Il ruolo della medicina di laboratorio nell’era del Value Based Healthcare: l’esempio della gestione del paziente con scompenso cardiaco nel contesto Italiano

AUTORI

Valentina Pecoraro¹, Tommaso Fasano², Nadia Aspromonte³, Simone Barocci⁴, Dario Bartolucci, Aldo Clerico⁶, Fernando Gallucci⁷, Paola Gnerre⁸, Bruna Lo Sasso⁹, Alessandro Mariottini¹⁰, Gerardo Medea, Marco Alfonso Perrone¹¹, Maurizio Ruscio¹², Laura Sciacovelli¹³, Tommaso Trenti¹, Vittoria Chiani¹⁴, Davide Paolini¹⁴, Giuseppe Banfi¹⁵
¹Department of Laboratory Medicine and Pathology, Azienda Unità Sanitaria Locale di Modena, Modena, Italy
²Clinical Pathology Unit, Azienda Unità Sanitaria Locale della Romagna, Cesena, Italy
³Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
⁴Department of Clinical Pathology, Azienda Sanitaria Territoriale Pesaro Urbino, Urbino, Italy
⁵Italian College of General Practitioners and Primary Care, Florence, Italy
⁶Fondazione CNR-Regione Toscana G. Monasterio and Scuola Superiore Sant’Anna, Pisa, Italy
⁷Internal Medicine, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Naples, Italy;
⁸Department of Internal Medicine, Azienda Sanitaria Locale Alessandria, Acqui Terme, Italy
⁹Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, Department of Biomedicine, Neuroscience, and Advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
¹⁰Hematology and Microbiology Laboratory, Azienda Ospedaliera Santa Maria di Terni, Terni, Italy
¹¹Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
¹²Division of Laboratory Medicine, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
¹³Department of Laboratory Medicine, Azienda Ospedale Università Padova, Padova, Italy
¹⁴Roche Diagnostics S.p.A., Monza, Italy
¹⁵Scientific Direction, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

Traduzione a cura di: Vittoria Chiani, Roche Diagnostics S.p.A., Monza, Italy.

ABSTRACT

The role of laboratory medicine in a value-based healthcare system: the example of heart failure patient management in the Italian context

Introduction: as of today, healthcare systems worldwide face severe challenges that undermine their sustainability. The value-based healthcare (VBHC) approach has been proposed as a strategic and methodological framework to ensure the delivery of the best patient outcomes with economic efficiency. Through the illustrative example of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) for heart failure (HF) patient management in the context of the Italian National Healthcare system, this article explores the role that in vitro diagnostics (IVDs) can play in enabling value-based care models.
Methods: 14 healthcare professionals representing the relevant professional figures involved in HF patient management met to revise the current HF patient journey and design a new care pathway that, leveraging on BNP/NT-proBNP, reflects the VBHC principles.
Results: the literature recognizes the determination of BNP/NT-proBNP as the gold standard for diagnosing HF. However, as of today, these IVDs are not employed at their full potential regarding HF patient management. A new patient journey is proposed so that patients are diagnosed early and properly monitored in the aftermath of hospitalization, improving outcomes at contained costs.
Discussion: as testified by the example of HF patient management in Italy, laboratory medicine can represent a lever for adopting value-based care models. Still, large-scale adoption of VBHC will call for structural reforms that revise how healthcare delivery is organized, measured, and reimbursed.

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