1. Protected discharges: an integrated approach, the experience of Emilia Romagna Florence, 19 May 2003 Rosanna Carbognani Director Primary Care Programme

2. Florence, 19 May 2003 Rosanna Carbognani Centrality of the individual in the construction of his/her own health project Continuity of treatment and network of services based on the individual The approach of the Local Health Board (Azienda USL) of Reggio Emilia

3. Florence, 19 May 2003 Rosanna Carbognani HP is a technology, not an end It aims to highlight the centrality of the individuals who come into contact with the system of supply and make them aware of their role in the individual health project

4. Florence, 19 May 2003 Rosanna Carbognani THE PERSON IN THE CENTRE EMPOWERMENT: A CONSCIOUS PACT COMPLEXITY OF SERVICE RELATIONSHIP (TECHNICAL, ORGANISATIONAL AND RELATIONAL DIMENSION) THE PATIENT’S HISTORY AS A RESOURCE AND ASSET

5. HOME CARE INDIVIDUAL MMG IP PDLS OBSTETRICS OTA SOCIAL ASSISTANT COMMUNITY PEDIATRICIAN CONSULTANTS PROTECTED HOUSING RSA HOSPITAL 2ND LEVEL OUTPATIENT SPECIALIST SERVICES HP Florence, 19 May 2003 Rosanna Carbognani VOLUNTARY SERVICES

6. Florence, 19 May 2003 Rosanna Carbognani HP as a framework within which to develop the individual treatment course which aims to achieve “possible health” using an alliance between the subjects that operate in it

7. Florence, 19 May 2003 Rosanna Carbognani CONTINUITY OF TREATMENT MMG Specialist IP Social assistant OTA Voluntary services person need possible health The alliances Recep tion tests Orien tation Implemen tation Care agree ment Follow -up

8. Florence, 19 May 2003 Rosanna Carbognani FROM SERVICE TO THE TREATMENT COURSE THROUGH THE ALLIANCES IN THE INDIVIDUAL HEALTH PROJECT

9. Florence, 19 May 2003 Rosanna Carbognani THE DEVELOPMENT OF THE LOCAL HEALTH BOARD (AZIENDA USL) IN REGGIO EMILIA 1997 Development of Protected Discharge Project 2003 90% of all patients who require a protected discharge now receive one

10. OBSTACLES ON PATH TO CONTINUITY Florence, 19 May 2003 Rosanna Carbognani Self-referencing status of structures Culture oriented towards clinical recovery Difficulty for professionals to have an overall vision of the entire process Difficulty of constructing an accompanying course of information Different languages created by specialism Communication is difficult Risk that continuity is only formal (the sum of events)

11. Florence, 19 May 2003 Rosanna Carbognani ACTIONS TO ACHIEVE CONTINUITY 1. organisational 2. technological development 3. cultural development 4. experimental

12. Florence, 19 May 2003 Rosanna Carbognani ACTIONS TO ACHIEVE CONTINUITY  Accompaniment  Concise information  Recomposition  Network  Treatment agreement  Promotion of health 1. Actions of an organisational type: primary care centres as a place for:

13. Florence, 19 May 2003 Rosanna Carbognani ACTIONS TO ACHIEVE CONTINUITY Implementation of information networks as virtual networks that provide computerised support to sharing a strategy 2. Actions focused on technological development:

14. Florence, 19 May 2003 Rosanna Carbognani ACTIONS TO ACHIEVE CONTINUITY Integrated training for all players involved in the continuity of treatment 3. Actions involving cultural development:

15. Florence, 19 May 2003 Rosanna Carbognani ACTIONS TO ACHIEVE CONTINUITY Treatment courses as a supply of care characterised by the sequential nature of connected actions 4. Experimental actions:

16. Florence, 19 May 2003 Rosanna Carbognani Continuity is constructed on the person and on the individual health project Not as continuous treatment But as an accompaniment and enhancement of the limits (possible health)

17. Florence, 19 May 2003 Rosanna Carbognani Continuity is the proposal of a journey that we make together (citizen and professionals) on which we share the destination, the course and the responsibilities.