Gestione dei rifiuti: Modelli predittivi di spesa ambientale

Lo studio ha lo scopo di identificare alcuni determinanti della produzione di rifiuti, indagando su indicatori predittivi di semplice applicabilità, tali da costituire un modello previsionale di stima della congruità delle scelte e dei costi delle politiche di Governance e fornire modelli predittivi del reale costo del governo dei rifiuti anche alla luce della negativa congiuntura economica e dell’incidenza che l’amministrazione del “sistema rifiuti” ha sulla stessa, fornendo un utile strumento per la programmazione economica/gestionale in un ottica di razionalizzazione e miglioramento

Wait watchers: the application of a waiting list active management program in ambulatory care

Objective: This study describes and evaluates the application of a waiting list management program in ambulatory care. Design: Waiting list active management survey (telephone call and further contact); before and after controlled trial. Setting: Local Health Trust in Veneto Region (North-East of Italy) in 2008\u201309. Participants: Five hundred and one people on a 554 waiting list for C Class ambulatory care diagnostic and/or clinical investigations (electrocardiography plus cardiology ambulatory consultation, eye ambulatory consultation, carotid vessels Eco-color-Doppler, legs Eco-color-Doppler or colonoscopy, respectively). Intervention: Active list management program consisting of a telephonic interview on 21 items to evaluate socioeconomic features, self-perceived health status, social support, referral physician, accessibility and patients' satisfaction. A controlled before-and-after study was performed to evaluate anonymously the overall impact on patients' self-perceived quality of care. Main outcome measures: The rate of patients with deteriorating healthcare conditions; rate of dropout; interviewed degree of satisfaction about the initiative; overall impact on citizens' perceived quality of care. Results: 95.4% patients evaluated the initiative as useful. After the intervention, patients more likely to have been targeted with the program showed a statistically significant increase in self-reported quality of care. Conclusions: Positive impact of the program on some dimensions of ambulatory care quality (health status, satisfaction, willingness to remain in the queue), thus confirming the outstanding value of \u2018not to leave people alone\u2019 and \u2018not to leave them feeling themselves alone\u2019 in healthcare delivery

How to achieve optimal organization of primary care service delivery at system level: lessons from Europe

Objective_ To measure the relative efficiency of primary care (PC) in turning their structures into services delivery and turning their services delivery into quality outcomes. Design_ Cross-sectional study based on the dataset of the Primary Healthcare Activity Monitor for Europe project. Two Data Envelopment Analysis models were run to compare the relative technical efficiency. A sensitivity analysis of the resulting efficiency scores was performed. Setting_ PC systems in 22 European countries in 2009/2010. Main Outcome Measures_ Model 1 included data on PC governance, workforce development and economic conditions as inputs and access, coordination, continuity and comprehensiveness of care as outputs. Model 2 included the previous process dimensions as inputs and quality indicators as outputs. Results_ There is relatively reasonable efficiency in all countries at delivering as many as possible PC processes at a given level of PC structure. It is particularly important to invest in economic conditions to achieve an efficient structure\u2013process balance. Only five countries have fully efficient PC systems in turning their services delivery into high quality outcomes, using a similar combination of access, continuity and comprehensiveness, although they differ on the adoption of coordination of services. There is a large variation in efficiency levels obtained by countries with inefficient PC in turning their services delivery into quality outcomes. Conclusions_ Maximizing the individual functions of PC without taking into account the coherence within the health-care system is not sufficient from a policymaker's point of view when aiming to achieve efficiency