An integrated pathway for acquired brain injuries: a regional policy in Tuscany, Italy

Introduction: Acquired brain injuries (ABI) are a crucial issue for healthcare and social services. In 2000 and 2005 two Consensus Conferences in Italy [1, 2] produced a set of recommendations to improve patients healthcare. In 2009, a regional policy identified specific goals for this health problem in Tuscany. Aims: To improve the continuum of care for acquired brain injuries in Tuscany, Italy (3,500,000 million inhabitants). Policy practice description: For the 2003–2007 study period, a total annual number of 465–770 incident cases of ABI with residual serious disability was estimated on the basis of integrated computerized administrative databases. In 2008, a regional project was started to improve the continuum of care for ABI patients. A multidisciplinary workgroup drafted a technical document designing a model of care based on: five fundamental steps of care, rigorous criteria for appropriate transfers between different steps, subgroups of patients requiring different combinations of steps according to their clinical conditions. Conclusions: The above-mentioned model of care is now being implemented throughout the region, addressing some readjustments of hospital beds, shared adoption of clinical protocols and integration between social and health care, different professional skills and subsequent levels of care. Discussion: The strengths of this model are its flexibility and circularity: according to their clinical needs, patients belonging to different subgroups can move along the clinical pathway in several ways: through subsequent steps, bypassing intermediate steps or being readmitted to previous steps.