Guarducci Giovanni, Messina Gabriele, Carbone Simona, Nante Nicola
Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy.
Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy.
Healthcare (Basel). 2023 Jul 17;11(14):2045. doi: 10.3390/healthcare11142045.
In a Beveridgean decentralized healthcare system, like the Italian one, where regions are responsible for their own health planning and financing, the analysis of patients' mobility appears very interesting as it has economic and social implications. The study aims to analyze both patients' mobility for hospital rehabilitation and if the beds endowment is a driver for these flows; Methods: From 2011 to 2019, admissions data were collected from the Hospital Discharge Cards database of the Italian Ministry of Health, population data from the Italian National Institute of Statistics and data on beds endowment from the Italian Ministry of Health website. To evaluate patients' mobility, we used Gandy's Nomogram, while to assess if beds endowments are mobility drivers, we created two matrices, one with attraction indexes (AI) and one with escape indexes (EI). The beds endowment, for each Italian region, was correlated with AI and EI. Spearman's test was carried out through STATA software; Results: Gandy's Nomogram showed that only some northern regions had good hospital planning for rehabilitation. A statistically significant correlation between beds endowment and AI was found for four regions and with EI for eight regions; Conclusions: Only some northern regions appear able to satisfy the care needs of their residents, with a positive attractions minus escapes epidemiological balance. The beds endowment seems to be a driver of patients' mobility, mainly for escapes. Certainly, the search for mobility drivers needs further investigation given the situation in Molise and Basilicata.
在贝弗里奇式的分散医疗体系中，比如意大利的医疗体系，各地区负责自身的医疗规划和融资，对患者流动情况的分析显得非常有趣，因为它具有经济和社会影响。该研究旨在分析患者因医院康复而产生的流动情况，以及床位配置是否是这些流动的驱动因素；方法：2011年至2019年期间，从意大利卫生部的医院出院卡数据库收集入院数据，从意大利国家统计局收集人口数据，并从意大利卫生部网站收集床位配置数据。为评估患者的流动情况，我们使用了甘迪列线图，而为评估床位配置是否是流动驱动因素，我们创建了两个矩阵，一个是吸引力指数（AI）矩阵，另一个是流出指数（EI）矩阵。针对意大利的每个地区，将床位配置与AI和EI进行关联。通过STATA软件进行斯皮尔曼检验；结果：甘迪列线图显示，只有一些北部地区有良好的康复医院规划。发现四个地区的床位配置与AI之间存在统计学显著相关性，八个地区的床位配置与EI之间存在统计学显著相关性；结论：只有一些北部地区似乎能够满足其居民的护理需求，呈现出正的吸引力减去流出的流行病学平衡。床位配置似乎是患者流动的驱动因素，主要是流出方面的驱动因素。鉴于莫利塞和巴西利卡塔的情况，对流动驱动因素的探寻当然需要进一步调查。
