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Italy: Where Are We Going?

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ICU Resource Allocation in the New Millennium

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Abstract

The Italian Hospital, as the institution at the source of health care delivery, has been operating under crisis conditions for a long time because of an increasing demand for health care from a rapidly and constantly changing population. In Italy, child birth survival has increased threefold [1], infantile mortality has fallen to 4.3 per 1,000 live births while the general population has basically aged [2]. It is estimated that the ageing index will double before 2050 and thus future public health expenditure will be more and more subordinate to long-time care [3]. In today’s Italy, health care is universally provided under the law to all Italian citizens and the state, in various guises, sustains the bulk of the expenditure [4]. The last decades have witnessed the development of a private health care sector, although state as well as insurance contributions still account for most of the expense. The Italian health system is characterised by marked regional differences. Italian economic growth has never been uniform and the gap between the wealthiest northern and central regions and the less affluent southern ones has never been bridged. Regional socio-economic disparities have caused wide differences in the quality and efficiency of health services in this country, especially in the south where a high percentage of low-income families mostly live [5]. In the course of time, the evolution of the health care system has been marked by various attempts at reform [6] in the face of ever more stringent budgetary limits on the one hand, and an ever increasing process of decentralisation on the other. This devolution is ongoing and could lead to the creation of as many diverse local health systems as there are regions in the country [7].

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References

  1. Istat. Italia in cifre 2005. Rome: Istat; 2006. http://www.istat.it. Accessed 5 Oct 2010.

  2. Organisation for Economic Cooperation and Development. OECD health data 2005. Paris: OECD; 2005.

    Google Scholar 

  3. Italian Ministry of Economics and Finance, Department of General Accounts. Mid-long term trends for the pension and health care systems summary and conclusions. The forecasts of the Department of General Accounts Updated to 2005. Rome: Ministry of Economics and Finance; 2005. Available in English at http://www.rgs.tesoro.it/ENGLISH-VE/Institutio/Social-exp/Forcast-ac/_____mid-long-term-trends-for-the-pension--health-and-long-term-care-systems.pdf. Accessed 10 Oct 2010.

  4. Constitution of the Italian Republic, Art. 32. http://www.governo.it/Governo/Costituzione/1_titolo2.html. Available in English at http://www.senato.it/documenti/repository/istituzione/costituzione_inglese.pdf. Accessed 10 Oct 2010.

  5. World Health Organization. World health report 2000. Geneva: WHO; 2000. http://www.who.int/entity/whr/2000/en/index.html. Accessed 12 Oct 2010.

  6. Decreto Legislativo 19 Giugno 1999, n. 229. “Norme per la razionalizzazione del Servizio sanitario nazionale, a norma dell’articolo 1 della legge 30 novembre 1998, n. 419”. Pubblicato nella Gazzetta Ufficiale n. 165 del 16 luglio 1999 – Suppl. Ord. n. 132. http://www.parlamento.it/parlam/leggi/deleghe/99229dl.htm. Accessed 12 Oct 2010.

  7. Giannoni M, Hitiris T. The regional impact of health care expenditure: the case of Italy. Appl Econ. 2002;14:1829–36.

    Article  Google Scholar 

  8. Marraro G. Choices that have to be made by a doctor. Int J Clin Monit Comput. 1993;10:163–6.

    Article  PubMed  CAS  Google Scholar 

  9. Giannini A, Consonni D. Physicians’ perceptions and attitudes regarding inappropriate admissions and resource allocation in the intensive care setting. Br J Anaesth. 2006;96:57–62.

    Article  PubMed  CAS  Google Scholar 

  10. Ward NS, Teno JM, Curtis JR, Rubenfeld GD, Levy MM. Perceptions of cost constraints, resource limitations, and rationing in United States intensive care units: results of a national survey. Crit Care Med. 2008;36:471–6.

    Article  PubMed  Google Scholar 

  11. McKee M. Reducing hospital beds: what are the lessons to be learned? European Observatory on Health Systems and Policies. Policy Brief No. 6, 2004.

