Antimicrobial resistance (AMR) represents a major public health threat. Italian AMR rates are among the highest in Europe. The Italian National action plan to combat AMR was launched in 2017 and updated in 2022. To monitor its implementation, the self-assessment tool SPiNCAR (Supporto al Piano nazionale per il contrasto all'antimicrobico resistenza) was developed. We conducted the first national data collection through SPiNCAR in 2023, assessing the level of implementation across Italian regions and autonomous provinces for the year 2022. Regional SPiNCAR scores were correlated with relevant indicators: healthcare-associated infection (HAI) and antimicrobial use prevalence, as well as antibiotic consumption. Thirteen regions and autonomous provinces participated. High implementation levels were observed in the SPiNCAR areas of governance, surveillance, HAI prevention and control, and antimicrobial stewardship, while education, stakeholder engagement, and performance assessment showed the lowest scores. Moderate inverse correlations emerged between governance scores and HAI prevalence, and between surveillance/appropriate use scores and antimicrobial use prevalence. A strong inverse correlation was found between performance assessment scores and antimicrobial use prevalence. This study provides the first national baseline assessment of the level of implementation of the Italian National action plan to combat AMR. Results suggest SPiNCAR could be a useful tool to monitor AMR policies in decentralized health systems. Findings highlight both achievements and gaps; repeated assessments are necessary to guide targeted interventions and reduce regional inequalities.
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To develop strategies to lower barriers to sexual and reproductive health (SRH) care for migrant women (MW) in Milan, Lombardy, Italy. SRH is a fundamental human right, yet MW experience poorer SRH outcomes than non-MW due to cultural, linguistic, legal, and financial barriers. Despite Italy's universal healthcare system (Servizio Sanitario Nazionale, SSN), disparities persist. Quantitative SRH data from the health information system of a non-governmental organization (NGO) clinic in Milan was used to describe the demographic, socioeconomic, and administrative profile of MW with SRH needs, and to examine factors associated with SRH-related consultations. Qualitative data were collected through semi-structured interviews with 29 stakeholders, including MW, healthcare workers, NGO representatives, and policymakers. Thematic analysis was guided by a socio-ecological framework across individual, organizational, societal, and policy levels. SRH needs were the most frequent presentations among MW accessing the clinic. Most MWs came from Romania, Morocco, and Peru. Nearly half of those eligible for SSN registration were not enrolled, primarily due to lack of awareness. Economic vulnerability was strongly linked to SRH needs, while language proficiency alone showed no significant effect. Interviews underscored the importance of culturally sensitive care and mental health support. They also emphasized the inconsistent enforcement of regulations across government facilities and legislative gaps that leave certain groups, particularly undocumented EU nationals, without essential services. Community networks and stronger coordination across providers - including formal collaboration between NGOs and the SSN - were identified as promising levers to improve SRH access and equity in Milan and similar settings.
Italy's rehabilitation workforce is fragmented and regulated by outdated decrees, limiting alignment with WHO and EU standards, and hindering efficiency, equity, and international comparability. Narrative policy and health systems analysis, with comparative review of selected European models, based on secondary data and illustrative comparators. Workforce planning relies on historical professional categories and regional variability rather than population functioning needs and evidence-based competencies. WHO Rehabilitation 2030 tools and European comparators show that coherent regulation, competency-based education, and need-driven planning improve service access, quality, and sustainability. Align professional profiles with international standards; clarify scopes of practice; strengthen interprofessional education; integrate workforce planning with functioning and epidemiological data. Reform offers a strategic opportunity to reduce disparities, enhance system performance, and align Italy with global standards.
