Rome, September 28 2009
CNR-ISTC
Workshop
“Telematics and Robotics for the Quality of Life of the Elderly”
The impact of Telecardiology in the Italian National Health Service
as a tool for resource management in elderly patients
The impact of Telecardiology in the
Italian National Health Service
as a tool for resource management
in elderly patients
Igino Genuini, MD.
Chief of Coronary Intensive Care Unit
Scientific Committee Expert of the Lazio Region-Public Health Agency
for Clinical -Welfare Pathways in Emergency
________________________________________
Cardiovascular, Respiratory and Morfological Sciences Department,
Director: Prof. Francesco Fedele
“Sapienza” University of Rome
Life span constantly increases in the
“Industrialized Countries”
ITALIAN POPULATION
AGEING:
In the last thirty years, thanks to the “healthy industry” input, general mortality decreased of
25-35% in the last twenties and estimated life changed from 40 years, at the beginning of the
century, to 80 years at the end of the century.
67% of the Italian population is aged between 15/64 years ,
19% over 65 years and 4% between 0 and 14 years.
At the regional level is present a higher aging index in the North
…………………………………
CHRONIC PATHOLOGIES
(Bad quality of life associated….):
The extension of the population life expectancy, and the defeat of many infective and acute
pathologies, put in evidence, in the nosological case history of the population, the problem of the
chronic pathologies.
By ISTAT surveys on the health status of the population show that about 35% is affected
one or more chronic conditions, essentially about 18 million chronic patients compared to 9
million annual hospitalized acute patients.
CONSIP (Concessionaria Servizi Informativi Pubblici) SpA-MEF; Programma di
razionalizzazione degli acquisti per le Pubbliche Amministrazioni .Strumenti innovativi
e Progetti specifici per la Sanità. “I Servizi di Telecardiologia”, Pietro Lavezzo.
Cernobbio, 8 Nov.2005
Sanitary Expense Increase
Sanitary expenses are increasing all over the world, which will prepare
an economical crisis in the sanitary system of the developed countries.
MAIN CAUSES OF EXPENSE TREND
1)
2)
ageing of the population and the more need of assistance;
inadequate investments in prevention and in homecare;
3) the transition from care of disease to maintaining health status,
in search of psychological well-being;
4) high quality service request of the citizens;
5)
6)
increase of consumeristic phenomenon and improper utilization of the services;
scientific progress, technological innovation and improvement of diagnostic tools.
CONSIP SpA-MEF; Programma di razionalizzazione degli acquisti per le Pubbliche Amministrazioni
Strumenti innovativi e Progetti specifici per la Sanità. “I Servizi di Telecardiologia”, Pietro
Lavezzo.
Cernobbio, 8 Nov.2005
Assistance Essential Levels (AEL)
These levels run through every phase of the diagnostic-therapeutic process.
I°
Sanitary collective assistance
II° Sanitary basic assistance
III° Specialistic and half-residential territorial assistance
IV° Hospital assistance
V° Sanitary residential assistance for dependent patients
CONSIP SpA-MEF; Programma di razionalizzazione degli acquisti per le Pubbliche Amministrazioni
Strumenti innovativi e Progetti specifici per la Sanità. “I Servizi di Telecardiologia”, Pietro Lavezzo.
Cernobbio, 8 Nov.2005
Resources allocation for the period 2002-2004 and
values obtained in the years 2000 2001 2002
Percentage
values
reference
2002-2004
Percentage
values
obtained
2000
5
3,6
4,3
4
Total district assistance
49,5
46,6
47,6
49,8
Hospital assistance
45,5
49,8
48,1
46,2
Macro levels
of Assistance
Sanitary collective
assistance in life and
work environment
Percentage Percentage
values
values
obtained
obtained
2001
2002
Hospital-territory integration- Sanitary Planning
Filippo Palumbo; Ministry of Health Camogli (GE), June 29-30, 2006
Heart Failure Example :
Percentages of Expense for Hospitalization
NATIONAL SANITARY PLAN
ADDRESSES
a) CENTRALITY OF THE CITIZENS :
__________ AEL SECURITY
INTEGRATION
QUALITY
b)
HEALTH AS DEVELOPMENT DRIVE
c)
EUROPE
Integrazione tra Ospedale e Territorio e Programmazione Sanitaria.
