Evaluation of Integrated Patient-Centered Model of Territorial Transfusion Medicine across Healthcare Settings: A Retrospective Study

Abstract

Background: In contemporary healthcare systems, the sustainability of complex care models increasingly depends on the transition toward decentralized frameworks. Community-based transfusion therapy have emerged as a strategic approach to ensure continuity of care for frail and chronically ill patients. This study reports the experience of outpatient transfusion therapy in a large area of northeastern Italy over a five-year period (2020–2024). Materials and Methods: Multiple operational settings were evaluated, including home transfusions, community hospitals, nursing homes, and outpatient clinics. Activity volumes recorded between 2020 and 2024 were analyzed. A comparative cost analysis was conducted between transfusions delivered in community settings and those performed in hospital settings (inpatient and day hospital), as well as cases requiring access to emergency departments. Results: Red blood cell concentrates were the most frequently transfused blood component in the community setting. The total number of transfusions delivered in outpatient settings increased from 4,222 in 2020 to 4,789 in 2024 (+507 units; +12%). Over the study period, community-based transfusion activity increased from 11.1% to 12.9% of total transfusion procedures. The incidence of post-transfusion adverse events was slightly higher than that observed in the overall hospital population, with a greater proportion of transfusion-associated circulatory overload reactions. Cost analysis demonstrated superior cost-effectiveness of community-based transfusion therapy compared with hospital-based care across the evaluated settings. Conclusions: Transfusion services delivered within, nursing homes, and community care centers represent a key component of a resilient, patient-centered healthcare system. Integration between the community network and specialized hospital services ensures the maintenance of hospital-level safety standards in decentralized settings. Consolidation of this model is essential to safeguard the right to health and the dignity of care, positioning transfusion medicine as a flexible and effective proximity-based service.