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Tuscan healthcare, overall 2023 performance results presented in Florence by the MeS Management and Healthcare Laboratory of the Sant'Anna School: about 160 out of 235 indicators improved or remained stable from the previous year

Strengths and weaknesses the focus of a day of reflection with healthcare managers and institutional representatives


Publication date: 16.05.2024
Bersaglio 2023
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A day of discussion with healthcare managers and institutional representatives on the first 2023 performance results, presented in Florence by the Management and Healthcare Laboratory of the Sant'Anna School in Pisa. The 2023 results show that Tuscan healthcare overall maintains a performance focused in the optimal "Target" bands ("Bersaglio"). The analysis shows that about two-thirds of the 235 indicators have improved or remained consistent since the 2022 data assessment.  

The strengths and weaknesses shown by the 2023 "Target" for Tuscan healthcare.

On the indicators that measure health and social care in general, most of those analyzed show good or optimal performance. The research team, in particular, noted the counter-trend in the reduction of hospitalizations in the medical area (generally slightly increasing), a sign that the link between hospital and territory is improving and how investments in intermediate and transitional care are working. Instead, areas for improvement are recorded in medical and diagnostic appropriateness, suggesting the need to investigate whether and why potentially avoidable diagnostic tests or treatments are prescribed in inappropriate care settings. The indicator on pharmaceutical appropriateness, in the critical performance range, depends mostly on a higher use of antidepressants than in the rest of Italy and a still limited use for pain control in the territory.

On the indicators that measure the performance of clinical care pathways, the research team reported significant improvements in the maternal and child and oncology pathways, with a reduction in cesarean deliveries in primiparae (from 18.5 percent to 17 percent) and improved timeliness for oncology surgeries (90 percent performed on time according to the national plan). One indicator with critical performance concerns Adapted Physical Activity (AFA), which falls under the sphere of prevention and promotion of healthy lifestyles. The volume of adapted physical activity is still low but on the upswing from last year, rising from 1.38 to 1.95 courses per high disability per 15 thousand residents.  Generally, performance shows an increase in the number of checkups under the diagnostic therapeutic pathways for the chronically ill and particularly the diabetes pathway. A critical element is the stay in the emergency room before admission. Just over 60 percent of ER admissions that result in hospitalization occur in less than 8 hours. Another critical element is the growth in the three-year suicide mortality rate, which has returned almost to pre-Covid levels, and especially the increase in hospitalization rates for psychiatric conditions in adults to 242 per 1,000 population (compared with a 234 in 2019).

On quality and safety of care, clinical quality indicators show an improvement in the timeliness of interventions for femoral neck fracture reaching rates exceeding 80 percent and an overall positive situation on clinical risk management. Good and stable data on voluntary inpatient discharges at the regional level.

On the capability to respond to the needs of the population in a timely manner (Responsiveness) and on user experience, although the data show an increase in outpatient services (well above 2019), waiting times for outpatient visits and diagnostic tests and the related capture index, which captures how much of the demand expressed by the population has been taken care of by the health system, are still critical. Positive, however, are the signs regarding elective surgery admissions focused mostly on meeting the interventions included in the national waiting list plan. In addition, the research team shows an increase in adherence to the PREMs survey, on inpatient outcomes. Regarding experience indicators, it is evident that the medical setting has the largest areas for improvement. Among the positive aspects, ward reception also emerges.

On efficiency, although sustainability is a critical point (financial resources from the health fund are lower than costs), the Tuscany Region manages to achieve good results in terms of efficiency (such as average cost per drg point or use of biosimilars). However, there remains room for maneuver within individual companies and hospitals, especially with regard to the use of medical devices and appropriate drug consumption.

Finally, new measures were included for the 2023 assessment to try to capture by the research team the capacity of the regional health system to cope with the challenges that arose after the pandemic. Major post-pandemic challenges include human resource management. In the face of increased stress noted especially by the medical component in the post-pandemic period, employees' interest in participating in company life is very positive (about 50 percent of employees had responded to the lab's biennial survey). In 2022, sickness absence (a critical indicator) increased to 14%, a 3% increase in almost all companies; gender parity, as measured by the crystal ceiling index, indicates an imbalance in the presence of women in top positions within the company. However, there is a marked improvement from the previous year. On the front of the digitization of the health care system, we continue to monitor digital televisits and prescriptions, which show a substantial stability compared to last year and a still limited use of the tool even in the inland areas of Tuscany with the sole exception of the cardiology area, which reaches 70% in some areas.

A set of indicators was also introduced to monitor the progress of the work and resources used for the PNRR. About 80% of the works, in Tuscany, have been started, with about 80% of the funding coming from PNRR funds and or PNC (National Plan for Complementary Investments). Lastly, among the challenges launched with the reorganization of the territory (DM77 at the national level) is the implementation of the family and community nurse model, which has led to the introduction of new indicators to analyze various key aspects including taking care, collaboration with general practitioners, specialists and other professions. By 2023, all district areas in Tuscany had activated the family and community nurse model with coverage reaching 90 percent of the territory. On average, the referral population per nurse is about 3,235, perfectly in line with the national standard.

Cover Photo"Target" ("Bersaglio") 2023 of the Tuscany Region.