Filippo Palumbo; Ministero della Salute. Camogli (GE), 29-30 Giugno 2006
Diagnostic-therapeutic process
To change the structure of the expenditure of the National Health Service is necessary to move analysis
from the individual essential levels of assistance to the diagnostic trial-therapeutic:
A detailed analysis of the diagnostic-therapeutic process agrees in fact of to identify:
1) Conditions allow a new planning for the total system
2)
Necessary measures to fulfill efficacy and quality Services
erogation in the respect of efficiency.
The chain of the process value would put evidence of the obvious inefficiency but not quality,
so the action does not add value to the patients such as eliminable.
Diagnostic-therapeutic process has 4 steps:
Prevention
Diagnosis
Therapy
Monitoring
The expenditure levels for each phase of the diagnostic-therapeutic process should
be different for the type of the patient (such as in emergency,
in urgency, chronic and in rehabilitation) and not only one phase of the hospital therapy.
CONSIP SpA-MEF; Programma di razionalizzazione degli acquisti per le Pubbliche
Amministrazioni
Strumenti innovativi e Progetti specifici per la Sanità. “I Servizi di Telecardiologia”, Pietro
Lavezzo.
Cernobbio, 8 Nov.2005
NATIONAL SANITARY PLAN
DIFFERENT LEVELS OF ASSISTANCE INTEGRATION AIMED TO:
-PERTINENCE
-COORDINATION AND CONTINUITY OF SANITARY ASSISTANCE AND SOCIAL SYSTEMS
-EXPEDITE ACCESS AND SUPPLY OF THE SOCIAL-SANITARY SERVICES
-KEEP DOWN COSTS
-PERMIT PATIENTS AND SERVICES MONITORING THROUGH THE VALUATION OF CLINICAL
AND MANAGEMENT RESULTS
-IMPROVE PATIENT COMPLIANCE WITH TRAINING AND DISEASE MANAGEMENT
Integrazione tra Ospedale e Territorio e Programmazione Sanitaria.
Filippo Palumbo; Ministero della Salute. Camogli (GE), 29-30 Giugno 2006
DIFFERENT LEVELS OF ASSISTANCE
INTEGRATION
CRITICAL COUPLING
TERRITORY AND HOSPITAL CONNECTION:
TWO SEPARATED REALITIES
Integrazione tra Ospedale e Territorio e Programmazione Sanitaria.
Filippo Palumbo; Ministero della Salute. Camogli (GE), 29-30 Giugno 2006
- Only 3% of General Practitioners (GPs) is
or wants to be involved in the treatment of
patients hospitalized/discharged.
- 20% receive the report of discharge.
- In 38% of cases, the report does not include
the results of the examinations.
- 66% of GPs treats patient before knowing
details of his admission/discharge directories.
JAMA, 2007
HOSPITAL PRIMARY TREATMENT
INTEGRATION
- NATIONAL COLLECTIVE AGREEMENT 2005
-ART.49 :
THE GP CAN PARTICIPATE DIRECTLY IN A FAVOR OF THE
ACTUAL BENEFICIARY, RECOVERED, IN THE DIAGNOSTIC AND
CURATIVE PHASES OR IN REHABILITATION PHASE,
OR
THROUGH INFORMATIC SYSTEM ACCESS
Integrazione tra Ospedale e Territorio e Programmazione Sanitaria.
Filippo Palumbo; Ministero della Salute. Camogli (GE), 29-30 Giugno 2006
Essential Requirements of re-balance
policy of the sanitary hospital expense :
“decentralization” of Public Health functions and
Citizen “active participation"
• Establishment of “carefulness” to the Territory Models;
• Establishment of “welfare continuity” between Hospital and Territory.
