Abstract Chapter 13

Chapter 13 explores the development, spread, and organizational service delivery model of Patient Centered Medical Homes (PCMH) in the INHS. The census units of analysis were the PCMH or similar models that fall under this label according to the definition provided: namely, a center providing at least primary care services with multidisciplinary teams and outpatient care. A national survey was conducted, targeting all Italian LHAs. The results rely on a sample of 166 PCMHs, which represent almost 50% of the national number of PCMHs, based on estimates from Regional Health Service (RHS) official documents. Most of the PCMHs participating in the survey are located in medium-sized cities, while only 13% are located in urban centers. Some 39% were created through reconfiguration of former hospitals: this result proves the tendency to maintain the PCMH as a core center providing and guaranteeing a minimum basket of health services at the community level within small- and medium-sized cities. The professionals currently managing the PCMHs stated that the set-up of PCMHs improved service delivery capacities to meet the needs of patients and the local community. Concentration of the different professionals in the same building, indeed, proved to be a great driver to foster clinical and organizational integration, particularly in chronic care management. Finally, compared to the preliminary hypothesis, the survey results did not reveal significant differences among regional models of PCMHs, albeit the process of development and investments made by different RHSs have greatly differed in the last 10 years. The mix of services provided and the professionals joining PCMHs are quite similar at the national level. In contrast, the most important dependent variables influencing the overall patterns and organizational models of PCMHs proved to be either previous use patterns, and characteristics or location of the PCMH, whether in urban or community centers. The major challenges to future development of PCMHs were identified at the organizational and managerial level.