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Le Regioni a Confronto: Gli Indicatori Per La Programmazione E La Prevenzione

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Le Regioni a Confronto: Gli Indicatori Per La Programmazione E La Prevenzione Le regioni a confronto: gli indicatori per la programmazione e la prevenzione Roberta Crialesi, Istat Roma, 10 luglio 2014 Il percorso dell’indagine 2012-2013 Lavoro condiviso con esperti di Regioni, dell’Agenas e del Ministero della Salute per la: revisione del questionario . Obiettivo principale: possibilità di monitorare i principali indicatori di salute, comportamenti e atteggiamenti su stili di vita e prevenzione, sull’accesso ai servizi sanitari nel tempo .Ampliamento di alcune aree tematiche e introduzione di nuovi temi per colmare esigenze informative emergenti progettazione del disegno campionario . Fornire stime a livello regionale e sub-regionale (Aree Vaste – Aggregati di ASL, ove possibile per ASL) per rispondere alle esigenze di programmazione sanitaria e non a livello sia locale che nazionale .Possibilità di applicare metodi di stima per piccole aree (ASL) – Gruppo di lavoro-SMART Il quadro dei contenuti informativi Dati anagrafici Assistenza domiciliare Famiglia di origine (NEW) Altri servizi Formazione Spese sanitarie NEW) Lavoro Opinioni su alcuni servizi di pubblica utilità Disturbi, malattie o incidenti Consumo di farmaci Invalidità Terapie non convenzionali Condizioni generali di salute Prevenzione generale Stato di salute percepito Vaccinazione antinfluenzale Malattie croniche o di lunga durata Prevenzione femminile Difficoltà permanenti nelle attività Peso, statura, dieta quotidiane Salute dei denti Attività fisica Visite mediche Consumo di tabacco Accertamenti diagnostici Gravidanza, Parto, Allattamento Servizi ospedalieri Metodi contraccettivi NEW) Day hospital Aiuti e Situazione economica della famiglia Interventi chirurgici Partecipazione alla vita sociale NEW) Servizi sanitari di riabilitazione Difficoltà di bambini e ragazzi in alcune attività della vita quotidiana NEW) Il disegno campionario dell’indagine 2012-2013 • E’ stato studiato un disegno campionario che, oltre i domini tradizionali delle indagini Multiscopo (Italia, 5 Ripartizioni territoriali, Regioni) preveda un dominio a livello subregionale - denominato Area Vasta (AV), nonché le ASL come dominio di stima (le ASL più piccole sono state accorpate). • Le Aree Vaste sono aggregati territoriali di interesse per la programmazione sanitaria a livello locale, individuate in collaborazione con esperti di settore delle Regioni, sulla base di un criterio di ampiezza demografica, dipendente da un vincolo di numerosità campionaria complessiva e di rappresentatività del campione. • Le 67 Aree Vaste individuate sono aggregazioni di Aziende Sanitarie Locali (ASL). Solamente nel caso della regione Marche, le Aree Vaste sono state definite accorpando le due province del Nord e le due del Sud. Distribuzione regionale della popolazione, del campione di famiglie e dei comuni per Aree Vaste. Anni 2012-2013 Famiglie Famiglie Famiglie campione campione Numero Comuni Individui Individui Regioni campione per area per area Aree vaste campione popolazione intervistati teorico vasta: vasta: minimo massimo Piemonte 5 104 4.344 800 976 4.443.892 7.976 Valle D'Aosta- Vallèe d'Aoste 1 26 1.080 - - 128.350 1.649 Liguria 3 43 2.564 800 920 1.601.910 4.373 Lombardia 8 173 6.596 688 1.164 9.996.322 12.125 Bolzano-Bozen 1 25 1.048 - - 510.050 2.266 Trento 1 29 1.108 - - 531.636 1.986 Veneto 5 106 3.972 764 820 4.931.841 8.375 Friuli Venezia Giulia 2 50 2.112 988 1.124 1.226.714 4.132 Emilia Romagna 5 96 4.260 740 912 4.451.888 7.301 Toscana 3 91 3.596 1.100 1.280 3.758.835 6.153 Umbria 1 31 1.420 - - 906.510 2.906 Marche 2 52 2.144 1.044 1.100 1.563.894 4.233 Lazio 4 82 4.220 940 1.320 5.807.181 7.856 Abruzzo 2 53 2.140 1.052 1.088 1.343.325 4.003 Molise 1 28 1.104 - - 317.132 2.375 Campania 6 111 4.464 708 770 5.818.893 10.657 Puglia 5 89 3.672 648 820 4.073.626 8.283 Basilicata 1 36 1.336 - - 582.786 3.076 Calabria 2 65 2.308 1.080 1.228 1.999.809 4.934 Sicilia 6 102 4.340 652 792 5.025.552 9.438 Sardegna 3 64 2.540 788 916 1.668.198 4.976 Italia 67 1.456 60.368 - - 60.688.343 119.073 Tassi di risposta dell'indagine 2012-2013 Tasso di Tasso di mancata risposta Campione Campione Campione risposta su REGIONI famiglie famiglie famiglie per famiglie per per altro teorico eleggibili realizzato mancato eleggibili rifiuto motivo contatto Piemonte 4.344 4.664 3.643 78,1% 8,1% 12,1% 1,7% Valle d'Aosta 1.080 1005 771 76,7% 5,1% 17,0% 