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Home Care Organisational Models in Italy: A Cross-Sectional Study of Cluster Analysis and Stakeholder Perceptions
Ilaria Marcomini1, Valeria Caponnetto2, Francesco Zaghini3
1Vita-Salute San Raffaele University, Milan, Italy.
Aim:
To classify Italian home care models based on structural characteristics, process factors and stakeholder perceptions.
Design:
This is a secondary analysis of the AIDOMUS-IT multicentre cross-sectional study, conducted in Italy between July 2022 and December 2023.
Methods:
Data were collected via online surveys completed by 33 Local Health Authority Nursing Directors, home care nurses and patients. Hierarchical cluster analysis was used to classify different organisational models based on structural and process-related factors. Nurses' and patients' perceptions of care were described for each identified cluster.
Results:
The analysis identified three distinct organisational home care models: The 'multidisciplinary model', in which nurses reported high dissatisfaction due to organisational complexity and excessive workloads. In the 'nurse-centred model', characterised by publicly employed nurses, strong leadership, and a supportive work environment, patients reported high levels of satisfaction. The 'performance-based model', which operated with a lower nurse-to-patient ratio, reduced service hours, and greater reliance on external professionals. Nurses in this model reported high job satisfaction but also a greater intention to leave, while patient satisfaction was lower.
Conclusions:
This study underscores the importance of leadership, resource management, and a supportive work environment in influencing both job satisfaction and patient outcomes in home care settings.
Implications For The Profession And/Or Patients Care:
Policymakers could use these findings to refine care models and improve service delivery.
Impact:
Limited research has examined the organisational structures of home care services, which are important for professionals' organisational well-being, patient safety, and quality of care. This study identified three distinct organisational home care models that could be used to refine care approaches and improve service delivery.
Reporting Method:
This study respects the EQUATOR guideline for observational studies (STROBE).
Patient Or Public Contribution:
This study did not include patient or public involvement in its design, conduct, or reporting.
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