Expense re-balance policy
Two main change directories:
Reorganization and integration of territory/hospital services
(welfare continuity)
Replanning hospital network:
“Virtual Hospital”
Sanitary Network
CONSIP SpA-MEF; Programma di razionalizzazione degli acquisti per le Pubbliche Amministrazioni
Strumenti innovativi e Progetti specifici per la Sanità. “I Servizi di Telecardiologia”, Pietro Lavezzo.
Cernobbio, 8 Nov.2005
Sanitary Network (1/2)
is the results of three interventional areas meeting:
information technology, telecommunications and medicine
The use of telecommunication and information technology
services in the sanitary fields pursues some goals:
a) allow better utilization of the different skills of
health facilities and knowledge of different specialists,
and a rational use of beds
b) allow a proper process of training health workers and
c) ensure greater accessibility to health services and to
specialist advice even by small hospitals scattered
throughout the territory
d) provide greater assistance to communities throughout
the area, and to family doctors to enable the management
of patients in urgent care and emergency
e) assist the elderly at home and some patients for whom
it is possible to avoid and/or reduce the hospital
CONSIP SpA-MEF; Programma di razionalizzazione degli acquisti per le Pubbliche
Amministrazioni Strumenti innovativi e Progetti specifici per la Sanità. “I Servizi di
Telecardiologia”, Pietro Lavezzo.Cernobbio, 8 Nov.2005
Sanitary telematics (2/2)
The goals pursued by Sanitary Telematics could be reached through its different
applications regrouped into three interventional areas:
management, social and sanitary.
SANITARY TELEMATICS APPLICATIONS:
TELEHEALTH
SOCIAL TELEMATICS
TELEMEDICINE
Area of health intervention: is on diagnostic and
therapeutic processes and therefore it relates the
development and testing of telematic systems for use
both within the hospitals, both patients monitoring on
the territory and for the extra-hospital treatment.
This area includes all the enabling technologies for
monitoring patients in their homes.
CONSIP SpA-MEF; Programma di razionalizzazione degli acquisti per
le Pubbliche Amministrazioni Strumenti innovativi e Progetti specifici per la Sanità.
“I Servizi di Telecardiologia”, Pietro Lavezzo.Cernobbio, 8 Nov.2005
TELEMEDICINE
Use of electronical communication nets to transfer
-real timemedical data (clinical informations, diagnosticinstrumental data) from one station to another
“move information ,
NOT patients”
Telemedicine: application fields
23%
26%
3%
12%
36%
Home Care
Diagnosis and Remote Consultations
ECG Trasmission
Data Trasmission Clinical Record
Teledidactics and Research
A special field of application is Cardiology
TELECARDIOLOGY
CHEST PAIN AND
ACUTE CORONARY SYNDROME
(ACS)
Chest
pain for ACS is often
ascribed to gastritis,
indigestion,
rheumatism,odontopathy
(if localized at jaw level)
One
over two italian people
with heart failure
arrives late in the hospital
(more than 2 hours after
symptoms beginning)
ANMCO-ISTAT Data
235.000 deaths/year
for cardiovascular diseases
(ACS; HF; Other causes.)
First mortality cause
ANMCO-ISTAT Data
TELECARDIOLOGY: Italian experience
1: J Telemed Telecare 1996;2(3):132-5
Related A\rticles, Links
Telecar: an Italian telecardiology project.
Bertazzoni G, Genuini I, Aguglia F.
Medical Emergency Department, La Sapienza University, Rome, Italy.
The Telecar (tele-assistance cardiology) project was an example of tele-assistance between health centres of the Regione
Lazio in Italy. The project was approved by the Ministry of Health, financed with 500,000,000 lire and carried out by an
operative station within 'La Sapienza' University (Rome). About 40 of the health centres in Lazio that did not
have cardiologists or electrocardiography (ECG) equipment were provided with telematic
instruments (Cardiophone and fax). With this equipment, they were able to transmit ECG signals and receive copies
of ECG reports. The 40 health centres included first-aid clinics, 'guardia medica' surgeries and
community centres. The project was carried out between 1989 and 1992. During these three years the health
centres transmitted a total of 4807 ECGs, 2057 (43%) of which were routine, the remaining 2750 (57%) being
suspected emergencies. Of the suspected emergencies, 681 cases (25%) had a confirmed abnormality.