Nurses are a vital component of healthcare systems, directly influencing the quality and continuity of patient care. Globally, demographic shifts have led to a rising proportion of older nurses. In Italy, this trend presents challenges, given the rapidly aging population and ongoing workforce shortages. With a retirement age of 67, many older nurses remain in physically demanding roles despite medically documented work limitations, raising concerns about workforce sustainability, safety, and long-term planning. This study analyzed demographic trends among nurses at a major Italian public hospital. Data were extracted from the hospital's human resources system (IRIS WIN) for the period 2010-2024. A total of 2,184 nurses employed as of 31 December 2024 were stratified into four age groups (24-44, 45-54, 55-58, and 59-67 years) and mapped against clinical settings with varying levels of work intensity. Retirement eligibility was projected through 2033. Health-related absenteeism and medically documented work limitations were analyzed by age group and job intensity level. Between 2010 and 2024, the proportion of nurses aged 24-44 declined by 36.6%, while those aged 55-58 and 59-67 increased by 222.3% and 1,914%, respectively. Projections indicate a further 91% increase in the oldest age group by 2033. In 2024, 66% of nurses aged 55-58 and 61% of those over 59 were working in high- or extremely high-intensity clinical areas. Older nurses (>55 years), representing 40% of the workforce, accounted for 54% of all health-related absenteeism, equivalent to 87 full-time nursing positions. The number of nurses with medically documented work limitations in the oldest age group is expected to double in the coming years. This study highlights the urgent challenges of an aging nursing workforce which are not unique to Italy's NHS, but are a global issue. A growing proportion of older nurses, many with medically documented work limitations, are working in demanding clinical environments, trends already testing healthcare systems in many countries worldwide with a potential impact on patient safety, quality of care, and workforce resilience. Urgent investment in workforce planning, age-responsive role adaptation, and transitional pathways is essential to ensure sustainable, high-quality care delivery and to safeguard workforce health.
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Multicriteria Decision Analysis (MCDA) has gained increasing relevance in healthcare as an approach for evaluating options across multiple criteria. This study aims to provide an overview of MCDA applications in Italy, examining their decision contexts, the preference elicitation methods employed, and the stakeholder groups involved. A literature review was conducted across PubMed and Google Scholar (searches up to November 2025), supplemented by Italian studies identified in an international systematic review. For each study, data were collected on publication year, decision context, preference elicitation methods, and stakeholder involvement. Nineteen studies met the eligibility criteria, 16 of which were published after 2017. Most applications concerned priority-setting decisions related to coverage, reimbursement or funding of healthcare interventions, particularly the evaluation of drugs, therapeutic products, and other health technologies. Preference elicitation methods were predominantly compositional, with direct rating and the Analytic Hierarchy Process being the most frequently applied techniques; decompositional approaches were rarely used. Approximately half of the studies implemented a multi-stakeholder approach. Clinicians were the most frequently included group, followed by healthcare providers, while other stakeholder categories, including patients, were less commonly involved. The use of MCDA in Italy is progressively increasing and generally aligns with global trends. However, important opportunities for further development remain. These include extending MCDA applications to earlier stages of the technology lifecycle, adopting more rigorous and robust preference elicitation techniques, and strengthening its multi-stakeholder orientation, particularly by enhancing patient involvement, in order to improve the methodological quality and policy relevance of future MCDA applications in the Italian context.
Selecting appropriate bioinformatics tools is critical for accurate and reproducible analysis, particularly in support of genomic surveillance and molecular biomarker monitoring. The importance of these analyses is underscored by the need for effective public health responses to emerging diseases like SARS-CoV-2. By using the detection of SARS-CoV-2 subgenomic RNAs (sgRNAs) as a case study, we show the importance of systematic benchmarking in selecting optimal workflows. We generated 25 synthetic Illumina datasets simulating both shotgun and amplicon sequencing strategies, along with a real-world wastewater dataset. Using these datasets, we assessed the influence of key variables including mutation profiles, read lengths, aligner choice, and primer design for targeted sequencing. Our results revealed substantial performance variability: common tools developed to identify sgRNAs struggled with shotgun data and were sensitive to mutations depending on the chosen aligner, while amplicon sequencing improved detection sensitivity, with aligners and primer design choices still significantly impacting outcomes. Our results highlight the need for benchmarking steps and analyses to inform workflow selection. Without such evaluations, researchers risk drawing inaccurate conclusions from suboptimal workflows. This case study underscores the value of context-aware tool selection and encourages standardised benchmarking practices to ensure reproducibility and reliability in bioinformatics analysis, particularly in evidence-based decision-making environments such as public health and policymaking.
