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Rapporto ISTISAN 18 12.Pdf (3268.3 ISTITUTO SUPERIORE DI SANITÀ Progetto It.DRG: stato dell’arte A cura di Laura Arcangeli (a, b), Federico Banchelli (c), Luigi Bertinato (d), Flavia Carle (b), Angelo L. Del Favero (e), Tiziana De Vito (b), Lucilla Frattura (f), Lucia Lispi (b), Cristiano Marchetti (g), Luca Merlino (g), Marino Nonis (d, h), Amelia Palinuro (i), Eleonora Verdini (c), Carlo Zavaroni (f) (a) Direzione Sanitaria, Ospedale Pediatrico Bambino Gesù, Roma (b) Direzione Generale della Programmazione Sanitaria, Ministero della Salute, Roma (c) Direzione Generale Cura della Persona, Salute e Welfare, Regione Emilia-Romagna, Bologna (d) Struttura per la Clinical Governance, Istituto Superiore di Sanità, Roma (e) Direzione Generale, Istituto Superiore di Sanità, Roma (f) Azienda per l’Assistenza Sanitaria n. 2 Bassa Friulana-Isontina, Regione Autonoma Friuli Venezia Giulia (g) Direzione Generale Welfare, Regione Lombardia, Milano (h) Direzione Strategica, Azienda Ospedaliera San Camillo Forlanini, Roma (i) UOC Oncologia Medica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma ISSN: 1123-3117 (cartaceo) • 2384-8936 (online) Rapporti ISTISAN 18/12 Istituto Superiore di Sanità Progetto It.DRG: stato dell’arte. A cura di Laura Arcangeli, Federico Banchelli, Luigi Bertinato, Flavia Carle, Angelo L. Del Favero, Tiziana De Vito, Lucilla Frattura, Lucia Lispi, Cristiano Marchetti, Luca Merlino, Marino Nonis, Amelia Palinuro, Eleonora Verdini, Carlo Zavaroni 2018, iii, 165 p. Rapporti ISTISAN 18/12 Il presente rapporto si propone di presentare lo stato dell’arte e le prospettive future del progetto nazionale per lo sviluppo del nuovo sistema di misurazione e valorizzazione dei prodotti delle strutture ospedaliere promosso da Ministero della Salute, Regioni, Agenzia Nazionale Servizi Sanitari Regionali (AGENAS) e Istituto Superiore di Sanità (ISS), denominato “Progetto It.DRG”. I singoli contributi illustrano le attività svolte e i primi risultati conseguiti dai diversi gruppi di lavoro coinvolti nel progetto, in particolare a partire dal 2013 e nei primi mesi del 2018. L’obiettivo è di fornire a tutti gli operatori interessati, in diversi livelli e ruoli, una prima organica sintesi del Progetto It.DRG con l’intento di diffondere una corretta conoscenza del nuovo sistema, per promuoverne un uso appropriato quale essenziale strumento di governo, valutazione e valorizzazione dell’attività ospedaliera. Parole chiave: Ricoveri ospedalieri; Scheda di Dimissione Ospedaliera; Diagnosis Related Group; Classificazione Internazionale delle malattie e dei problemi sanitari correlati-Decima revisione-Modifica Italiana; Classificazione Italiana Procedure e interventi; Costi; Pesi Relativi Istituto Superiore di Sanità It.DRG Project: state of the art. Edited by Laura Arcangeli, Federico Banchelli, Luigi Bertinato, Flavia Carle, Angelo L. Del Favero, Tiziana De Vito, Lucilla Frattura, Lucia Lispi, Cristiano Marchetti, Luca Merlino, Marino Nonis, Amelia Palinuro, Eleonora Verdini, Carlo Zavaroni 2018, iii, 165 p. Rapporti ISTISAN 18/12 (in Italian) The present report aims to present the state of the art and the future outlook of the It.DRG Project, that is the new system for measuring and placing a value to the products of hospital facilities (inpatients), promoted by the Ministry of Health, Regions, AGENAS (Agenzia Nazionale Servizi Sanitari Regionali) and Istituto Superiore di Sanità (ISS). The individual contributions illustrate the activities carried out, the first results achieved and the planned developments of the various working groups involved in the project, in particular since 2013 and in the first months of the 2018. The objective of this monograph is to provide a first organic synthesis of the It.DRG project to all the interested professionals, in different roles, so to spread a correct knowledge of the new system and promote its full and appropriate use as an essential tool for the governance, evaluation and enhancement of hospital activity. Key words: Hospitalization; Hospital discharge card; Diagnosis Related Groups; International Classification of Diseases and Health Related Problems-10th Revision-Italian Modification; Italian Classification of Procedures and Interventions; Costs; Relative weights Si ringraziano la Dott.ssa Sandra Salinetti per il supporto tecnico-redazionale e la Dott.ssa Chiara Cadeddu per il prezioso lavoro di consulenza sul testo. Per informazioni su questo documento scrivere a: [email protected] Il rapporto è accessibile online dal sito di questo Istituto: www.iss.it. Citare questo documento come segue: Arcangeli L, Banchelli F, Bertinato L, Carle F, L. Del Favero AL, De Vito T, Frattura L, Lispi L, Marchetti C, Merlino L, Nonis M, Palinuro A, Verdini, E Zavaroni C (Ed.). Progetto It.DRG: stato