Managing the performance of general practitioners and specialists referral networks: A system for evaluating the heart failure pathway

Nuti, Sabina; Ferrè, Francesca; Seghieri, Chiara; Foresi, Elisa; Stukel, Thérèse A.

doi:10.1016/j.healthpol.2019.11.001

Cited by 6 publications

(9 citation statements)

References 28 publications

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“…To promote sustainability and better use of resources, several approaches should be considered, including evidence-based clinical pathways for diabetes care, encouraging healthcare workers working in different setting of care (e.g., primary care, hospital, public health), to be responsible and accountable for patients with diabetes they have in common [ 29 ] also with new governance and reimbursement models [ 30 ], engaging patients in shared decision-making, and considering patients’ goals and preferences [ 31 , 32 ]. In general, there is a need to improve the treatment value in the whole population, which requires adopting a population medicine approach [ 33 ].…”

Section: Conclusion and Discussionmentioning

confidence: 99%

Healthcare costs of diabetic foot disease in Italy: estimates for event and state costs

et al. 2022

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Objective This study aimed to estimate healthcare costs of diabetic foot disease (DFD) in a large population-based cohort of people with type-2 diabetes (T2D) in the Tuscany region (Italy). Data sources/study setting Administrative healthcare data of Tuscany region, with 2018 as the base year. Study design Retrospective study assessing a longitudinal cohort of patients with T2D. Data collection/extraction methods Using administrative healthcare data, DFD were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Methods We examined the annual healthcare costs of these clinical problems in patients with T2D between 2015 and 2018; moreover, we used a generalized linear model to estimate the total healthcare costs. Principal findings Between 2015 and 2018, patients with T2D experiencing DFD showed significantly higher average direct costs than patients with T2D without DFD (p < 0.0001). Among patients with T2D experiencing DFD, those who experienced complications either in 2015–2017 and in 2018 incurred the highest incremental costs (incremental cost of € 16,702) followed by those with complications in 2018 only (incremental cost of € 9,536) and from 2015 to 2017 (incremental cost of € 800). Conclusions DFD significantly increase healthcare utilization and costs among patients with TD2. Healthcare costs of DFD among patients with T2D are associated with the timing and frequency of DFD. These findings should increase awareness among policymakers regarding resource reallocation toward preventive strategies among patients with T2D.

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Section: Conclusion and Discussionmentioning

confidence: 99%

Healthcare costs of diabetic foot disease in Italy: estimates for event and state costs

et al. 2022

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“…The proposed integrated framework, as well as the study design can be exploited in the healthcare sector, beyond the specific sector-case here presented. In particular, the hybrid systems of cross-boundary collaborations appear to have great potentiality to be applied in complex cross-sectoral policies, such as those integrating social and healthcare services, but also in more simple collaborative settings where healthcare professionals are encouraged to work in networks (e.g., primary care networks) or multi-disciplinary physicians are informally working in network to provide care for patients along all phases of complex care pathways [91].…”

Section: Discussionmentioning

confidence: 99%

An Integrated Framework to Measure the Performance of Inter-Organizational Programme on Health Technology Assessment

2021

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Combining insights from collaborative governance, performance management, and health technology assessment (HTA) literature, this study develops an integrated framework to systematically measure and monitor the performance of HTA network programmes. This framework is validated throughout an action research carried out in the Italian HTA network programme for medical devices. We found that when building up collaborative performance management systems, some elements such as the participation in the design and the use of context specific performance assessment framework, facilitate their acceptance by managers and policy makers especially in high professionalized and sector-specific organizations because it reflects their distinctive language and culture. The hybrid framework may help health authorities and policymakers to understand the HTA network, monitor its performance, and ensure network sustainability over time.

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“…Care pathways entail multi‐professional and multi‐disciplinary collaboration. Collaboration is often created informally through referral networks, 25 , 26 or managed through virtual organisations (e.g., clinical networks) based on the sharing of clinical management tools such as clinical guidelines and pathways.…”

Section: Introduction: Performance Management and The Role Of Patientsmentioning

confidence: 99%

“…Traditionally, PMSs were designed to account for a single organisation (‘silos vision’) for which only results within a specific area were reported and acted upon instead of focussing on the creation of value across the whole system and for the entire population. 7 , 26 Putting the people's voices at the core of PMSs has also the potential of assessing the collective achievements and interconnections occurring between the different parts of the care pathway. In fact, patients move between care levels and settings, and can therefore provide feedback regarding the different services and professionals encountered.…”

Section: Introduction: Performance Management and The Role Of Patientsmentioning

confidence: 99%

Including patient‐reported measures in performance evaluation systems: Patient contribution in assessing and improving the healthcare systems

Rosis

Ferrè

Pennucci

2022

Health Planning & Management

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In healthcare, the introduction of quality standards and indicators to assess performance triggered the development of multidimensional Performance Management Systems (PMSs). The concept of performance in healthcare has recently evolved and broadened its scope. One of the current challenges of PMSs is measuring and integrating the patient perspective into traditional measures. In the regional healthcare system of Tuscany (Italy), a PMS has been implemented and used since 2005. The PMS counts on the systematic involvement of clinicians and managers. Furthermore, the PMS also includes patients' perspective. Moreover, Tuscany has recently implemented the first regional permanent Patient‐Reported Outcome and Experience Measures (PROMs and PREMs) Observatory in Italy. This paper presents the results of an action research aimed at analysing the integration of patient‐reported outcome and experience indicators into a consolidated PMS. The study describes the process of identifying and discussing of patient‐reported indicators with practitioners and categorising findings into three domains: design of patient‐reported indicators, integration process into the PMS, and goal of adoption of the patient‐related indicators. The paper also describes facilitators, challenges, and lessons learnt with respect to organisational, methodological, cultural, and responsibility‐linked factors. The study discusses the ability to agree on how to transform patient data, especially PROMs, into effective performance indicators. The integration of patient‐reported indicators into the PMS poses two main challenges: one in terms of sustainability of the performance system itself, and another regarding the attribution of the responsibility for patient outcomes between care settings and providers. This paper provides initial insights on how the integration of patient‐reported indicators can make PMSs more inclusive and focussed on the patient‐centred perspective.

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Managing the performance of general practitioners and specialists referral networks: A system for evaluating the heart failure pathway

Cited by 6 publications

References 28 publications

Healthcare costs of diabetic foot disease in Italy: estimates for event and state costs

Healthcare costs of diabetic foot disease in Italy: estimates for event and state costs

An Integrated Framework to Measure the Performance of Inter-Organizational Programme on Health Technology Assessment

Including patient‐reported measures in performance evaluation systems: Patient contribution in assessing and improving the healthcare systems

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