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Research Area

The Community Medicine develops research and scientific activity in the Primary Health Care (PHC) area. This activity is documented by books , scientific journal articles, dissemitating medical knowledge, international and national congresses.
Becchi M.A.
Il caregiver del paziente complesso ed il suo addestramento .
Edizioni Panorama della Sanità, Roma, 2010., Roma
The Manual provides technical support for Hospital and  Community health care and social care professionals who enter into  complex, elderly and fragile patient care pathways. It also provides Technical support to form “the caregiver” in the patient care.
The Manual is a product of a scientific team  that works in Modena USL primary and social care network.
Becchi M.A., Bernini-Carri E.
Qualità ed efficienza nell'assistenza domiciliare
Franco Angeli Editore, Milano, 2000
The book is a guide for the development of the quality of home care
Becchi Maria Angela
Il paziente complesso e l'approccio alla tutela della sua salute .
In “la continuità di cura e assistenza al paziente complesso” a cura di C. Destro, N. Sicolo
Edizioni Medico Scientifiche, Torino 2009.
Aim of the book is to provide unified methods and instruments to get a  coordinated approach to complex patient, according to the principles set out by the WHO in the many documents offered at various Countries for over 30 years.
Becchi M.A, Carulli N., Pescetelli M., Caiti O.
Characteristics of patients in a ward of Academic Internal Medicine. Implications for medical care, training programs and research .
Internal and emergency medicine 2010; 5: 205-213
Objective: To describe the characteristics of “delayed discharge patients” and the factors associated with “delayed discharges”. Material and methods: We performed a 12-month observational study on patients classified as “delayed discharge patients” admitted to an Academic Internal Medicine ward. We assessed the demographic variables, the number and severity of diseases using the Geriatric Index of Comorbidity (GIC), the cognitive, affective and functional status using respectively the Mini Mental State Examination (MMSE), the Geriatric Depression Scale (GDS) and the Barthel Index. We assessed the total length of stay (T-LHS), the total inappropriate length of stay (T-ILHS), the median length of stays (M-LHS), the median inappropriate length of stay (M-ILHS) and evaluated the factors associated with delayed discharge. Results: “delayed discharge patients” were 11.9% of all patients. The mean age was 81.9 years, 74.0% were in the IV class of GIC and 33.5% were at the some time totally dependent and affected by severe or not assessable cognitive impairments. The patients had 2584 T-LHS, of which 1058 (40.9%) were T-ILHS. Their M-LHS was 15 days, and the M-ILHS was 5 days. In general the more is the LHS, the more are the ILHS (Spearman’s rho + 0.68, p<0.001). Using a multivariate analysis only the absence of formal aids before hospitalization was independently associated with delayed discharge (F= 4.39, p=0.038). The majority of delays (69%) resulted from the difficulty in finding beds in long-term hospital wards, but the higher M-ILHS (9 days) was evidenced for patients waiting for the Geriatric Evaluation Unit. Conclusions: The profile of patients and the pattern of hospital utilisation suggest to reorient the health care system and develop appropriate resources for the academic functions of education, research and patient care. Keywords Elderly people – Multidimensional assessment - Delayed discharge - Inappropriate hospital stay
Carulli N, Rondinella S, Carulli L, Caiti O, Pescetelli M, Becchi MA
Tipologia dei ricoveri negli Ospedali Universitari: l'impatto sulle attività istituzionali
Internal and emergency medicine 2008; 3: S213-219
The study shows the characteristics of patients admitted to University Internal Medicine Departments. It shows the health and social care profiles of hospitalized patients, the issues related to admission and discharge, focusing on the " difficult hospital discharge" and on the related factors. It discusses the impact of these aspects on training and research and it is outlined the role of internal medicine in an innovative model of academic training-oriented service.
Becchi MA
L'integrazione professionale: aspetti generali e indicazioni per il suo sviluppo
Studi Zancan 2006; 4:127-145
It describes the paradigm of Professional Integration in terms of people involved (professionals in the health, social and educational services), application areas (citizens belonging to the weakest area of the population), mission (exceeding the cultural, ethical, demographic, and organizational critical aspects) , vision (bio-psycho-social approach, the centrality of patient and family, co-ordination), goals (global care of the patient), methods and instruments of implementation (legislative, organizational, training) and monitoring (indicators) in integration of Services for the achievement of which are necessary institutional integration, economic, managerial and professional. Particular emphasis is put on training, in fact it is essential that professionals learn to work together in treatment plans into projects of care.
