Ugolini Cristina, Nobilio Lucia
Department of Economics, University of Bologna.
Int J Integr Care. 2003;3:e20. doi: 10.5334/ijic.82. Epub 2003 Jun 26.
We analysed the integrated planning model adopted by the Italian region Emilia Romagna in year 2000 to cover the entire range of treatment of cardiovascular disease. This model, called "hub and spoke", provides for the transfer of patient care and treatment from peripheral units (the spokes) to central units (the hubs) once a certain complexity threshold has been reached.
We examined inter-temporal variations in patients flows for the selection/referral and follow-up phases between cardiac surgery and cardiology units during two periods characterised by different organisational set-ups, in order to reflect on the progress being made in the organisation of the network. The database consisted of regional records of hospital discharges during the 1997-2001 period.
The investigation pointed to the achievement of a good degree of coordination between structures at different levels of specialisation in the case of cardiac surgery, for which six centres were selected already in 1996. On the other hand, the more recent introduction of a hierarchical system for interventional cardiology points to the prevalence of operations on patients previously treated within the same centre, to admissions by direct access, and to follow-up mainly conducted within the hub providing the initial service.
Despite the progress made towards the more effective rationalisation of the health care network, there is still room for improvement in relations between different centres, in particular with regard to the clearer definition of the roles and interdependence of those intermediate-level centres located between the hub centres and basic healthcare facilities.
我们分析了意大利艾米利亚-罗马涅大区在2000年采用的综合规划模式，以涵盖心血管疾病的全范围治疗。这种被称为“中心-辐条”的模式规定，一旦达到一定的复杂程度阈值，患者护理和治疗将从周边单位（辐条）转移至中心单位（中心）。
我们研究了在两个具有不同组织架构的时期内，心脏外科和心脏病学单位之间患者在选择/转诊及随访阶段的跨期流量变化，以便思考网络组织方面取得的进展。数据库由1997 - 2001年期间的区域医院出院记录组成。
调查表明，在心脏外科方面，不同专业化水平的机构之间实现了良好程度的协调，1996年就已选定了六个中心。另一方面，介入心脏病学分级系统的较新引入表明，手术多针对先前在同一中心接受治疗的患者，直接入院情况较多，且随访主要在提供初始服务的中心内进行。
尽管在医疗保健网络更有效的合理化方面取得了进展，但不同中心之间的关系仍有改进空间，特别是在更清晰地界定位于中心枢纽和基层医疗设施之间的中级中心的作用和相互依存关系方面。
