Taking care of people with Spinal Cord Injury
in the Italian regions
A National Research Project
Salvatore Ferro
Department of Hospital Services
Regional Health and Welfare Authority
Emilia-Romagna Region
Siracusa, October 21th, 2013
Ministero della Salute
Points of excellence
Primary Objectives
• To estimate the incidence of traumatic spinal cord injury in the
Italian regions in the period October 1, 2013 September 30, 2014;
• To describe the pathways of care of spinal cord injury (SCI) patients
from the acute to rehabilitation phase and from hospital to primary
care services in order to improve the quality of care;
• To define the cost of hospital care for SCI patients
• To perform a cost-effectiveness analysis between different model of
care
Work Packages
•
The National Agency for Health Service Research , Rome (Age.Na.S.) – PI Salvatore Ferro
•
The Montecatone Rehabilitation Institute (Azienda Usl di Imola) – PI Marco Franceschini;
•
The Department of Statistics of University of Florence – PI Annibale Biggeri;
•
The Department of Economics Studies of University of Milan (CERGAS) – PI Giovanni Fattore
•
in .collaboration with the National Association of SCI patients (FAIP)
2 year Project
FUNDING : 496.500 Euro
Spinal Cord Injury (SCI)
Background
•
•
•
•
•
•
Spinal Cord Injury (SCI) is one of the most significant causes of mortality and
disability in the world. The reported incidence varies in a range from 15 to 45
cases per million.
In Italy the incidence of SCI is approximately 18-20 per million inhab./year;
Results of the Italian survey of SCI on rehabilitation services (37) found 1014
new cases in two years (GISEM);
The most common causes of SCI are motor vehicle accidents, falls, violence
and sports injuries.
Outcomes are strongly influenced by the surgical and pharmacological
treatment in the acute phase, the place of medical care, the relative length of
stay (LOS) in hospital and the availability of services.
In US, costs for medical care and intensive rehabilitations are extraordinarily
high.
Rapporto Fondazione ISTUD per INAIL - FAIP
La composizione dell’offerta socio-sanitaria per le persone con lesione
midollare in Italia. Report completo - Aprile 2011
Disability
70.000 people with Spinal Cord Injury in Italy
1 aprile 2011. Ogni anno diventano para e tetraplegiche circa duemila cittadini,
due terzi dei quali under 60. Ma a fronte di una domanda di ricoveri intorno ai
2.000-2.500 casi, l'offerta sanitaria è scarsa. A Roma il convegno "Disabilità: ora
serve una rete sanitaria e sociale che sappia prendersi cura delle persone con
lesione midollare"
ROMA - In Italia sono circa 70mila le persone con esiti di lesione al midollo
spinale di cui i 2/3 hanno una età inferiore ai 60 anni. Ogni anno diventano para
e tetraplegiche nel nostro paese circa 1.500 -2.000 persone (almeno
quattro/cinque al giorno), con un'età per i 2/3 inferiore ai 60 anni. Ma a fronte di
una domanda di ricoveri, sia in fase acuta che in fase di secondo ricovero, che
si aggira sui 2.000-2.500, l'offerta sanitaria rimane scarsa, con circa 400-500
posti letto qualificati sull'intero territorio nazionale.
Spinal Cord Units – Number of Beds in the Italian Regions
(Anno 2011) – Italian Health System
Descrizione Regione
Posti
letto
Ordinari
Posti
letto
Day
Hospital
Totale
posti
letto
PIEMONTE
72
11
83
LOMBARDIA
99
9
VENETO
104
FRIULI VENEZIA GIULIA
ABITANTI
TASSO
PL ORD
per
milione
ab
TASSO
PL TOT
per
milione
ab
CASI
ATTESI
TOTALI
*
Indice di
affollam
ento
4362010
16,5
19,0
109
1,5
108
9748171
10,2
11,1
244
2,5
5
109
4866324
21,4
22,4
122
1,2
49
1
50
1220078
40,2
41,0
31
0,6
LIGURIA
27
1
28
1577439
17,1
17,8
39
1,5
EMILIA ROMAGNA
60
0
60
4351393
13,8
13,8
109
1,8
TOSCANA
40
3
43
3677610
10,9
11,7
92
2,3
UMBRIA
12
1
13
886479
13,5
14,7
22
1,8
LAZIO
44
1
45
5551135
7,9
8,1
139
3,2
SARDEGNA
14
1
15
1643584
8,5
9,1
41
2,9
CAMPANIA
15
0
15
5772388
2,6
2,6
144
9,6
PUGLIA
14
0
14
4050817
3,5
3,5
101
7,2
ABRUZZO
25
0
25
1307199
19,1
19,1
33
1,3
Totale 13
575
33
608
49.014.627
11,7
12,4
1225
2,1
Spinal Cord Injury Incidence Study
To estimate the Incidence
• Incidence data are very important both in tracing the occurrence of
SCI and in deciding on SCI prevention strategies. In this way,
epidemiologic data are essential to plan clinical and community
services for individuals with traumatic SCI, whose post injury survival
has increased conspicuously in recent years.
• The incidence rate is the number of new cases of cord injury per
person-time ;
Spinal Cord Injury Incidence Study
• Recruitment of Acute and Rehabilitations Units in Italy
for SCI patients (the study network);
– Spinal Surgery Units ;
– ICU;
– Spinal Cord Units and Rehabilitation Unit ;
• Study Protocol and the Data Collection Forms;
• Use of information systems: National data base of
hospital discharges ; trauma registries ect .
