Rosanna Spanò

Home Therapy with Plasma-Derived C1 Inhibitor: A Strategy to Improve Clinical Outcomes and Costs in Hereditary Angioedema

Background: Attacks of hereditary angioedema with C1 inhibitor deficiency (C1-INH-HAE) are commonly treated in the emergency department. Self-administration is emerging as an effective treatment option. In this study, we assessed the impact of home therapy with plasma-derived C1 esterase inhibitor (pdC1-INH) concentrate on treatment outcomes and costs. Methods: This is an observational study in C1-INH-HAE patients who switched to home therapy with pdC1-INH (Berinert®) after learning intravenous self-infusion in a training course at a center in Southern Italy. Before starting home therapy and after the first year of home therapy, patients were interviewed about their treatment and outcomes during the prior 12 months. Annual costs were analyzed by cost minimization from the Italian health care payer perspective and the societal perspective. Outcomes and costs before and after the switch to home therapy were compared. Results: The training course was attended by 36 participants, 17 (47.2%) of whom decided to switch to home therapy. This therapy was associated with a significant decrease in the mean annual number of hospitalizations (16.8 vs. 2.1, p = 0.003) and missed work/school days (20.3 vs. 7.1, p = 0.037) compared to conventional treatment. The times from symptom onset to treatment administration and from treatment administration to symptom improvement/resolution were not significantly different between the two strategies. The mean annual per-patient costs decreased with home therapy from EUR 30,010.57 to EUR 26,621.16 (11.3% saving) and from EUR 29,309.34 to EUR 26,522.04 (9.5% saving) from the societal and payer perspective, respectively. Conclusions: Home therapy with pdC1-INH is a feasible strategy for the management of C1-INH-HAE and may result in cost savings.

(Un)useful risk disclosure: explanations from the Italian banks

Purpose - – The purpose of this paper is to better understand how mandatory risk categories are disclosed and to provide a better understanding of the reasons why risk disclosure looks less useful than it ought to be. Design/methodology/approach - – We analyze how Italian banks provide risk information, by focusing on its characteristics to find out any differences between the notes to the financial statements and the public report, both prepared in compliance with the instructions of the Bank of Italy. We assess the risk-related reporting practices of 66 Italian banks, based on a content analysis of the two mandatory reports, and verify whether bank-specific factors explain any differences. Findings - – Italian banks formally comply with the Bank of Italy’s instructions, but there is discretion to choose the characteristics of the information provided. Despite different risk categories to disclose in each report, disclosure is quite uniform, although banks tend to provide denser information in the notes to the financial statements and the difference in the economic signs between the two reports decreases as the level of risk increases. Practical implications - – The significance of this study goes beyond the debate taking place in the academic arena, as it can be largely relevant for preparers, those responsible for setting international and national accounting standards, the Basel Committee on Banking Supervision and the domestic supervisory authorities, particularly concerning the possible introduction of requirements that are more explicit than the existing ones. Originality/value - – The Italian setting is very relevant because unlike other countries, Italy adopts “interventionist enforcements”, which are regarded as a critical tool for achieving the minimum disclosure requirements. Moreover, the two sets of disclosure required by the Bank of Italy have never been investigated in a single data set.

CEO performance evaluation systems: empirical findings from the Italian health service

This paper examines the way that the performance of chief executive officers of Italian healthcare organizations is evaluated. The aim is to analyse the extent of the use of New Public Management techniques in the highly regionalized and political Italian healthcare sector. A positive association was found between formal CEO performance evaluation systems and the quality of regional governance. There was no significant relationship between formal CEO performance evaluation and the duration of CEO tenure.

Successful changes in management accounting systems: A healthcare case study

Abstract This paper explores how a change in the management accounting systems (MAS) of healthcare organisations was implemented in a manner acceptable to those involved. The study employed a longitudinal case study of a university hospital in southern Italy, and was informed by Broadbent and Laughlins Middle Range Theory (MRT). The findings revealed that the change in the MAS was successful due to the involvement of professionals in the ongoing process of change. This involvement reduced their natural tendency to resist, and increased the commitment of the various groups of professionals to the new business culture.

I sistemi di valutazione della performance dei Direttori Generali come processo trasformazionale. Un’analisi empirica dei Servizi Sanitari Regionali Italiani.

The research aims at investigating the issues related to the implementation of systems useful to assess the performance of the CEOs in the healthcare organizations belonging to Italian Regional Health Services. The implementation of such systems is regarded here as a transformational process and, accordingly, this paper employs Habermas’ theory about society - as advanced by Broadbent and Laughlin - to interpret and discuss the results. A meaning-oriented content analysis of the Regional Health Plans has been carried out to understand the characteristics of the performance evaluation systems designed by each Region. Moreover, a cluster analysis has been performed to identify homogeneous groups of Regions. The results are then discussed in the light of the theoretical framework in order to understand the type of change that the Italian Regions are experiencing. Furthermore, several contextual factors have been considered to enhance comprehension and to interpret the findings from an evolutionary perspective.