Background: Artificial intelligence (AI) is poised to fundamentally reshape healthcare delivery, offering unprecedented advancements in diagnostics, treatment personalization, and operational efficiency. However, a growing body of international research reveals a critical "optimism-knowledge gap": healthcare professionals are enthusiastic about AI's potential but possess limited technical knowledge and practical experience. This gap compromises the safe and effective implementation of AI tools. The Italian healthcare context presents a unique and amplifying challenge, as it is defined by the stringent "human-in-the-loop" oversight mandated by the Garante per la protezione dei dati personali (Italy's Data Protection Authority). This legal framework makes clinician competence not just a goal, but a prerequisite for regulatory compliance. Objective: This study aimed to provide an exploratory quantitative assessment of AI awareness, practical application, and understanding of its limitations among a sample of clinicians in Italy. It specifically sought to compare the preparedness of hospital-based clinicians and general practitioners (GPs) and to identify the workforce's perceived educational needs within this unique legal environment. Methods: A descriptive, cross-sectional survey was conducted from February to August 2025. Using a non-probability convenience sampling method via professional networks, the survey yielded 362 total responses. Data were analyzed descriptively and inferentially using Chi-square (χ2) tests to compare cohort responses on familiarity, practical exposure, knowledge of limitations, and interest in further training. Results: A universal and high demand for education was found, with 89.9% of all respondents being "Moderately" or "Very" interested in learning more about AI. This optimism coexists with dangerously low practical exposure. The gap was most profound among GPs, 44.1% of whom have "Never" used an AI tool-a rate significantly higher than hospital clinicians (34.9%; χ2=3.14, p = 0.045). Furthermore, 32.6% of GPs admitted that they "understand some benefits but not the limitations." Conclusions: Italian clinicians mirror the global optimism-knowledge gap. These findings underscore the urgent need for structured, continuous education in AI literacy to address ethical and regulatory imperatives within the Italian healthcare system.
Staphylococcus aureus is an opportunistic pathogen that colonizes humans and animals and causes a wide range of infections. Within a One Health framework, this study investigated nasal carriage, antimicrobial resistance, and genetic diversity of S. aureus in dogs and their owners attending two Veterinary Teaching Hospitals in Southern and Northern Italy. Strains were characterized using minimum inhibitory concentration testing and spa typing to assess resistance profiles and potential host- or region-associated patterns. A total of 108 S. aureus isolates were recovered from 77 owners and 31 dogs. In 17 dog-owner pairs (6 from Southern Italy and 11 from Northern Italy), S. aureus was isolated from both hosts. Overall, resistance was most frequent to penicillin (72.2%), followed by erythromycin (38%), and cefoxitin and gentamicin (13.9% each). Isolates from Southern Italy showed higher levels of antimicrobial resistance compared to that of Northern Italy. Fifteen isolates (13.9%) were classified as methicillin resistant, and all of which were multidrug resistant. The most common spa type was t1451 in both regions, while other prevalent types differed geographically. Identical spa types were detected in 11/17 dog-owner pairs (64.7%), suggesting possible interspecies transmission or shared environmental sources. No association was observed between spa type and multidrug resistance. These results highlight regional differences in S. aureus populations and confirm the lack of strict host specificity, underlining the importance of integrated One Health surveillance to address zoonotic transmission risks.
This study explores the integration of Earth Observation (EO) data within Italy's civil protection and disaster risk management (DRM) framework, with a focus on enhancing response, preparedness, and recovery efforts. Recognizing the critical role of satellite and in-situ EO products in monitoring hazards such as earthquakes, volcanic activity, meteo-hydrological (i.e., landslides, floods, land subsidence, droughts), wildfires, and technological hazards, the research evaluates current European Copernicus services and products, and their applicability to Italian civil protection needs. Through the creation of a comprehensive database of the Italian Civil Protection Department's (DPC) needs and technical requirements, the study identifies existing gaps and unexploited opportunities for EO data utilisation. It emphasizes the importance of a user need-driven approach, with potential applicability across Europe, to inform future mission planning, service improvements, and the ongoing development of the Italian IRIDE EO constellation.
To compare the pattern of psychotropic drug prescriptions in adolescents who started a drug therapy after the COVD-19 pandemic and in adolescents who began before the pandemic. A healthcare database from Italy's Lombardy region was analysed to compare the prescription profiles of psychotropic drugs (N05 and N06 groups of the Anatomical Therapeutic Chemical classification system) and access to healthcare services among two cohorts of adolescents aged 12-17 years. One cohort received their first psychotropic drug prescription in 2018 (pre-pandemic), and the other received theirs in 2021 (post-pandemic). The incidence, number of prescriptions and persistence of therapy within 12 months of the first prescription date and prevalence of polytherapy (prescription of more than one psychotropic class) were evaluated. Additionally, access to healthcare services was monitored before and after the index prescription. The incident users were 1734 in 2018 and 2943 in 2021; the incidence increased from 3.01 per 1000 to 4.97 per 1000 (incidence rate ratio [IRR] 1.64; 95% CI 1.55-1.74), with the largest rise in girls aged 12-14 (IRR 2.35; 95% CI 2.01-2.77). Among girls, the median number of prescriptions (+50%), prevalence of polytherapy (+57%) and persistence at 12 months (+31%) all increased post-pandemic, while no significant changes were observed among boys. Healthcare service use was higher prior to initiation in 2021 (65.7%) than in 2018 (58.4%). The increase in incidence and intensity of psychotropic drug prescriptions in adolescent girls confirms the existence of sex-related differences in mental health during the pandemic.
