Les données fournies par les citoyens sont cruciales pour améliorer la qualité des services et l’innovation dans divers secteurs, y compris la santé. Cette étude se concentre sur la compréhension des déterminants qui empêchent ou encouragent les professionnels et les gestionnaires de la santé à utiliser les données rapportées par les utilisateurs. À cet effet, nous avons opté pour le modèle de la Théorie unifiée de l’acceptation et de l’utilisation de la technologie ( Unified Theory of Acceptance and Use of Technology – UTAUT), largement appliqué dans plusieurs domaines. Cette recherche est en cours. Sa première phase comprend une étude qualitative impliquant 13 entretiens semi-structurés avec des professionnels et des gestionnaires de la santé en Italie et au Pays de Galles. Les résultats de cette phase permettront d’élaborer une enquête quantitative ultérieure impliquant un échantillon plus large. Les résultats préliminaires indiquent que tous les facteurs hypothétisés par le modèle UTAUT influencent l’utilisation des données fournies par les utilisateurs du système de santé. Les participants ont confirmé l’importance de facteurs tels que l’attente de performance, de l’effort attendu, de l’influence sociale, des conditions facilitatrices, de l’habitude, de la sécurité perçue, de la confiance et de l’anxiété comme principaux déterminants. Les futures explorations fourniront une vue d’ensemble complète de ces facteurs dans les divers scenarii de données rapportés par les utilisateurs et des plateformes numériques.

The efficacy of healthcare performance evaluation systems depends on their design and implementation, as well as on their perceived value and integration into daily practice. This study explores the acceptability of a healthcare performance evaluation system, used by health and administrative professionals in four rural healthcare settings in Ethiopia, Tanzania, and Uganda, three years after its implementation. In-depth semi-structured interviews were conducted, either in person or via video conference, with 17 professionals involved in system design and implementation. The analysis of qualitative data drew on Sekhon’s Theoretical Framework of Acceptability, using content analysis to identify themes across seven dimensions of acceptability. Key findings show that participants’ perceptions of acceptability of the performance evaluation system are influenced by data disclosure and reputational effect, the system’s understandability, alignment with their mission to improve quality of care, perceived usefulness, experienced opportunity costs, and intervention burden. The key features of the performance evaluation system are the most critical factors contributing to its acceptability, but the administrative burden, which includes professionals’ need to invest more time and change work habits to use the new system, poses some challenges and may hinder the medium- to long-term effectiveness of the intervention.

Background: In recent years, public health and social care systems have faced pressures due to socio-demographic changes and sustainability issues. Integrating social and health services is critical to ensuring equitable, continuous, and high-quality assistance, adopting a holistic approach to individuals' health and well-being. The framework of Population Health Management (PHM) has gained traction for its focus on improving the quality and sustainability of public health systems, reducing health inequalities, and enhancing social and health outcomes. A key initial step in PHM involves identifying the target population, with the concept of "community" being a focal point in primary care and population health since the Alma Ata Declaration. However, conceptualizing "community" remains complex, influenced by the specific goals and structures of health organizations. [1, 2, 3, 4] Approach: This study aims to analyze the concept of ‘community’ by exploring perspectives from key stakeholder groups involved in district management, particularly middle managers. Grounded in MacQueen's definition [5], the research seeks to understand how participants identify and define "community." A web-based brief poll was conducted during meetings and seminars, posing both open-ended and closed-ended questions regarding participants' perceptions of community. Results: Results indicated that 35% of respondents defined community as "a group of people linked by social ties, relationships, or family connections," while 20% viewed it as "a group of people who recognize their role in supporting each other and the collective well-being." Participants noted that if they had responded from a professional perspective, they would have defined community in geographical terms. The discussion emphasized the necessity of a broad definition of community, allowing for various organizational approaches to community engagement. Open responses revealed associations of "community" with geographical locations, specific populations, shared values, and mutual support, reflecting its multifaceted nature and the diverse perspectives on collective engagement. The need for multisectoral approaches is highlighted to address social determinants that influence health outcomes. Implications: The findings underscore the need for a unified definition of ‘community’ to effectively implement PHM strategies and associated organizational reforms. The distinction made by managers between ‘population’ and ‘community’ illustrates a broader understanding of these terms, with ‘community’ viewed as an active participant in shaping health initiatives. Achieving a shared understanding of community is essential for the successful application of PHM strategies, facilitating proactive health interventions and fostering effective multisectoral collaboration. References 1.World Health Organization. Primary health care policy paper series. Population health management in primary health care: A proactive approach to improve health and well-being. Copenhagen: WHO Regional Office for Europe; 2023. 2.World Health Organization. Declaration of Alma-Ata. WHO Regional Office for Europe; 1978. 3.Mannarini T, Fedi A. Multiple senses of community: the experience and meaning of community. J Community Psychol. 2009;37:211-27. 4.Kassler WJ, Tomoyasu N, Conway PH. Beyond a Traditional Payer—CMS’s Role in Improving Population Health. N Engl J Med. 2015;372(2):109-11. 5.MacQueen KM, McLellan E, Metzger DS, Kegeles S, Strauss RP, Scotti R, et al. What Is Community? An Evidence-Based Definition for Participatory Public Health. Am J Public Health. 2001;91(12):1929-38.

