programs organizational models facilities, expenditure, activity

Facts and fi gures of the Regional Health Service of Emilia-Romagna (2007)

SSSRE-R_2008_INGLESE9.inddSRE-R_2008_INGLESE9.indd 1 222-05-20092-05-2009 17:37:1017:37:10 2 THE EMILIA-ROMAGNA REGIONAL HEALTH SERVICE

SSSRE-R_2008_INGLESE9.inddSRE-R_2008_INGLESE9.indd 2 222-05-20092-05-2009 17:37:2017:37:20 THE EMILIA-ROMAGNA REGIONAL HEALTH SERVICE 3

The Social and Healthcare Plan 2008-2010 of Emilia-Romagna Region 4-5-6-7 The Emilia-Romagna Regional Health Service: Results and commitments 8-9

Facilities, expenditure, activity Health Trusts, population, employees, general practice physicians and paediatricians 10-11 Population 12-13-14 Expenditure trend: comparison with the other Italian Regions 15 Health Trusts’ Social accountability report 16 Expenditure by functions and levels of health care for resident citizens, per capita expenditure 17 Health care and social services: projects for new facilities and for modernizing existing facilities 18-19 Hospital care: hospital beds, admissions and waiting lists for planned surgery 20-21 Beds in facilities for elderly, people with disabilities, mental health problems, addictions 22 Hospice care 23 Services for senile dementias 24 Home care 25 Care allowances 26 Outpatient specialist care 27-28 Pharmaceutical expenditure 29 Mental Health Services 30 Substance Abuse Services 31 Care in Family advisory health centres, Youth health centres, Health centres for immigrant women and their children 32 Donations and transplants of organs, tissues and cells 33-34 Blood collection and consumption 35 Screening programs for prevention and early diagnosis of breast, cervical and colorectal cancer 36-37 Infl uenza vaccination 38 Childhood vaccinations 39 Occupational health and safety 40 Occupational safety in major projects: the Bologna railway junction 42 Food safety 43-44 Programs Research and Innovation Programs 45 Programs for prevention, surveillance and risk management in healthcare 46 Plan to reduce waiting lists for outpatient specialist care and planned hospital admissions 47 Program for the regional Fund for non self-suffi cient people 48 Education and training in the Regional Health Service 49 Program for the odontological, prosthetic and orthesic care 50 The Human Papilloma Virus (HPV) vaccination 51 Care program for people with autism spectrum disorders 52 Regional Plan against Asian tiger mosquito and for prevention of Chikungunya and Dengue diseases 53 Birth path 54

Organizational models Guidelines for editing the Health Trust’s Deed 55 Authorization and accreditation of healthcare, social-health and social services 56 The Social accountability report 57 Organization of the Health District 58-59 Agreement with general practice physicians 60 Hub & spoke model for hospital care 61 Hub & spoke networks for severe disabilities 62 Hub & spoke networks for diagnosis and care of rare diseases 63 The “Stroke care” network, integrated care for stroke patients 64 The reorganization of Emergency Rooms 65 Agreement between Region and private hospitals 66 Regional Observatory for Innovations in Healthcare 67 Goods and services purchase: agreements with Intercent-ER 67 Sole Project (online healthcare) 68 Public Trusts for Personal Services 69 Information on services: toll free number 70

SSSRE-R_2008_INGLESE9.inddSRE-R_2008_INGLESE9.indd 3 222-05-20092-05-2009 17:37:2017:37:20 4 THE SOCIAL AND HEALTHCARE PLAN 2008-2010 OF EMILIA-ROMAGNA REGION

The Social and Healthcare Plan 2008-2010 of Emilia-Romagna Region

The fi rst Social and Healthcare Plan of Emilia-Romagna Region was approved by the Legislative Assembly on May 22nd 2008 (regional law n. 175). It was developed through the joint effort of the regional authorities in charge for healthcare policies and social policies; it underwent the control of the so-called Control room for welfare (the seat devoted to promoting interaction between the regional government and local administrators); it was discussed and shared with all the components of the regional society and with the institutional representatives during some initiatives organized all over the region. Vasco Errani, President of the Emilia-Romagna Region, wrote in his presentation of the Plan: ”We acknowledge the need of a new project giving us the opportunity to reassemble what modern society tends to split; a project that will recreate the social cohesion that the community is no more able to spontaneously reproduce; a project that will reassure people who are facing a widespread feeling of uncertainty at both economical and cultural level due to the pressing changes in social life. These are the reasons that urged us to propose a “deal” to the regional society, aimed at assuring high quality services, supporting families, reinforcing trust and safety”. During the Plan approval by the Legislative Assembly, Giovanni Bissoni, regional Minister for Healthcare Policies, commented as follows: “It is the fi rst Plan elaborated through a shared planning with social forces and local administrations: starting from a new reading of people’s and communities’ needs, it proposes a substantial innovation of policies and services, based on the integration of all the institutions and individuals involved in the welfare development: Region, Local Authorities, Non governmental organizations”. In the same occasion Annamaria Dapporto, regional Minister for Social Policies, added: “The Plan is an important result for the whole regional welfare system; now local institutions are entitled to transform the planning in concrete interventions and services for citizens”. Year 2008 is the running-in period for the Plan implementation, particularly with reference to governance mechanisms to be started in order to guarantee the real integration of policies, services and health professionals. Specifi c guidelines will be approved to assure that the different planning paths will be based on common elements and that NGOs will be involved at all planning levels. General lines for policies development will be stated in the “Act for policies defi nition” elaborated by in Territorial Social and Healthcare Conference (organism composed by all the mayors of the Municipalities in the area corresponding to a single Local Health Trust, usually a province; the Conference plays a central role in promoting and evaluating social and health policies and programs). The Health District Plan for healthcare and social welfare worked out by the District Committee will adopt the strategic choices stated in the 2009-2011 Plan and in the fi rst 2009 Implementation Plan. Preliminarily, Territorial Conferences will be entitled to elaborate and share the “Community outline”, fundamental tool for the identifi cation and acknowledgment of population’s need for health and welfare and for the detection of priorities and criticisms. The organizational network to support Territorial Conferences will be completed in order to make the planning process and its implementation and monitoring effective.

Synthesis of the Social and Healthcare Plan for sectional answers (i.e. to illness or hard life conditions) A new community welfare for a changing society but for organic solutions that should consider individuals The Social and Healthcare Plan 2008-2010 aims to in their entirety and guarantee continuity of care. complete an integrated system of social and healthcare The aim is to develop a solidarity society, able to ensure services able to provide a new welfare system that fair access to rights and to consolidate the social cohesion is universalistic, fair and rooted in local communities that has always characterized the regional community and and in the region. The process began with the Regional is an important growth and competitiveness factor. Laws no. 2/2003 (Outline law for social services) and The Plan is not simply a juxtaposition of planning lines; no. 29/2004 (Law for the re-organization of the Regional it represents a perspective transformation and the Health Service). acknowledgment of the need to jointly consider healthcare The need for substantial changes is due to the occurring and social issues so that welfare becomes a positive and demographic and socio-economic transformations – ageing substantial part of the ongoing transformation. population, increasing immigration phenomenon, reduction of the number of family members and concurrent increase Integration: a new welfare need of families with slender relatives network, rising number The aim to guarantee personalized answers and fair of people with temporary work and conflict among access throughout the territory is feasible only through generations on future and job opportunities. The more and an integration logic at all levels. This integration logic more complex needs of the “changing society” do not ask allows the development of a welfare network formed

SSSRE-R_2008_INGLESE9.inddSRE-R_2008_INGLESE9.indd 4 222-05-20092-05-2009 17:37:2017:37:20 THE SOCIAL AND HEALTHCARE PLAN 2008-2010 OF EMILIA-ROMAGNA REGION 5

by different services and, at the same time, it gives the Tools for integrated planning opportunity to involve - enhancing their autonomy - all The Plan has unifi ed and synthesized the planning tools the subjects (Region, Local Authorities, Health Trusts, Non tested in the last years: Health Plans, Area Plans, Territorial governmental organizations, profi t private organizations, Action Programs, Action Plan for the Elderly, Integration social forces) that in various ways are called to play a Program for Immigrants. role in affi rming citizens’ rights, thus giving a fundamental Integration is set up at regional, provincial and district contribution to the development of a more coherent, civil level through the involvement of all subjects in the and dynamic society. welfare system, according to their specifi c competence For this reason the Plan focuses on integration (Region, Local Authorities, public institutions, non-profi t development in planning, assessment, organization and and profi t private organizations, associations, volunteers, supply of social, healthcare and social-health services, social forces). defi ning roles and responsibilities of the institutions The allocation program for the Regional Social Fund and for involved. the Fund for non self-suffi cient people, the Regional Plan for Prevention and the planning guidelines of the Health Integration among institutions, services, Service are defi ned every year at regional level. health professionals Territorial Conferences are entitled to elaborate and share The institutional structure that the Region and Local the “Community Outline”, a structured and participated Authorities created to organize the governance of the reading of population’s need for health and welfare that public system of regional and local welfare is founded on allows to identify criticisms, priorities and the strategic two basic principles: the Region’s role in the governance choices that are described in the “Three-year Intervention of the Health Service and the Local Authorities’ role in Policies Act”. the governance of social services, both working in a The District Committee (together with the District Director cooperation and integration logic. for the social-health integration interventions) will approve The means by which the integration is developed are: - in coherence with the Intervention Policies Act - the • the Territorial Social and Healthcare Conference and three-year District Area Plan for health and social welfare, the District Committee (organisms connecting Local that is articulated in annual implementation programs. Authorities and Health Trusts for the local governance of healthcare and social-health functions and services); The regional Fund for non self-suffi cient people • associative forms among Local Authorities (for the In Emilia-Romagna region people aged over 65 are 968,208 governance and provision of social services); (at December 31st, 2007), nearly a quarter of the total • management agreements between Municipalities and regional population. A particular attention must be paid Local Health Trusts (to create the new “Plan Offi ces”, to population aged over 80 (291,829 people), in which the the technical administrative network supporting service incidence of the most important problems related to non planning and supply in the District area); self-suffi ciency and care needs is higher. • and the “Control room for welfare”, the regional seat Nevertheless, the Fund for non self-suffi ciency does devoted to the identifi cation and setting up of social not consider only problems of the elderly but also and healthcare policies (this organism is formed by the severe chronic disabilities or progressively degenerative regional Ministers for Healthcare Policies and for Social disabilities requiring long term, complex and expensive Policies, the Mayors, the Presidents of the Territorial treatments. Conferences). The Fund is managed by the Health Districts; it receives Through the Region-University Conference, Universities funds also from a heavier and more targeted taxation, have been involved in this integration process for their and it must therefore provide a fairly developed services fundamental role in research, training and services network and guarantee the best equality in care conditions innovation. and homogeneous access opportunities, treatments The organizational model of the new welfare, confi rming quality, citizens’ fair contribution. The aims of the Fund that adopted by the previous Regional Healthcare Plan, is are: to expand service network (in particular home care), based on territorial integrated networks among hospital to curb citizens’ sharing of accommodation expenditure services, and among hospital, healthcare, social-health in residential facilities (on an income basis), to give some and social services. kind of recognition to self-organized families with specifi c The Health District becomes the main seat for the attention to the use of foreign home assistants (duly integration between the District Committee and the trained) and the promotion of innovative forms of care. District Director (supported by the new Plan Offi ces for the governance and planning of healthcare, social-health and Public Trusts for Personal Services social services at district level); for the integration among The Regional Law no. 2/2003 (Outline law on social family practitioners (through Primary Healthcare Units), services) regulated the transformation of Public Institutions territorial healthcare and social services among themselves for Assistance and Charity into Public Trusts for Personal and with hospital services; for the predisposition of the Services: new public entities formed by the Municipalities Plan and the use of the Fund for non self-suffi cient people; in district or sub-district areas that will produce and for the integration among Public Trusts for Personal provide social-health and social services for people in Services (evolution of Public Institutions for Assistance every age group. The Public Trusts for Personal Services and Charity); for the relationship with profi t and non-profi t guarantee the joint management and qualifi cation of private organizations for the provision of residential and services thanks to the overcoming of interventions home social and social-health services; for the connection fragmentations and to the development of integration with volunteers and associations.

SSSRE-R_2008_INGLESE9.inddSRE-R_2008_INGLESE9.indd 5 222-05-20092-05-2009 17:37:2117:37:21 6 THE SOCIAL AND HEALTHCARE PLAN 2008-2010 OF EMILIA-ROMAGNA REGION

with the other subjects and services that constitute the communication system in order to: community welfare. - strengthen people’s ability to make correct choices on health matters and to adopt healthy behaviours (i.e. Innovation food-related choices, vaccinations, screening programs, The innovation process does not involve only policies emergencies management); and planning aimed at giving global answers to complex - involve people in services assessment in order to needs (with the new territorial governance system). It implement proper improving processes; implies also the ability to introduce the technological and - valorise communities’ participation in health-related biomedical innovations that research makes available for choices and in social and health planning. healthcare services and the organizational and professional The partnership between citizens and services is one of innovations to face the evolving needs of people and the fundamental tools which can improve health and life families, the ongoing demographic changes and the socio- quality and can offer a universalistic social and healthcare economic changes. system based on equity, free access and effectiveness The joint intervention fi elds of Universities and Regional principles. Health Service, mainly developed in the 4 University Hospital Trusts, are: regenerative medicine, oncology, neurosciences, advanced diagnostics. The healthcare area The Emilia-Romagna Research and Innovation Program The National Health Service (instituted with Law no. (called PRI E-R) is meant for all the regional Health Trusts. 833/1978) represents one of the most important The goal of the Program is to assess the impact of specifi c achievements and one of the fundamental social cohesion interventions and technologies, starting from those related factors for our country with its principles of universality to cardiovascular and oncological fi elds. of access, comprehensive coverage, public fi nancing A particular attention is given to non-conventional through general taxation guaranteed by regional and medicine: a regional Observatory has been instituted national laws. to promote research projects aimed at verifying the The regional health policy developed through the Third opportunity of integration of acupuncture, homeopathy Health Plan and organized by Law no. 29/2004 aimed at and phytotherapy in care pathways. setting up a system able to offer universalistic guarantees As far as the social and social-health fi elds are concerned, to citizens and communities and, at the same time, to the innovation is focused on: services organization, satisfy local expectations. This led to: integration between that must be aimed at assuring a central role to the regional and Health Trusts’ programs and the management individual and his/her family in the defi nition of the support functions of local entities on health and social services projects, giving an answer to complex and multidisciplinary (Territorial Conferences, District Committees); need for needs; the development of professional competences a wider participation of professionals in Health Trusts’ and collaboration among professionals (through specifi c strategies and services organization (Directors’ Board); training initiatives); the qualifi cation of the access system professionals’ investment with responsibilities through the (through integrated information systems); the set up of adoption of work methods aimed at improving professional a relationship network with service providers based on practice and at promoting a correct use of available accreditation. resources for diagnosis and therapies (clinical governance); The creation of the Public Trusts for Personal Services progressive integration of technological innovations contributes to support this plan clarifying the role of (Region-University Program, PRI E-R); training for health the public sector in carrying out social and social-health professionals (Continuing Medical Education); participation services. According to this perspective an important of citizens and their associations (District Area Plans for element of innovation, started with the experience of Area health and welfare). Plans, refers to the enhancement of active resources in The Regional Social and Healthcare Plan 2008-2010 society and service sector, their involvement in planning, confi rms and reasserts the new role of the Health District working out and monitoring interventions. as the seat of services planning, primary care provider and ideal context for the integration between citizens and Communication and participation healthcare, social-health and social public services supplied To orient citizens in the access to the new welfare services by public subjects (Local Health Trusts, Public Trusts for and to assure them the opportunity to have an active role Personal Services, Municipalities) or by private profi t in the defi nition of support pathways also for themselves, and non-profi t bodies. In this framework, a fundamental the Regional Social and Healthcare Plan provides for importance is recognised to the role of family practitioners the integration of local information points and access whose associated activity through the Primary Healthcare points to services, with special attention to the “weak” Units will guarantee better access thanks to extended population groups (elderly, immigrants, people living in opening hours and continuity of care through connection social and economical disadvantaged conditions): this with other services. means that the so-called “Social helpdesks”, “District The hub and spoke model of services integrated networks unifi ed helpdesks” and the “Offi ces for relations with the was confi rmed as the leading model for hospital care: public” (Health Trusts’ and Municipalities’ offi ces that the connection between highly specialized hospitals provide information on health services to citizens) must (hub) and local hospitals (spoke) to provide the best be in connection. treatment for complex cases needing high professional More generally speaking, the strategy proposed by the competences and technologies. Beyond genetics, severe Plan aims not only at facilitating the appropriate use traumas, cardiology and heart surgery, emergency system, of services, but also at developing a regional and local transplants and transfusion system (among the others),

SSSRE-R_2008_INGLESE9.inddSRE-R_2008_INGLESE9.indd 6 222-05-20092-05-2009 17:37:2117:37:21 THE SOCIAL AND HEALTHCARE PLAN 2008-2010 OF EMILIA-ROMAGNA REGION 7

one of the priorities of the Plan is the development of the situations and the strongest needs. The basic principles oncological regional network. still remain fair access (same needs and conditions = The approach to health promotion and diseases prevention same services) and fair expenditure based on some requires the involvement of different subjects (Regional specifi c parameters (used to calculate families’ economic Plan for Prevention); the need to develop professional conditions: income, properties, number of family competences and a more organic participation of the components). Public Health Departments of Local Health Trusts in public A new kind of “allowances for services use” will be tested health overall objectives, through the promotion of shared during the three-year period of Plan implementation; as interventions with the other healthcare services. an alternative to care allowances, they will be assigned The development of Mental Health and Pathologic on the basis of specifi c requisites for access to services Addiction Departments involved all the areas engaged - beginning from homecare services, once these services in offering mental health care to population of any age: are accredited. mental health promotion, prevention, diagnosis, care and The so-called “Social services supply charters” will be rehabilitation of patients affected by psychic disorders, worked out and spread by associated Municipalities in mental problems and pathologic addictions. The strategic order to highlight access procedures to services and instruments are: health professionals’ training, research quality standards. For the access to the services system, and innovation promotion to be set up also through the each area (local, District, where the District Plan for Health strengthening of the collaboration with Universities, and Social Welfare is implemented) will have to create a integration of Non governmental organizations in service “Social helpdesk” that is a network of information points providing. aimed at orienting citizens on services use and on access procedures through initiatives for enhancing access addressed to people living in disadvantaged conditions The social area such as immigrants and elderly. Emilia-Romagna Region relies on a widespread and functional public and private services network, Trade Unions’ large representation, cooperation, lay and religious volunteers’ associations, that represent a social “richness” and an important resource against the risks of social marginalization and loneliness; however the changes occurred in the last 30 years were characterized by a Healthcare planning: subjects and tools pace and a depth never experienced before. Emilia-Romagna is undoubtedly a richer region than in the past with widespread wellbeing, but inequalities and the risk of vulnerability and social marginalization for some parts of the population are potentially increasing. This is the reason why the social area is included and developed SocialSocial anandd in the Regional Social and Healthcare Plan, according to Region HealthcareHealthcare PPlanlan Regional Law no. 2/2003. 2008-20102008-2010 In recent years regional policies were aimed at the creation of local welfare systems focused on needs understanding and on shared and agreed planning (Area Plans). This objective is linked with enhancing the Region’s role as planning and regulatory subject; the role of Local Authorities as subjects for service planning and supply; the role of associations and volunteers as participants Territorial in providing services. Social policies and services, Social and 3-year3-year Intervention integrated with the healthcare and social-health ones, are and CCoordinationoordination devoted in particular to children, young people, families, Healthcare PoliciesPolicies ActAct elderly, disabled, people living in social and economical Conference disadvantaged situations, and pursue general aims of social welfare. In particular: struggle against poverty and risks of social marginalization; support to social and working integration for immigrants and their families; support to families; promotion of children’s and young people’s wellbeing and self-promotion; improvement of the housing 3-year3-year DDistrictistrict Area Plan for Health system for minors in foster care or in communities; District Committee and Social WelWelfarefare support to non self-suffi cient subjects, to home care and (or single Municipality, to family care with particular attention to women’s role, or associated AnnuaAnnuall Municipalities) development of education services for disabled and to ImpImplementationlementation PPlanlan enhance their integration and autonomy. This services system is universalistic and fi nanced by national and regional social funds managed by the All the tools are integrated and include social, social-health Municipalities. It is based on an access grading in order and healthcare planning. to devote resources and services to the socially weakest

SSSRE-R_2008_INGLESE9.inddSRE-R_2008_INGLESE9.indd 7 222-05-20092-05-2009 17:37:2117:37:21 8 THE EMILIA-ROMAGNA REGIONAL HEALTH SERVICE: RESULTS AND COMMITMENTS

The Emilia-Romagna Regional Health Service: Results and commitments

With the approval of the 1st Social and Healthcare Plan Service – universality and fair access, public responsibility 2008-2010, the Region has set up the planning and for health protection, public fi nancing through general organizational instruments needed to concretely pursue taxation - is composed by 16 Health Trusts and 1 Research the development of the new universalistic community Hospital. Three Vast Areas were defi ned to optimize quality welfare, founding its activities on integration with the and effi ciency of technical-logistic and care services aim of fairly providing specifi c and global answers to provided to populations beyond the Local Health Trust’s individuals’ and families’ needs in the whole territory. territorial competence: north Emilia, central Emilia and Romagna The 3rd Health Plan 1999-2001 had already adopted On December 31st, 2007 the Regional Health Service integration as a working method for the Regional Health counted 60,710 employees (+985 with respect to 2006). Service. This principle was confi rmed by the Regional Contracting general practice physicians and contracting Law no. 29/2004 and thanks to the Social and Healthcare paediatricians were respectively 3,221 and 584. Plan it now involves also to the social fi eld through the strengthening of the relationship with Local Authorities, On the same date the regional population showed an NGOs and citizens’ representatives organizations. increase of 52,258 persons with respect to 2006: the total number of citizens was 4,275,843. The increase in the Important results of the development of the integration population is related to the birth rate rising (40,518 births between healthcare and social policies are: the evolution registered in 2007, of which foreign mothers accounted for of the Public Institutions for Assistance and Charity into 23%) and to the growth in the number of people arriving the Public Trusts for Personal Services (50: 34 already from other countries of the world (365,720 people on created and 16 in the preliminary phase) and the program December 31st, 2007, 8.6% of the population). Emilia- for using the regional Fund for non self-suffi cient people Romagna is still one of the “oldest” Italian regions with (that in 2007 – start-up year – used 255 million Euros to 968,208 persons aged over 65 years representing 22.6% of grant services to 54,500 people, 7,200 of which were new the population while the national level is 19.8%, 488,469 benefi ciaries). persons aged over 75 years representing 11.4% and 134,527 persons aged over 85 years representing 3.1% The guidelines for drawing up the “Health Trust’s Act” of the total regional population. enable the Health Trusts to reinforce integration with Local Authorities. The Health District is still the seat for Hospital beds numbered 19,983 (19,887 in 2006); acute the elaboration of the “Engagement Plans”, that are the care beds numbered 3.83 and long-term care and expression of population needs, and it is also the elective rehabilitation beds numbered 0.9 per 1,000 population. context for the elaboration of social and healthcare Hospital admissions in 2007 totalled 851,574. The policies, the use of the Fund for non self-suffi cient people admission rate in Emilia-Romagna hospitals for patients and the creation of the Public Trusts for Personal Services from other regions was 15.01% (14.5% in 2006). with total involvement of Local Authorities. Beds in residential and semi-residential facilities numbered 27,126 (the 28,314 beds reported in 2006 included 1,200 The process for authorization and accreditation of beds in facilities that did not operate within the RHS). services is active since 2004 for healthcare services; Hospice beds numbered 216 (170 in 2006). many hospitals, hospices, public psychiatric facilities, Visits and new users of the 48 Centres for diagnosis private nursing homes and outpatient facilities have been and care of senile dementias have constantly increased, already visited. In 2007 the same process was extended respectively from 50,784 in 2006 to 56,542 in 2007 and also to social-health and social services. from 14,668 in 2006 to 16,214 in 2007. The number of people receiving home care rose from The activities, programs, organizational models, 77,085 in 2006 to 81,123 in 2007; in the same year 20,602 agreements developed within the Regional Health Service persons benefi ted of care allowances (18,395 in 2006). and presented in this publication are aimed at developing The outpatient specialist attendance is almost stable: integration as an operational method. 70,045,980 in 2007 as compared to 69,812,752 in 2006. The network of Mental Health Services showed an increase Results as of December 31st, 2007 in the number of adult patients – from 62,618 in 2006 to 66,813 in 2007 – and of minor patients – from 36,818 in The globally positive results achieved in 2007 are 2005 to 38,296 in 2006. synthetically commented below but widely reported through People affected by drug and alcohol addiction treated at graphics, tables and comments in the following pages. the Substance Abuse Services numbered 22,066 (4,055 coming from other regions). The Emilia-Romagna Regional Health Service that is Data on activities and users of the network of Family founded on the distinctive principles of the National Health health advisory centres remained substantially stable

SSSRE-R_2008_INGLESE9.inddSRE-R_2008_INGLESE9.indd 8 222-05-20092-05-2009 17:37:2117:37:21 THE EMILIA-ROMAGNA REGIONAL HEALTH SERVICE: RESULTS AND COMMITMENTS 9

with respect to 2006 (920,126 interventions in 2007 vs Inspections on food safety reported a decrease in the 893,124; and 467,800 users vs 452,891). number of irregularities in plants for processing milk and Data on assistance to pregnant women is particularly dairy products (from 63% in 2006 to 25.8% in 2007), in fi sh interesting, as they registered a relevant growth: from processing plants (from 25% in 2006 to 11% in 2007), in 7,069 in 1995 to 16,405 in 2007 (from 740 to 7,811 meat processing plants and deposits (from 40% in 2006 immigrant women). to 29.6% in 2007), in poultry farms (from 4.3% in 2006 to 1.1% in 2007). Concerning organ donations, Emilia-Romagna confi rms for 2007 to rank above the national average (26.4 donors The program for dental, prosthetic and orthesic care for per million population as compared to 19.3 at national people with pathologies causing dental problems or living level). Organ transplants numbered 320 (311 in 2006), 15 in disadvantaged economical conditions has risen the from living donors. number of people benefi ting of free of charge care and In 2007, blood donations registered a decrease due to the income segments giving the right to gratuitousness the interruption in the areas affected in the Summer by or controlled prices. the Chikungunya epidemic (virus transmitted by tiger mosquito). Blood units collected were 245,173 (248,764 All the Health Trusts and Research Hospitals are involved in 2006). The regional self-suffi ciency was guaranteed but in the development of research and innovation programs. the number of blood units usually transferred to lacking Training through the Continuing Medical Education has regions decreased: 6,301 in 2007 vs 15,115 in 2006. involved 61,400 professionals.

