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bogana, gianna (2015) Le cure perinatali nel Veneto: analisi degli outcome e prospettive di azioni future. [Tesi di dottorato]

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Abstract (inglese)

ABSTRACT

Proper health planning of the mother-child care is a fundamental objective both in Europe than in other countries.
The quality of maternal and perinatal care is based not only on the availability of medical technology and on the improvement of the social and economic situation of the population, but also on the organization of the network of perinatal care. The quality of perinatal care is based on many indicators: maternal and neonatal outcomes, such as rates of infant and child mortality, but also indicators of the level of hospital care or size of the maternity units.
In the National and Regional Health Service is foundamental the creation of an optimal organization and of an adequate internal control system capable of measuring out the main performance of healthcare processes both in terms of effectiveness of medical treatments and of efficient allocation of economic and financial resources.
The analysis and processing of certificates of birth assistance in our region transformed the information flow called CEDAP in a rich and detailed report on the birth, instrument appreciated by clinicians and professionals of the organization and planning services.
As we have already point out from the annual reports and from the current pubblications, the structure of the report and the use made of it - at different levels, in the network of health services during pregnancy, childbirth and postpartum and neonatal health - have made it possible not only to monitor the effectiveness and appropriateness of care provided, but also to use all these informations and their critical evaluation to engage processes of quality improvement.
In this first chapter of the work we tried to assess the impact on maternal and child health in the current Regional health care network checking the status of health planning regulations, the health demand, its control and the implications of present and future on perinatal care, useful to improve maternal - fetal outcomes.
By studying the epidemiology of the outcomes in the Veneto Region we have attempted to identify possible factors, from information sources of current data on the birth, identifying as pathologies that most influence the neonatal outcome the "prematurity" and the "fetal growth restriction”.
While the current system of regional organization works very well in the management of premature infants as such its concentration is properly distributed for both levels of care and by monitoring the performance of neonatal outcomes - confirming the validity of the actual state of health planning regulations - some considerations should be made regarding the redistribution of born with diagnosis of “fetal growth restriction” according to the levels of hospital care in the Veneto Region, as is clear from the work presented in the second chapter of this work.
Posing as main objective the improvement of maternal-fetal outcome in the Veneto Region has been proposed as a useful tool to share the same philosophy of care and to create a network connection between the different Regional Hospital Unit and Gynecologists of the territory, the creation of a Computerized Unic Integarted Hospital Chart based on the path of women in the sanitary services, as set out in the third chapter of this work.

Abstract (italiano)

La corretta programmazione sanitaria delle cure madre-bambino rappresenta un obiettivo fondamentale sia nella realtà Europea sia negli altri paesi.
La qualità delle cure materne e perinatali si basa non solo sulla disponibilità della tecnologia medica e sul miglioramento della situazione sociale ed economica della popolazione, ma anche sull'organizzazione della rete di assistenza perinatale. La qualità delle cure perinatali si fonda su molti indicatori: indicatori di outcome materno e neonatale, come i tassi di mortalità neonatale e infantile, ma anche su indicatori di livello di cure ospedaliere o di dimensioni delle unità operative.
Di fondamentale importanza strategica nel Servizio Sanitario Nazionale e Regionale è quindi la creazione di un’ottimale organizzazione e di un adeguato sistema di controllo interno capace di misurare attentamente le principali performance dei processi sanitari sia in termini di efficacia delle cure mediche che di efficiente allocazione delle risorse economiche e finanziarie.
L’analisi e le elaborazioni dei certificati di assistenza al parto nella nostra Regione, da molti anni, trasformano il flusso informativo CEDAP in un ricco e dettagliato Rapporto sulla nascita, strumento apprezzato dai clinici e dalle professioniste e dai professionisti dell’organizzazione e della programmazione dei servizi.
Come abbiamo avuto modo di rilevare dai numerosi report annuali regionali e dagli studi pubblicati in letteratura, la struttura del Rapporto e l’utilizzo che ne viene fatto - a diversi livelli, nella rete dei servizi per la salute in gravidanza, parto e puerperio e per la salute neonatale - hanno consentito non solo di monitorare l’efficacia e l’appropriatezza dell’assistenza fornita, ma anche di utilizzare le informazioni e la loro valutazione critica per innestare processi di miglioramento della qualità.
In questo primo capitolo della tesi si è cercato di valutare l’impatto sulla salute materno-infantile dell’attuale rete di assistenza sanitaria Regionale controllando lo stato della programmazione sanitaria vigente, la domanda sanitaria, il suo controllo e le implicazioni presenti e future sulle cure perinatali, utili a migliorare l’outcome materno-fetale.
Studiando l’epidemiologia degli outcome nella regione Veneto abbiamo tentato di individuare i possibili fattori determinanti, a partire dalle fonti informative correnti di dati sulla nascita, che ci hanno permesso di identificare come patologie maggiormente influenti l’outcome neonatale “la prematurità” e “la restrizione della crescita fetale”.
Se da un lato il sistema attuale di organizzazione regionale funziona molto bene nella gestione dei nati prematuri in quanto tale concentrazione risulta correttamente distribuita sia per livelli di assistenza sia monitorizzando l’andamento degli esiti neonatali - confermando la validità dello stato della programmazione sanitaria vigente - alcune considerazioni andrebbero fatte riguardo alla redistribuzione dei nati con restrizione della crescita in utero in base ai livelli ospedalieri di assistenza nella Regione Veneto, come emerge dal lavoro esposto nel secondo capitolo della tesi.
Ponendoci come obiettivo principale il miglioramento dell’outcome materno-fetale nella Regione Veneto è stata proposta, come strumento utile a condividere una stessa filosofia di assistenza e a creare una rete di connessione Regionale tra le differenti Unità Ospedaliere e ginecologi del territorio, la creazione di una Cartella Informatizzata Unica integrata ospedaliero-ambulatoriale che si basa sul percorso della donna all’interno dei servizi, come esposto nel terzo capitolo della tesi.

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Tipo di EPrint:Tesi di dottorato
Relatore:Facchin, Paola
Dottorato (corsi e scuole):Ciclo 27 > scuole 27 > MEDICINA DELLO SVILUPPO E SCIENZE DELLA PROGRAMMAZIONE > SCIENZE DELLA PROGRAMMAZIONE
Data di deposito della tesi:29 Gennaio 2015
Anno di Pubblicazione:28 Gennaio 2015
Parole chiave (italiano / inglese):cartella ostetrica regionale/IUGR/regione veneto
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/40 Ginecologia e ostetricia
Struttura di riferimento:Dipartimenti > Dipartimento di Medicina
Codice ID:7692
Depositato il:16 Nov 2015 12:05
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