Lippi Bruni Matteo, Nobilio Lucia, Ugolini Cristina
Department of Economics, University of Bologna, Bologna, Italy.
Health Econ. 2008 Feb;17(2):221-33. doi: 10.1002/hec.1255.
We analyse referral patterns for patients undergoing percutaneous transluminal coronary angioplasty (PTCA) in the Emilia Romagna region of Italy, a procedure for which the assumption of a negative association between volume and adverse outcomes is used to justify its territorial concentration. Nevertheless, recent clinical evidence shows PTCA superiority for immediate treatment of acute myocardial infarction, which advises an increase in the number of points of delivery. Our paper aims to develop analytical tools designed to provide support to policy makers when they are asked to evaluate the spatial distribution of catheterisation laboratories that perform PTCA. Information is drawn from the regional administrative hospital discharge data (SDO) for the year 2002. We first use entropy indexes to investigate the spatial accessibility of the cardiological network. Secondly, by means of a gravity model estimated using Bayesian techniques we identify the determinants of patient flows in terms of demand and supply factors. Our results suggest that information on destinations is processed hierarchically and that agglomeration-like forces are dominant. Furthermore, although self-sufficiency of provision at the provincial level has been achieved to a large extent, there is still scope to improve the organisational efficiency of the network.
我们分析了意大利艾米利亚-罗马涅地区接受经皮冠状动脉腔内血管成形术（PTCA）患者的转诊模式。对于该手术，人们认为手术量与不良后果之间存在负相关关系，以此来证明其在地域上集中的合理性。然而，最近的临床证据表明，PTCA在急性心肌梗死的即时治疗方面具有优越性，这建议增加手术实施点的数量。我们的论文旨在开发分析工具，以便在政策制定者被要求评估进行PTCA的导管实验室的空间分布时为其提供支持。信息取自2002年该地区的行政医院出院数据（SDO）。我们首先使用熵指数来研究心脏病网络的空间可达性。其次，通过使用贝叶斯技术估计的重力模型，我们从需求和供应因素方面确定了患者流动的决定因素。我们的结果表明，关于目的地的信息是分层处理的，并且类似集聚的力量占主导地位。此外，尽管在很大程度上已实现省级层面的供应自给自足，但仍有提高网络组织效率的空间。
