1,721,006 research outputs found
Assistenza territoriale
No full textL’invecchiamento della popolazione e l’aumento della prevalenza delle patologie croniche sono due tra
i fenomeni più descritti nella letteratura scientifica degli ultimi decenni. Le patologie ad andamento cronico, ad
oggi, rappresentano la principale quota di malattia e di ricorso ai servizi sanitari. I dati dell’Istituto Nazionale di
Statistica relativi all’anno 2015 riportano che il 38,3% dei residenti in Italia dichiarava di essere affetto da almeno
una delle principali patologie croniche e il 19,8% da multicronicità (almeno 2 patologie croniche). Nell’ambito
della popolazione residente ultra 75enne tali percentuali raggiungono, rispettivamente, l’85,2% e il 65,4%.
Queste modificazioni demografiche ed epidemiologiche determinano una complessificazione del bisogno
di assistenza socio-sanitaria nella popolazione che, a sua volta, impone al Servizio Sanitario Nazionale
(SSN) una rimodulazione delle dinamiche assistenziali. In risposta a ciò si rende necessario il passaggio da una
assistenza di tipo “prestazionale”, basata prevalentemente sul setting ospedaliero, a logiche di “presa in carico”
dell’individuo, da realizzare a livello territoriale tramite l’implementazione di un sistema basato sull’Assistenza
Primaria. In questo Capitolo vengono presentati i risultati di indicatori core che hanno il fine di misurare i processi
di assistenza rivolti a specifici target identificati dalla natura del bisogno o dalle diverse età della vita; i target
individuati comprendono:
- assistiti con condizioni di bisogno legate alla non autosufficienza;
- assistiti in età pediatrica.
Il monitoraggio dei processi di assistenza mediante i suddetti indicatori consente di apportare miglioramenti
continui, con il fine ultimo di affrontare nel modo più appropriato le specifiche configurazioni del bisogno
assistenziale per i particolari target individuati
Investigating the impact of influenza on excess mortality in all ages in Italy during recent seasons (2013/14-2016/17 seasons)
No full textObjectives: In recent years, Italy has been registering peaks in death rates, particularly among the elderly during the winter season. Influenza epidemics have been indicated as one of the potential determinants of such an excess. The objective of our study was to estimate the influenza-attributable contribution to excess mortality during the influenza seasons from 2013/14 to 2016/17 in Italy.
Methods: We used the EuroMomo and the FluMomo methods to estimate the annual trend of influenza-attributable excess death rate by age group. Population data were provided by the National Institute of Statistics, data on influenza like illness and confirmed influenza cases were provided by the National Institutes of Health. As an indicator of weekly influenza activity (IA) we adopted the Goldstein index, which is the product of the percentage of patients seen with influenza-like illness (ILI) and percentage of influenza-positive specimens, in a given week.
Results: We estimated excess deaths of 7,027, 20,259, 15,801 and 24,981 attributable to influenza epidemics in the 2013/14, 2014/15, 2015/16 and 2016/17, respectively, using the Goldstein index. The average annual mortality excess rate per 100,000 ranged from 11.6 to 41.2 with most of the influenza-associated deaths per year registered among the elderly. However children less than 5 years old also reported a relevant influenza attributable excess death rate in the 2014/15 and 2016/17 seasons (1.05/100,000 and 1.54/100,000 respectively).
Conclusions: Over 68,000 deaths were attributable to influenza epidemics in the study period. The observed excess of deaths is not completely unexpected, given the high number of fragile very old subjects living in Italy. In conclusion, the unpredictability of the influenza virus continues to present a major challenge to health professionals and policy makers. Nonetheless, vaccination remains the most effective means for reducing the burden of influenza, and efforts to increase vaccine coverage and the introduction of new vaccine strategies (such as vaccinating healthy children) should be considered to reduce the influenza attributable excess mortality experienced in Italy and in Europe in the last seasons. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases
Healthcare organization mergers: a systematic review of the literature on clinical outcomes
No full textBackground:
A wave of healthcare organization mergers have been pursued for more than two decades in different countries regardless the type of health systems, although little attention is paid to their impact and assessment. The objective of this work is to synthesize evidence on the effect on clinical outcomes of patients after a merger of a healthcare organization, through a systematic review of the literature
Methods:
This systematic review was conducted according to the Population-Intervention-Comparison-Outcome model, using specific keywords and Boolean operators to build a search string, and by querying 3 electronic databases. Articles that reported quantitative evaluation of the impact of mergers on clinical outcomes were included. Titles, abstracts, and data extraction performed by 2 independent investigators
Results:
From a total of 28748, 5 studies met our inclusion criteria and 37 indicators were identified: 54.1% didn’t show any variation, 32.4% worsened and only 13.5% improved significantly after the merger. In particular, orthopedic care didn’t show any statistically significant variation in 44.5% indicators, while 33.3% showed a worsening and 22.2% an improvement in clinical outcomes. Obstetrics and neonatal indicators care didn’t change in 50.0% and 33.3% of them showed a statistically significant worsening. Cardiovascular disease indicators showed that acute myocardial infarction mortality didn’t variate in 75.0% of the indicators but 25.0% worsened. Indicators of heart failure, percutaneous coronary intervention and coronary artery bypass graft mortality didn’t improve significantly. Eventually, 60.0% of stroke mortality indicators showed a significant worsening.
