Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
Protected discharges: an
integrated approach, the
experience of Emilia Romagna
Rosanna Carbognani
Director Primary Care Programme
Florence, 19 May 2003
Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
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
Rosanna Carbognani
Florence, 19 May 2003
Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
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
Rosanna Carbognani
Florence, 19 May 2003
Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
THE PERSON IN THE CENTRE
•
EMPOWERMENT: A CONSCIOUS PACT
•
COMPLEXITY OF SERVICE RELATIONSHIP
(TECHNICAL, ORGANISATIONAL AND
RELATIONAL DIMENSION)
•
THE PATIENT’S HISTORY AS A RESOURCE
AND ASSET
Rosanna Carbognani
Florence, 19 May 2003
Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
HOME
CARE
HP
COMMUNITY
PEDIATRICIAN
SOCIAL
ASSISTANT
RSA
PROTECTED
HOUSING
INDIVIDUAL
MMG
PDLS
VOLUNTARY
SERVICES
Rosanna Carbognani
IP
OTA
CONSULTANTS
OBSTETRICS
HOSPITAL
2ND LEVEL OUTPATIENT SPECIALIST
SERVICES
Florence, 19 May 2003
Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
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
Rosanna Carbognani
Florence, 19 May 2003
Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
CONTINUITY OF TREATMENT
Specialist
OTA
Voluntary services
Social
MMG
assistant
IP
person
need
Recep
tion
Rosanna Carbognani
tests
Orien
tation
Care
Implemen
agree
tation
ment
The alliances
possible
Follow
-up
health
Florence, 19 May 2003
Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
FROM SERVICE
TO THE TREATMENT COURSE
THROUGH THE ALLIANCES
IN THE INDIVIDUAL
HEALTH PROJECT
Rosanna Carbognani
Florence, 19 May 2003
Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
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
Rosanna Carbognani
Florence, 19 May 2003
Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
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
Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
ACTIONS TO ACHIEVE CONTINUITY
1.
organisational
2.
technological development
3.
cultural development
4.
experimental
Rosanna Carbognani
Florence, 19 May 2003
Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
ACTIONS TO ACHIEVE CONTINUITY
1.
Actions of an organisational type:
primary care centres as a place
for:






Rosanna Carbognani
Accompaniment
Concise information
Recomposition
Network
Treatment agreement
Promotion of health
Florence, 19 May 2003
Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
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
Rosanna Carbognani
Florence, 19 May 2003
Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
ACTIONS TO ACHIEVE CONTINUITY
3. Actions involving cultural
development:
Integrated training for all players
involved in the continuity of
treatment
Rosanna Carbognani
Florence, 19 May 2003
Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
ACTIONS TO ACHIEVE CONTINUITY
4. Experimental actions:
Treatment courses as a supply of
care characterised by the
sequential nature of connected
actions
Rosanna Carbognani
Florence, 19 May 2003
Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
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)
Rosanna Carbognani
Florence, 19 May 2003
Ospedali per la
promozione della salute:
una Rete dell’ O.M.S.
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.
Rosanna Carbognani
Florence, 19 May 2003