The three screening programs for prevention and early The agreement with general practice physicians aimed diagnosis of breast, cervical and colorectal cancer have at their integration into the Health Trust’s activities has achieved good results: screening for breast cancer brought signifi cant results: 94% of them are organized registered a participation of 73.8% of invited women in Primary Healthcare Units; signifi cant experiences of (60.4% at national level); 55.6% for cervical cancer (39.8% care for patients affected by chronic diseases are spread at national level), 46.7% for colorectal cancer (46% at in various Health Trusts (diabetic patients are cared for national level). in all the Health Trusts); the telematic network Sole (connecting family physicians and paediatricians, services Still maintaining high levels of coverage, the 2007-2008 and professionals of the Health Trusts) involves already regional program for infl uenza vaccination registered a 2,075 family physicians and paediatricians. slight decrease as compared to 2006 campaign in the population aged over 65 (707,387 in 2007 vs 715,239) and In 2007, total expenditure for the Regional Health Service in adults and children with chronic diseases (188,232 vs amounted to 7.616 billion Euros (7.285 in 2006 and 7.053 195,917). Vaccination coverage has to be improved among in 2005). Per capita expenditure amounted to 1,773 Euros healthcare service personnel: 14,844 people adhered to (1,725 in 2006). the 2007-2008 vaccination campaign while 15,845 people For some years Emilia-Romagna has worked to balance adhered to the preceding one. hospital and territorial healthcare expenditures (respectively Good results were achieved in childhood vaccination too, 42.02% and 53.3% in 2007), an effort that ran parallel with with levels of coverage above the national average. the qualifi cation of both territorial and hospital services as A vaccination program against HPV serotypes 16 and demonstrated by the percentage of people coming from 18 (responsible of 70% cervical cancers) was started in other regions to be hospitalized in Emilia-Romagna, that March 2008. in 2007 reached 15.01% (14.56% in 2006). In 2007 the investments to modernize or build healthcare Concerning occupational safety, from 2000 to 2007 in and social-health facilities were carried on: between 1998 Emilia-Romagna the number of injuries reported to the and 2007 the funds used amount to 2.5 billion Euros. National Insurance Institute for Occupational Accidents Global pharmaceutical expenditure increased by 1.6%, decreased of about 7% (from 140,766 to 130,626) and but the most considerable expenditure item – local fatal accidents were reduced by 36% (from 174 to 111). distribution of drugs by pharmacies, representing 73.7% Particularly in the construction sector that is registering of total expenditure – decreased by 1.4%. an important increasing trend in the number of fi rms and workers employed, both irregularity index and accident In 2008 the National Healthcare Fund allowance for Emilia- incidence are decreasing: the fi rst moves from 38.94 in Romagna regional Health Service amounts to 7.183 billion 2001 to 32.65 in 2007 and the second from 8.97 in 2001 Euros (3.5% increase as compared to 2007); 150 million to 6.25 in 2007. A plan specifi cally aimed at identifying the Euros deriving from regional budgetary measures are to be causes of accidents and professional diseases in personnel added: 100 million aimed at assuring the economical and working at the healthcare and social services was set up; fi nancial balance of the RHS in 2008; 50 million assigned to in this fi eld data on the Regional Health Service reported the Regional Fund for non self-suffi cient people, that can 7,827 accidents in 2006; controls on workers revealed that: now rely on 353 million Euros. Moreover, the Health Trusts’ 87.1% cases are safe from professional risks; 6.9% cases own revenues and the positive balance by interregional need limitations or prescriptions on duties performed and healthcare mobility contribute to the total healthcare 0.4% cases are potentially exposed. expenditure coverage.

SSSRE-R_2008_INGLESE9.inddSRE-R_2008_INGLESE9.indd 9 222-05-20092-05-2009 17:37:2117:37:21 10 SSSRE-R_2008_INGLESE9.indd 10 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ I N Vast Areas setupandoperative arethree: northEmilia the LocalHealth Trust’s territorialcompetence. The logistic andcareservicesprovidedtopopulationsbeyond T defi According totheregionalplanning, Vast Areas havebeen numbered 16,158. On December31 in theregion). Local Health Trusts areorganizedinHealthDistricts(38 Hospital Trusts, 1Hospital Trust, 1ResearchHospital; the G nvriyHsia rs fFraa342,550 4,996 2.645 2,429 1,197 3,830 324 1,730 904 775 60,710 17,647 876 1,361 16,158 5,970 * PopulationonDecember31 Total hospitalbedsandemployeesinEmilia-Romagna Health Trusts Total Hospital Trusts, University Hospital Trusts, ResearchHospital “Istituti OrtopediciRizzoli” Research HospitalofBologna University Hospital Trust ofFerrara University Hospital Trust ofBologna University Hospital Trust ofModena Hospital Trust ofReggioEmilia No. ofpublichospital University Hospital Trust ofParma Hospital Trusts, UniversityHospital Trusts, ResearchHospitals iii283370 1 ,2 2 44 30 23 224 49 38 20 149 153 3,429 116 2,708 286 2,673 286 96 97 584 910 55 79 652 4,795 634 3,151 33 634 1,706 2 531 3,221 2 1 305 1,220 753 8,368 341 577 43,063 7.0% 216 6,258 3 4.7% 3 2,450 4.3% 10,188 1,859 1 3,926 298,333 3,599 1,612 38 8.9% 200,364 6 182,682 393 8.3% 735 3.0% 7 843 100.0% 379,467 4 19.6% 355,809 6 127,554 4,275,843 15.8% 3 Total LocalHealth Trusts 836,511 10.0% Rimini 677,672 11.9% Cesena 6.6% Forlì 425,690 510,148 Ravenna 281,613 Ferrara Imola Bologna Modena Reggio Emilia Parma % Piacenza Population* Local Health Trusts ** Accredited privatehospital bedsarenotincludedinthetable(whiletheygraphsonpage20). L Health Trusts, population,employees,generalpractice Health Trusts, E ned tooptimizequalityandeffi S composed of11LocalHealth Trusts, 4University he Emilia-RomagnaRegionalHealthServiceis E 9 . i n d d

1 0 st , 2007hospitalbedsinHealth Trusts st , 2007. physicians andpaediatricians ciency oftechnical- population per Health Trust Health Trusts Districts Health No. of of No. persons withrespecttoDecember31 The residentpopulationamountsto4,275,843(+52,258 are respectively3,221and584. general practice physiciansandcontracting paediatricians in thenumberofnursingpersonnel: +328). Contracting (+985 ascomparedto2006, withaconsiderable increase The RegionalHealthServicecounts60,710employees Forlì, RavennaandRiminiHealth Trusts). Ferrara Health Trusts) andRomagna(includingCesena, Health Trusts), central Emilia(includingBologna, Imolaand (including Piacenza, Parma, ReggioEmiliaandModena hospital beds ** public No. of of No. beds ** mlye General Employees physicians practice st , 2006). Employees Paediatricians 222-05-2009 17:37:21 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 2 1 SSSRE-R_2008_INGLESE9.indd 11 S R E - R _ 2 0 0 8 _ I N * Dyingoutfunction. * PopulationonDecember31 G pcaie uiir esne 72 621 762 3,350 1,131 568 3,264 1,122 578 Total Religious personnel Administrative personnel Specialized auxiliarypersonnel Social care personnel Assisting personnel Technical personnel Social workers Rehabilitation personnel Prevention personnel Laboratory anddiagnosticpersonnel Nursing personnel Technical andadministrative professionals Other healthprofessionals Veterinarians Physicians ataesPplto No. ofpeople Population* Total (Ravenna, Forlì, Cesena, RiminiHealth Trusts) Romagna Vast Area (Bologna, Imola, Ferrara Health Trusts) Emilia VastCentral Area (Piacenza, Parma, ReggioEmilia, ModenaHealth Trusts) Emilia VastNorth Area Vast areas L E S E 9 . i n d d

1 1 Personnel employed by the Regional Health Service, 2006-2007 Personnel employedbytheRegionalHealthService, st , 2007. Vast Areas 42583 9828 22.6% 968,208 4,275.843 ,6,4 3,6 22.4% 24.3% 237,769 21.6% 320,668 1,060,846 409,771 1,319,874 1,895,123 5,2 60,710 59,725 2,6 26,193 25,865 586 5,865 4,623 5,267 5,806 2,282 3,860 5,130 2,250 8,638 8,550 062007 2006 62 296* 425 911 642 415 530 914 549 1 10 18 aged 65+ % ofpeople aged 65+ 222-05-2009 17:37:21 2 - 0 5 - 2 0 0 9

1 7 11 : 3 7 :

2 facilities, expenditure, activity 1 12 SSSRE-R_2008_INGLESE9.indd 12 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ I N T the totalpopulation(4.6%atnationallevel). In1997, the In 2006residentforeignersnumbered318,076, 7.5%of 8.6% ofthetotalpopulationascomparedto5.8%nationally. On December31 reporting thelast20yeartrend. growth becamesignificant, asshowedinthegraphs foreigners. Startingfromthesecondhalfof ‘90s the Tunisia, China): onDecember31 fi was 9.4. (9.5); in1997theregionalrate was7.6andthenationalone The 2007Emilia-Romagnabirthrate reachesthenationalone 30,139 in1997. births were39,435(ofwhich21%fromforeignmothers); of which23%fromforeignmothers. In2006registered foreign families: birthsregisteredin2007were40,518, The increaseinbirthrate ispartlyduetothepresenceof national level). the increasewas8.3%, thatisatotalof328,695(4.8%at +52,258 personsascomparedto2006. Inthelast10years to 4,275,843(2,195,877femalesand2,079,966males), 3,700,000 3,800,000 3,900,000 4,000,000 4,100,000 4,200,000 4,300,000 4,400,000 G rst 5countriesoforiginareMorocco, Albania, Romania, 25,000 27,500 30,000 32,500 35,000 37,500 40,000 42,500 L E S the recoveryofbirthrate andtheincreaseinresident he populationofEmilia-Romagnaisgrowingthanksto E 9 1987 . i n 3,922,388 25,112 d The numberofresidentforeignersisgrowing(the d 9718 9919 9119 9319 9519 9719 9920 0120 0320 0520 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987

1 1988 2 2007: 23%fromforeignmothers st 1989 , 2007theresidentpopulationamounted 1990 Resident populationinEmilia-Romagna,1987-2007 1991 Residents born inEmilia-Romagna,1987-2007 Residents born st , 2007theywere365,720, 1992 1993 1994 Population 1995 1996 For furtherdetails: total population). and morethan85years(134,527, representing3.1%ofthe years (48,469, representing11.4%ofthetotalpopulation) has alsoasignifi while thenationallevelis19.8%(19.7%in2006). The region representing 22.6%ofthetotalpopulation(22.8in2006) Italian regionswith968,208personsagedover65years Emilia-Romagna confirmstobeoneofthe “oldest” total population). province withthesmallestnumberisFerrara (5.3%ofthe Piacenza (10.1%), Modena(9.9%)andParma (9.2%). The immigrants areReggioEmilia(10.3%ofthetotalpopulation), The provinceswiththelargestnumberofresident population (malesdecreasedform57.6%to50.6%). between 1997and2007, from42%to49.4%offoreign from EasternEuropecountries-considerably increased even ifthefemalecomponent-thankstoimmigration population, malesstillprevail: 185,022vs180,698females, foreigner populationnumbered81,265. Inimmigrant implemented bythesocalled “Martelli law” of1990, fi http://www.regione.emilia-romagna.it/statistica rstyearofsystematicsurveyafterthefi 1997 9819 0020 0220 0420 062007 2006 2005 2004 2003 2002 2001 2000 1999 1998 cant presence of people aged more than 75 cant presenceofpeopleagedmorethan75 rstregularization 4,275,843 40,518 222-05-2009 17:37:22 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 2 2 SSSRE-R_2008_INGLESE9.indd 13 S R E - R _ 2 0 0 8 _ I N G 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% iii 9,3 255 7.6% 7.7% 8.2% 22,545 5.3% 6.4% 15,397 8.0% 9.9% 4,275,843 31,239 298,333 18,858 8,158 9.2% 200,364 8.6% 10.3% 365,720 67,113 10.1% 379,467 67,316 355,809 127,554 39,147 52,420 836,511 28,419 677,672 425,690 510,148 281,613 Total Total no. Rimini Cesena Forlì Ravenna Ferrara Imola Bologna Modena Reggio Emilia Parma Piacenza Local Health Trusts L E 10 12 S 11 E 9719 9920 0120 0320 0520 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1987 5 6 7 8 9 Percentage offoreignpopulationwithrespecttoresidentinEmilia-Romagna, 9 . Emilia-Romagna i 9719 9920 0120 0320 0520 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 n d d 2.1%

1988

1 3 Emilia-Romagna 8.6% Italy 5.8% Resident foreignpopulationin2007: 1989 2.4% 1990 Italy Resident foreign population by Local Health Trusts, 2007 Resident foreignpopulationbyLocalHealthTrusts, 1991 Birth rateinEmilia-Romagna/Italy, 1987-2007 Birth 2.8% 1992 1993 3.3% 1994 1995 3.6% 1997-2007 1996 1997 4.0% of resident population 1262 1,0 8.3% 15,108 182,682 5.1% 6.2% of resident foreigners Total no. 6.9% % offoreigners population 7.5% on total 8.6% 222-05-2009 17:37:22 2 - 0 5 - 2 0 0 9

1 7 13 : 3 7 :

2 facilities, expenditure, activity 2 14 SSSRE-R_2008_INGLESE9.indd 14 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ I N G 10% 12% 14% 16% iii 9,3 090 04 2,2 1.% ,4 2.6% 2.6% 3.5% 7,844 3.1% 5,277 6,308 3.4% 3.3% 3.2% 10.0% 134,527 10.1% 11.4% 12.1% 13,063 29,720 11,730 4,114 3.4% 488,469 20,300 22,188 2.9% 20.4% 12.3% 22.6% 12.7% 3.4% 21.0% 11.6% 23.7% 28,643 60,950 46,639 968,208 2.8% 19,524 3.4% 45,221 42,128 14,768 43,329 14,294 24.1% 12.2% 4,275,843 298,333 25.5% 10.4% 14,220 22.7% 9,510 91,362 102,226 200,364 182,682 11.8% 90,835 70,789 28,986 24.0% 10.1% 50,268 12.4% 379,467 20.9% 355,809 200,847 51,532 127,554 34,818 23.0% 141,551 20.0% 836,511 98,012 24.3% 677,672 101,796 Total 68,412 Rimini 425,690 Cesena 510,148 281,613 Forlì Ravenna Ferrara Imola Bologna Modena Total Reggio Emilia Parma Piacenza Local Health Trusts 0% 2% 4% 6% 8% L E S Resident foreign population in Emilia-Romagna by country oforigin,December31 Resident foreignpopulationinEmilia-Romagnabycountry E 9 . i n d d

1 10% 20% 30% 40% 50% 60% 70% 4 % male 9719 9920 0120 0320 0520 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997

% female Resident elderly population by Local Health Trust, 2007 Resident elderlypopulationbyLocalHealthTrust, Foreign residentpopulationbygender, 1997-2007 population vr6 er %over65 Over 65years Poland India Pakistan Moldova Ukraine People’s RepublicOfChina Tunisia Romania Albania Morocco years Over 75 years % over75 years Turkey Bulgaria Sri Lanka(exCeylon) Serbia andMontenegro Bangladesh Nigeria Senegal Macedonia (ex Yugoslavia) Ghana Philippines Over 85 years st , 2007 % over85 years 222-05-2009 17:37:23 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 2 3 SSSRE-R_2008_INGLESE9.indd 15 S R E - R _ 2 0 0 8 _ I N population growthinEmilia-Romagna(4.3%)wasgreater aligned withthenationalaverage, eventhoughthe fi I Expenditure trend:comparisonwiththeotherItalianRegions Source fornationaldata: ItalianNationalInstituteofStatistics(ISTAT). Source: Emilia-RomagnaRegion (self-servicestatistics). Resident populationasofDecember31 Source for2005and2007: Generalreportonthenationaleconomicsituation, 2007. Source for2003: Generalreportonthenationaleconomicsituation, 2006. G ve yearsbetween2003and2007showsgrowthindexes tla8,6,7 637221202211.7 .9 24.60% 5.89% 17.67% 17.05% 23.80% 102,002,261 25.21% 22.37% -1.19% 96,327,292 5.24% 29.12% 7.29% 81,863,675 10.71% 22.97% 16.78% 18.46% 17.64% 7.44% 15.13% 10.53% 16.70% -0.90% -6.06% 2,660,276 29.15% 21.65% 8,224,197 20.18% 1.09% 16.99% 3,164,400 2,692,359 963,149 24.08% 24.31% 25.15% 23.08% 7,814,847 Italia 3.14% 8.09% 6,619,515 2,858,194 Sardegna 2,272,758 6.73% 13.89% 897,681 24.11% 9,577,045 Sicilia 6,642,986 614,769 24.63% 17.02% 9.03% 6.54% 25.21% 6,160,918 Calabria 2,585,899 25.21% 12.54% 24.93% 2,270,761 9,663,536 Basilicata 769,244 9.61% 4.87% 7.98% 654,418 9.86% Puglia 5,126,498 14.79% 15.52% 10,425,232 10.07% 2,246,372 2,534,824 Campania 7,788,404 7.90% 1,492,953 Molise 526,421 15.42% 10,107,400 18.34% 6.52% 2,167,322 Abruzzo 1,972,322 2,345,038 6,315,076 26.77% 13.75% 1,398,837 Lazio 8,072,280 15.78% 26.18% 7,615,948 1,987,822 3,067,154 Marche 2,083,768 5,927,252 941,072 9.09% 247,401 Umbria 1,276,166 7,053,411 1,731,769 2,924,715 Toscana 8,157,991 5,130,930 7.82% Emilia-Romagna 6,110,902 856,642 224,758 16.21% Liguria 2,471,386 7,560,710 Friuli VeneziaGiulia 17.03% 804,212 197,592 Veneto 6,530,028 16,120,234 Provincia autonoma Trento 7,754,971 14,777,327 Bolzano Provincia autonoma 7,192,655 Lombardia 12,716,438 Valle d’Aosta Piemonte 6,145,739 Autonomous Provinces Regions and mlaRmga21%21%4.26% 59,619,290 4,275,843 2.11% 58,751,711 4,187,544 2.10% 57,888,245 4,101,324 Emilia-Romagna Italy Emilia-Romagna tl .9 .8 2.99% 1.48% 1.49% Italy L E Service was7.616billionEuros. The analysisofthe n 2007, totalexpenditurefortheRegionalHealth S E 9 . i n d d

Trend oftheresidentpopulationinEmilia-RomagnaandItaly, 2003-2005-2007

1 5 Expenditure byRegion,2003-2005-2007(absolutefi expenditure Total 2003 0,3 8,0 ,6,7 .0 .1 17.63% 8.71% 8.20% 1,067,971 982,400 907,932 st nrae20/03%ices 0720 %increase2007/2003 %increase2007/2005 % increase2005/2003 . 0320 2007 2005 2003 expenditure Total 2005 expenditure as comparedto308millionEurosin2006. mobility shouldalsobeadded: 329millionEurosin2007 the increasinglypositivebalanceofinwardhealthcare than thenationalone(3%). To thisappreciableresult, Total 2007 % difference 2005/2003 gures inthousandEuros) % difference 2007/2005 % difference 2007/2003 222-05-2009 17:37:24 2 - 0 5 - 2 0 0 9

1 7 15 : 3 7 :

2 facilities, expenditure, activity 4 16 SSSRE-R_2008_INGLESE9.indd 16 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ I 100.00 150.00 200.00 250.00 300.00 350.00 N complementary totheeconomic-fi with theRegionalGovernment Resolutionno. 213/2005)is (instituted byRegionalLaw no. 29/2004andintroduced healthcare objectives. The Socialaccountabilityreport carried outaccordingtotheregionalandlocalplanning report, anannualreportontheresultsofcareactivities F 50.00 G 0.00 L E S

Hospital “Rizzoli” issuetheSocialaccountability rom 2007everyHealth Trust and theResearch E 100 120 130 140 150 160 170 180 190 200 210 220 110 The startingvalueof1995issetat100asindexnumber. The graphrepresentstheannualgrowthofpercapitaexpenditureinEmilia-Romagna andItaly. 9 . i n d Emilia-Romagna d

9519 9719 9920 0120 0320 0520 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1 6 231.81 0220 0420 062007 2006 2005 2004 2003 2002 Total percapitaexpenditureinEmilia-RomagnaandItaly, 1995-2007 Balance of interregional mobility,Balance ofinterregional 2002-2007(inmillionEuros) Health Trusts’ Social accountability report Socialaccountabilityreport Health Trusts’ Italy 249.56 nancialbalancesheet; (index number1995=100) 270.34 For further details: Health Service. 2007 itisissuedbyeachHealth Trust oftheRegional and extendedin2005toallLocalHealth Trusts; from was experimentedin2004by5pilotLocalHealth Trusts of theresultsachieved. The Socialaccountability report the tworeportstogetherallowtohaveaglobaloutlook http://asr.regione.emilia-romagna.it/ 289.16 308.26 329.07 222-05-2009 17:37:24 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 2 4 SSSRE-R_2008_INGLESE9.indd 17 S R E - R _ 2 0 0 8 _ I N H years, expenditureforlocalcareservicesexceededthat been developed, diversifiedandqualified. For some same time, territorialandhomecareserviceshave of technologyandprofessionalcompetences. At the provide complexcareinfacilitieswithahighconcentration have beenassignedanincreasinglymorespecifi offer betweenhospitalandterritorialservices. Hospitals aspects oftheentiresystem, strivingtobalancethe regional screeningprograms(mammographic, cervicalandcolorectal), estimatedaround15-16millionEurosandthatareallocate (1) Publichealthcaretotal, accordingtoanupdateoftheguidelinesforfi ll-in rules, doesnotincludetheexpenditureford from theRegionalHealthcareFund, amountingto211millionEuros. For careactivitiesfi nanced throughtheregionalFundfornonself-suffi cient people, costsincludeexclusivelythe2006conso The expenditurebylevelsofcareincludesglobalmanagementcosts. NOTES Population asofDecember31 yrtemltetet1,8 .%46 56203 6.00 1.10 4.35 74.70 745.17 0.3% 0.0% 0.2% 42.02% 946.09 4.2% 78.67 25,662 15.13 4,705 3,186,219 18,587 27.51 53.3% 319,412 35.32 712.29 1,773.18 4.68 4.4% 0.8% 4,045,313 0.99 4.02 73.91 1.5% 100.00% 41.2% 336,364 1.9% 936.25 64,700 7,581,830 0.2% 3,008,422 117,619 0.0% 151,043 4.2% 1,725.00 0.2% 74.63 54.2% 14.75 19,787 Population asofDecember31 4,163 27.81 (self-service statistics). 3,954,312 100.0% 312,172 16,975 35.87 Source: FinalbalanceLAform 2006and2007. Percapitacostsarecalculatedfortheresidentregionalpopulation asofDecembe 4.3% Total 7,285,695 25.79 0.8% Total hospitalcare 1.6% 26.64 315,193 2.0% Total HealthDistrictcare 62,311 Hydrothermal treatment 1.4% 117,479 Care forpeoplewithHIV 151,483 1.5% Care forterminallyill 110,253 Care forelderly 81.92 113,896 Care forsubstanceabusers 26.18 Rehabilitation fordisabled Psychiatric care 25.27 4.6% centres, communitypaediatricians) 1.5% couples (Family advisoryhealth 350,298 Healthcare forwomen, families, 1.4% Home care 110,560 76.47 care notfollowedbyadmission) Specialist care (includingemergency 106,724 Supplementary care andprosthesis expenditure 4.43% Territorial pharmaceutical Costin 322,961 Territorial emergency services paediatricians, continuityofcare) general practice physiciansand Primary care (contracting Total publichealthcare(1) Levels ofcare G L E S Expenditure byfunctionsandlevelsofhealthcarefor E modifi ealth policystrategies inEmilia-Romagnahavedeeply 9 . i n d d

1 edthestructural, organizationalandplanning 7 resident citizens,percapitaexpenditure Expenditure byfunctionsandlevelsofhealthcare,2006-2007 st st , 2007: , 2006: 4,275,843 4,223,585 Euros in2006 thousand . . ,3,5 69 9.3122831.%295.35 16.6% 237.85 1,262,853 13.4% 293.03 1,017,009 16.9% 241.01 1,237,655 13.9% 1,017,909 9,6 .5 39 1,3 .%97.63 5.5% 417,434 93.94 5.45% 396,764 51711 01 57611 20.06 1.1% 85,776 20.16 1.1% 85,137 croleto fttlPercapita % oftotal to 1,773in2007, withagrowthslightlybelow3%. Per capitaexpenditureincreasedfrom1,725Eurosin2006 the RegionalHealthcareFund. exclusively the2006consolidatedexpendituresharefrom the regionalFundfornonself-suffi has beenused; thecostsforcareservicescoveredby In 2006and2007thesamedataprocessingmethodology resources allocated. for hospitalcareandin2007absorbed53.3%oftotal cost inEuros in 2006 Euros in2007 thousand Cost in fttlPercapita % oftotal iagnostic testsforthethree lidated expenditureshare cient peopleinclude r 31 d tospecialistcare. st

cost inEuros in 2007 222-05-2009 17:37:25 2 - 0 5 - 2 0 0 9

1 7 17 : 3 7 :

2 facilities, expenditure, activity 5 18 SSSRE-R_2008_INGLESE9.indd 18 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ I N * BodiescanbeMunicipalities, formerPublicInstitutionsfor Assistance andCharitynon-profi t organizations. I healthcare facilities according to safety and accreditation healthcare facilitiesaccordingtosafetyandaccreditation started inthepreviousthree-yearperiods, atimproving documents areaimedatcompletingtheinterventions Fund allocationsestablishedbythetwoabovementioned Region and8.311millionEurosbyHealth Trusts). National Government; 3.484millionEurosbyEmilia-Romagna expenditure of57.239millionEuros(45.433by projects approvedbythe2003regionalplanningforatotal Program Agreement theNationalGovernmentauthorized8 million Eurosforthedentistryprogram. With theIntegrative (including 2.2millionEurosfromHealth Trusts’ funds)and3.6 update oftheRegionalProgram forHealthcareInvestments million Eurosdividedasfollows: 5.4millionEurosforthe4 approved theprojectplanningforatotalallocationof9 By Resolutionno. 1183/2007theRegionalGovernment Agreement. and theRegionsignednationalIntegrative Program G oa ,3,3,4 6,3,8 0,9,9 2,507,069,122 908,493,597 938,364,714 267,538,884 734,167,573 411,479,072 834,536,834 1,331,036,640 154,293,398 208,938,234 342,721,127 34,008,522 317,947,408 24,592,128 545,865,652 467,223,579 Total Third phase-ongoing Second phase–nearlycompleted First phase-completed Health care and social services facilities: projects for new fornew facilities:projects Health careandsocialservices Cesena, Rimini. infectious diseaseunitsinthe hospitalsinPiacenza, Parma, ReggioEmilia, Modena, Ferrara, Ravenna, Forlì, Projects thathavebeencompletedandactivatedinclude: hospitalfacilitiesinSassuoloandBaggiovara (Modena), Cona (Ferrara) and Vecchiazzano (Forlì-Cesena). Carpi(Modena), Bologna(3)andFerrara; andnursing homesforelderly(56)anddisabled(19); * The infectiousdiseaseunitinBolognaUniversityHospital Trust -PolyclinicSant’Orsola-Malpighiisnearcompletion. • • • • • The projectsincluded: L E n 2007, theLegislative Assembly approvedthe4 of theRegionalProgram forHealthcareInvestments

renovation orenlargementof24hospitalsincludingthose inReggioEmiliaandParma, constructionofnew construction ofpsychiatricresidentialfacilitiesinScandiano andGuastalla(ReggioEmilia), Modena(2), construction ofHealthDistrictfacilitiesinFerrara, Predappio andCesenatico(Forlì-Cesena); construction ofoutpatientclinicsinZolaPredosa, ImolaandBorgo Tossignano (Bologna); renovation oftheDepartmentsPublicHealthinParma andBologna; S E 9 . i n d d

1 8 facilities and for modernizing existingfacilities facilities andformodernizing Programs andfi Programs Investments: about734millionEuros tt einBde*Total Bodies* Region State First phase:completed* nancing (in Euros), 1998-2007 nancing (in Euros), th update update 161 projects Programs th

