Monitoring and evaluating Community Hospitals using a multidimensional approach to enhance healthcare quality: a Real-World assessment in Romagna’s Local Healthcare Authority

Community-based care has gained increased attention, especially after the impact of the Coronavirus disease 2019 pandemic. In Italy, Ministerial Decree No. 77, issued in May 2022, established standards to develop and strengthen community-based care nationwide, particularly focusing on two types of settings that can address people's (socio)health needs in the face of a profound change in the epidemiological structure of the population: Community Homes and Community Hospitals. The thesis study examined seven Community Hospitals in Romagna’s Local Healthcare Authority, focusing on characterising the patient’s case-mix, referral sources, discharge destinations, and using different types of quality indicators. These included examining risk and performance models for prolonged length of stay, improvement in the Activity of Daily Living, and re-admissions to these facilities, as well as implementing a new-generation indicator: the Patient-Reported Experience Measures (PREMs) questionnaire. A multi-indicator representation summarised each facility’s performance. The analyses outlined a strong rehabilitation vocation of these settings, confirming its positive impact on the outcomes considered. Other key factors that emerged included both clinical factors, such as pressure injuries, and social factors, like living alone. Normalised mean questionnaire scores were globally high, although analysis revealed variations among facilities depending on the question, highlighting potential areas for improvement and facilitating a positive deviance approach in examining best practices. Further developments will include organisational assessments of Community Hospitals, regular sharing of questionnaire results, and an annual report to ensure ongoing quality improvement.