facing covid-19emergency: comparing organizational models

Facing Covid-19 Emergency:Comparing organizational models for response inItalian Regions

AMERICO CICCHETTI, Ph.D.Professor of Healthcare ManagementDirector, School of Healthcare Systems Economics and Management

Thanks to:ALTEMS’s Covid-19 Research Team: Gianfranco Damiani, Maria Lucia Specchia, Michele Basile, Rossella Di Bidino,Eugenio Di Brino, Maria Giovanna Di Paolo, Andrea Di Pilla, Fabrizio Massimo Ferrara, Luca Giorgio, Maria TeresaRiccardi, Filippo Rumi, Angelo Tattoli, Entela Xoxi, Andrea Silenzi, Rocco Reina, Marzia Ventura, Concetta LuciaCristofaro, Walter Vesperi, Anna Maria Melina, Teresa Gentile, Giovanni Schiuma, Primiano Di Nauta, RaimondoIngrassia, Paola Adinolfi

In collaboration with:Department pf Life Sciences and Public Health, School of Medicine «A.Gemelli» Università Cattolica S. Cuore

Departmente of ManagementUniversità Magna Graecia di Catanzaro

Center for Reaserch and Studies on Healthcare Management (Cerismas) Università Cattolica del Sacro Cuore

Center for Research in Medical LeadershipUniversità Cattolica del Sacro Cuore

Outline

• Background• Goals• Methodology and data• Evidences• National epidemiology and response• Regional Epidemiology• Regional Response (phase 1)• Regional Response (phase 2)

• Take home messages

Background

Health systems in transition Italy16

delivery of a package of benefits through a network of population-based ‘local health authorities’ (aziende sanitarie locali, ASLs) and public and private accredited hospitals. Fig. 2.1 summarizes the main organizational actors and the relationships between them.

Fig. 2.1Overview of the Italian health-care system

General practitioners

Directly managed hospitals

Private accredited hospitals, teaching

hospitals, and specialists

Co-paymentsambulatory

care

Public hospital enterprises and

teaching hospitals


care

IRCCS


care

Pharmacies

List prices

CITIZENS PATIENTS

Public health and community health services

Capitation, fee-for-service,

pay-per-performance

Local health authorities (ASLs)

Regional health departments

Government

Parliament

Regional governments

Ministry of Health CSS(National health council)

National budget

Regional budgets

National taxes

Regional agency for health services

(where present)

Regional taxes

Global budget,activity-based

funding


funding


funding

ISSNational Institute of Health

AGENASNational Agency for

Regional Health Systems

CCMNational Centre for Disease

Control and Prevention

AIFANational Pharmaceutical

Agency

List prices

Fonte: HIT Health Systems In Transition: Italy (OECD 2014)

The Italian NHSItalian NHS is a “three layers” public universal healthcare system, free at the point of care

Is structured in 21 politically and operationally autonomous Regional Healthcare Systems

Any Region is asked to provide a Core Benefit Package of Services (LEAs)

Provision of services is ensured by a Regional network of Local Health Units and autonomous hospitals (public and private)

Ministry of Health monitors the respect of the LEA provided by Regions to citizens

Ministry of Treasury monitors the respect of financial balance

Regionalization in 20 years has increased differences among Regions

Background

• Sars-COV-2 diffusion in Italy has generated an impact on society,economics and healthcare system

• It has been a human tragedy (33.000 deaths)

• Italian healthcare system’s conditions in January 2020 …

• Facing demographic and epidemiological challenges

• Under-financed for 10 years

• Major regional differences (north south) regarding governance,organizational models, resources’ availability (e.g. ICU beds),competences and performance (clinical, financial)

Goals

• To better understand the implications of the differentstrategies adopted by Italian Regional Healthcare Systems todeal with the spread of the virus and the consequences ofCovid19;

• To draw indications for the near future and to make the wholeItalian NHS resilient in the long range;

• To offer to researchers and policy makers a knowledge base todevelop further analyses for a better understanding of anevent of historical significance

Ministry of Health supported by a Scientific Task Force provide Regions with guidelines regarding

the re-organization of the hospital and community care network and related facilities.