On December31 the Health Trusts. standards andatenhancingreorganizationprocessesin Trust’s funds. interventions oftheirownfacilities, coveringthecostswith Moreover, theHealth Trusts regularlyprovide formodernizing health area)fora938millionEurosfi projects (228inthehealthcareareaand295social- a wartimeexplosivedevice). The thirdphaserefersto523 with thecontracting fi other projectsweresuspendedbecauseofalegaldispute interventions werecompletedand33areongoing(two 123 projectsforatotalfi of about734millionEuros. The secondphaseincluded completed, concerned161projectsandatotalfi The investmentstookplaceinthreephases. The first, eighteen yearsamountedgloballyto2,507millionEuros. st , 2007theinvestmentsactivatedinlast rm andbecauseofthediscovery nancing of835millionEuros: 88 nancing. nancing nancing 222-05-2009 17:37:25 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 2 5 SSSRE-R_2008_INGLESE9.indd 19 S R E - R _ 2 0 0 8 _ I N G discovery ofawartime explosive device. There are33ongoingprojects, including: • • • • • • 188 projectsconcernthehealthcareareaalone, including: As ofDecember31 • • • • • • • 88 projectshavebeencompleted, including: L E 1 newnon-hospitalfacility; construction of42nursinghomesforelderlyanddisabled. upgrading tosafetyandaccreditationstandardsofhospitalterritorialfacilities; Department ofPublicHealthinPiacenza, SocialassistancecentreinLanghirano (Parma), HealthDistrictin new hospitalsinFidenza(Parma), Baggiovara andSassuolo(Modena), SanGiovanniinPersiceto(Bologna), 111 otherprojectsincludedinregionalprograms: 40completed (36operating), 25ongoing, 46inthebidding 1 ongoingprojecttoexpandthehospitalinParma (2005RegionalPlanning Agreement); 11 projectsincludedinthe2004RegionalPlanning Agreement: 4operating, 7underconstruction; 69 projectsforin-hospitalprivatepractice: 32completed(26operating), 35underconstruction, 5inthe 20 facilitiesforpalliativecare: 14completed(13operating), 5underconstruction; 8 projectsforthemetropolitanareaofBologna: technologicalcentreofSant’OrsolaPolyclinicinBologna conclusion oftheinterventionsathospitalinFiorenzuola(Piacenza), PolyclinicinModena, Sant’Orsola 13 nursinghomesforelderlyanddisabledpeople; purchase andinstallationoflinearaccelerator inPiacenza; Mirandola (Modena), thenewbuildingforRegionalEnvironmentalHealth Agency (ARPA) inRavenna, (Modena); renovationandenlargementofthe “New Pathologies” UnitofBolognaUniversityHospital Trust; Emilia, completionoftheRehabilitationhospitalin Villanova d’Arda(Piacenza)andoftheHospitalin Vignola Lagosanto (Ferrara); enlargementofMaggioreHospitalinParma andSantaMariaNuovaHospitalinReggio phase. bidding phase; (ongoing), hospitalsinBazzano(alreadystarted)andBudrio(completed)theRoncaticomplexBologna; renovation ofRizzoliOrthopaedicInstitutesinBolognaand4otherprojectsBellariaHospital (already operating), cardiologyandheartsurgerycentresatSant’OrsolaPolyclinic(inplanningphase), building Hospital inRimini. (Ferrara), modernizationofSantaMariadelleCrociHospitalinRavenna, BufaliniHospitalinCesenaandInfermi Polyclinic, MaggioreHospitalandBellariainBologna, newhospitalinPorretta(Bologna)andCona S E 9 . i n d d

1 9 st , 2007twoprojects weresuspendedbecauseofalegaldisputewiththecontracting fi Investments: 835millionEuros Investments: 938millionEuros Second phase:nearlycompleted Third phase:Third 123 projects 523 projects rm andbecauseofthe 222-05-2009 17:37:25 2 - 0 5 - 2 0 0 9

1 7 19 : 3 7 :

2 facilities, expenditure, activity 5 20 SSSRE-R_2008_INGLESE9.indd 20 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ I N A admissions in public and accredited private hospitals covered admissions inpublicandaccreditedprivatehospitalscovered 31,269 forlong-termcare). Inthesameyear, planned (797,677 inacutecarebeds, 22,628forrehabilitationand In 2007, thetotalnumberofadmissionswas851,574 in 2006and13.8%2005). growing: in2007theattraction indexis15.01%(itwas14.5% The numberofpatientscomingfromotherregionsisstill is 138; thedayhospitaladmissionrate is45.4. population. The inpatientadmissionrate per1,000population and 0.9bedsforlong-termcarerehabilitationper1,000 3.83 acutecarebeds(inpatientadmissionsanddayhospital) situation asofDecember31 of bedsremainedsubstantiallystableascomparedtothe rehabilitation (3,821), dayhospital(1,826). The totalnumber including bedsforacutecare(14,336), long-termcareand a totalof19,983(16,158public, 3,825accreditedprivate) 80.9% G Public andaccreditedprivatebedsper1,000 L oa 851,574 31,269 22,628 797,677 3.83 Total Long-term care 0.90 Rehabilitation Acute care Long-term andrehabilitation Acute care Admissions (acutecare,rehabilitationand E S Hospital care:hospitalbeds,admissionsandwaiting s ofDecember31 private hospitalbedsinEmilia-Romagnaamountedto E 19.1% 9 population, asofDecember31 long-term), as ofDecember31 long-term), . i n d d

Public

2 0 st , 2007publicandaccredited Public andaccreditedprivatebeds,in2007=19,983 st 19.1% , 2006(19,887beds). There are Accredited private lists forplannedsurgery Beds asofDecember31 st st , 2007 , 2007 80.9% 19.1% 71.8% actually bejustifi date (betweendiagnosisandsurgery, timeextensioncould from thedateofsurgeryprescriptionbutdiagnosis surveying methodsofwaitingtimesthatarenotcalculated pre-surgical diagnosticandtherapeutic pathsandbythe to oncologyareinfl hip replacementsurgeryitshouldbeimproved. Datarelated cardiologic, vascularandophthalmologicalareas, whilefor In 2007too, goalattainmentisgenerally satisfactoryinthe replacement within180days. 90 days; treatmentof90%casescataract andhip treatment of90%casescarotidendarterectomywithin angioplasty andaortocoronarybypasswithin60days; cancer within30days; treatmentof90%casescoronary of allcasessurgeryforuterine, breastandcolorectal specifi In linewithnationalstandards, theRegionestablished by theRegionalHealthServiceamountedto296,000. Hospital admissionrateper1,000population, 9.1% a optl 45.4 Day hospital Inpatients 138.0 Extraregional attractionindexin2007: (public +private) Long-term andrehabilitation Inpatients acute(public+private) c objectivesforsometypesofsurgery: treatment st , 2007 as ofDecember31 edbysomenecessarytherapies). uenced byoverall timesrequiredby 15.01% 9.1% st , 2007 Day hospital(public+private) 71.8% 19,1 222-05-2009 17:37:25 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 2 5 SSSRE-R_2008_INGLESE9.indd 21 S R E - R _ 2 0 0 8 _ 100 I N 10 20 30 40 50 60 70 80 90 Public bedsdecreased from20,657in1996to16,1582007andhavebeenpartiallydevotedlong-termacutecare. 105.0 115.0 125.0 G 0 25.0 35.0 45.0 55.0 65.0 75.0 85.0 95.0 L E Percentage of planned surgery performed within time limits set by national standards, 2007 withintimelimitssetbynationalstandards, performed Percentage ofplannedsurgery S Cervical cancer E 9 . i n d 9619 9819 0020 0220 0420 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 d

2 Inpatient hospitaladmissionrate Overall hospitaladmissionrate Beds forinpatientacutecareanddayhospital(publicprivate) 1 Hospital admissionrates,1996-2007(indexnumber1996=100) Colorectal cancer Breast cancer Carotid endarterectomy Angioplasty (PTCA) DRG LEAadmissions(inpatientadmission>1day) Total dayhospitaladmissionrate Medical dayhospitaladmissionrate Coronary bypass Cataract (DH) 2007 Hip replacement 222-05-2009 17:37:26 2 - 0 5 - 2 0 0 9

1 7 21 : 3 7 :

2 facilities, expenditure, activity 6 22 SSSRE-R_2008_INGLESE9.indd 22 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ I N On December31 and semi-residentialfacilities. pathologic addictionsincludeanetworkofresidential institutions registeredinthe Auxiliary EntitiesRegional is concerned, untillastyearallthebedsofferedby the numberofbedsdevotedtopathologicaddictions in semi-residentialfacilities(7,5332006). As faras residential facilities(20,779in2006)and7,476beds S G L E S people withdisabilities, mentalhealthproblemsor ocial andhealthcareservicesfortheelderly, for E Beds infacilitiesforelderly, peoplewithdisabilities, 9 . i n d d

2 2 Beds inresidentialandsemi-residentialfacilities,2007=27,126 st , 2007therewere19,650bedsin mental health problems, addictions mental healthproblems, 2.8% 13.2% 8.5% 8.5% 35.9% 6.8% 35.9% 48.1% 76.2% 8.5% Elderly people Disabled people Psychiatric patients Elderly people Semi-residential facilities Residential facilities 6.8% 8.5% services fornonself-suffi is involvedinaprocessoffurtherqualifi the networkofresidentialandsemi-residentialfacilities the useofregionalFundfornonself-suffi From 2007, withthestartupofthree-yearprogram for accredited facilities. regional offerhasbeenredefi Through theaccreditationprocessstartedin2007, the facilities notoperating withintheNationalHealthService. Register werecalculated, thusincluding1,200bedsin 13.2% 2.8% Patients withaddictions Disabled people Patients withaddictions Psychiatric patients 76.2% 48.1% cient people. cient ned takingintoaccountonly cation ofallthe ciency, also 222-05-2009 17:37:26 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 2 6 SSSRE-R_2008_INGLESE9.indd 23 S R E - R _ 2 0 0 8 _ I N I admissions in2005to18hospices(includingtheGuastalla last years: from14hospiceswith170bedsand2,389 The hospicecarenetworkhasgrownconsiderably in in thetablebelow). beds –wasopenedonMarch2008anditisnotincluded offered 202beds(theGuastallaHospice-offering14 G oa 7 ,8 78102891. 0 ,8 18.0 3,182 202 19.0 2,859 170 17.8 2,389 170 Total Health Trust Rimini Local Trust Local Health Cesena Health Trust Forlì Local Trust Local Health Ravenna Health Trust Ferrara Local Health Trust Imola Local * InMarch2008theGuastallapublicHospicewasopenedwith14bedsin Hospital(ReggioEmiliaLocalHealth Trust). Trust Local Health Piacenza Trust Local Health Bologna Trust Hospital Modena elhTut opcsNo.of Hospices Health Trusts Health Trust Parma Local Trust (*) Local Health Reggio Emilia L E beds. As ofDecember31 n Emilia-Romagnathereare18hospicesoffering216 S E 9 . i n d d

2 3 atlSPer Pbi 2181. 2271. 21721.0 197 12 17.0 217 12 17.9 148 12 Public Castel S.Pietro Piccole Figlie sul Rubicone olmooiPbi 1321. 1251. 12614.5 256 11 14.5 265 11 12.5 302 11 Forlimpopoli Public dell’Uliveto agiaoPbi 22 161 73. 21531.2 115 12 38.9 57 12 21.6 25 12 Public Langhirano Borgonovo of Modena Savignano ogtr ulc85 248171. 123.9 81 8 17.3 107 8 22.4 59 8 Public Borgotaro di Albinea Chiantore Madonna Polyclinic oaoaPbi 22. 0 2981419.7 134 8 22.9 108 8 20.5 12 8 Dovadola Public Valtidone Seragnoli oiooPbi 12 15.4 25 11 Codigoro Public Fidenza elraPbi 31319.2 143 13 Bellaria Public iiiPbi 0121. 0151. 01414.1 194 10 15.1 195 10 17.7 162 10 Rimini Public uoPbi 32. 2 9681324.0 103 8 19.6 120 8 23.2 83 8 Lugo Public Ado Accredited Accredited Accredited Accredited Accredited private private private private private ulc1 4 661 3 501 3 19.1 232 12 25.0 233 12 16.6 246 12 Public ulc1 8 271 9 251 8 12.9 282 10 12.5 297 10 12.7 286 10 Public ulc1 011 4 661 5 18.9 159 10 16.6 149 10 20.1 7 10 Public st , 2007theywere17and beds 2272. 2201. 21421.0 194 12 19.5 200 12 20.1 207 12 0431. 0542. 06015.2 620 30 20.0 514 30 19.3 493 30 2272. 2242. 22119.1 221 12 20.6 204 12 20.2 207 12 5122. 5132. 52218.8 202 15 24.2 193 15 23.1 152 15 Hospices, 2005-2006-2007 Hospice care admitted patients No. of 0520 2007 2006 2005 stay (days) length of Average the Health Trusts. volunteer associationsthroughspecifi can bedirectlymanagedbyHealth Trusts orbynon-profi Hospices arelocatedinhospitalsorotherfacilities; they and psychologicalsupport. They guarantee personalizedcareincludingpaintherapy Hospices areintegrated intheregionalhealthcaresystem. Hospice) with216bedsand3,182admissionsin2007. No. of beds admitted patients No. of stay (days) length of Average No. of beds 412.0 24 8 cagreementswith admitted patients No. of stay (days) length of Average 222-05-2009 17:37:27 t 2 - 0 5 - 2 0 0 9

1 7 23 : 3 7 :

2 facilities, expenditure, activity 7 24 SSSRE-R_2008_INGLESE9.indd 24 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ I N S counselling. family membersandhealthcarepersonnel, specialist for familymembers, training andinformativecoursesfor cognitive stimulation, psychologicalsupportandhelpgroups requires differentlevelofinterventions: pharmacological, Care of Alzheimer disease(themaincauseofseniledementia) 1 inForlì, 1inCesenaandRimini. Modena, 10inBologna, 1inImola, 6inFerrara, 4inRavenna, dementia: 4inPiacenza, 4inParma, 7inReggioEmilia, 9in Health Trusts specializedinthediagnosisandcareofsenile In Emilia-Romagnathereare48facilitiesbelongingtoLocal of familymembers, volunteers. involving LocalHealth Trusts, Local Authorities, associations in specifi 10,000 12,000 G 10,000 20,000 30,000 40,000 50,000 60,000 2,000 4,000 6,000 8,000 L E S throughout the entire course of the disease at home or throughout theentirecourseofdiseaseathomeor upport andcaretodementiapatientstheirfamilies E 0 0 9 . i Psychological First visits n d c facilities has been organized as a network system c facilitieshasbeenorganizedasanetworksystem d

2 4 0120 0320 0520 2007 2006 2005 2004 2003 2002 2001 0120 0320 0520 2007 2006 2005 2004 2003 2002 2001 Controls

Healthcare Specialist consultationsforfamilymembers,2001-2007

Total visits Services forseniledementias Services

Legal Lifecontext Visits, 2001-2007 Visits, Total in 2006). and 10,806specialistconsultationswereoffered(11,893 In 2007newpatientsnumbered16,214(14,668lastyear) 50,784 in2006). centres doubledbetween2007and2001(56,542vs28,128; The totalnumberofvisitscarriedoutinregionalspecialized activities, suchasthe “Alzheimer Cafés”. Fund fornonself-suffi allocated atotalamountof684,000Eurosfromtheregional with associationsoffamilymembers. In2008, HealthDistricts promoted bysomeLocalHealth Trusts, oftenincollaboration so-called “Alzheimer Cafés” werecreated: meetingoccasions their problemswithpeoplelivingthesameexperience, the and, atthesametime, theopportunitytofamiliesshare To offerinformalcognitivestimulationto Alzheimer patients ciency for the development of group ciencyforthedevelopmentofgroup 222-05-2009 17:37:28 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 2 8 SSSRE-R_2008_INGLESE9.indd 25 S R E - R _ 2 0 0 8 _ 100 150 200 250 300 350 400 I 50 N 37.6% 3.2% T with dailyactivitiesorpeopleatriskofnonself-suffi The homecaresystemtakesofpeoplewhoneedhelp 2,252,130 ascomparedto2,078,765in2006. Also homevisitsbyhealthprofessionalshaveincreased: handled wererespectively90,403and84,001. amounted respectivelyto77,085and71,237, whilepatients the samepatient). In2006and2005, homecarepeople of 96,258patientshandled(moretreatmentperiodsto 0 G L 2006 E S In 2007assistedpeoplenumbered81,123foratotal he numberofhomecaredpatientsisconstantlygrowing. E 9 1 0-14 . i n 2007 d d

1 2 5 37.6% 57.5% 1.7% 3.2% Home caredpeople:specifi 54 56 56 07 57 08 58 =0Total onthe >=90 85-89 80-84 75-79 70-74 65-69 45-64 15-44 1 yeo oecr Levelsofcareintensity ofhomecare Type Specialist care Social care Nursing care General medicalcare 1 5 5 People caredfor, in2007=81,123 People handled,in2007=96,258 17 18 c ratesbyage per1,000population,2006-2007 Home care ciency, 57.5% 35 1.7% 35 the prioritiesofregionalFundfornonself-suffi simplifying accesstoaids. To supporthomecareisoneof autonomy andrelationalabilities, supportingfamiliesand admissions, whileguaranteeing continuityofcare, enhancing This formofcareaimsatavoidingimproperusehospital family orneighbours. live insuitableconditionsandcanbesupportedbythe who haveclinicalconditionsthatcanbetreatedathome, 17.7% 70 73 140 17.7% 33.2% 49.1% 147 High Medium Low 208 246 356 365 entire population ciency. 21 33.2% 49.1% 23 222-05-2009 17:37:28 2 - 0 5 - 2 0 0 9

1 7 25 : 3 7 :

2 facilities, expenditure, activity 8 26 SSSRE-R_2008_INGLESE9.indd 26 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ I N 10,000 15,000 20,000 25,000 30,000 35,000 Total expenditureforcareallowanceshasalsoincreased, from 9,600in2000to20,6022007. with careallowanceshavemorethandoubled, increasing From 2000uptonow, Emilia-Romagna familiessupported 2005: +1.9%). with 2006(thatshowedaslightgrowthrespectto 20,602 benefi suffi I G 5,000 L E allowances totakecareofsick, disabledornonself- n 2007, thenumberoffamiliesbenefi S cient familymembersathomehassignifi E 9 Benefi . i n d d

66316,700 16,623 2 6 9,634 ciaries 0020 0220 0420 062007 2006 2005 2004 2003 2002 2001 2000 ciaries witha10.7%increaseascompared ExpenditureinthousandEuros 11,508 People whobenefi Benefi 12,544 18,304 ciaries andexpenditure,2000-2007 Care allowances ting fromcare cantly grown: ted from careallowances,in2007=20,602 tedfrom 20,491 14,096 be completelyimplementedin2008). aimed attheregularizationoffamilyassistants(thatwill Care allowanceprovidesalsoforanadditionalcontribution funding allocationfortheabovementionedFund. self-suffi included intheresourcesforregionalFundnon Starting from2007, fundingforcareallowanceshasbeen million EurosfromMunicipalities’resources. from theregionalFundfornonself-suffi amounting in2007to33.6millionEuros: 31.9millionEuros 17,119 25,994 ciencyanditrepresents13.7%ofthe2007total 28,549 18,040 29,413 18,395 ciency and1.7 33,663 20,602 222-05-2009 17:37:30 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 3 0 SSSRE-R_2008_INGLESE9.indd 27 S R E - R _ 2 0 0 8 _ I N otolaryngology, orthopaedicsandurology. visits withsignifi mother-child andgeriatricareas, and5typesofspecialist identifi specialist care, 41typesofmedicalprocedureswere testing) andadmissions(insomespecifi containing waitinglistsforspecialistcare(visitsand in 2006Emilia-RomagnaapprovedtheRegionalplanfor As establishedbyanationalagreementofMarch2006, therapeutic. 71.6% laboratory testing, 3%rehabilitationand3.4% supplied include: 11.8%specialistvisits, 10.2%diagnostics, fi I 3.0% 3.4% G gureascomparedwith2006(69,812,752). The services L 10.2% 11.8% 71.6% E attendances wereregistered, asubstantiallystable n 2007, atotalof70,045,980outpatientspecialist S E 9 60,132,065 Types ofoutpatientspecialistmedical Types . edandgroupedintheoncological, cardiovascular, i n d d 2003

2 Diagnostics Visits Laboratory 7 cant impact: dermatology, ophthalmology, procedures, 2007 procedures, 65,084,557 Outpatient specialistcare 2004 3.0% 3.4% Specialist medical procedures, 2003-2007 Specialist medicalprocedures, Rehabilitation Therapeutics c areas). For 10.2% 11.8% 71.6% 64,947,896 2005 24 groupsofdiagnosticacts. medical proceduresandincludes12specialistvisits is focusedontheabovementioned41outpatientspecialist diagnostic teststhroughtheyears. Since2007, monitoring Regional Plan, ithasconstantlycovered25%visitsand17% lists beganin1999and, untiltheadoptionofnew In Emilia-Romagna, asystematicmonitoringofwaiting 90% cases. the maximumwaitingtimesmustberespectedinatleast the 41typesofoutpatientspecialistmedicalprocedures fi deferrable urgentcases, 30daysforfi providing care: 24hoursforurgentcases, 7daysfor The Planreconfi 1.7% 18.8% rst-accessinstrumentaldiagnosticacts. Inparticular, for 22.2% 24.7% 32.5% Economic values,2007 rms themaximumwaitingtimesfor 69,812,752 Visits Laboratory Diagnostics 2006 18.8% 1.7% rst visits, 60daysfor 70,045,980 2007 Rehabilitation Therapeutics 32.5% 22.2% 24.7% 222-05-2009 17:37:30 2 - 0 5 - 2 0 0 9

1 7 27 : 3 7 :

3 facilities, expenditure, activity 0 28 SSSRE-R_2008_INGLESE9.indd 28 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ I N G L Total Therapeutic treatments Rehabilitation Laboratory Diagnostics Visits E S E 9 . i n d d

2 8 oa hrpui ramns237253.4% 18,478 311,483 149,000 449,678 2,347,265 1,119,704 3.0% 298,922 100,654 2,100,014 556,115 71.6% Totaltreatments Therapeutic Other therapeutic treatments 1,320,328 Outpatient surgery 122,917 Transfusions 50,180,172 121,730 Odontology Dialysis Radiotherapy 2,425,035 Total rehabilitation 559,154 10.2% Other rehabilitation 6,875,848 35,340,801 Physical therapy 4,681,515 71,080 Functional rehabilitation 176,089 Diagnostic rehabilitation 319,527 7,127,744 11.8% Total Laboratory Genetics/cytogenetics Anatomy andpathologichistology 8,290,785 Microbiology/virology 2,415,564 Immunohaematology andtransfusion 5,818,798 Haematology/clotting 56,423 Clinical chemistry 3,894,967 2,842,170 Blood samplings Total Diagnostics Other diagnostics Biopsy Instrumental diagnosticswithoutradiations Instrumental diagnosticswithradiations Total Visits Intensive shortobservation Controls First visit Specialist medical procedures bytype,2007 Specialist medicalprocedures 00590100.0% 70,045,980 o % No. 222-05-2009 17:37:31 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 3 1 SSSRE-R_2008_INGLESE9.indd 29 S R Drugs delivered topublicbypharmacies E - R _ 2 0 0 8 _ I N Drugs totallycovered byRHS, the commercializationofinnovativehigh-costdrugs services –hasgrownby11.3%. The growthisdueto to inpatientsinhospitalsandusedoutpatientcare Hospital pharmaceuticalexpenditure–drugsdelivered of theObservatoryonMedicines–OSMED, 2007). expenditure decreasedof6.8%(source: NationalReport At nationallevel, prescriptionrate increasedof4.3%while at regionallevel. Drugs Agency andtothedirect “on behalf” delivery to areductionofdrugs’pricesestablishedbytheItalian prescriptions by4.7%. This restraint canbeattributed decreased by3%withrespecttoanincreasein by 1.4%. The contracted pharmaceuticalnetexpenditure In 2007, territorialpharmaceuticalexpendituredecreased • • • territorial andhospital. The firstoneincludes: Public pharmaceuticalexpenditureisclassifiedin continuity andconsistencyoftherapeutic treatments. P directly delivered topublic Pharmaceutical netexpenditure fordrugstotallycovered byRHS, by pharmaciescontracted withRHS Pharmaceutical netexpenditure fordrugsdelivered topublic oa einlpamcuia xedtr ,3,3,0 ,5,3,5 1.6% 73.7% 1,254,233,056 -1.4% 1,234,131,301 26.3% 924,856,149 11.3% 938,091,480 329,376,906 296,039,821 Total regionalpharmaceuticalexpenditure Pharmaceutical expenditureforinpatientsinhospitals Total territorialpharmaceuticalexpenditure G H OSP2drugsdirect delivery drugs deliveredbypharmacies “on behalf” ofRHSto drugs totallycoveredbyRHSanddirectlydelivered drugsdeliveredtopublicbypharmaciescontracted L directly delivered topublic chronic patientsandelderly. facilities; treated atresidentialorsemi-residentialhealthcare Trusts’ structures, homecaredpatients, patients affected bycomplexpathologiestreatedatHealth by RHSservicestochronicpatients, elderly, patients with theRegionalHealthService; fwihb hraiso eafo H ,3,0 ,4,2 28.2% 8,641,122 6,738,808 of whichbyHealth T of whichbypharmaciesonbehalfRHS fwihfrduscasfie HOP”addrcl eiee 750879,5,1 19.6% 92,758,916 77,580,877 of whichfordrugsclassifi ed “H OSP2” anddirectly delivered E of whichbyHealth Trusts’ S of whichbypharmacies E between hospitalandterritorialservicestoensure harmaceutical assistanceisbasedontheintegration 9 contracted with RHS . Hospital expenditure i n d d on behalfofRHS

2 Division of pharmaceutical expenditurebytype,2006-2007(inmillionEuros) Division ofpharmaceutical 9 pharmacies Pharmaceutical expenditurebytypeandpercentagevariation, 2005-2006 Pharmaceutical rusts’ pharmacies Pharmaceutical expenditure Pharmaceutical 2007 0 0 0 0 0 0 0 800 700 600 500 400 300 200 100

2006 the regionalHealth Trusts. personalized distributionthroughdirectdeliveryinall the centralized preparation ofantiblasticdrugs, the development ofcomputerizedsystemsforprescriptions, fosters thestrengtheningofdrugcontrolsystems, the For preventionofrisksrelatedtodruguse, theRegion effectiveness assessment. evidences’ transferability into clinicalpractice andcost- sharing ofsuchevidencesamonghealthprofessionals, availability ofdrugswithdocumentedclinicalevidences, Handbook wasissued, ausefulinstrumenttoguarantee and HealthcarePlan2008-2010theRegional Therapeutic According towhatestablishedbytheRegionalSocial one. expenditure withaverysignificantdecreaseinthefirst respectively 73.7%and26.3%oftotalpharmaceutical Territorial expenditureandhospitalcovered of thedirectdeliveryexpenditure. for homecareandthatregisteredanincreaseby19.6% part ofdrugsclassified “H OSP2”, thatcanbeusedalso immunosuppressants. This lastclasscoversasignificant degenerative diseases, inparticularantineoplasticsand and theincreaseindrugsconsumptiontotreatchronic Euros ascomparedto194.4Euros. Health Servicewithrespecttothenationalcost: 172.1 expenditure coveredbyagreementwiththeRegional Also in2007, Emilia-Romagnahadalowerpercapitadrug 3,6,2 4,8,2 6.2% 146,480,825 137,969,325 4,0,3 5,2,4 .%12.4% 7.2% 61.4% -3.0% 155,121,948 769,734,202 144,708,132 793,383,348 0620 % 2007 2006 Per capita drug expenditure Per capitadrug variation % on2007 total 222-05-2009 17:37:32 2 - 0 5 - 2 0 0 9

1 7 29 : 3 7 :

3 facilities, expenditure, activity 2 30 SSSRE-R_2008_INGLESE9.indd 30 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ I N L this result. Emilia-Romagna isoneofthefewregionshavingreached and servicestherelatedcarepathswasconcluded: childhood andadolescenceneuropsychiatryfacilities requested fortheaccreditationofterritorialandhospital During 2007, thedefi 2008-2010 wereelaborated. Plan 2008-2010andtherelatedimplementation section onmentalhealthintheSocialandHealthcare problems. StartingfromtheConferenceoutcomes, the in 2007, dealtalsowithsomeorganizationalandclinical The SecondRegionalConferenceonMentalHealth, held provide globalanswerstocareneeds. childhood andadolescenceneuropsychiatry, inorderto already presentOperational Unitsforadultpsychiatryand includes alsotheSubstance Abuse Service, beyondthe instituted in2007eachLocalHealth Trust andthatnow Department ofMentalHealthandPathologic Addictions, or pathologicaddictions. Coordinationisguaranteed bythe society ofpeopleallagesaffectedbymentaldisorders of prevention, care, rehabilitationandreintegration in 20,000 30,000 40,000 50,000 60,000 70,000 80,000 G L E S

non profi ocal Health Trusts, Local Authorities, volunteersand E 9 Adults . i n d d