Objectives: This study aims to assess and compare the real-world outcomes and healthcare resource utilization of Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) procedures, acknowledging the challenges associated with medical device evaluations. Methods: The two cohorts of TAVI and SAVR patients were identified using individual-level administrative data in the Tuscany region of Italy from 2016 to 2021. Patients in treatment cohorts were followed for up to one-year post-procedure, with outcomes and costs assessed. Clinical indicators were selected from the Valve Academic Research Consortium-3 (VARC-3) consensus document. Follow-up costs, in euros (), were calculated for each patient up to three years post-procedure, from the perspective of the Italian National Healthcare System. Results: No significant differences in 30-day and 1-year mortality were found between TAVI and SAVR, though TAVI showed a slight increase in 3-year mortality (OR 1.05, p = 0.004). TAVI patients had higher rates of conduction disturbances and pacemaker implantation at all time points. They also experienced more ER admissions and hospital readmissions at 3 years, but shorter hospital stays. At 1 year, TAVI incurred in 234 higher total costs, driven mainly by higher ER costs, while pharmaceutical costs were similar. At 3 years, total costs were 2132 for TAVI and 1915 for SAVR, with higher ambulatory and ER costs in the TAVI group but lower pharmaceutical costs. Conclusion: The study explores the potential of Real-World Evidence to inform the clinical and economic evaluation of new technologies and procedures. The study differs from some prior randomized controlled trial-based studies, highlighting the impact of diverse analytical approaches and patient populations. Public interest abstract: Aortic stenosis (AS) is a common heart valve disease in the elderly, whose standard treatment consists of Surgical Aortic Valve Replacement (SAVR). For patients that are ineligible for surgery due to high risk or comorbidities, Transcatheter Aortic Valve Implantation (TAVI), has emerged as a less invasive option. This study used real-world data from Tuscany, Italy, to compare clinical outcomes and costs. We found no significant difference in mortality rates between TAVI and SAVR at 30 days and one year and higher mortality at 3 years. TAVI patients were more likely to experience conduction disturbances, often requiring pacemaker

