Healthcare Quality Management and Integrated Care Pathways (ICPs)

Giuseppe Gambale*, Andrea De Giorgi**, Marta Castellani**, Elisa Mazzeo**, Rosario Andrea Cocchiara*, Giovanni Profico*, Simona Amato*

*Rome Healthcare Local Authority 2
** Department of Public Health and Infectious Diseases – Sapienza University of Rome

Keyword: Integrated care pathways, public health management, e – health


Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the largest causes of morbidity and chronic mortality and a public health problem of high importance. In Italy, COPD afflicts 5.6% of adult (3.5 million people) and is responsible for 55% of all deaths related to respiratory diseases. Smokers have a higher risk, in fact up to 40% develop the disease. From the Covid-19 pandemic, the most affected population is the elderly (mean age 80 years old), with previous chronic diseases, in 18% with chronic respiratory.

The aim of the present work was to validate and measure the outcomes produced by the recruitment and care of COPD patients enrolled by an Healthcare Local Authority in the corresponding Integrated Care Pathways (ICPs) in order to measure how a multidisciplinary, systemic and e-health monitored care impacts upon mortality and morbidity.

Healthcare Management, avoidable mortality, telemedicine to improve health of the diabetic population

Giuseppe Gambale*, Marta Castellani**, Elisa Mazzeo**, Andrea De Giorgi**, Rosario Andrea Cocchiara*, Giovanni Profico*, Simona Amato*

*Rome Healthcare Local Authority 2
** Department of Public Health and Infectious Diseases – Sapienza University of Rome

Keywords: telemedicine, avoidable mortality, management Abstract

Background: Worldwide the International Diabetes Federation (IDF) estimated that in 2021 9.2% of adults (536.6 million, between 20 and 79 years of age) are diabetic and 32.6% under 60 years (6.7 million) die because of diabetes. This disease is set to become the leading cause of disability and mortality by 2030. In Italy, the prevalence of Diabetes is about 5%; in the pre-pandemic period, from 2010 to 2019, diabetes was responsible for 3% of deaths recorded, while during the pandemic in 2020, these deaths increased to about 4%.

The present work aimed to measure the outcomes obtained from the ICPs (integrated care pathways) implemented by a Health Local Authority according to the model of the Lazio region and its impact on avoidable mortality, i.e.,

Management of an Integrated Care Pathways (ICPs): an Italian Study

Giuseppe Gambale*, Elisa Mazzeo**, Andrea De Giorgi**, Marta Castellani**, Rosario Andrea Cocchiara*, Giovanni Profico *, Simona Amato*

*Rome Healthcare Local Authority 2
** Department of Public Health and Infectious Diseases – Sapienza University of Rome

Keyword: Integrated care pathways, public health management, e – health


Background: The World Health Organization defines chronic disease as long duration and generally slow progression disease, with a continuous treatment over decades. The management of such diseases is complex, as the aim of treatment is not cure, but maintenance of a good quality of life and prevention of possible complications. Cardiovascular diseases are the leading cause of death worldwide (18 million deaths per year) and hypertension remains the largest preventable cause of cardiovascular disease globally. In Italy, the prevalence of hypertension was of 31.1%. The goal of antihypertensive therapy should be to reduce blood pressure back to physiological levels or to a range of values identified as targets.

Topical interest of the origin of Hygiene and Public Health

Topical interest of the origin of Hygiene and Public Health

Attualità delle origini dell’Igiene e Sanità pubblica

Nihil sub sole novum (nulla di nuovo sotto il sole) Bibbia – Ecclesiaste (1, 10)

Potrebbe destare stupore richiamare l’attenzione dei cultori dell’Igiene e Sanità pubblica su una tra le opere più significative delle circa settanta che costituiscono il Corpus ippocratico – probabilmente assemblato nella biblioteca di Alessandria, all’inizio del III secolo a.C. – cioè sull’ “Aria, Acqua, Luoghi”, che identifica nell’ambiente, nelle condizioni metereologiche, nelle sostanze presenti nell’acqua da bere e in altri fattori molto concreti le possibili cause delle malattie, anziché attribuire loro un’origine soprannaturale.

Questa intuizione millenaria attribuita ad Ippocrate, padre della Scienza medica, ha improntato tutta la storia dell’Igiene e Sanità pubblica dando luogo ad un immenso corpus dottrinale che, seguendo man mano le nuove conoscenze, ha dimostrato la natura dinamica e il continuo ampliamento della disciplina. Disciplina che sta ora sempre più interessando il mondo non solo scientifico ma anche politico e popolare impressionato dalla manifestazione di vistosi fenomeni naturali attribuibili ad una modificazione di equilibri tra i componenti dei tre regni della natura: animale, vegetale e minerale.

Impact of the Covid-19 pandemic on palliative care provision by a hospital-based unit: results from an observational study

Anita Maria Tummolo1, Maria Adelaide Ricciotti1, Eleonora Meloni1, Sabrina Dispenza1, Marcello Di Pumpo 2,3, Gianfranco Damiani 1,2,3, Christian Barillaro.1

1 Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
2 Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
3 These authors contributed equally to this work and share last authorship



Palliative care is a key approach in improving the quality of life of patients and their families facing the end-of-life care process. It is widely regarded as a public-health concern, especially considering the rapidly increasing end-of-life care needs worldwide. Its provision has been highly challenged by the COVID-19 pandemic emergency.


This study aims to analyse whether and to what extent the provision of Palliative Care to non-COVID patients provided by a hospital-based unit has changed during the COVID-19 pandemic.