Italy, among the leading asbestos producers and users until the national ban in 1992, continues to register a high burden of asbestos-related diseases, mainly due to their long latency and delays in remediation. This study investigates the spatio-temporal evolution of pleural mesothelioma (PM) mortality over the past 40 years. Malignant pleural tumours and PM deaths (1980-2020) were extracted from the national death registry, adjusted for misclassification of pleural tumours, and analysed by region and birth cohort (1905-1984). The analyses by calendar period and cohort, stratified by sex assigned at birth, were followed by a space-cohort Bayesian Hierarchical Model with structured random effects for time (cohorts up to 1960-1969) and space (administrative regions). In Italy, from 1980 to 2020, 35 134 people died from PM (24 380 males and 10 754 females). A mortality decrease was observed in males after 2010-14 and in females after 2000-4. Mortality steadily declined in both males and females across cohorts after 1935-44. The space-time analysis enabled the clear identification of the Italian regions most affected by PM. Italy's trend mirrors those of other Western countries that have banned asbestos, with the highest risks for birth cohorts in working age before the ban. The results reveal distinct spatio-temporal patterns, with the northern regions exhibiting the highest rates. The Italian experience with asbestos-related diseases detection could help other countries to assess the impact of asbestos, raise awareness, and promote a global ban on asbestos.
Following Italy's psychiatric reform, national inpatient numbers declined, but how the age at admission has changed across sex, diagnostic, and admission-type subgroups remains unclear. This study examined 17 consecutive years (2006-2022) of psychiatric admissions to the sole ward serving L'Aquila, assessing temporal trends in age at admission by diagnosis, sex, and admission status (voluntary vs. compulsory). All adult admissions (≥ 18 years) were extracted from hospital discharge records (Schede di Dimissione Ospedaliera, SDO). Analyses were conducted at the admission-episode level. Primary diagnoses were grouped into four ICD-9 categories: schizophrenia spectrum, major depressive disorder, bipolar disorder, and alcohol/substance use disorder. Multiple linear models tested time-related changes in mean age at admission, including interactions for time × diagnosis × sex × admission type. Across 5,207 admission episodes, the Trimester × Diagnosis interaction showed a marked decline in age at admission for major depression (B = - 0.20 per trimester, p < 0.001) and bipolar disorder (B = - 0.09, p = 0.03), equivalent to approximately - 0.80 and - 0.36 years per year, yielding total reductions of ~ 13.6 and ~ 6.1 years over 2006-2022. The Trimester × Diagnosis × Sex interaction indicated that the decline in depression was driven by men (B = - 0.32, p < 0.001; ≈ -1.28 years/year; -21.76 over 17 years), while in bipolar disorder it was driven by women (B = - 0.14, p = 0.03; ≈ -0.56 years/year; -9.52 over 17 years). The Trimester × Admission type interaction showed the reduction was specific to voluntary admissions (B = - 0.10, p < 0.001; ≈ -0.40 years/year), while compulsory admissions were stable (B = - 0.01, p = 0.87). No significant age change occurred in schizophrenia spectrum disorders or in alcohol/substance use disorders. Between 2006 and 2022, we observed a progressive rejuvenation of voluntary and affective-disorder inpatient admissions, with the clearest subgroup-specific reductions detected in men with major depression and women with bipolar disorder, while remaining stable in schizophrenia spectrum, alcohol/substance use disorder, and compulsory admissions. These findings underscore the need to balance youth-focused outreach with adequate capacity for chronic psychosis and substance use disorder.
The aim of this study was to evaluate whether the treatment effects of tolebrutinib on confirmed disability worsening (CDW) diverge from its effects on relapse prevention compared with other disease-modifying therapies (DMTs) for relapsing multiple sclerosis (MS). We extracted published effect estimates for annualized relapse rate (ARR) and CDW confirmed at 24 weeks from all phase 3 trials with teriflunomide as the active comparator: ASCLEPIOS (ofatumumab), OPTIMUM (ponesimod), ULTIMATE (ublituximab), EVOLUTION (evobrutinib), and GEMINI (tolebrutinib). When duplicate trials were available, pooled estimates were derived. Log-transformed estimates were used in a weighted linear regression of CDW vs ARR, with bubble size reflecting statistical precision. Tolebrutinib was excluded from the regression fit but displayed for comparison. Across 4 DMTs other than tolebrutinib, a strong linear association was observed between treatment effects on ARR and CDW (R2 = 0.997), indicating that disability benefit was generally proportional to relapse reduction. By contrast, tolebrutinib deviated from this relationship, with a hazard ratio for CDW of 0.71 (95% CI 0.53-0.95) despite a relapse rate ratio of 1.03 (95% CI 0.85-1.25). Tolebrutinib was the only therapy to show a benefit on CDW without a measurable effect on relapses, highlighting a dissociation between disability worsening and relapse suppression not observed with other DMTs.