BACKGROUND:Hepatitis C virus (HCV) infection remains a critical public health issue worldwide. Direct-acting antivirals (DAAs) have revolutionized the treatment of hepatitis C. However, real-world elimination efforts are hindered by barriers in diagnosis, treatment access, and follow-up. Embedding patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) into routine care may improve service delivery. This study evaluates clinical and patient-reported outcomes in the HCV care cascade in Tuscany (Italy), offering insights into how health service organization affects effectiveness, equity, and patient experience. METHODS:We conducted a multicenter, longitudinal, prospective study on 953 adults with HCV chronic infection. These adults were treated between 2021 and 2023 in seven prescribing centers in Tuscany. Clinical data included demographics, comorbidities, fibrosis staging, virological response (SVR12), and loss to follow-up (LTFU). PROMs and PREMs were collected at baseline (T0), 3 months post-treatment (T1), and 6 months after T1 (T2). We used the SF-12 tool and custom surveys. Patients were stratified by referral source (GPs, harm reduction services/prison, specialists). Clinical and questionnaire data were analyzed separately. Statistical analyses included ANOVA, Chi-square, Kruskal-Wallis, Cochran's Q, Friedman, and repeated measures ANOVA with Bonferroni corrections. Significance was set at p ≤ 0.05. RESULTS:DAA therapy achieved high clinical efficacy: SVR12 was reached in 93.4% of patients. The rate rose to 98.6% when excluding those lost to follow-up. Patients referred by harm reduction/prison services were younger and mostly male. They had higher psychiatric comorbidities and risk behaviors. PROMs demonstrated significant improvements in perceived physical and emotional health following treatment, particularly among individuals referred by GPs and specialists. PREMs revealed increasing satisfaction with referring doctors over time. Satisfaction with specialist care remained high and stable. Referral pathways markedly influenced patient profiles and reported outcomes. There were notable disparities in experience and quality-of-life indicators. CONCLUSIONS:This study highlights the importance of integrating clinical and patient-reported data in monitoring HCV care. High SVR rates confirm the effectiveness of DAAs, while PROMs and PREMs provide valuable insight into patient engagement and equity of access. Stratified analyses reveal the need for tailored approaches across care pathways, and high-risk populations require special attention. Embedding patient voice in evaluation fosters a more responsive, people-centered health system, advancing progress toward HCV elimination.

Les données fournies par les citoyens sont cruciales pour améliorer la qualité des services et l’innovation dans divers secteurs, y compris la santé. Cette étude se concentre sur la compréhension des déterminants qui empêchent ou encouragent les professionnels et les gestionnaires de la santé à utiliser les données rapportées par les utilisateurs. À cet effet, nous avons opté pour le modèle de la Théorie unifiée de l’acceptation et de l’utilisation de la technologie ( Unified Theory of Acceptance and Use of Technology – UTAUT), largement appliqué dans plusieurs domaines. Cette recherche est en cours. Sa première phase comprend une étude qualitative impliquant 13 entretiens semi-structurés avec des professionnels et des gestionnaires de la santé en Italie et au Pays de Galles. Les résultats de cette phase permettront d’élaborer une enquête quantitative ultérieure impliquant un échantillon plus large. Les résultats préliminaires indiquent que tous les facteurs hypothétisés par le modèle UTAUT influencent l’utilisation des données fournies par les utilisateurs du système de santé. Les participants ont confirmé l’importance de facteurs tels que l’attente de performance, de l’effort attendu, de l’influence sociale, des conditions facilitatrices, de l’habitude, de la sécurité perçue, de la confiance et de l’anxiété comme principaux déterminants. Les futures explorations fourniront une vue d’ensemble complète de ces facteurs dans les divers scenarii de données rapportés par les utilisateurs et des plateformes numériques.

