Nobilio L, Ugolini C
Department of Economics, University of Bologna, Piazza Scaravilli 2-40126 Bologna, Italy.
Health Policy. 2003 Jan;63(1):95-107. doi: 10.1016/s0168-8510(02)00080-5.
We analyse the highly-regulated cardiovascular sector of the health service in the Italian region of Emilia Romagna: this sector is characterised by strict regulatory control and a great emphasis on co-ordination and co-operation between public and private producers. These features have been even more marked since 2000, due to the adoption of the 'hub and spoke' organisational model, whereby a close relationship of selective referral from the network of satellite cardiology units (spokes) to the six Cardiac Surgical Centres (hubs) has been developed, so as to concentrate high risk procedures in highly specialised units. We focus on coronary angioplasty procedures (PTCA) and examine relations among centres before and after the official introduction of this hierarchical system completed the regionalisation of cardiovascular services. Secondly, since earlier regional efforts to reconfigure cardiovascular care by sending referrals to a few major centres may already have produced a high level of co-ordination among units, we investigate what happens to the volume-effect advantage across hospital categories with regard to the likelihood of adverse results for PTCA. We used descriptive statistics and logistic regression models to assess the existence of selective referrals and the concentration of clinical complexity in more specialised centres. Figures were taken from a regional administrative database based on hospital discharge abstracts (SDO) for the period 1998-2000.
我们分析了意大利艾米利亚-罗马涅地区医疗服务中监管严格的心血管领域：该领域的特点是严格的监管控制以及高度重视公共和私人医疗机构之间的协调与合作。自2000年以来，这些特点愈发显著，这是由于采用了“轴心辐射”组织模式，即建立了从卫星心脏病学单位网络（辐射点）到六个心脏外科中心（轴心）的选择性转诊紧密关系，以便将高风险手术集中在高度专业化的单位。我们聚焦于冠状动脉血管成形术（PTCA）手术，并研究在这个分级系统正式引入完成心血管服务区域化之前和之后各中心之间的关系。其次，由于该地区早期通过将转诊患者送到少数几个主要中心来重新配置心血管护理的努力可能已经在各单位之间产生了高度协调，我们调查了不同医院类别在PTCA手术出现不良结果可能性方面的数量效应优势会发生什么变化。我们使用描述性统计和逻辑回归模型来评估选择性转诊的存在情况以及临床复杂性在更专业化中心的集中程度。数据取自1998 - 2000年期间基于医院出院摘要（SDO）的区域行政数据库。
