[Hospital without pain: hospital experiences in the Lazio Region of Italy]. / Ospedale senza dolore: esperienze nelle strutture ospedaliere della Regione Lazio.

The aim of the study is showing the results of the experience of "Hospital without pain" in the Lazio Region, in order to plan a specific regional project. This was a cross-sectional study conducted through the administration of a questionnaire during the month of October 2007, sent by the Social Department of the Regional Direction Health Planning to the General Directors of Local Health units, Hospital Trusts and Teaching Hospitals. 24 hospitals entered the study (response rate 80%). 37.5% of responders declare that pain level is routinely controlled by a trained health professional, mainly in smaller hospitals (50% vs. 20% in larger ones). In most hospitals (62.5%), pain monitoring is based on the use of the Visual analogue scale (VAS), whereas other scales are less frequently used (20.8%). VAS is mainly used in roman hospitals (84.6%) (p = 0.033). In 10 hospitals (41.7%) there are pain management tools inserted in the clinical chart, and in 14 hospitals (58.3%) specific protocols have been developed and implemented for the treatment of acute and chronic pain. In the last case, these protocols are predominant in the roman (76.9%; p = 0.045), larger (80%; p = 0.069) and teaching hospitals (100%; p = 0.064). The management of pain in the Lazio Region shows a high heterogeneity, both in terms of geographical and dimensional issues. This study highlighted critical elements to be considered for the improvement of the situation at the regional level.

[Performance indicators: INCA (cardiovascular indicators) project]. / Indicatori di performance: progetto INCA (INdicatori CArdiovascolari).

The objective of INCA project was the development and implementation of Acute Myocardial Infarction (AMI type ST elevation) process and outcome indicators for the regional cardiology units, testing the possibility of using regional healthcare information data to evaluate the quality of provided healthcare within the regional healthcare accreditation process. The project is introduced by an overview of major concepts of evaluating and managing quality of healthcare. We performed a literature review of structure, process and outcome indicators in cardiology and of accreditation standards for cardiology at national and international level. Through consensus procedures and according to international evidence based literature a set of 18 process and outcome indicators for AMI was defined. A specific procedure for data collection has been developed. Education and training of participants on procedures, quality and accreditation was achieved. Expected verifiable end-points have been achieved over a three months period of data collecting throughout 21 cardiology units, differentiated for level of complexity and location, for a total of 409 clinical observed cases of AMI. Analysis of data was followed by the diffusion of results. Successful data collection of clinical performance indicators on a regional basis was achieved. Participants have been trained to quality sciences. Results will be useful to evaluate and design implementation strategies of regional accreditation of health care services within a shared framework. Benchmarking within Regional hospital cardiology care services will be developed following self evaluation and continuous quality improvement cycle activities.

[Public health: from the past toward new frontiers]. / Sanità Pubblica: dal passato alle nuove frontiere.

The Authors analyse and discuss the contents of some recent international meetings devoted to Public Health, namely the 10th Congress of the WFPHA, the 12th British annual Forum of Public Health and the 12th Conference of the EUPHA. Their efforts to evaluate health services comes off enriched with new scenarios of integration and convergence. Objectives of global interest in the world cannot be faced by individual countries alone: on the contrary, the whole scientific community of public health operators must be involved. The cultural, social and economic development is the unavoidable condition to increase the health level of the populations. No health organization with the characteristics of excellence can exist without a comparable, balanced development regarding the society and its economy. With such considerations in mind, the European Commission in 1997 has began to develop the Health Monitoring Programme, with the aim to build a system for monitoring health in the UE. Within this Programme, the Study ECHI 1 (European Community Health Indicators 1) has been published, which includes 4 large groups of indicators (demographic and socioeconomic indicators, health indicators, determinants of health/disease indicators, health services indicators); such a study was performed with the cooperation of OCSE and WHO/Euro researchers. The following ECHI 2 research did not change the supporting philosophy of ECHI 1. We are trying to evaluate whether the intervention of health operators and health structures could influence - increasing or decreasing - the phenomena described and measured by the indicators, inviting the readers to start a debate with us.