Leader: Cristina Ugolini (UNIBO); Other collaborator(s): UNIBO, AUSL DELLA ROMAGNA
To achieve hospital and territorial care integration, this task studies the impact of the de-hospitalization process based on integrated networks of intermediate care centers - at the center of the PNNR and whose standards are set by the Decree 77/2022 - and its implications for the organization of hospital care. Using patient data from administrative sources and collecting information on the infrastructural and human capital endowment of intermediate care centers, we assess whether such organisational process can improve efficiency and health outcomes and the impact produced on the first-level hospitals that would be affected by these organisational solutions. The econometric analysis will help to identify the areas of improvements.
From November 2023 to March 2024, several meetings were organized with members of the Bologna unit and the Romagna LHA to develop various dimensions of the project in detail.
Regarding the policy evaluation of supply-side interventions, Task 5 has focused on assessing the impact—both in terms of guideline adherence and health outcomes—of a key organizational innovation aimed at managing an aging and multimorbid population: the introduction of Family and Community Nurses (IFeCs) in selected areas within the Romagna LHA. In collaboration with the LHA personnel, the Bologna unit worked to define an empirical strategy and analytical framework for this evaluation.
- Based on this strategy the first part of a descriptive report is expected by the end of 2024. Meanwhile, a detailed analysis of the new organizational settings introduced by DM 77/22 was conducted in collaboration with Marta Giachello of Spoke 10, resulting in a working paper that will be published in Rivista di Politica Economica.
- A survey on the multidimensional evaluation of care quality in territorial care was conducted, which helped reflect on the evaluation processes in place and the indicators currently used to measure the quality of local care. It also explored how the collection of available information could be improved through the development of new indicators. Following this analysis, Deliverable 1 included Travaglini's contribution, which focused on reviewing methods for measuring and evaluating home care. The aim was to move beyond analyses based on non-representative averages to identify more meaningful aggregates of care episodes and enable their organizational and informational integration with other care settings. The goal is to achieve full integration between home care and other levels of care that interact with the patient's health, facilitating an adequate economic and clinical evaluation of the care provided throughout the patient's treatment journey.
- A study was started to examine the impact of emergency room (ER) overcrowding on general emergency surgical interventions for the population aged 65 and over, which will be the focus of the next few months of research. This study contributes to the literature on the relationship between waiting times and health outcomes by developing a novel instrument to address the endogeneity of ER waiting times, based on the link between ER admissions and surgical procedures. This identification strategy allows for establishing a causal relationship between treatment delays and patient outcomes for time-sensitive conditions.
- Held meetings with the Romagna LHA to define a study aimed at investigating the first-year implementation of ten Family Nurses (IFeC) in the Romagna LHA.
- Completed the analysis of the new organizational settings introduced by DM 77/22 conducted in collaboration with Marta Giachello of Spoke 10, resulting in an article published in Rivista di Politica Economica.
- Analyzed the impact of the first year (2023) of the introduction of IFeC in Romagna, and began drafting a report due by the end of the year.
- Participated in the AGE-IT General Meeting in Venice, held from May 20th to 22nd, 2024.
- Completed the survey on quality indicators for evaluating territorial care, which will serve as the foundation for Deliverable 2: a policy brief with recommendations for care provision at the national and regional levels.
- Preliminary draft titled "Death by waiting? Treatment delays, emergency department congestion, and patients' outcomes" authored by Lippi Bruni M., Mazza J., Ugolini C., and Verzulli R. The findings have important policy implications for the design and organization of emergency care within a highly regulated public National Health Service (NHS) system, offering new insights into the consequences of ER congestion for the elderly.
- Presented the work titled "Death by waiting? Treatment delays, emergency department congestion, and patients' outcomes," authored by Lippi Bruni M., Mazza J., Ugolini C., and Verzulli R., at the European Health Economics Association (EUHEA) conference. The program is available at this link.
- Drafted the policy brief with recommendations for care provision at the national and regional levels, due as Deliverable 2.
- Completed the first draft of the initial three sections of the report "Family and Community Nurses in the LHA of Romagna, Year 2023," and held meetings with Romagna LHA staff to define the content for the fourth section.
- Preparing the first draft of the study examining the impact of emergency room (ER) overcrowding on general emergency surgical interventions for individuals aged 65 and over, "Death by waiting? Treatment delays, emergency department congestion, and patients' outcomes," authored by Lippi Bruni M., Mazza J., Ugolini C., and Verzulli R.
- Completed the final draft of the report "Family and Community Nurses in the LHA of Romagna, Year 2023" (in Italian), preparing the data base for the econometrics analysis.
- The survey on the multidimensional evaluation of care quality in territorial care was conducted, with its conclusions forming the basis of Deliverable 2, , was submitted to Politiche sanitarie (in Italian).
- Presentation at the EUHA conference, June 30th - July 3rd, 2024: "Death by waiting? Treatment delays, emergency department congestion, and patients' outcomes," authored by Lippi Bruni M., Mazza J., Ugolini C., and Verzulli R.
- Article published in Rivista di Politica Economica: “La Medicina di Famiglia nel Riassetto dell’Assistenza Territoriale,” by Marta Giachello and Cristina Ugolini, 2024, 1, pp. 67–90. Available at: https://www.confindustria.it/home/centro-studi/rivista-di-politica-economica/dettaglio?doc=RPE_la_salute_dei_sistemi_sanitari_2024_1