Forecasting future needs and optimal allocation of medical residency positions: the Emilia-Romagna Region case study

OBJECTIVES: Italian regional health authorities annually negotiate the number of residency grants to be financed by the National government and the number and mix of supplementary grants to be funded by the regional budget. This study provides regional decision-makers with a requirement model to forecast the future demand of specialists at the regional level. METHODS: We have developed a system dynamics (SD) model that projects the evolution of the supply of medical specialists and three demand scenarios across the planning horizon (2030). Demand scenarios account for different drivers: demography, service utilization rates (ambulatory care and hospital discharges) and hospital beds. Based on the SD outputs (occupational and training gaps), a mixed integer programming (MIP) model computes potentially effective assignments of medical specialization grants for each year of the projection. RESULTS: To simulate the allocation of grants, we have compared how regional and national grants can be managed in order to reduce future gaps with respect to current training patterns. The allocation of 25 supplementary grants per year does not appear as effective in reducing expected occupational gaps as the re-modulation of all regional training vacancies

Comune (ordinamento)

L'ordinamento delle autonomie locali: fondamento costituzionale, evoluzione legislativa, organi di governo, funzioni, organizzazione, relazione con gli altri enti territorial

Politica e Organizzazione, vol. 2/2006

Il volume della rivista \ue8 dedicato all'analisi, sotto punti di vista diversi (giuridici, della comunicazione, della politica comunitaria) delle Carte dei Servizi

Emergency Department Management in Lazio, Italy

The assignment of service requests to emergency departments is of paramount importance both from a life-threatening and an economical viewpoints. In the process of a more general project that aims at defining optimal allocation policies of patients to regional hospital network facilities (together with the potential reorganization of the facilities), the Department of Epidemiology of the Regional Health Service of Lazio, Italy, was interested in obtaining a completely offline picture of the effect of an optimal assignment of requests to emergency departments. This is in the spirit of evaluating the so-called Price of Anarchy, where the fully centralized (admittedly unrealistic) allocation is used as a reference for both the state-of-the-art completely decentralized approach and future reorganization ideas. We have implemented and tested with real-world data of all service requests of 2012 a mixed-integer programming model that computes such an optimal request allocation by minimizing travel and waiting times and penalizing workload unbalance among emergency departments in the region. Within the development process we have studied special cases and relaxations of the complete model showing interesting mathematical properties that are, in turn, useful from a practical viewpoint, for example, in obtaining a real-time version of the approach. The present study is an important, quantitative step in the evaluation of centralized allocation strategies like remote triage that could have a remarkable impact in making the allocation process much more efficient and effective. More precisely, the developed methodology as well as the software tools are currently used by the DEP-Lazio for the reorganization of the regional networks of emergency healthcare

Trace elements distribution in Antarctic sediments by neutron activation analysis

In the present investigation iron and trace elements were determined by instrumental neutron activation analysis in a number of sea bottom sediment samples, collected in the Ross Sea and close to the Italian Station at Terra Nova Bay in Antarctica. Full listing of results is presented and discussed as well as the evaluation of precision and accuracy. In order to find correlations and similarities among the sediment samples, the analytical data were submitted to statistical treatment. In addition rare earth element patterns were obtained. Typical trends were observed with no evident Eu negative anomaly and a depletion of heavy rare earth elements. © 1993 Akadémiai Kiadó