BACKGROUND:Caesarean section (CS) rates have increased worldwide, raising concerns about maternal and child health and healthcare costs. Although vaginal birth after caesarean (VBAC) is considered a safe alternative, its use remains limited and variable. We aimed to identify sociodemographic, clinical, and organizational factors associated with VBAC utilization in Tuscany, Italy, and to assess the impact of VBAC on perinatal outcomes. METHODS:We conducted a retrospective population-based study using administrative healthcare data (2021-2024), including women with one previous CS who delivered at term (n = 6,737). Single-level and multi-level logistic regression models were used to investigate independent determinants of VBAC utilization and its association with perinatal outcomes. Missing data were handled using multiple imputation. RESULTS:Overall, 27% of women underwent VBAC. Older maternal age, unemployment, Italian nationality, assisted reproductive technologies, diabetes, private care pathways, and indicators of more intensive prenatal surveillance were associated with lower odds of VBAC, whereas antenatal class attendance and early initiation of prenatal care were associated with higher odds. VBAC rates increased from 2021 to 2022 to 2023-2024. The multi-level model showed that 25.4% of the variance in VBAC utilization was attributable to differences between hospitals. VBAC was associated with improved perinatal outcomes (higher Apgar scores; increased breastfeeding and skin-to-skin contact; lower neonatal ventilation) and reduced length of stay and hospitalization costs. CONCLUSIONS:VBAC utilization in Tuscany remains below recommended levels. Hospital-level differences explain a substantial proportion of the observed variation, supporting the need to standardize VBAC practices at the regional level.

Public sector organizations (PSOs) operate in dynamic environments where they must anticipate change in societal needs. Developing sensing capabilities, understood as the capacity to detect opportunities and threats, is critical to ensure adaptability. This study investigates how PSOs develop sensing capabilities by analyzing combinations of internal (organizational) and external (environmental) antecedent factors using a Fuzzy-set Qualitative Comparative Analysis. Drawing on the implementation of the Family and Community Nurse (FCN) model across 26 Tuscan local health districts, the analysis identifies three configurations for sensing capabilities development: (1) strong interorganizational structures paired with a moderately dynamic external environment, (2) the joint presence of organizational experience, culture, and structure, and (3) a highly dynamic environment paired with a strong trust-based and results-oriented culture, combined with low levels of inter-organizational structures. The findings show that sensing capabilities can emerge through multiple pathways determined by complementarities between internal organizational conditions and external environments. The study advances dynamic capabilities theory in the public sector and challenges the assumption that high environmental turbulence is a necessary precondition for capability development. Practically, the results indicate that health authorities can actively foster sensing capabilities through alternative combinations of organizational design, professional culture, and inter-organizational coordination.

The study provides valuable insights for public sector managers across different domains, with a particular focus on those operating in professional bureaucracies. While the empirical analysis concentrates on hybrid professionals in healthcare organizations, the findings are broadly applicable to all public service contexts where performance information from service users is becoming increasingly relevant. The article highlights a growing openness among professionals to integrate both financial and user-reported information into their decision-making processes. In the healthcare sector, this refers specifically to patient-reported measures, but the logic extends to any public service where users' experiences and outcomes can inform performance management. Public managers should rethink how performance systems are designed and implemented to better incorporate the perspectives of service users. Doing so would enhance transparency, responsiveness, and strategic alignment, leading to more effective and person-centred public services. This research supports evidence-based innovation in performance management (PM) practices. Performance management (PM) was introduced in the public sector with the idea that decision-makers could use performance information (PI) to guide public service organizations. However, the mere collection of PI is not sufficient; it is necessary to effectively PI in the decision-making process to enable value-creation processes. Despite this, the existing literature lacks evidence on how various types of PI influence decision-makers' choices. This study contributes to the literature on PM by offering theoretical insights into how different PI types (financial, administrative, and user-reported) are valued by hybrid professionals. It challenges existing assumptions by showing that financial and patient-reported data are both highly prioritized, suggesting a need to rethink the design of PM systems. The findings advance the debate on integrating user-centred measures and call for a rebalancing of information types to better align with professional values and patient needs.

