1,721,050 research outputs found
L'innovazione nell'organizzazione dell'assistenza territoriale per sviluppare efficacia ed equità
No full textUno dei problemi all'interno delle aziende sanitarie riguarda l'atteggiamento che si ha nei confronti dell'innovazione. E' vista come un qualcosa che arriva dall'esterno e che si può solo contenere. Non viene percepita come una tensione alla soluzione dei problemi esistenti. Ma se i sistemi sanitari non sapranno innovarsi di fronte alle sfide future, non riusciranno ad essere sostenibili
When peers count: the effects on integrated type II diabetes care of communication within general practitioner-only subgroups in interprofessional primary care teams
No full textBackground. Primary care teams (hereafter referred to as primary care units, PCUs) composed of general practitioners (GPs), nurses and specialist doctors have recently been established in the Italian context, with the main aim of improving integrated care for chronic diseases. Purposes. To assess whether the increased professional diversity of PCUs has resulted in an improvement in the integrated care of type II diabetes and to identify a potential mechanism mediating this effect. Methodology/Approach. We analyzed 213 PCUs, comparing their performance in integrated type II diabetes care at two time points. Using social categorization theory and a fixed effects regression analysis, we tested a mediation model in which the frequency of communication among GPs in the PCUs, i.e., within-subgroup communication, mediates the relationship between PCU professional diversity and team performance in diabetes care. Findings. We show that when the professional diversity of the PCUs increases, integrated care of type II diabetes improves and better meets the standards of optimal care. Within-GP subgroup communication works as a mediating mechanism that translates the PCU professional diversity into better team performance. The mediation effect, however, is curvilinear. Beyond certain levels, within-subgroup communication can hamper PCUs’ capacity to work collaboratively in integrated type II diabetes care. Practice Implications. The paper suggests that when creating interprofessional primary care teams, managers might be able to steer teams towards a better performance by encouraging communication among peers of the same profession
Organizzare la salute nel territorio
No full textQuesto volume propone, nella prima parte, un metodo comparativo di misurazione dei servizi sul territorio e confronta in ottica di benchmark i dati di costo e di attività di un campione di 13 aziende USL rappresentative dell'intera realtà italiana. L'analisi dei dati di dotazione strutturale, spesa e attività delle aziende, e la parallela ricerca di correlazioni tra variabili indipendenti (vale a dire frutto delle scelte strategiche delle aziende) e variabili dipendenti (ovvero i risultati in termini di efficienza nell'uso delle risorse e efficacia nella capacità di risposta ai bisogni della popolazione), costituiscono il primo passo per orientare le aziende verso una maggiore consapevolezza nel "governo" dei propri servizi sul territorio. In sanità la parola "territorio" definisce un insieme di servizi tra loro eterogenei (servizi di prevenzione e sanità pubblica, medicina di famiglia, servizi per la salute mentale e le dipendenze, assistenza in hospice e le diverse forme di assistenza domiciliare), orientati a una progressiva de-specializzazione dell'ambito di cura, che richiedono la partecipazione di un network multidisciplinare di professionisti e necessitano di livelli elevati di integrazione professionale. Nella seconda parte del volume vengono presentate le esperienze innovative di assistenza territoriale delle aziende sanitarie protagoniste della ricerca
I profili di utenza e la mobilità dei pazienti
No full textIl capitolo analizza la possibile clusterizzazione degli utenti nel settore sanitario, analizzando le criticità strategiche della segmentazione prospettica e le possibili strategie aziendali di rispost
Gli scenari istituzionali e la missione delle aziende
No full textIl capitolo analizza la geografia attuale e prospettica dei sistemi di welfare socio sanitari e dei meccanismi di riproduzione sociale finanziata direttamente dalle famiglie. Propone le possibili strategie delle aziende pubbliche che ne determinano la missione rispetto al sistema welfare socio-sanitario complessiv
Francia, Germania, Italia, Regno Unito: obiettivi, criticità e scelte per un'analisi comparativa dei modelli di welfare
No full textcapitolo introduttivo del libro con descrizione dei metodi di ricerca
A framework to assess and plan welfare institutional arrangements and provision forms: theory and practice in two prominent Italian regions
No full textModern Welfare States are characterized by the provision of a complex mix of public and private services.
The traditional configuration of Welfare regimes as the sole responsible for social security has been replaced
in theory and practice by the presence of institutional networks of various actors with a varied allocation of
resources and responsibilities (Heitzmann, 2006). Not only Public but also Private and Non for profit
organizations together with families, are thus involved in service provision (Powell & Barrientos, 2011). Even
if the assumption of the prevalence of welfare mix (Esping Andersen, 1990) rather than public Welfare
regimes is clearly stated in the literature, the issue is not systematically approached and a gap in methods
and analytical tools exists. Moving from a critical appraisal of previous contributions, in this paper we aim to
develop an analytical framework aimed at studying services provision forms and institutional arrangements in
a welfare mix context. Moreover, we test this method on the case of social care in two prominent Italian
regions, Lombardia and Emilia-Romagna.