Orthopaedics and Sports Medicine (OSM) research plays a central role in advancing musculoskeletal healthcare. Although previous bibliometric studies have evaluated regional and continental trends, a detailed and standardised assessment of Italy's long-term contribution remains limited. This study aimed to comprehensively analyse Italy's OSM research output, impact, and publishing landscape from 1996 to 2024 using harmonised SCImago indicators. A descriptive bibliometric analysis was conducted using data retrieved from the SCImago Journal & Country Rank database, derived from Scopus-indexed sources. Publications classified under the "Orthopaedics and Sports Medicine" category (code 2732) and affiliated with Italy were identified. Annual and cumulative document counts, total citations, self-citations, H-index, and citations per publication (CPP) were extracted. Multinational publications were assigned to Italy based on author affiliation. All data were independently collected and cross-validated by two reviewers. Citation indicators were recalculated to ensure internal consistency. Italy's annual OSM output increased from 356 publications in 1996 to 1711 in 2024, corresponding to a 4.8-fold growth and a cumulative total of 22,129 documents. In 2024, Italy ranked ninth globally and fourth in Western Europe, accounting for 9.55% of worldwide output. Impact indicators were substantial, with an H-index of 211, 1845 citations in 2024, and a cumulative CPP exceeding 22, based on more than 504,000 citations. Eleven Italian journals covered all SJR quartiles, led by the Journal of Orthopaedics and Traumatology (Q1, H-index 57). Italy demonstrates sustained growth and high international visibility in OSM research. The application of transparent and standardised bibliometric methods strengthens the reliability of these findings and supports their relevance for research policy and strategic planning in European musculoskeletal science.
Background/Objectives: To assess the prevalence of eating disorder (ED) risk in a sample of Italian university students and to examine its independent associations with mental health indicators, self-rated health, body mass index (BMI), lifestyle behaviours, and engagement with digital food-related applications. Methods: Of the 2779 Italian university students who accessed the survey, 2691 completed and were included in the analysis. ED risk was assessed with the validated 5-item SCOFF questionnaire. Exposure included socio-demographics, BMI, depressive symptoms (PHQ-9), self-rated health, adherence to the Mediterranean diet (Medi-Lite), smoking, alcohol use (AUDIT-C), and use of food delivery and food waste apps. Multivariable logistic regression models, stratified by sex, and adjusted by age and education, estimated associations with ED risk. Results: Overall, 34.6% of participants screened positive for ED risk (women 39.5%, men 21.8%). Smoking and use of food delivery apps and food waste apps were independently associated with ED risk. Clinically relevant depressive symptoms (PHQ-9 ≥ 10) (aOR 3.37, 95% CI 2.82-4.02) and poor/fair self-rated health (aOR 2.45, 95% CI 1.93-3.11) showed the strongest association. Overweight (aOR 1.47, 95% CI 1.06-2.03) and obesity (aOR 2.48, 95% CI 1.53-4.01) increased the likelihood of ED risk. Risky alcohol use was also associated (aOR 1.42, 95% CI 1.15-1.75). Conclusions: More than one in three Italian university students is at risk for an ED, highlighting a substantial public health concern. Strong links with depression, perceived poor health, digital food app use, and unhealthy behaviours underscore the need for early screening and integrated mental health and nutrition interventions within university settings.