Conclusions:
The impact of mergers showed contrasting effect on health outcomes that should be considered when these activities are intended to be pursued. These processes should be followed by a periodic assessment and actions that try to continuously improve and reach the targeted results
Key messages:
Mergers may imply important consequences in terms of clinical outcomes that should not be underestimated.
A continuous evaluation approach to health risks linked to this type of intervention is suggested
Integration model between hospital and community care services: the bibliometric impact
No full textBackground:
Due to these trends, there is a steady increase in healthcare complexity, and coordination has become a high-priority need in healthcare delivery. The aim is to provide a comprehensive overview on the role of integration between hospital and community care setting in primary care from three different conceptual frameworks: integrated care, intermediate care and transitional care.
Methods:
A comprehensive literature review and a bibliometric analisys were carried out. MEDLINE database was queried for relevant studies using the standard Population-Intervention-Context-Outcome (PICO) model to ensure the included articles matched the study objectives. The concepts of integrated care, transitional care, intermediate care and hospital were combined into a standardized search string using MeSH and non-MeSH entry terms. Descriptive and inferential statistics were performed. A linear regression analysis was used to study the research trends: the number of articles per year was considered as dependent variable in a logarithmic scale.
Results:
A total of 2102 documents were screened according to the inclusion and exclusion criteria. The distribution of articles among the countries vary from 0,005% of the Switzerland to 26,7% of the USA. Linear regression analysis was performed on the countries grouped by geographical area, excluding countries with a small number of articles. The time trend analysis showed an increase by 8% of the number of published articles per year (CI 95% 5%-11%) in the total of Countries, by 7% per year (CI95% 4%-10%) in North American Countries and of 6% per year (CI95% 2%-10%) in European Countries.
Conclusions:
The bibliometric analysis revealed escalating trends in the number of interventions carried out to implement the concept of integration between hospital and community care services. Integration in care delivery is a promising approach for improving patients and health professionals experience and health outcomes.
Key messages:
To evaluate and summarize the interest of the academic community on to the impact of hospital and community care services integration.
Three conceptual frameworks: integrated care, intermediate care and transitional care were examined to analyze this topic
[Governance in a project addressing care of disabled elderly persons within the regional healthcare system of Tuscany, Italy]
No full textPopulation aging and the concurrent increase of age-related chronic degenerative diseases and disability are associated with an increased proportion of elderly persons who are dependent in activities of daily living (ADL). ADL-dependent persons need continuous and long-term health and social care according to the "taking charge" rationale, in order to warrant access and continuity of care. A healthcare system needs to respond to the long-term and complex needs, such as those of disabled elderly people, by providing appropriate health and social care services in Primary Care. A Primary Health Care system is organized according to two governance levels have distinct aims but are closely inter-dependent in their operational mechanisms. The system governance is accountable for the community and individual health protection while the delivery governance is accountable for the provision of services in accordance with appropriateness, safety and economic criteria. Delivery governance can be considered "integrated governance" as a synergy exists between two decision-making systems guiding provider choices, which are corporate governance and clinical governance. The aim of this study was to analyse the abovementioned governance levels within the healthcare system in Tuscany (Italy) referring to long-term residential care for disabled elderly people. The case of excessive accesses to emergency departments from different types of Nursing Homes (NH) is used as an example to analyse different levels of responsibility involved in the management of a critical phenomenon. Suggestions for improvement in the different levels of governance for disabled elderly people are provided, in order to support institutional programming activities
L’impatto di interventi di interprofessional education (IPE) e di interprofessional collaboration (IPC) sulla gestione della cronicità: una revisione sistematica della letteratura.
No full textIntroduzione
L’interprofessional education (IPE) e l’interprofessional collaboration
(IPC) stanno acquisendo sempre maggiore riconoscimento tra i professionisti e le istituzioni che si occupano di organizzare i servizi sanitari.
Dall’analisi della letteratura si evince che il lavoro in team interprofessionali aiuti a massimizzare e rafforzare le competenze dei singoli
professionisti, migliorare l’efficienza e garantire la continuità delle cure
soprattutto nella gestione di pazienti cronici. L’obiettivo di questo studio
è quello di valutare l’impatto di interventi di IPE e/o IPC rispetto al trattamento standard su pazienti affetti da cronicità.
Materiali e metodi
È stata effettuata una ricerca sistematica della letteratura secondo il
modello PICO, consultando le seguenti banche dati: Medline, Scopus
e Web of Science fino a maggio 2019. Tutte le ricerche sono state effettuate senza restrizioni di lingua. Lo screening dei titoli e degli abstract e
l’estrazione dei dati sono stati effettuati da tre autori separatamente. I tre
autori hanno valutato la qualità degli studi inclusi in modo indipendente
ed opinioni divergenti circa l’inclusione degli articoli sono stati risolti
con il consenso. Per la valutazione della qualità metodologica, sono stati
utilizzati i criteri raccomandati dalla National Institutes of Health Study
Quality Assessment Tool.
