Bridging the Gap between Theory and Practice in Integrated Care: The Case of the Diabetic Foot Pathway in Tuscany.

INTRODUCTION AND BACKGROUND: As diabetic foot (DF) care benefits from integration, monitoring geographic variations in lower limb Major Amputation rate enables to highlight potential lack of Integrated Care. In Tuscany (Italy), these DF outcomes were good on average but they varied within the region. In order to stimulate an improvement process towards integration, the project aimed to shift health professionals' focus on the geographic variation issue, promote the Population Medicine approach, and engage professionals in a community of practice. METHOD: Three strategies were thus carried out: the use of a transparent performance evaluation system based on benchmarking; the use of patient stories and benchmarking analyses on outcomes, service utilization and costs that cross-checked delivery- and population-based perspectives; the establishment of a stable community of professionals to discuss data and practices. RESULTS: The project enabled professionals to shift their focus on geographic variation and to a joint accountability on outcomes and costs for the entire patient pathways. Organizational best practices and gaps in integration were identified and improvement actions towards Integrated Care were implemented. CONCLUSION AND DISCUSSION: For the specific category of care pathways whose geographic variation is related to a lack of Integrated Care, a comprehensive strategy to improve outcomes and reduce equity gaps by diffusing integration should be carried out.

[Assessment of competence: literature review and project research]. / La valutazione delle competenze: dall'analisi della letteratura alla proposta di un progetto di ricerca.

The authors propose a research project aimed at developing a system for evaluating and codifying nursing competencies. The purpose of the project is to improve the outcome of care and the way nurses perceive their profession, by introducing a new concept of professional roles that allows innovation, creativity, methodological flexibility and functionality in group working. Although reference models for evaluating nursing competencies have been devised, in Italy they but have not yet been become operative and nurses are evaluated by the single health authorities.

[A system for evaluating nursing competencies: definition of operative instruments]. / Un sistema per valutare le competenze nell'infermieristica: la definizione degli strumenti operativi.

Assessment of competencies is an essential element of staff management. Many approaches have been suggested at international level but their application is not always straightforward due to cultural interference. The system for monitoring nursing competencies merges the concepts of Advanced Practice Nursing and the Learning Organization model. This study addresses the introduction of a system of for assessing nursing competencies by modules for evaluation and self-assessment as well as outcome indicators The first phase of the study has made it possible to define the areas , variables and contexts to be evaluated together with the relevant indicators and methodology, as established in 2009.