This study examines the future stability of Italy's health and social systems in the context of demographic decline. The Italian healthcare system, grounded in a universalistic and public model, founded on the principle of equity, is undergoing a phase of instability. The COVID-19 pandemic represented a critical rupture, exposing systemic weaknesses, territorial disparities, infrastructural inadequacies, the rigidity of financing mechanisms and the lack of reform regarding citizenship rights for foreign residents. An inductive, interpretive approach was adopted, starting with data analysis from Italy's population dynamics as of 1 January 2025, including births and deaths among citizens, growth of the foreign residents, and total social security contributions collected by the National Institute for Social Security. The analysis considered three major immigration reports, several academic articles from the legal, social, and medical fields, Constitutional Court Judgment No. 192/2024 on regional autonomy, and Mission 6 of the National Recovery and Resilience Plan within the framework of the Next Generation EU. The issuance of long-term visas and easier access to citizenship for foreign residents foster a more equitable society and can enhance the long-term sustainability of the Italian National Health System by offsetting demographic decline, lowering the median age, and stabilizing social security contributions. The success of such measures depends on integration policies and the efforts to combat racial discrimination. The findings highlight the need for citizenship and integration policy reforms and a governance framework consistent with the One Health approach. These measures would enhance the sustainability of Italy's NHS and promote an equitable society.
Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible neurological condition predominantly affecting individuals over 65 years of age. Despite its treatability through cerebrospinal fluid (CSF) shunting-with clinical improvement in up to 80% of appropriately selected patients-iNPH remains substantially underdiagnosed, with only approximately 13% of affected individuals in Europe receiving appropriate care. This study evaluates the long-term epidemiological and economic burden of iNPH underdiagnosis in Italy over the decade 2024-2033, quantifying potential savings achievable through systematic diagnosis and surgical treatment. A dual-scenario epidemiological modeling approach was employed using Italian demographic projections from ISTAT for the population aged ≥ 65 years, stratified into two age cohorts (65-79 years and ≥ 80 years). Scenario 1 applied a conservative pooled prevalence of 1.30% derived from an international systematic review; Scenario 2 applied realistic age-stratified rates from a prospective Swedish population-based study (2.1% for ages 65-79; 8.9% for ≥ 80 years). Per-patient annual care costs (€35,866) and surgical intervention costs (€11,803) were modeled with an annual inflation adjustment of 1.78%. The Incremental Cost-Effectiveness Ratio (ICER) was calculated using a reported QALY gain of 1.7 following shunt surgery. The Italian population aged ≥ 65 years is projected to grow by 16.7% over the study period, reaching 16.77 million by 2033. Estimated iNPH cases range from 186,812 (Scenario 1, conservative) to 611,435 (Scenario 2, realistic) in 2024, increasing to 217,967-707,882 by 2033. Cumulative ten-year costs to the Italian National Health System (INHS) and families without intervention ranged from €145.53 billion (Scenario 1, conservative) to €475.19 billion (Scenario 2, realistic). Systematic shunt surgery could generate cumulative savings ranging from €113.21 billion to €369.74 billion across all four modeled scenarios. The ICER was consistently -€14,166.47/QALY across all scenarios, establishing CSF shunt surgery as an economically dominant intervention. iNPH underdiagnosis represents a major and escalating economic and clinical challenge for Italy's aging healthcare system. Even under the most conservative scenario, the magnitude of avoidable costs is substantial. The consistently negative ICER confirms that CSF shunt surgery simultaneously reduces healthcare expenditure and improves patient outcomes. Urgent investment in standardized screening programs, enhanced clinical awareness among physicians, and integrated care pathways is required to address this preventable burden.
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, requiring a multidisciplinary approach for effective management. The MDT Project aimed to define and pilot a structured care model for HCC management in Italy, supported by the implementation of integrated care pathways (ICPs), to standardize organizational processes and ensure the organizational requirements needed for appropriate patient management. A multi-phase approach included a narrative review, semi-structured interviews with national experts, and the development of an optimal care model operationalized through a maturity model with 15 organizational elements. A total of 13 hospitals, selected to reflect national heterogeneity, participated in a pilot phase involving tailored action plans and hospital-specific ICPs. In total, ten hospitals proceeded to ICP implementation, and eight achieved certification by an external accreditation body. An expert consensus meeting subsequently validated the care model, key performance indicator (KPI) panel, and assessment tools. Organizational changes were assessed pre- and post intervention through the maturity model evaluation and a survey capturing clinicians' perceptions. Organizational improvements were observed primarily in areas directly targeted by the action plans, including the formalization of care-flow processes, multidisciplinary team structuring, case management, and coordination processes. More limited progress was seen in information systems and KPI monitoring, which require structural investments. Clinicians perceived the certification process as helpful in consolidating procedural standardization and documentation quality. The MDT Project piloted an organizational model for HCC management in Italy, focusing on care-pathway governance, multidisciplinary coordination, and center readiness. These findings represent an initial step toward broader implementation; future phases should incorporate clinical outcomes and patient-reported measures to evaluate the model's long-term impact.