3 49,647 35,293 0 0020 0220 0420 062007 2006 2005 2004 2003 2002 2001 2000 t organizationsareallinvolvedinactivities Minors nition processoftherequisites 53,384 35,030 Mental HealthServices Adult andminorpatients,2000-2007 50,638 34,837 63,142 37,442 to 18.7%per10,000population. and accreditedprivatehospitalsnumbered14,041, equal Centres amountedto1,617,000andadmissionsinpublic The careactssuppliedin2007byterritorialMentalHealth acts provided. 38,296 in2006(lastavailabledatum)with643,737care Operational Unitsincreasedfrom35,293in2000to for bytheChildhoodand Adolescence Neuropsychiatry 2007, ofwhich58%female(49,647in2000); minorscared Services hasgrownfrom62,618in2006to66,813 The numberofadultscaredforbypublicMentalHealth operational fromthatyear). 2006 isduetothenewinformativesystemthatwasfully starting from2000(theslightdropobservedforadultsin Data showanincreaseinbothminorandadultpatients the treatmentofeatingdisorders. start upofthecoordinationregionalnetworkfor the commercializationofspecifi defi multidisciplinary approachtochildrenwithattention guidelines forLocalHealth Trusts ontheappropriate integrated program onautism; clinical-organizational In 2007, someotherinitiativeswereimplemented: regional citandhyperactivity disorders(ADHD), alsofollowing 81668,604 68,176 36,124 36,818 c drugsforthispathology; 62,618 38,296 66,813 222-05-2009 17:37:32 2

- 0 5 - 2 0 0 9

1 7 : 3 7 : 3 2 SSSRE-R_2008_INGLESE9.indd 31 S R E - R _ 2 0 0 8 _ 10,000 11,000 I 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 N volunteers. Interventionsincludethedefi Health Trusts, Local Authorities, nonprofi involving theSubstance Abuse Services(SerTs)oftheLocal C heroin: 85.7%patientsin2007(ascomparedwith91,4% The primarysubstanceofabuseamongSerTs’patientsis coming fromotherregionsneedtobeadded. 5,499 foralcoholaddiction, towhich4,055drugaddicts 2007, 12,512personsweretreatedfordrugaddictionand necessarily linkedtosociallydisadvantagedsituations. In use morethanonesubstanceandthataddictionisnot demonstrate thatmoreandoftenthesepeople the lastfewyears: populationsurveysandactivitydata The profi pathways forcareandsocialjobrehabilitation. 071,1 ,5 ,9 22,066 21,432 5,499 20,792 5,174 19,288 5,108 18,709 4,055 4,686 3,699 4,176 3,474 12,512 3,371 12,559 2007 3,759 12,210 2006 11,231 2005 10,774 2004 2003 Years G L 0 E (primary and secondary substance of abuse) substanceofabuse) andsecondary (primary Persons with heroin and cocaine addictions andcocaineaddictions Persons withheroin S Persons with drug andalcoholaddictions Persons withdrug 9119 9319 9519 9719 9920 0120 0320 0520 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 Heroin and theirfamiliesisensuredbyanintegrated system are forpeoplewhodrugandalcoholabusers E 9 persons residingin . i n Emilia-Romagna d Drug addicted le ofsubstanceabusershasradically changedin d

Cocaine 3 1 treated at SerTs, 2003-2007 treated atSerTs, treated at SerTs, 1991-2007 treated atSerTs, persons coming Drug addicted from other regions Substance AbuseServices t organizations and t organizationsand Alcohol addicted persons residing nition ofspecifi Romagna in Emilia- Total c Internet website: indicators andtimeschedule. strategies throughanaccurate defi objectives for2008-2010” adoptedin2008offersconcrete drug use. The “Regional program forpathologicaddictions– Abuse Services’abilitytodealwiththenewphenomenaof Government approvedtheguidelinestoupgrade Substance Confronted withthesechanges, in2006theRegional addicts, 20.7%cocaineaddictsand14.3%alcoholaddicts. in 2006(lastavailabledatum), 55.9%wereprimarilyheroin the changeinpatients’profi Data fromresidentialandsemi-residentialfacilitiesconfi to 39.3%in2007. public serviceshassignifi 1991). The numberofcocaineaddictedpeoplereferringto 20.7% 55.9% 100% 10% 20% 30% 40% 50% 60% 70% 80% 90% residential andsemi-residentialfacilities,2006 20.7% values. Comparison1991-2007(multiple%)* 55.9% Persons with substances addiction treated at Persons withsubstancesaddictiontreatedat * Eachpersoncan use morethanonesubstance. 1991 Patients by substance of abuse. Percentage Patients bysubstanceofabuse.Percentage eonCcieCannabis Cocaine Heroin

2007 Cocaine Heroin http://www.saluter.it/dipendenze 14.3% 5.7% derivates cantly grownfrom5.9%in1991 le: outof2,722peopletreated substances Other Alcohol loo ezdaeieOther Benzodiazepine Alcohol nition ofobjectives, 0.6% 2.8% substances Unknown Cannabis substances 14.3% 0.6% 5.7% 2.8% rm rm 222-05-2009 17:37:32 2 - 0 5 - 2 0 0 9

1 7 31 : 3 7 :

3 facilities, expenditure, activity 2 32 SSSRE-R_2008_INGLESE9.indd 32 S R E - R facilities, expenditure, activity _ 2 0 Care in Family advisory healthcentres,Youth Care inFamilyadvisory healthcentres, 0 8 _ I N care amountsto20.9%ofthetotal; counsellingforpregnancy increased from6,329to8,594). Gynaecologicalspecialist women attendance(from740to7,811; Italianwomen 1995-2007 hasregisteredasignifi the total. Nextwasmaternitycare(22.7%), thatintheperiod and breastexamination)prevailed, representing33.2%of for earlydiagnosisoffemalecancers(pap-test, colposcopy and psychologicalservices(452,891in2006). Attendances centres forobstetrics-gynaecologyservices, pap-testscreening In 2007, 467,800personsturnedtoFamily advisoryhealth mostly thesame. increased by15%. Between2006and2007, dataremained From 1995to2007, activityincreasedby19%andusers available onaverage 74hoursaweekineachcentre. The team(obstetrician, gynaecologistandpsychologist)is with healthpersonnelandotherhealthcaresocialservices. cultural mediatorisalwaysavailabletoensuretheconnection centres forimmigrant womenandtheirchildren, wherea T G 1,000,000 L Health centresforimmigrantwomenandtheirchildren E 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 S 214 centres, including29 Youth centresand16Health he Family advisoryhealthcentresnetworkisformedby E 9 . i n d 0 d

3 2 Attendances 405,256 773,057 10,000 12,500 15,000 17,500 9520 0220 0420 062007 2006 2005 2004 2003 2002 2001 1995 2,500 5,000 7,500 Italians 397,392 806,923 9519 9719 9920 0120 0320 0520 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1996 Users Foreigners 823,719 435,079 1997 cant growthinforeign Patients andattendances,1995-2007 771,557 454,427 1998 20.9% 22.7% 33.2% Maternity care,1995-2007 Maternity 759,635 427,290 1999 (screening) Cancer prevention Gynaecology Pregnancy 764,151 422,021 2000 2007). for teenagers(about36,000adultsandyouthsinvolvedin couples involvedin2007), sexualhealthand AIDS prevention mainly onreproductionproblems(about12,000women/ Family advisoryhealthcentresalsooffereducation certifi prevention to6.5%(20%ofwhichareforeignwomen); medical 452,544 794,275 2.9% 6.5% 2.4% 20.9% 3.4% cation forvoluntaryabortionsto2.4%. 426,099 798,389 5.7% 6.5% 2.9% 3.4% Areas ofactivity, 2007 813,621 450,786 Psychological support Pregnancy prevention Menopause Post-natal care 918,008 454,959 463,540 899,935 2.4% 2.3% 893,124 452,891 to breastfeeding Support Voluntary abortion 920,126 467,800 33.2% 22.7% 2.3% 5.7% 222-05-2009 17:37:34 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 3 4 SSSRE-R_2008_INGLESE9.indd 33 S R E - R _ 2 0 0 8 _ I N (31.2%). oppositions wereregistered, belowthenationalaverage ineligibility). Onatotalof182potentialdonors, 51(28%) compatible recipientinItalyorEurope, donor’s ororgan’s (opposition byPublicProsecutor’s offi reasons independentfromthedonation-transplant network potential donorswhoseorganscouldnotbeusedfor new categoryintroducedatnationalleveltocountalso Data analysisnowincludesalso “notifi the regionasaboveItalianaverage (19.3). I Donations G 100 150 200 250 L 50 E Donations and transplants of organs, tissues andcells Donations andtransplantsoforgans, donors were26.4permillionpopulation, confi n 2007, inEmilia-Romagnathenumberofeffective 0 S E 9 . i n d d 196

2002

3 3 Donors (registered,notifi 231

2003 eitrdNtfidEfcieUsed Effective Notified Registered 214

2004 229 207

57.7% 2005 Potential donorsregisteredinEmilia-Romagna,2007 2.2% 8.2% 28% 182

2006 2.2% 8.2% 1.1% 2.2% 0.5% Prosecutor’s offi ce Opposition byPublic Ineligible Oppositions Used

2007 143 ce, unavailabilityof 138 ed donors”, a ed, effective, usedinEmilia-Romagna),2002-2007 ed, effective, 127 152 rming 127 118 volunteers’ andpatients’associations. as “A consciouschoice” withtheparticipationofregional donations arecarriedoutalsothroughregionalcampaigns Activities tomakecitizensawareoftheimportance Transplant Organization. Italy Transplant Program and12.4bytheCentral-Southern other interregionalassociations: 23.6bytheNorthern this datumisabovethevaluesregisteredbytwo Region, useddonorsnumbered23.9permillionpopulation; Association (AIRT)directedtill2009bytheEmilia-Romagna Within theterritoryofInterregional Transplant 0.5% 1.1% 2.2% 134 137 of ineligibilitytheorgan Effective donorsnotusedbecause pre-transplant ineligibility Effective donorsnotusedbecauseof their Cardiac arrest 120 145 118 108 57.7% 28% 122 119 114 140 114 105 222-05-2009 17:37:36 2 - 0 5 - 2 0 0 9

1 7 33 : 3 7 :

3 facilities, expenditure, activity 6 34 SSSRE-R_2008_INGLESE9.indd 34 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ I N liver transplant havebeenimplemented. In Emilia-Romagna, singlelistsforkidneytransplant and multivisceral transplant and12forlungtransplant. transplant, 470forlivertransplant, 18forintestine I Transplants O to 65, in2007twodonorsaged58and66wereused. that evaluatestheeligibilityofheartsfromdonorsagedup average age; yet, throughtheregionalprogram “Adonhers”, hypothetical regionalneed, activityisconditionedbydonors’ As forhearttransplants, althoughnearlycoveringthe also abovethenationalaverage. (33, equalto8.3transplants permillionpopulation)were transplants permillionpopulation)andhearttransplants world excellence. Kidneytransplants (146, equalto32.9 above thenationalaverage andalwaysreachinglevelsof of 34.6transplants permillionpopulation)werestill (138 performedinBolognaandModena, withavalue interventions ascomparedwith2006. Livertransplants G 100 200 300 400 500 L E Romagna (15fromlivingdonors), withanincreaseof10 n 2007, 320organtransplants wereperformedinEmilia- S 0 E n December31 numbered 1,724forkidneytransplant, 63forheart 9 . i n d d

Kidney 3 4 146 Patients inthewaitinglistasofDecember31 Transplants of organs, cellsandtissuesinEmilia-Romagna, 2007 Transplants oforgans, er ie netn ugCresCardiac Corneas Lung Heart Liver Intestine 33 st , 2007patientsinthewaitinglist 138 2 1 474 valves 10 vs 1.8yearsofnational datum isbelowthenationalone(1.7yearsinEmilia-Romagna (national average: 2.2years). Also forlivertransplant the2007 transplant (asatnationallevel), 0.4yearsforlungtransplant transplant (nationalaverage: 3years), 2.5yearsforheart In 2007waitingtimesfortransplant were: 2.8yearsforkidney transplants hasitsownInternetwebsite: The regionalsystemofdonationsandorganstissues 58 skin. bone marrowfromdonors, 326bonemarrowselfdonation, vessels, 99amnioticmembrane, 199skeletalmuscle, 84 concerned: 474corneas, 10cardiacvalves, 60blood The transplants performedin2007Emilia-Romagna surgeons andanaesthetists. the integration amongcardiologists, lungspecialists, thoracic of thetransplant programs forthetwoorgans, thusfostering with hearttransplant wasperformed, thankstothemerging Sant’Orsola-Malpighi), abilateral lungtransplant combined In 2007attheUniversityHospital Trust ofBologna(Polyclinic http://www.saluter.it/trapianti vessels Blood 60 membrane Amniotic 99 Skeletal average). muscle 199 marrow donors Bone from 84 st , 2007 donation marrow Bone 326 self Skin 58 222-05-2009 17:37:37 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 3 7 SSSRE-R_2008_INGLESE9.indd 35 S R E - R _ 2 0 0 8 _ I N 190,000 200,000 210,000 220,000 230,000 240,000 250,000 260,000 I Nevertheless, theregionaltransfusion systemguaranteed a decreaseof4,000donationsinSeptember2007alone. areas wasinterruptedfor20days. These measuresprovoked who hadstayed, evenforaveryshorttime, intheaffected infection werelocated, andbloodcollectionfromdonors donation wassuspendedintheareaswherecentresof affected someEmilia-Romagnaareas. Inparticular, blood fever epidemic(virustransmitted bythetigermosquito)that adopted inthe2007SummerbecauseofChikungunya collected); thisdecreaseisduetopreventionmeasures trend startedin2000(in2006, 248,764bloodunitshadbeen with thepreviousyear(-1.4%), thathasinterruptedthegrowth Collection activityhasregisteredaslightdropifcompared to 2006). units ofbloodconsumed(+4,649withrespect oa 4,7 4,6 1424502928246920230,187 2.0 234,629 239,278 244,510 -1.4 248,764 245,173 Total G Programs aen 7622,0 612,6 5522,7 . 22,303 21,800 72,350 7.7 29,000 -0.6 22,134 0.2 23,679 18,500 0.9 22,832 15,100 7.9 72,470 25,502 0.4 22,685 31,389 -10.2 72,607 24,010 29,762 20,500 31,666 17,815 15,334 25,896 60,000 -6.1 2.6 38,200 17,892 13,770 -0.3 28,248 29,404 -2.0 22,800 21,547 15,000 1.2 63,335 27,602 -1.9 36,045 22,109 Department -1.7 63,140 Rimini Unifi 28,218 ed Forlì, Cesena, 35,337 23,690 Ravenna 14,931 28,564 Ferrara 23,241 Bologna 14,682 Modena Reggio Emilia Parma Piacenza L E with 245,173 units of whole blood collected and 239,278 with 245,173unitsofwholebloodcollectedand239,278 n 2007, Emilia-Romagnaconfi S E 9 . i n d Collection d

3 215,640 226,875 5 0020 0220 0420 062007 2006 2005 2004 2003 2002 2001 2000 Blood collectionandconsumption(redunits).Comparison2007-2006 collection Consumption 2007 0483,9 353,0 9202,0 . 29,000 8.0 27,100 29,260 30,000 -3.5 31,594 30,498 Transfer ofblood(redunits) tootherregions,in2007=6,301 Blood collectionandconsumption Blood collectionandconsumption(redunits),2000-2007 217,991 227,827 rmed regionalself-suffi collection 2006 223,652 234,688 2007-2006 difference % ciency ciency 223,851 238,231 collection for 2007 Goals The EmiliaRomagnabloodsystemInternetwebsiteis: from infectiousrisks. of donors, bloodandcomponentstoprevention processes, withparticularreferencetotraceability methods to involvedonors, furtherdevelopingtransfusion safety transfusion facilities, spreadingpromotionalinitiatives was approvedin April 2007; thePlanisaimedataccrediting The BloodandPlasmaPlanforthethree-yearperiod2008-2010 indications. its institutionalframework accordingto2005national Starting from2008, the “blood system” hasmodified in 2007). (from 15,115bloodunitstransferred in2006to6,301units Emilia-Romagna hadtoreducebloodtransfer toneedyregions plasma use. But, asaconsequenceofthedropincollection, self-suffi http://www.donaresangue.it consumption 229,544 243,265 ciency andallhealthactivitiesrequiringblood 2007 consumption 231,987 247,243 2006 2007-2006 difference 234,629 248,764 % consumption for 2007 239,278 245,173 Goals 222-05-2009 17:37:37 2 - 0 5 - 2 0 0 9

1 7 35 : 3 7 :

3 facilities, expenditure, activity 7 36 SSSRE-R_2008_INGLESE9.indd 36 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ 100 I N 10 20 30 40 50 60 70 80 90 care, whichareimmediatelyofferedifnecessary. – arefreeofcharge, asanyrequiredadditionaltestingand The testsoffered–mammography, pap-test, faecalblood total of1,050,000). colorectal cancer(menandwomenaged50-69, fora cancer (womenaged25-64, foratotalof1,200,000)and cancer (womenaged50-69, foratotalof540,000), cervical system onlifestyles(“PASSI”), basedontelephone their habittoundergothesetests: anationalsurveillance Women’s attentiontopreventionisdemonstrated alsoby and 40.2%attendanceforcervicalscreening. data thatreported60.4%attendanceformammography average, asshownbytheNationalScreeningObservatory’s for pap-test. The outcomesarelargelyabovethenational Participation washigh: 73.8%formammography and55.6% mammography. time tohaveapap-testandforthefi 2007, thewomeninvolvedwereinvitedforfourth These programs havebeenactivesince1996. Throughout E G % % % % % % % % % % L E Screening programs for prevention and early diagnosis forpreventionandearlydiagnosis Screening programs S Screening programs: invitedpopulation Screening programs: E programs forpreventionandearlydiagnosisofbreast milia-Romagna hasthreeactiveoncologicalscreening as ofDecember31 9 . i 97.5% n between Emilia-RomagnaandItaly National ScreeningObservatory Emilia-Romagna Breast cancer d d

Screening programs forbreast Screening programs 3 6 75.1% and cervical cancer and cervical of breast, cervical andcolorectalcancer of breast,cervical 101.1% evclcne Colorectalcancer Cervical cancer st , 2007,comparison 82.8% fth timetohavea 92.9% 80.6% 100% 10% 20% 30% 40% 50% 60% 70% 80% 90% Internet website: in thelast2years. between 50and69yearsreporthavinghadamammography a pap-testinthelast3years, while80.6%womenaged women agedbetween25and64yearsreporthavinghad interviews, revealsthatin2007Emilia-Romagna84.3% Internet website: the last2years. having undergonefaecalbloodtestorcolonoscopyin 53% personsbetween50and69yearsofagereported The surveillancesystemPASSI documentatesthatin2007 program forcolorectal cancer. people aged50-69areinvolvedinanorganizedscreening It ishoweverimportanttopointoutthatinItalyonly48.4% National ScreeningObservatory(46%). (45.9%), andalignedwithnationalrates reportedbythe is 46.7%, slightlyhigheramongwomen(49.6%)thanmen were actuallycontactedwhileparticipationpercentage and men, halfofthereferencepopulation), 92.9%people With respecttothecallsplannedfor2007(536,580women and thesecondonewasstarted. As planned, during2007thefi Screening program forcolorectalcancer Screening program comparison betweenEmilia-Romagna 73.8% Screening programs: participation, participation, Screening programs: Breast cancer 60.4% http:// http://www.saluter.it/colon and Italy, 2007 www.saluter.it/screening 55.6% evclcne Colorectalcancer Cervical cancer rst roundwasconcluded 39.8% 46.7% 46% 222-05-2009 17:37:38 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 3 8 SSSRE-R_2008_INGLESE9.indd 37 S R E % positivetests - R _ 2 0 0 8 _ 10% I N 1% 2% 3% 4% 5% 6% 7% 8% 9% provides for a colonoscopy examination in case of positive provides foracolonoscopyexaminationincaseofpositive is morefrequentinmeneveryagegroup. The program 50 and54to7.5%intheagegroupbetween6569) test increasesbyage(from4.2%inthegroupbetween F W conservative treatments. The lastavailabledata(2006) Percentage of positive results from faecalblood Percentage ofpositiveresultsfrom G 0 L E S program’s datashowthatpositiveresultoffaecalblood rom March21 E Men andwomen Women Men 9 to suggestingandadoptingappropriatebreast hen surgeryisneeded, particularattentionisgiven . i n 0-5 5-5 60- 64 55 -59 50 -54 d 3.5% 4.2% 5.0% d

test, by age groups andgender test, byagegroups 3 7 Screening program forcolorectalcancer:fi Screening program st , 2005toDecember31 4.0% 5.0% 6.2% Conservative surgery forbreastcancer surgery Conservative 15% 85% 4.9% 6.2% 7.7% st , 2006, screening Conservative surgery Breast cancersurgery 65 -69 6.1% 7.5% 9.1% was discovered. or precancerouslesions, whilein7%casesamalignantcancer was detected, in49%casestheendoscopictestfoundbenign colonoscopy testswereperformed: in44%casesnolesion result fromfaecalbloodtest. Intheconsideredperiod, 18,338 surgery. show thatconservativesurgeryhasreached85%oftotal 35% 7% 15% (from March21 (from 14% 44% Colonoscopy outcomesinpatientstested Non conservativesurgery Low riskpolypus No lesion 2006), %values st , 2005toDecember31 85% rst outcomes rst 35% 7% Malignant cancer High riskpolypus st , 14% 44% 222-05-2009 17:37:38 2 - 0 5 - 2 0 0 9

1 7 37 : 3 7 :

3 facilities, expenditure, activity 8 38 SSSRE-R_2008_INGLESE9.indd 38 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ I N T slight decreaseinthecoverage forpeopleover65as The vaccinationcampaign2007-2008hasregistereda infl probably duetothelargemassmediainterestforavian The 2005-2006campaignregisteredanadhesionpeak working withthepublic, blooddonors). their professionalactivity(healthcarepersonnel, people protection againsttheinfl and childrenwithchronicdiseasespeoplethatneed G 10% 20% 30% 40% 50% 60% 70% 80% Infl L E uenza. Campaigns from 2003-2004to2007-2008 Campaigns from S 0 ted -freeofchargetopeopleagedover65, adults he regionalprogram forinfl E 100 150 200 250 uenza vaccination inadultsandchildren 9 50 . with chronic diseases(inthousands) with chronic i 0 n 9719 9819 9920 0020 0120 0220 0320 0420 0520 0620 2007-2008 2006-2007 2005-2006 2004-2005 2003-2004 2002-2003 2001-2002 2000-2001 1999-2000 1998-1999 1997-1998 d d

3 8 0320 0420 0520 0620 0720 0320 0420 0520 0620 2007-2008 2006-2007 2005-2006 2004-2005 2003-2004 2007-2008 2006-2007 2005-2006 2004-2005 2003-2004 177,131 Infl 171,734 uenza virusinfectionbecauseof uenza vaccinationinpopulationover65(%ofcoverage) uenza vaccinationisdirec- 202,521 Campaigns from 1997-1998to2007-2008 Campaigns from Infl 195,917 uenza vaccination uenza 188,232 (28.5% ofthetotal)vs15,845inpreviousone. 14.844 vaccinatedpeopleinthe2007-2008campaign Vaccine coverage isstilllowamonghealthcarepersonnel: gistered (188,232vs195,917inthe2006-2007campaign). by adultsandchildrenwithchronicdiseaseswasalsore- little decreaseinadhesiontothisvaccinationcampaign they amountedto715,239witha74.4%coverage rate). A with a73.1%coverage rate (inthe2006-2007campaign still high: 707,387personsagedover65werevaccinated compared tothepreviouscampaign, evenifthelevelsare Infl 2005; December31 physicians andcontractingpaediatriciansas ofDecember31 personnel employedintheRegionalHealth Service inhealthcareroles, generalpractice * Coveragewascalculatedconsideringasdenominator thenumberofhealthcare Campaigns from 2003-2004to2007-2008 Campaigns from uenza vaccination inhealthcarepersonnel 16,001 st , 2006. 13,062 (in thousands)* 18,751 15,845 st , 2004; December31 14,844 st , 222-05-2009 17:37:40 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 4 0 SSSRE-R_2008_INGLESE9.indd 39 S R E - R _ 2 0 0 8 _ I N for meningococcalvaccination, thatrepresentvery now 94.2%forpneumococcalvaccinationand88.5% vaccinations fornewbornchildren; coverage rates are Starting in2006, Emilia-Romagnapromotedtwonew rubella, measlesandparotitisisover93%. that isabovethenationalaverage, whilecoverage for haemophilus meningitisarerespectively97.3%and96.7% aged 2years, coverage rate forwhoopingcoughand As forvaccinationsstronglyrecommendedinchildren 97.3% coverage in2007. 2 years(polio, diphtheria, tetanus, hepatitisB), witha this targetforcompulsoryvaccinationsinchildrenaged Emilia-Romagna hasformanyyearsconstantlyexceeded T E 2007 Winter and crossed Europe affecting also Emilia-Romagna 2007 Winter andcrossed EuropeaffectingalsoEmilia-Romagna is goingon(lastmeaslesandrubella epidemicstartedinthe The campaigntopromotemeasles-parotitis-rubella vaccination objective ofspreadingeducation andrelianceonvaccinations. G 87% 88% 89% 90% 91% 92% 93% 94% 95% 96% 97% 98% % coverage: 97.3 Hepatitis B Tetanus Diphtheria Polio 24 months vaccinations, Compulsory L E S level istoreachlevelsofcoverage of95%children. he goalofchildhoodvaccinationprograms atnational vaccination against HPV but also to the more general vaccination againstHPVbutalsotothemoregeneral milia-Romagna isnotonlycommittedtopromoting E 9 . i n d Compulsory d

3 9 Rubella Haemophilus meningitis Childhood vaccinations,2007(%ofcoverage) Childhood vaccinations Vaccinations: 2008objectives 24 months Whooping Meningococcal vaccination88.5% Pneumococcal vaccination94.2% Measles 93.5% Whooping cough97.3% Haemophilus meningitis96.7% Rubella 93.4% within 24months-%coverage Recommended vaccinations, cough Measles Pneumococcal of charge. All thevaccinationsabovementionedareofferedfree charge uponparents’requestalsotogirlsbornin1996. undergo thevaccination. The vaccineisofferedfreeof girls bornin1977(foratotalof16,611)wereinvitedto addressed togirlsintheirtwelfthyear. During2008 serotypes 16and18ofHumanPapilloma Virus (HPV), Regions, activatedthevaccinationprogram against In March2008Emilia-Romagna, asallotherItalian cochlear implants(93.5%)andasplenicones(90.5%). 2007 goodcoverage levelsespeciallyinchildrenwith vaccination -whichisofferedsince2001showedin predisposing chronicdiseases, thepneumococcal up phase. Inchildrenatincreasedriskbecauseof satisfactory resultsconsideringthatitwasthestart vaccination is stillgoingon. abortion orseveredamagesto thechild(congenitalrubella) in womenchild-bearingage topreventspontaneous commitment topromotethediffusion ofrubellavaccination have notyetbeeninvolvedandtohealthcarepersonnel. The Region) andisaddressedinparticulartoboysgirlswho Meningococcal vaccination Measles 94.9% Rubella 92.8% 13 years-%coverage Recommended vaccinations, uel Measles Rubella 13 years 222-05-2009 17:37:40 2 - 0 5 - 2 0 0 9

1 7 39 : 3 7 :

