Although still not formally integrated into medical curricula, self-directed digital learning resources may overcome the limitations of traditional teaching methods and promote evidence-based and cost-effective practices. 1,2 Massive online open courses (MOOCs) 3 have become increasingly popular in many fields, including medical education 4 because of their flexibility, interactivity and potential to provide free high-quality education. 5 We aimed to develop a MOOC on cardiac semeiotics using an innovative methodology (Fig. 1) and evaluate its teaching efficiency and user satisfaction.
Methods'The Heart, Its Signs and Symptoms' (HISS) was a MOOC developed through co-creation between undergraduate medical students and academic staff, with the collaboration of healthcare management and virtual reality experts from the Scuola Superiore Sant'Anna, Fondazione Toscana Gabriele Monasterio, and University of Pisa. The course was available online for 1 month (April 2016) during the 'TalentItaly' competition promoted by the Italian Ministry of University and Research, and was promoted through an advertising campaign on traditional and social media.
Background
Equity and quality in healthcare are key goals embraced by universal healthcare systems; however, inequalities in access and unwarranted variations in quality of care are well documented in the Italian healthcare system. To reduce unwarranted variation and improve equal utilization of services at hospital level, national quality standards have been applied for selected clinical procedures including oncological surgery for which there is evidence of a positive relationship between volumes and clinical outcomes. However, high dispersion of surgical interventions across hospitals still exists highlighting the need to understand the determinants behind women’s choice for hospital for breast surgery.
Methods
We apply mixed logit regression to investigate the determinants, both at patient and provider level, associated with women’s choice of hospital for breast surgery. Patient level non-emergency hospital data are used to model breast cancer surgical choices in Tuscany region, Italy. We considered hospitalizations occurring during 2016. We focused on the effects of travel time and hospital performance for breast cancer treatments (elective surgery) in different patient groups. Hospital quality indicators include structural variables (volumes), measurement of process (timeliness) and quality of surgical procedures as recommended by clinical guidelines (proportion of breast-conservative surgery and execution of the sentinel lymph node biopsy).
Results
Results reveal that women prefer hospitals nearby, delivering high volumes of interventions with an appropriate surgical approach. Differences in women choice depend on education and age. Highly educated patients travelled further to seek surgical intervention for breast cancer and were likely to select high performing hospitals. Moreover, older women preferred quicker response compared to younger women when awaiting surgical interventions.
Conclusions
Differences in patient choice highlight equity concerns in access to elective breast cancer surgery. These results could be used to optimize the allocation of resources toward breast cancer units that meet quality and efficacy standards to increase the efficiency and responsiveness of breast cancer care.
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