Healthcare site

Ageing and chronic patients, how 'the hospitalist' makes care pathways more manageable and sustainable

Italy is still in its infancy in the introduction of a highly specialised medical internist in intra-hospital treatment, coordination of care and improvement of hospitalisation efficiency and outcomes, but the US experience demonstrates the strategic effectiveness of this figure

by Ludovico Furlan* , Nicola Montano **

8 January 2026

Aggiungi Il Sole 24 Ore
ai preferiti su Google

3' min read

Translated by AI

Versione italiana

3' min read

Translated by AI

Versione italiana

Demographic developments in recent decades have painted a profoundly changed global picture, marked by increasing longevity and an unprecedented ageing population. Whereas in 1950 the world's population numbered around 2.5 billion, by 2024 it will have reached 8.2 billion, thanks to economic development and an overall improvement in living conditions. This progress, however, has as a direct consequence the increase in the elderly population, particularly in industrialised countries: the United Nations estimates that by 2054, the number of people over 65 will exceed 1.2 billion. Mass ageing is accompanied by an inevitable and worrying increase in the prevalence of chronic diseases, such as cardiovascular, respiratory, diabetes and oncological diseases.

The Italy Framework

In Italy, the epidemiological data are eloquent and dramatic: an estimated 24 million people live with a chronic disease, and of these, 12 million have at least two. The situation is even more critical for the over 75s, among whom 85 per cent have at least one chronic disease and as many as 64 per cent have at least two. The numbers translate into an exponential increase in the complexity of patients arriving both in hospital and on the territory.

Polypathology

A study published in JAMA Internal Medicine, based on more than 3 million hospitalisations in Canada between 2002 and 2017, confirmed this trend, showing a 40 per cent increase in the number of patients with a high degree of complexity and a 60 per cent increase in those chronically taking ten or more drugs. The phenomenon of polypathology and polypharmacy generates a complex interaction between diseases and treatments.

A control room

Faced with changing patients and diseases, healthcare systems urgently need to redefine their strategies. Specialised and ultra-specialised expertise, while fundamental to the management of individual diseases, risks fragmenting the care pathway. For this reason, there appears to be an increasing need for a 'control room' figure with a holistic vision that can guarantee safe care pathways, truly geared to the needs of the individual patient and, above all, sustainable in the long term.

The Role of Internal Medicine

Who can take on this leading role? Internal Medicine is a candidate, on the strength of its history as one of the first medical specialities (in Italy, Simi is the oldest medical society, founded in 1887). Originally, the internist physician dealt with all non-surgical problems, thus developing multidisciplinary skills in cardiology, pneumology, hepatology, immunology and many other fields. Today, this figure is indispensable for the management of complex patients with multiple conditions, acting as a guarantor of the overall view and continuity of care.

The role of the Hospitalist

It was precisely from this need that the figure of the Hospitalist was born in the United States in the early 1990s. This is a doctor with internist training who is highly specialised in intra-hospital treatment, in coordinating care, and in improving the efficiency and outcomes of hospitalisation. The success of this model has grown: today, there are more than 60,000 Hospitalists in the United States, and almost 100 per cent of hospitals with more than 200 beds use their expertise.

Although the modalities vary (from simple consultation to co-management with the surgeon to assuming primary responsibility for the patient), the measured benefits seem tangible, especially in orthopaedic and neurosurgical patients. The data suggest that joint surgeon-internist management leads to a reduction in the length of hospital stay, a lower risk of in-hospital complications, and a decrease in new hospitalisations after discharge. While there is disagreement about the benefits in terms of mortality and cost reduction, there is no denying the high satisfaction rate found among surgeons, nurses and patients.

Native experiences

In Italy, the introduction of the Hospitalist is still at an embryonic stage, with experience limited to a few centres. However, the rationale and the premises are excellent, as confirmed by one of the few national studies, conducted in the Department of Neurosurgery of the Careggi Hospital in Florence, which showed concrete clinical benefits in joint management. The upcoming challenge for the Italian healthcare system is therefore to understand and define how to effectively introduce and integrate this crucial figure.

* Department of Internal Medicine, Irccs Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan
** Department of Clinical and Community Sciences, University of Milan, President, Italian Society of Internal Medicine