Internal medicine network: a new way of thinking hospital-territory integration and public-private partnership

摘要

This working proposal aims to establish an Internal Medicine Network (IMN) model for the appropriate management of the poly-pathological complex patient in the different phases of his illness natural hystory. The IMN is based on an organization recalling the Hub and Spoke system already used for existing specialized networks. The Internal Medicine Unit (IMU) is the natural destination of acutely ill patients suffering from systemic or multi-organ diseases. Three are the IMU specific tasks: i) to stabilize acute, severe, poly-pathologic and complex patients; ii) to develop difficult etiological diagnosis in these patients and in those who should necessarily be admitted to the hospital, not being possible, for different reasons, alternative routes; iii) to select the acute poly-pathological complex patient’s priorities. The expected results of a new model of integration system inside the IMN are: i) reduction and rationalization of expenditure in the medical area, increasing effectiveness, quality and safety guaranteeing patient centrality; ii) patients stratification based on characteristics of gravity, acute illness, estimated duration of hospitalization; iii) reduction of inappropriate hospital admissions ensuring connections between hospital and primary care units; iv) definition of different care pathways for patients hospitalized due to non-communicable diseases; v) implementation of new common medical records. The public-private partnership inside the IMN could be able to increase appropriateness reducing health costs. Patient-centered problems assessment, together with integration, cooperation, coordination and effective communication are some simple rules useful to achieve tangible results in a complex system and the IMN model represents its practical application.