The aim of this thesis is the definition of an integrated medical design method based on Hospital Based - Health Technology Assessment (HB-HTA), in the Value Based Healthcare (VBHC) perspective, for the characterization and standardization of different hospital wards to maximize value creation for the patient and pursue long-term economic sustainability. An additional goal of this work is the estimation, through the definition of an index, of the total technological investment (acquisition investment, maintenance costs, consumption costs and management costs) referred to the technological square meter (€ / m2 ) for different hospital wards designed according to the integrated and value-based design methodology. To pursue long-term sustainability, which is essential for the resilience of a hospital, it is crucial to develop a method for hospital design that consider the VBHC perspective and can become a design reference for future investments to replace the traditional design methodology. Moreover, it is of paramount importance the introduction of hospital economic planning models, such as the estimation of the annual total technological cost referred to the square meter, to evaluate the sustainability of technological investments over time. The discussion will be developed starting from the analysis of the current socio-economic context in which hospitals operate and its changes due to the Covid-19 pandemic crisis. The design method will be structured in the following phases: i) analysis of the minimum technological, organizational, plant and architectural requirements envisaged by current regulations; ii) analysis of the reference hospital layouts for the delineation of the specific technological requirements for each ward (room by room lists); iii) definition of the clinical need with a view to VBHC and evaluation through technical economic comparisons and HB-HTA tools; iv) creation of room data sheets, i.e. cards containing information for the installation of electromedical equipment within the wards (microclimate, mechanical, plant, architectural, special requirements, dimensions, power and water supply, data connection); v) exemplary description of the layout approval phase (layout hypothesis, comparison between assumed layout and operational needs). Finally, an index for the estimation of the total technological cost referred to the square meter will be defined and applied in different hospital wards to evaluate the sustainability of the design choices from a VBHC perspective according to the defined method. Data from the Humanitas Research Hospital, considered as a technological reference, will be used to define the design method and verify the applicability of the index to different hospital departments.
Lo scopo del presente elaborato è la definizione di un metodo di progettazione medicale integrato basato su valutazioni di Hospital Based Health Technology Assessment (HB-HTA), nell’ottica della Value Based Healthcare (VBHC), per la caratterizzazione e standardizzazione di aree tecnologiche ospedaliere che massimizzino la creazione di valore per il paziente e che siano economicamente sostenibili nel lungo periodo. In seguito, attraverso la definizione di un indice, si vuole stimare il costo tecnologico totale annuo (investimento iniziale, costi manutentivi, costi di consumo e di gestione) riferito al metro quadro tecnologico (€/m2 ) per diversi reparti ospedalieri progettati secondo la metodologia definita in questo lavoro. Per il perseguimento della sostenibilità economica, fondamentale per la resilienza di un’azienda ospedaliera, sono cruciali l’elaborazione di un metodo per la progettazione ospedaliera in ottica VBHC che possa diventare un riferimento progettuale per investimenti futuri (in sostituzione alla metodologia di progettazione tradizionale) e l’utilizzo di modelli di pianificazione economica ospedaliera, come la stima del costo tecnologico totale annuo riferito al metro quadro, al fine di valutare la sostenibilità degli investimenti tecnologici nel tempo. La trattazione sarà sviluppata a partire dall’analisi del contesto socioeconomico attuale in cui operano le aziende ospedaliere e ai cambiamenti di questo come conseguenza della crisi pandemica dovuta al diffondersi del Covid-19. Il metodo sarà strutturato nelle seguenti fasi: i) analisi dei requisiti minimi tecnologici, organizzativi, impiantistici e architettonici previsti dalle normative vigenti; ii) analisi dei layout ospedalieri di riferimento per la delineazione dei requisiti tecnologici specifici reparto per reparto (elenchi room by room); iii) definizione del bisogno clinico nell’ottica di VBHC e valutazione attraverso comparazioni tecnico-economiche e strumenti di HB-HTA; iv) creazione dei room data sheet, i.e. schede contenenti informazioni per l’installazione delle apparecchiature elettromedicali all’interno dei reparti (microclima, requisiti meccanici, impiantistici, architettonici, speciali, ingombri, alimentazione elettrica e idrica, collegamento dati); v) descrizione esemplificativa della fase di approvazione del layout (ipotesi di layout, confronto tra layout ipotizzato e necessità operative). Infine, sarà definito e applicato in diversi reparti ospedalieri un indice per la stima del costo tecnologico totale riferito al metro quadro per valutare la sostenibilità delle scelte progettuali in ottica VBHC secondo il metodo definito. Nella definizione del metodo progettuale e nella fase di verifica dell’applicabilità dell’indice a diversi reparti ospedalieri si utilizzeranno i dati provenienti dell’azienda ospedaliera considerata come riferimento tecnologico: Istituto di Ricovero e Cura a Carattere scientifico Humanitas di Rozzano.
Progettazione medicale integrata in ottica value based healthcare (VBHC) e parametrizzazione economico-funzionale dell'impatto tecnologico
Meo, Martina
2021/2022
Abstract
The aim of this thesis is the definition of an integrated medical design method based on Hospital Based - Health Technology Assessment (HB-HTA), in the Value Based Healthcare (VBHC) perspective, for the characterization and standardization of different hospital wards to maximize value creation for the patient and pursue long-term economic sustainability. An additional goal of this work is the estimation, through the definition of an index, of the total technological investment (acquisition investment, maintenance costs, consumption costs and management costs) referred to the technological square meter (€ / m2 ) for different hospital wards designed according to the integrated and value-based design methodology. To pursue long-term sustainability, which is essential for the resilience of a hospital, it is crucial to develop a method for hospital design that consider the VBHC perspective and can become a design reference for future investments to replace the traditional design methodology. Moreover, it is of paramount importance the introduction of hospital economic planning models, such as the estimation of the annual total technological cost referred to the square meter, to evaluate the sustainability of technological investments over time. The discussion will be developed starting from the analysis of the current socio-economic context in which hospitals operate and its changes due to the Covid-19 pandemic crisis. The design method will be structured in the following phases: i) analysis of the minimum technological, organizational, plant and architectural requirements envisaged by current regulations; ii) analysis of the reference hospital layouts for the delineation of the specific technological requirements for each ward (room by room lists); iii) definition of the clinical need with a view to VBHC and evaluation through technical economic comparisons and HB-HTA tools; iv) creation of room data sheets, i.e. cards containing information for the installation of electromedical equipment within the wards (microclimate, mechanical, plant, architectural, special requirements, dimensions, power and water supply, data connection); v) exemplary description of the layout approval phase (layout hypothesis, comparison between assumed layout and operational needs). Finally, an index for the estimation of the total technological cost referred to the square meter will be defined and applied in different hospital wards to evaluate the sustainability of the design choices from a VBHC perspective according to the defined method. Data from the Humanitas Research Hospital, considered as a technological reference, will be used to define the design method and verify the applicability of the index to different hospital departments.File | Dimensione | Formato | |
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https://hdl.handle.net/10589/186391