Valeria Domenica Tozzi

Adopting integrated care pathways in non-small-cell lung cancer: from theory to practice.

Introduction: Integrated care pathways (ICPs) have been proposed as effective strategies for quality improvement. To date, limited data are available that detail the methodology to design an optimal care pathway for patients with non–small-cell lung cancer (NSCLC). The main aim of this study was to assess the quality of health care delivered to lung cancer patients referred to a hub university hospital. Methods: All professionals involved with the management of NSCLC patients, in cooperation with health care researchers, identified 11 quality indicators and associated benchmarks. These were used to estimate the quality and efficiency of health care delivered to a cohort of 175 NSCLC patients. Results: The gap between “desired” and “actual” performance has been measured by benchmarking current practice against key quality indicators. Diagnostic workup, multidisciplinary team care and medical treatment of advanced disease have emerged as areas of good performance. Conversely, the management of early-stage disease offers room for improvement, in terms of both accuracy of nodal staging and surgical timeliness. Conclusions: Analyzing the process of caring for NSCLC patients is feasible and offers room for improvement. Acquired knowledge may be shared with hospital administrators, guide the revision of ICPs, and enable the delivery of consistent, high-quality clinical standards.

La presa in carico dei pazienti cronici in Lombardia: quale governance e quali indeterminatezze nel modello

Il sistema sanitario lombardo ha recentemente avviato una serie di interventi normativi volti a riordinare l’assetto istituzionale e organizzativo dei propri servizi sanitari e socio-sanitari e il proprio modello di presa in carico della cronicita. L’architettura finale del sistema risulta tuttavia indeterminata, dipendendo fortemente dal livello di adesione allo schema degli attori delle cure primarie, dal peso sistemico che assumeranno gli erogatori pubblici e privati e dall’evoluzione del processo di integrazione e coordinamento che li vedra coinvolti. Questo elaborato si pone l’obiettivo di analizzare nel dettaglio le indeterminatezze del modello di presa in carico lombardo, discutendo per ognuna di esse le principali criticita emergenti e proponendo delle proposte di policy che possano supportare i policy makers nell’implementazione di azioni correttive finalizzate a favorire l’evoluzione del modello verso una configurazione che risponda efficacemente ai bisogni della collettivita.

Managing cancer care through service delivery networks: The role of professional collaboration in two European cancer networks

Background The study examines two meso-strategic cancer networks, exploring to what extent collaboration can strengthen or hamper network effectiveness. Unlike macro-strategic networks, meso-strategic networks have no hierarchical governance structures nor are they institutionalised within healthcare services’ delivery systems. This study aims to analyse the models of professional cooperation and the tools developed for managing clinical practice within two meso-strategic, European cancer networks. Methods Multiple case study design based on the comparative analysis of two cancer networks: Iridium, in Antwerp, Belgium and the Institut Català d’Oncologia in Catalonia, Spain. The case studies applied mixed methods, with qualitative research based on semi-structured interviews (n = 35) together with case-site observation and material collection. Results The analysis identified four levels of collaborative intensity within medical specialties as well as in multidisciplinary settings, which became both platforms for crosscutting clinical work between hubs’ experts and local care teams and the levers for network-based tools development. The organisation of clinical practice relied on professional-based cooperative processes and tiers, lacking vertical integration mechanisms. Conclusions The intensity of professional linkages largely shaped the potential of meso-strategic cancer networks to influence clinical practice organisation. Conversely, the introduction of managerial techniques or network governance structures, without introducing vertical hierarchies, was found to be critical solutions.

The strategy role of transitional care units to support Integrated Care and Personalised pathways for frail persons

The paper presents a comparative analysis of three models of transitional care units that have been set up in Italy in the last three years within the processes of Regional Healthcare Services and healthcare organisations’ reforms. The comparative analysis is worth of providing interesting insights and generalizable lessons learnt from integrated care in practice. The three cases of transitional care units belong to a similar background wherein greater needs for care coordination across the supply chain have risen, but the implementation has brought to different organizational solutions to meet the contextual features. The common base-line scenario can be described by four fundamentals: 1) the merge and establishment of larger Local Health Authorities, serving a population of 1.2mln inhabitants on average; 2) the set-up of integrated care models between hospital care and primary care (as intermediate care, rehab., residential care, palliative care, home care or hospital at home); 3) the use of clinical governance tools and methods (as Integrated care pathways (ICPs), clinical networks), exploiting approaches deriving from the population health management (PHM); 4) the efforts to strengthen the integration between health and social care, foremost by using tools and targeted case management models for the most fragile persons. From this scenario, three different models of transitional care units rose, in Veneto Region, in Tuscany and in Lombardy, to build up integrated care by streamline ICPs across the supply chain of services and professionals within the newly established LHAs. The paper discusses comparatively the three cases of transitional care units. It analyses in depth three cases, one from each Region, based on different healthcare organization unit. The case study analysis allows to tackle out the organizational, professional and operational tools applied distinctively, based on the data collection of their initial activities and interviews with the key players. From the comparisons, lesson learnt can be drawn for generalization, detangling the contextual organizational features and service design’s needs (the path and resources dependency of each model) from more general observations and tips that could foster the sustainability and efficacy of similar services.