Improving Emergency Care through Data:
Evaluating Ambulance Dispatch, Hospital Access, and System Efficiency in Lombardy
Elena Lucchese
Awards: Modigliani Research Grant - Unicredit Foundation
Abstract
This project investigates the effectiveness and efficiency of emergency medical services (EMS) in Lombardy, Italy, using integrated administrative health data on ambulance dispatches, emergency room visits, hospitalizations, and mortality. The project generates robust, policy-relevant evidence on how pre-hospital and inter-hospital decisions affect patient outcomes, system congestion, and healthcare costs.
The study develops a series of quasi-experimental designs (instrumental variables, difference-in-differences, regression discontinuity) to address key questions in emergency care organization, including:
the clinical and economic trade-offs between advanced and basic ambulance units (stay-and-play vs. scoop-and-run),
the impact of ambulance destination strategies on emergency room crowding,
the role of hospital and ER productivity cycles on access and outcomes.
The project adopts a multidisciplinary and data-driven approach, combining insights from health economics, public policy, and operations research. It is carried out in collaboration with institutional stakeholders and aims to inform decisions at the regional and national level on the organization of EMS and acute care pathways.
Understanding the Socio-Economic Burden of Chemotherapy-Induced Peripheral Neurotoxicity (CIPN): Evidence from Clinical and Administrative Data in Lombardy
Paola Alberti and Elena Lucchese
Awards: Bicocca Starting Grant
Abstract
This project investigates the social and economic impact of Chemotherapy-Induced Peripheral Neurotoxicity (CIPN), a frequent but often underestimated side effect of cancer treatment. The study leverages a unique integration of clinical data collected from oncology outpatients in Lombardy and regional administrative health databases to assess the burden of CIPN on patients’ functional capacity, health outcomes, and use of healthcare and social services.
Combining quantitative measures (biomarkers, functional tests, administrative records) with qualitative indicators (self-reported limitations, employment status, care needs), the project aims to estimate the direct and indirect costs associated with CIPN. Particular attention is given to the risk of underdiagnosis and the role of socio-demographic factors in exacerbating disparities in care and outcomes.
Findings from this research are expected to support the development of targeted health and social policies, with implications for clinical guidelines, service planning, and the economic evaluation of cancer care pathways.
Elena Lucchese, (2024) Health Economics, 33(4):652-673, https://doi.org/10.1002/hec.4791
Awards:
EIEF Grant
Young Researcher Best Paper Award by the Italian Health Economics Association
Abstract
The cost-effectiveness of medical treatments is not precisely known due to the compounding effect of multiple determining factors. Ambulance response time (RT) to emergency calls is exploited to learn more about the effect of the timing of treatment on health outcomes. This causal relation is identified by exploiting rainfall at the time of the ambulance run as a shock to RT. The analysis focuses on patients who have undergone a cardiac event and shows that a one-minute increase in average RT leads to 105 more deaths each year in one Italian region. Finally, the economic value of the lives that would be saved by reducing RT is quantified to facilitate policymaking. [JEL: C26, I12, I18, R41].
Elena Lucchese. (2020) DEMS Working Papers Serie Nr 439.
Award:
"La metamorfosi della città – In ricordo di Guido Martinotti" by the University of Milan-Bicocca
Abstract
Rapid responses in emergency increases the likelihood of clearing crimes for police and saving lives for care providers. Very little is known, however, about the determinants of response time. I take advantage from rich and comprehensive administrative data from the Liguria Emergency Medical System to discuss and estimate the problem of localization faced by ambulance drivers. I make use of a difference-in-differences identification strategy by considering two factors: (i) each ambulance mission includes two driving times: the way to go, characterized by uncertainty about the location of patient; and the way to go back: during this phase of mission the location of the destination (the hospital) is known by the driver; (ii) some locations are more difficult to locate than others: is less likely that the ambulance driver knows the location of private homes compared to public buildings. I document that the localization problem delays the response of urgent (non- deferrable) missions by 5 minutes, 30% at the average. The magnitude of the effect is not affected by the distance travelled by the ambulance. The delay is halved for non-urgent missions, when the caller is less stressed and communicates more clearly. [JEL: D29, D90, I12, I18, R41].
with Paolo Roberti
Abstract
Work schedules is a general form of coordination in organisations. In this study of emergency medical treatments dispensed by care providers working in shifts, schedules induce distortions near the end of shift. Examining how performance changes according to the level of urgency of the patient, we are able to distinguish between leisure (slacking-off) and fatigue motives as potential drivers. Fatigue appears to be an important determinant of performance.
A. Furgani, E. Lucchese, S. Esposito, S. Ferlito, G. Abregal, F. Ferrari, R. Sanna, S. Ruffoni, and F. Bermano
(2016) Annals of Emergency Dispatch and Response, Vol. 4 Issue 2.
Abstract
A fast response to an emergency call is one of the main objectives of an emergency medical communication centers (EMCCs). In 2011 the MPDS®, was implemented in the Liguria Region EMCCs to manage emergency medical calls. The primary objective of the study was to evaluate whether or not the use of the MPDS has reduced the RD. The secondary objective was to evaluate the change in the DEC after the implementation of the MPDS.