La riorganizzazione delle prestazioni sanitarie in ottica di appropriatezza: l’esperienza dell’AOU "San Giovanni di Dio e Ruggi d’Aragona" nella gestione del DRG 127 - Insufficienza cardiaca e shock

Journal title MECOSAN
Author/s Lucia Soriente, Silvio Cigolari, Alberto Gigantino, Chiara Aliberti, Pasquale Ardovino, Paola Adinolfi, Rocco Palumbo
Publishing Year 2021 Issue 2020/115
Language Italian Pages 22 P. 7-28 File size 465 KB
DOI 10.3280/MESA2020-115002
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The article proposes a care path intended to improve the standards of specialist care in the field of heart failure, in compliance with the criteria of effectiveness, efficiency and equity on which the Italian National Health Service (INHS) relies. A case study approach was undertaken. The attention was focused on the experience of the University Hospital "San Giovanni di Dio e Ruggi d’Aragona" located in Salerno, Southern Italy. In particular, data were collected from with the collaboration of the "Hospital Discharge Form" office. Examining a set of indicators - such as the average hospitalization and percentage of hospitalizations - about the Diagnosis-Related Group no. 127 "Heart failure and intensive cardiology shock" in the financial year 2017, we untangled the criticalities of the existing process and, adopting the Business Process Improvement (BPI) methodology, we proposed a process redesign. Technology, asset management, care paths, training, and monitoring were identified as the primary levers to enhance the standards of specialist care in the field of heart failure.

Keywords: Quality, heart failure, process improvement, BPI, organizational change.

