Nuovi strumenti di management per la gestione integrata dei percorsi assistenziali dei pazienti cronici

Titolo Rivista MECOSAN
Autori/Curatori Francesca Casalini, Chiara Seghieri, Michele Emdin, Sabina Nuti
Anno di pubblicazione 2018 Fascicolo 2017/102 Lingua Italiano
Numero pagine 25 P. 35-59 Dimensione file 23771 KB
DOI 10.3280/MESA2017-102003
Il DOI è il codice a barre della proprietà intellettuale: per saperne di più clicca qui

Qui sotto puoi vedere in anteprima la prima pagina di questo articolo.

Se questo articolo ti interessa, lo puoi acquistare (e scaricare in formato pdf) seguendo le facili indicazioni per acquistare il download credit. Acquista Download Credits per scaricare questo Articolo in formato PDF

Anteprima articolo

FrancoAngeli è membro della Publishers International Linking Association, Inc (PILA)associazione indipendente e non profit per facilitare (attraverso i servizi tecnologici implementati da CrossRef.org) l’accesso degli studiosi ai contenuti digitali nelle pubblicazioni professionali e scientifiche

Nella gestione dei pazienti cronici, la tradizionale organizzazione per setting assistenziali contrapposti (ospedaleterritorio) fatica a garantire qualità delle cure, assistenza personalizzata e sostenibilità finanziaria complessiva. Le aziende sanitarie, pur riconoscendo l’ineludibile necessità di lavorare in rete, adottano sistemi di programmazione e controllo impostati per setting assistenziale, che non permettono di misurare la capacità di produzione di "valore" per il paziente in ottica di percorso. Scopo di questo studio è la sperimentazione nel contesto italiano (Toscana) di una metodologia per identificare reti di professionisti che hanno in cura il paziente cronico (in questo caso con scompenso cardiaco) e misurare gli esiti e l’appropriatezza clinica dei percorsi di cui sono responsabili. La valutazione della performance per rete assistenziale può costituire uno strumento efficace per migliorare l’assistenza e introdurre una logica di accountability coerente con i nuovi modelli organizzativi.;

Keywords:Patologie croniche, scompenso cardiaco, percorsi assistenziali, valutazione della performance, reti assistenziali, referral.

