Setting di cure intermedie: introduzione di un modello organizzativo innovativo e gestionale nell’ASLTO3
Davide Minniti, Stefano Passi, Flavio Boraso, Roberto Galassi, Mauro Occhi
Introduction The current scenario requires a necessary modulation of the setting of care in order to optimize costs and economic resources. Despite the actions already carried out, such as the creation of non hospital beds known as CAVS, the analysis of the healthcare processes did not show the expected results (economic and clinical outcomes).
The purpose of the present study is to develop a new model of transitional healthcare based on home care, modular assistance, public-private management.
Materials and Methods An evaluation of the sample has been conducted (period of study December 2017 to June 2017). Concerning the methodology, the planning of the new model of health care has been developed in five steps:
1) analysis of performance of the current model in Local Health Unit of Turin 3 (ASLTO3);
2) selection of the health outcomes for the new model;
3) review of the scientific literature;
4) development of the new model;
5) selection of indicators (process, clinical, economic, satisfaction).
Results During the pilot study seventeen patients have been discharged from the Susa Hospital (ASLTO3), nine of them from Medical department, five patients from Surgical department and three patients were also discharged from the Emergency room. The hospital length of stay (average) was 28.4 days and the time between clinical evaluation and admission to the new model was 2.6 days. The highest score of assistance scales (>15) was reached in 82% of the patients admitted (T0), while 47% of the sample had a middle score of clinical scales. During the period of the new model (maximum 30 days per patient) the assistance and clinical scores improved in only 24% and 20% of the patients, respectively. During the study, only two patients were readmitted to the hospital because of the deterioration of their clinical status. The average health expenditure was € 95 per patient/die and the total pharmaceutical expenditure was € 1,465.27. Customer satisfaction was collected through a questionnaire and in 90% of the patients this new model of healthcare has been evaluated positively.
Conclusions This study describes an example of transitional healthcare with innovatory solutions such as home care, modular assistance and public-private management and it could be a model to replicate by other Local Health Units.
Key words: setting of care, home care, modular assistance, public-private management, clinical and economic outcomes