The composition of the social and health care offer for
people with spinal cord injury: census of the
organizations, the professionals and the types of
assistance in Italy
Paola Chesi, Maria Giulia Marini, Verdiana Morando, Luigi Reale, 2011
Objectives
To map the care pathway for people with spinal cord injury; to compare
the Italian situation with other European States (England, Spain and
Switzerland); to carry out a national census of the centres that provide
care to people with spinal cord injury; to get retrospective updated data
regarding the medullary injuries in Italy; to draw up a proposal of
detailed national register with the social and health care organizations
(for examples Unipolar Spinal Unit, Spinal Unit and Rehabilitation
Centre) that offer assistance to people with this pathology.
Methods
The project is divided into two main phases:
1. a national and international desk research;
2. a field research, through a questionnaire for the centres registered during the desk
research, focus groups with patients and interviews to the professionals.
The first phase has been divided into:
a) desk research to collect all the documents useful to define the Italian health care offer;
b) consultation of the key opinion leaders, through questionnaires and focus groups, in order
to validate the information obtained by the desk research;
c) desk research of the international literature and direct consultation of foreign key
opinion leaders to analyze the health care offer in other States, in order to have a
benchmark to compare and improve the Italian organizations.
Main results
155 centres stated that they take care of people with spinal cord injuries all over the country;
in particular there are 22 Spinal Units, of which 8 are Unipolar ones, mainly present in the
North/Centre (95% of the overall centres) of Italy. The 67% of the all the beds dedicated to
these patients belongs to Spinal Units which are, in the 86% of the cases, public. Considering the
acute phase of the disease, 23% of new patients with spinal cord injury does not get any expert
beds, while regarding the rehabilitation phase, there is an excess (107 ratio beds
and patients) of beds in the Rehabilitation Centers, mainly private, so the request of
rehabilitation is oversatisfied. Concerning the care pathway for people with spinal cord lesions
(which starts with the first aid in an emergency room, followed by a Trauma Centre and a Spinal
Unit), the 53% of patients follow a wrong pathway that includes at least one more step in a
hospital not assigned for the management of this pathology, to make up for the lack of beds in
the acute phase.
Conclusions
considering a three level organization for the medical and social management of spinal cord
injury, formed by an acute phase, a rehabilitation phase and a return at home phase, which
means the possibility to be independent, in Italy it’s necessary to increase the number of
expert beds in Unipolar Spinal Units or Spinal Units, to maintain and even to restrain the
number of beds for the rehabilitation and to promote and develop the services on the territory,
including the domiciliary assistance and the integration of the general pratictioners and the
Primary Care Units in the therapeutical and social pathway.
The inappropriate organization, that leads more than half of the patients with spinal cord lesions
to a instay in a wrong hospital, implies the lost of resources and a low level of quality felt by the
patients themselves. Therefore, it would be desirable to defend and potentiate the diffusion of
the Unipolar Spinal Units and their networking, considered the best organizations for the
management of this condition, thanks to the application of integrated treatments that involve
physicians coming from different specializations. In conclusion, a hub and spoke model in which
hub is the Unipolar Spinal Unit and the spoke is the rehabilitation center or home.
The Spinal Units present in Italy
Unipolar Spinal Units
Spinal Units
Spinal Units expected but not yet active