BACKGROUND:Patient satisfaction and experience are key outcomes of healthcare and can be computed as powerful measures of service quality. Understand what affects them is essential for service quality improvement. Investigating whether the care setting (i.e., medical or surgical) can impact the patients' perception of the quality can be also important for the actionability of this data. The aim is to explore which experiential factors should be prioritized to improve patient satisfaction with hospitalization service, using experience items as intermediate results and considering different settings. METHODS:Patient-reported experience measures are used in an Italian region. This study uses the optimization approach to identify factors of healthcare user experience affecting and enhancing satisfaction. RESULTS:The results confirm that, among the significant determinants of satisfaction, some specific experiential aspects emerged as the potential primary focus to be prioritized in improvement actions. These aspects vary according to the specific departmental area. CONCLUSIONS:The study presents an optimization model directly informed by healthcare service users, utilizing their insights to drive healthcare delivery improvements. It emphasizes the necessity of not only collect patient perspectives but also applying different methodologies to understand what matters to patients and what interventions could be prioritized, and to strategically use diverse insights to enhance the delivery of healthcare services and patient experience and satisfaction.

[This corrects the article DOI: 10.1371/journal.pone.0291628.].

Geographic variation in elective surgical procedures poses challenges to healthcare equity, efficiency, and resource allocation. This study investigates variation in 14 elective surgical procedures performed in Tuscany, Italy, in 2022, focusing on both regional and Local Health Authority levels. Using hospital discharge data, we calculated treatment rates and the Systematic Component of Variation (SCV) to quantify unwarranted variation, applying McPherson et al. (1996)‘s thresholds for interpretation. Results revealed substantial differences across procedures, with low SCVs for hip replacement and inguinal hernia repair, and very high SCVs for vein stripping and coronary artery bypass grafting. To support interpretation and governance, we developed a graphical tool that visually represents SCV levels using an intuitive, color-coded format. The tool was designed to reduce the uncertainty healthcare professionals often face when interpreting variation without clear clinical benchmarks, helping them distinguish between acceptable and potentially unwarranted differences. It was presented during the 2023 Tuscan Performance Evaluation System event and pilot-tested in 2025 with 23 healthcare professionals. The tool improved participants’ ability to identify the most appropriate level of governance for action and increased confidence in understanding variation patterns. This study offers a replicable model for analyzing variation and demonstrates the value of user-friendly data visualizations in supporting informed, equity-oriented healthcare decisions. Further validation is recommended to assess long-term impact.

The prioritization of digitalization is crucial to the agendas of nations worldwide. While substantial funds have been allocated to foster it, there remains a scarcity of tools dedicated to systematically monitoring the performance of the digital transformation. This work describes the level of digitalization and information of a fundamental primary care service: the “General Practitioner (GP) selection”. The analysis was conducted by consulting websites of Italian Local Health Authorities (LHAs). First, we explored the digitalization levels of 105 websites through the Primary Care Digital Information (PCDI) composite index. It comprises four dimensions: informativeness, accessibility, inclusiveness, and adaptability, scoring on a five-point scale (low-high digitalization). Second, we conducted a readability analysis, employing three validated measures. We found an average level of digitalization and information, although dimensions perform differently. The best-performing dimension was adaptability, while the worst was inclusiveness. Half of the LHAs provided several digital alternatives to GP selection, while the remaining provided limited or no options. Regarding readability, just 29% of the LHA's websites were found easy to read. Overall, our findings depict that Italian LHAs have different approaches. This study highlights that, despite best practices, several areas require monitoring and intervention. Moreover, some barriers characterize Italian health communication strategies, notably the variability of information across and within regions and on average low website readability.