dell’arte. Roma: Istituto Superiore di Sanità; 2018. (Rapporti ISTISAN 18/12). Legale rappresentante dell’Istituto Superiore di Sanità: Gualtiero Ricciardi Registro della Stampa - Tribunale di Roma n. 114 (cartaceo) e n. 115 (online) del 16 maggio 2014 Direttore responsabile della serie: Paola De Castro Redazione: Sandra Salinetti La responsabilità dei dati scientifici e tecnici è dei singoli autori, che dichiarano di non avere conflitti di interesse. © Istituto Superiore di Sanità 2018 viale Regina Elena, 299 – 00161 Roma INDICE Presentazione .................................................................................................................................... iii Introduzione Laura Arcangeli, Federico Banchelli, Luigi Bertinato, Angelo L. Del Favero, Lucilla Frattura, Lucia Lispi, Cristiano Marchetti, Luca Merlino, Marino Nonis, Amelia Palinuro, Eleonora Verdini, Carlo Zavaroni ......................................................................... 1 Capitolo 1. Progetto It.DRG: contesto di riferimento........................................................ 4 Laura Arcangeli, Federico Banchelli, Luigi Bertinato, Angelo L. Del Favero, Lucilla Frattura, Lucia Lispi, Cristiano Marchetti, Luca Merlino, Isabella Morandi, Marino Nonis, Amelia Palinuro, Eleonora Verdini, Carlo Zavaroni .................................................. 4 Capitolo 2. Messa a punto della modifica clinica italiana di ICD-10 ai fini della classificazione delle diagnosi Lucilla Frattura, Carlo Zavaroni, Vincenzo Della Mea ................................................................... 27 Capitolo 3. Nuova classificazione delle procedure e degli interventi Luca Merlino, Cristiano Marchetti ................................................................................................... 66 Capitolo 4. Prima definizione del nuovo sistema di classificazione It.DRG dei ricoveri per acuti Eleonora Verdini, Federico Banchelli .............................................................................................. 93 Capitolo 5. Approccio italiano alla definizione dei costi dei ricoveri ospedalieri per acuti e dei pesi relativi dei nuovi It.DRG: il modello it.Cost Laura Arcangeli, Flavia Carle, Lucia Lispi ..................................................................................... 126 Capitolo 6. Attività in corso e sviluppi futuri: implementazione, gestione e manutenzione degli It.DRG Laura Arcangeli, Federico Banchelli, Luigi Bertinato, Alessandra Campolongo, Angelo L. Del Favero, Lucilla Frattura, Lucia Lispi, Cristiano Marchetti, Luca Merlino, Marino Nonis, Amelia Palinuro, Eleonora Verdini, Carlo Zavaroni ............................................... 150 Appendice A Partecipanti al team multidisciplinare Progetto It.DRG.................................................................... 161 i ii Rapporti ISTISAN 18/12 PRESENTAZIONE Es ist nicht genug zu wissen; man muß auch anwenden; es ist nicht genug zu wollen: man muß auch tun. Non basta sapere, si deve anche applicare; non è abbastanza volere, si deve anche fare. Wolfgang von Goethe È con molto piacere e soddisfazione che presentiamo questo volume monografico dei Rapporti ISTISAN, dedicato allo stato dell’arte del Progetto It.DRG. Si tratta di uno dei primi frutti della rinnovata collaborazione tra l’Istituto Superiore di Sanità (ISS) (che ha da poco compiuto 83 anni) e la Direzione Generale della Programmazione Sanitaria del Ministero della Salute (che compie, nel 2018, 60 anni dalla propria istituzione), e soprattutto del corale e del proficuo lavoro dei gruppi regionali di Emilia-Romagna, Friuli Venezia Giulia e Lombardia. Questo progetto (e oggi la sua dettagliata presentazione ad uso di tutti gli operatori e gli stakeholder del Servizio Sanitario Nazionale, SSN) rappresenta il nuovo corso dei rapporti tra ISS e Ministero della Salute nell’ottica di offrire a tutti gli interessati un modello di sinergie tra istituzioni e strumenti innovativi per la gestione dell’SSN che avviene in un clima di trasparenza ed esplicito trasferimento delle informazioni atte a contribuire al dibattito e alla crescita del nostro sistema sanitario. Dal punto di vista dell’Istituto, l’accordo con il Ministero della Salute sul progetto It.DRG (che data dall’autunno 2017), rappresenta uno dei primi tasselli e una sfida per il posizionamento dell’ISS nell’area della Clinical Governance, a supporto del Ministero e degli altri protagonisti dell’SSN (in primis le Regioni), per una gestione più consapevole del patrimonio comune, costituito dal nostro Servizio Sanitario Nazionale che il 23 dicembre 2018 compie 40 anni dall’emanazione della legge 833 del 1978. Dicevamo tassello o uno dei primi passi, perché nel frattempo sono divenute operative collaborazioni in tema di LEA (Livelli Essenziali
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