Clear progress in the effectiveness of procedures in the North, smaller steps forward in the South too: recourse to caesarean sections still far too frequent.
The quality of hospital care in Italy continues to register steady improvement — more evident in some parts of the country and less perceptible in southern Italy, where, nonetheless, small but important steps forward are being recorded. It is precisely the disparities that persist between geographical areas, and also between hospitals in the same region, with respect to international standards (for example, in the still far too high number of caesarean sections) that represent the challenges Italian healthcare will need to address in future. This is the picture that emerges from the results of the 2016 edition of the Programma nazionale esiti of the Agenzia nazionale per i servizi sanitari regionali, which is responsible for evaluating the effectiveness of Italian healthcare facilities.
The monitoring focused on seven different clinical areas: cardiovascular, neurological, respiratory, general surgery, oncological surgery, pregnancy and childbirth, and musculoskeletal: improvements are evident across all sectors. In 2015, at national level, the facilities reaching high or very high quality levels account for 14.7 per cent of the total facilities assessed; had the same criteria been applied in 2010, the figure would have been less than 9%. Hospitals that proved inadequate in at least half of the areas assessed account for 10 per cent — an average that rises to over 30 per cent in Campania and Abruzzo.
Two areas in which improvements were recorded in 2015, but which remain below international standards, are those relating to femur fractures and childbirth. In the first case, the proportion of femoral neck fractures in patients over 65 years of age operated on within two days (a timeframe that is crucial to the success of the procedure) rose from 31 per cent in 2010 to 55 per cent in 2015, still remaining below the expected international standard of over 80: moreover, operating promptly also represents an advantage in terms of resources used, with more than 670,000 hospital days saved, of which 200,000 in 2015 alone. With the exception of Campania, Molise and Calabria, every region has at least one facility that meets the minimum quality standards in this area. The Istituto ortopedico Galeazzi in Milan, the Santa Maria della Scala in Imola and the Fondazione Poliambulanza in Brescia are Italy's best-performing hospitals, with over 90 per cent of operations carried out within two days.
As regards caesarean sections, the World Health Organization considers a proportion of no more than 15 per cent of cases to be justifiable: in Italy the proportion continues to fall progressively, from 29% in 2010 to 25% in 2015, with large differences within each individual region and between regions. The differences between the regions of northern Italy and those of the south remain clearly visible, with average figures that in the case of Campania remain stable at 50 per cent. Liguria is an exception, with results comparable to those of the southern regions. The hospital of Carate Brianza, the hospital of Lecco and the Ospedale del Ponte in Varese are the ones that resort least to caesareans, in fewer than 7 per cent of cases.
Where improvements are instead uniform across the whole country is in 30-day mortality following hospital admission for acute myocardial infarction, which continues to decline, from 10.4 per cent to 9.0 in 2015. But at the San Raffaele in Milan, the Cliniche Gavazzeni in Bergamo and the Santa Chiara in Trento, deaths within 30 days of an aortocoronary bypass procedure are below 0.50.
More generally, but above all in relation to childbirth, the study highlights a strong correlation between procedure volumes and outcomes: that is to say, the greater the number of procedures a hospital manages over the course of a year, the better the outcomes, and vice versa. The correlation therefore suggests that, with due exceptions, it is preferable to choose a large hospital over a small facility, as a matter of both equipment and staff experience — so much so that departments performing fewer than 500 deliveries a year are in sharp decline.