In the quest for healthcare systems enhancement, the improvement of patient experience plays a central role. The challenge lies in converting patient-reported experience data into actionable knowledge for quality improvement. This study aims to investigate the use of patient-reported data as knowledge base for actions and to identify and map actions derived from the use of patient-experience data within two Italian regional healthcare systems. Patient Experience Data are systematically collected in both systems, providing real-time updates accessible by professionals and managers through web-based reporting systems and including a collaborative network among practitioners. A sequential exploratory mixed-method study was carried out in several qualitative and quantitative phases. In the first phase, a qualitative method was conducted to discuss the actionability of patient-reported data and to design a tool for collecting the improvement actions based on these data. In the second phase, a quali-quantitative survey was performed to explore the professionals' use of patient-reported information and the types of actions implemented. Finally, a workshop was held to discuss, interpret and validate the results. The initial workshop identified key dimensions for improvement initiatives. After design and distribution of survey, a total of 189 responses was collected, respectively 96 from Region A and 93 from Region B. Both regions ensured widespread use of patient-reported data (89%). The establishment of a collaborative network seemed to reduce the learning curve in using patient-reported data and fostered a culture of using patient feedback effectively. The results reveal a difference between the two regions, with a more extensive patient-reported data use in Region A, attributed to its systematic joining the PREMs Observatory, prior experiences with patient-feedback collection and use, and patient-experience indicators integrated into the performance evaluation system. Regarding practices of data use, four themes emerged, namely, internal actions addressed to hospital staff (35.9%), external actions addressed to users (18.6%), comfort and hospitality aspects (34.7%) and review of processes and procedures (10.8%). The study highlights the importance of effectively using patient-reported data to achieve organisational goals, by combining different managerial strategies. It demonstrates how professionals use such data for improvement actions and underscores the significance of various forms of knowledge dissemination and sharing. It advocates for fostering a culture of continuous learning and improvement within and across healthcare organisations.

Relational continuity, care coordination, and teamwork are widely recognized as key components of quality in primary care. This study investigates population preferences regarding organizational models of primary care, with a particular focus on the roles of general practitioners, specialists, and nurses. A Discrete Choice Experiment (DCE) was conducted through a nationwide online cross-sectional survey, employing a full factorial experimental design with 20 randomly selected choice sets to minimize cognitive burden. The attributes examined included coordination, relational continuity, and teamwork. Data were collected from a representative sample of 2,553 respondents across Italy in early 2021. Results underscore the centrality of teamwork (OR=1.85 in mild and 2.31 in severe chronic conditions), followed by relational continuity (OR=1.60 in mild and 1.55 in severe conditions). Coordination ranks third (OR=1.31) for mild conditions but reaches parity with relational continuity in the context of severe chronic conditions. These findings offer robust evidence of differentiated preferences based on chronic disease severity and support the design of tailored primary care models. In conclusion, this analysis highlights the importance of incorporating coordination, relational continuity, and teamwork in the configuration of primary care services, offering policy-relevant insights for adapting delivery models to the needs of patients with varying levels of chronicity.

This study explores how digital transformation (DT) is operationalized and measured within Health System Performance Assessments (HSPAs) across European Union (EU) countries. By conducting a documentary analysis of national HSPAs through the READ approach, we identified 11 EU countries that include digital health metrics and extracted a total of 93 Key Performance Indicators (KPIs). These indicators were systematically categorized using the Input-Process-Output-Outcome (IPOO) framework and clustered into four deductively derived domains and corresponding sub-domains. Building on this empirical foundation, we propose a novel conceptual framework that integrates theoretical and practical dimensions of DT monitoring. The framework assigns representative KPIs to each IPOO phase and highlights critical but currently under-monitored areas. Despite notable progress in areas such as electronic health records, telemedicine, and digital service usage, the findings reveal persistent challenges. Furthermore, significant variability exists across countries in the adoption and computability of DT indicators. By providing a structured model and a comprehensive pool of indicators, this study contributes to both academic literature and practical policymaking. It supports efforts to guide DT measurement across healthcare systems while maintaining the flexibility needed to adapt to diverse national contexts. Future research should explore the evolving integration of DT metrics and continue to address gaps that hinder effective performance monitoring and policy development in healthcare digitalization.