Becchi MA, Bellelli F, Clarizio M, Carulli N.
Caratteristiche dei pazienti ricoverati in un Reparto per acuti di Medicina Interna. E’ l’Ospedale il luogo più idoneo di cura?.
Annali Italiani di Medicina interna 2005; 20:233-244
The study outlines:
-        the profile of patients admitted for a period of 3 months in a department of Internal Medicine of the University Hospital,
-        the modalities of admission and discharge and the characteristics of the resources used.
In the study 318 patients, mean age of 73.8 years. At admission 29.9% of patients had impairment of bodily functions is that cognitive status but 21.1% in the mental state was not assessed. 70.8% of patients had polipatologia to  high comorbidity class (3 and 4), with prevalent of the digestive tract desease (MDC 6), liver and pancreas desease (MDC 7). However, this complexity health has generated lower average weights of DRG (1.15 ± 0.59), required nursing minimum (21 ± 15) and obtained low protection assistance  (19 ± 16). The median hospital stay of patients was of 9 days, with duration significantly greater for patients with co-morbidity classes 3 and 4 (p <0.01). Have been highlighted critical on admission (emergency room without medical request of 71.7%, 17.9% in readmissions, hospitalizations improper 12.6%) and critical discharge ( protected resign only 18.5% compared to the high proportion of patients dependent, resignation difficult in 15.0%). This patient population entails to underutilization of skilled resources and the problems involved in admission and discharge suggest the need for integrated organizational models between hospital and community services.
Becchi MA, Callegaro A, Campagna A, Tasinato M et al
Le dimissioni Protette nella Azienda Ospedaliero-Universitaria Policlinico di Modena. .
Tendenze Nuove 2005; 3:297-313
It reports data for Hospital Discharges (HD) and protected Hospital Discharge (PHD) carried out at the Polyclinic of Modena in 2002 and 2003. It shows the Organizational procedure and Methods of collecting information that is used for the reporting of patients eligible for PHP. It reports  activity indicators, process and outcome of the PHD, obtained through business Information systems.
Becchi MA, Rucci P, Piacentino A et al
Quality of life in patients with schizophrenia. Comparison of self report and proxy assessments .
Social Psichiatry and Psychiatric epidemiology
2004; 39: 397-401
While Quality Of Life (QOL) in subjects suffering from schizophrenia has been studied using a variety of generic or specific instruments, only very few studies have analyzed the agreement between patients and proxy ratings on patients’QOL. We administered the WHOQOL-100 to 292 patients and the Quality of Life for Proxies (QOL-P) totheir proxies, respectively. Agreement between patients and proxies on the four main QOL areas was highest for the physical area and lowest for the psychological area. In line with the results of other studies comparing patients’ and proxies’ ratings, proxies generally underestimated patients’ physical and psychological QOL. Moreover, the agreement between patients’ and proxies’ ratings was consistently higher across all QOL areas when the proxy was a relative compared to a non-relative proxy. The agreement between patients and proxies in QOL assessment is modest, but it is relatively higher when observable aspects of QOL are rated and when the proxy who makes the evaluation is a family member who has closer contacts with the patient. In order to obtain a comprehensive picture of patients’QOL,it would be advisable to compare patients’ ratings with the assessments made by close informants.
Becchi MA, Caiti O, Ghelfi I, Pescetelli M, Zurlini A
Le identità della Medicina di Comunità
Panorama della sanità 2008; 17: 45-49 .
Professional and scientific vision of community medicine in terms of academic and welfare. Shows the possible care pathways that can be generated from it: unified approach to the patient and his family, continuity of care, activities of multiprofessional team, global care of the patient.
Introduces the MC degree in the reorganization of the university Specilizzazioni (DM 08/01/2005) placed in the medical class of general clinical medicine. Are referred to the professional activities of the specialist present in MC and innovative activities that can be entrusted to specislista for the activities provided for in the professionalized training of Specializzzaione in Community Medicine.
Becchi MA, Caiti O, Ghelfi I, Pescetelli M, Zurlini A
I requisiti per lo sviluppo delle Cure Primarie .
ASI: Agenzia Sanitaria Italiana
2008; 20:17-21
Illustrates the concept of Primary Care (PC), a term used in our country to indicate the Primary Health Care as well as indicated by the WHO. Shows the typical aspects of PC (bio-psycho-social approach, continuity of care and support, multi-team activities, participation of the patient and his family) who require:
  • Integration of resources
  • Coordination of processes.
