Protected discharges: an integrated approach, the experience of Emilia Romagna

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Protected discharges an integrated approach, the
experience of Emilia Romagna
Rosanna Carbognani Director Primary
Care Programme
Florence, 19 May 2003
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Centrality of the individual in the construction
of his/her own health project Continuity of
treatment and network of services based on the
individual The approach of the Local Health
Board (Azienda USL) of Reggio Emilia
Florence, 19 May 2003
Rosanna Carbognani
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HP is a technology, not an end It aims to
highlight the centrality of the individuals who
come into contact with the system of supply and
make them aware of their role in the individual
health project
Florence, 19 May 2003
Rosanna Carbognani
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THE PERSON IN THE CENTRE

• EMPOWERMENT A CONSCIOUS PACT
• COMPLEXITY OF SERVICE RELATIONSHIP (TECHNICAL,
  ORGANISATIONAL AND RELATIONAL DIMENSION)
• THE PATIENTS HISTORY AS A RESOURCE AND ASSET

Florence, 19 May 2003
Rosanna Carbognani
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HP
HOME
COMMUNITY
PEDIATRICIAN
CARE
SOCIAL
ASSISTANT
RSA
PROTECTED
INDIVIDUAL
OTA
HOUSING
IP
MMG
CONSULTANTS
PDLS
OBSTETRICS
HOSPITAL
VOLUNTARY SERVICES
2ND LEVEL OUTPATIENT SPECIALIST
SERVICES
Rosanna Carbognani
Florence, 19 May 2003
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HP as a framework within which to develop the
individual treatment course which aims to achieve
possible health using an alliance between the
subjects that operate in it
Florence, 19 May 2003
Rosanna Carbognani
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CONTINUITY OF TREATMENT
Specialist
OTA
Voluntary services
The alliances
Social assistant
MMG
IP
possible
person
Care agree ment
Recep tion
Orien tation
Implementation
Follow-up
tests
need
health
Rosanna Carbognani
Florence, 19 May 2003
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FROM SERVICE
TO THE TREATMENT COURSE
THROUGH THE ALLIANCES IN THE INDIVIDUAL HEALTH
PROJECT
Florence, 19 May 2003
Rosanna Carbognani
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THE DEVELOPMENT OF THE LOCAL HEALTH BOARD
(AZIENDA USL) IN REGGIO EMILIA
1997 Development of Protected Discharge
Project 2003 90 of all patients who require a
protected discharge now receive one
Florence, 19 May 2003
Rosanna Carbognani
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OBSTACLES ON PATH TO CONTINUITY

• Self-referencing status of structures
• Culture oriented towards clinical recovery
• Difficulty for professionals to have an overall
  vision of the entire process
• Difficulty of constructing an accompanying course
  of information
• Different languages created by specialism
• Communication is difficult

Risk that continuity is only formal (the sum of
events)
Rosanna Carbognani
Florence, 19 May 2003
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ACTIONS TO ACHIEVE CONTINUITY

1. organisational
2. technological development
3. cultural development
4. experimental

Florence, 19 May 2003
Rosanna Carbognani
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ACTIONS TO ACHIEVE CONTINUITY

1. Actions of an organisational type primary care
   centres as a place for

• Accompaniment
• Concise information
• Recomposition
• Network
• Treatment agreement
• Promotion of health

Florence, 19 May 2003
Rosanna Carbognani
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ACTIONS TO ACHIEVE CONTINUITY
2. Actions focused on technological development
Implementation of information networks as virtual
networks that provide computerised support to
sharing a strategy
Florence, 19 May 2003
Rosanna Carbognani
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ACTIONS TO ACHIEVE CONTINUITY
3. Actions involving cultural development
Integrated training for all players involved in
the continuity of treatment
Florence, 19 May 2003
Rosanna Carbognani
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ACTIONS TO ACHIEVE CONTINUITY
4. Experimental actions
Treatment courses as a supply of care
characterised by the sequential nature of
connected actions
Florence, 19 May 2003
Rosanna Carbognani
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Continuity is constructed on the person and on
the individual health project Not as continuous
treatment But as an accompaniment and enhancement
of the limits (possible health)
Florence, 19 May 2003
Rosanna Carbognani
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Continuity is the proposal of a journey that we
make together (citizen and professionals)
on which we share the destination, the course and
the responsibilities.
Florence, 19 May 2003
Rosanna Carbognani