L’analisi delle politiche di riduzione dei cesarei attraverso il Dynamic Performance Management: la valutazione del percorso nascita in un’azienda sanitaria

Journal title MECOSAN
Author/s Enzo Bivona, Federico Cosenz
Publishing Year 2018 Issue 2017/102
Language Italian Pages 20 P. 85-104 File size 23853 KB
DOI 10.3280/MESA2017-102005
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Applying the Dynamic Performance Management approach to cesarean reduction policies: an analysis of the maternity pathway in a local health authority Since last three decades, the World Health Organisation strongly encourages countries to reduce the Caesarean Section (CS) rate down to 10-15%. However, this goal nowadays appears still far from its achievement. Public decision makers are still struggling to design and implement effective policies to reduce the CS rate. This study, based on the analysis of the maternity pathway recently introduced in Sicily, applies the Dynamic Performance Management approach to investigate the drivers impacting on the CS. Such analysis provided the basis to build a System Dynamics model customised on a local health authority. Simulation results reveal that to effectively reduce the CS rate implemented policies should favour a coordination of the actors playing a crucial role in the maternity pathway.

Keywords: Caesarean Sections, Dynamic Performance Management, Public Policy, public management, outcome, performance indicators

  1. Betrán A.P., Merialdi M., Lauer J.A. et al. (2007). Rates of cesarean section: analysis of global, regional and national estimates. Paediatric Perinatal Epidemiology, 21: 98-113.
  2. Bianchi C. (2016). Dynamic Performance Management.
  3. Springer. Bianchi C., Bovaird T. (2016). Balancing service quality and public governance principles to achieve quality-of-life outcomes through dynamic performance management. Paper presented at the International Symposium on The Paradigm Shift from Output to Outcome Measures in the Public Sector, Palermo, May 25-27.
  4. Pollitt C., Bouckaert G. (2004). Public Management Reform: A Comparative Analysis. Second Edition. Oxford, England: Oxford University Press.
  5. Poma P.A. (1998). Effect of departmental policies on cesarean delivery rates: A community hospital experience. Obstetrics & Gynecology, 91(6), 1013- 1018.
  6. Robson M., Hartigan L., Murphy M. (2013). Methods of achieving and maintaining an appropriate caesarean section rate. Best Practice & Research Clinical Obstetrics & Gynaecology, 27(2): 297-308.
  7. Sterman, J.D. (2000). Business Dynamics: Systems Thinking and Modeling for a Complex World. Boston: Irwin McGraw-Hill.
  8. Triunfo S., Ferrazzani S., Lanzone A., Scambia G. (2015). Identification of obstetric targets for reducing cesarean section rate using the Robson Ten Group Classification in a tertiary level hospital. European Journal of Obstetrics Gynecology and Reproductive Biology, 189: 91-95.
  9. Vennix J., Gubbels J. (1994). Knowledge elicitation in conceptual model building: a case-study in modelling a regional Dutch health care system.
  10. In: Morecroft J., Sternam J. (a cura di). Modeling For Learning. Portland, Oregon: Productivity Press, 121-145. Villar J., Caroroli G., Zavaleta N. et al. (2007). Maternal and neonatal individual risks and benefits as associated with cesarean delivery: Multicentre prospective study. BMJ, 335: 1025.
  11. Wildman K., Blondel B., Nijhuis J., Defoort P., Bakoula C. (2003). European indicators of health care during pregnancy, delivery and the postpartum period. European Journal of Obstetrics & Gynecology and Reproductive Biology, 111: S53-S65.
  12. Wolstenholme E. (1999). A patient flow perspective of U.K. health services: exploring the case for new ‘intermediate care’ initiatives. System Dynamics Review, 15(3): 253-271.
  13. World Health Organization (2001). Antenatal care randomised trial for the evaluation of a new model of routine antenatal care. The Lancet, 357(9268): 1551-1564.
