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Carpe Diem
Personalized Medicine is acquiring a central role in healthcare practice, however making this perspective become reality poses many challenges, above all the fact that a number of different parameters of the patient have to be evaluated in order to determine the best diagnostic and therapeutical path, both in compliance with common guidelines and according to the complexity of the individual phenotype. This requires the availability and integration of information from different, non-homogeneous data flows, and the possibility to have to be extracted and appropriately presented to operators who will perform clinical assessment and to government systems which have to evaluate consistency in the healthcare process.
The transition from reactive to proactive care requires the ability to stratify patients with respect to their own individual risk level in order to steer them to the most appropriate levels of care intensity. In summary, current planning of intervention in the healthcare field should aim to modulate the system with respect to users’ specific needs, rather than to the standardization of health care according to the rigidity of an organizational system as has often occurred in the past. This past behavior has resulted in failure both concerning the efficacy of patient intervention and system cost effectiveness.
The Tuscany Region, referring to Chronic Care Model, carried out the “Medicina di iniziativa” project (DGR 469/2010) as regards patients suffering from chronic diseases (e.g. diabetes and heart failure). The project provides that General Practitioners include patients suffering from chronic diseases in individual pathology registries based on specific clinical requirements As patients should be directed to different diagnostic and therapeutic care paths based on their risk profile, the criteria for characterization of the users ought to be as objective and specific as possible.
The goal of this project is to use existing information about individual patients, stored in health information flows, to stratify patients at different risk levels.
The data warehouse, obtained and managed in a completely anonymous way, by integrating the information currently collected at each contact of a subject with the NHS, using appropriate algorithms that combine codes of pathology ICD-9 CM (from the hospital discharge), specialized care (from the SPA flow), pathology ticket exemptions (from the SEA flow ), drug prescriptions, etc., with the aim of identifying, for each subject, the pathological profile to which he belongs and the relative risk level.
The risk profile will be validated on a sampling of randomly selected subjects by using some standardized scales (such as the Seattle HF score) and performing a reassessment of the outpatient and/or his medical records (if hospitalized during the reference period of the study) by a specialist.
A further aim of the project is the detection of the possible variability in diagnostic-therapeutic behaviors and the specific drug approach within each pathological pattern identified at each risk level.
Should this information be shared across the entire organization, it could also be used to promote better integration between hospitals and the territorial health service: that would enable simultaneous achievement of a clinical-translational target oriented to better care and a system cost containment as a whole.