The indications provided by the MoH on carrying out diagnostic tests provide for the priority

execution of the test to symptomatic / paucisymptomatic clinical cases and to symptomatic family

and / or residential risk contacts and to health and similar operators at greater risk

The re-organization of the hospital network is planned with the increase of available ICU’s beds (+

50%) and in the pneumology and infectious diseases through construction and retrieval of new

hospitals (Covid Hospital) and expansion of beds in existing structures

Establishment of Special Assistance Continuity Units (USCA) to monitor patients at home and in

nursing homes for elderly

Active monitoring by family doctors, pediatricians and public health offices of Local Health Units

Possibility of requisition of hotels or other properties with similar characteristics to accommodate

people under medical surveillance (intermediate care).

MoH’s guidelines to Regions to respond to Covid-19 outbreak

(March 1° 2020)

Methodology and data

Methodology and data (1/2)

• Weekly Reports from March31st 2020 (#7 on May 15th);

• Multidisciplinary workinggroup (Healthcare manager,public health specialists,pharmacologist, biomedicalengineers)

• Researcher and healthcaremanagers from 10 ItalianRegions were involved inthe analysis

Analisi dei modelli organizzativi di risposta al Covid-19Focus su Lombardia, Veneto, Emilia-Romagna e Lazio

Instant REPORT#1: 31 Marzo 2020

Gruppo di Lavoro

Americo Cicchetti, Michele Basile, Eugenio Di Brino, Maria Giovanna Di Paolo, Luca Giorgio, Filippo Rumi e Angelo Tattoli

Analisi dei modelli organizzativi di risposta al Covid-19Focus su Lombardia, Veneto, Emilia-Romagna, Piemonte e Lazio

Instant REPORT#2: 8 Aprile 2020

Gruppo di Lavoro

Americo Cicchetti, Gianfranco Damiani, Maria Lucia Specchia, Michele Basile, Rossella DiBidino, Eugenio Di Brino, Maria Giovanna Di Paolo, Andrea Di Pilla, Fabrizio Massimo Ferrara,Luca Giorgio, Maria Teresa Riccardi, Filippo Rumi, Angelo Tattoli

Analisi dei modelli organizzativi di risposta al Covid-19Focus su Lombardia, Veneto, Emilia-Romagna, Piemonte, Lazio e Marche


Gruppo di Lavoro

Americo Cicchetti, Gianfranco Damiani, Maria Lucia Specchia, Michele Basile, Rossella DiBidino, Eugenio Di Brino, Maria Giovanna Di Paolo, Andrea Di Pilla, Fabrizio Massimo Ferrara,Luca Giorgio, Maria Teresa Riccardi, Filippo Rumi, Angelo Tattoli, Entela Xoxi

In collaborazione con: Dipartimento di Scienze della Vita e Sanità Pubblica (Sezione di Igiene) Facoltà di Medicina e Chirurgia «A. Gemelli»



Gruppo di Lavoro

Americo Cicchetti, Gianfranco Damiani, Maria Lucia Specchia, Michele Basile, Rossella DiBidino, Eugenio Di Brino, Maria Giovanna Di Paolo, Andrea Di Pilla, Fabrizio Massimo Ferrara,Luca Giorgio, Maria Teresa Riccardi, Filippo Rumi, Angelo Tattoli, Entela Xoxi, Rocco Reina,Marzia Ventura, Concetta Lucia Cristofaro, Walter Vesperi, Anna Maria Melina, TeresaGentile, Giovanni Schiuma, Primiano Di Nauta, Raimondo Ingrassia


Gruppo di Organizzazione AziendaleUniversità Magna Graecia di Catanzaro

Centro di Ricerche e Studi in Management Sanitario (Cerismas)Università Cattolica del Sacro Cuore



Gruppo di Lavoro

Americo Cicchetti, Gianfranco Damiani, Maria Lucia Specchia, Michele Basile, Rossella DiBidino, Eugenio Di Brino, Maria Giovanna Di Paolo, Andrea Di Pilla, Fabrizio Massimo Ferrara,Luca Giorgio, Maria Teresa Riccardi, Filippo Rumi, Angelo Tattoli, Entela Xoxi, Andrea Silenzi,Rocco Reina, Marzia Ventura, Concetta Lucia Cristofaro, Walter Vesperi, Anna Maria Melina,Teresa Gentile, Giovanni Schiuma, Primiano Di Nauta, Raimondo Ingrassia, Paola Adinolfi


Gruppo di Organizzazione AziendaleUniversità Magna Graecia di Catanzaro

Centro di Ricerche e Studi in Management Sanitario (Cerismas)Università Cattolica del Sacro Cuore