    Google Scholar 

  12. Szalados JE. Access to critical care: medical rationing of a public right or privilege? Crit Care Med. 2004;32:1623–4.

    Article  PubMed  Google Scholar 

  13. Cook D, Giacomini M. The sound of silence: rationing resources for critically ill patients. Crit Care. 1999;3:R1–3.

    Article  PubMed  Google Scholar 

  14. Vincent JL. European attitudes towards ethical problems in intensive care medicine: results of an ethical questionnaire. Intensive Care Med. 1990;16:256–64.

    Article  PubMed  CAS  Google Scholar 

  15. Metcalfe MA, Sloggett A, McPherson K. Mortality among appropriately referred patients refused admission to intensive-care units. Lancet. 1997;350:7–11.

    Article  PubMed  CAS  Google Scholar 

  16. Coomber S, Todd C, Park G, Baxter P, Firth-Cozens J, Shore S. Stress in UK intensive care unit doctors. Br J Anaesth. 2002;89:873–81.

    Article  PubMed  CAS  Google Scholar 

  17. Associazione Anestesisti Rianimatori Ospedalieri Italiani (AAROI). Censimento nazionale dei posti letto di rianimazione attivi al 30 giugno 2005. http://www.aaroi.it/Pagine/iniziative/iniziative_2005/censimento_nazionale_01.pdf. Accessed 15 Oct 2010.

  18. Gallesio AO. Improving quality and safety in the ICU: a challenge for the next years. Curr Opin Crit Care. 2008;14:700–7.

    Article  PubMed  Google Scholar 

  19. Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand. 2009;53:143–51.

    Article  PubMed  CAS  Google Scholar 

  20. Reader TW, Flin R, Mearns K, Cuthbertson BH. Developing a team performance framework for the intensive care unit. Crit Care Med. 2009;37:1787–93.

    Article  PubMed  Google Scholar 

  21. Garrouste Orgeas M, Timsit JF, Soufir L, Tafflet M, Adrie C, Philippart F, Zahar JR, Clec’hC, Goldran-Toledano D, Jamali S, Dumenil AS, Azoulay E, Carlet J, Outcomerea Study Group. Impact of adverse events on outcomes in intensive care unit patients. Crit Care Med. 2008;36:2041–7

    Google Scholar 

  22. Levy MM, Rapoport J, Lemeshow S, Chalfin DB, Phillips G, Danis M. Association between critical care physician management and patient mortality in the intensive care unit. Ann Intern Med. 2008;148:801–9.

    PubMed  Google Scholar 

  23. Nasraway SA, Cohen IL, Dennis RC, Howenstein MA, Nikas DK, Warren J, Wedel SK. Guidelines on admission and discharge for adult intermediate care units. American College of Critical Care Medicine of the Society of Critical Care Medicine. Crit Care Med. 1998;26:607–10.

    Article  PubMed  CAS  Google Scholar 

  24. Jackson JC, Mitchell N, Hopkins RO. Cognitive functioning, mental health, and quality of life in ICU survivors: an overview. Crit Care Clin. 2009;25:615–28.

    Article  PubMed  Google Scholar 

  25. Hopkins RO, Jackson JC. Short- and long-term cognitive outcomes in intensive care unit survivors. Clin Chest Med. 2009;30:143–53.

    Article  PubMed  Google Scholar 

  26. Adhikari NK, McAndrews MP, Tansey CM, Matté A, Pinto R, Cheung AM, Diaz-Granados N, Barr A, Herridge MS. Self-reported symptoms of depression and memory dysfunction in survivors of ARDS. Chest. 2009;135:678–87.

    Article  PubMed  Google Scholar 

  27. Cheung AM, Tansey CM, Tomlinson G, Diaz-Granados N, Matté A, Barr A, Mehta S, Mazer CD, Guest CB, Stewart TE, Al-Saidi F, Cooper AB, Cook D, Slutsky AS, Herridge MS. Two-year outcomes, health care use, and costs of survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2006;174:538–44.

    Article  PubMed  Google Scholar 

  28. Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, Stern EJ, Hudson LD. Incidence and outcomes of acute lung injury. N Engl J Med. 2005;353:1685–93.

