NSG-PDTA Indicators
The New Guarantee System (NSG, Nuovo Sistema di Garanzia) is the instrument that makes it possible to verify - in terms of equity, effectiveness, and appropriateness - that all Italian citizens receive the care and services included in the Essential Levels of Care (LEA, Livelli essenziali di assistenza).
It represents a breakthrough in the methodologies for monitoring the LEAs and updates the Guarantee System launched in 2000.
The NSG was introduced by the Ministerial Decree of 12 March 2019 'New Guarantee System for Health Care Monitoring', published in the Gazzetta Ufficiale on 14 June 2019, and has been operational since 1 January 2020.
NSG-PDTA indicators (NSG-PDTA, Nuovo sistema di garanzia per il Percorso diagnostico terapeutico assistenziale) are calculated annually.
The PDTA (Diagnostic-Therapeutic-Assistance Pathway) is a predefined, articulated and co-ordinated sequence of services provided at an outpatient and/or inpatient and/or territorial level, which envisages the integrated participation of various specialists and professionals (in addition to the patient himself), at a hospital and/or territorial level, in order to achieve the most appropriate diagnosis and therapy for a specific pathological situation or even the healthcare assistance needed in particular conditions of life.
The indicators for monitoring and evaluating PDTAs on a national level measure the effects in terms of type of services, timing and clinical outcomes. In this way, it is possible to compare indicator values obtained through different regional organisational models, providing an important information tool for identifying the best organisational choices.
Since 2017, indicators have been calculated for the following PDTAs:
- PDTA Chronic Obstructive Pulmonary Disease (COPD)
- PDTA Heart Failure
- Diabetes PDTA
- PDTA Breast cancer in women
- Colon Cancer PDTA
- Colorectal cancer PDTA
The indicators provide indications for measuring adherence to drug therapies and the timeliness of treatments, which, if observed, are associated with an increased probability of survival. The results obtained are useful to initiate a direct comparison with the regional referents in order to identify and discuss the potential determinants of the limited adherence and the high variability between regions and P.A., and to promote audit activities to investigate particular aspects relating both to the quality of the data and to the organisational systems of care delivery.
The project is ongoing and the indicators are calculated annually and published on the Ministry of Health website.
The methodology developed ("Operational Manual" updated in June 2021) has been shared with positive feedback from, in chronological order: the Expert Group on Health Systems Performance Assessment of the European Commission, the Medical Scientific Societies and Health Professional Associations, the LEA Committee, all 21 Regions and Public Administrations.
Lucia Bisceglia is Scientific head.