Centro di ricerca e studi sulla Leadership in MedicinaUniversità Cattolica del Sacro Cuore

Analisi dei modelli organizzativi di risposta al

Covid-19

Instant REPORT#6: 8 Maggio 2020

Gruppo di Lavoro

Americo Cicchetti, Gianfranco Damiani, Maria Lucia Specchia, Eugenio Anessi Pessina, Giuseppe Scaratti, Michele

Basile, Rossella Di Bidino, Eugenio Di Brino, Maria Giovanna Di Paolo, Andrea Di Pilla, Fabrizio Massimo Ferrara, Luca

Giorgio, Roberta Laurita, Marzia Vittoria Gallo, Maria Teresa Riccardi, Filippo Rumi, Angelo Tattoli, Entela Xoxi, Carlo

Favaretti, Andrea Silenzi, Marta Piria, Rocco Reina, Marzia Ventura, Concetta Lucia Cristofaro, Walter Vesperi, Anna

Maria Melina, Teresa Gentile, Giovanni Schiuma, Primiano Di Nauta, Raimondo Ingrassia, Paola Adinolfi, Chiara Di

Guardo

In collaborazione con: Dipartimento di Scienze della Vita e Sanità Pubblica (Sezione di Igiene)

Facoltà di Medicina e Chirurgia «A. Gemelli»

Gruppo di Organizzazione Aziendale

Università Magna Graecia di Catanzaro

Centro di Ricerche e Studi in Management Sanitario (Cerismas)

Università Cattolica del Sacro Cuore

Centro di ricerca e studi sulla Leadership in Medicina


Analisi dei modelli organizzativi di risposta al

Covid-19

Instant REPORT#7: 14 Maggio 2020

Gruppo di Lavoro

Americo Cicchetti, Gianfranco Damiani, Maria Lucia Specchia, Eugenio Anessi Pessina, Antonella Cifalinò, Giuseppe

Scaratti, Rocco Reina, Michele Basile, Rossella Di Bidino, Eugenio Di Brino, Maria Giovanna Di Paolo, Andrea Di Pilla,

Carlo Favaretti, Fabrizio Massimo Ferrara, Marzia Vittoria Gallo, Luca Giorgio, Roberta Laurita, Marta Piria, Maria

Teresa Riccardi, Filippo Rumi, Andrea Silenzi, Angelo Tattoli, Entela Xoxi, Marzia Ventura, Concetta Lucia Cristofaro,

Walter Vesperi, Anna Maria Melina, Teresa Gentile, Giovanni Schiuma, Primiano Di Nauta, Raimondo Ingrassia, Paola

Adinolfi, Chiara Di Guardo

In collaborazione con: Dipartimento di Scienze della Vita e Sanità Pubblica (Sezione di Igiene)

Facoltà di Medicina e Chirurgia «A. Gemelli»

Gruppo di Organizzazione Aziendale

Università Magna Graecia di Catanzaro

Centro di Ricerche e Studi in Management Sanitario (Cerismas)


Centro di ricerca e studi sulla Leadership in Medicina


Methodology and data (2/2)

PHASE 1 (March 1st – May 3rd)

• Legislation (national, regional, local)• Epidemiological indicators (10)• Organizational Indicators (12)

PHASE 2 (May 4th – Now)

• Legislation (national, regional, local)• Epidemiological indicators (7)• Organizational Indicators (9)

Profiling OrganizationalResponse to Covid-19

Emergency in 21 Regions

Data Source

Gazzetta Ufficiale della Repubblica Italiana (Official Gazette of the Italian Republic): https://www.gazzettaufficiale.it/Protezione Civile Italiana; available at: http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.html#/b0c68bce2cce478eaac82fe38d4138b1;

Ministry of Health; available at: http://www.dati.salute.gov.it/dati/dettaglioDataset.jsp?menu=dati&idPag=96

https://www.gazzettaufficiale.it/

http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.html%23/b0c68bce2cce478eaac82fe38d4138b1%3B

http://www.dati.salute.gov.it/dati/dettaglioDataset.jsp?menu=dati&idPag=96

Evidences (1/4)National epidemiology and response

Phase 1

Jan 31st 2020 Declaration of National emergency

Feb 23rd 2020 Lock down is specific areas (Lombardia, Veneto, Emilia Romagna, Marche)

March 1st 202050% increase of ICU beds, 100% increase sub-ICU beds; identification of Covid-hospitals;

