewed by 2178

Abstract

Background: Value-Based Care (VBC) is being discussed to provide better outcomes to patients, with an aim to reimburse healthcare providers (HCPs) based on the quality of care they deliver. Little is known about German HCPs’ knowledge of VBC. This study aims to investigate the knowledge of HCPs of VBC and to identify potential needs for further education toward implementation of VBC in Germany. Methods: For evidence generation, we performed a literature search and conducted an online survey among HCPs at 89 hospitals across Germany. The questionnaire was based on published evidence and co-developed with an expert panel using a mixed methods approach. Results: We found HCPs to believe that VBC is more applicable in surgery than internal medicine and that well-defined cycles of care are essential for its application. HCPs believe that VBC can reduce health care costs significantly. However, they also assume that implementing VBC will be challenging. Conclusions: The concept in general is well perceived, however, HCPs do not want to participate in any financial risk sharing. Installing an authority/independent agency that measures achieved value, digital transformation, and that improves the transition between the inpatient and the outpatient sectors are top interests of HCPs. Full article

(This article belongs to the Special Issue Promoting Innovation in Health Systems)

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18 pages, 3451 KiB

Open AccessArticle

Participation in Low Back Pain Management: It Is Time for the To-Be Scenarios in Digital Public Health

by Michela Franchini, Massimiliano Salvatori, Francesca Denoth, Sabrina Molinaro and Stefania Pieroni

Int. J. Environ. Res. Public Health 2022, 19(13), 7805; https://doi.org/10.3390/ijerph19137805 - 25 Jun 2022

Cited by 6 | Viewed by 2498

Abstract

Low back pain (LBP) carries a high risk of chronicization and disability, greatly impacting the overall demand for care and costs, and its treatment is at risk of scarce adherence. This work introduces a new scenario based on the use of a mobile health tool, the Dress-KINESIS, to support the traditional rehabilitation approach. The tool proposes targeted self-manageable exercise plans for improving pain and disability, but it also monitors their efficacy. Since LBP prevention is the key strategy, the tool also collects real-patient syndromic information, shares valid educational messages and fosters self-determined motivation to exercise. Our analysis is based on a comparison of the performance of the traditional rehabilitation process for non-specific LBP patients and some different scenarios, designed by including the Dress-KINESIS’s support in the original process. The results of the simulations show that the integrated approach leads to a better capacity for taking on patients while maintaining the same physiotherapists’ effort and costs, and it decreases healthcare costs during the two years following LBP onset. These findings suggest that the healthcare system should shift the paradigm towards citizens’ participation and the digital support, with the aim of improving its efficiency and citizens’ quality of life. Full article

(This article belongs to the Special Issue Promoting Innovation in Health Systems)

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12 pages, 1449 KiB

Open AccessArticle

Unmet Information Needs of Patients with Rheumatic Diseases: Results of a Cross-Sectional Online Survey Study in Germany

by Christian Becker, Matthias Diener, Axel J. Hueber, Jörg Henes, Martin Krusche, Yuriy Ignatyev, Susann May, Ulrike Erstling, Corinna Elling-Audersch, Johannes Knitza and Felix Muehlensiepen

Int. J. Environ. Res. Public Health 2022, 19(12), 7071; https://doi.org/10.3390/ijerph19127071 - 9 Jun 2022