We can confirm that telematic aids are very important for an operative station, where all kinds of emergencies must be dealt
with.
TELECARDIOLOGY:
Application AREAS
 STEMI DIAGNOSIS
 PRECOCIOUS ACTIVATION OF
THE EMERGENCY SYSTEM
AND THE HEMODYNAMIC
SERVICE
• PRE-HOSPITAL
INTERACTION BETWEEN
• INTRA-HOSPITAL
HOSPITALS OF DIFFERENT
• POST-HOSPITAL
OF ASSISTANCE
TECHNOLOGICAL LEVEL
TELECONSULT GP AND
SPECIALIST
 CARDIOLOGIC HOMECARE
 ARRHYTHMIA DIAGNOSIS
Scalvini S, Glisenti F -J Telemed Telecare. 2005;11(7):325-30
TELECARDIOLOGY:
Application AREAS
 STEMI DIAGNOSIS
 PRECOCIOUS ACTIVATION OF
THE EMERGENCY SYSTEM
AND THE HEMODYNAMIC
• PRE-HOSPITAL
SERVICE
• POST-HOSPITAL
TELECONSULT GP AND
SPECIALIST
 CARDIOLOGIC HOMECARE
 ARRHYTHMIA DIAGNOSIS
PRE-HOSPITAL AREA:
Acute Coronary Syndromes
STEMI Guidelines AHA/ACC 2004
TeleECG -Pre-hospital
ECG interpretation
Staff on board +
Automatic reading +
Transmission to CO 118 / CICU
Primary Triage :
-organizational delay reduction
-intra-hospital delay reduction
Regional Network Experiences
Clinical Welfare Path in EmergencyAcute Coronaric Syndromes
Stefania Cardo, Anna Patrizia Barone, Nera Agabiti,
Cesare Greco*, Tom Jefferson, Gabriella Guasticchi,
a nome del
Gruppo di Lavoro Multidisciplinare PCAE-Sindromi Coronariche Acute
(vedi Appendice 1)
Agenzia di Sanità Pubblica del Lazio, *Area Emergenza-Urgenza ANMCO-Lazio
We present an evidence-based diagnostic and therapeutic pathway for the treatment of
subjects
with suspected acute elevated ST-segment myocardial infarction (STEMI). The pathway was
developed to aid the reorganization of the emergency service (ES) of the Lazio Region of
Italy.
Pathway development followed several phases:
a) setting up of a multidisciplinary panel
comprising all professional figures involved in the management of STEMI subjects;
b) drafting of a list of important research questions with a particular focus on areas
of clinical and organization uncertainty;
c) systematic searches for relevant international scientific evidence to answer research questions;
d) assessment, synthesis and classification of identified evidence according to the quality of
evidence;
e) formulation of management recommendations by their strength according to the
methods used by the national guidelines program;
f) presentation of draft findings and recommendations;
g) external peer review of the draft document;
h) editing the final version of the document.
Our document identifies possible action scenarios (community, emergency room, major accident
and emergency departments) and the following critical points: 1) quick diagnosis and individual risk
definition; 2) rapid transmission of the electrocardiogram and vital parameters to the ES control
center
or to the competent coronary care unit (CCU) depending on where the event took place; 3) a direct
link between the ES control center and the competent CCU; 4) the structuring of the regional
CCU into a Hub & Spoke model; 5) electronic communication of data between ambulance, ES
control
center and the competent CCU. Our document also defines Hub regional reference centers and
local Spoke centers.