HUB & SPOKE - MAJOR TRAUMA
Hub and Spoke – Major Trauma
Hospital Facilities
•
Trauma Center (Hub) : Trauma Leader, 400-500 patients/year,
presence of the following facilities H24/year:
–
–
•
Ready on Demand
–
–
•
Orthopaedist Surgeon ; Interventional Radiologist ; Thoracic and Vascular Surgeon ;
Plastic Surgeon; Otolaryngologist and Ophthalmologist; Urologist
Regional Service for rare major trauma
–
•
•
•
•
•
Emergency Department ; Intensive Care Unit (ICU); General Surgery; NeuroSurgery
Images Department – Laboratory and Haematology Service (blood tranfusion)
Pediatric Surgeon; Pediatric Intensive Care Unit; Surgery for artificial limb; Hand Surgery; Center for
High Degree Burn; Heart Surgery
Transfer Criteria from Spoke to Hub (Head and Spinal)
Inhospital Trauma Service to look and control the organization
Telemedicine (TC images on intranet)
Regional Information System on Major Trauma
Regional Technical Commission on Major Trauma
HUB & SPOKE – SPINAL CORD INJURY REHABILITATION
Points of excellence
The Film Director
Federico Fellini
Piero della Francesca “Sigismondo Pandolfo Malatesta Praying in Front
of St. Sigismund” - 1451 – Fresco, Tempio Malatestiano di Rimini
Methods (1)
Study Population
• Patients with traumatic spinal cord injury in the Italian regions will
enrolled during the period October 2013 - September 2014;
Case Definition :
• A case of spinal cord injury is defined as the occurrence of an
acute traumatic lesion of neural elements in the spinal canal
(spinal cord and cauda equina), resulting in temporary or
permanent sensory and/or motor deficit.
Neurological evaluation
•
According to American Spinal Injury Association (ASIA) define level and
completeness ASIA Impairment Scale (A-B-C-D-E).
Materials and methods (2)
Diagnostic validation = Clinical + CT or MRI of the spinal cord
Inclusion criteria
•
•
All patients with traumatic spinal cord injury in the Italian regions enrolled
between October 2013 and September 2014;
The spinal cord injury’s etiology is defined according to the International Data
Set for Spinal Cord Injury recently suggested by ISCoS.
Exclusion criteria
•
All patients with ereditary and/or congenital deseases, with Multiple Sclerosis,
with secondary neoplasms and with 1st and 2nd motorneuron deseases will
be excluded
Materials and methods (3)
Data collection (demographic and clinical data)
• Forms for collecting information about a incident case of
traumatic SCI;
• T1: Forms for collecting information on adimission to Spinal Cord
Unit ;
• T2: Forms for collecting information on discharges from Spinal
Cord Unit ;
• Forms for collect structural and organization information on
Spinal Cord Unit (year 2012);
Points of excellence
Santiago Calatrava Bridge in Reggio Emilia
The Italian politician and
statesman Romano Prodi
Spinal Cord Injury Network
Regione
Referente Regionale
Referente Rete Trauma
Esperto di Paraplegia
Emilia Romagna
S. Ferro
G. Gordini - F. De Iure
J. Bonavita
Friuli Venezia Giulia
A. Fanzutto
P. Del Fabro
A. Zampa
Lazio
F. Fei
C. Pilati
Liguria
A. Massone
A. Massone
Lombardia
M. A. Banchero
A. Signorelli
C.M. Borghi
Marche
P. Carletti
P. Pelaia
M. A. Recchioni
Piemonte
D. Nizza
M. V. Actis
Puglia
M. Ruccia
P. Fiore
Sardegna
G. Campus
G. Campus
Sicilia
M. G. Furnari
F. Franchina
M. P. Onesta
Toscana
P. Salvadori
M. Moresi
G. Del Popolo
Umbria
M. Zenzeri
L. Caruso
M. C. Pagliacci
Veneto
M. Saia
G. Bertagnoni
Data Collection
Regione
Figura Professionale
Responsabile di
riferimento
Lombardia
Physioterapist
M. A. Banchero
Lombardia
Physioterapist
M. A. Banchero
Umbria
Physioterapist
M.C. Pagliacci
Piemonte
Welfare worker
M.V. Actis
Toscana
Physician
G. Del Popolo
Veneto
Physician
G. Bertagnoni
Puglia
Physician
P. Fiore
Emilia-Romagna
Statistician
J. Bonavita
The Steering Committee of the Study
Salvatore Ferro;
Marco Franceschini;
Annibale Biggeri;
Gabriele Accetta;
Giovanni Fattore;
Elenora Corsalini;
Mariadonata Bellentani;
Augusto Cavina;
Jacopo Bonavita;
Giovanni Gordini;
Maria Cristina Pagliacci;
Antonietta Citterio;
Renato Avesani;
Vincenzo Falabella;
Maria Vittoria Actis;
Giulio Del Popolo;
Agostino Zampa;
Tiziana Redaelli;
Giannettore Bertagnoni.
Federico De Iure;
Points of excellence
The musical art director Riccardo Muti
The mosaic of Emperor Justinian and his
retinue (executed in 548 ac )
Thank you for your attention!