  1. Hibbard J.H., Stockard J., Tusler M. (2003). Does publicizing hospital performance stimulate quality improvement efforts? Health Affairs, 22(2): 84-94.
  2. Jonas S., Raleigh V., Foot C., Mountford J. (2012). Measuring quality along care pathways. The Kings’ Fund. -- Testo disponibile al sito: http://www.kingsfund.org.uk/sites/files/kf/field/field_document/Outcomes-measuring-quality-the-king’sfund-aug-2012.pdf (14/08/2017).
  3. Joynt K.E., Jha A.K. (2011). Who has higher readmission rates for heart failure, and why? Implications for efforts to improve care using financial incentives. Circulation: Cardiovascular Quality and Outcomes, 4: 53-9. DOI: 10.1161/CIRCOUTCOMES.110.950964
  4. Kasper E.K., Gerstenblith G., Hefter G. et al. (2002). A randomized trial of the efficacy of multidisciplinary care in heart failure outpatients at high risk of hospital readmission. Journal of the American College of Cardiology, 39: 471-80. DOI: 10.1016/S0735-1097(01)01761-2
  5. Kinchen K.S., Cooper L.A., Levine D. et al. (2004). Referral of patients to specialists: Factors affecting choice of specialist by primary care physicians. Annals of Family Medicine, 2: 245-252.
  6. Landon B.E., Keating N.L., Barnett M.L. et al. (2012). Variation in Patient-Sharing Networks of Physicians across the United States. Journal of the American Medical Association, 308: 265-273.
  7. Lawrence J., Delaney C.P. (2013). Integrating Hospital Administrative Data to Improve Health Care Efficiency and Outcomes : “The Socrates Story”. Clinics in Colon Rectal Surgery, 1(212): 56-62.
  8. Leatt P., Pink G.H., Guerriere M. (2000). Towards a Canadian model of integrated healthcare. Healthcare Papers, 1(2): 13-35.
  9. MacLean C.H., Louie R., Shekelle P.G. et al. (2006). Comparison of Administrative Data and Medical Records to Measure the Quality of Medical Care Provided to Vulnerable Older Patients. Medical Care, 44(2): 141-148. -- Testo disponibile al sito: http://www.jstor.org/stable/3768384 (14/08/2017).
  10. Maggioni A.P., Dahlstrom U., Filippatos G. et al. (2013). EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). European Journal of Heart Failure, 15: 808-817.
  11. Manuel D.G., Lam K., Maaten S., Klein-Geltink J. (2011). Using administrative data to measure the extent to which practitioners work together: “interconnected” care is common in a large cohort of family physicians. Open Medicine, 5: E177. PMCID: PMC3345380.
  12. Martínez-González N.A., Berchtold P., Ullman K., Busato A., Egger M. (2014). Integrated care programmes for adults with chronic conditions: a metareview. International Journal for Quality in Health Care, 26: 561-570.
  13. Accountable Care around the World: A Framework to Guide Reform Strategies. Health Affairs, 33(9): 1507-1515.
  14. Ministero della Salute. Agenzia Nazionale per i Servizi Sanitari Regionali (2016). Programma Nazionale Esiti – PNE. -- Testo disponibile al sito: http://95.110.213.190/PNEedizione16_p (14/08/2017).
  15. Mosterd A., Hoes A.W. (2007). Clinical epidemiology of heart failure. Heart, 93: 1137-1146.
  16. Murray C.J., Vos T., Lozano R. et al. (2012). Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380: 2197-2223. DOI: 10.1016/S0140-6736(12)61689-4
  17. National Clinical Audit Support Programme (NHS) (2008). National Heart Failure Audit 2008/09. -- Testo disponibile al sito: http://www.ic.nhs.uk (14/08/2017).
  18. NHS (2012). The NHS Outcomes Framework 2012/13. -- Testo disponibile al sito: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213711/dh_131723.pdf (14/08/2017).
  19. Nolte E., Knai C., Hofmarcher M. et al. (2012). Overcoming fragmentation in health care: Chronic care in Austria, Germany and the Netherlands. Health Economics, Policy and Law, 7(1): 125-46. DOI: 10.1017/S1744133111000338
  20. Noto G., Raschetti R., Maggini M. (2011). Gestione integrata e percorsi assistenziali. Roma: Il Pensiero Scientifico Editore.
  21. Nuti S. (a cura di) (2008). La valutazione della performance in sanità. Bologna: il Mulino.
  22. Nuti S., Bini B., Grillo Ruggieri T., Piaggesi A., Ricci L. (2016). Bridging the Gap between Theory and Practice in Integrated Care: The Case of the Diabetic Foot Pathway in Tuscany. International Journal of Integrated Care, 16(2): 9.
  23. Nuti S., De Rosis S., Bonciani M., Murante A.M. (2018). Rethinking Healthcare Performance Evaluation Systems towards the People-Centredness Approach: Their Pathways, their Experience, their Evaluation. Healthcare Papers, 17(2).
