Archive for settembre 2012


Carlo Favaretti


Recently, I decided to take up surfing again. As a 20-year old kid, I was pretty good at most things that required athleticism (even surfing).

However, as a 42-year old, things come a little harder. My daughter began taking surfing lessons about 9 months ago from a young professional surfer. She quickly was able to get up on the board and was soon riding waves (upright) to shore. I decided that I wanted to re-learn how to catch a wave so that I could spend some quality time in the water with her during the warmer months.

I borrowed a longboard (you know, the one the old men ride) and quickly realized that I needed to get a few lessons from her teacher as well. After a few lessons, I was back up, riding waves to shore. However, the toll on my body…

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Carlo Favaretti


At academic medical centers (AMCs) all over the country, health care delivery and payment reform are becoming reality. AMCs need to think in a new way about the markets they serve. Timing for AMCs transforming care delivery is critical. We need to find the perfect middle ground, or what I like to call the “Goldilocks Factor.” AMCs need to transform delivery, definitely not too slowly, but not too fast for their markets either.  And finding “just fast enough” is not easy.

The services we provide are, now more than ever, about comprehensive care and population management to achieve the “Triple Aim” of improved quality, improved health, and controlled cost.  Primary care is key to successful care of defined populations under payment models such as Patient Centered Medical Homes, capitation, and shared savings. But some highly subspecialized services will likely remain fee-for-service…

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Carlo Favaretti

Le “classifiche” degli ospedali diventano una cosa seria. Straordinario post  di Ashish Jha sul suo blog “An Ounce of Evidence”. Medico, ricercatore di politica sanitaria, Ashish Jha sostiene il concetto che un’oncia di dati vale molto di più di migliaia di libbre di opinioni.

Il post riporta i dati sulle “classifiche” degli ospedali da parte di tre organizzazioni: The Leapfrog Group; Consumer Reports; US News & World Report.

Metodologie diverse, risultati diversi!

Analisi molto approfondita e commenti immediati da parte di Consumer reports e The Leapfrog Group.

Anche in Italia il programma nazionale esiti di AGENAS  e la partecipazione di alcune Aziende Ospedaliero-Universitarie ( al momento Udine e Verona ) a Global Comparator di Dr Foster va nella giusta direzione.

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XV Conferenza nazionale Ospedali per la promozione della salute e servizi sanitari @HPHitaly

Il CCM dà notizia della XV Conferenza degli HPH italiani che si terrà a Trieste il prossimo 8 novembre 2012.

Condividendo i principi del programma ministeriale Guadagnare Salute, la Conferenza nazionale Hph & Hs (Health Promoting Hospitals and Health Services) intende trattare i temi fondamentali della promozione della salute in una visione unitaria e integrata lungo le due direttrici fondamentali: i setting e le fasce di età.

Il programma della conferenza ha l’obiettivo di focalizzare le buone pratiche delle Regioni aderenti alla rete Hph & Hs nell’applicare metodi efficaci di lavoro in rete e di alleanze stabili, il tutto finalizzato al recupero dell’unitarietà del percorso assistenziale che, comincia nella comunità, transita nei servizi sanitari e negli ospedali e rientra nelle funzioni della comunità.

L’evento si articola in due sessioni: quella della mattina privilegia gli approcci metodologici e innovativi efficaci, che nelle varie fasce target si propongono di dare una visione sistemica dell’approccio di promozione, prevenzione e assistenza, scegliendo tali buone pratiche tra le eccellenze nazionali grazie al contributo dei coordinatori di rete. Nel pomeriggio ci saranno due percorsi distinti: da una parte si entrerà più nel dettaglio pratico rispetto ai temi della mattina,dall’altra si farà un approfondimento monotematico dedicato alla salute e sicurezza del porto.

Per maggiori informazioni, visita il sito dell’evento.

Richard Smith: How to start the day @Richard56 @Medici_Manager

Richard Smith

It is a bold and foolish person who advises others how to live, but I can’t resist a little advice. I’m not going to tell you how to be smarter, sexier, stronger, or richer (as I have no idea) but rather how to start the day.

My advice is simple: 90 minutes reading good books. I prescribe 45 minutes of fiction, 30 minutes of non-fiction, and 15 minutes of poetry. The fiction must be deep, deal with issues that matter (death, love, relationships), and have excellent style. Remember that, as Martin Amies says, “the truth is in the ficton.” You might follow the advice of a young doctor friend and avoid books written in the past 30 years. His argument is that there are far too many books to read and time is the best way of sorting the good from the bad. The non-fiction should also ideally be well written—because excellent style will get your brain started in the right way—and should take you to new places, perhaps in history, another person’s life, or to the far end of the universe. The poetry—and remember that most poetry is bad, so be careful—will give you a rhythm for the day.

Other ways to start the day are prayer, meditation, and yoga, and I always enjoy being in Muslim countries where a day of learning starts with sung verses from the Koran. Reading, I believe, achieves the same end as these alternative methods, particularly as you are still and silent. You are, I suppose, filling your brain rather than emptying it, which sounds bourgeois and consumerist. But you are—if reading correctly—filling you brain with excellent mental nutrition.

Ideally the 90 minutes of reading is topped off with 30 minutes of running, preferably beside the sea—but I must confess that I usually skip this; and the sea is rarely possible living in South London.

We are all familiar with “he must have got out of the wrong side of bed this morning,” and the way we start the day is crucial for the whole day. The reading sets us up beautifully to cope with the inanities, rush, trivia, silly demands, and ugliness that will inevitably occur during even the best of days.

You must make your own choices on what to read (although I am willing to prescribe), but let me illustrate my general advice with my start this morning. I began with 30 pages of Thomas Mann’s The Magic Mountain, specifically one of the  furious and barely intelligible arguments between Semprini and Naptha and then a detailed account of the death of one of the characters. I learn that when dying “Even the most manly men succumb to credulous, oblivious self-deception; the process is as natural as melancholy when the process of deterioration approaches its fatal end.” A momento mori is highly refreshing in the early morning. (Ideally you wouldn’t read in translation but in the original language, but I’m too stupid.)

Then to 16th century Venice, an excellent place to start the day, to read of Titian paintingSacred and Profane Love, one of the greatest pictures of the Italian renaissance. What might the picture mean? Nobody knows or will ever know, which is wonderful, but Sheila Hale believes it to be the painterly equivalent of a poem written for a wedding, an important Venetian custom.

And so to poetry. Stevie Smith’s Away Melancholy.

The ant is busy
He carrieth his meat,
All things hurry
To be eaten or eat.
Away, melancholy.

Man, too, hurries
Eats, couples, buries,
He is an animal also
With a hey ho melancholy,
Away with it, let it go.

You might go further and like my friend, Ant (a man not the insect above), learn some verses by heart. Ant learns poems every morning as he shaves.

For the couple, especially the single parent, who must get children out of bed, dress and feed them, send them to school, and then run for the crowded tube, my advice will be unrealistic hogwash. And I haven’t started each day in such a privileged way throughout my life, but think on this: might you do better to miss News at 10, go to bed at 9.30, wake at 5.30 (that’s eight hours) and read for at least 30 minutes?

Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.


Girolamo Sirchia

La riduzione delle morti premature da ictus e cardiopatie ischemiche registrata negli USA dal 1970 in poi è dovuta per il 44-72% alle intervenute modificazioni dei fattori di rischio coronarico, primariamente l’uso di tabacco, la pressione arteriosa e il tasso di lipidi ematici.

Wolf SH – The big answer: redescovering prevention at a time of crisis in health care Harv. Health Policy Rev. 7, 5-20, 2006

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