Xavier Diego Ricardo, Oliveira Ricardo Antunes Dantas de, Barcellos Christovam, Saldanha Raphael de Freitas, Ramalho Walter Massa, Laguardia Josué, Viacava Francisco
Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Faculdade de Medicina, Universidade de Brasília, Brasília, Brasil.
Cad Saude Publica. 2019 Jun 13;35Suppl 2(Suppl 2):e00076118. doi: 10.1590/0102-311X00076118.
This study addressed health regionalization on various spatial scales based on patient flow. The article analyzed data through data linkage on the origin and destination of admissions at the municipal level in Brazil in 2016. The analysis is based on graph theory and uses a modularity algorithm that seeks to group municipalities in communities with a large number of interlinks. The algorithm optimizes the number of hospital admissions and discharges, taking patient flow into account. The results are shown, considering different political and administrative spatial structures. Considering patient flow without spatial restrictions, 29 communities were created in the country, compared to 64 communities when the boundaries of the major geographic regions were respected, and 164 when considering only patient flows within the respective states. The results show the importance of historically constituted regions, ignoring formal administrative boundaries, in order to implement access to health services. They also reveal adherence to administrative boundaries in many states of Brazil, demonstrating this spatial scale's importance in the context of access to hospital admissions. The methodology makes relevant contributions to regional health planning.
本研究基于患者流动情况，探讨了不同空间尺度上的卫生区域划分。文章通过对2016年巴西市级层面入院和出院的来源地与目的地进行数据关联，分析了相关数据。该分析基于图论，并使用一种模块化算法，旨在将各市划分为相互联系紧密的社区。该算法在考虑患者流动的情况下，优化了医院的入院和出院人数。研究结果呈现了不同政治和行政空间结构下的情况。在不考虑空间限制的患者流动情况下，全国划分出29个社区；尊重主要地理区域边界时，划分出64个社区；仅考虑各州内部的患者流动时，则划分出164个社区。结果表明，为实现卫生服务的可及性，忽视正式行政边界的历史形成区域具有重要意义。研究还揭示了巴西许多州对行政边界的遵循情况，表明这种空间尺度在医院入院可及性方面的重要性。该方法对区域卫生规划做出了重要贡献。