Shown here is the specialization in Community Medicine, now the only university specialization that trains specialists in the area of ​​CP. Are given the skills they acquire in training specialists (clinical skills of health promotion and disease prevention, diagnosis, treatment and rehabilitation and management skills organizzzaione pathways of care and support and coordination of the network of the CP). Shows the location of the current work of the Community Physician in the Departments of Primary Care that are springing up in various regions and perspectives in the light of the skills acquired in training.
Becchi MA
La formazione specialistica nell’area della assistenza sanitaria primaria ..
Salute e Società 2003; 3: 205-209lute e società
The recent rapid development of primary care in the districts meets new needs of the population, is highlighting the need for a medical management with new skills not only organizational, but also clinical care, for the better integrated management  of complex patients'  care pathways in the network of services.
The reorganization of the university specializations (DM 01/08/2005) provided an appropriate specialization to these needs. This is the Specialization in Community Medicine, located in the medical Area of general clinical medicine Class. The academic program includes qualifying activities in all care services network (acute care hospitals and long-stay patients Ward, first aid, studies of general practitioners, clinics and residential areas) and in the direction of the District. Therefore, the specialist acquires clinical skills (health promotion, prevention, diagnosis, treatment) but also managerial skills (management, health and care coordination, coordination of hospital-territory).
Becchi MA
L’equipe socio-sanitaria al domicilio del paziente complesso. Aspetti organizzativi, assistenziali, relazionali e strategia di sviluppo
Atti del 9° Congresso Nazionale CARD “le cure domiciliari tra utopia e quotidiano” Roma 12-14 maggio 2011
a cura di G. Maciocco,
Quaderni CARD, Iniziative Sanitarie, Roma
The social and health integration is a complex process that comes from Institutional arrangements (Conventions, Protocols of Understanding) that strengthen the operational and economic cooperation between different institutions through activation of Interdisciplinary Teams.This is composed of professionals who have different training and experience  but common goal:  provide patient-centered interventions. Starting precisely from the patient-centered concept , are evaluated the clinical and organizational aspects,  care and relationship necessary at interdisciplinary Team to ensure   appropriate integrated and continuous care, for the needs of the patient and his family.
Becchi MA, Camboa PL
Aspetti culturali, metodi e strumenti per la continuità di cura ed assistenza
Atti del 7° Congresso Nazionale CARD “Il Distretto come produttore di salute” Pisa 19-20 Marzo 2009
a cura di G. Maciocco,
Quaderni CARD, Iniziative Sanitarie, Roma
The increase of chronic disease and disability raises the question of continuity of care for these patients. Today there are several critical points in the approach to these patients related to the "monodisciplinary approach" that determines the fragmentation in care and support pathways.
WHO has long suggested the Primary Health Care as a strategy to respond to the needs of global and unified multidimensional public health, with particular reference to chronic patients.Goals of the intervention are to provide cultural guidelines, methods and tools across the various professions for a better approach to patients with disease / chronic disabilities, or rather give a better organizational strategy that you can use in the Local Health Units (italy's USL).
The aim is to stimulate the leadership of local health interest in a renewal of existing services in relation to disease and disability, so as to make the most complete traditional diagnostic and therapeutic welfare, based on the monoprofessional activies.
Becchi MA
La qualità della Assistenza Domiciliare Integrata
Atti del Congresso Nazionale “Moderni Aspetti della Assistenza Territoriale. Maglie 20-22 Novembre 2003” a cura di Camboa PL, Dattoli V, Calasso A, Di Rienzo A..
CIC Edizioni Internazionali, Roma.
Here are presented the principles of cultural, regulatory, operational and training for the development of Quality of integrated home care (IHC)
The IHC must have some basic requirements such as:
  • quality
  • Accessibility and usability
  • Appropriateness, effectiveness and efficiency
  • Competence of the operators
  • Communication between operators, patient and his family, continuity of care,
  • family participation.
Quality ADI must be a business strategy, with an indication of mission, vision and objectives. Quality must be planned, indicating responsibilities, organization, structures and processes, and also the quality must be documented through documents recording the data.
Quality must be communicated through regulatory documents, recording. Quality must be verified by performance tests and outcome.
For the purposes of an adequate quality of service is necessary to train professionals to work in multiprofessional teams.