Rqequisition of hotels as intermediate care; activation of CROSS; limitation of other NHS

activities

March 4th 2020 Schools and universities closed (Nation wide)

March 9th 2020 National lock-down, new resources for the NHS (more physicians and nurses), establishment of

USCA (Special Units for Community Care)

March 11th 2020 Suspension of any business activity

March 17th 2020 Initial economic support measures

March 22nd 2020 Harder lockdown measures, New resources fo NHS (physicians and nurses mobility)

March 25th 2020 Introduction of specific penalties to ensure lockdown

April 1st 2020 Introduction of specific indications for business still open

April 10th 2020 New measures to ensure safety

April 26th 2020 Regulation to start serologic tests and epidemiological studies

Phase 2May 4th Reduction of limitation to people mobility within same municipality, new measures to support

national economy

May 18th Reduction of limitation to people mobility within same Region, Major commercial business, pub

and restaurants to be re-opened

Legislation milestones

0

20000

40000

60000

80000

100000

120000

14000024

/02/

2020

26/0

2/20

20

28/0

2/20

20

01/0

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20

16/0

5/20

20

Evolution of Cov-Sars2 (Italy)

Positive cases Recovered Deceased

RECOVERED 125.176

POSITIVES 68.351

DEATHS 31.908

POSITIVES 108.257 (April 20 2020)

March 9thNational Lock down begins

Feb 23rd Regional Lock down begins

March 1°NHS plan

May 4thLock down

ends

March 22thMobiity

restrictions

April 10thSafety

measures to restart some businesses

0

20000

40000

60000

80000

100000

120000

24/0

2/20

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5/20

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16/0

5/20

20

Healthcare System Response

Hospitalized ICU Home Isolation and Care



March 1°NHS plan

May 4thLock down

ends

March 22thMobiity

restrictions

April 10thSafety


Peak of Positives 108.257 (April 20 2020)

4.98%

0.37%

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%2

4/02

/202

0

26/

02/2

020

28/

02/2

020

01/

03/2

020

03/

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14/

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16/

05/2

020

Testing capacity

Tests/population Cases/population



March 1°NHS plan

May 4thLock down

ends

March 22thMobiity

restrictions

April 10thSafety


12%

1%

73%

16%

0%

10%

20%

30%

40%

50%

60%

70%

80%24

/02/

2020

26/0

2/20

2028

/02/

2020

01/0

3/20

2003

/03/

2020

05/0

3/20

2007

/03/

2020

09/0

3/20

2011

/03/

2020

13/0

3/20

2015

/03/

2020

17/0

3/20

2019

/03/

2020

21/0

3/20

2023

/03/

2020

25/0

3/20

2027

/03/

2020

29/0

3/20

2031

/03/

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02/0

4/20

2004

/04/

2020

06/0

4/20

2008

/04/

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10/0

4/20

2012

/04/

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4/20

2016

/04/

2020

18/0

4/20

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/04/

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22/0

4/20

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/04/

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/04/

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30/0

4/20

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/05/

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5/20

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2010

/05/

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12/0

5/20

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/05/

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16/0

5/20

20

NHS response (Hospital vs home care)

ICU/Positives Hospitalized/positives



March 1°NHS plan

May 4thLock down end

March 22thMobiity

restrictions

April 10thSafety


Evidences (2/4)Regional epidemiology

High prevalence

Medium-low prevalence

Low-very low prevalence

Indicator 2.1. Total confirmed cases

CommentoLombardia Region had the vast majority of cases in Italy. Is now declining, The trend is still unclear. Piedmont has reacherd the«peak» later that others

0

5000

10000

15000

20000

25000

30000

35000

40000

24

-fe

b

25

-fe

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26

-fe

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-fe

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29

-fe

b

01

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-ma

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01

-ap

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01

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09

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g

10

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11

-ma

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12

-ma

g

Abruzzo Basilicata Calabria Campania Emilia-Romagna Friuli Venezia Giulia Lazio

Liguria Lombardia Marche Molise P.A. Bolzano P.A. Trento Piemonte

Puglia Sardegna Sicilia Toscana Umbria Valle d'Aosta Veneto

Lombardy

Piedmont

Veneto

Emilia-Romagna

0

2,000

4,000

6,000

8,000

10,000

12,000

Piemonte

Lombardia

Veneto

Emilia-Romagna

MarcheLazio

Decessi con presenza di malatt ie sistema respiratorio - A nno 2017 Decessi con Covid-Anno 2019

