Valentina Iacopino

Unfolding similarity in interphysician networks: the impact of institutional and professional homophily

BackgroundModern healthcare is characterized by high complexity due to the proliferation of specialties, professional roles, and priorities within organizations. To perform clinical interventions, knowledge distributed across units, directorates and individuals needs to be integrated. Formal and/or informal mechanisms may be used to coordinate knowledge and tasks within organizations. Although the literature has recently considered the role of physicians’ professional networks in the diffusion of knowledge, several concerns remain about the mechanisms through which these networks emerge within healthcare organizations. The aim of the present paper is to explore the impact of institutional and professional homophilies on the formation of interphysician professional networks.MethodsWe collected data on a community of around 300 physicians working at a local health authority within the Italian National Health Service. We employed multiple regression quadratic assignment procedures to explore the extent to which institutional and professional homophilies influence the formation of interphysician networks.ResultsWe found that both institutional and professional homophilies matter in explaining interphysician networks. Physicians who had similar fields of interest or belonged to the same organizational structure were more likely to establish professional relationships. In addition, professional homophily was more relevant than institutional affiliation in explaining collaborative ties.ConclusionsOur findings have organizational implications and provide useful information for managers who are responsible for undertaking organizational restructuring. Healthcare executives and administrators may want to consider the structure of advice networks while adopting new organizational structures.

Investigating the Generalizability of Economic Evaluations Conducted in Italy: A Critical Review

OBJECTIVES To assess the methodological quality of Italian health economic evaluations and their generalizability or transferability to different settings. METHODS A literature search was performed on the PubMed search engine to identify trial-based, nonexperimental prospective studies or model-based full economic evaluations carried out in Italy from 1995 to 2013. The studies were randomly assigned to four reviewers who applied a detailed checklist to assess the generalizability and quality of reporting. The review process followed a three-step blinded procedure. The reviewers who carried out the data extraction were blind as to the name of the author(s) of each study. Second, after the first review, articles were reassigned through a second blind randomization to a second reviewer. Finally, any disagreement between the first two reviewers was solved by a senior researcher. RESULTS One hundred fifty-one economic evaluations eventually met the inclusion criteria. Over time, we observed an increasing transparency in methods and a greater generalizability of results, along with a wider and more representative sample in trials and a larger adoption of transition-Markov models. However, often context-specific economic evaluations are carried out and not enough effort is made to ensure the transferability of their results to other contexts. In recent studies, cost-effectiveness analyses and the use of incremental cost-effectiveness ratio were preferred. CONCLUSIONS Despite a quite positive temporal trend, generalizability of results still appears as an unsolved question, even if some indication of improvement within Italian studies has been observed.

Il ruolo degli stakeholder nel processo di HTA

The aim of this paper is to identify the stakeholders involved in the Health Technology Assessment (HTA) process with particular attention to their role and potential contribution from patients and citizens. Moreover, a focus on elements to be shared among stakeholders will be provided. These topics were discussed at the Health Policy Forum, an initiative promoted by the Italian Society of Health Technology Assessment (SIHTA) in partnership with other scientific societies. Manufacturers, regulators, institutions and citizens could talk freely under the “Chatham House Rules” in plenary sessions and subgroups, suggesting proposals on the issues addressed.Healthcare managers, policy makers, health providers, researchers, manufacturers, patients and the public were identified as main stakeholders. The contribution they provide to HTA process is closely related to their position within the “pertinence-relevance-weight matrix”. All participants focused on the need of rigorous methods and measures of assessment. Finally, the potential contributions of citizens and patients are related to the time of involvement and their level of information.In conclusion, there is a growing awareness of the need of greater stakeholders’ involvement in defining methods, responsibilities, quality and timing of interactions in order to improve the impact of HTA in healthcare decision-making.

Professional Networks and the Adoption of Medical Technologies: An Empirical Study on Robotic Surgery

The advancement of knowledge and the availability of new technologies in health care deeply influence patients’ length and quality of life. Current health care systems have thus re-organized services provided in order to select effective solutions and to the increasing demand of more complex and costly services. Such need frequently implies a re-orientation of health care organizations and providers. Given that the real success of a specific technology is measured by its use in clinical practice, the exploration of those factors affecting the adoption and use of innovations seems to be convenient. Particularly, a number of information is considered in the decision-making process of clinicians: the mindlines, namely, tacit and informal knowledge and the clinical guidelines. This chapter presents and discusses retrospectively these dynamics in the Italian National Health Care Service (I-NHS) with regard of an innovative surgical system, the Da Vinci Robot, which is a minimally invasive surgical system receiving great organizational and managerial interest. The objective of the study is to understand the role of informational determinants, both mindlines and guidelines, in the temporal choice of adoption of the technology by the Italian adopters. A semi-structured questionnaire was built and submitted to surgeons in order to collect information about the usage of the technology, the advice network of professionals, and the sources of information accessed to determine the choice of adoption of the technology. At the end of the administration period, twenty-eight adopters fully answered to the questionnaire. Social network analysis (SNA) techniques were used to analyze the advice inter-physician networks, and pseudo-network measures were used to the identify the degree of similarity/difference between each pair of surgeons involved in the study. Multiple regression quadratic assignment procedures (MR-QAP) were run to test the statistical association among our dependent variable (temporal difference in the adoption of the surgical system) and the different sources of information selected in the study both guidelines and the mindlines. We found a significant and positive effect of the extent to which two individuals used guidelines such as evidence-based medicine (EBM) documents and information to discover for the first time about the technology on their subsequent adoption. In other words, the greater the number of same sources used, the smaller the distance in terms of months in the adoption of the new technology. Overall, we confirm the importance of sharing the same formal sources of information (guidelines) above and beyond individual’s informal network (mindlines) in affecting the similarity in the temporal choice of adoption of the technology. Our study contributes with original evidence to understand the adoption process of a new technology in health care, providing new insights about how beliefs and values about the technology are created and concur to define the temporal choice of adoption. Contrarily to what stated in previous research, we elicit the prominent role of different formal informational sources (EBM) in determining the final judgment toward technological change in health care and in controlling the uncertainty of highly innovative technologies.