Cited by 6 | Viewed by 2301

Abstract

To effectively self-manage a chronic disease, patients require specific education. In clinical routines, rheumatologists and other healthcare professionals often cannot devote the necessary time to adequately educate their patients. Digital technologies such as mobile applications represent promising tools to overcome this problem. This study aims to identify unmet information needs of patients with rheumatic diseases to inform the conception of a mobile education application. An online national survey was developed together with rheumatic patients and rheumatologists and distributed between June and September 2021 via social media (Instagram, Facebook, Twitter), QR code and email. Self-reported rheumatic patients, rheumatologists, specialized rheumatology nurses (SRN) and self-reported relatives of rheumatic patients were eligible to participate in the survey. Three major topics were addressed: (1) How well do patients feel informed about disease-relevant topics; (2) how important do patients rate different disease-relevant topics; and (3) patient willingness to adopt digital education services. Responses of 254 patients and 53 SRN were analyzed. Most patients were female (91%; n = 231), the median age was 48 years and the most common disease was rheumatoid arthritis (23%; n = 59). Only 24% of patients perceived their disease education level as very good or good compared to an SRN estimate of 42%. The three information topics rated as most important (very/important) were: individual disease (98%), medication (94%) and coping techniques (91%). In total, 89% of patients asserted that they would very likely, likely or rather likely use digital education tools in the future to learn about their condition, and 82% of SRN would very likely, likely or rather likely recommend digital information services to their patients. These findings depict currently unmet patient information needs and a high willingness of patients and SRN to use digital education services. A mobile education application is currently adapted based on these results and will be evaluated in a multicenter study. Full article

(This article belongs to the Special Issue Promoting Innovation in Health Systems)

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Review

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18 pages, 1521 KiB

Open AccessReview

Main Challenges of Incorporating Environmental Impacts in the Economic Evaluation of Health Technology Assessment: A Scoping Review

by Carmen Guirado-Fuentes, Analía Abt-Sacks, María del Mar Trujillo-Martín, Lidia García-Pérez, Leticia Rodríguez-Rodríguez, Carme Carrion i Ribas and Pedro Serrano-Aguilar

Int. J. Environ. Res. Public Health 2023, 20(6), 4949; https://doi.org/10.3390/ijerph20064949 - 11 Mar 2023

Cited by 6 | Viewed by 3968

Abstract

Health technology assessment (HTA) provides evidence-based information on healthcare technology to support decision making in many countries. Environmental impact is a relevant dimension of a health technology’s value, but it has been poorly addressed in HTA processes in spite of the commitment that the health sector must have to contribute to mitigating the effects of climate change. This study aims to identify the state of the art and challenges for quantifying environmental impacts that could be incorporated into the economic evaluation (EE) of HTA. We performed a scoping review that included 22 articles grouped into four types of contribution: (1) concepts to draw up a theoretical framework, (2) HTA reports, (3) parameter designs or suitable indicators, and (4) economic or budgetary impact assessments. This review shows that evaluation of the environmental impact of HTAs is still very incipient. Small steps are being taken in EE, such as carbon footprint estimations from a life-cycle approach of technologies and the entire care pathway. Full article

(This article belongs to the Special Issue Promoting Innovation in Health Systems)

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19 pages, 791 KiB

Open AccessReview

Ethical, Legal, Organisational and Social Issues of Teleneurology: A Scoping Review

by Alezandra Torres-Castaño, Analía Abt-Sacks, Ana Toledo-Chávarri, José Carlos Suarez-Herrera, Janet Delgado-Rodríguez, Beatriz León-Salas, Yadira González-Hernández, Montserrat Carmona-Rodríguez and Pedro Serrano-Aguilar

Int. J. Environ. Res. Public Health 2023, 20(4), 3694; https://doi.org/10.3390/ijerph20043694 - 19 Feb 2023

Cited by 4 | Viewed by 2782

Abstract

Background: Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. Teleneurology (TN) allows neurology to be applied when the doctor and patient are not present in the same place, and sometimes not at the same time. In February 2021, the Spanish Ministry of Health requested a health technology assessment report on the implementation of TN as a complement to face-to-face neurological care. Methods: A scoping review was conducted to answer the question on the ethical, legal, social, organisational, patient (ELSI) and environmental impact of TN. The assessment of these aspects was carried out by adapting the EUnetHTA Core Model 3.0 framework, the criteria established by the Spanish Network of Health Technology Assessment Agencies and the analysis criteria of the European Validate (VALues In Doing Assessments of healthcare TEchnologies) project. Key stakeholders were invited to discuss their concerns about TN in an online meeting. Subsequently, the following electronic databases were consulted from 2016 to 10 June 2021: MEDLINE and EMBASE. Results: 79 studies met the inclusion criteria. This scoping review includes 37 studies related to acceptability and equity, 15 studies developed during COVID and 1 study on environmental aspects. Overall, the reported results reaffirm the necessary complementarity of TN with the usual face-to-face care. Conclusions: This need for complementarity relates to factors such as acceptability, feasibility, risk of dehumanisation and aspects related to privacy and the confidentiality of sensitive data. Full article

