[Project of contrast to avoidable mortality in a metropolitan local health authority]. / Progetto di contrasto alla mortalità evitabile in una asl metropolitana.

INTRODUCTION: The avoidable mortality (ME)represents the share of deaths that occurs at an early age (0-74 aa) for causes that cannot be faced by means of public health or health care measures. The work develops a strategic intervention plan aimed at the reduction of ME by identifying local priority actions based on epidemiologic and social-health data. METHODS: a working group among the Department of Prevention, Health Information Systems and Health District was set up. The databases used were: "State of Health Lazio" of the Department of Epidemiology of the Lazio Region; ASL Roma 2 local health data on general mortality (2014-2016) and the local health profile of the surveillance systems "OKkio alla Salute", Passi and HBSC Lazio. The analysis results in an estimation of Asl Roma 2's data and in a comparison of this data set with the regional level of three indicators: avoidable mortality, prevalence and incidence of chronic diseases and lifestyle profile. RESULTS: in the three-year period (2014-2016) there were about 1,900 avoidable deaths per year; in the ASL Roma2 the ME represents about 16% of the total mortality and 60% of them are borne by the male sex. 51% of ME concerns cancer, 27% is linked to cardio-vascular diseases, 10% to trauma and poisoning. A preliminary comparison of standardized ASL Roma 2 rates of prevalence and incidence with regional values shows higher figures for some pathologies in ASL Roma 2: COPD prevalence (114 vs 107), breast neoplasia incidence (174 vs 153), incidence of lung neoplasia (71 vs 65). Prevalence and incidence of chronic diseases at the District level are not entirely consistent with the regional values according to a two level score. Incorrect lifestyles are widespread in at least 30% of the population and are more frequent in families with low educational level and with reported economic difficulties. CONCLUSIONS: despite the intrinsic limitations of a precise estimate of the data and the possible biases in a process of inference, the method has allowed to identify the priorities to assign in primary and secondary prevention interventions planning and for the improvement of health care; this analysis has been structured in a three years Local Strategic Plan to face the ME and was articulated in general and operational objectives and actions measured by indicators both process and, where possible, outcome evaluation.

[A system of indicators for identifying the specific healthcare needs of communities by large health departments]. / Un sistema di indicatori distrettuali come strumento di lettura di una realtà aziendale complessa.

Clinical governance of healthcare and community services by healthcare organizations requires the use of validated tools for identifying the specific healthcare needs of the local population. The population served by a local health organization may be large and although data regarding this population as a whole is useful for a preliminary evaluation, it may be too generic for an accurate estimation of the healthcare needs at the district level since different districts may face different challenges and have profoundly different realities. In this context, it can be strategically useful to use a system of indicators targeted at districts, the latter regarded as the basic unit of the health care system and characterized by a relatively constant structure and size.A set of district indicators has been developed and adopted by a local health authority in Rome (Italy) "ASL Roma B", as part of a collaborative project with the Public Health Agency of the Lazio region. In this paper, we present the main results of the first four years of implementation of the system (from 2007 to 2010).The data shows that even within a metropolitan health organization serving an apparently homogeneous population, health needs, provision of services and outcomes may vary greatly between different districts suggesting the adoption of diverse operational strategies.