4 facilities, expenditure, activity 0 40 SSSRE-R_2008_INGLESE9.indd 40 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ I N (ratio betweenthenumberofaccidentsand employed workers(-26.1%). The accidentincidenceindex absolute fi decreased, alsothankstoinspectionactivities, bothas In thesameperiod, however, thenumberofaccidents workers increasedby25.6%(from132,521to165,385). (from 57,537to77,632)andthenumberofemployed growth trend: thenumberoffi between 2001and2007, thissectorregisteredasignifi penal procedurewasstartedin32.6%cases. Intheperiod the constructionsector3,161siteswereinspected, anda In thesameyear, withintheSpecialinspectionplanfor at theLocalHealth Trusts inspected10,004fi In 2007, theServicesforoccupationalhealthandsafety decreased by36%, from174to111. decreased by7%, from140,766to130,626; fatalaccidents from 2000to2007thenumberofaccidentsreported 5/100 workersreportedaccidents. Intheeight-yearperiod Institute forOccupational Accidents (INAIL). Onaverage I (*) Sites. G otcncl1%1 74 276 10,004 142 877 221 427 120 12 2,219 51 5 151 51 208 32 88 40 10 11 1,902 22.2% 16% 747 18% 314 17% 4% 42 23% 3,161(*) 122 7% 44 17 443 252 2 8% 2 398 94 1,032(*) 68 196 384 25 20% 23% 9 19% 25 5% 81 18% 32.6% 13% 22% 19 48 Total Region 20% Zootechnical 10% 20% Transportation 20% Textile/clothing Services School 10% 13% Health Public Metal andmechanical Finedfi Wood industry Energy, water, gas Publishing Irregularityindex Construction Credit Trading Chemical Ceramics Dockyards Other Food Hotel/catering Agriculture Activity sector L E accidents werereportedtotheNationalInsurance n Emilia-Romagnain2007130,626occupational S E 9 . i n d d

gure (-7%)andascomparedtothenumberof

4 0 Number offi Occupational healthandsafety rms inspected in Emilia-Romagna and irregularity index,2007 inspectedinEmilia-Romagnaandirregularity rms rms increasedby34.9% rms. cant cant completely unprotected. restrictions againstrisksand0.4%wereconsidered of which87.1%wereconsideredsafe, 6.9%needed activity involved81%workersexposedtospecifi accidents (employeesnumbered59,725); inspection Regional HealthService, referredto2006, report7,827 and socialactivitiessector. The lastavailabledataonthe accidents andoccupationaldiseasesinthehealthcare A specifi ceramic producers’associationsand Trade Unions. National Insurance InstituteforOccupational Accidents, the Romagna manufacturingleadingdistrict)bytheRegion, the A similaragreementwassignedfortheceramic sector(Emilia- activities. through theimprovementofworkqualityandinspection period 2007-2009thelevelsofsafetyabovelawstandard, working intheport, toguarantee andincreaseinthe Municipality, portauthorities, Trade Unionsandthefi Region, thePublicProsecutor’s offi In 2007, anagreementwassignedinRavennabythe of workers)shiftedfrom8.9in2001to6.32007. cplanwasimplementedtodetectthecausesof rsInspected fi rms ce, theProvince, the c risks, c rms rms 222-05-2009 17:37:41 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 4 1 SSSRE-R_2008_INGLESE9.indd 41 S R E - R _ 2 0 0 8 _ I N 29% 30% 31% 32% 33% 34% 35% 36% 37% 38% 39% 40% G oa ciet 7,827 accidents 59,725 Total daysofabsencefromworkdueto Total accidents blood orotherbiologicliquids) Accidents duetobiologicalcauses(contactwith to INAIL) Accidents withprognosis<3days(notreported INAIL) Accidents withprognosis>4days(reported to Health Trusts’employees L E Regional Health Service –accidents,2006 Regional HealthService S E Construction sector – irregularity index sector–irregularity Construction 9 38.94% . i n 2001 d (no. offi d

4 1 32.92% 2002 ned fi ned 35.22% 2001-2007 2003 rms/100 inspected), rms/100 34.25% 2004 34.28% 2005 32.99% 2006 86,745 2,556 2,165 3,096 32.65% 2007 100% 10% 20% 30% 40% 50% 60% 70% 80% 90% 10% 1% 2% 3% 4% 5% 6% 7% 8% 9% on employees exposed to professional risks, on employeesexposedtoprofessional Construction sector–accidentsincidence Construction index (no.ofworkers/no.accidents), Regional Health Service –inspections Regional HealthService Complete ineligibility 8.97% 2001 to duties 0.4% 8.34% 0220 0420 062007 2006 2005 2004 2003 2002 2006 (%values) Partial ineligibility 7.98% to duties 2001-2007 5.6% 7.64% 7.09% Restriction cases 6.9% 7.01% Eligible workers 6.25% 87.1% 222-05-2009 17:37:41 2 - 0 5 - 2 0 0 9

1 7 41 : 3 7 :

4 facilities, expenditure, activity 1 42 SSSRE-R_2008_INGLESE9.indd 42 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ I N T From 2002to20072,697inspections(about450peryear) necessary. and interventionsontheurbanroadsystemarealso the territorialcontext, existingrailway linesrenovation this railway line. To integrate thenewrailway linewithin embankments, viaducts, anewundergroundstationfor artificial galleries, wellsforaccesstogalleries, The junctionareaincludes: 3natural gallerysections, the projectisdivided. where thesitesarelocatedandseveral lotsinwhich the widerange ofinterventionsactivated, thecitycontext G 07594 .1 2 268%292 9.32% 21.68% 27.25% 26 39.30% 67 23.84% 103 279 100 309 36 378 6.87% 257 11.54% 151 7.74% 22 6.94% 51 10.53% 25 320 24 442 20 8.01% 323 16.14% 346 190 18.26% 48 118 20.56% 16.42% 128 599 124 731 56 701 603 2007 341 2006 2005 2004 2003 erEmployed Year L E S speed/high-capacity railway lines, characterized by he Bolognajunctionisamajorprojectinthehigh- E 9 . i n and powerlinesubstations d d and organizational setting

Building forequipments

electrification andtrims 4 Railway embankments Box-shaped structures 2 Check ofequipments Base camps, plants, and othercontrols bridges, subways station andwells workshops, sites Railways tracks, Artificial gallery Natural gallery workers Underground Road system, and cuttings Occupational safety in major projects: Occupational safetyinmajorprojects: Viaduct 2004 ciet %incidence Accidents l ie pnarstsNaturalgalleriessites Openairsites All sites

2005 the Bolognarailwayjunction Inspections by area of intervention, 2004-2007 Inspections byareaofintervention,

2006 Accidents frequencyindex,2003-2007

2007 %1%1%2%2%30% 25% 20% 15% 10% 5% index Employed workers half (from21.68%in2006to9.32%2007). accident indexinnatural galleriesdecreasedbymorethan work usingthemillingcutterended-fi sliding, falls, liftingstressingalleries. When theexcavation during excavationswiththemillingcutterandweredueto a 39.3%peakin2004). Manyoftheseaccidentsoccurred of workers/no. ofaccidents)waslargelyabove20%(with In theperiod2003-2006accidentsincidenceindex(no. in 2006and2007). the gallerysites(morethan20%oftotalinspectionsboth station. Inthelasttwoyearsmoreattentionwaspaidto 2007, 1inspectionoutof4(24.9%)wasintheunderground were carriedout, inparticularhigherrisksareas: in ciet %incidence Accidents index Employed workers ciet %incidence Accidents rst halfof2006- index 222-05-2009 17:37:42 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 4 2 SSSRE-R_2008_INGLESE9.indd 43 S R E - R _ 2 0 0 8 _ I N L products havesignifi In 2007irregularitiesinplantsforprocessingmilkanddairy regulations. inspections onanimalhealthaccordingtonewEuropean this phenomenonisduealsototheintensifi progressive increaseofirregularitiesstartingfrom2003: Data oncontrolscattleandpigfarmsevidencea companies, inordertosafeguardcitizenshealth. production totransformation plantsandfoodretail G Rabbit Poultry Horse Sheep andgoats Pigs Cattle L 1 2 3 4 5 6 7 E % % % % % % % S pathway: fromprimaryzootechnicalandagricultural ocal Health Trusts controlfoodsafetyovertheentire E 2005 9 . i n d d Food pathway:facilities,inspectionsandirregularities

2006 Cattle farms 4 3

2007 cantly decreased, from63%in2006to Irregularities found in animal farms, 2005-2007 foundinanimalfarms, Irregularities Pig farms Inspections in animal farms, 2007 Inspections inanimalfarms, Food safety cto of cation Sheep and goat farms those workinginfoodpathway. addressed inparticulartohealthprofessionalsand The website poultry farms(from4.3%in2006to1.1%2007). and deposit(from40%in2006to29.6%2007) 25% in2006to11%2007); inplantsformeatprocessing Irregularities decreasedalsoinfi by afl surveillance plansin2003tofacetheemergencycaused 25.8% in2007, thankstotheimplementationofpermanent atoxins thataffectedcattlefeedandmilk. Horse farms http://www.saluter.it/ambientiesalute aiiisIsetosIrregularities Inspections Facilities ,6 16877 49 71 11,698 254 8,037 611 4,452 7,161 26,927 6,358 63,250 3,266 3,923 9,191 2 ,6 7 1,462 523 Poultry farms sh processing plants (from sh processingplants(from Rabbit farms is 222-05-2009 17:37:42 2 - 0 5 - 2 0 0 9

1 7 43 : 3 7 :

4 facilities, expenditure, activity 2 44 SSSRE-R_2008_INGLESE9.indd 44 S R E - R facilities, expenditure, activity _ 2 0 0 8 _ I N G odrti n itiuin1,4 ,3 623 5,837 14,542 925 4,361 10,574 Food retail anddistribution Catering Plants forvegetablesprocessing, productionandpackaging lnsfrml n ar rdcspoesn 5 ,1 220 314 13 6,111 237 19,727 854 250 38,565 1,062 451 45 Plants formilkanddairyproductsprocessing Plants foreggpackagingandprocessingofproducts Fish processingplants Plants formeatanddepositprocessing Slaughterhouses andmeatcuttingplants L 10% 12% 10% 20% 30% 40% 50% 60% 70% Irregularities found in plants for vegetables processing, production, cateringanddistribution, production, foundinplantsforvegetablesprocessing, Irregularities E 2% 4% 6% 8% S Inspections in plants for vegetables processing, production, catering anddistribution,2007 production, Inspections inplantsforvegetablesprocessing, E 9 2005 . i 2005 n d d Slaughterhouses and

meat cuttingplants

4 2006 4

Irregularities found in production plantsoffoodanimalorigin,2005-2007 foundinproduction Irregularities 2006 Plants forvegetablesprocessing, production andpackaging

2007

2007 Inspections in production plantsoffoodanimalorigin,2007 Inspections inproduction Plants formeatand deposit processing 2005-2007 ihpoesn lnsPlantsforeggpackaging Fish processingplants aeigFood retail anddistribution Catering aiiisisetosirregularities inspections facilities and processing of eggproducts aiiisisetosirregularities inspections facilities 6921,0 3,076 15,100 36,962 1 ,4 23 4,249 210 Plants formilkanddairy products processing 222-05-2009 17:37:42 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 4 2 SSSRE-R_2008_INGLESE9.indd 45 S R E - R _ 2 0 0 8 _ I N A Region-University ResearchProgram 1) divided in3mainareas: amount of30millionEurosforthe3-yearperiod2007-2009, The Regionisinvesting(throughspecifi professional networks. The Program aimsatdevelopingcentresofexcellenceand (representing thehubofsynergies)andallHealth Trusts. integration withUniversitiesandUniversityHospital Trusts educational methodsthroughthecollaboration and innovations andnewmanagement, organizationaland activated atthebeginningof2007todevelopscientifi 2005, theRegion-UniversityResearchProgram was 2) 3) program, togetherwiththeGeneral DirectionforHealthand the roleofscientifi The RegionalHealthcareandSocial Agency, whichhas are issuedalsofor2008and2009. clinical governanceresearchandtraining annualtenders research areahasbeencompleted, whilefor theareasof The evaluationprocessofprojectsfortheinnovative complete proposals. adjusting projectproposalsaswellintheevaluationof referees. They canintervene intheinitialphasetohelp of theproposals, andissupportedbyItalianforeign follows differentstagesdependingonthecomplexity for furtherevaluationandfi Directors areentitledtoselecttheprojectsbesubmitted Research Hospital “Rizzoli”. Inparticular, theBoardof Departments oftheUniversityHospital Trusts andofthe played bytheBoardofDirectorsandintegrated In theproposalphaseofprojectanimportantroleis G L E training neurosciences, regenerative medicine; particular ontransplants, oncology, advanceddiagnostics, technologies/instruments usefulforhealthcareactivity, in of excellencecapabledesigningandproducing area isaimedatthedevelopmentofcentres/groups information onappropriateuseisstillmissing; entry stage, oralreadyusedinclinicalpractice, forwhich risk profi resources): thegoalistoenlargeknowledgeonbenefi projects (bothcontrolledevaluationandmonitoring). organizational andhealthcareissuesintoresearch able todoresearchandtransform themostrelevant to encourage the developmentofprofessionalnetworks innovative research research forclinicalgovernance S Region-University Agreement ProtocolofFebruary ccording toRegionalLawno. 29/2004andtothe E 9 . i n d d

4 le oftechnologiesandinterventionsintheir 5 (5% oftotalresources): theaimofthisareais c and operational coordinatorofthis Research andInnovationPrograms (70% oftotalresources): this nancing. Projectselection c tenders)atotal (25% oftotal t- c Healthcare andSocial Agency: More informationisavailableonthewebsiteofRegional patients, suchasmentalhealthandprimarycare. to additionalimportantthemesforhealthservicesand The projectareasofresearch-interventionwillbeextended Italian Drug Agency). in Oncology; tendersforIndependentResearchby the Programs forHealth; 2007-2009SpecialtenderforResearch Ministry ofLabour, Healthand Welfare (NationalResearch other Regionswithinnationalprograms fi Many oftheseprojectsaredevelopedincollaboration with ------in PRIE-Rcoverdifferentareas: subscribe tothegeneral objectives. The projectsincluded contribution ofotherpublicandprivatesubjectsthat established withregionalresourcesandthe PRI E-RisfinancedbyaspecialFundforinnovation signifi points insafeguardingaspectsthatareethicaland and discussoperational modelsandtoidentifycritical involvement oftheLocalethicscommittees(tocompare and Social Agency guarantees thecoordinationwith multidisciplinary workgroups. The RegionalHealthcare PRI E-Rorganizesitsactivitiesbythemesinspecific part ofthehealthcaresystem. process inwhichresearchandinnovationareanintegral and personnelfromparticipantstoprotagonistsina structures, withtheintentionoftransforming organizations transfer ofclinical-organizationalinnovationstoRHS purpose istopromotepriorityresearchforthetimely T Research andInnovationProgram(PRIE-R) http://asr.regione.emilia-romagna.it/ of aspecialSteeringCommittee. for activatingandmonitoringprojects, withthesupervision Social PoliciesoftheRegionalGovernmentisresponsible families. relational aspectsandtotheneedsofpatientstheir organizational andcaremodelsassuringattentionto humanization inIntensiveCareUnits severe sepsis; infection transmissionrisk multislice computedtomography incoronarydisease; high-cost diagnostics patients; cerebrovascular area in patientswithmultivesselcoronarydisease; cardiology patients; appropriate useofoncologicaldrugs, follow-upof oncology participation ofalltheregionalHealth Trusts. The main he PRIE-RProgram wasactivatedin2004withthe cantforresearch). : innovationinoncologicalradiotherapy; : useofdrugelutingstents(DES)andbypasses : useofPETinoncology, useof : integrated careforstroke : reductionofmortalityfor nanced bythe : adoptionof 222-05-2009 17:37:43 2 - 0 5 - 2 0 0 9

1 7 45 : 3 7 :

4 programs 3 46 SSSRE-R_2008_INGLESE9.indd 46 S R E - R programs _ 2 0 0 8 _ I N through: Every Health Trust improvesglobalsafetyinitsstructures accreditation processofthefacility. policies andtodamagesrefund)ischeckedforthe Plan” (thatincludesalsoissuesrelatedtocommunication existence andthecontentsofHealth Trust’s “Safety for patients’andhealthprofessionals’safety. The actual clinical activitiesandtoelaborate appropriatemeasures Trusts tograde thepotentialriskslinkedtotheirspecifi out. The mostimportantonewastherequesttoHealth training, surveillanceandimprovementhavebeenworked In latestyears, manyinitiativesforhealthprofessionals’ Healthcare Plan2008-2010. Healthcare Plan, alsore-statedinthefi to patientsafetyamongtheprioritiesofRegional Since 1999, Emilia-Romagnahasincludedattention error). misunderstanding, equipmentmalfunctioningorhuman as arelinkedtocare(forexample, anorganizational risks pertaintothefacility(forexample, afall)aswell • • • P and riskmanagementinhealthcare Programs forprevention, surveillance of theeconomicaspects damage. communication withthepublic, training, andmanagement Health Trusts thatareengagedinsafety, caredelivery, the problem, involvingthevariousstructuresin the their implementation, makeitpossibletodeal with and spreadin2006currentlyunderverifi The developedinitiatives, togetherwithguidelines prepared • • • G techniquesthatanalyzecriticalpointsofcareprocesses aregionalsystemforgatheringreportsandcomplaints professionals’training onmattersrelatedtofacilities, increasedattentiontorelationswithpatients, inthe asystemofincidentreporting: voluntaryreportingof introductionofpractices andproceduresthathave L from thepublic; aspects tobereviewed; or studythedynamicsofadverseeventstoevidence equipments andbehaviourssafety. more respectfulway; administrative aspectsincaseofdamagedpeoplea effort ofbecomingabletosolveconfl protective orpreventivemeasures; of theseverityoutcome, inordertoactivate dangerous situationsoraccidentsbyworkers, regardless of falling; antibiotics beforesurgery, selectionofpatientsatrisk of patientsthatneedsurgicaloperations ortransfusions, implementation ofsystemsforthereliableidentifi proven effectivetoreduceknownrisks, suchasthe E S E the environmentwherecareisprovided. These atients incurriskswhentheycomeincontactwith 9 . i n d d

4 6 Programs for prevention, surveillance forprevention,surveillance Programs and riskmanagementinhealthcare icts and to manage icts andtomanage rst Socialand cation for cation cation c The priorityareasofinterventionare: resources specifi objectives, toolsneededtoreachtheseobjectivesand the developmentofaplandefi specifi services andinhomecare, shouldbeconsideredasa in hospitals, interritorialhealthcareandsocial-health prevention andcontrolofinfectionsrelatedtohealthcare According totheSocialandHealthcarePlan2008-2010, and tofi meet periodicallytocompareexperiencesandproblems Committees areconnectedinaregionalnetworkand physicians andnursestocoordinatetheseactivities. The an InfectionControlCommitteeandhaveidentified the regionalguidelines, allHealth Trusts haveinstituted system coordinatedatregionallevel. As indicatedin but alsoresidentialfacilities, andisbasedonanetwork The program regardsnotonlypublicandprivatehospitals guidelines andauditprograms inhigh-riskareas). reduction (defi promote caremeasuresofproveneffectivenessforrisk surveillance ofinfectionsinintensivecareunits)andto events, surveillanceofsurgicalinfectionsatregionallevel, on laboratories data, surveillanceofepidemicsandsentinel developed forriskdetectionandgrading (surveillancebased health organizations, toolsandmethodologieshavebeen the aimtoimprovepreventionandcontrolabilitiesin competences withintheHealth Trusts. Inlatestyears, with outcomes) itrequiresspecifi of preventionandcontrolmeasures, varietyofclinical for itscharacteristics (complexityofdeterminantsand management activityinhealthorganizations, evenif T infections correlatedwithcare Program forsurveillanceandcontrolof and Social Agency: The programs arecoordinatedbytheRegionalHealthcare • • • • elaboration anddevelopmentofsurveillancecontrol spreadingandadoptionofgoodpractice procedures preventionoftheselectionanddiffusionmicro- surveillanceandcontrolofepidemicssentinel organisms andantibioticmultiresistantorganisms; intensive careunits); for infectionprevention(inparticularinsurgeryand events; care. programs forinfectionsinresidentialfacilitiesandhome correlated withcarepractices ispartoftherisk he preventionofcomplicationsduetoinfections c taskforHealth Trusts tobeachievedthrough ndsolutions. nition, spreadingandimplementationof callyassigned.

http://asr.regione.emilia-romagna.it/ c interventions and professional c interventionsandprofessional ning short/mediumperiod 222-05-2009 17:37:43 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 4 3 SSSRE-R_2008_INGLESE9.indd 47 S R E - R _ 2 0 0 8 _ I N access. systematic relationshipforanalyzingresultsandsimplifying on thedecisionstaken, butabovealltocreateafi representatives, notonlytosupplycorrectinformation creating astablerelationshipwithcitizensandtheir Healthcare Conferences. They arealsocommittedto District Committeesandtothe Territorial Socialand had previouslybeensubmittedtotherespectiveHealth Hospitals, presentedthelocalimplementationplanwhich together withUniversityHospital Trusts orResearch As requiredbytheRegionalPlan, LocalHealth Trusts, implementing nationalstandards. (Resolutions no. 1532/2006andno. 73/2007), thus specifi inguinal herniaanddecompressionofcarpaltunnel. vein ligationandstripping, haemorrhoidectomy, repairof colon surgery, tonsillectomy, percutaneousliverbiopsy, also concernspecifi and geriatrics(hipreplacementcataracts). They angioplasty, carotidendarterectomy, coronarography) chemotherapy), cardiology(aortocoronarybypass, coronary areas ofinterventionarefocusedononcology(surgery, For inpatientanddayhospital/daysurgeryadmissions, the hospital admissions Areas ofinterventionforplanned ophthalmology, otolaryngology, orthopaedics, urology. 5 typesofspecialistvisitsgreatimpact: dermatology, cardiovascular area, mother-child health andgeriatrics, and care concern41typesofproceduresgroupedinoncology, The areasofinterventionthePlanonoutpatientspecialist specialist care Areas ofinterventionforoutpatient A in 80%cases. Care wasdeliveredwithintheprescribedwaitingtimes through theyears–25%visitsand17%diagnostictests. specialist carebeganin1999andcovered–constantly In Emilia-Romagna, monitoringofwaitinglistsforoutpatient for outpatientspecialistcare Objectives onwaitinglists G L E S

specialist care (visits and diagnostic) and admissions (in specialist care(visitsanddiagnostic)admissions(in Regional Plantoreducewaitinglistsforoutpatient E Plan toreducewaitinglistsforoutpatientspecialist 9 c areas)wasapprovedbytheRegionalGovernment . i n d d

4 7 c medicalprocedures: lungsurgery, care andplannedhospitaladmissions rmand procedures foraccess. that isdeliveredincentresofexcellence, andtherelated specifi be respected. The implementationplansalsocontain territorial contextwithinwhichsuchwaitingtimesmust In theirimplementationplans, Health Trusts identifythe waiting timesmustberespectedinatleast90%cases. specialist care, theRegionalPlanspecifi In particular, forthetargeted41typesofoutpatient access instrumentaldiagnostics. care, 30daysforfi care: 24hoursforurgentcare, 7daysfordeferrable urgent The Planreconfi was alreadyactivesince2000inEmilia-Romagna. The Planextendstoadmissionsthemonitoringsystemthat cataracts and hipreplacement). coronarography) andgeriatrics(includingsurgeryfor coronary angioplasty, carotidendarterectomy, cardiovascular area(includingaortocoronarybypass, prostate, colorectalandcervicalcancerchemotherapy), monitoring: oncology(includingsurgeryforbreast, waiting timesinatleast90%cases-asobjectsof healthcare services-tobedeliveredwithinmaximum The Planidentifi hospital admissions Objectives onwaitinglistsforplanned and effi for careandguarantees asystembasedontransparency citizens withinformationaboutavailabilityofappointments system called “CUP” (unifi each Health Trust throughacomputerizedcentral booking The offerofoutpatientspecialistcareismadeavailablein specialist care The systemforbookingoutpatient c pathwaysfor “complex specialistcare” orcare ciency. rms maximum waiting times for delivering rms maximumwaitingtimesfordelivering es theareasthatgrouptogether rst specialistvisits, 60daysforfi ed bookingcentre). CUPprovides esthatmaximum rst- 222-05-2009 17:37:43 2 - 0 5 - 2 0 0 9

1 7 47 : 3 7 :

4 programs 3 48 SSSRE-R_2008_INGLESE9.indd 48 S R E - R programs _ 2 0 0 8 _ I N self-suffi expenditures relatedtothedevelopmentofservicesfornon and health-relatedsocialcharges, whilehealthcostsand are usedtoassurethecoverage forsocialexpenditures The Fundcanalsocountonextra funds; theseresources and theirfamilies. integrated system ofservicesfornonself-suffi Trade Unions, areallengagedintheimplementationofan Trusts, volunteers’associationsandnon-profi and localwelfare: theRegion, Local Authorities, LocalHealth an importantaspectofthecreationprocessaregional the SocialandHealthcarePlan2008-2010itrepresents The Fundreferstothestrategic guidelinesestablishedby citizens’ faircontribution. and homogeneousaccessopportunities, treatmentsquality, services networkandguarantee thebestequalityincare taxation, anditmustthereforeprovideafairlydeveloped FNA receivesfundsthroughheavierandmoretargeted to anyoneaffectedbyseveredisabilities. consider onlyproblemsoftheelderly; itisaddressedalso Nevertheless, theFundfornonself-suffi suffi 80 (291,829people), inwhichtheincidenceofnonself- particular attentionmustbepaidtopopulationagedover (22.6% ofthepopulationvs19.8%atnationallevel). A December 31, 2007peopleagedover65numbered968,208 Emilia-Romagna isoneoftheoldestItalianregions: at people andtowhotakecareofthem. health andsocialservicesdevotedtononself-suffi Law no. 27/2004), theRegionhascreatedFNAtofi services) andtheRegionalFinancial Act for2005(Regional With theRegionalLawno. 2/2003(outlinelawforsocial people (FNA) The regionalFundfornonself-suffi T accommodation expenditureinresidentialfacilities. forms ofassistance, andcurbingcitizens’ sharingof to theuseofforeignhomeassistants; promotinginnovative recognition toself-organizedfamilieswithspecifi strengthening homecareservices, giving some kindof qualification andinnovationoftheservicenetwork: The resourcesaresetasideforthedevelopment, Objectives n noaieiiitvst upr oecr. and innovativeinitiativestosupporthomecare. program managementandinparticularfortheservices 1206/2007 providedforimplementationguidelinesthe Government (Resolutionno. 509/2007). The Resolutionno. help fortheirdailyactivities)wasapprovedbytheRegional G L E S ciencyrelatedproblemsishigher. Fund fornonself-suffi he fi E 9 . i n rst three-year Program (2007-2009) for the regional rst three-yearProgram (2007-2009)fortheregional d cientpeoplearecoveredbyLocalHealth Trusts. d

4 8 cient people(peoplerequiring Program fortheregionalFund Program for nonself-suffi ciency doesnot t organizations, cient cient people c attention nance cient disabilities. of thenumberpersonsaffectedbysevereacquired the basisofresidentpopulationagedover75yearsand and HealthcareConferencestoDistrictCommitteeson the region. The allocationisguaranteed by Territorial Social network offl - alsothroughtheaccreditationprocessofanintegrated Resources arefi contribute toitsformulation. profi Conference andtheRegion, andsocialinstitutions, non- of theindications Territorial SocialandHealthcare Committee andbytheDirectorofDistrict, onthebasis The Annual PlanofactivitiesisissuedbytheDistrict Government. organizations, anditisfi of the Trade Unions, volunteers’associations, non-profi it isdiscussedandsharedwiththeregionalrepresentatives the interaction betweentheRegionandLocal Authorities), the ControlRoomforwelfare(theregionalseatdevotedto The regionalprogram forFundplanningiselaborated with The planning new benefi million Euros); 54,000peopleassisted, ofwhich7,200 allocated inthe2008budget(thusamountingto353,8 which 255million-84%used); theremainingresources signifi The resultsachievedintheProgram’s firstyearare Achievements in2007 residences, daycentres). of socialresidentialservices(safehomes, assistedliving the reductionofindividualcontributiontocosts “custodian”); interventionstoguarantee moreequityand networks ofsocialsolidarity(from “doorman” tosocial “relief” admissionsinresidentialhomes; supporttoinformal assistance managedalsowithvolunteers; temporary implementation ofservicestelephoneemergencyand assistants (throughtraining andcounsellingcentres); for nonself-sufficientelderly; qualificationoffamily integrated homecare; increaseofcareallowances The prioritiesfor2007and2008are: developmentof Priorities for2007-2008 disabled). t organizations andalltheservicesproviderscan cant: 311millionEurosassignedtotheProgram (of cient people cient ciaries (6,750non-suffi exible services, evenlydistributedthroughout xedtothedevelopmentandqualifi nally approvedbytheRegional cient elderlyand450 cation 222-05-2009 17:37:43 t 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 4 3 SSSRE-R_2008_INGLESE9.indd 49 S R E - R _ 2 0 0 8 _ I N T Continuing medicaleducation(CME) T Collaboration withtheUniversities for atotalofabout2.200participants. 2007-2008, 65three-yearUniversitycourseswereactivated professionals isincreasingtoo: inthe Academic Year The collaboration ontraining initiativesforhealth than 3,000physicians. professionalizing opportunitieswillbeofferedtomore no. 1546/2006), 140schoolswillbeaccreditedand medical specializationtraining (RegionalResolution Thanks tothe Agreement Protocolonpost-graduate Hospital Trusts. of theRegionalHealthService, startingfromUniversity and promotethequalityoftraining andthecontribution (Resolution no. 733/2006), thatwerecreatedtomonitor Rehabilitative andPreventiveHealthcareProfessions 340/2004) andtheObservatoryforNursing, Technical, Post-graduate SpecialistMedical Training (Resolutionno. no. 297/2005)andtheinstitutionofObservatoryfor through an Agreement Protocol(RegionalResolution and Parma) hasbeensignifi the region(Bologna, Ferrara, ModenaandReggioEmilia, In recentyears, thecollaboration withtheUniversitiesin professionals. education ofphysiciansandotherhealthcare of thefi G 10,000 12,000 Education andtrainingintheRegionalHealthService 2,000 4,000 6,000 8,000 L E S personnel, playsanimportantroleinUniversity he healthcaresystem, withitsownfacilitiesand education, startedin2002, isnowended. The layout he firstItalianProgram forcontinuingmedical E 0 9 . i n Residential training On-the-job training rst regionalProgram (Resolutionsno. 1072/2002 d d