……………………………………………………
Ital Heart J 2005; 6
(Suppl 6): 27S-40S
(Appendice 1)
Gruppo di Lavoro Multidisciplinare
PCAE-Sindromi Coronariche Acute
N. Agabiti, F. Balzani, C. Barletta, S. Cardo, G. Casali,
A. Carbone, M. Conte, M. Costa, F. Fedele, G. Ferraiolo,
I. Genuini, N.Gentiloni, M. La Sala, E. Giovannini,
C. Greco, T. Jefferson, G. Lamberti, P. Mamone, M.
Mazzone, G. Monteforte, F. Musumeci,Q. Piacevoli, L.
Pietrangeli, C. Pristipino, G. Richichi, R. Ricci,
F. Romeo, P. Tasciotti, A. Zaffiro, L. Zulli
Società Scientifiche rappresentate
AAROI - Associazione Anestesisti Rianimatori
Ospedalieri Italiani
ANMCO - Associazione Nazionale Medici
Cardiologi Ospedalieri
ANMDO - Associazione Nazionale Medici di
Direzione Ospedaliera
SICI-GISE - Società Italiana di Cardiologia Invasiva
SIC - Società Italiana di Cardiologia
SICCH - Società Italiana di Chirurgia Cardiaca
SICUT - Società Italiana di Chirurgia d’Urgenza e del
Trauma
SIGO - Società Italiana Geriatri Ospedalieri
SIMEU - Società Italiana di Medicina d’Emergenza-Urgenza
……………………………………………………..
 Less intervention time:
door-to-needle Time;
door-to-balloon Time
 Most suitable structure identification:
CICU/HEMODYNAMIC
LABORATORY
 Less wrong diagnosis,
Less useless hospitalizations
Less bed confinement time:
NHS COSTS
TELECARDIOLOGY:
Application AREAS
 STEMI DIAGNOSIS
 PRECOCIOUS ACTIVATION OF
THE EMERGENCY SYSTEM
• PRE-HOSPITAL
AND THE HEMODYNAMIC
SERVICE
• POST-HOSPITAL
 TELECONSULT GP AND
SPECIALIST
 CARDIOLOGIC HOMECARE
 ARRHYTHMIA DIAGNOSIS
POST-HOSPITAL AREA:
Telecardiology-Home Care
CHRONIC PATHOLOGIES
General Practitioner
(phases: pre-post/acute; acute)
Hospital Cardiologist
(phases: acute; pre-post/acute)
HEART FAILURE
first Mortality and Morbility cause
high hospitalization level
human, logistic and economic resources
expenditure
multidisciplinary
diagnostic-therapeutic approach
Heart Failure Example :
Excess of Hospitalization?…
NO NEED FOR HOSPITALIZATION
OF ELDERLY PATIENTS WITH HEART FAILURE
In Italy, the ELDERLY PATIENTS with “symptomatic” Heart Failure
annually hospitalized are about 640,000.
The number includes the patients who are in the Classes II, III and IV according
to the Classification of the NYHA, that divides all the typologies of patients in 4 Classes:
Cl I: No symptoms in daily activity;
Cl II: Small limitation of the daily activity. They can support also light physical efforts;
Cl III: Strong limitation of the daily activity. They are well when they rest;
Cl IV: should be stay at rest, in the bed or sitting position; cannot support some
physical efforts and have troubles also at rest.
-The Class I patients do not need of hospitalization
-The Class IV patients (3%) require hospitalization
-The Class II (69%) and the Class III (28%) patients (620,000 patients in total)
can be cared for at home and be hospitalized only for real emergency causes
“
Goals:
• Realization of a “virtual hospital “ assuring the
•
•
•
•
•
continuous assistance and a high standard level
care ;
Hospitalizations reductions (filter activity);
Quick identification of the precipitating factors;
Improvement of the organization and of the
synchronization of the involved structures and
figures;
Multidisciplinary potential approach;
Integration of specialistic competences
(overcoming of the individual specialistic sector)
Telecardiology-Home Care
 “Hospitalization”and “home assistance”, meaning the
transfer to the territory of some typical hospital activities,
are one of the main key factors supporting sanitary and
clinical efficacy increase strategies.
