Design and Operation of the Lombardy Parkinson's Disease Network

Abstract

Background: Parkinson's disease (PD) is one of the most common chronic neurological conditions leading to disability and social burden. According to the 2016 Italian National Plan on Chronic Diseases, regional health authorities are implementing dedicated networks to manage neurological diseases, including PD. Methods: A panel of experts representing health-care providers in Lombardy reached consensus on the organization of a patient-centered regional PD healthcare network. Results: The panel proposed a structure and organization implementing a hub-and-spoke PD network model. Three levels of neurological services were identified: General Neurologist, PD Clinic, PD Center. This model was applied to health service providers currently accredited in Lombardy, yielding 12 candidate PD Centers, each serving an area of ~1,000-2,000 km², and not less than 27 PD Clinics. The panel agreed on uniform diagnostic and staging criteria for PD, and on a minimum common clinical data set, on PD patient management by the network at initial and follow-up assessments, on the cadence of follow-up visits, on patient referrals, and on outcome measures for the assessment of network activities. Conclusions: The implementation of disease-centered networks for chronic neurological diseases provides an innovative opportunity to improve patient management, facilitate research and education.

Keywords: Parkinson disease; consensus; disease management; health maintenance organizations; managed care programs.

Figure 1

Schematic relationship between different HCP centers within the PD network. The patient's journey is indicated by lines. A PD Center is a high level excellence center for PD with multidisciplinary inpatient facilities and an outpatient PD Clinic. PD Clinics, General Neurologists (GNs) and General Practitioners (GPs) interface with a PD Center in order to address patients' needs or contribute to research programs. GN, General Neurologist; GP, General Practitioner; PD, Parkinson's disease.

Figure 2

The different competences between Parkinson Disease (PD) Centers and Clinics are outlined. PD Centers and PD Clinics interact and cooperate on patient-centered issues at different levels: diagnosis (green), treatment (purple), research (blue), and education (yellow).

Figure 3

Geographic distribution of potential Parkinson Disease (PD) Centers in the Lombardy region. Twelve health care providers (HCPs) fulfilling strict criteria for PD Centers are represented by red circles; eight additional HCPs fulfilling more lenient criteria are shown by green circles. The eight territorial branches of the Lombardy region Health Directorate are shown by different colors. Provincial districts are shown by lines. See text for further details.