Institute of Medicine defined medical errors as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. In neonatal intensive care units and pediatric intensive care units the areas most frequently associated with medical errors are medication, including prescribing, preparation, administration and monitoring; health-care associated infections; mechanical ventilation; events related to the use of medical devices or procedures and, more recently, caregivers fatigue and communication strategies.
In Italy, Maternal-Neonatal Health is one of the national priorities, but there are still wide and deep differences among Regions. Despite most indicators attest the good performance of the National health care, a further area to be addressed is the perception of its quality by the people. The discrepancy between quality of care and its public perception is in fact reported in many industrialized countries. Accreditation programs can improve the availability and access to a standardized quality of care.
As far as accreditation of perinatal care is regarded, in the U. Joint Commission has defined a set of measures known as the perinatal care core measure set, which consider elective delivery, cesarean section, antenatal steroids, healthcare-associated bloodstream infections in newborns, exclusive breastmilk feeding. In Italy, the National Health Care Plan underline the need for developing and implementing certification programs for Hospital Birth Centers.
In , a multidisciplinary working group Italian Group for Safe Birth has thus been established. Health Care Organizations must reduce random variations and improve activities by a standardized process whose results can be measured both in terms of patients outcome and in terms of transparency of each activity. Newborn and infants are one of the weakest population group; to improve their health outcome is thus mandatory to do all efforts to obtain a safe, effective, efficient and patient-centered health care assistance.
A review of the different BFCI models worldwide was conducted. There is now one fully accredited Baby-Friendly Community in Italy, and 17 other communities are working on the various stages. A multivariate logistic regression was applied to estimate the adjusted odds ratio of an ED visit. The exposure was the type of paediatric practice that served the child: individual, network or group practice.
Various characteristics of the child were considered. In the , 43, ED visits occurred Multivariate logistic models showed lower ED use for group paediatrician patients OR 0. Our results highlight the necessity to continue to improve the organization of paediatrician primary practice, in order to increase patient access to primary paediatric care.
Avoidable hospitalizations for ACSC have been used to assess access, quality and performance of the primary care delivery system.
Preventable hospitalizations were significantly associated to age and sex since they were higher in older patients and in males. The proportion of patients who had a preventable hospitalization significantly increased with regard to the number of hospital admissions in the previous year and to the number of patients for each primary care physician PCP , with lower number of PCP accesses and PCP medical visits in the previous year, with less satisfaction about PCP health services, and, finally, with worse self-reported health status and shorter length of hospital stay.
METHODS: For each patient aged 16 years or younger, there were collected information on demographics and socioeconomic characteristics, medical history, route of referral, clinical complaints that they presented at the moment of their presentation at the ED, duration of presenting problems prior to arrival, hour of arrival, day of the week of arrival, and reason for attending the ED.
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Data about the consultation process and the final decision made were also recorded. Multiple logistic regression analysis showed that the visit was non-urgent in younger population, in females, and in those attending the ED on the weekend. The results of the second multivariable regression analysis model indicate that patients who did not receive medical or surgical examination at the ED, with problems of longer duration prior to arrival at the ED, with non-traumatic injuries, and who did not require inpatient hospital admission were more likely to use the ED as a source of non-urgent care.
The most frequent presenting problems for patient visits to ED were injury, respiratory diseases, and digestive symptoms. Italy has a national health service SSN that is moving toward decentralization and empowerment of local health enterprises LHEs -the arms of the regions for delivering health services. Drug policy and spending decisions are both influenced by central government and local authorities.
So far, the government concern has been predominantly on cost containment, and its approach in selecting drugs for reimbursement has been cost minimization. Italy has no centralized office for health technology assessment and this hinders the search for an efficient use of drugs.
One of the tools employed is local voluntary agreements between LHEs and general practitioners GPs that may be supported by economic incentives, in cash or in kind. Monitoring, moral suasion, and clinical guidelines are the main incentives for efficiency at local level, but focus on health outcomes is limited. The cost-containment mentality still prevails and the use of drug budget for purchasing better health is at its very early stage.
This paper deals with the issue of primary care in Italy, and intends to contribute to the discussion on the current critical issues as well as on how to reorganize it. The economical sustainability of health services is the most difficult challenge lying ahead for welfare systems, especially in Southern Europe countries. Among them, Italy presents an high degree of inconsistency and contradiction in how social protection expenditure is composed. In particular, in the health sector, the redistribution of resources between hospital assistance and primary care, favoring the latter, is the area where the most urgent work is needed.
