Protected discharges: an integrated approach, the experience of Emilia Romagna

1. Protected discharges: an integrated approach, the experience of Emilia Romagna Rosanna Carbognani Director Primary Care Programme Florence, 19 May 2003

2. Centrality of the individual in the construction of his/her own health project Continuity of treatment and network of services based on the individual The approach of the Local Health Board (Azienda USL) of Reggio Emilia Rosanna Carbognani Florence, 19 May 2003

3. HP is a technology, not an end It aims to highlight the centrality of the individuals who come into contact with the system of supply and make them aware of their role in the individual health project Rosanna Carbognani Florence, 19 May 2003

4. THE PERSON IN THE CENTRE • EMPOWERMENT: A CONSCIOUS PACT • COMPLEXITY OF SERVICE RELATIONSHIP (TECHNICAL, ORGANISATIONAL AND RELATIONAL DIMENSION) • THE PATIENT’S HISTORY AS A RESOURCE AND ASSET Rosanna Carbognani Florence, 19 May 2003

5. HP HOME COMMUNITY PEDIATRICIAN CARE SOCIAL ASSISTANT RSA PROTECTED INDIVIDUAL OTA HOUSING IP MMG CONSULTANTS PDLS OBSTETRICS HOSPITAL VOLUNTARY SERVICES 2ND LEVEL OUTPATIENT SPECIALIST Rosanna Carbognani SERVICES Florence, 19 May 2003

6. HPas a framework within which to develop the individual treatment course which aims to achieve“possible health” using an alliance between the subjects that operate in it Rosanna Carbognani Florence, 19 May 2003

7. CONTINUITY OF TREATMENT Specialist OTA Voluntary services The alliances Social assistant MMG IP possible person Care agree ment Recep tion Implementation Orien tation Follow-up tests need health Rosanna Carbognani Florence, 19 May 2003

8. FROM SERVICE TO THE TREATMENT COURSE THROUGH THE ALLIANCES IN THE INDIVIDUAL HEALTH PROJECT Rosanna Carbognani Florence, 19 May 2003

9. THE DEVELOPMENT OF THE LOCAL HEALTH BOARD (AZIENDA USL) IN REGGIO EMILIA 1997 Development of Protected Discharge Project 2003 90% of all patients who require a protected discharge now receive one Rosanna Carbognani Florence, 19 May 2003

10. OBSTACLES ON PATH TO CONTINUITY • Self-referencing status of structures • Culture oriented towards clinical recovery • Difficulty for professionals to have an overall vision of the entire process • Difficulty of constructing an accompanying course of information • Different languages created by specialism • Communication is difficult Risk that continuity is only formal (the sum of events) Rosanna Carbognani Florence, 19 May 2003

11. ACTIONS TO ACHIEVE CONTINUITY organisational technological development cultural development experimental Rosanna Carbognani Florence, 19 May 2003

12. ACTIONS TO ACHIEVE CONTINUITY Actions of an organisational type: primary care centres as a place for: • Accompaniment • Concise information • Recomposition • Network • Treatment agreement • Promotion of health Rosanna Carbognani Florence, 19 May 2003

13. ACTIONS TO ACHIEVE CONTINUITY 2. Actions focused on technological development: Implementation of information networks as virtual networks that provide computerised support to sharing a strategy Rosanna Carbognani Florence, 19 May 2003

14. ACTIONS TO ACHIEVE CONTINUITY 3. Actions involving cultural development: Integrated training for all players involved in the continuity of treatment Rosanna Carbognani Florence, 19 May 2003

15. ACTIONS TO ACHIEVE CONTINUITY 4. Experimental actions: Treatment courses as a supply of care characterised by the sequential nature of connected actions Rosanna Carbognani Florence, 19 May 2003

16. Continuity is constructed on the person and on the individual health project Not as continuous treatment But as an accompaniment and enhancement of the limits (possible health) Rosanna Carbognani Florence, 19 May 2003

17. Continuity is the proposal of a journey that we make together (citizen and professionals) on which we share the destination, the course and the responsibilities. Rosanna Carbognani Florence, 19 May 2003