-

2,000

4,000

6,000

8,000

10,000

12,000

1-15 Marzo 16-31 Marzo 1-15 Aprile

Decessi con malattie sistema respiratorio 2017 Deeessi con COVID- A nno 2019

Lethality of Covid-19

Tavola Decessi fornita dall’ISTAT al seguente indirizzo webhttps://www.istat.it/it/archivio/240401

Deceased Covid 19Deceased Respiratory diseases (2017)

Deceased Covid 19Deceased Respiratory diseases (2017)

https://www.istat.it/it/archivio/240401

Evidences (3/4)Regional response (Phase 1)

Regional response model (Phase 1)

Testing

Planning

Hospital vs Home Care

Intermediate care

ICT and digital

Regional «Readiness»: Regional healthcare contingency plans

Phase 1

16 out of 21 Regionshas issued an emergency RegionalHealth Plans for phase 1 in few daysafter the contagionoutbreak

Indicator 2.3. Total tests

CommentTesting capacity has increased over time and the propensity to test is different Region to Region. The highest number of tests have been made in Lombardy and Veneto

0

50000

100000

150000

200000

250000

300000

350000

400000

450000

24-feb

26-feb

28-feb

01-mar

03-mar

05-mar

07-mar

09-mar

11-mar

13-mar

15-mar

17-mar

19-mar

21-mar

23-mar

25-mar

27-mar

29-mar

31-mar

02-apr

04-apr

06-apr

08-apr

10-apr

12-apr

14-apr

16-apr

18-apr

20-apr

22-apr

24-apr

26-apr

28-apr

30-apr

02-mag

04-mag

Abruzzo Basilicata Calabria Campania Emilia-Romagna Friuli Venezia Giulia Lazio

Liguria Lombardia Marche Molise P.A. Bolzano P.A. Trento Piemonte

Puglia Sardegna Sicilia Toscana Umbria Valle d'Aosta Veneto

Lombardy

Veneto

Piedmont

Emilia-Romagna

Indicator 2.1 Tests/ Regional population

6.81%

6.69%

5.49%

5.28%

3.87%

3.84%

3.58%

3.56%

3.49%

3.32%

2.95%

2.70%

2.19%

1.93%

1.89%

1.73%

1.46%

1.45%

1.35%

1.22%

0 0.01 0.02 0.03 0.04 0.05 0.06 0.07 0.08

TRENTINO-ALTO ADIGE

VENETO

VALLE D'AOSTA

FRIULI VENEZIA GIULIA

EMILIA-ROMAGNA

UMBRIA

TOSCANA

MARCHE

LOMBARDIA

PIEMONTE

LIGURIA

ABRUZZO

LAZIO

BASILICATA

MOLISE

CALABRIA

SICILIA

PUGLIA

SARDEGNA

CAMPANIA

% tamponati Regions Tests

Abruzzo 35.356

Basilicata 10.889

Calabria 33.755

Campania 70.566

Emilia-Romagna 172.589

Friuli Venezia Giulia 64.151

Lazio 128.664

Liguria 45.719

Lombardia 351.423

Marche 54.313

Molise 5.776

Piemonte 144.531

Puglia 58.496

Sardegna 22.116

Sicilia 73.008

Toscana 133.617

Trentino-Alto Adige 72.969

Umbria 33.881

Valle d'Aosta 6.897

Veneto 328.218ITALY 1.846.934

CommentA significant difference emerges between the incidence of tests made by Veneto Region and in Trentino Alto Adige compared to the other Regions. In total, tests in Italy were 1,846,934 equal to 3.06% of the population (April 28th 2020).

Indicator 2.2.1 ICU beds x 100.000 ab.

8.60

7.81

7.50

8.71

7.40

7.82

9.82

9.71

9.38

8.22

8.95

7.54

6.43

10.07

9.30

10.07

9.87

7.51

11.61

7.96

8.71

9.29

9.64

10.58

12.97

13.43

13.61

13.74

13.74

14.18

14.58

15.31

15.41

15.95

16.28

16.44

16.82

17.53

18.98

24.12

27.85

15.52

0.00 5.00 10.00 15.00 20.00 25.00 30.00

CAMPANIA

SARDEGNA

CALABRIA

BASILICATA

PUGLIA

UMBRIA

MOLISE

LAZIO

ABRUZZO

SICILIA

LOMBARDIA

MARCHE

P.A. TRENTO E BOLZANO

EMILIA ROMAGNA

TOSCANA

VENETO

FRIULI V. G.

