B. Bini

Bridging the Gap between Theory and Practice in Integrated Care: The Case of the Diabetic Foot Pathway in Tuscany

Introduction and Background: As diabetic foot (DF) care benefits from integration, monitoring geographic variations in lower limb Major Amputation rate enables to highlight potential lack of Integrated Care. In Tuscany (Italy), these DF outcomes were good on average but they varied within the region. In order to stimulate an improvement process towards integration, the project aimed to shift health professionals’ focus on the geographic variation issue, promote the Population Medicine approach, and engage professionals in a community of practice. Method: Three strategies were thus carried out: the use of a transparent performance evaluation system based on benchmarking; the use of patient stories and benchmarking analyses on outcomes, service utilization and costs that cross-checked delivery- and population-based perspectives; the establishment of a stable community of professionals to discuss data and practices. Results: The project enabled professionals to shift their focus on geographic variation and to a joint accountability on outcomes and costs for the entire patient pathways. Organizational best practices and gaps in integration were identified and improvement actions towards Integrated Care were implemented. Conclusion and Discussion: For the specific category of care pathways whose geographic variation is related to a lack of Integrated Care, a comprehensive strategy to improve outcomes and reduce equity gaps by diffusing integration should be carried out.

Definizione delle priorità di intervento in sanità: approcci socio-tecnici a confronto

La maggiore responsabilizzazione degli enti locali e i crescenti limiti di budget hanno determinato in ambito sanitario un maggiore interesse per l’applicazione di approcci socio-tecnici, come il PBMA e lo STAR per la definizione delle priorita d’intervento. In questo articolo si confrontano le tecniche utilizzate e il processo decisionale (fasi, attori coinvolti e durata del processo) di questi approcci, tramite l’utilizzo di esempi di applicazione in diverse realta nazionali e internazionali (Canada, UK e Toscana). Tale analisi fornisce indicazioni utili per strutturare nel contesto sanitario italiano processi di allocazione delle risorse e diffusione di strategie piu appropriati ed efficaci, tramite una maggiore collaborazione tra decisori, professionisti e manager.