  1. Adinolfi P., Matonti G., Piscopo G., Annarumma C., Palumbo R. (2018). I costi della sicurezza e della non sicurezza in sanità: un’analisi esplorativa. Mecosan, 103: 9-30.
  2. Adinolfi P., Starace F., Palumbo R. (2016). Health Outcomes and Patient Empowerment The Case of Health Budgets in Italy. Journal of Health Management, 18(1): 117-133.
  3. Agenas (2018). Programma Nazionale Esiti. Roma: Agenzia Nazionale per i Servizi Sanitari Regionali.
  4. Ahmed E., Ahmad M., Othman S. (2019). Business process improvement methods in healthcare: a comparative study. International Journal of Health Care Quality Assurance, 32(5): 887-908.
  5. AOU “San Giovanni di Dio e Ruggi d’Aragona” (2016). Piano di Organizzazione e Funzionamento Aziendale (POFA). Salerno: Direzione Generale.
  6. Bianciardi C., Guercini J. (2019). Lean Management: innovazioni organizzative nei Day Hospital ematologici. About Open, 5(1): 62-69.
  7. Bleakley A. (2013). The dislocation of medical dominance: making space for interprofessional care. Journal of Interprofessional Care, 17(2): 24-30.
  8. Borgonovi E. (1996). Principi e sistemi aziendali per le pubbliche amministrazioni. Milano: Egea.
  9. Brock D., Powell M.J., Hinings C.R. (1999). Restructuring the Professional Organization: Accounting, Health Care and Law. London: Routledge.
  10. Cacciatore G., Di Lenarda A. (2006). IN-CHF: il registro italiano dello scompenso cardiaco. Dieci anni di esperienza. Giornale Italiano di Cardiologia, 7: 689-694.
  11. Cook C., Cole G., Asaria P., Jabbour R., Francis D.P. (2014). The annual global economic burden of heart failure. International Journal of Cardiology, 171(3): 368-376.
  12. Delgado J.F., Oliva J., Llano M.P.-F., Grillof J.J., Comín-Coletg J., Díazh B., ... Peña L.M. (2014). Health care and non-health care costs in the treatment of patients with symptomatic chronic heart failure in Spain. Revista Espanola de Cardiologia, 67(8): 643-650.
  13. D’Ambrosio G., Filippi A., Battaggia A., De Maria R., Cricelli C. (2014). I pazienti con scompenso cardiaco nell’ultimo anno di vita: il punto di vista della Medicina Generale. Giornale Italiano di Cardiologia, 15(10): 569-576.
  14. European Society of Cardiology (2019). ESC Clinical Practice Guidelines. Brussels: ESC.
  15. Fang J.C., Ewald G.A., Allen L.A., Butler J., Westlake Canary C.A., Colvin-Adams M., ... Teerlink J.R. (2015). Advanced (stage D) heart failure: a statement from the Heart Failure Society of America Guidelines Committee. Journal of Cardiac Failure, 21(6): 519-534.
  16. Fonarow G.C., Abraham W.T., Albert N.M., Gattis W.A., Gheorghiade M., Greenberg B., ... Young J. (2004). Organized program to initiate lifesaving treatment in hospitalized patients with heart failure (OPTIMIZE-HF): rationale and design. American Heart Journal, 148(1): 43-51.
  17. Francis S.D., Alley P.G. (1996). A “patient focus review” of surgical services Business process re-engineering in health care. Business Process Reengineering and Management Journal, 2(1): 48-62.
  18. Hammer M. (1990). Reengineering work: don’t automate, obliterate. Harvard Business Review, 4: 104-112.
  19. Harrington H.J. (1991). Business Process Improvement The Breakthrough Strategy for Total Quality, Productivity, and Competitiveness. New York: McGraw-Hill.
  20. Kasparian N., Pidcock M., McElduff M., Macintosh-Evans P., Sholler G. (2019). Engaging hearts and minds: An in-depth qualitative examination of health professionals’perceptions of, and experiences with, an integrated, hospital-based mental health service dedicated to childhood heart disease. International Journal of Integrated Care, 19(1): 1-2.
  21. Kaul P., McAlister F.A., Ezekowitz J.A., Bakal J.A., Curtis L.H., Quan H., ... Armstrong P.W. (2011). Resource use in the last 6 months of life among patients with heart failure in Canada. Archives of Internal Medicine, 171(3): 211-217.
  22. Kelleher D., Gabe J., Williams G. (2006). Challenging Medicine. Abingdon: Sage.
  23. Lega F. (2012). Oltre i pregiudizi e le mode: natura e sostanza dell’innovazione organizzativa dell’ospedale. In: Anessi Pessina E., Cantù E. (a cura di). Rapporto OASI 2012, 503-522. Milano: Egea.
  24. Maggioni A., Spandonaro F. (2014). Lo scompenso cardiaco acuto in Italia. Giornale Italiano di Cardiologia, 15(2): 3-4.
  25. Manuli A., Maggio M.G., De Cola M., Tripoli D., De Luca R., Calabrò R.S. (2019). Towards improving primary care: Considerations on a Sicilian population-based survey. Journal of Family Medicine and Primary Care, 8(11): 3647-3652.
  26. McMurray J.J., Adamopoulos S., Anker S.D., Auricchio A., Böhm M., Dickstein K., ... Popescu B.A. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. European Heart Journal, 33(14): 1787-1847.
  27. McNulty T., Ferlie E. (2002). Reengineering Health Care: The Complexities of Organizational Transformation. Oxford: Oxford University Press.
  28. Ministero della Salute (2018). Rapporto Annuale sull’attività di ricovero ospedaliero. Dati SDO 2017. Roma: Direzione Generale della Programmazione Sanitaria.
  29. Mortara A. (2016). Scompenso cardiaco cronico dalle finalità terapeutiche alla rete. Monza: Anmco.
  30. National Institute for Cardiovascular Outcomes Research (2015). National Heart Failure Audit – April 2013 – March 2014. London: British Society for Heart Failure.
  31. Norton C., Georgiopoulou V.V., Kalogeropoulos A.P., Butler J. (2011). Epidemiology and cost of advanced heart failure. Progress in Cardiovascular Diseases, 54(2): 78-85.
  32. Palumbo R. (2013). New health governance: nuovi approcci nella pianificazione nazionale italiana. In: Adinolfi P., Cafferata R., Tommasetti A., Management senza Confini – Gli studi di management: tradizione e paradigmi emergenti, 239-248. Bologna: il Mulino.
  33. Palumbo R. (2015). Comprensione vs ipertensione: gli impatti dell’alfabetizzazione sanitaria sulla gestione dell’ipertensione arteriosa. Mecosan, 95: 81-107.
  34. Palumbo R. (2016). Contextualizing co-production of health care: a systematic literature review. Int J Pub Sec Manage, 29(1): 72-90.
  35. Palumbo R., Cosimato S., Tommasetti A. (2017). Dream or reality? A recipe for sustainable and innovative health care ecosystems. TQM journal, 29(6): 847-862.
  36. Perrone V., Sangiorgi D., Degli Esposti L., Modugno G., Dambtosio G., Diaferia G.D., ... Buda S. (2019). Lo scompenso cardiaco nella ASL Barletta-Andria-Trani (BT): analisi dei trattamenti farmacologici, del consumo di risorse e relativo costo per il Servizio Sanitario Nazionale. Recenti Progressi in Medicina, 110(1): 23-32.
  37. Radnor Z. (2011). Implementing Lean in Health Care: Making the link between the approach, readiness and sustainability. International Journal of Industrial Engineering and Management, 2(1): 1-12.
  38. Rebuge Á., Ferreira D.R. (2012). Business process analysis in healthcare environments: A methodology based on process mining. Information Systems, 37(2): 99-116.
  39. Rengo F., Leosco D., Iacovoni A., Rengo G., Golino L., Borgia F., ... Senni M. (2004). Epidemiologia clinica e fattori di rischio per scompenso cardiaco nell’anziano. Italian Heart Journal, 5(10): 9-16.
  40. Rognoni C., Gerzeli S. (2019). Ferric carboxymaltose for patients with heart failure and iron deficiency in Italy: cost-effectiveness and budget impact. Journal of Comparative Effectiveness Research, 8(13): 1099-1110.
  41. Tavazzi L., Senni M., Metra M., Gorini M., Cacciatore G., Chinaglia A., ... Maggioni A.P. (2013). Multicenter Prospective Observational Study on Acute and Chronic Heart Failure. One-Year Follow-up Results of IN-HF (Italian Network on Heart Failure) Outcome Registry. Circulation: Heart Failure, 6(3): 473-481.
  42. Vanwersch R.J., Shahzad K., Vanderfeesten I., Vanhaecht K., Grefen P., Pintelon L., ... Reijers H.A. (2016). A Critical Evaluation and Framework of Business Process Improvement Methods. Business & Information Systems Engineering, 58: 43-53.
  43. Williams S.J., Caley L. (2020). Quality Improvement in Healthcare: Where Are We Now and Where Next?. In: Williams S.J., Caley L., Improving Healthcare Services, 15-24. Cham: Palgrave Pivot.
  44. Zairi M., Sinclair D. (1995). Business process re‐engineering and process management: A survey of current practice and future trends in integrated management. Business Process Re-engineering & Management Journal, 1(1): 8-30.

Lucia Soriente, Silvio Cigolari, Alberto Gigantino, Chiara Aliberti, Pasquale Ardovino, Paola Adinolfi, Rocco Palumbo, La riorganizzazione delle prestazioni sanitarie in ottica di appropriatezza: l’esperienza dell’AOU "San Giovanni di Dio e Ruggi d’Aragona" nella gestione del DRG 127 - Insufficienza cardiaca e shock in "MECOSAN" 115/2020, pp 7-28, DOI: 10.3280/MESA2020-115002