Evaluation of the Performance of an Innovative Model for the Organisation of Specialised Hospital Activities throughout Italy: The "Diffuse Hospital".

Aim: The objective of the study is to evaluate the performance of an innovative model of hospital activity known "Diffuse Hospital" (DH) that involved 3 hospital wards/departments (A, B and C) located throughout Italy and the Reference Hospital (RH) that organised the construction of this model.

Methods: An organisational retrospective observational study was conducted on the orthopaedic ward of each hospital from March 2022 to March 2023. Hospitals A, B and C had organisational differences in relation to the working relationship of healthcare professionals, the care pathways implemented, the presence or absence of an emergency department and the management of operating theatres. The primary indicator was the number of Diagnosis-Related Groups (DRGs) provided by the individual facilities. Additionally, a series of indicators were collected, and to enable comparison, these indicators were calculated in relation to the available resources.

Results: The total number of DRGs provided by the DH was 3904, broken down into 1187 at Hospital A, 1851 at Hospital B and 866 at Hospital C. The RH comparison standard recorded 1603 DRGs. Hospital B showed higher DRG indicators of 39.7, 2.5 and 30.9 percentage points, respectively, than the RH. In relation to theatre activities and healthcare staff, Hospitals A and C revealed lower scores than the standard.

Conclusions: The DH model may become a useful tool in healthcare policy strategies to enable national RHs to deliver treatments with high standards of care at a territorial level. The facilities involved in the DH organisational model produced different outcomes in terms of both efficiency and clinical outcomes. Where there is no direct management by the RH of healthcare staff, care pathways and operating theatres, replication of the standard is more difficult and outcomes are poorer. In the hospital where there is no need for emergency surgical activity and scheduling is concentrated within the week, better efficiency levels can be achieved.