Community hospitals and their services in the NHS: identifying transferable learning from international developments - scoping review, systematic review, country reports and case studies

Background: The notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential. Objectives This study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care. Methods A multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland. Results The evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented. Limitations The use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth. Conclusions At a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s). Funding: The National Institute for Health Research Health Services and Delivery Research programme

Progetto Russia Regioni Centro-Meridionali Krasnodar e Stravopol.

Progetto Università Politecnica delle Marche, Regione Marche, Confindustria March

La Carta Geologica e Geomorfologica della Regione Marche, Scala 1:10.000.

DVD Rom, Giunta Regionale delle Marche Informazioni Territoriali

Valutazione dell'impatto traumato-nevrotico prodotto dal sisma Marche-Umbria 1997

Il presente studio mira a valutare gli effetti psicologici conseguenti all'evento sismico che ha colpito alcune zone del territorio umbro-marchigiano a partire dal settembre '97. La ricer- ca è stata condotta utilizzando il questionario sulla nevrosi traumatica di L. Crocq e A. Stei- nitz distribuito su un campione di 99 soggetti residenti nelle zone epicentrali del sisma, in particolare Serravalle del Chienti e frazioni (1). Per quanto riguarda i dati anagrafici, il campione esaminato risulta costituito dal 48,5% di soggetti di sesso maschile e 51,5% di sesso femminile

AN INTEGRATED FRAMEWORK FOR DOCUMENT MANAGEMENT: THE ROLE OF SEMANTIC AND ADMINISTRATIVE COOPERATION ABSTRACT

Nowadays, document management is one of the most important chalenges facing Public Administration‟s operators owing to the wide numbers of the PA information in form of documents such as agreements, forms, letters, contracts, deliberation, contracts, and so on. Moreover, most of the PA‟s business processes are based on document flows. In this context, the Information and Communication Technology (ICT) can plan again inter-organizational relationships inter and intra PA to (a) improve digital flows, and (b) share digital information to make a good use of information systems. We present a general framework for intelligent document management – DODIBOX-. It allows good productivity and major performance increases by applying intelligent technology to documents and document processing. The framework is organized by two different subsystems considering the design time and the run time functionalities. We explain the use of the framework together with richer representation of PA documents

Indagine sulla diffusione dell'ICT nella pubblica amministrazione delle Marche

Consiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7 , Rome / CNR - Consiglio Nazionale delle RichercheSIGLEITItal

Indagine conoscitiva sulla diffusione dell'ICT nella Pubblica Amministrazione delle Marche svolta dal Laboratorio per l'Analisi dello Sviluppo territoriale

Project CRC - Centri Regionali di Competenza per l'e-government e la societa' dell'Informazione -Consiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7 , Rome / CNR - Consiglio Nazionale delle RichercheSIGLEITItal