Gli interventi descritti sono stati classificati in funzione dell’outcome e
suddivisi in base all’ indicatore di esito o di processo utilizzato.
Risultati
Di un totale di 1963, 30 studi hanno soddisfatto i criteri di inclusione.
Gli indicatori più studiati sono stati quelli di processo dove abbiamo riscontrato un aumento significativo degli outcome in seguito a interventi
di IPE e/o IPC nel 58% dei casi e solamente nel 4% dei casi un peggioramento. Un impatto positivo è stato rilevato anche sugli indicatori di esito.
Due articoli hanno valutato interventi di IPE cui è seguita una attività di
IPC, mostrando risultati tra loro contrastanti: da una parte viene riscontrato un miglioramento se si analizzano gli indicatori di processo, mentre
l’intervento sembra ininfluente sugli indicatori di esito; il secondo articolo invece conclude per l’inesistenza di un guadagno in riferimento alla
usual care, eccezion fatta per un incremento della copertura vaccinale
nella popolazione target dell’intervento.
Conclusioni
L’IPC è una strategia innovativa per affrontare i complessi bisogni di salute dei pazienti cronici. C’è tuttavia una mancanza di evidenze sull’impatto che l’IPE può avere sul trattamento delle cronicità. Sono quindi
necessari ulteriori studi sia per valutare il ruolo dell’IPE nel favorire la
collaborazione interprofessionale che nel miglioramento dei risultati nei
pazienti cronici
Andamento delle pubblicazioni sui piani di assistenza individuali: analisi bibliometrica della letteratura
No full textIntroduzione: L’aumento della prevalenza delle condizioni ad andamento cronico impone, nell’ambito dell’Assistenza
Primaria, un passaggio da logiche di trattamento frammentario a logiche di ricomposizione unitaria dell’assistenza per la
presa in carico degli individui. In questo contesto emerge la necessità di piani individuali personalizzati quali strumenti
che assicurino a ciascun individuo una continuità assistenziale. Lo scopo della presente revisione di letteratura è valutare
l’andamento nel tempo dell’attenzione della comunità scientifica al ruolo dei Piani di Assistenza Individuali (PAI). Metodi: E’
stata condotta una revisione sistematica di letteratura interrogando il database MEDLINE per l’intero periodo di archiviazione
fino al 2014, attraverso specifiche parole chiave. Gli articoli rilevanti ottenuti sono stati successivamente categorizzati in base
all’anno di pubblicazione. L’analisi statistica è stata condotta mediante un modello di regressione lineare in cui l’anno è stato
considerato quale variabile indipendente e il numero di articoli quale variabile dipendente espressa in scala logaritmica in
quanto la regressione risultava non lineare per i parametri. Risultati: Il totale degli articoli ottenuti è stato di 611. In seguito a
revisione per titoli ed abstract, 238 articoli hanno presentano un focus sul ruolo dei PAI e sono stati inseriti nella successiva
analisi. Il modello di regressione ha mostrato un incremento annuo del numero di pubblicazioni dell’8,6% (CI95% 6,7% e
10,5%). Conclusioni: Tale ricerca mostra un interesse scientifico crescente, negli ultimi 30 anni, riguardo allo sviluppo di PAI
che leggano e rispondano adeguatamente alle necessità del singolo. Ulteriori studi sono, tuttavia, necessari per valutare
l’impatto che i Piani di Assistenza Individuali hanno in relazione alla gestione complessiva del paziente, sia in termini di
miglioramento degli outcome di salute che di implementazione dei processi di assistenza
[Impact of merging healthcare organizations: a review of the literature]
No full textOver the last two decades, the healthcare sector of different Countries has been involved in a wave of mergers. This wave first started in the US and in the UK and, later, has involved Italy. Despite these activities are still pursued, little attention is paid to the assessment of their impact. The aim of this study is to summarize, through a review of the literature, evidence on the impact of these mergers. The main results are divided into four areas: the impact of mergers on clinical outcome, processes and use of resources; the association between population size and performance of primary care organizations; the analysis of the main drivers; and eventually, staff perception and satisfaction. Evidence is conflicting and small number of indicators of clinical outcome, processes and use of resources show a significant improvement. The performance of the Primary care Organizations does not seem significantly related to the size of the population served but to numerous factors, among others the function of the organization itself. Drivers that lead the pursuing of merging can be distinguished in stated and unstated drivers the first ones originating from public consultation document, the second ones from staff interview. Concerns about mergers derive from responses of personnel interview, in particular about the cultural differences and the distance perceived from top managers. Evidence shows that these processes do not necessarily lead to the expected benefits. It is important, therefore, to periodically and systematically assess the impact of mergers in a continuous quality improvement cycle that makes professionist, recipients and policy maker accountable. These latter, in particular are responsible for protecting the health of the community
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