Purpose. Drug shortages disrupt healthcare delivery and pose significant challenges to pharmaceutical supply chains. This study analyzes the drivers of drug shortages in Italy—Europe's leading pharmaceutical producer—to identify factors influencing supply disruptions and inform mitigation strategies. Design. We conducted a retrospective cohort study using data from 2018 to 2023, encompassing 17,623 drugs across 3,017 groups of substitutes. The analysis focused on three types of drugs: community, dual- dispensed, and hospital drugs. Generalized linear mixed models were employed to assess the impact of drug characteristics, market dynamics, and regulatory factors on the likelihood of shortages. Findings. Shortages were most frequent among community drugs, which exhibited higher market competition and turnover. Essential drug status increased the risk of shortages in hospital and dual- dispensed drugs, while patent protection reduced shortages for non-sterile drugs across all classes. Sterile drugs faced higher shortage risks regardless of patent status. Market dynamics, including recent market entries and exits and high competition levels, significantly affected supply stability. Notably, we found nuanced effects of price depending on drug age, where higher prices in community and hospital drugs are able to offset increased shortage risks among older drugs. Originality. This study is the first to comprehensively map drug shortage trends in the Italian market. By identifying critical factors such as drug characteristics and market dynamics, the study contributes to the empirical understanding of drug shortages. It offers insights for policymakers and industry stakeholders to develop targeted interventions aimed at enhancing consistent access to medications.

The increasing use of real-world evidence (RWE) and real-world data (RWD) to assess post-market medical devices (MDs) might satisfy the urgent need for data sharing and traceability. This study sought to (i) get an overview of current practice in post-market assessments of MDs reporting on RWE/RWD; (ii) draw policy recommendations for governments and health organisations and identify a research agenda for scholars.A systematic review was undertaken until February 2024 following the PRISMA guidelines. Original peer-reviewed articles in English and incorporating RWE/RWD into any sort of post-market assessment strategy for an MD were included and their reference lists manually checked. A narrative synthesis was employed to describe evidence retrieved.Totally, 145 research articles were identified. Administrative databases were mostly utilised; clinical and/or economic evidence gathered in a short/medium time horizon the most frequently reported; other evidence types (e.g., organisational) underreported; patient perspectives rarely incorporated; the innovation complexity of MDs relatively low.To our knowledge, this study is the first in its kind to provide a comprehensive picture of how non-randomised evidence has been used when assessing MDs working in real-life conditions. The implications of this review might help health policy scholars in addressing the avenues for research in RWE for MDs and policy-makers to better understand the risks and benefits of medium and long-term use of MDs alongside clinical practice and make more informed decisions about adoption and use.

Introduction: Pregnant women can choose from different prenatal genetic tests throughout their maternity journey. We aim to investigate the clinical, societal, and economic determinants influencing the selection of different options (non-invasive, invasive, or both). Methods: A systematic survey focusing on maternity pathways was launched by the Region of Tuscany, Italy, to collect data on pregnant women's experience, outcomes and satisfaction levels. Drawing from this survey, we retrospectively analyzed data on women who filled out the second-trimester questionnaire between March 2019 and February 2023 (n = 27,337), providing complete data on relevant variables. Logistic regression models were applied to identify the factors contributing to a higher likelihood of opting for non-invasive prenatal testing (NIPT) and invasive testing. Results: Among the participants, 42.7 % chose only NIPT, 3.8 % opted for invasive tests exclusively, 1.3 % underwent both tests, and 52.2 % did not pursue any genetic testing. NIPT was more often chosen by older, Italian, highly educated, nulliparous women, who perceived better health, were employed (versus unemployed), had higher economic status, planned pregnancy, received hospital-based care (versus counseling center), under gynecologist supervision (versus midwife), not opted for combined testing and received pregnancy vaccinations. Conversely, invasive testing was more prevalent among older women but less common among those who were nulliparous, had Italian nationality, and had a perceived better health status. This group also tended to experience unplanned and high-risk pregnancy, did not take folate during pregnancy, received public hospital-based assistance, less frequently chose combined tests or NIPT, and had frequent delays in examinations. Conclusions: Various factors beyond clinical considerations influence the selection of a prenatal test. Therefore, NIPT pathways should include balanced, high-quality information about benefits and limitations, ensuring laboratory specialists' active and integrated involvement in decision-making.