Analysis of an injuries database in Italian ski resorts

Saverio Giampaoli1, Lorenzo Lupi1, Luigi Faccia2, Antonio Tessitore1, Sabrina Demarie1

1 University of Rome ‘‘Foro Italico’’, Department of Movement, Human and Health Sciences, Piazza Lauro De Bosis, 6, 00135 Rome, Italy
2 Scuola Italiana Sci Assergi – Gran Sasso, s.s. 17 bis, 79, 67100 Assergi (AQ), Italy


Italy is one of the main destinations for winter tourism. Specifically, the country can currently count on more than 5.700 km of ski runs, served by more than 1.700 lift facilities.

The purpose of this study has been the analysis of injuries in ski resorts in a continuous period spanning over several seasons (17 years). In addition, the possible effect of safety law enforcements, introduced in the selected period, were considered.

Material and methods
A ski injuries database, prepared as a duty of policemen involved in rescue activity and consisting of 246616 records of injuries for the period from 7th December 2002 to 31st December 2019, has been analysed for qualitative and quantitative variables.

Competitive colonization of Legionella and Pseudomonas aeruginosa in water systems of residential facilities hosting closed communities Legionella versus Pseudomonas aeruginosa in water systems of residential facilities

Gian Loreto D’Alò,1,2,* Alessandra Messina1, Cinzia Mozzetti1, Domenico Cicciarella Modica3, Patrizia De Filippis1


1 Section of Hygiene, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, via Montpellier 1, 00133 Rome, Italy
2 District 6 – Local Health Agency Rome 2, Via della Tenuta di Torrenova 138 00133, Rome, Lazio Region, Italy
3 District 4 – Local Health Agency Rome 6, Via dei Castelli Romani 2/P 00071, Pomezia (Rome), Lazio Region, Italy

Keywords: Antibiosis; Biofilm; Drinking water; Legionella; Microbial interactions; Pseudomonas aeruginosa


Legionella and Pseudomonas aeruginosa are pathogens that live and multiply in water systems and resist disinfection through biofilm formation. As suggested by some studies, we wanted to verify whether the presence of P. aeruginosa can lead to a less frequent presence of Legionella in water systems of retirement homes and group homes. We collected 123 hot water and biofilm samples from showerheads.

Hospital networks in Italy: state of the art and future pespectives. Insights from a qualitative research study.

G. Damiani1, M. Di Pumpo*1, G. Giubbini2, L. Lombi3, M.L. Specchia1, L. Sommella4

1 Università Cattolica del Sacro Cuore – Rome, Italy
2 Fondazione Policlinico Universitario “A. Gemelli” IRCCS – Rome, Italy
3 Università Cattolica del Sacro Cuore – Milan, Italy
4 Fondazione Policlinico Universitario “Campus Bio-Medico di Roma” – Rome, Italy

Keywords: Hospital networks, complexity, integration/coordination, governance, future developments.



Hospitals have undergone important that changes that have led, in recent decades at the international level, to the need for greater integration between hospitals and local healthcare services. The main institutional networks that have been developed in Italy are, as commended by the institutional levels, of 4 main types: the Emergency-Urgency Network, the Time-Dependent Networks, the Oncological Networks, and the Networks with primary care settings. It was important to assess the state of the art and analyze it in relation to possible future developments.

When there is no communication between urban planners and public health operators: urban Dermanyssus gallinae infestations in humans.

Annunziata Giangaspero1*, Vito D’Onghia2, Antonella Puccini3, Maria Filomena Caiaffa4, Luigi Macchia5, Alessandra Barlaam1

1Department of Agriculture, Food, Natural Resources and Engineering (DAFNE), University of Foggia, Via Napoli 25, 71121 Foggia, Italy
2Department of Science in Civil Engineering and Architecture (DICAR), Polytechnic University of Bari, Via E. Orabona 4, 70125, Bari, Italy
3Agenzia Sanitalia Locale, Via Tratturo Castiglione 14, 71122, Foggia, Italy
4School and Chair of Allergology and Clinical Immunology, Department of Medical and Surgical Sciences, University of Foggia, Italy
5School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari – Aldo Moro, Italy

Keyword: urban health


At the international level, it is necessary to apply urban health strategies that can integrate concrete actions to protect and promote health in urban and architectural planning. In cities, the “urban fauna” mostly consists of synanthropic birds (sparrows, starlings, swallows, martins, jackdaws, crows, hawks, gulls, pigeons) that have adapted to a continuous relationship with humans.

La “ri-disorganizzazione” del Servizio Sanitario Nazionale

Non vi è alcun dubbio che, sotto la spinta degli effetti sanitari della pandemia da COVID19 e della approvazione (il 13/7/2021) del Piano Nazionale di Ripresa e Resilienza (PNRR), si è in presenza ancora una volta di un tentativo di riorganizzazione del Servizio sanitario nazionale. Alcuni significativi elementi di questa volontà politica sono stati già indicati negli Editoriali di questa Rivista pubblicati negli ultimi due anni – dalla dichiarazione dello stato di emergenza nazionale per il contenimento della diffusione dell’epidemia da COVID-19 (D.L. 25/3/2020, n. 19) a tutt’oggi.

Gli esperti diScienze politiche applicate alla sanità hanno fatto rilevare che le proposte di riorganizzazione – soprattutto tendenti a rafforzare la sanità territoriale (cure primarie e servizi territoriali)2 – risalgono addirittura alla legge istitutiva del Servizio sanitario nazionale e sono state “rinnovellate”da numerosi successivi atti legislativi mai completamente realizzati.

La motivazione è facile da comprendere perché da tempo è fin troppo noto che non è possibile modificare un sistema, come quello sanitario (ma non solo questo), unicamente attraverso cambiamenti strutturali3.