One of the priorities set by the Emilia-Romagna Regional Health and Social Plan focuses on care for the elderly and vulnerable subjects. A complex system and articulate answers have been implemented to respond to the growing number of individuals with specific care needs.
The concept of continuity of care - defined as the process by which patients and physicians actively cooperate in health care management - extends beyond the interpersonal aspects of care, and it can be seen as prolonging the physician-patient relationship; such perspective cannot be separated by a quality and cost/efficiency assessment of services. It is therefore an ongoing care relationship, focused on patients’ individual needs, on communicating and managing pathologies in the wider context of patients’ life (Tarrant et al., 2006). A well-functioning continuity of care is associated with a reduced risk of hospitalization in elderly patients (Counsell et al., 2007; Menec et al., 2006).
At the same time there is a need to improve care quality, which has objectively reached significant levels of complexity aggravating the critical elements constituted by the integration in the system between the various components of service delivery. Ensuring continuity means promoting the centrality of patients in health care management (Haggerty et al., 2003), but not only by placing patients at the center of a service system: Shortell (1976) already defined continuity of care as “the extent to which medical care services are required as a coordinated and uninterrupted succession of events consistent with the medical care needs of the patients”. More recently the emphasis has been placed on the vertical integration of health care services, ranging from the specialistic areas of hospital facilities to the context of primary care (Gulliford et al., 2006). The perception of continuity of care, i.e. the continuous and coordinated progression of care, is a key element in patients’ satisfaction (Freeman et al., 2003) and, especially for chronic patients, it is more affected by the health care model than by the pathology itself (Cowie et al., 2009).
Getting into the details of the health services network and verifying its effectiveness and appropriateness appears therefore as a priority, especially in the light of changes within patients’ population. It is not so much a question of assessing the services’ degree of integration, but rather of understanding the extent to which the articulation of a health care pathway affects patients’ quality of life. For example, previous European researches have assessed the condition of self-management programs by chronically ill patients (Elzen et al., 2007), but without conclusive results.
In this regard, this Dossier presents the results emerging from the project “Continuity of care: application of a minimum data set for the assessment of elderly patients and health care pathways” (conducted in Emilia-Romagna in 2008-2009). The project involved the development and testing of a minimum data set for the assessment of elderly chronic patients, in order to compare of homogeneous health care settings, services’ appropriateness, and estimates of vulnerable subjects’ care needs. The project consists of several research centers converging towards the same goals, even if characterized by specific contributions.
The current situation, in terms of health care for elderly patients - especially if not self-sufficient - highlights several critical issues. Some of these are related to health care processes, including:
a cura di: Agenzia sanitaria e sociale regionale
e-mail: asrdirgen@regione.emilia-romagna.it
aggiornamento: 27 gennaio 2012
