Tuscan Healthcare System: 71% of Indicators Improve or Remain Stable, Excellence Confirmed in Oncology and Maternal-Child Care Pathways

Tuscan Healthcare System: 71% of Indicators Improve or Remain Stable, Excellence Confirmed in Oncology and Maternal-Child Care Pathways

Results of the 2025 performance evaluation of the Tuscan Regional Health Service were presented in Florence: progress in quality of care and childbirth management, though challenges remain regarding waiting times and financial balance.

The presentation day for the results of the 2025 performance evaluation of the Tuscan Regional Health Service was held in Florence. The event was organized by the Management and Health Laboratory (MeS) of the Sant'Anna School of Advanced Studies in Pisa, in collaboration with the Tuscany Region, ARS Toscana, and ISPRO. The initiative, now a well-established appointment for the regional healthcare system, provided an opportunity for discussion among healthcare management teams, regional executives, and the regional health department to analyze performance data and guide future planning decisions.

The overall picture highlights positive results: approximately 71% of the more than 300 monitored indicators showed improvement or remained stable compared to 2024, with particular emphasis on oncology and maternal-child care pathways, which continue to represent areas of excellence in Tuscan healthcare. However, some critical indicators remain, especially regarding financial sustainability, appropriateness of prescriptions, and the system's ability to ensure timely access to specialist visits and diagnostic tests, with still significant differences among territories and healthcare organizations.

"In recent years, the healthcare system has been subjected to various pressures, both on the demand side (driven by demographic trends) and on the supply side (resulting from the organizational innovations introduced through the PNRR reforms). Tools that assess overall performance through a multidimensional perspective represent an important compass for bringing the quality of care back to the center across all sectors and services, from prevention to end-of-life care, from the organizational level to district and territorial functional aggregation levels," stated Professor Milena Vainieri, head of the Management and Health Laboratory.

The 2025 Target Framework in Tuscany: More Than 70% of Indicators Improving or Stable

The overall framework shows that the indicators improving or remaining stable significantly outnumber those where performance has declined. In particular, around 71% of the more than 300 monitored evaluation indicators improved or remained stable compared to 2024. The concentration of indicators in the "green zone" demonstrates a generally very positive performance level.

In particular, clinical care pathways related to oncology and maternal-child care continue to stand out as areas of excellence.

The maternal-child care pathway shows positive signs regarding the humanization of childbirth practices, with a reduction in the use of cesarean sections, which dropped to 16%, and episiotomies, declining from 8.4% in 2024 to 6.7% in 2025. Concerning prenatal care for foreign women, the situation is more mixed. The percentage of women undergoing fewer than four prenatal visits improved, decreasing to 11.6%, while the percentage of women accessing their first prenatal visit late remains critical, although slightly improved compared to the previous year.

The oncology pathway shows excellent performance both for breast cancer and other cancer sites. The concentration of treatment volumes - a factor closely linked to outcomes - is optimal for breast, lung, and prostate cancers, while colorectal cancer appears more problematic. A critical issue emerges regarding hospice stays shorter than seven days for patients transferred from hospitals or unsupported home settings, accounting for 35%, a high figure indicating delayed access to palliative care.

Care pathway performance charts also highlight, in certain areas and regions, further opportunities for improvement aimed at reducing geographical disparities and ensuring greater equity. Examples include hospitalization rates during the first year of life in the maternal-child pathway and the timeliness of surgery following diagnosis of malignant colon cancer in the oncology pathway.

As for indicators measuring chronic disease management pathways, they show a reduction in potentially avoidable hospitalization rates (those concerning conditions that could be managed earlier at the community level), such as admissions due to short- and long-term complications of diabetes, COPD, and heart failure. This may indicate improved accessibility and effectiveness of community healthcare services. On the other hand, indicators also show increased emergency department visits among residents with heart failure (+2.8%), diabetes (+3.8%), and COPD (+4.9%), suggesting that the healthcare network for continuity of care still requires better coordination and activation mechanisms.

Other Indicators: Critical Issues Concerning Financial Sustainability and Waiting Times for Specialist Visits and Diagnostic Tests

The most critical areas concern the financial dimension. Increases caused by inflation, innovations in pharmaceuticals and diagnostics, as well as rising overall management costs, have made it difficult to fully maintain budget balance. Against this backdrop, indicators related to pharmaceutical and diagnostic appropriateness suggest opportunities to recover resources currently allocated inefficiently.

In particular, pharmaceutical prescribing appropriateness shows signs of improvement in antibiotic consumption, with reductions among both adults (-6.25%) and pediatric populations (-32.14%), although levels remain within the critical range. However, significant variability persists among Territorial Functional Aggregations (AFTs) - groups of General Practitioners established to address population health needs and promote clinical governance initiatives.

A critical situation also persists regarding antibiotic consumption in hospital wards, which recorded a slight increase (+0.64%), reaching 78.6 Defined Daily Doses (DDD) per 100 inpatient days. Antidepressant consumption is also rising, increasing by 2.28% among adults and by 6.84% among individuals aged 18-25.

Regarding clinical appropriateness, the upward trend in musculoskeletal MRI scans continues, reaching 24 scans per 1,000 inhabitants, while repeated lumbar MRI scans slightly decreased to 6%.

The main issue concerning indicators positioned in the lower performance bands relates to the healthcare system's ability to respond to public demand in terms of access and timeliness of specialist visits and diagnostic testing. The "capture index," which measures the regional healthcare system's ability to meet outpatient and diagnostic service demand, shows that approximately 58% of prescriptions for specialist visits are booked within the year, while around 62% of prescribed diagnostic tests are booked within the same year.

These figures must be considered alongside waiting times, which vary among district areas and healthcare organizations depending on the type of diagnostic test or specialist visit. Overall, 72% of specialist visits are provided within the timeframes established by the National Waiting List Management Plan, with territorial differences ranging from 46% to 89%. The situation is better for diagnostic services: at the regional level, 88% of diagnostic appointments meet the expected waiting times, with greater consistency among territories, ranging from 73% to 98%.

Attached is the press release containing the performance indicators.

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