Mapping home palliative care disparities: a regional case study from Piedmont, Italy

Abstract Background Access to quality Home Palliative Care (HPC) is a public health priority. This study analyzed HPC services in Piedmont, a large, diverse Italian region (4.3 million inhabitants), as a case study to understand organizational variations in complex settings and inform equity-focused policies. Methods A cross-sectional survey covered Piedmont's 12 Local Health Authorities (LHAs) and 35 districts. Pre-pandemic data for 2019 were collected in 2023 via in-person questionnaires and interviews with HPC managers/directors. Key structural, process, and outcome indicators were analyzed descriptively. 2022 data were collected for comparison. Results Substantial heterogeneity was found across LHAs in 2019. Formal Local Palliative Care Networks existed in only 8/12 LHAs. Dedicated HPC units were present in 11/12 LHAs, but with varying structures and staffing (physician Full-Time Equivalents, or FTEs, range 0.59-3.00 per 100,000 inhabitants; regional average 1.71, below standards). Nurse FTE data faced challenges. Care pathways showed fragmentation and coordination with emergency services were limited, but psychological support was guaranteed. Large disparities emerged in care intensity (ratio of actual assistance days to total care days range 0.09-0.64) and place of death for cancer patients (home deaths range 6.26%-44.03%). Fragmented data systems hindered monitoring. The 2019-2022 comparison showed improvements (hospital deaths decreased from 23.6% to 16.0%) but confirmed persistent heterogeneity. Conclusions Mapping revealed marked variability in Piedmont's HPC organization, resourcing, delivery, and outcomes. Key challenges identified include network gaps, resource disparities (esp. physicians), fragmented models/pathways, poor care continuity, and inadequate monitoring. Addressing these disparities requires understanding a complex, often poorly documented system lacking systematic data. This study offers a valuable methodology applicable in similar contexts. Key messages • Mapping regional Home Palliative Care reveals significant disparities in organization, resources, and outcomes, impacting equity of access and quality. • Detailed regional analysis provides an evidence base for targeted policies and standardized improvements towards equitable, high-quality HPC across Europe.