  14. World Health Organization (1985). Appropriate technology for birth. The Lancet, 2: 436-437.
  15. Zizza A., Tinelli A., Malvasi A. et al. (2011). Caesarean section in the world: a new ecological approach. Journal of Preventive Medicine and Hygiene, 52: 161-73.
  16. Piano Esiti Nazionale (2016). – Consultabile al sito: (ultimo accesso effettuato il 3 luglio 2017).
  17. Macfarlane A.J., Blondel B., Mohangoo A.D. et al. (2016). Wide differences in mode of delivery within Europe: risk-stratified analyses of aggregated routine data from the Euro-Peristat study. BJOG, 123: 559-568.
  18. Loke A.Y., Davies L., Li S. (2015). Factors influencing the decision that women make on their mode of delivery: the Health Belief Model. BMC Health Services Research, 15: 274.
  19. Lo J.C. (2003). Patients’ attitudes vs physicians’ determination implications for cesarean sections. Social Science and Medicine, 57(1): 91-96.
  20. Lane D., Huseman E. (2008). System dynamics mapping of acute patient flows. Journal of the Operational Research Society, 59: 213-224
  21. Lagrew D.C., Morgan M.A. (1996). Decreasing the cesarean section rate in a private hospital: Success without mandated clinical changes. American Journal of Obstetrics and Gynecology, 174: 184-191.
  22. Klemetti R., Che X., Gao Y. et al. (2010). Cesarean section delivery among primiparous women in rural China: an emerging epidemic. American Journal of Obstetrics and Gynecology, 202(1): 65. e1-65.e6.
  23. Kaimal A.J., Kuppermann M. (2012). Decision making for primary cesarean delivery: the role of patients and provider preferences. Seminars in Perinatology, 36(5): 384-389.
  24. Istituto Superiore di Sanità Ministero della Salute. (2010). Sistema nazionale per le Linee Guida. Linea guida 19. Taglio Cesareo: una scelta appropriata e consapevole. -- Consultabile al sito: www.salute.gov.it/imgs/C_17_publications_1330_attachedfile.pdf (ultimo accesso effettuato il 3 luglio 2017).
  25. Ghaffarzadegan N., Lyneis J., Richardson G.P. (2011), How small system dynamics models can help the public policy process, System Dynamics Review, 27(1): 22-44.
  26. Ghaffarzadegan N., Epstein A.J., Martin E.G. (2013). Practice variation, bias, and experiential learning in cesarean delivery: a data-based system dynamics approach. Health Services Research; 48: 713-34.
  27. Donabedian A. (2005). Evaluating the Quality of Medical Care. Milbank Quarterly, 83: 691-729.
  28. Degani N., Sikich N. (2015). Caesarean delivery rate review: an evidence-based analysis. Ontario Health Technology Assessment Series, 15(9): 1-58. -- Consultabile al sito: http://www.hqontario.ca/evidence/publications-and-ohtac-recommendations/ontario-health-technologyassessment-series/caesarean-delivery-rate-review (ultimo accesso effettuato il 3 luglio 2017).
  29. DECRETO 2 dicembre 2011. Riordino e razionalizzazione della rete dei punti nascita. Parte I, n. 1. -- http://www.gurs.regione.sicilia.it/Gazzette/g12-01/g12-01.pdf (ultimo accesso effettuato il 3 luglio 2017).
  30. Consultori familiari pubblici della Regione Sicilia al 31/12/2015, Assessorato regionale della salute, Dipartimento per la pianificazione strategica, -- http://pti.regione.sicilia.it/portal/page/portal/PIR_PORTALE/PIR_LaStrutturaRegionale/PIR_AssessoratoSalute/PIR_DipPianificazione-strategica/PIR_Consultorifamiliari (ultimo accesso effettuato il 3 luglio 2017).
  31. Chaillet N., Dumont A. (2007). Evidence-Based Strategies for Reducing Cesarean Section Rates: A Meta-Analysis. Birth, 34(1): 53-64.
  32. Brennan D.J., Robson M.S., Murphy M., O’Herlihy C. (2009). Comparative analysis of international cesarean delivery rates using 10-group classification identifies significant variation in spontaneous labor. American Journal of Obstetrics and Gynecology, 201(308): 1-8.

Enzo Bivona, Federico Cosenz, L’analisi delle politiche di riduzione dei cesarei attraverso il Dynamic Performance Management: la valutazione del percorso nascita in un’azienda sanitaria in "MECOSAN" 102/2017, pp 85-104, DOI: 10.3280/MESA2017-102005