 Home cares are a whole of sanitary, medical, nursening
and rehabilitative activities aiming at the patient care at his
own home, where he can keep his natural affections, his
environment and his customs.
Telecardiology-Home Care
Clinical and
instrumental
informations,
medical
directions
Patient or
family member
Clinical and
instrumental
informations,
medical
directions
GP
SERVICE STATION
Specialistic Physicians
(CARDIOLOGIST
RESPONSIBLE FOR THE SERVICE)
Intervention
demand
REFERTATION
Information
exchange
Hospital staff (no physicians)
DATA STORAGE
1: Am Heart J. 1998 Mar;135(3):373-8.
Prevention of hospitalizations for heart failure with
an interactive home monitoring program
.
Shah NB, Der E, Ruggerio C, Heidenreich PA, Massie BM.
1: Am Heart J. 1999 Oct;138(4 Pt 1):633-40.
Effect of a home monitoring system on hospitalization
and resource use for patients with heart failure.
Heidenreich PA, Ruggerio CM, Massie BM.
1: Eur J Heart Fail. 2003 Oct;5(5):583-90.
A systematic review of telemonitoring for
the management of heart failure.
Louis AA, Turner T, Gretton M, Baksh A, Cleland JG.
1: BMJ. 2007 May 5;334(7600):942. Epub 2007 Apr 10 .
Telemonitoring or structured telephone support
programmes for patients with chronic heart failure:
systematic review and meta-analysis.
Clark RA, Inglis SC, McAlister FA, Cleland JG, Stewart S.
What monitoring?
ECG
Vital parameters (AP, weight,
water balance, saturimetry...)
Blood Tests
Instrumental Tests
POST-HOSPITAL AREA: :
…….. Also Arrhythmias diagnosis
1: Int J Cardiol. 2005 Feb 15;98(2):215-20.
Incidence of atrial fibrillation in an Italian population
followed by their GPs through a telecardiology service.
Scalvini S, Piepoli M, Zanelli E, Volterrani M, Giordano A, Glisenti F.
“In Italy, many patients, in particular the elderly, with AF are
followed by their GPs on a routine basis; a telecardiology service
may provide a useful tool in the home management of chronic AF
and in the first detection of new cases of AF.”
Other applications
 1: Pacing Clin Electrophysiol. 1995 May;18(5 Pt 1):1032-6.
Accuracy and clinical utility of transtelephonic pacemaker followup.
Gessman LJ, Vielbig RE, Waspe LE, Moss L, Damm D, Sundeen F.
“This study found transtelephonic pacemaker monitoring TTM follow-up testing to have
a sensitivity of 94.6%, specificity of 98.5%, positive predictivevalue of 93.3%, and
negative predictive value of 98.8%. The study also documents the clinical utility of TTM
in identifying various modes of pacemaker malfunctions and instances of significant
arrhythmia.”
1: J Interv Card Electrophysiol. 2004 Oct;11(2):161-6.
Remote interrogation and monitoring of implantable cardioverter
defibrillators.
Joseph GK, Wilkoff BL, Dresing T, Burkhardt J, Khaykin Y.
Remote ICD interrogation provides frequent, convenient, safe and comprehensive
monitoring.Device and patient related problems were reliably detected and reduced the
frequency of outpatient visits. Patients were highly satisfied with the convenience and
ease of use of the system.
Telecardiology-Home Care Project
“NET-ROME,
HEART CITY”
The electronic medical record
The management, at home, of patients (age over
65 years) with chronic, post-ischemic heart
failure is registered with the principal vital
parameters to a electronical clinical file which is
installed in the Coronary Intensive Care Unit of
the Cardiovascular and Respiratory Sciences
Department of the "Umberto I” Hospital.
Project Net
Goals :
• Improvement and increase of the “Sanitary
Culture” in the population;
• Quality of life improvement of patients and
their families;
• Contribution to the reorganization and
modernization of the National Health Service
rationalizing human, economic and logistic
resources;
• Fight back to the “Sudden Death” (home
defibrillation).