  24. Nuti S., Fantini M.P., Murante A.M. (a cura di) (2014). Valutare i percorsi in sanità. Bologna: il Mulino. Nuti S., Seghieri C. (2014). Is variation management included in regional healthcare governance systems? Some proposals from Italy. Health Policy, 114(1): 71-78.
  25. Nuti S., Seghieri C., Vainieri M. (2012). Assessing the effectiveness of a performance evaluation system in the public health care sector: Some novel evidence from the Tuscany region experience. Journal of Management and Governance, 17(1): 59-69.
  26. Nuti S., Vola F., Bonini A., Vainieri M. (2016). Making governance work in the health care sector: evidence from a “natural experiment” in Italy. Health Economics, Policy, and Law, 11(1): 17-38.
  27. OECD (2015). Health at a Glance 2015: OECD indicators. -- Testo disponibile al sito: http://www.oecd.org (14/08/2017).
  28. Opasich C., Febo O., Riccardi P.G. et al. (1996). Concomitant Factors of Decompensation in Chronic Heart Failure. American Journal of Cardiology, 78: 354-7. DOI: 10.1016/S0002-9149(96)00294-9
  29. Opasich C., Rapezzi C., Lucci D. et al. (2001) Italian Network on Congestive Heart Failure Investigators. Precipitating factors and decision-making processes of short-term worsening heart failure despite “optimal” treatment (from the IN-CHF Registry). American Journal of Cardiology, 88: 382-387. DOI: 10.1016/S0002-9149(01)01683-6
  30. Patel V., Belkin G.S., Chockalingam A. et al. (2013). Grand Challenges: Integrating Mental Health Services into Priority Health Care Platforms. PLoS Med, 10(5): e1001448.
  31. Van Peursem K.A., Prat M.J., Lawrence S.R. (1995). Health management performance: A review of measures and indicators. Accounting, Auditing & Accountability Journal, 8(5): 34-70. DOI: 10.1108/09513579510103254
  32. Pollack C.E., Weissman G.E., Lemke K.W., Hussey P.S., Weiner J.P. (2013). Patient Sharing Among Physicians and Costs of Care: A Network Analytic Approach to Care Coordination Using Claims Data. Journal of General Internal Medicine, 28(3): 459-465.
  33. Scardi S., Humar F., Di Lenarda A. et al. (2007). Continuità assistenziale ospedale-territorio per il paziente con scompenso cardiaco cronico: una rivoluzione e una sfida nella cura ambulatoriale. Giornale Italiano di Cardiologia, 8(2): 83-91. --Testo disponibile al sito: http://www.giornaledicardiologia.it (14/08/2017).
  34. Scott L., Caress A.L. (2005). Shared governance and shared leadership: meeting the challenges of implementation. Journal of Nursing Management, 13(1): 4-12.
  35. Shortell S.M., Casalino L.P., Fisher E.S. (2010). How the center for medicare and medicaid innovation should test accountable care organizations. Health Affairs, 29: 1293-1298.
  36. Stukel T.A., Croxford R., Bierman A.S., Glazier R.H. (2016). Variations in Quality Indicators across Ontario Physician Networks. Institute for Clinical Evaluative Sciences. Toronto: Institute for Clinical Evaluative Sciences. -- Testo disponibile al sito: http://www.ices.on.ca (14/08/2017).
  37. Stukel T.A., Glazier R.H., Schultz S.E. et al. (2013). Multispecialty physician networks in Ontario. Open Medicine, 7: e40. PMCID: PMC3863751.
  38. Valentijn P.P. (2015). Rainbow of Chaos : A study into the Theory and Practice of Integrated Primary Care. International Journal of Integrated Care, 16(2): 1-4.
  39. Weeks W.B., Gottlieb D.J., Nyweide D.E. et al. (2010). Higher Health Care Quality And Bigger Savings Found At Large Multispecialty Medical Groups. Health Affairs, 29(6): 1275.
  40. World Health Organization (2014). Global status report on noncommunicable diseases 2014. -- Testo disponibile al sito: http://www.who.int (14/08/2017).
  41. American College of Cardiology Foundation, American Heart Association task force on practice guidelines (a cura di) (2013). 2013 ACCF/AHA Guideline for the Management of Heart Failure. A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Circulation, 128: e240-e327.
  42. American Heart Association’s Expert Panel on Disease Management (a cura di) (2004). Improving quality of care through disease management. Principles and recommendations from the American Heart Association’s expert panel on disease management. Circulation, 109: 2651-2654. DOI: 10.1161/01.CIR.0000128373.90851.7B
  43. Barnett M.L., Keating N.L., Christakis N.A., O’Malley A.J., Landon B.E. (2011). Reasons for choice of referral physician among primary care and specialist physicians. Journal of General Internal Medicine, 27(5): 506-512.
