Caputo Alessia, Vainieri Milena, Nuti Sabina
Management and Healthcare Laboratory, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy.
Interdisciplinary Research Center "Health Science", Scuola Superiore Sant'Anna, Pisa, Italy.
Res Health Serv Reg. 2025 Sep 17;4(1):14. doi: 10.1007/s43999-025-00074-0.
Geographic variation in elective surgical procedures poses challenges to healthcare equity, efficiency, and resource allocation. This study investigates variation in 14 elective surgical procedures performed in Tuscany, Italy, in 2022, focusing on both regional and Local Health Authority levels. Using hospital discharge data, we calculated treatment rates and the Systematic Component of Variation (SCV) to quantify unwarranted variation, applying McPherson et al. (1996)'s thresholds for interpretation. Results revealed substantial differences across procedures, with low SCVs for hip replacement and inguinal hernia repair, and very high SCVs for vein stripping and coronary artery bypass grafting. To support interpretation and governance, we developed a graphical tool that visually represents SCV levels using an intuitive, color-coded format. The tool was designed to reduce the uncertainty healthcare professionals often face when interpreting variation without clear clinical benchmarks, helping them distinguish between acceptable and potentially unwarranted differences. It was presented during the 2023 Tuscan Performance Evaluation System event and pilot-tested in 2025 with 23 healthcare professionals. The tool improved participants' ability to identify the most appropriate level of governance for action and increased confidence in understanding variation patterns. This study offers a replicable model for analyzing variation and demonstrates the value of user-friendly data visualizations in supporting informed, equity-oriented healthcare decisions. Further validation is recommended to assess long-term impact.
选择性外科手术的地域差异对医疗公平、效率和资源分配构成了挑战。本研究调查了2022年在意大利托斯卡纳进行的14种选择性外科手术的差异，重点关注地区和地方卫生局层面。利用医院出院数据，我们计算了治疗率和变异的系统成分（SCV）以量化不必要的变异，并应用麦克弗森等人（1996年）的解释阈值。结果显示，不同手术之间存在显著差异，髋关节置换术和腹股沟疝修补术的SCV较低，而静脉剥脱术和冠状动脉搭桥术的SCV非常高。为了支持解释和治理，我们开发了一种图形工具，以直观的颜色编码格式直观地表示SCV水平。该工具旨在减少医疗专业人员在没有明确临床基准的情况下解释变异时经常面临的不确定性，帮助他们区分可接受的差异和潜在的不必要差异。它在2023年托斯卡纳绩效评估系统活动中展示，并于2025年在23名医疗专业人员中进行了试点测试。该工具提高了参与者确定最适当治理行动水平的能力，并增强了他们对变异模式理解的信心。本研究提供了一个可复制的变异分析模型，并展示了用户友好的数据可视化在支持明智的、以公平为导向的医疗决策方面的价值。建议进行进一步验证以评估长期影响。