    Article  PubMed  CAS  Google Scholar 

  29. Task Force of the American College of Critical Care Medicine. Guidelines for ICU admission, discharge, and triage. Crit Care Med. 1999;27:633–8.

    Article  Google Scholar 

  30. Bioetic Commission SIAARTI. SIAARTI guidelines for admission to and discharge from intensive care units and for limitation of treatment in intensive care. Minerva Anestesiol. 2003;69:101–18.

    Google Scholar 

  31. Walter KL, Siegler M, Hall JB. How decisions are made to admit patients to medical intensive care units (MICUs): a survey of MICU directors at academic medical centers across the United States. Crit Care Med. 2008;36:414–20.

    Article  PubMed  Google Scholar 

  32. Irone M, Parise N, Bolgan I, Campostrini S, Dan M, Piccinni P. Assessment of adequacy of ICU admission. Minerva Anestesiol. 2002;68:201–7.

    PubMed  CAS  Google Scholar 

  33. SIAARTI – Italian Society of Anaesthesia Analgesia Resuscitation and Intensive Care Bioethical Board. End-of-life care and the intensivist: SIAARTI recommendations on the management of the dying patient. Minerva Anestesiol 2006;72:927–63.

    Google Scholar 

  34. Bertolini G, Boffelli S, Malacarne P, Peta M, Marchesi M, Barbisan C, Tomelleri S, Spada S, Satolli R, Gridelli B, Lizzola I, Mazzon D. End-of-life decision-making and quality of ICU performance: an observational study in 84 Italian units. Intensive Care Med. 2010;36:1495–504.

    Article  PubMed  Google Scholar 

  35. Iapichino G, Radrizzani D, Bertolini G, Ferla L, Pasetti G, Pezzi A, Porta F, Miranda DR. Daily classification of the level of care. A method to describe clinical course of illness, use of resources and quality of intensive care assistance. Intensive Care Med. 2001;27:131–6.

    Article  PubMed  CAS  Google Scholar 

  36. Dries DJ, Adams AB, Marini JJ. Time course of physiologic variables in response to ventilator-induced lung injury. Respir Care. 2007;52:31–7.

    PubMed  Google Scholar 

  37. Vincent JL, de Souza Barros D, Cianferoni S. Diagnosis, management and prevention of ventilator-associated pneumonia: an update. Drugs. 2010;70:1927–44.

    Article  PubMed  Google Scholar 

  38. Diaz E, Lorente L, Valles J, Rello J. Mechanical ventilation associated pneumonia. Med Intensiva. 2010;34:318–24.

    Article  PubMed  CAS  Google Scholar 

  39. Kress JP, Marini JJ. Acute respiratory distress syndrome: adjuncts to lung-protective ventilation. Semin Respir Crit Care Med. 2001;22:281–92.

    Article  PubMed  CAS  Google Scholar 

  40. Marraro GA. Protective lung strategies during artificial ventilation in children. Paediatr Anaesth. 2005;15:630–7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anaesthesia, Intensive Care, & Pain Management, A. Manzoni General Hospital, Via dell’Eremo 9/11, Lecco, 23900, Italy

    Marco Luchetti M.D.

  2. Department of Anesthesia and Intensive Care, Fatebenefratelli and Ophthalmiatric General Hospital, University of Milan, Milan, Italy

    Giuseppe A. Marraro M.D.

Authors
  1. Marco Luchetti M.D.
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  2. Giuseppe A. Marraro M.D.
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Correspondence to Marco Luchetti M.D. .

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Editors and Affiliations

  1. and Neurological Surgery, University of Pittsburgh, Departments of Critical Care Medicine, School of Medicine, Pittsburgh, 15219, Pennsylvania, USA

    David W. Crippen

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Luchetti, M., Marraro, G.A. (2013). Italy: Where Are We Going?. In: Crippen, D. (eds) ICU Resource Allocation in the New Millennium. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3866-3_19

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  • DOI: https://doi.org/10.1007/978-1-4614-3866-3_19

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