Number ofon-the-jobtrainingandresidentialeventsaccreditedforCME

4 9 2002 cantly developed, inparticular 2003 3% by Emilia-RomagnaRegion,2002-2007 2004 6% or non-profi partially) byorganizationswithcommercialinterests, profi accreditation oftraining eventsdirectlyfi The rulesoftheregionalProgram donotpermitthe experimental programs ine-learning. audits, improvementprojects, researchprojects)andsome activities (training, participationincommissions, clinical seminars, conferences), butalsoon-the-jobtraining accredited, mainly “residential” training events(courses, 2007 morethan51,000training initiativeshavebeen bodies –hasgivengoodresults. Between2002and of expertsandtheregionalCouncilprofessional Health Trusts andtheactivityofaregionalCommission accreditation systemfortheinitiativesproposedby and no. 1217/2004)–withtheimplementationof Internet website: facilities, pharmacistsandothers. medical specialists, employeesofcontracting private 3,800 general practice physiciansandpaediatricians, of theHealth Trusts andResearchHospital “Rizzoli”, about 2007 numberedabout61,400, including43,000employees The healthcarepersonnelinvolvedinEmilia-Romagna bodies, …). of providers(publicandprivateHealth Trusts, professional One oftheinnovationsconcernregionalaccreditation are goingonaccordingtotherulesoffi at nationallevelarebeingintroduced, whileCMEactivities At present, someinnovationsestablishedin August 2007 as PRIE-Rispermitted. of Health Trusts’ training plansorregionalprograms such 13% 2005 tbearing, inthehealthcarefi http://ecm.regione.emilia-romagna.it 2006 16% eld. Sponsorship nanced (even nanced rst Program. rst 2007 18% 222-05-2009 17:37:43 t 2 - 0 5 - 2 0 0 9

1 7 49 : 3 7 :

4 programs 3 50 SSSRE-R_2008_INGLESE9.indd 50 S R E - R programs _ 2 0 0 8 _ I N Local Health Trusts. conservative, prostheticandorthodonticcareatallthe development ofaservicenetworkabletoguarantee One ofthemainobjectivesProgram wasthe Euros to22,500Euros/year. the newISEEincomelimithasbeenraised from15,000 reduced expenditurecontributionhasbeenwidened: Also thenumberofpeoplethatcanaccesscarewitha personal -income). (ISEE parameters areusedtocalculatefamiliar-andnot year, whileinthefi include peoplewithanISEEincomeupto8,000Euros/ benefi As forincome, thesegmentofpopulationentitledto disturbs. of communicationabilitiesandtoseverebehaviour of dentaldiseases, thusleadingtolackorreduction than 66%–couldpreventfromacorrectprevention handicap conditionsorwithaninabilitydegreehigher psychophysical disabilitiesthat–associatedwithsevere The Program nowincludesalsosomesevere access toservicesatcontrolledprices. segments thatallowtohavefreeofchargeassistanceor program toincreasethenumberofpeopleandincome In 2008theEmilia-RomagnaRegionhasrevised The programexpansion T persons indisadvantagedconditions. 20,000 peoplewithdentalproblemsandtoabout300,000 In thefi became effectiveonJanuary 1, 2006. on June1, 2005(RegionalResolutionno. 2678/2004)and or livingindisadvantagedeconomicalconditionsstarted people affectedbypathologiescausingdentalproblems G L E S orthesic care offered by the Regional Health Service to orthesic careofferedbytheRegionalHealthServiceto he regionalProgram forodontological, prostheticand E 9 t offreechargecarehasbeenenlargedto . i n rst phasetheProgram wasaddressedtoabout d d

5 0 rst phasethelimitwas7,000Euros Program fortheodontological, Program prosthetic and orthesic care andorthesic prosthetic value is74%. orthodontic fi respected in82%cases(regionalaverage); inthe conservative-prosthetic visits, waitingtimeswere 30 days, datashowaprogressivesettling-down: for As forwaitingtimesvisitstobeprovidedwithin Health Service(36%in2005). regional program werefullycoveredbytheRegional than 7,500Euros: in2007, 68%devicesprovidedbythe prosthesis suppliedtopeoplewithanISEEincomelower was developedtoguarantee totalexpensecoverage for In thiscontext, theSpecialSocialandHealthcareProgram to 2005. devices distributed)witha59%increaserespect the sameperiod3,539prosthesisweresupplied(3,728 treatments numbered7,579, 41%morethanin2005. In income lowerthan15,000Euros)undergoingorthodontic up to14yearsandbelongingfamilieswithanISEE 44% to73%. Duringthefi an ISEEincomelowerthan7,500Euros)increasedfrom guaranteed to peopleindisadvantagedconditions(with development periodoftheprogram, thecoverage Among themostsignifi the Regionprovidedforafi allocated; fortechnologicalandfacilitiesupgrade, in2007 In thefi fi from 42,733inthesecondhalfof2005to64,906 At regionallevelthenumberofassistedpeopleshifted Health Trustarea. this supplyisconsideredsuffi specialist branch thatcanbeprovidedonlybyspecialists, in 67%oftheDistricts(59%2005); however, beinga assistance forchildrenagedunder14isguaranteed (with a18%growthrate inprostheticcare). Orthodontic guaranteed inall38DistrictsoftheLocalHealth Trusts conservative andprostheticcareinterventionswere with respecttotheprogram start-upin2005. In2007 which 2privateaccreditedstructures)witha5%increase On June30, 2007workingfacilitiesnumbered103(of Outcomes rst halfof2007, withanincreaserate of52%. rst phaseoftheProgram 1,651,650Euroswere eld (braces forchildren)theaverage regional cant datarelatedtothe2-year rst halfof2007, children(aged nancing of3.6millionEuros. cient forthewholeLocal 222-05-2009 17:37:44 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 4 4 SSSRE-R_2008_INGLESE9.indd 51 S R E - R _ 2 0 0 8 _ I N for vaccination. the vaccine, thatcanthenbeboughtinpharmacies, and to theirgeneral practice physicianfortheprescriptionof After theageof18, girlswillingtobevaccinatedmustrefer Trusts ataspecialprice. vaccinated at Vaccination DivisionsoftheLocalHealth the opportunityforgirlsagedbetween12and18tobe The Emilia-Romagnavaccinationcampaignalsooffers girls bornin1996, whowere11in2007. Vaccination isavailable, uponparents’request, alsofor years everygirlturning12willreceivethesameinvitation. Trust toundergothevaccinationfreeofcharge. Innext born in1997receivedaninvitationfromtheirLocalHealth The vaccinationcampaignstartedinMarch2008: girls March 2008: thestart-up W Region hasconformedtotheseindications. their twelfth(thatisgirlsturned11), andEmilia-Romagna established toofferfreeofchargevaccinationgirlsin The ItalianState-RegionsConferencehastherefore already hadsex. of sexualactivity), whileitdecreasesto40%ingirlswho are notyetaffectedbythevirus(thatisbeforeonset Vaccination effectivenessishighest(90-100%)ingirlswho for prevention. vaccine againstthesetwoserotypesisagreatopportunity by persistentHPV16/18infections. The availabilityofa Organization’s data, 70%cervicalcancercasesarecaused cancer ifnotpromptlytreated. According to World Health seldom causecervicalcellsalterations thatcanevolvein the serotypes16and18aremostdangerous–can spontaneously, butsomekindsofpapillomavirus–and provokes transitory, asymptomaticinfectionsthatheal women around25yearsofage. Inmostcases(90%)HPV infection, highlywidespreadespeciallyamongyoung HPV causesthemostcommonsexuallytransmitted their twelfththroughouttheregion. vaccination againstHPVserotypes16and18ingirls has activatedtheprogram offreechargesupplyfor the vaccineagainstHPVinfectioninItaly” –Emilia-Romagna of December20, 2007onthe “strategy foractivesupplyof G L E S E 9 236/2008 –implementingthenationalagreement ith theRegionalGovernmentResolutionno. . i The Human Papilloma Virus (HPV)vaccination The HumanPapillomaVirus n d d

5 1 regularly undergothepap-test. Also womenvaccinatedagainstHPV16and18needto in-depth analysisandcaretreatments, ifneeded. the pap-testevery3years, assuringalsofurtherdiagnostic incidence ofthiskindcancerishigher)theexecution (totally amountingto1,200,000, agegroupinwhichthe program proposestoallwomenagedbetween25and64 Since 1996, inEmilia-Romagnaafreeofchargescreening test. to regularlyundergoasimpleexamination: thepap- (included thoserelatedtoHPV16and18), itisnecessary For preventionandearlydiagnosisofallcervicallesions by HPV16/18persistentinfections. every kindofcervicalcancerbutonlyfromthosecaused The vaccineagainstHPV16and18doesnotprotectfrom time agoforthepreventionofcervicalcancer. Euros; theprogram ispartoftheglobalstrategy activated serotypes, theRegionwillallocatein2008about4million For thevaccinationprogram againstHPV16and18 Importance ofpap-testandscreening 222-05-2009 17:37:44 2 - 0 5 - 2 0 0 9

1 7 51 : 3 7 :

4 programs 4 52 SSSRE-R_2008_INGLESE9.indd 52 S R E - R programs _ 2 0 0 8 _ I N Emilia, BolognaandRimini. of Emilia-Romagna, attheLocalHealth Trusts ofReggio governance hubswillbelocatedinthethree Vast Areas the integrated path, whilespecialistreferenceandclinical act asreferencepointsforallthoseinvolvedinstructuring Health Trust/Province willsetupspokecentresthat for highspecialties: thehub&spokemodel. EveryLocal The organizationalmodeladoptedisthatimplemented affected byautismdisordersindifferentagegroups. and appropriatediagnosis, assistanceandcaretopersons The general goal oftheprogram istoassurefair, timely Objectives andorganizationalmodel A disorders” wasapproved. for assistancetopeopleaffectedbyautismspectrum and inMarch2008the “Regional integrated program disorders” addressedtotheHealth Trusts wereissued, in peopleaffectedbyautismandotherdevelopment panels; in2004the “Guidelines forhealthpromotion improve servicesthroughthecontributionoftechnical Policies hasdeeplystudiedautismissueinorderto Starting from2000theRegionalDepartmentforHealthcare recent surveys). around 3‰inthisagegroup(itishigheraccordingto point ofview, theexpectedprevalenceisestimated in peopleunder18yearsofage. From theepidemiological facilities dealyearlywith1,166autismrelateddisorders adolescence neuropsychiatryshowsthatterritorialhealth The regionalinformationsystemonchildhoodand competent supporttofamilies. integrated collaboration aspects andfortheneeded and healthcaresystembothforclinical, organizationaland G L E S important challenge for the improvement of the social important challengefortheimprovementofsocial utism andtheautismspectrumdisordersrepresentan E 9 . i n d d

5 2 Care program forpeoplewith Care program autism spectrum disorders autism spectrum protocols andtothedefi implementation ofuniformclinicalandorganizational complex designingofthehub&spokenetwork, tothe long-term sharedobjectiveswilllead, throughthe defi The completeimplementationoftheProgram willbe care pathsforautisticadolescentsandadults. objectives, fromthetimelydiagnosistorevisionof and totheachievementofgeneral andspecific support totheimplementationofhub&spokenetwork A specifi genetic fi approaches (i.e. inthegastroenterological, neurometabolic, particular attentiontoprospectivenewclinical-therapeutic proposes researchandinnovationinitiatives, paying of theProgram activities. The Scientifi monitoring resultsandsupportstheaccreditationprocess provides clinicalandepidemiologicalassessmentof literature, giveshintsforcarepathappropriateness, by nationalexpertsthat, accordingtorecentscientifi team andbyaregionalScientifi coordination ofclinical-organizationalfunctionseach The Program issupportedbyaLocalCommitteeforthe of peoplewithautismdisorders. cognitive andbehavioural approachesforthehabilitation in appropriatediagnosesandthepsycho-educational, disorders formedbydifferenthealthprofessionals, skilled strengthening ofspoke-teamsonautismspectrum The 11LocalHealth Trusts areengagedinthecreation/ and careinearlychildhood. requisites foraccreditation, particularlyrelatedtodiagnosis ned inthe3-yearperiod2008-2010: mediumand c regional 3-year period funding will guarantee the c regional 3-year periodfundingwillguarantee the elds). nition andupgrade ofspecifi cCommitteeformedalso c Committeealso c c 222-05-2009 17:37:44 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 4 4 SSSRE-R_2008_INGLESE9.indd 53 S R E - R _ 2 0 0 8 _ I N promote andstimulatepublicparticipation. The Planalsoschedulesalargeinformationcampaignto at diseasecontrolanddiffusion. diagnostic activitiesandimplementationofmeasuresaimed Regional HealthServiceischargedwithhealthsurveillance, for disinfestationmanagement; ontheotherside in particularMunicipalities, aredirectlyresponsible institutional responsibility: ononesideLocal Authorities, At organizationallevel, thePlanpointsoutadouble 2. to strengthenthehealthsurveillancesysteminorder 1. to decreaseas muchaspossibletigermosquito Started April 1, 2008thePlanhastwomaingoals: French MinistryofHealth). Disease PreventionandControl, World HealthOrganization, international healthorganizations(EuropeanCentrefor national (MinistryofHealth, NationalHealthInstitute)and collaboration withregionalscientifi of Emilia-Romagnainstitutionsanditresultsfromthe The Planisbasedoncoordinatedandsynergicinterventions diseases, unknowninItaly. the strategy adoptedtopreventandcontrolthiskindof The fi Objectives I such asDengue. diffusion ofotherdiseasestransmitted bytigermosquitoes, the spreadofnewChikungunyainfectionoutbreaksor Region adoptedaninterventionplanaimedatpreventing As aconsequenceofthisepidemic, Emilia-Romagna to havegottheinfection. ‘90s). In August andSeptember, 217personswereverifi to South-East Asia thatiswidespreadinItalysincethe course transmitted bythetigermosquito(aninsectnative Romagna. Chikungunyaisaviral diseasewithabenign G L pest controlmeasures. precociously detectsuspectcasesandtotimelyadopt disinfestation interventions; population inthewholeregionalterritory, increasing E

of Chikungunyaepidemicoutbreakwasregisteredin n 2007Summer, thefi S E Regional PlanagainstAsiantigermosquitoandfor ghtagainstthevectorinsectismainelementof 9 . i n d prevention ofChikungunyaandDenguediseases d

5 3 rst European autochthonous case rst Europeanautochthonouscase c bodiesandwith ed Health Trusts. surveillance systemthroughperiodiccontactswithLocal for continuityofcarehavebeeninvolvedintheactive Emergency Roomphysiciansandprofessionalsinservices general practice physicians, communitypaediatricians, For theirroleinearlydetectionofpossiblecases, warning system”. Notification adoptsthesameproceduresas “quick transmission. activate theinterventionsneededtoavoiddisease of cases-evenonlysuspectones–inordertotimely The systemisaimedattheprecociousidentification The surveillancesystem transmit yellowfever). newly introducedinsects(i.e. the Aedes Aegypti, thatcan Moreover, surveillanceactivitieswillbeelaborated todetect every provinceandinthemaintowns. monitoring networkistoestimatetheinfestationlevelin ideal numberineachProvince. The 2008objectiveofthe of ovitraps throughouttheterritoryanditsuggests The Planalsoprovidesfortheincreaseindiffusion areas willbeconducted. in 2007, extraordinary disinfestationinterventionsinprivate where theChikungunyaepidemicoutbreaksweredetected has carriedoutordinarydisinfestationplans. Intheareas (except thehillsareawherenoinsecthasbeenlocated) Every Municipalityinwhichtigermosquitoispresent The fightagainsttigermosquito Internet website: deal withpossiblerequestpeaks. been strengthenedwithfacilitiesandequipmentsto reference centreformicrobiologicalemergencies, has This laboratory, alreadyrecognizedastheregional for theexecutionofdiagnostictests. Hospital Trust hasbeenidentifiedasthereferencepoint The MicrobiologyDepartmentatBolognaUniversity Diagnostic tests

http://www.zanzaratigreonline.it 222-05-2009 17:37:44 2 - 0 5 - 2 0 0 9

1 7 53 : 3 7 :

4 programs 4 54 SSSRE-R_2008_INGLESE9.indd 54 S R E - R programs _ 2 0 0 8 _ I N • • • T Theguidelinesprovideindicationsonhowtopromote Theobstetricianfi Theaimoftheseguidelinesistodefi by aspecifi with theguidelinesforwholebirthpathelaborated Government Resolutionno. 533/2008providedHealth Trusts As farasthePlanobjectivesareconcerned, theRegional procreation. and counsellingactivityonsexualityresponsible protection, assistanceduringpregnancy, birth, puerperium, by theFamily Advisory Centresfocusedonprocreation the interventionstobedeveloped-activitiespromoted integrated carepaths-themother-child areaand-among strategic objectives. The Planindicates-amongthehighly approved bytheRegionalGovernmentarelistedbelow. The mainguidelinesissuedbytheCommissionand Resolution no. 1921/2007. worked outbythesameCommission, wereapprovedwith Commission. The guidelinesonpaincontrolduringdelivery, G

L family, fromconceptiontopost-deliveryperiod. with aprivilegedrelationshipthewomanandher and isnowrecognizedasaqualifi humanization anddemedicalizationduringbirth. delivery Control offetalwellbeingduringlabourand puerperium Obstetric assistancetopregnancy, deliveryand that sometimesareparticularlyinvasive. child inundergoingtestsforanomaliesidentifi choices, alsoconcerningtherisksforbothmotherand counselling pathenablingwomentomakeresponsible chromosome anomalies Prenatal earlydiagnosisofthemostrecurrent E S reinforces carequalityinthebirthpathasoneofits he fi E 9 . i n rst Regional Social and Healthcare Plan 2008-2010 rst RegionalSocialandHealthcarePlan2008-2010 d d

5 cally setupregionaltechnicalandscientifi 4 gure withinthecareteamisrevised ed healthprofessional ne adiagnosticand Birth path Birth cation, c Itisabibliographical reviewforhealthcareprofessionals Theguidelinesgiveindicationsforaqualifi Theguidelinesprovideforaprogram ofanalysisand Theseguidelinesgiveindicationsonpathorganization Accordingtotheseguidelines, withintheendof2008at • • • • •

of theirperceptioncarequality. to promotecounsellingserviceswomenandanalyses Birth pathandqualityperception these situations. Observatory forcaremonitoringandassessmentin the regionalterritory; theyalsosetuparegional promotes uniformprotocolsandproceduresthroughout during deliveryathomeorprivatefacilitiesand hospital settings Labour assistancetophysiologicalbirthinnon- and ofaprotocolfordiagnosticsurveys. introduction ofamedicalrecordforstillbornchildren where mortalityislinkedtoitspossiblecauses, andthe practice. The guidelinessuggestareviewofliterature stillborn childrenthroughchangesindiagnosticandcare monitoring ofeventsinordertodecreasethenumber Mortality reductionatbirth and duringchild’s fi thus completingcarepathtowomenduringpregnancy the promotionofhealthprofessionals’specifi the enhancementofamultidisciplinaryapproachand aimed athandlingwomen’s emotionaltroublesthrough during child’s fi Woman’s emotionaltroublesduringpregnancyand non-pharmacological methodstocontroldeliverypain. all theseBirthDepartmentswillassuretheadoptionof charge, 24hoursaday, all yearlong)uponrequest, and guarantee the opportunitytodeliverinanalgesia(freeof least oneBirthDepartmentineachregionalProvincewill Delivery paincontrol rst yearoflife rstyearoflife. ed assistance ctraining, 222-05-2009 17:37:44 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 4 4 SSSRE-R_2008_INGLESE9.indd 55 S R E - R _ 2 0 0 8 _ I N specialists). (general practice physicians, paediatriciansandoutpatient but alsobyrepresentativesofcontracted professionals not onlybymanagersoftheRegionalHealthService As amatteroffact, theBoardofDirectorsiscomposed elective seatwherehealthprofessionalscanparticipate. As fortheBoardofDirectors, itismeanttobecomethe and organizationprograms. in theelaboration andverifi all technicalandprofessionalcompetenceswilltakepart Trust (ascollegialorganism), inordertoguarantee that coherence ofthegovernancefunction, oftheHealth For Trust’s Management, policiesaimtostrengthenthe no. 29/2004). to theBoardofDirectors(neworganismsetupbyLaw Indications areaddressedtothe Trust’s Managementand in Health Trust’s strategicchoices Healthcare professionals’participation T Health Districtsandorganized inDepartments. Policies confi Health DistrictsandDepartments The organizationalmodel: Regional HealthService. Trusts, ResearchHospitalsandother hospitalsofthe “intensity” oftheactivitiesdevelopedinUniversity Hospital to allHealth Trusts, with somedifferencesonlyinthe development ofthesefunctionsthathavetobetransversal The BoardofDirectorshastoplanandimplementthe the managementpoliciesofallHealth Trusts. innovation andeducationmustthereforebeincludedin fundamental institutionalfunction, likecare. Research, The RegionalHealthServicehasidentifi Research andinnovationfunctions and HealthcarePlan2008-2010. integration thatisoneoftheprinciplesstatedinSocial attention tothenecessaryorganizationalandprofessional of theLocalHealth Trusts wereissued, withparticular guidelines fortheorganizationofterritorialDepartments hospital Departments’organization). InDecember2007the Departments’ organization(withspecifi and innovationsfunctionsHealthDistricts’ participation in Trust’s strategic choices; forresearch methodological indicationsforhealthprofessionals’ enhancing clinicalgovernancefunctionandproviding Region establishedthegeneral linesfortrustorganization, Regional SocialandHealthcarePlan. InFebruary 2006the Health Service(no. 29/2004)andaccordingtothe1 by theRegionalLawofre-organization Local Authorities, citizens’representatives, asindicated governance policiesanditsrelationswiththeRegion, document outliningtheHealth Trust’s organizationand G L E S Health Trusts fortheeditingoftheirDeed, thatisthe he RegionalGovernmenthasissuedguidelinesforthe E 9 . i n d d

5 Guidelines for editing the Health Trust’s Deed Guidelines foreditingtheHealthTrust’s 5 rm thatLocalHealth Trusts aredivided in cationphasesofdevelopment ed researchasa c referenceto st

guarantee entiretyincareandclinicalgovernance. are dividedinoperational units/servicescommittedto The Departmentsareorganizationalstructuresand healthcare services. healthcare andtotheintegration amongsocialand Local Authorities, particularlywithrespecttoprimary for therelationshipbetweenLocalHealth Trusts and by thereferencepopulation; itistheprivilegedcontext on thebasisofneedsanddemandshealthcareservices territorial partition, wherecommitmentplansareprepared The DistrictrepresentstheHealth Trust’s governance ThePrimaryHealthcareUnithastopromoteandreach TheDepartmentcarriesoutthefunctionsofPrimary ThePublicHealthDepartmentguarantees aglobal The activityoftheMentalHealthandPathologic ThisDepartmentmanagesacaresystemthatconnects Department • Territorial Departments • • PrimaryCareDepartment PublicHealthDepartment MentalHealthandPathologic Addictions care. outpatient specialistcare, improvementofpharmaceutical chronicity management, waitinglistsreductionfor The integration withhealthprofessionalsisaimedat diagnostic-therapeutic pathsandcontinuityofcare. the healthcaresystem, inordertoguarantee shared a completeintegration ofgeneral practitioners in devoted toelderlypeople. Family Advisory HealthCentresandofcareservices Unit (contracting andcommunitypaediatricians), of and paediatricians), ofthePaediatric PrimaryHealthcare Healthcare Unit(fi on health. diseases control, fi interdepartmental programs suchasscreenings, infective beyond thePublicHealthDepartment’s plansand on supporting Trust’s HealthcareDirection onprograms to healthsafeguardandpromotion. Itisaimed at other institutionsandsocialforcesthatcancontribute of individualsandthecommunity. Italsointeracts with to provideunitaryandtimelyanswershealthproblems approach, thatinvolvesdifferentspecialtiesprofessionals Modena, Parma andFerrara, involvingUniversities. will becreatedattheLocalHealth Trusts ofBologna, private facilities. SomeIntegrated CareDepartments Municipalities, volunteers’associationsandaccredited Addictions Departmentiswellintegrated with enrichment perspective. related todrugaddictioninanintegration andreciprocal psychiatry andchildrenneuropsychiatry)withthose the traditional disciplinesformentalhealthcare(adults ght against socialinequalities’effects rst ofallgeneral practice physicians 222-05-2009 17:37:44 2 - 0 5 - 2 0 0 9

1 7 55 : 3 7 :

4 organizational models 4 56 SSSRE-R_2008_INGLESE9.indd 56 S R E - R organizational models _ 2 0 0 8 _ I N already beenvisited. nursing homesandprivateoutpatientcarefacilitieshave many hospitals, hospices, publicpsychiatricfacilities, The verifi • • • • T services Authorization andaccreditationofhealthcare In particular, theregionalResolution: professionals workingfortheRegionalHealthService. requirements concerninghealthstructuresand Accreditation guarantees therespectofquality in anypublicorprivatehealthfacilityEmilia-Romagna. structural andsafetyrequirementsforpatientsworkers Authorization ismeanttoguarantee therespectof sequential. accreditation proceduresaretobelinkedandtemporarily Law no. 229/1999, accordingtowhichauthorizationand The basiccriteriaistoconcretelyapplythenational with Resolutionno. 327/2004. were defi G authorizesthestartupofinstitutionalaccreditation. defi underlinestheneedofauthorizationalsofordental defi L safety; particularly complexorpotentiallydangerousforpatients’ diagnostic and/ortherapeutic proceduresthatare surgeries andotherprofessionalofficesusedfor establishing modesandtimes; private facilities; among professionalsandexpertsworkinginpublic are theresultofalengthyconfrontationandsharing for healthfacilitiesandworkers; theserequirements E S accreditation ofhealthcarefacilitiesandprofessionals he standardsforauthorizationandinstitutional E nes authorizationandaccreditation requirements 9 nes authorizationandaccreditationprocedures, . i n d cation processisactivesinceSeptember1, 2004; d ned byEmilia-RomagnaRegionalGovernment

