The Operational Control Unit in the Health Protection Agency of the Metropolitan City of Milan

Issue Lombardy health system (SSL) separates the function of purchasing health benefits from the provision of services. Hospitals may be public or private and must be accredited and contracted with SSL to be refunded. Description of the Problem The Health Protection Agency of the Metropolitan City of Milan covers about 3,500,000 inhabitants and 54 hospitals. The SSL has funded 548,250 episodes of ordinary hospitalization and Day Hospital. Total reimbursement of these admissions was 2,175,426,335 € with an average reimbursement of 3,697€ per average hospitalization of 7 days. The main diagnoses were cardiovascular (16.1%) and muscular-skeletal diseases (13.2%); the main reasons for hospitalization are birth and delivery (5.3 and 4.2% of admissions); hip and knee replacements absorbed 5.9% of total reimbursements and 2.7% of hospitalizations. Results The Operational Control Unit (NOC) evaluate settings and duration of hospital stays, diagnosis and procedures encoding on hospital discharge forms (SDO) and compilation of clinical documentation quality assurance. NOC make yearly inspections on a specific percentage of hospitalizations decided by the Lombardy Region by a targeted sampling mode or by a validation of hospitals' self-evaluations. Lessons In 2019 NOC evaluated 40,040 hospitalizations with targeted sampling mode that meant a total refund of 156,374,990 € and economic cuts in 19.2% of cases, that is 9,236,586 € (5.9% of the original reimbursement). In 2,428 cases NOC made changes in diagnosis or procedures of SDOs, in 916 cases reduced days of hospitalization, in 1,408 cases turned admissions into outpatient services and in 982 cases they applied a refund reduction due to quality failures in clinical documentation. Concerning self-evaluations, all admissions related to 2019, NOC analyzed 35,424 hospitalizations for a total refund of 130,781,615 € and modified 4,168 of them, the 11.8% of the total sample, returning an economic cut of about 5,259,532 €. Key messages NOC in 2019 evaluated 75,464 hospitalizations in 54 hospitals amending 11,838 admissions, the 15.7% of the total, returning an economic cut of 14,496,118 €, about the 5% of the total amount. NOC activities can have a remarkable impact on correct reimbursement of hospitalizations.

Timeliness of Electronic Reporting and Acceptability of Public Health Follow-Up of Routine Nonparatyphoidal and Nontyphoidal Salmonella Infections, London and South East England, 2010 to 2011

Nonparatyphoidal and nontyphoidal Salmonella (NTS) infections are major causes of food poisoning in England. Diagnostic laboratories and clinicians have a statutory responsibility to report NTS infection cases to the Health Protection Agency via various means, with electronic reporting encouraged as the universal method. The Health Protection Agency (Public Health England since 1 April 2013) refers cases to environmental health departments for follow-up. Timeliness of reporting and adequacy of NTS infection case follow-up are key factors in the implementation of public health actions. Laboratories, health protection units, and environmental health departments in London and South East (SE) regions of England completed three surveys between December 2010 and April 2011, collecting data about the NTS infection case reporting methods and the time elapsed between symptom onset and public health actions. The median period between symptom onset and public health investigation was 25 days in London and 23 days in SE when electronic reporting was used and 12 days in London and 11 days in SE when other means of reporting were used. The most common follow-up method was a telephone questionnaire in London (53%) and a postal questionnaire in SE (52%). The telephone questionnaire had the highest response rate (98% in London; 96% in SE). Timeliness and efficiency of electronic NTS infection case reports can be improved by decreasing the electronic laboratory report period and using telephone-administered questionnaires to maximize the public health benefit when following up single cases of NTS infection.

Using public health scenarios to predict the utility of a national syndromic surveillance programme during the 2012 London Olympic and Paralympic Games

SUMMARYDuring 2012 real-time syndromic surveillance formed a key part of the daily public health surveillance for the London Olympic and Paralympic Games. It was vital that these systems were evaluated prior to the Games; in particular what types and scales of incidents could and could not be detected. Different public health scenarios were created covering a range of potential incidents that the Health Protection Agency would require syndromic surveillance to rapidly detect and monitor. For the scenarios considered it is now possible to determine what is likely to be detectable and how incidents are likely to present using the different syndromic systems. Small localized incidents involving food poisoning are most likely to be detected the next day via emergency department surveillance, while a new strain of influenza is more likely to be detected via GP or telephone helpline surveillance, several weeks after the first seed case is introduced.