Assessment of Integrated Care Pathways for dementia in Italy according to the National Guidance

Abstract Background Italy counts 1 million people with dementia and 3 million caregivers. An integrated management system provides comprehensive care for people with non-communicable diseases, including dementia, through integrated care pathways (ICPs). Our study identified available dementia ICPs and assessed their compliance with the National Guidance on ICPs for People with Dementia (NGICPD). The project is carried out with the technical and financial support of the Ministry of Health (Chapter 2302). Methods We located ICPs by browsing all the websites of regions and Local Health Authorities (LHAs), contacting by email all LHAs, collecting ICPs from a survey carried out by the Dementia Observatory of the Italian National Institute of Health, and communicating with regional contacts. We included the ICPs produced after the NGICPD by the end of 2023. We applied a checklist developed on NGICPD consisting of 3 domains: Reference framework (0-15), Elements of the ICP (0-14), Construction of the ICP (0-14). ICPs were assessed by two researchers; a third solved the conflict points. The concordance was expressed by the intra-class correlation coefficient. Results We analysed 39 ICPs (11 regional, 28 LHAs) out of 87 collected. 15/21 regions and 30/110 LHAs developed an ICP. The observed mean total score was 23.5±7.9 for the regional ICPs and 23.1±5 for the LHAs ICPs. We observed low compliance with NGICPD, particularly in domain 3. The development of a health information system was included in 5/11 of regional and 12/28 of ICPs of LHAs; a monitoring system was present in 8/11 of regional and 25/28 LHAs ICPs. Concordance analysis showed an excellent correlation for regional ICPs and good for LHAs ICPs. Conclusions Our analysis highlighted low compliance of ICPs with the NGICPD and critical issues in monitoring. Our analysis stresses the need for all regions and LHAs to develop or update ICPs in line with NGICPD and the Italian Guidance on diagnosis and treatment of dementia. Key messages • Developing a pathway of efficient and coordinated care is essential to guarantee the quality of care for people with dementia and their families. All regions and LHAs must develop or update ICPs. • Monitoring ICP with indicators is crucial to planning cost-effective healthcare services.