Authorization andaccreditationofhealthcare,

5 6 social-health andsocialservices be compulsoryforthecreationofanynewservice. Once theseindicationsareapproved, accreditationwill and implementationwaysoftemporary accreditation. The RegionalGovernmentisdefiningprocedures, costs the facilitymanagers. that assignsfullresponsibilityforcareproceduresto plan oforganizationalandmanagementtransformation the temporary accreditationisthepredispositionofa One oftheminimalrequisitesnecessarytobenefit accreditation willthenbestarted. possess alltheneededrequirementsandtoobtainfinal responding tosomeminimalrequisites; theprocessto disabled adults–canbetransitorily accreditedif socio-rehabilitative centresanddaycarefor centres fornonself-sufficientelderlypeople; residential nursing homecare, residentialfacilitiesanddaycare through theregionalFundfornonself-sufficiency- Social-health servicesandinterventionsfinancedalso in 2010. for theaccreditationofsocial-healthservices, ending The RegionalLawno. 4/2004definedatransition period services. the accreditationprocessofsocial-healthandsocial 772/2007) definitelyapprovedreferencecriteriafor In 2007, theRegionalGovernment(Resolutionno. updated withtheregionalResolutionno. 564/2000. of theseserviceswerefullydefinedin1991andthen The requirementsandproceduresfortheauthorization started in2007. The accreditationofsocial-healthandsocialservices of social-healthandsocialservices Authorization andaccreditation 222-05-2009 17:37:44 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 4 4 SSSRE-R_2008_INGLESE9.indd 57 S R E - R _ 2 0 0 8 _ I N A Trusts. The quantitativeindicatorsarecontextualized including asetofindicatorsthatarecommonforallHealth The documentpresentsawiderange ofinformation 7. specifi researchandinnovation 6. toolsintheHealth Trust relationalnetworksystemandcommunication 5. ofworkorganizationalmodel workconditions, competenciesandeffi 4. institutionaltargetsandtruststrategies 3. 2. Health Trust’s profi contextofreference 1. shared model, organizedin7chapters: public, technicaldocument, correspondingtoaregional The Socialaccountabilityreportisayearly, compulsory, regional interestandfi of everyHealth Trust andtoelaborate asynthesesof common tool. Itisnowpossibletoexaminetheoutcomes and theHealth Trusts, sotheresultcanbeconsideredasa during thisexperimentalperiodweresharedbytheRegion Research Hospital “Rizzoli”. All themethodologicalchoices since 2007itinvolvesalsotheHospital Trusts andthe In 2005itwasextendedtoalltheLocalHealth Trusts and experimental phaseinvolving5pilotLocalHealth Trusts. The projectstartedinthesecondhalfof2004withan the document. provided guidelinesandareferencemodelforediting The RegionalGovernmentResolutionno. 213/2005 to eachHealth Trust. objectives assignedbytheRegionandLocal Authorities a periodiccontrolontheaccomplishmentlevelof to healthcareoutcomesinacoherentway, andtoallow balance. This reportismeanttolinkeconomicalresults accountability reporttogetherwiththeannualfi every Health Trust hastoissueeveryyearaSocial G L E S Regional HealthServiceorganizationandfunctioning, s establishedbytheRegionalLawno. 29/2004on E 9 . i n d d c objectivesofinstitutionalrelevance

5 7 le rst indepthevaluations. The Social accountability report The Socialaccountabilityreport ciency nancial bilmissione/index.htm by theRegionalHealthcareandSocial Agency ( no. 107/2005, no. 148/2007andno. 163/2008edited Social accountabilityreportsisavailableintheDossiers More informationontheEmilia-RomagnaHealth Trusts’ accountability. provided careandthusemphasizinghealthcaresystems Unions, professionals, citizens), reportingonqualityof external subjects(Nongovernmentalorganizations, Trade report alsotocommunicatewithotherinternaland their side, Health Trusts usetheSocialaccountability reactivate internalandexternalplanningprocesses. On attainment ofpre-defi In thisway, theseinstitutionalsubjectscanverifythe Territorial SocialandHealthcareConferences). interlocutors (theRegionandLocal Authorities, inparticular between theHealth Trust anditsmaininstitutional Trust anditsupportsinanactivewaytherelationship illustrates theoutcomesofactionsperformedbyHealth accountability reporthaswiderandmoretargetedgoals: it If comparedtothetrustbalancesheet, theSocial context. of itselfexplainingitsroleintheregionalandlocalpolicies choices andactionsimplemented: theHealth Trust talks and accompaniedbydetailednarrative descriptionsof ( archivio_dossier_1.htm asr.regione.emilia-romagna.it/wcm/asr/collana_dossier/ http://www.regione.emilia-romagna.it/agenziasan/ ). ned goalsand–ifnecessary ) andonthe Agency’s website http:// 222-05-2009 17:37:44 2 - 0 5 - 2 0 0 9

1 7 57 : 3 7 :

4 organizational models 4 58 SSSRE-R_2008_INGLESE9.indd 58 S R E - R organizational models _ 2 0 0 8 _ I N Thisreorganizationaimsatintegrating professionals Theseareknownobjectives; thenewrulesgiveoperative territorial Departmentsundergoreorganization. Together withthenewroleofHealthDistrict, also Reorganization ofterritorialDepartments • • • • This meansthatDistrictsareresponsiblefor: full guarantor fortheEssentialLevelsofCaredelivery. the Health Trust’s Deed, givestoHealthDistrictstheroleof no. 29/2004andbythesubsequentregionalguidelineson Regional HealthServicereorganization, asdefi of Caredelivery identifi The HealthDistrictguarantorforcareneeds • • different carelevels(hospital, territory). and hospitalones, tofacilitatepatients’handlingat Departments oftheRegionalHealthService, bothterritorial The DistrictDirectorassignsdutiestothedifferent also theintegration amonghealthprofessionals. through thepromotionofcaremodalitiesthatenhance becomes theguarantor ofsupplyanddemandmatching, the availableresources. InthiscontexttheDistrictDirector clarify theassignedfunctionsandtoeffi (territorial andhospitalDepartments), allowstobetter responsible fororganizinghealthservicesprovision Direction andLocalHealth Authorities) andsubjects between subjectsresponsibleforidentifyingneeds(District new organizationalmodel, thankstothecleardistinction delivering, butalsoofensuringhigh-qualityhealthcare. The role oftheHealthDistrict, notonlyintermsofservice Planning andevaluationarepeculiaritiesofthenew G The The assessmentofinterventionsoutcomes. provisionofhealthandsocial-healthservices; planningofhealthcareassistanceneededbyreference survey andanalysisforresidentpopulation’s care L organization; theirintegration occurs: operating withintheRegionalHealthServiceintrust Departments oftheRegionalHealthService. access tospecialisedhealthcareprovidedbytheother healthcare planningasregardschronicpathologiesand professionals workingintheterritory, inordertoensure paediatricians, nursingpersonnel, obstetriciansandother gathers servicesprovidedbygeneral practitioners, instruments toputthemintopractice.

Department by hingingonthe population; needs; E • • S byidentifyingopportunitiesfortheirparticipationin regional healthcareorientations. defi byharmonizingtheirprofessionalapproachwith E 9 DepartmentofPrimaryCare . i n Mental HealthandPathologic Addictions ning healthcare policiesaffectingpatients; d cation andforEssentialLevels d

5 8 has reviseditsobjectivesbyexpanding Primary HealthcareUnit Organization oftheHealthDistrict Organization redefi caciously manage nes its structure nes itsstructure ned byLaw ; thisUnit Primary HealthcareUnits. In Emilia-Romagnathereare38HealthDistrictsand214 the specifi etc.) tosettleappropriateinterventionsonthebasisof Trusts forPersonalServices, nonprofi participate (Municipalities, LocalHealth Trusts, Public involving alltheentitledsubjectsorthosewillingto and discussedwithintheDistrictgovernanceframework, Also theregionalFundfornonself-suffi planning activitiesisclearlypresented. which theunifi by anintegration purposestrongerthaninthepast, in multi-year planningcyclehasstarted; itischaracterized activities relatedtononself-suffi the socialplanningandsocial-healthinterventions appropriate healthcaretocitizens, butalsotodevelopboth The HealthDistrictisnotonlycommittedtoguarantee non self-suffi for social-healthactivitiesandtheFund Health Districtasplanningfi • Prevention, care, re-habilitationandsocialreintegration The vascular riskprevention, isparticularlyimportant. trends forthePlanPrevention, inparticularforcardio- Department ofPrimaryCareforthedevelopment between theDepartmentofPublicHealthand are allexamplesofthisreorganization. The integration cooperation withclinicalcompetencesathospitallevel, integrated managementofinfectiveemergenciesin the supporttoHealthDistrictplanningfunction, the Departments. The newroleplayedinthescreeningfi to providehealthcareincollaboration withother by mentaldisordersorpathologicaddictions. activities areaddressedtopeopleofeveryageaffected associations). involvement ofLocal Authorities andvolunteers’ in handlingminordisorders– “Leggieri Program”; external integration (supporttogeneral practitioners psychiatry topathologicaddictions, andbyenhancing its areasofinterestfromthetraditional onefocusedon Department ofPublicHealth c territorialneedsandpeculiarities. cation ofsocial, healthandsocial-health ciency ciency. In2008thisthird eld ciency is negotiated ciency isnegotiated wasreorganized t organizations, t eld, 222-05-2009 17:37:44 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 4 4 SSSRE-R_2008_INGLESE9.indd 59 S R E - R _ 2 Local Health Trust 0 0 Population: Piacenza Local Population: 2007: 38 Health Districts, 214 Primary HealthcareUnits 2007: 38HealthDistricts,214Primary 8 Reggio Emilia Primary Healthcare Primary Primary Healthcare Primary Health Districts: _ Health Districts: Health Trust I N ■ VAST AREAS G Population asofDecember31 L NorthEmilia Units: Units: E S E 9 . i n 510,148 23 281,613 12 d Population: d Bologna Local Primary Healthcare Primary

Health Districts:

Health Trust 5 9 6 3 Units: Health Districts, Primary HealthcareUnits,referencepopulation Health Districts,Primary ■

836,511 41 Central Emilia st , 2007. 6 Population: Primary Healthcare Primary Health Districts: Health Trust Imola Local Population: Primary Healthcare Primary Health Districts: Parma Local Health Trust ■ Units:

Romagna Units: 127,554 7 425,690 21 1

4 Population: Primary Healthcare Primary Population: Modena Local Health Districts: Primary Healthcare Primary Health Trust Health Districts: Health Trust Forlì Local Units: Units: 182,682 11 677,672 38 1 7

Population: Primary Healthcare Primary Cesena Local Population: Health Districts: Health Trust Primary Healthcare Primary Ferrara Local Health Districts: Health Trust Units: Units: 200,364 7 355,809 18 2 3 Population: Primary Healthcare Primary Health Districts: Rimini Local Health Trust Population: Ravenna Local Primary Healthcare Primary Health Districts: Health Trust Units: Units: 298,333 19 379,467 17 2 3 222-05-2009 17:37:44 2 - 0 5 - 2 0 0 9

1 7 59 : 3 7 :

4 organizationalanizational models 4 60 SSSRE-R_2008_INGLESE9.indd 60 S R E - R organizational models _ 2 0 0 8 _ I N I (through thecoordinationamonggeneral practitioners lengthening ofopeninghoursforoutpatientfacilities The neworganizationalmodelprovidesforagradual and thelinkwithotherhealthcareservices. Healthcare Units, thatarethecornerstoneofprimarycare physicians inHealth Trust’s lifeandmainlyintoPrimary This processisaimedatfullintegration ofgeneral practice quality thankstodailyinteraction andcontacts. on theterritory, whohavetheopportunitytoimprovecare the patient-andininterestofprofessionalsworking physician’s fundamentalandprivilegedfi professionals forcitizens’interest-safeguardingthe home) allowstheinteraction amongterritorialhealth problems areconcentrated inasinglefacilitynear of organization(completeanswerstohealthrelated resources thatcitizenscaneasilyaccess. This kind outpatient facilities, nursingresourcesandspecialist Units, organizationalstructureswhichcanshare a totalof3,221)wereintegrated inPrimaryHealthcare At theendof2007, 94%general practitioners (3,013on guarantee careappropriatenessandcontinuity. Regional HealthService, tosimplifyaccessservices, to practitioners toworkatbest, inconnectionwiththe physicians’ organizationsandUnions-istoallowgeneral by anagreementbetweentheRegionandgeneral practice Trusts wasmade. The maingoalofthisprocess-supported G einlaeae15 Regional average Rimini LocalHealth Trust Cesena LocalHealth Trust Forlì LocalHealth T Ravenna LocalHealth Trust Ferrara LocalHealth Imola LocalHealth Trust Bologna LocalHealth Trust Modena LocalHealth Trust Reggio EmiliaLocalHealth T Parma LocalHealth T Piacenza LocalHealth Trust L E

development ofgeneral practice servicesinallHealth n 2007, animportantsteptowardstheorganizational S E Integrated care paths for chronic pathologies in Local Health Trusts, asofDecember31 pathologiesinLocalHealthTrusts, Integrated carepathsforchronic 9 . i n General practice physicians (GPP) and assisted population for Primary Healthcare Unit (PHU), HealthcareUnit(PHU), General practicephysicians(GPP)andassistedpopulation forPrimary d d

6 0 Agreement withgeneralpracticephysicians ut1 5-24 14 rust rs 16 Trust ut1 6-23 14 rust ut1 4-28 15 rust Chronic bronchopneumopathy Chronic kidneyinsufficiency Oral anticoagulanttherapy GPP average per Orthopaedic patient Local Health Trusts Oncologic patient PHU Leggieri Project Heart failure Diabetes 25-17 12 115-31 21 79-25 17 36-21 13 58-28 15 44-28 14 512-22 15 duciary rolewith 0246810 as ofDecember31 Min & max number Min &maxnumber of GPPperPHU 1357911 for reportsandtreatmentsrequests. safeguarding his/herprivacy, andtocontactHealth Trusts the networkallowstosharepatient’s information, other HealthServicephysicianshasbeenexpanded; general practice physiciansamongthemselvesandwith network (SOLEProject-onlinehealthcare)thatconnects From thetechnologicalpointofview, thetelematic 7 daysaweek. guarantee healthcareservicessupply24hoursperday, with carecontinuityprofessionalsaredevelopedto levels. During2008, plansaimedatadeeperintegration that Health Trusts havealreadydevelopedatdifferent heart problems, chronicbronchitis, kidneydefi affected bythemostcommonchronicdiseases(diabetes, spread innovativeexperiencesindealingwithpatients technological reorganizationofgeneral practice andto The goalfor2008istocompletetheorganizationaland to chronicpatients. social-health residencesandinparticularofhomecare the coordinationofclinicalactivities, ofcaresupplyin integrated withtheotherHealthDistrictprofessionalsfor With suchanorganization, thegeneral practitioner ismore Emergency Rooms(thesocalled “white codes”). even forurgentproblemsthatdonotrequireturningto wider chancesofcarefromthegeneral practice physician, till 12hoursperdaywhenevernecessary. This implies “network” medicine), fromaminimumof7hoursperday of aspecifi 13 18,073 11-30 -117,674 4-31 st , 2007 Average populationassisted c Unitandthedevelopmentof “group” and per PHU 13,754 25,017 14,251 19,611 15,978 20.524 15,725 16,720 17,972 18,120 Min &maxassistedpopulation per PHU st 3,862-36,224 15,706-34,614 11,429-27,393 10,005-36,224 12,458-26,759 , 2007 ciency, …) 7,311-20,285 5,449-22,469 9,836-34,748 7,277-24,699 4,087-32,332 3,862-30,855 6,533-29,885 222-05-2009 17:37:47 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 4 7 SSSRE-R_2008_INGLESE9.indd 61 S R E - R _ 2 0 0 8 _ I N emergencies). The systemiscomposedof: cases (fromearlytreatmentofheartinfarctiontomaxi 400,000 in2007)andwithmorecomplex intervention location, therescueteamdecidesbest network ofavailablerescuevehicles; oncereachedthe operational centres andarequicklysortedouttothe The callsforhealthinterventionsarrivetooneofthe8 car withphysicianandnurse). intervene (ambulance, helicopterambulance, equipped call, thenursedecideswhatrescuevehicleshould On thebasisofinformationcollectedduringphone procedures andprotocolswithamedicalsupervision. answers thecallingcitizenaccordingtostandard The operational centreswork24hoursaday; anurse • • • T G 4 basesforhelicopterambulances. a networkof347mobilestationsunits: ambulances 8 operational centres; L and equippedcarswithphysiciannurse; E This networkmodelwasdefinedbytheRegional local hospitals. to hubcentrescanonlyberequestedbyspecialistsat specialty centres)andspokes(localhospitals). Access spoke) isbasedontheconnectionbetweenhubs(high regional level. The organizationalmodeladopted(hub& Planning forhighspecialtycentresisdevelopedat conditions aretransferred fromlocalhospitals. a fewhospitals, wherepatientswithparticularclinical F S with ahighnumberofaidinterventions(morethan he 118EmergencysystemofEmilia-Romagnadeals E 9 . i care, highspecialtyfunctionsareofferedonlyin or theirlowfrequencyforthecomplexityof n d d

6 1 Hub &spokemodelforhospitalcare 118 Emergency system 118 Emergency Internet website: centre (locatedinRavenna). Rimini provincearehandledbytheRomagnaoperative From thebeginningof2009, emergencycallsinthe 118, CityPoliceandCivilDefenceDepartment. technologies thatwillintegrate communicationbetween has implementedanewradio networkwithdigital Recently, Emilia-RomagnaRegion–firstinItaly rescue vehicle. that, insomeareas, canlocatethepositionof advanced computerandradio-communication systems The 118Emergencysystemcanactuallyrelyon in urbanareasandwithin20minutesrural areas. guarantee that rescuevehiclesarrivewithin8minutes According totheagreedstandard, 118systemhasto private organizations. voluntary associations, byItalianRedCrossand Health Trusts, or–withspecificagreementsby ANPAS The networkofvehiclesisdirectlymanagedbythe referral hospitalonthebasisofcareneeds. oncology andhighcomplexitylaboratory diagnostics. The regionalplanningisnowfocusedparticularlyon rare diseases, genetics. urgency system, transfusion systemandbloodplan, therapies, rehabilitationhighspecialties, emergency- severe burns, perinatalandpaediatricintensive surgery andcardiology, neurosciences, transplants, disciplines; thosealreadyimplementedare: heart and HealthcarePlan2008-2010. Itreferstospecifi Health Plan1999-2001andisconfi http://www.118er.it/ rmed bytheSocial c 222-05-2009 17:37:47 2 - 0 5 - 2 0 0 9

1 7 61 : 3 7 :

4 organizational models 7 62 SSSRE-R_2008_INGLESE9.indd 62 S R E - R organizational models _ 2 0 0 8 _ I N neuromotor disabilitiesindevelopmentalage The in Bologna, “Bufalini” HospitalinCesena). (hosted atMaggioreHospitalinParma, MaggioreHospital Trust) actashubswiththethreeregional Trauma Centres Montecatone RehabilitationInstitute(ImolaLocalHealth d’Arda Hospital(PiacenzaLocalHealth Trust) and The tworehabilitativemedicinecomplexunitsat Villanova emergency andacutephases. care topeoplewithmyelolesionandthemanagementof through a “network ofspinalunits” thatguarantee timely In thistransition processtheregionalsystemisacting severe myelolesions centre ofthe near futurewillalsohosttheUnifi Trauma CentreatMaggioreHospitalinBologna, thatinthe Spoke centresforacutecases: Regional hubcentre: HUB I Spoke centresforacute/traumas: Local spokecentres: Hospital spokecentres: G L E spoke networkofrehabilitationhighspecialties. The n 2008Emilia-RomagnaRegioncompletedthehub& S E regional networkforrehabilitationfromsevere 9 SA . i n Regional networkforrehabilitation d SO d HUB

ST 6 2 Hub &spokenetworksforseveredisabilities SAT regional networkforrehabilitationfrom from severemyelolesions from SA SO ST ST SO SO Local spokecentres: ST Spoke centresforacutecases: Hospital spokecentres: Hub/spoke centres: Regional hubcentre: HUB . po e o u ST SA cal spokecentres: S gional hubcentre: s b/s ke centres p SA SO ital p SAT SA oke centres: spo SO ST ke centres: SA ST ed SpinalUnit, isthehub SA f SO or acutecases: SAT SO Regional networkfortherehabilitation SO ST H/SH/ from severeacquiredbrainlesions from f HUB SA T S HUB ST SO ST SA SO H/S SO ST SA ST SA ST ST SA

SO • SO ST ST ST SAT ST SO refers ST H/S SA q SO ST ST ST ST ST centres. Internetwebsite: & spokecentresandtothehospitalterritorial Ferrara UniversityHospital Trust, thatislinkedtothehub of referenceattheSevereBrain LesionsOperational Unitat brain lesions The facilities inthenetwork. centres betweentheReggioEmiliahubandother Bologna ResearchHospital “Rizzoli” -actasintermediate centre forspinabifi Roncati” centre(BolognaLocalHealth Trust), “Regional disabilities hostedat3highlyspecialisedstructures- “Corte The multifunctionaltechnologicalpolesforchildhood neuropsychiatry. the HealthDistrictUnitsofchildhoodandadolescence acts ashubcentrethatgatherspatientscomingfrom developmental ageatReggioEmiliaHospital Trust, which to theRehabilitationUnitforseveredisabilitiesin Hub/spoke centres: Health Districtspokecentres: Spoke centresforacutecases: Regional hubcentre: HUB ST SO SO network forrehabilitationfromsevereacquired ST SA SO Regional networkforrehabilitation from severe neuromotor disabilities severeneuromotor from SD ST H/S HUB ST (the fi SA ST H/S in developmentalage SD SO ST H/S da” (Parma UniversityHospital Trust) and rst to be created) has its regional centre rst tobecreated)hasitsregionalcentre SO SA HUB SO ST SD H/S SA SD http://www.gracer.it ST SD SA H/S SA H/S SD SA SD SA SA SA SD SD SD SA SD SA SD 222-05-2009 17:37:51 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 5 1 SSSRE-R_2008_INGLESE9.indd 63 S R E - R _ 2 0 0 8 _ I N Spoke centre Hub centre B haemophiliaandcongenitalhaemorragic diseases; - activated: have beensetup. At present, 4networkshavebeen a singlepathologyortosmallgroupsofpathologies Within thiscontext, specifi prescription charges. diagnosis certifi Only theRareDiseasesCentresofnetworkcanrelease of rare diseases. Regional networkforprevention, diagnosisandtreatment Consequently, Emilia-RomagnaRegioninstitutedthe Act. established in2001atnationallevelwithaMinisterial 600 rare disordersclassifi National networkforrare diseasesandalistofabout G L E S E of people(fewerthan1inevery2,000persons). A y defi Hub &spokenetworkforglycogenosis 9 . i S S n d d

nition, “rare diseases” affectonlysmallgroups

6 3 Hub &spokenetworksfordiagnosisandcare for the Marfan syndrome for theMarfan S Hub &spokenetwork cationsneededtoobtainexemptionfrom S S S ed bypathologicbranch were c carenetworksdevotedto H S H S H S S S S of rarediseases S Internet website: care centres. of rare diseasesandtheEmilia-Romagnadiagnosis A searchengineprovidesinterestedpeoplewiththelist benefi specifi A regionaltechnicalgroupischargedwithconsultingabout of RareDiseases. the creationandimplementationofRegionalRegister professionals. Patient’s datainputinthesystemallows implemented, thusallowingdataexchangeamonghealth Centres andDepartmentsforPrimaryCare-was - basedonthenetworkconnectionamongauthorized Since June2007aninformationsystemonrare diseases - Marfan syndrome. - glycogenosis; hereditaryhaemolyticanaemia; - ts. c problemsalsorelatedwithparticularassistance for congenital haemorragic diseases for congenitalhaemorragic for hereditary haemolyticanaemia for hereditary f S S H Hub &spokenetwork S S Hub &spokenetwork http://www.saluter.it/malattierare/ S S y S S S S y H S S S S S S 222-05-2009 17:37:53 2 - 0 5 - 2 0 0 9

1 7 63 : 3 7 :

5 organizational models 3 64 SSSRE-R_2008_INGLESE9.indd 64 S R E - R organizational models _ 2 0 0 8 _ I N amultidisciplinaryclinicalapproachbytheinvolved - - early identifi The mostsignifi acute event. goal todecreasemortalityanddisabilitiescausedbythe to integrated homecareforthepatient, withtheprimary diagnostic-therapeutic guidelines, tomaincarepathsand treatments intheacutephase, tothemostimportant to availableeffectivenessevidences, topharmacological and post-discharge), referstostrokeepidemiologyinItaly, in thewholehospitalpath(pre-admission, hospitalization phase andafterwards. The “stroke care” model, considered integrated carepathtostrokepatientsduringtheacute provincial “stroke networks” thatshouldguarantee an Region providedHealth Trusts withindicationstoimplement W • • G L Emergency Room Neurology operationalunit specialists; Emergency Rooms); (triage nurses, thatfi centre, rescueteams)andtotheEmergencyRoomteams continuity physicians, to118professionals(operational specific training togeneral practitioners andcare E S E 9

care tostrokepatients-Strokeprogram” the ith the “Guidelines ontheorganizationofintegrated . i n d d

Centres authorisedforfi

6 4 cant organizationalaspectsofthismodelare: cation ofstrokesymptoms, alsothrough integrated care for stroke patients integrated careforstroke rst evaluatepeopleadmittedto The “Stroke care”network, The “Stroke brinolytic treatment of acute ischemic stroke withActilyse brinolytic treatment ofacuteischemicstroke Internet website: therapy andrehabilitation. and newinformationonstrokediagnosis, prognosis, to fosterthetransfer intoclinicalpractice ofknowledges clinical andorganizationalresearchforstrokecareinorder aims atcreatinganinterregionalnetworkfocusedon Italian Ministryof Work, Healthand Welfare. The project in theHealthcareResearchProgram promotedbythe strategic program forresearchanddevelopment” included project “New knowledgesandcareproblemsforstroke: a Since 2007, Emilia-Romagnacoordinatesthenational ischemic stroke. use Actilyse druginthefi Moreover, theRegionhasauthorizedsomeCentresto - defi - identifi - and betweenhealthsocialservices. coordination betweenhospitalandterritorialservices a globalcareofthepatientthroughintegration and of careaftertheacutephase; rehabilitation treatments(within48hours)andcontinuity nitionofindividualrehabilitationprograms allowing cation of a stroke care area in hospitals for prompt cation ofastrokecareareainhospitalsforprompt http://www.saluter.it/stroke/ brinolytic treatmentofacute 222-05-2009 17:37:57 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 5 7 SSSRE-R_2008_INGLESE9.indd 65 S R E - R _ 2 0 0 8 _ I N deciding ifhospitalizationisreallyneeded. Inpastyears of patient’s clinicalconditionsforashortperiod, before according tosharedguidelinesandcontroltheevolution use appropriatediagnosticandtherapeutic instruments on thepossibilityforEmergencyRoompersonnelto as nonprogrammed accessesareconcerned, isbased make hospitalizationactivitymoreappropriateasfar 24/2005).effi The short observation” werealsoapproved(Resolutionno. “Regional guidelinesontheactivitiesofintensive if suppliedbyEmergencyRooms. can beconsideredasnormaloutpatienttreatmentseven the so-called “white codes” asnonurgenttreatments, that measures (RegionalResolutionNo. 264/2003)classifi of emergencyareaprofessionals). Expendituresharing of accesscolourcodes(defi and throughGuidelinesforanhomgeneousclassifi through theuseofspecifi implementation ofthetriagefunctionwasenhanced criteria thatallowaninterventionprioritization. Standardized accessibility andtotreatpatientsaccordingdefi Rooms isoneofthemosteffi The introductionofthetriagefunctioninEmergency participation tocosts). short observation, complexoutpatientpathsandindividual or paediatrician)andinhospitals(nursetriage, intensive upon urgentrequestbythegeneral practice physician longer openinghours, specialistoutpatienttreatment Continuity OutpatientUnits, PrimaryHealthcareUnitswith improve alternativepathsinlocalHealthDistricts(Care new solutions. Someinterventionswereidentifi use ofexistingstructuresandtheimplementation paths alternativetoEmergencyRoomthroughabetter 264/2003 gaveindicationstoHealth Trusts tooffercare in amultidimensionallogic. The RegionalResolutionNo. F Source: Ministerialdatabase. G oa ,7,1 441742814.4 1,774,208 14.4 20.9 13.6 17.9 13.5 1,774,416 13.4 19.8 15.2 12.8 74,052 5.3 90,006 137,217 13.2 21.7 13.9 13.1 106,179 118,389 79,129 19.0 13.8 79,364 57,937 12.5 14.5 12.8 45,502 19.3 13.8 15.8 13.1 73,759 15.3 175,745 86,606 61,229 11.1 5.4 135,958 90,189 13.5 13.9 106,116 13.6 12.5 122,003 228,081 79,723 80,478 57,910 193,996 38,260 16.0 90,947 13.3 44,810 175,509 88,907 13.8 64,790 111,569 10.6 13.9 219,226 Total 195,424 Bologna RizzoliOrthopaedicInstitutes Research hospital Ferrara 36,712 UniversityHospital Trust Bologna UniversityHospital Trust 91,390 Modena UniversityHospital Trust 111,512 Reggio EmiliaHospital Trust Parma University Hospital Trust Rimini LocalHealth Trust Cesena LocalHealth Trust Forlì LocalHealth Trust Ravenna LocalHealth Trust Ferrara Local Health Trust Imola LocalHealth Trust Bologna LocalHealth Trust Modena LocalHealth Trust Reggio EmiliaLocalHealth Trust Parma LocalHealth Trust Piacenza LocalHealth Trust Health Trust L E S

facilities isacrucialproblemthatneedstobefaced ull accessibilityandcorrectuseofEmergencyRoom E 9 . i n d d