Relationships between public and private actors have been addressed in different disciplines and
networks: Economics - focus on the allocation of public and private expenditure; Social Science -
investigating norms and values; Political Studies - defining ideology and policy values - and Management –
with emphasis on networks of providers and efficiency in administrative processes. In synthesis, four
different approaches to welfare mix might be distinguished: 1) Welfare provision, interpreting welfare mix
from a production perspective and considering different industrial models and features of services delivery
systems (Vogel, 1999; Dahlberg, 2005); 2) Regulation and Governance, adopting a wider perspective by
adding to provision the dimension of regulation and governance (for example supply and demand regulation
and financing mechanism) (Goodin and Rein, 2001; Ascoli and Ranci, 2003; Bode, 2006); 3) Norms and
values that define Welfare participation, analyzing circumstances inducing public and private actors to take
part in the Welfare Mix (Evers and Laville, 2004); 4) Synergetic approach, exploring welfare mix systems
with a focus on relationships and allocation of responsibilities within and between Welfare actors (Borgonovi,
2002).
Our method is tested on two case studies: social care provision in Lombardia and Emilia-Romagna,
two prominent Italian regions, with 10 and 4 million inhabitants, accounting together 24% of the national
population, and about 30% of national Gross Income Product (500 billion Euros). The two regions present
consolidated and mature Welfare systems, where national social reforms 1 were implemented since the early
years of 2000. The resulting Welfare systems are very different and representative of others regimes existing
in Europe: Lombardia Welfare system, on one hand, is strongly based, at least in its inspiration, on publicprivate partnership and users’ free choice; Emilia-Romagna Welfare system, instead, is more inclusive with a
strong focus on public planning and a distinctive finance pooling mechanism (the “Fondo per la Non
Autosufficienza”). We use case study method to verify the validity of an emerging theory, as proposed by
Eisenhardt (1989) and Eisenhardt & Graebner (2007), through the definition of two instrumental studies
(Stake, 2005). Social care has been chosen among other services, because it is representative of Welfare
regimes due to its intrinsic relevance and increasing importance (Daly and Lewis, 2000; Jensen, 2008) and
because it is a policy field where, traditionally, the interaction between Public, Private and Not for Profit
Organizations and families is high
Expression of genes involved in oxidative stress response in colonies of the ascidian Botryllus schlosseri exposed to various environmental conditions
No full textEnvironmental stress conditions are ultimately related to the induction of oxidative stress in organisms,
as a consequence of an increased production of reactive oxygen species (ROS). This could be exploited to
study sub-lethal effects induced by the environment in the organisms. In the present work, we evaluate
the possibility to use the colonial ascidian Botryllus schlosseri as a bioindicator, to assess the environmental
quality in the Lagoon of Venice. Three colony batches were immersed, for 22 days, at two sites (1
and 2) with different grades of hydrodynamics and anthropogenic impact and physico-chemical features
of seawater; a control batch was kept in a large tank with continuous seawater flow at the Marine Station
of the Department of Biology, University of Padova, in Chioggia (site 3). Seawater at site 2 had higher pH
and temperature than site 1. Colonies were then retrieved, their mRNA was extracted and the level of
transcription of genes involved in oxidative stress response (glutathione synthase, g-glutamyl-cysteine
ligase, modulatory subunit, two isoforms of glutathione peroxidases and Cu/Zn superoxide dismutase)
was evaluated. In colonies from sites 1 and 2, most genes showed significantly increased transcriptional
levels with respect to control values. Spectrophotometric analyses of colony homogenates revealed that
the enzymatic activity of superoxide dismutase and catalase was higher in colonies from site 2 as
compared to site 1, allowing us to speculate that colonies in site 2 were under higher stress level than
those in site 1. Overall, we can conclude that B. schlosseri seems a good indicator of the ecological status
of the Lagoon environment, within a range of pH and temperature in which colonies are used to live
La struttura degli scenari e la Nominal group technique
No full textIl capitolo analizza la tecnica degli scenari per rappresentare le dimaniche critiche del futuro del settore sanitario. Propone e descrive la Nominal Group technique come strumento di analisi del lavoro con gli opinion leader del settor
Innovative models of chronic care management: the case of Regione Lombardia
No full textTo date, there is much excitement to re-examine the reorganization of health systems and to re-direct the focus on the appropriateness. Chronic care management is affirming its importance in terms of economic and medical relevance. In this article, the research goal is to provide a rationalization of the main organizational models which are springing for the systems of primary care with a focus on chronicity. The effort is aimed at identifying the paradigms from which derive the various initiatives scattered around institutions and territories. In fact, in this work we try to contribute in terms of theoretical positioning. Then, the focus is on CREG model of Regione Lombardia: a new organizational model for taking care of chronic patients
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