  44. Beaulieu M-D., Samson L., Rocher G., Rioux M., Boucher L., Del Grande C. (2009). Investigating the barriers teaching family physicians’ and specialists’ collaboration in the training environment: a qualitative study. BMC Medical Education, 9: 31. DOI: 10.1186/1472-6920-9-31
  45. Bevan G., Evans A., Nuti S. (2018). Reputations count: why benchmarking performance is improving health care across the world. Health Economics, Policy and Law, 16 Mar: 1-21.
  46. Braunwald E. (2015). The war against heart failure: the Lancet lecture. Lancet, 385: 812-24. DOI: 10.1016/S0140-6736(14)61889-4
  47. Brown P., Vainieri M., Bonini A., Nuti S., Calnan M. (2012). What might the English NHS learn about quality from Tuscany? Moving from financial and bureaucratic incentives towards “social” drivers. Social & Public Policy Review, 6(2): 30-46. -- Testo disponibile al sito: http://ssrn.com/abstract=2252676 (14/08/2017).
  48. Bynum J.P.W., Bernal-Delgado E., Gottlieb D., Fisher E. (2007). Assigning Ambulatory Patients and Their Physicians to Hospitals: A Method for Obtaining Population-Based Provider Performance Measurements. Health Services Research, 42: 45-62.
  49. Chin M.H., Goldman L. (1997). Factors contributing to the hospitalization of patients with congestive heart failure. American Journal of Public Health, 87: 643-8. DOI: 10.2105/AJPH.87.4.643
  50. Cho K.H., Desai A.S., Stevenson L.W. (2012). Rehospitalization for Heart Failure. Predict or Prevent? Circulation, 126: 501-506. DOI: 10.1161/CIRCULATIONAHA.112.125435
  51. Cowie M.R., Anker S.D, Cleland J.G.F. et al. (2014). Improving care for patients with acute heart failure: before, during and after hospitalization. ESC Heart Fail, 1: 110-145. -- Testo disponibile al sito: http://www.oxfordhealthpolicyforum.org/files/reports/ahf-report.pdf (14/08/2017).
  52. Diaz A., Ciocchini C., Esperatti M. et al. (2011). Precipitating factors leading to decompensation of chronic heart failure in the elderly patient in South-American community hospital. Journal of Geriatric Cardiology, 8: 12-4. DOI: 10.3724/SP.J.1263.2011.00012
  53. Van Dooren W., Van de Walle S. (2016). Performance information in the Public Sector – How it is used. Springer. DOI: 10.1007/978-1-137-10541-
  54. Driscoll A., Meagher S., Kennedy R. et al. (2016). What is the impact of systems of care for heart failure on patients diagnosed with heart failure: a systematic review. BMC cardiovascular disorders, 16(195): 1-20.
  55. Edmondstone J. (1998). Making shared governance work. Nursing Management, 5(3): 7-9.
  56. Ezekowitz J.A., van Walraven C., McAlister F.A., Armstrong P.W., Kaul P. (2005). Impact of specialist follow-up in outpatients with congestive heart failure. Canadian Medical Association Journal, 17: 189-94.
  57. Ferré F., de Belvis A.G., Valerio L. et al. (2014). Italy: Health system review. Health Systems in Transition, 16(4): 1-168. -- Testo disponibile al sito: http://www.euro.who.int/__data/assets/pdf_file/0003/263253/HiT-Italy.pdf (14/08/2017).
  58. Fisher E.S., Staiger D.O., Bynum J.P.W., Gottlieb D.J. (2007). Creating Accountable Care Organizations: The Extended Hospital Medical Staff. Health Affairs, 26: w44-w57.
  59. Francesconi A., Furnari A., Lecci F. (2016). I sistemi di programmazione e controllo nelle aziende sanitarie pubbliche italiane. L’impatto della crisi economica sulle loro caratteristiche e finalità. In: CERGAS Bocconi (a cura di). Rapporto OASI 2016 Osservatorio sulle Aziende e sul Sistema sanitario Italiano. Milano: Egea.
  60. Geoghegan J., Farrington A. (1995). Shared governance: developing a British model. British Journal of Nursing, 4(13): 780-783.
  61. Gonseth J., Guallar-Castillon P., Banegas J.R., Rodriguez-Artalejo F. (2004). The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports. European Heart Journal, 25: 1570-95.

  • Elementi di performance governance nei servizi sanitari: alcune evidenze empiriche sullo stato dell'arte nella sanità p Fabio De Matteis, in MECOSAN 121/2022 pp.7
    DOI: 10.3280/mesa2022-121oa13857
  • Enabling Collaborative Governance through Systems Modeling Methods Enzo Bivona, Guido Noto, pp.297 (ISBN:978-3-030-42969-0)

Francesca Casalini, Chiara Seghieri, Michele Emdin, Sabina Nuti, Nuovi strumenti di management per la gestione integrata dei percorsi assistenziali dei pazienti cronici in "MECOSAN" 102/2017, pp 35-59, DOI: 10.3280/MESA2017-102003