6 5 The reorganization of Emergency Rooms ofEmergency The reorganization cacy ofthisorganizationalsolutionto Emergency Room activity by Health Trust, 2006-2007 RoomactivitybyHealthTrust, Emergency cally trained nursepersonnel cacious measures to improve cacious measurestoimprove ned withthecollaboration cation e to ed nite ed accesses No. of of No. 50,000 in2006). that didnotresultinadmissionwereover56,000(over was 15%). Accesses inintensiveshortobservationunits these accesses, samepercentagein2006(in2005it 1,730,219). Hospitalizationwasnecessaryfor14.4%of increase rate withrespectto2005hadbeen2.5%= (almost thesameasin2006=1,774,416, whenthe In 2007accessestoEmergencyRoomswere1,774,208 and paths. manage avoidableadmissionsandtoimprovecaretimes opportunity toidentifycriteriaandtoolsinorder planning ofhospitalandterritorialservices, givingthe reorganization isactuallyconnectedwiththeintegrated from theSocialandHealthcarePlan2008-2010: of EmergencyRoomservicesisconsistentwithindications The activitiestoimproveaccessibilityandappropriateness care path. general practitioner canfollow thepatientinwhole continuity andgeneral practice physicians; inthiswaythe services andPrimaryHealthcareUnits, andbetweencare implemented withtheSOLEProjectamongemergency during theday); usingcommunicationprocedures turning toEmergencyRooms(typologyanddistribution the lengtheningofopeninghourswithneedspeople opportunities offeredbycarecontinuityphysicians; linking needs ofthereferencepopulation); evaluatingintegration hours (tobeestablishedonthebasisofemergency Healthcare Units)throughthelengtheningofopening access toappropriateservices(fi Emergency Roomsthroughstrategies aimedat: improving with indicationstoreduceinappropriateaccesses The Resolutionno. 602/2008providesHealth Trusts from internationalexperiences. attacks andstrokes, adoptingevidence-basedmodels personnel andspecialists, inparticularfortraumas, heart were alsoelaborated with118Emergencysystem some intra- andextra-hospital pathsforcriticalpatients 062007 2006 hospitalization % accesses No. of of No. rst ofalltoPrimary hospitalization % 222-05-2009 17:37:59 2 - 0 5 - 2 0 0 9

1 7 65 : 3 7 :

5 organizational models 9 66 SSSRE-R_2008_INGLESE9.indd 66 S R E - R organizational models _ 2 0 0 8 _ I N T agreements system, localneedsareredefi Ten yearsaftertheimplementationofregional defi the merely “historic” concepthasbeenabandonedinthe Some signifi between Health Trusts andprivatehospitals. can bemorespecifi previous ones; thevolumesandtypesofservicesoffered The 2007-2009agreementisanoutlineasthe cutting down. identifi To avoidexcessesbeyondbudgetlimits, theagreement regional budgetisagreedforthepsychiatricarea. not residentintheareawherefacilityislocated; a budget arebeingdefi complex specialties, localbudgetsandatotalregional moment thepreviousagreementisstillvalid. For non- the fourinvolvedhealthfacilitiesand AIOP, soatthe neurosurgery highspecialtiesisunderdiscussionwith In particular, theagreementonheartsurgeryand as highspecialties. and theotherhospitalizationactivitiesnotconsidered as heartsurgeryandneurosurgery-, psychiatriccare and servicesrelatedtohighspecialtyactivities–such while itconsidersseparately thedefi treatments, paymentscontrolandothergeneral aspects, In itsgeneral part, theagreementdealswithaccessto were usedbyeachsingleLocalHealth Trust. budget alltheadditionallocalresourcesthatinpast the needsforhospitalcare, integrating intheregional was carriedoutinvolvingLocalHealth Trusts, toregister For thesubscriptionof2007-2009agreement, asurvey involved intheglobalcarenetwork). goals toensurefullintegration amongthestructures specifi determining maximumbudgetsforprovincialareasand regulate therelationshipsbothonfi G L E nition oftheprovincialbudget. S and thePrivateHospitals Associations (AIOP-ARIS) he agreementbetweenEmilia-RomagnaRegion E 9 c activities)andthequalitativeone(byidentifying . essomepenaltymechanismsthroughscalartariff i n d Agreement betweenRegionandprivatehospitals d

6 6 cant changesareimplemented, forexample ned for treatments offered to citizens ned fortreatmentsofferedtocitizens cly defi cally ned throughagreements nition ofbudgets nancial side(by ned through ned phenomenon, thatrepresentsanationalissue. other ItalianRegionsforthegovernanceofmobility respect theagreementsbetweenEmilia-Romagnaand Private healthcareprovidersalsocommitthemselvesto are alsoprogrammed. and fromLocalHealth Trusts’ MentalHealthDepartments the participationofrepresentativesfromprivatefacilities continuity ofcare, meetingsforactivitiescoordinationwith better ensureintegration withthepublicnetworktoallow and long-termcarewasreconsideredand, inorderto inpatient andspecialistresidentialcare, andforintensive number ofhospitalbedsinintensivecareunitsforordinary psychiatric areainthepublichealthcaresystem. The The 2007-2009agreementfullyintegrates theprivate also fromprivatefacilities. Health Trusts’ servicestoimplementprotecteddischarges systematic developmentofconnectionpathswithLocal of theRegionalHealthServiceandpushestowardsa deeper integration ofprivatefacilitiesinthecarenetwork for thethreeyears, representsastepforwardtowards The agreement, thatalreadyallocatesthetotalamount net turnoveroffacilities. that evaluatespenaltyapplicationandcertifi penalty evaluationsbyaJointCommission–theorganism from publichospitalacuteunits)andtheywillaffect Rooms accessandforlong-termcarefollowingdischarge responding tohospitalizationneedsfollowingEmergency of privatefacilitiesinreducingsurgerywaitingtimesand maintained (particularlywithreferencetothecontribution use throughtheyears. Qualitygoalsareupdatedand now integrated inthebudget, consideringitsactual a specifi case ofattainmentdefi As aconsequence, thesystemofpenaltyannulmentin private facilities. and moreconnectedwiththerealuseintegration of for budgetdefi the directinvolvementofLocalHealth Trusts, anewbasis c regionalfund–iscancelled, andthefundis nitionisdetermined, thatismorerealistic nedtargets–fi nancedthrough es thefi nal 222-05-2009 17:37:59 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 5 9 SSSRE-R_2008_INGLESE9.indd 67 S R E - R _ 2 0 0 8 _ I N Health Service. support toolforpurchasestrategies oftheRegional Romagna –andIntercent-ERhasbecomethefundamental Romagna Vast Areas –NorthEmilia, Central Emiliaand This processalsoledtothecreationofthreeEmilia- use andexpenditurequalifi above Trust level, aimedattheoptimizationofresources to pursueaprogressivereorganizationofthefunctions system allowstoobtainbettereconomicaloutcomesand procedures ofgoodsandservicesintheHealth Trusts. This implemented initiativestohomologatepurchase Starting from2002, theRegionalHealthService agreements signedbythe Agency. to acquiregoodsandservicesexclusivelythroughthe included alltheHealth Trusts –thusengagingthemselves was activated; 49regionalpublicbodieshaveadhered– A organizational settingsinordertogiveproperanswers diagnostic-therapeutic technologiesortorearrange If ontheonehandneedtoacquireinnovative • • • T and hasthefollowingobjectives: Emilia-Romagna RegionalHealthcareandSocial Agency G to register and document relevant clinical-organizational toregisteranddocumentrelevantclinical-organizational to earlyidentify-throughthecollaboration with to supportandguidetheadoptionofprocedures L spreading. aim tofostertheirknowledge, sharingandpossible innovations adoptedbyhealthcareservices, withthe that includeimpactassessment; implications andthedefi Service inordertoallowtheevaluationoftheirpotential technologies potentiallyrelevantfortheRegionalHealth of technologyassessmentagencies-innovative companies andwiththeinternationalnetworks healthcare contexts; of diagnosticandtherapeutic newtechnologiesin E S (ORI) wasinstitutedin2007. Itismanagedbythe he RegionalObservatoryforInnovationsinHealthcare Regional Observatory forInnovationsinHealthcare Regional Observatory E 2005 theRegionalPurchase Agency (Intercent-ER) s establishedbyRegionalLawno. 11/2004, inFebruary 9 . i n d d

6 7 cation. nition ofadoptionprograms agreements withIntercent-ER Goods and services purchase: Goods andservices Internet website: collection, databases. logo, drugs, healthdevices and equipments, specialwaste healthcare facilitieswiththeRegionalHealthService phone services, energy, internalandexternalsigns for through Intercent-ERcentralized tendersconcerning: The objectiveisnowtowidenthepurchasevolume million Euros. hormone, intraoperatory radiotherapy devices)for67 laboratory equipments, needlesandsyringes, growth anti-decubitus systems, antisepticsanddisinfectants, specific healthcare-relatedexpenditure(vaccines, phone services, surveillance, food)for25millionEuros; to: ordinaryexpenditure(stationery, personalcomputers, of which92millionforHealth Trusts’ contracts related Intercent-ER agreementsamountedto190millionEuros, In 2007, thevalueofcontracts activatedthrough For furtherinformation: adoption. of regionalworkinggroupsdealingwithhightechnologies innovative technologiesadoptionin Trusts, thecreation the defi organization oftraining initiativesandothercourses, and training. The Observatorybegantooperate inthe of thestrategic developmentofresearch, innovation Regional Lawno. 29/2004, aspromotersandverifi Boards ofDirectorsthathavetoact, accordingto and fromtheHealth Trusts, involvinginparticularthe Emilia-Romagna RegionalHealthcareandSocial Agency The Observatoryisanetworkofexpertsfromthe and guaranteeing economicsustainability. access throughouttheregion, avoidingredundantservices introduction inthehealthcareserviceensuringeasy true innovationsfromfalseones, andtoharmonizetheir other handitislikewisenecessarytotimelydiscriminate positive dynamicelementforthewholesystem, onthe to theevolutionofhealthcarecomplexneedscanbea http://asr.regione.emilia-romagna.it/ nition ofsharedmethodstoelaborate planfor http://www.intercent.it ers 222-05-2009 17:37:59 2 - 0 5 - 2 0 0 9

1 7 67 : 3 7 :

5 organizational models 9 68 SSSRE-R_2008_INGLESE9.indd 68 S R E - R organizational models _ 2 0 0 8 _ I N while alwaysrespectingprivacylaws. as farpossible, informationandnotpeople “moving”, continuity ofcareforpatients. The SOLEprojectwillmake, citizens’ accesstoservices, thusimprovingtreatmentsand healthcare professionalsandtoconsequentlysimplify services beganin2003toeasecommunicationamong care program isactive). diseases (i.e. patientswithdiabetes, forwhomaspecifi integrated management ofpatientsaffectedbyparticular prescriptions, admissionrequests, homecarerequests, general practice physiciansandpaediatriciansonpatients, Research Hospital “Rizzoli”) timelycommunicationfrom Trusts, Hospital Trusts, UniversityHospital Trusts andthe territorial services, tohospitalservices(ofLocalHealth SOLE networkwillguarantee toLocalHealth Trusts, to and qualifi to accessvirtuallibraries tomakelifelonglearningeffective Departments ofPrimaryCare; itwillwidentheopportunity between general practitioners andpaediatriciansthe it willeasecommunicationandadministrative procedures health services(inordertoguarantee continuityofcare); knowledge ofservicessuppliedtotheirpatientsindifferent general practitioners andpaediatriciansthecomprehensive of healthcarepathways. This networkwillguarantee to paediatricians asclinicalreferencepointsandstarters the fundamentalroleofgeneral practitioners and SOLE networkisanintegrated networkbasedon administrative procedures. personalized careplans; thenetworkalsosimplifies visit prescription, medicalreports, admissions, discharges, on patients’clinicalrecords, specialistdiagnosticsand giving allofthemtheopportunitytoexchangeinformation mental healthcentresandfamilyadvisorycentres, and hospitalgeneral outpatients’departments, hospices, care services, continuityofcareservices, hospitals, District practice physiciansandpaediatricians, nursingdomiciliary Once fullyoperative, thenetworkwillconnectgeneral exchange The computerizednetworkforinformation T • • • The followingserviceshavealreadybeenactivated: with Health Trusts. a PC, aprinter, ADSL lineandasoftwaretocommunicate connected withinthenetwork. All ofthemhavereceived As ofMay2008, 2,075, physiciansandpaediatriciansare Services alreadyavailable G useofaunifi communication fromgeneral practice physiciansand automatic communicationfromLocalHealth Trusts L of outpatientspecialistservices inordertoautomatize Trusts andtheResearch Hospitalfortheprescription general practice physiciansandpaediatricians, Health vaccinations); services suppliedtopatients(drips, dressings, paediatricians toLocalHealth Trusts onadditional including choices/repealnotifi and transmission oftheupdatedregisterpatients, to general practice physiciansandpaediatricians E S physicians, paediatricians, hospitalandterritorial he planningofacomputerizednetworkthatconnects E 9 . i n d d

ed.

6 8 edregionalcatalogue(SOLEcatalogue)by SOLE Project (onlinehealthcare) SOLE Project cations; c • • • • • million Euros. 34 millionEurosandtheyearly managementwillcost8 within 2009. The totalcostoftheprojectwill amountto The systemwillbecompletelyactivatedandoperating records, hospitaldischargeletters. signature cardtobeusedsignprescriptions, medical Health Trusts’ administrative personnelreceiveadigital outpatient specialistsandhospitalthe Within 2008general practice physiciansandpaediatricians, access tootherHealth Trusts. able toconsulthealthdocumentsrelatedtheirpatients’ General practice physiciansandpaediatricianswillalsobe access informationonpatientsreferringtothatUnit. Healthcare Unitphysiciansastoalloweachofthem SOLE networkwillkeepontestingthelinkamongPrimary physician/paediatrician withtheHealth Trust’s services, Apart fromthedirectconnectionofeachgeneral practice spread. of informationondiabetespatientswillbeprogressively will beconnectedinthenetwork. The realtimeexchange Other 1,075general practice physiciansandpaediatricians Future objectives • • • communicationbyhospitalfacilitiestogeneral practice LocalHealth Trusts’ managementoftheadministrative unifi computerized managementamonggeneral practice computerizedmanagementofthesystemforprescription helpdeskalldaylong. availability onlineofthe “Regional ClinicalEventsIndex” testinginsomeHealth Trusts ofrealtimeexchange recording; the phasesofinformation, bookingandmedical · · · Emergency Rooms(infullrespectofprivacylaws); and briefmedicalrecordsofservicessuppliedby physicians andpaediatriciansonadmissions, discharges treatment sinceitsbeginning; paediatricians andLocalHealth Trusts inthepatient’s to theparticipationofgeneral practice physiciansand process forintegrated homecare, thatispossiblethanks paediatricians; that isavailabletogeneral practice physiciansand medium; the requestformsforclinicalteststhatrequirecontrast physicians andpaediatriciansLocalHealth Trusts of transmission: the managementofpatients’clinicalfi Health Trusts andtheResearchHospitaltobeusedfor for general practice physiciansandpaediatricians, practice physicians andpaediatriciansspecialists; the diabetesintegrated careprogram, amonggeneral of informationonpatientswithdiabetesincludedin with thepossibilitytosendimages); priority tolaboratory andradiology testsoutcomes, general practice physicians/paediatricians (giving Local Health Trusts sendmedicalrecordsbackto prescriptions totheunifi Local Health Trusts automaticallycommunicatethe for specialistvisitsanddiagnostics; communicate toLocalHealth Trusts theprescriptions general practice physicians/paediatricians ed codelistofservicesofferedfreecharge, ed bookingcentres; les; 222-05-2009 17:37:59 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 5 9 69

Public Trusts for Personal Services he transformation of Public Institutions for Assistance programs; Tand Charity (IPAB) into Public Trusts for Personal Services • Public Institutions for Assistance and Charity interested in (ASP), established by Regional Law no. 6/2003, is part of a transforming into the Public Trusts for Personal Services local and regional welfare development process based on identifi ed in the program, prepared their transformation the principles of universalism, equity and solidarity aimed plans; at guaranteeing uniform and undeniable rights to citizens. • the Public Institutions for Assistance and Charity that The goal is to create a public network of social and social- possessed the needed requisites and that had chosen this health, residential, semi-residential and home care services pathway, applied for privatization; that is as homogeneous as possible throughout the region • the Region evaluated the submitted plans and Statute and that can strengthen its capacity for response, together proposals and sent the evaluation outcomes to the with services offered by the private sector. interested Municipalities and Public Institutions for The reform gives the opportunity to IPABs in possess of the Assistance and Charity; needed Law requirements to become private institutions. • the Region instituted the Public Trusts for Personal IPABs are public organizations, often established many Services. centuries ago, that arose as “charitable” answer to the need of assistance from the weaker parts of the population. In At present, 226 Public Institutions for Assistance and Charity Emilia-Romagna, in the last years these institutions were are still located in Emilia-Romagna: 50 of them will be closed transformed to adapt to new care needs brought on by because of long inaction periods or upon specifi c request; the social-demographic development. Nevertheless, they 55 applied to become private organizations; 121 asked to be remained anomalous because they were not connected transformed into ASP, but as a consequence of unifi cations to any institutional level of government nor to community or merging they will fi nally be 50. participation. This led to the decision to transform IPABs into As of July 1st, 2008, 34 Public Trusts for Personal Services had the new Public Trusts for Personal Services, which retain already been instituted; the remaining 16 are undergoing the a public legal status in the institutional and governmental fi nal steps of transformation. responsibility system. ASPs are public bodies entitled to The regional Legislative Assembly has defi ned (Resolution No. manage and supply the social and social-health services 170/2008) the principles and rules regulating the autonomy indicated in the District planning with the collaboration of of Public Trusts for Personal Services; the same Resolution Municipalities. establishes also incompatibility and decadence causes of The transformation process went through various stages: governance organisms members and the criteria to defi ne • the Health District Committees issued transformation wages for the members of the governing bodies.

Public Trusts for Personal Services already instituted, as of July 1st, 2008

Province District Institution name Municipality Date of institution Bologna Bologna Giovanni XXIII Bologna January 1, 2007 Modena Vignola G. Gasparini Vignola January 1, 2007 Parma Parma Ad Personam Parma May 3, 2007 Bologna Bologna Poveri vergognosi Bologna January 1, 2008 Modena Carpi ASP delle Terre d’Argine Carpi January 1, 2008 Ferrara Centro Nord Centro servizi alla persona Ferrara January 1, 2008 Bologna Imola Circondario imolese Castel S.Pietro January 1, 2008 Modena Modena Caritas – ASP servizi assistenziali per disabili Modena January 1, 2008 Bologna Pianura Est Donini-Damiani Budrio January 1, 2008 Bologna Pianura Est Galuppi-Ramponi Pieve di Cento January 1, 2008 Bologna Pianura Ovest Seneca Crevalcore January 1, 2008 Reggio Emilia Reggio Emilia Opus Civium Castelnuovo di sotto January 1, 2008 Reggio Emilia Reggio Emilia Rete – Reggio terza età Reggio Emilia January 1, 2008 Rimini Rimini Nord Valle del Marecchia Santarcangelo di Romagna January 1, 2008 Ravenna Faenza Solidarietà insieme Castelbolognese February 1, 2008

Ravenna Lugo Bassa Romagna Bagnacavallo February 1, 2008 modelli organizzativi Ravenna Faenza Prendersi cura Faenza March 1, 2008 Parma Provinciale Rodolfo Tanzi Pama March 1, 2008 Bologna Bologna Irides (Istituzioni riunite infanzia disabilità e sociale) Bologna April 1, 2008 Forlì-Cesena Forlì Oasi Forlì April 1, 2008 Reggio Emilia Guastalla ProgettoPersona – Azienda intercomunale servizi alla persona Guastalla April 1, 2008 Modena Mirandola ASP dei Comuni modenesi Area Nord San Felice s/P April 1, 2008 Reggio Emilia Reggio Emilia OSEA Opere di servizi educativi assistenziali Reggio Emilia April 1, 2008 Rimini Rimini Nord Casa Valloni Rimini April 1, 2008 Forlì-Cesena Rubicone Costa ASP del Rubicone San Mauro Pascoli April 1, 2008 Reggio Emilia Correggio ASP Magiera Ansaloni Rio Saliceto May 1, 2008 Ferrara Ferrara sud-est ASP del Delta Ferrarese Codigoro May 1, 2008 Modena Castelfranco Emilia Delia Repetto Castelfranco Emilia June 1, 2008 Ravenna Ravenna ASP Ravenna Cervia e Russi Ravenna July 1, 2008 Bologna San Lazzaro di Savena L. Rodriguez y Laso De’ Buoi San Lazzaro di Savena JJuly 1, 2008 Parma Sud-est Azienda sociale Sud Est Langhirano July 1, 2008 Parma Fidenza Distretto di Fidenza Fidenza July 1, 2008 Ferrara Ferrara sud-est Argenta – Portomaggiore “Eppi-Manica-Salvatori” Argenta July 1, 2008 Modena Modena Patronato pei Figli del Popolo e Fondazione San Paolo e San Modena July 1, 2008 Geminiano

SSSRE-R_2008_INGLESE9.inddSRE-R_2008_INGLESE9.indd 6969 222-05-20092-05-2009 17:37:5917:37:59 70 SSSRE-R_2008_INGLESE9.indd 70 S R E - R organizational models _ 2 0 0 8 _ I N Most callscomefromtheareaofBologna. information. vaccination information; 7%referredtohealthcampaigns facilities andprofessionals; 11.4%wereoncertifi therapies, surgeryinterventions; 14.5%relatedtohealth 42% callsconcernedspecialistvisits, diagnostictests, 2006, +4.8%); inthesameyear, confi calls forinformationnumbered113,880(108,413in more than530,000calls. In2007alone, thereceived In thefi more detailedinformationisnecessary. to transfer -free ofcharge-thephonecall, iffurtherand of theHealth Trusts. This connectionallowsthecallcentre phone networktotheOffi duly trained operators, connectedthroughcomputerand Phone callsarecollectedinacallcentre, managedby standard repliestofrequentlyaskedquestions. provisions, regionalprograms, aglossaryandsetof a singledatabaseconsistingin2,300healthservices/ The informationserviceofthetollfreenumberrelieson time updating. the servicemanagement, ensuringitsconstantandreal laid theinformationandtechnologicalfoundationsfor communication structuresandthoseoftheHealth Trusts, The Region, thankstoitsowninformationand country, frombothmobileandfi p.m. onSaturday. The callisfreeofcharge alloverthe p.m. fromMondaytoFriday andfrom8:30a.m. to1:30 The tollfreenumberisavailablefrom8:30a.m. to5:30 delivery allovertheregion. services supplied, thewaysofaccessandplaces homogeneous informationabouthealthandsocial-health activated inJune2002ordertoguarantee clearand Regional HealthServicetelephonenumber, whichwas These arethebasisforcreationofafreeandunique act intheframework ofanintegrated system. as fi For thepurposeofprovidingfairaccesstoinformation– appropriateness intheuseanddeliveryofservices. fair accesstoservicesforall–andthepursuitof principles ofpublichealthservice–universalityand I The tollfreenumber800033 the SocialandHealthcarePlan 2008-2010. information pointswillbeimplementedasestablishedby for theconnectionoftollfreenumbertosocialservices for specialistvisitsanddiagnostics. Inthefuture, projects connect thetollfreenumbertophonebookingcentres information onservicesandprovisionsInternetto with thePublic, twoprojectswereactivated topublish service andbytheHealth Trusts’ Offi On thebasisofdatabasesharedbycallcentre Evolution ofthetollfreenumberservice G L E importance fortheachievementofdistinctive nformation andcommunicationhaveastrategic S rststeptofairaccessservices–itisnecessary E 9 . i n d rst sixyearsofactivity, theservicesreceived d

7 0 Information on services: tollfreenumber onservices: Information ces forRelationswiththePublic xed network. xed ces forRelations rming thetrend, cates and during birth. charges, healthcarefortravellers, homecare, care youth assistanceandcounsellingservices, prescription physicians choice, certifi frequently askedinformationconcernedgeneral practice In 2007, thepagescounted71,592accesses. The most will besoonaddedintheGuide. on specialistvisitsanddiagnostics(notyetavailable) Offi information onHealth Trusts, Hospitals, Districtsand an expresslydevelopedsearchengine. The Guideoffers is nowdirectlyavailablealsotonavigators, thanksto centre andattheHealth Trusts, hasbeenrevisedand Service –thatwaspreviouslyavailableonlyatthecall social-health servicessuppliedbytheRegionalHealth to go, howtodo, whatisneededtousehealthand Trusts’ websites. Specifi phone unifi (only thoseforwhichphonebookingisallowed)tothe requiring informationonspecialistvisitsanddiagnostics carried out. The projectconsistedintransferring thecalls Beginning fromMarch2007, anewexperimentwas diagnostics 2) Phonebookingofspecialistvisitsand Service ( published inthewebportalofRegionalHealth In November2006the “Online guidetoservices” was 1) Onlineguidetoservices and economicdisadvantagedconditions. such aselderly, immigrants andpeoplelivinginsocial with particularattentiontosociallyvulnerable groups services andOffi services (i.e. Municipalities’information desksforsocial other informationandaccesspointstosocial-health the coordinationbetweentollfreenumberand regional community. Oneofthemainchallengeswill be as asupportforwelfaredevelopmentinthelocaland Healthcare Plan2008-2010istousethetollfreenumber The futureperspectiveoftheRegionalSocialand information points 3) Connectionwiththesocialservices number totheHealth Trusts’ unifi booking callshavebeentransferred fromthetollfree March toDecember2007, 2,773visitsanddiagnostics regional accessandwithstandardizedpaths. From specialist visitsanddiagnosticsbymeansofasingle represents thefi ces fortheRelationswithPublic. Information http://www.saluter.it ed bookingcentresoftheHealth Trusts; it rststeptowardsthephonebookingof ces fortheRelationwithPublic), cates, vaccinations, healthcard, c information–suchaswhere ) andinalltheHealth ed bookingcentres. 222-05-2009 17:37:59 2 - 0 5 - 2 0 0 9

1 7 : 3 7 : 5 9 THE EMILIA-ROMAGNA REGIONAL HEALTH SERVICE

Editorial coordination: Marta Fin

Edited by: Marta Fin, Nicola Quadrelli, Nicola Santolini, with contributions from the General Direction for Health and Social Policies and from the Regional Healthcare and Social Agency, Emilia-Romagna Region, Italy English version: Elisabetta Petruzzelli, Federica Sarti, Marco Biocca, Regional Healthcare and Social Agency, Emilia-Romagna Region, Italy

Graphic project: Tracce - Modena, Italy Printing: Nuovagrafi ca - Carpi (Modena), Italy May 2009

Regione Emilia-Romagna Assessorato politiche per la salute Viale Aldo Moro, 21 40127 Bologna, Italy Tel. +39 051 6397150

http://www.saluter.it [email protected]

Toll free number of the Regional Health Service 800 033 033

SSSRE-R_2008_INGLESE9.inddSRE-R_2008_INGLESE9.indd 7171 222-05-20092-05-2009 17:37:5917:37:59 SSSRE-R_2008_INGLESE9.inddSRE-R_2008_INGLESE9.indd 7272 222-05-20092-05-2009 17:37:5917:37:59