PIEMONTE

LIGURIA

VALLE D'AOSTA

ITALIA

Today Before

CommentThe indicator shows theincrease in PL in TI over100,000 inhab. in thedifferent regions.Almost all of the regionshave increased ICU morethan requested by theMoH (+ 50%) despite therecent change of directionconsisting in the reductionof PL in TI that someregions are undertaking.

ICU Saturation (March 31st)

1260 962 825 7071324 353 356 173

105%

37%43%

24%

0%

20%

40%

60%

80%

100%

120%

0

200

400

600

800

1000

1200

1400

Lombardia Emilia Romagna Veneto Lazio

Posti T.I . attuali Casi T.I. attuali Tasso di saturazione T.I..ICU Beds (Now) ICU Cases (Now) ICU Saturation (Now)

Percentage of hospitalized / confirmed cases (March 31st)

0.473

0.214

0.000

0.100

0.200

0.300

0.400

0.500

0.600

0.700

0.800

0.900

1.00020

20-0

3-01

T17:

00:0

020

20-0

3-02

T18:

00:0

020

20-0

3-03

T18:

00:0

020

20-0

3-04

T17:

00:0

020

20-0

3-05

T17:

00:0

020

20-0

3-06

T17:

00:0

020

20-0

3-07

T18:

00:0

020

20-0

3-08

T18:

00:0

020

20-0

3-09

T18:

00:0

020

20-0

3-10

T18:

00:0

020

20-0

3-11

T17:

00:0

020

20-0

3-12

T17:

00:0

020

20-0

3-13

T17:

00:0

020

20-0

3-14

T17:

00:0

020

20-0

3-15

T17:

00:0

020

20-0

3-16

T17:

00:0

020

20-0

3-17

T17:

00:0

020

20-0

3-18

T17:

00:0

020

20-0

3-19

T17:

00:0

020

20-0

3-20

T17:

00:0

020

20-0

3-21

T17:

00:0

020

20-0

3-22

T17:

00:0

020

20-0

3-23

T17:

00:0

020

20-0

3-24

T17:

00:0

020

20-0

3-25

T17:

00:0

020

20-0

3-26

T17:

00:0

020

20-0

3-27

T17:

00:0

020

20-0

3-28

T17:

00:0

020

20-0

3-29

T17:

00:0

020

20-0

3-30

T17:

00:0

020

20-0

3-31

T17:

00:0

0

Emilia Romagna Lazio Lombardia Veneto

Indicator 2.4. Percentage hospitalized/confirmed cases (Nothern Regions)

Data Emilia-Romagna

Friuli Venezia Giulia Liguria Lombardia P.A. Bolzano P.A. Trento Piemonte Toscana Valle d'Aosta Veneto Total

Mean 0,39 0,20 0,49 0,52 0,34 0,26 0,48 0,34 0,21 0,23 0,43

Max 0,56 0,37 0,79 0,96 1,00 0,50 0,92 0,59 0,41 0,35 0,75

Min 0,23 0,00 0,22 0,22 0,11 0,00 0,19 0,13 0,00 0,13 0,20

Std Dev 0,11 0,08 0,17 0,16 0,27 0,11 0,23 0,14 0,09 0,07 0,15

Var 0,01 0,01 0,03 0,03 0,07 0,01 0,05 0,02 0,01 0,01 0,02

0.00

0.20

0.40

0.60

0.80

1.00

1.2001

-mar

03-m

ar

05-m

ar

07-m

ar

09-m

ar

11-m

ar

13-m

ar

15-m

ar

17-m

ar

19-m

ar

21-m

ar

23-m

ar

25-m

ar

27-m

ar

29-m

ar

31-m

ar

02-a

pr

04-a

pr

06-a

pr

08-a

pr

10-a

pr

12-a

pr

14-a

pr

16-a

pr

18-a

pr

20-a

pr

22-a

pr

24-a

pr

26-a

pr

28-a

pr

mar apr

Emilia-Romagna Friuli Venezia Giulia Liguria Lombardia P.A. BolzanoP.A. Trento Piemonte Toscana Valle d'Aosta Veneto

