The general aim of the Laboratory of Clinical Epidemiology is to contribute to the improvement of health care in different medical fields.
The are two main guiding principles: to help physicians in using the available knowledge and resources at their best, and to contribute to the growth of applied knowledge for clinical practice.
Emergency medicine
The collaboration with the world of emergency medicine has led to the establishment of a new collaborative research group called Fenice (https://fenicenetwork.marionegri.it/). Several research projects are underway in emergency departments: APPROPRIATENESS OF HOSPITALIZATION (STUDIO DELL'APPROPRIATEZZA DEII RICOVERI IN PRONTO SOCCORSO, STAR). The study is focused on the appropriateness of hospitalization of patients who access the emergency department with non-specific manifestations affecting the pulmonary, cardiovascular and abdominal districts. The aim is the construction and validation of an appropriateness classification algorithm based on data collected in current clinical practice; ENABLING CLINICAL RESEARCH IN EMERGENCY AND ACUTE CARE MEDICINE THROUGHT AUTOMATED DATA EXTRACTION (eCREAM). The project, coordinated by the laboratory, involves 8 country (France, Greece, England, Italy, Poland, Slovakia, Slovenia, Switzerland) and 11 partner. The aim is to develop new technical solutions to extract reliable clinical information from structured and unstructured data contained in different electronic patient files to use in scientific research. The project plans to exploit the established databases into two relevant use cases: i) assessment of ED propensity to hospitalise a patient, and ii) development of a dashboard to be used by citizens and policymakers to improve the quality of care in ED. Databases of the project will be FAIRified, thus made Findable, Accessible, Interoperable, and Re-usable for clinicians, researchers, health policymakers and citizens while respecting the European and national legislations; INDICATORS FOR EMERGENCY DEPARTMENT CARE (PROGETTO INDICATORI PER I SERVIZI DI MEDICINA DI EMERGENZA E URGENZA, PRIME). The overall objective of the study is to build a monitoring system for the quality of care in emergency departments. Thanks to the contribution of professionists in the field of emergency and urgent care from all over Italy, a list of indicators to be monitored has been drawn up. Specifically, one of these indicators was designed to measure the level of crowding in emergency departments. The indicator was developed to detect one objective consequence of crowding, i.e., the increase in waiting times for patients with problems classified as minor or deferrable at triage (codes 3 and 4). The project has been supported by collaborations with Azienda Zero of the Piemonte Region and the Regional Emergency Agency (AREU) of the Lombardy Region.
High-Dependency Care Units
The overarching aim of the study is to implement a continuous evaluation of the quality of care in High-Dependency Units based on outcome indicators and trigger a process of improvement of care. In this sense, various indicators will be developed according to the characteristics of the patients. Each department will receive an annual report and various personalized performance indicators. Furthermore, each unit will have the opportunity to conduct data analyses independently through ad hoc systems. The study, which is the first project of the Fenice collaborative group for clinical research in emergency medicine (https://fenicenetwork.marionegri.it/), will also promote research activities in HDU.
Intensive rehabilitation in severe brain injuries
A collaboration between the laboratory and the units dedicated to the intensive rehabilitation for severe acquired brain injuries has started with the CREACTIVE project on traumatic brain injury. The collaboration led to the creation of a collaborative group (Tiresia) with the aim of continuously evaluating the quality of care and making comparative evaluations of the effectiveness of different rehabilitation treatments. The group has designed an initial study to compare participating centers based on their success in achieving three key treatment goals within four months of the acute event in patients with acquired severe brain injuries: resumption of oral nutrition, trunk control and successful decannulation.
International Consensus on Cardiopulmonary Resuscitation.