Accountants Are from Mars, ICT Practitioners Are from Venus. Predicting Technology Acceptance Between Two Groups

Several authors tried to explain the key determinants in technology acceptance using the technology acceptance model (TAM). TAM posits that ease of use and usefulness predict technology usage. Despite it strong usage there are several studies that show a lack in the model due to the absence of personal factors that should be considered. This paper aims to show the existence of significant difference in technology usage between different groups of people. Two hundred and fifty individuals responded to a survey about technology usage in their firms. Our results show that there is a statistically significant difference in ease of use and in perceived usefulness. The investigation applies TAM to help researchers, developers and managers understand antecedents to users’ intention to use.

Hi-tech start-ups: legitimacy challenges and funding dynamics

ABSTRACT Studies on the legitimacy challenges faced by hi-tech start-ups are still scarce, leaving room for research, and policymaking debate. Legitimacy issues may become difficult to face for hi-tech firms in comparison with other start-ups, because they work in an extreme environment where the technological challenges are at the edge of the scientific possibility. The paper proposes a conceptual model to grasp the relevance of three legitimacy drivers of the hi-tech start-ups for investment decisions. We investigated the ability of 30 hi-tech start-up firms to obtain financial resources from the US investors, employing a set-theoretic approach and carried out fuzzy-set Qualitative Comparative Analysis. Our findings clarify that the funding decisions of US investors are driven by the location of headquarter and R&D of hi-tech start-ups and by the educational experience of the founders. Our study has significant theoretical, practical, and policymaking implications.

Value co-creation in healthcare: evidence from innovative therapeutic alternatives for hereditary angioedema

BackgroundOur research focuses on the co-creation of value in healthcare with reference to a case of hereditary angioedema with C1 inhibitor deficiency (C1-INH-HAE). Our work is mainly based on the concept of value co-creation in healthcare. The aim of this study is to assess the impact of an alternative treatment strategy – self-administration – by focusing on treatment outcomes and costs to understand if innovative therapeutic solutions can create value for patients and healthcare systems.MethodsThis paper compares home-based and hospital-based therapeutic strategies (independent of treatment type) with a cost minimization analysis. It encompasses compliance issues and focuses on both payer and societal perspectives, also benefiting from an operationalization of the service-dominant logic model for healthcare delivery. Data were collected over a 6-month period (August 2014–January 2015) through monthly patient interviews. Archival data were used for variable measurement.ResultsThirty-nine out of 62 patients enrolled in the study, experienced at least one HAE attacks, equally distributed between home and hospital-based strategies. No evidence of correlation between therapeutic strategy and disease severity score (p = 0.351), compliance (p = 0.399), and quality of life (p = 0.971), were found. Total direct cost per attack amounts to € 1224 for home-based strategy with respect to € 1454 for hospital-based strategy, with a savings of € 230. The economic advantage of the home-based strategy almost doubles if the societal perspective was considered due to a further savings of €169 (less missed work/school days and no travel expenses).ConclusionsOur study suggests that home-based therapies represent a feasible strategy for managing C1-INH-HAE and may result in lower costs and increased value for both patients and the healthcare systems. The findings are relevant to the debate on and extend the extant literature to provide a broader view of value co-creation dynamics for home-based therapies in healthcare and their positive effects. The insights are relevant to practitioners and policy makers.

La disclosure nei Piani della Performance delle università italiane. Intenti simbolici verso approcci sostanziali di legittimazione

This research focuses on the Performance Plans drawn up by Italian universities, to understand whether the information conveyed in this documents are able to achieve increasing transparency and greater accountability - fulfilling the willingness expressed by recent regulatory attempts - or if, conversely, they constitute a mere symbolic compliance effort. The study embraces the legitimacy framework and relies upon a meaning oriented content analysis of 66 Performance Plans. The main findings show little strategic value underlying Performance Plans, as well as the persistence of certain information gaps on key areas of strategic importance, offering a noteworthy contribution not restricted to the academic debate, but valuable for policy makers and practitioners.

Controlling innovation and innovating control: insights from a knowledge intensive network

The purpose of this paper is to deepen the countervailing relationship between control and innovation in knowledge-intensive complex organizations. It adopts a middle range theory perspective (Broadbent and Laughlin, 2013) to explore how control systems and innovation dynamics interact and shape each other in the contexts of high complexity and intensive knowledge creation.,The paper employs single case study of a research-intensive biotech network located in Southern Italy, focusing on the change in the management accounting practices fostered by evolving environmental conditions and regulations that the network has faced in recent years.,The paper finds out how successful organizational changes are facilitated by the implementation of innovative control devices, favoring informal collaborative relationships, which in turn contribute to further innovate and to share knowledge and capabilities within the organization.,The findings are relevant to all organizations involved in complex processes of co-production of knowledge and innovation. They allow for unpacking the “black box” of the interplay between innovation and control, which is becoming increasingly central to these organizations and to policy makers.,The value of the study lies in its ability to depict how contrasting and molding forces in control systems and innovation dynamics contribute to re-shape a complex organizational setting. The study offers a newer perspective of analysis to interpret the role of control systems in innovative networks, thus contributing to the growing academic debate on the antecedents and facilitators of knowledge sharing and knowledge integration.