0.088

0.1490.111

0.325

0.212

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

01/03/202

0

02/03/202

0

03/03/202

0

04/03/202

0

05/03/202

0

06/03/202

0

07/03/202

0

08/03/202

0

09/03/202

0

10/03/202

0

11/03/202

0

12/03/202

0

13/03/202

0

14/03/202

0

15/03/202

0

16/03/202

0

17/03/202

0

18/03/202

0

19/03/202

0

20/03/202

0

21/03/202

0

22/03/202

0

23/03/202

0

24/03/202

0

25/03/202

0

26/03/202

0

27/03/202

0

28/03/202

0

29/03/202

0

30/03/202

0

31/03/202

0

Percentage ICU/hospitalized

Emilia Romagna Lazio Lombardia Veneto

DATA Emilia Romagna Lazio Lombardia Veneto ItalyMedia 0,108 0,132 0,130 0,244 0,135Max 0,156 0,350 0,266 0,388 0,230Min 0,086 0,000 0,113 0,218 0,119Dev Std 0,022 0,082 0,046 0,044 0,034Varianza 0,000 0,007 0,002 0,002 0,001

Indicator 2.4. Percentage ICU/hospitalized (Selected Regions)

DimensionHospital Centered

approachIntegrated Approach

Community-Home

Approach

Testing

Testing used for

hospitalized or

syntomatic patients only

Diffused testing in

specific territories

(symptomatic and pauci-

symptomatic patients

(contagion outbreaks)

Diffused testing in the

whole regional territory

(symptomatic and pauci-

symptomatic patients

(contagion outbreaks)

Hospital use

Intensive use of

hospitalization (>40%)

and average use of ICUs

(<15% of hospitalized)

Intertemdiate use of

hospitalization ( between

20 - 30%) and average

ICUs use of hospitalized

Limited use of

hospitalization (lower

than 20%) and intensive

ICUs use (>20%)

Primary and

community care

involvement

GPs active on an

individual basis

GPs active in structured

mobile teams in

collaboration with

nurses, with DPIs

provided by RHAs

GPs active in structured

mobile teams in

collaboration with

nurses, with DPIs

provided by RHAs

ICU use

ICUs intensively used

and rapidly saturated

(13-14% of hospitalized

patients)

ICUs used to support

specific contagion

outbreaks (lower

intensity: 10% of

hospitalized patients)

ICUs used to support

specific contagion

outbreaks (higher

intensity of use: 20% of

hospitalized patients)

Digital solutionsUse of digital solution

limited for contact

tracing

Regional platforms to

support Covid-19

patients at home (e.g.

DoctorCovid, Lazio

Region)

Local platforms to

support Covid-19

patients at home (e.g.

Trentino Region)

Regions and models of response

Hospital Centered approach Integrated Approach Community-Home Approach

LombardiaLiguriaLazio

PiemonteBasilicata

SiciliaUmbria

Emilia-RomagnaMarche Toscana

Valle D’AostaCalabria

Campania

VenetoPA Trento

PA BolzanoFriuli Venezia Giulia

PugliaMolise

AbruzzoSardegna

Regions and models of response


Phase 1

Phase 2

May 5th 2020May 12th 2020

Regional «readiness» Healthcare planning (Phase 1 and Phase 2)

Covid – Hospital Hospitals networks Hub and spoke

Marche(supported by infectious

disease clinical departments located in other regional hospitals)

Lombardia Lazio

Liguria(+ covid-free hospitals)

Emilia –Romagna ( only for intensive care

«covid-19 intensive care»)

Table shows the different approaches planned by Italian Regions for the management of Covid – 19 patients. Itreveals an heterogeneity in the choices: two regions (Lombardia and Liguria) plan to operate an hospitalnetworks while others (Lazio and Emilia Romagna) have designed an hub and spoke organizational model. At themoment, only one region (Marche) has deliberate to carry all covid patients’ in a dedicated hospital.

Hospital Care Contingency Plans (Models)

Discussion & Conclusion

Phase 1 of Covid-19 outbreaks was characterized by an uneven response to the emergency between the Italian Regions and three dominant organizational models were identified: hospital centered approach, community care approach, integrated approach

Regions has adjusted their response granting on their own assets and traditional approach to healthcare (more or less hospital-centric);

Nevertheless a progressive convergence towards common management methods that include both hospital and local / home assets can be seen;

Post lock-down phase has been just started and new models of analysis are needed to monitor the evolution of the contagion and the regional adaptive response

facing covid-19emergency: comparing organizational models

Documents