1,2% Lombardia 6.596 6.704 5.206 77,7% 3,5% 12,1% 1,3% Bolzano 1.048 1030 888 86,2% 8,4% 12,1% 1,9% Trento 1.108 1059 872 82,3% 3,1% 9,5% 1,2% Veneto 3.972 3.995 3.430 85,9% 6,6% 9,0% 2,1% Friuli-Venezia Giulia 2.112 2.391 1.864 78,0% 4,5% 8,5% 1,1% Liguria 2.564 2.596 2.159 83,2% 7,4% 12,8% 1,9% Emilia-Romagna 4.260 4.068 3.255 80,0% 7,8% 10,8% 1,5% Toscana 3.596 3.223 2.668 82,8% 5,4% 10,1% 1,7% Umbria 1.420 1.381 1.184 85,7% 4,6% 8,8% 0,9% Marche 2.144 2.076 1.739 83,8% 6,3% 8,8% 1,2% Lazio 4.220 4.855 3.474 71,6% 8,3% 18,8% 1,3% Abruzzo 2.140 1.871 1.595 85,2% 4,0% 9,7% 1,1% Molise 1.104 1067 992 93,0% 1,7% 4,9% 0,5% Campania 4.464 4.544 3.921 86,3% 3,9% 9,1% 0,8% Puglia 3.672 3.597 3.195 88,8% 4,0% 6,5% 0,7% Basilicata 1.336 1.333 1.236 92,7% 2,3% 4,5% 0,5% Calabria 2.308 2.245 2.001 89,1% 3,0% 7,5% 0,4% Sicilia 4.340 4.437 3.789 85,4% 4,4% 9,2% 1,0% Sardegna 2.540 2.592 2.093 80,7% 5,6% 12,5% 1,2% ITALIA 60.368 60.733 49.975 82,3% 5,7% 10,7% 1,3% Il file di microdati semplificato Principali obiettivi Agevolare la diffusione dell’utilizzo dei risultati dell’indagine per le politiche a livello locale, anche avvalendosi delle esperienze maturate nella precedente edizione Facilitare la comparazione tra aree territoriali (interregionali e intraregionali) fornendo un set di indicatori sintetici condivisi Garantire la comparabilità con il 2005 Rispondere al mandato delle regioni fornendo il dettaglio territoriale pianificato per la programmazione locale (Aree Vaste/ASL) Il file di microdati semplificato Principali caratteristiche Selezione o ricostruzione di nuove variabili: per facilitare l’uso, da parte di utenti esperti delle principali variabili di interesse con formati uniformi Predisposizione di strumenti per la comparazione tra aree territoriali (TR conterrà i coefficienti per la standardizzazione) Costruzione di indicatori/indici sintetici . Indice di condizione abitativa . Indice di stato fisico (PCS), indice di stato piscologico (MCS), indice di salute mentale (MHI) . Presenza di limitazioni funzionali . Indice di cronicità . Indice ADL . Indice di consumo di servizi . Indici su prevenzione e stili di vita . …….. Primi confronti sulla precisione di stime a livello di ASL Distribuzione degli errori relativi percentuali di stime per Asl, anni 2005 e 2012 Errore relativo % – Indagine 2005 Errore relativo % – Indagine 2012 Stima Minimo Mediana Massimo Minimo Mediana Massimo Prevalenza di individui che hanno effettuato almeno una 7,6 18,2 46,4 5.5 12.3 42.4 visita specialistica a pagamento Prevalenza di individui obesi 6,8 16,2 66,0 3.5 11.3 36.4 Primi confronti sulla precisione di stime a livello di ASL Distribuzione delle Asl per classe di errore relativo %, anni 2005 e 2012 Classe di Numero di ASL Numero di ASL Stima errore Indagine 2005 Indagine 2012 <=16,5 78 108 Prevalenza di individui che hanno effettuato almeno una visita 16,5-33,3 102 33 specialistica a pagamento <=33,3 7 3 <=16,5 97 111 Prevalenza di individui obesi 16,5-33,3 86 31 <=33,3 5 2 Le regioni a confronto Alcuni esempi di indicatori a livello regionale Persone di 65 anni e più per presenza di multicronicità e salute percepita per regione. Anni 2005 e 2013 tassi standardizzati per 100 persone MULTICRONICI SALUTE PERCEPITA (MALE O MOLTO MALE) 0 5 10 15 20 25 30 35 40 45 50 0 5 10 15 20 25 30 35 40 45 50 ITALIA ITALIA Piemonte Piemonte Valle d'Aosta- Vallèe d'Aoste Valle d'Aosta- Vallèe d'Aoste Liguria Liguria Lombardia Lombardia -Bolzano-Bozen -Bolzano-Bozen 2005 -Trento 2005 -Trento Veneto Veneto 2013 2013 Friuli-Venezia Giulia Friuli-Venezia Giulia Emilia-Romagna Emilia-Romagna Toscana Toscana Umbria Umbria Marche Marche Lazio Lazio Abruzzo Abruzzo Molise Molise Campania Campania Puglia Puglia Basilicata Basilicata Calabria Calabria Sicilia Sicilia Sardegna Sardegna Aumentano le disuguaglianze territoriali nel tempo per effetto di miglioramenti nel Centro Nord e peggioramenti nel Mezzogiorno Indice di stato fisico e indice di stato psicologico delle persone di 14 anni ed oltre per regione. Anno 2013 punteggi medi standardizzati Indice di stato fisico (PCS) Indice di stato psicologico (MCS) Indice di stato fisico Indice di stato psicologico 49,4 a 50,4 (5) 51,1 a 51,4 (7) 49,3 a 49,4 (1) 51 a 51,1 (1) 49 a 49,3 (6) 50,8 a 51 (2) 48,6 a 49 (4) 50,1 a 50,8 (6) 47,9 a 48,6 (4) 49,2 a 50,1 (4) Netto gradiente Nord-Centro-Mezzogiorno per l’indice PCS, meno evidente per l’indice MCS, con valori comunque più elevati della media in molte regioni del Nord Persone di 65 anni e più con limitazioni funzionali per regione.
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