Epidemiol Prev
-
Improving quality and effectiveness of health care is one of the priorities of health policies. Hospital or physician volume of activity may be a measurable variable with a relevant impact on effectiveness of health care. There are several studies and systematic reviews evaluating the association between volume and outcome of health care. The aim of this review is to identify: areas, clinical conditions or interventions (prevention, diagnostic, therapeutic, surgical or clinical) for which an association between volume and outcome has been investigated; those for which an association between volume and outcome has been proved ⋯ In some areas the evidence seems strong enough to guide health care organizational choices, although it is not possible to identify well defined volume thresholds. In other areas, particularly for non surgical conditions, where there is not enough evidence, it seems necessary to conduct proper epidemiological studies. Also the evaluation of effectiveness of using volume as an instrument of health policy requires further research. Taking into account the rapid and continuing process of technology development, the definition of standard and prerequisite volumes of care should be specific of each temporal period and health care system. It is therefore a dynamic process requiring a continuous review of the available evidence. In the area of evidence based public health, the limited available evidence should not impair the choice of actions based on limited evidence, but rather it should lead to the application of thefew available evidence on one side and to the planning of proper research in the areas of lack of evidence.
-
Comparative Study
[Evaluation of the effectiveness of influenza vaccination among the elderly in Friuli-Venezia Giulia (Italy)].
To evaluate the effectiveness of the influenza vaccination in reducing medical visits, hospital admissions, and deaths among the population > or =65 years of age in Friuli-Venezia Giulia. ⋯ Overall, the influenza vaccination appeared to have a low impact on the study cohorts. The vaccination was more effective in subjects <85 years of age and in those affected by comorbidity.