Franco Berti

Could clustering of comorbidities be useful for better defining the internal medicine patients’ complexity?

Internal medicine patients are mostly elderly with multiple comorbidities, usually chronic. The high prevalence of comorbidity and multimorbidity has a significant impact on both positive responses to treatment and the occurrence of adverse events. Clustering is the process of nosography grouping into meaningful associations with some index disease, so that the objects within a cluster have high similarity in comparison with one another. In the decision-making process it is imperative that, in addition to understanding the immediate clinical problems, we are able to explicit all the contextual factors that have to be taken into account for the best outcome of care. Cluster analysis could be leveraged in developing better interventions targeted to improve health outcomes in subgroups of patients.

The Italian charter for quality assurance in internal medicine

The Italian Charter for Quality Assurance in Internal Medicine is a response to the European Charter of Patients’ Rights presented in Brussels in 2002. It is the product of collaborative efforts by Cittadinanza Attiva (a nonprofit citizens’ rights group), the National Association of Hospital Nurses (ANIMO), and the Federation of Associations of Executive-Level Hospital Internists (FADOI). Its objectives are to enhance respect for patients’ rights and promote uniformity in the quality of care delivered in Italy’s health-care facilities, which is currently characterized by marked inter-regional and inter-hospital variability. This article describes the reasons and principles that have guided the Charter’s elaboration and the benefits of partnership between citizens and health-care providers.