Sudden Death: where?
70%
66%
60%
50%
40%
30%
17%
20%
10%
0%
11%
2%
4%
Home
Office
Public places
Ambulances
Other places
Home defibrillation
Specific Training:
 Anxiety
 Stress
 Rest
=
 Security
 Confidence
BEST EVENT MANAGEMENT
SUDDEN DEATH
*McDaniel CM et al:Automatic External Defibrillation of Patients after Myocardial
Infarction by Familiar Members: Practical Aspects and Psychological Impact of Training.
Pace 1988; 11 (Part II):2029-2034.
“Home defibrillation: a feasibility study in
myocardial infarction survivors at
intermediate risk of sudden death”
Sanna T, Fedele F, Genuini I, Puglisi A, Azzolini P,
Altamura G, Lobianco F, Ruzzolini M, Perna F, Micò M,
Roscio G, Mottironi P, Saraceni C, Pistolese M, Bellocci F
Am Heart J. 2006 Oct;152(4):685.e 1- 7
Project RESULTS (1)
Today the obtained results make us feel
optimistic for what concerns:
 The decreasing of the health expenses:
the mean duration of the hospitalization period is
decreased as 8 days, the re-hospitalization tax is
attested to 3%.
 The enhancement of the therapy quality:
a.
b.
c.
d.
e.
Guaranteed continually medical presence;
Improved management of the therapy out of the hospital;
Early assessment of changes of the clinical conditions;
Reduction of the times of intervention;
Potential reduction of the death incidence (BLSD-AED)
Project RESULTS (2)
 Patient’s life quality improvement,estimated by the
Minnnesota Living with Heart Failure Questionnaire,
before and after the telecardiology program
(-11,3%):
- enhancement of the symptoms;
- possible benefits of the domestic ambient’s
advantages;
- serious psychological protection.
Project RESULTS (3)
 Checking, through specific questionnaires, the
acceptability or the unacceptability of the
telecardiology system between the medical staff
and patients, shown how patients accepted
enthusiastically the system, and how telecardiology
is going to spread over the medical staff as an
everyday methodology, after the first mistrusts.
 The cultural sanitary level increase of both patients
and their families members, through the on going
long distance training.
O.A.S.I. 2007 Report
The idea of a Health Corporation in Italy
Institutional endorsement and quality improvement:
many approaches for a common goal
di Manuela Brusoni, Loredana Luzzi, Luca Merlino e Anna Prenestini
………………………………
Se da un lato il livello regionale di governo della sanità ha un fondamento
nell’autonomia e nel decentramento, dall’altro, su un piano tecnico-gestionale,
erogare buoni servizi sanitari non dovrebbe essere declinabile su base geografica,
ma rispondere a criteri scientifici, manageriali e di equità sociale condivisi a livello di
più ampia comunità professionale, non solo nazionale, ma internazionale. Non è
da trascurare, infatti, che l’accettazione e il consenso sulla rilevanza e il significato
di uno standard di buone prassi cliniche e gestionali si fonda su evidenze raccolte
su larga scala, raramente nazionale, ormai quasi sempre sovranazionale.
Non è altresì da trascurare che l’esperienza cumulata derivante dalla messa in atto
e dalla verifica di standard di qualità su vasta scala, una sorta di break-even tecnico
e applicativo, conferisce credibilità e robustezza alle prassi raccomandate e
maggiore accettabilità ai conseguenti giudizi di rispondenza e idoneità.
………………………………
Collana CE.R.G.A.S.
(Centro Ricerche sulla Gestione della Assistenza Sanitaria Sociale).
Conclusions
Telecardiology Impact
assure a high level sanitary presence on the territory
identify real emergencies and reduce intervention time
assure the therapeutic continuity
obtain the adhesion to the diagnostic-therapeutic
programs and the optimization of therapy
early detection worsening clinical conditions,
fighting back and reducing hospitalizations
reduce the length of stay
enact “psychological” protection”
reduce sanitary expense.
thanks