The first paragraph introduces and synthetically deals with some macro-variables, defined as extra-sectorial, which are deemed to be relevant for the purpose of our work. Paragraph 3 and 5 offer an historical analysis of sectorial regulation, till the novelties introduce by the Balduzzi reform.
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Paragraph 4 deals with the peculiar legal framework of general medicine practitioners, trying to outline the related criticalities. Finally, paragraph 6, by capitalizing on some effective policy interventions on primary care promotion carried out in South Korea and Denmark, tries to outline some useful hints for Italy. The data hereby utilized principally refer to the last two years — a pretty stable time frame after the financial crisis — and are provided by eminent international as well as national institutions. However, in several national health systems, primary care is not directly managed by the regions but is in charge of smaller territorial entities.
We evaluated whether PQIs might be used to compare the performance of local providers such as Italian local health authorities LHAs and health districts. Potential predictors were investigated using multilevel modelling.
Composite PQIs were able to differentiate LHAs and health districts and showed small variation in the performance ranking over years. This paper analyses migrant access to health care through the Italian legal framework and the use of health care services.
In both analyses, an underlying gap and critical issues are demonstrated for migrants regarding their knowledge of the health care system as well as the accessibility and use of health services. In particular, immigrants have a lower hospitalisation rate than the native population. However, hospitalisation for some events i. The results suggest that the health care system is unable to ensure an equitable use of the same services between populations with identical needs horizontal equity or accessibility for specific conditions prevalent in the migrant population vertical equity.
In Italy, the immigrant population is growing and the differences in access to care are demonstrated. Consequently, it is necessary to rethink a possible model of integration and welfare for the migrant population, where access to the healthcare system is not only a desired result but also an opportunity for integration and inclusion. This paper enquires the health conditions of two groups of migrant considered to be more at risk due to their legal status — neither legal nor illegal.
These groups encompass diverse people — asylum seekers, refugees and unaccompanied minors.
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These categories considered are far from being representative of the actual spectrum of people at risk of social exclusion. However, the paper builds on the lack of literature on the matter at the Health and welfare section of the ISMU Foundation and to the relevance of the topic being within the EU public debate e. Each case study opens with an overview of the legal provisions and moves on to describing how the reception system works, with particular attention to healthcare services.
The analysis focuses on health not by simply looking at healthcare services, but rather by seeing it as strongly linked to other important elements such as nutrition, education and social security. In Italy health is enshrined as a fundamental rights by art. This applies to regular registered migrants including refugees , asylum seekers and undocumented migrants, and all irregular categories. Everyone has the right to receive emergency and essential healthcare, but also specific treatments if necessary.
Dependant family members regularly residing in Italy can also access healthcare services. Many actors are involved within these Plans, and among them, the involvement of the General Practitioner GP and of the Family Pediatrician is described. Aim: the purpose of the study is the systematic analysis of the 21 PRPs and PPPs to define the role assigned to primary care physician as either a direct issuer of planned interventions, or as part of the organizational-functional processes or in the advocacy process of the various actions described in the plans.
Methodology: the design of the study is descriptive and evaluative. The statistical unit considered was the Health Promotion or Prevention Program, each evaluated according to a set of variables shared with the Ministry of Health. Results: in the 21 PRPs and PPPs examined, programs have been identified that meet all the macro-objectives and health needs defined by the Ministry of Health. Primary care physicians are involved in a total of programs, mostly as part of the organisational-functional processes.
In programs, primary care physicians play the role of issuer; 88 of these take place in the healthcare facilities and 73 in the community; 58 programs aim to the adult group; the contrast to chronic illnesses comes up as the health need with the highest number of programs 37 out of The involvement of primary care physicians turns out to be different among the various Regions and Autonomous Provinces.
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It is evident that they are predominantly called into question in the struggle against chronic and infectious diseases. They are often involved in organizational-functional actions, but these are not always followed by actions on final targets. Their involvement could be increased in projects to be carried out on children, adolescents and for occupational health. A fornire queste cure sono professionisti sanitari e sociali per conto della Asl, su segnalazione del medico di famiglia.
Per fare questo, il progetto prevede sia una ricerca tramite consultazione di tutti i documenti ufficiali di Regioni e fonti secondarie, sia la diretta consultazione dei soggetti interessati , ovvero professionisti sanitari e pazienti. La maggior parte degli studi relativi alla copertura vaccinale riguarda aree geografiche ampie e generalmente non forniscono stime a livello locale.
Stime di coperture vaccinali e relativi intervalli di confidenza a livello di ASL e regionale, sono stati calcolati pesando, rispettivamente, per il numero dei nati nei Distretti e nelle ASL.