The value of scientific production for patient care in Academic Health Science Centres
Project Code: P2022RF38Y
Funding Scheme: PRIN 2022 (Progetti di Ricerca di Rilevante Interesse Nazionale)
This is a national research project on Academic Health Research Value (AHSC) funded under the PRIN 2022 PNRR programme. It explores how research activities and scientific outputs of Italian Academic Health Science Centres (AHSCs) impact patient care quality, outcomes, and healthcare system performance.
Academic Health Science Centres play a crucial role in healthcare systems worldwide, integrating three strategic missions: education, research, and advanced clinical care. Despite their importance, little is known about how these missions interact, particularly regarding the impact of research on patient care delivery.
This project addresses this gap by combining scientometric analysis of research outputs with healthcare performance data, investigating the relationship between scientific production and clinical outcomes, patient mobility, and hospital case-mix complexity.
Research Context and Rationale
Academic Health Science Centres (AHSCs) share the same three strategic missions worldwide:
First, they train healthcare professionals to be able to treat and reduce the burden of disease effectively using more valuable health technologies.
Second, they experiment with innovative treatment methods, health technologies, new tools, and digital solutions that can make the EU health industry more pioneering, sustainable, and globally competitive.
Third, they provide advanced high-quality health care through the development and adoption of groundbreaking and effective solutions that are increasingly people-centered and data-driven.
Balancing these three components is very complex, with well-known side effects such as strategic ambiguity and organizational tensions. While some studies have examined how the teaching function affects patient care, the impact of research on care remains largely uninvestigated.
Today, disciplines such as bibliometrics and scientometrics make it possible to measure research outputs comprehensively. The scientific production of AHSCs includes:
- Peer-reviewed publications
- Clinical trials
- Patents
- Research grants
- Social impact (measured through altmetrics)
While these outputs can be measured separately by scientometrics, they have not been systematically analyzed to understand their relationship with healthcare performance.
Italian AHSC Setting
This research focuses on 51 Italian public AHSCs for five key reasons:
- Economic impact: AHSCs are increasingly considered economic engines where research strongly impacts society
- Geographic diversity: Italian AHSCs cover the whole country, from metropolitan areas to small and medium-sized cities
- Heterogeneity: They differ significantly in governance, organizational structure, scale and scope of operations, and formal relationships between universities and hospitals:
- Fully integrated AHSCs: Historically university-run hospitals (AOU SSN)
- Affiliated AHSCs: Autonomous hospitals affiliated to the School of Medicine
- Research-focused AHSCs: Predominantly research-oriented (IRCCSs)
- Institutional evolution: Over the past two decades, Italian AHSCs have undergone several changes due to reforms in the health sector (Legislative Decree 517/99) and university sector (Legislative Decree 240/2010)
- Performance evaluation context: Italian AHSCs are subject to performance reviews that compare academic and generalist hospitals, but these primarily investigate the mission of care, not research outputs
According to existing benchmarking studies, the academic nature of hospitals does not significantly influence care performance. However, research outputs have not been systematically evaluated in relation to care quality.
Research Objectives
This project’s threefold contribution aims to answer three critical research questions:
📊 Build a comprehensive scientometric database
Collect and integrate bibliometric and scientometric metadata of the scientific production of all 51 Italian public AHSCs from 2000 to the present. This longitudinal study will enable understanding of research trends and patterns.
🔬 Develop a composite indicator of scientific performance
After measuring research productivity, growth, impact, and novelty across multiple dimensions (publications, clinical trials, patents, grants, altmetrics), construct a combined and weighted indicator of scientific production for each AHSC.
🏥 Analyze the impact of research on patient care
Conduct an econometric study to investigate how research performance affects:
- Patient outcomes: 30-day mortality, hospital readmissions, waiting times
- Hospital case-mix: Complexity and specialization of cases treated
- Patient mobility: Inter-regional patient flows seeking better care
Key Research Questions:
- Does academic research performance in public AHSCs lead to better healthcare outcomes?
- Is academic research performance a driver for AHSCs case-mix complexity?
- Is academic research performance in public AHSCs a driver for patients’ mobility?
Research Methodology
The project unfolds through four main milestones:
🧩 Milestone 1: Scientometric Data Gathering
We build a database through the integration of data from multiple sources:
- Primary sources: Clarivate Web of Science, PubMed/MEDLINE, OpenAlex, Dimensions
- Data types: Publications, clinical trials, patents, competitive grants, altmetrics
- Timespan: 2000 to present
- Coverage: All 51 Italian public AHSCs
Data undergo rigorous cleaning, disambiguation, and normalization procedures following PRISMA guidelines. Standardized identifiers (ROR, GRID, MAG, DOI) are used for merging and deduplication.
The research team has already developed specialized R packages for metadata extraction:
- dimensionsR: Gathering metadata from Digital Science Dimensions
- pubmedR: Extracting data from PubMed database
- openalexR: Querying OpenAlex database
All source codes are open-source and available on GitHub.
🗺️ Milestone 2: New Tools for Scientometric Analysis
We upgrade the existing bibliometrix R-package to create Scientometrix, a comprehensive tool for analyzing all types of scientometric metadata together.
Key metrics calculated:
- Productivity: Scientific output normalized by affiliated authors, publication growth rate
- Impact: Research impact (citations normalized by publications), social impact (altmetrics)
- Innovation: Disruption index, novelty/conventionality measures, interdisciplinarity indexes
- Other metrics: Grant attraction capacity, clinical trials volume and impact, patent production
These metrics are then aggregated into a composite indicator that provides a comprehensive assessment of each AHSC’s scientific performance.
📈 Milestone 3: Econometric Analysis
Using Hospital Discharge Records (SDO - Schede di dimissione ospedaliera), we extract clinical and administrative data including:
- Patient characteristics (age, sex, education, residence)
- Clinical information (diagnoses, procedures, comorbidities using ICD-9-CM)
- Admission details (institution, dates, priority, mode of discharge)
Analytical approach:
- Coarsened Exact Matching (CEM): To control for selection bias by matching patients with similar characteristics across different AHSCs
- Discrete Choice Analysis: To model patient mobility and hospital choice decisions
- Longitudinal analysis: To measure causal effects of research performance on care outcomes
We exclude emergency admissions and focus on elective procedures to isolate the relationship between research quality and planned care delivery.
📢 Milestone 4: Dissemination
Results are disseminated through multiple channels:
- Traditional modes: 4 scientific articles in international journals, 1 scientific book, presentations at national and international conferences
- Open science: Open-source tools on GitHub, open-access datasets, transparent methodologies
- Social media: Project website, Twitter, LinkedIn, YouTube tutorials
- Public engagement: Workshop with stakeholders, policy briefs, non-specialist summaries