(This article belongs to the Special Issue Promoting Innovation in Health Systems)

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13 pages, 360 KiB

Open AccessReview

Health Technology Assessment for In Silico Medicine: Social, Ethical and Legal Aspects

by Carlo Giacomo Leo, Maria Rosaria Tumolo, Saverio Sabina, Riccardo Colella, Virginia Recchia, Giuseppe Ponzini, Dimitrios Ioannis Fotiadis, Antonella Bodini and Pierpaolo Mincarone

Int. J. Environ. Res. Public Health 2022, 19(3), 1510; https://doi.org/10.3390/ijerph19031510 - 28 Jan 2022

Cited by 5 | Viewed by 4424

Abstract

The application of in silico medicine is constantly growing in the prevention, diagnosis, and treatment of diseases. These technologies allow us to support medical decisions and self-management and reduce, refine, and partially replace real studies of medical technologies. In silico medicine may challenge some key principles: transparency and fairness of data usage; data privacy and protection across platforms and systems; data availability and quality; data integration and interoperability; intellectual property; data sharing; equal accessibility for persons and populations. Several social, ethical, and legal issues may consequently arise from its adoption. In this work, we provide an overview of these issues along with some practical suggestions for their assessment from a health technology assessment perspective. We performed a narrative review with a search on MEDLINE/Pubmed, ISI Web of Knowledge, Scopus, and Google Scholar. The following key aspects emerge as general reflections with an impact on the operational level: cultural resistance, level of expertise of users, degree of patient involvement, infrastructural requirements, risks for health, respect of several patients’ rights, potential discriminations for access and use of the technology, and intellectual property of innovations. Our analysis shows that several challenges still need to be debated to allow in silico medicine to express all its potential in healthcare processes. Full article

(This article belongs to the Special Issue Promoting Innovation in Health Systems)

Other

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21 pages, 802 KiB

Open AccessSystematic Review

Economic Evaluations of Magnetic Resonance Image-Guided Radiotherapy (MRIgRT): A Systematic Review

by Alessandra Castelluccia, Pierpaolo Mincarone, Maria Rosaria Tumolo, Saverio Sabina, Riccardo Colella, Antonella Bodini, Francesco Tramacere, Maurizio Portaluri and Carlo Giacomo Leo

Int. J. Environ. Res. Public Health 2022, 19(17), 10800; https://doi.org/10.3390/ijerph191710800 - 30 Aug 2022

Cited by 4 | Viewed by 2749

Abstract

Objectives: This review systematically summarizes the evidence on the economic impact of magnetic resonance image-guided RT (MRIgRT). Methods: We systematically searched INAHTA, MEDLINE, and Scopus up to March 2022 to retrieve health economic studies. Relevant data were extracted on study type, model inputs, modeling methods and economic results. Results: Five studies were included. Two studies performed a full economic assessment to compare the cost-effectiveness of MRIgRT with other forms of image-guided radiation therapy. One study performed a cost minimization analysis and two studies performed an activity-based costing, all comparing MRIgRT with X-ray computed tomography image-guided radiation therapy (CTIgRT). Prostate cancer was the target condition in four studies and hepatocellular carcinoma in one. Considering the studies with a full economic assessment, MR-guided stereotactic body radiation therapy was found to be cost effective with respect to CTIgRT or conventional or moderate hypofractionated RT, even with a low reduction in toxicity. Conversely, a greater reduction in toxicity is required to compete with extreme hypofractionated RT without MR guidance. Conclusions: This review highlights the great potential of MRIgRT but also the need for further evidence, especially for late toxicity, whose reduction is expected to be the real added value of this technology. Full article

(This article belongs to the Special Issue Promoting Innovation in Health Systems)

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