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Activity-Based Algorithm for Translating Observed Outpatient Activity into Specialist Working-Hour Requirements
Edoardo Trebbi1, Tommaso Barlattani2, Antony Bologna2
1Department of Public Health and Infectious Diseases, "La Sapienza" University of Rome, 00100 Rome, Italy.
Healthcare (Basel, Switzerland)
|August 13, 2026
Summary
This study developed an activity-based workload model to estimate specialist working hours for community health centers in Italy. The model translates observed cardiology activity into required hours, aiding workforce planning in complex geographical settings.
Area of Science:
- Health Services Research
- Healthcare Management
- Public Health Policy
Background:
- Ministerial Decree 77/2022 mandates community-based care reorganization in Italy, establishing community health centers and hub-and-spoke networks.
- Translating territorial allocation into specialist working-hour requirements presents operational challenges, especially in remote and mountainous regions.
- Accurate workforce planning is crucial for effective implementation of new healthcare delivery models.
Purpose of the Study:
- To develop and apply an activity-based workload model for estimating specialist working-hour requirements in a specific Italian hub-and-spoke network.
- To translate observed outpatient cardiology activity into quantifiable specialist time needs.
- To inform workforce planning for community health centers in geographically challenging areas.
Main Methods:
- A workforce planning analysis utilized outpatient cardiology administrative data from 2019 for Local Health Authority (ASL 1) Avezzano-Sulmona-L'Aquila.
- Data were aggregated across hub and spoke centers based on predefined municipality-to-node assignments, incorporating standardized procedure scheduling durations.
- Procedure volumes were converted into annual and weekly workload hours, then into nominal 36-hour weekly specialist-schedule equivalents.
Main Results:
- The network served 286,832 residents, with 44,039 outpatient cardiology procedures equating to 12,719.8 annual workload hours.
- This translated to 244.6 weekly workload hours, equivalent to 6.79 specialist-schedule equivalents.
- Workload distribution was uneven, with significant variations across catchments not solely explained by population size.
Conclusions:
- Activity-based workload estimation provides an operational layer for territorial planning in hub-and-spoke networks.
- The model offers a transparent and transferable framework for estimating specialist working hours based on service utilization.
- This approach supports the operational planning of community health centers, particularly in complex geographical settings and can be adapted for other specialties.
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