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The analysis of a cardiological network in a regulated setting: a spatial interaction approach
Matteo Lippi Bruni1, Lucia Nobilio, Cristina Ugolini
1Department of Economics, University of Bologna, Bologna, Italy.
Insights
This study analyzes percutaneous transluminal coronary angioplasty (PTCA) referral patterns to optimize catheterization lab distribution. Findings suggest hierarchical patient flow processing and dominant agglomeration forces, with room to enhance network efficiency.
Area of Science:
- Health Services Research
- Cardiovascular Interventions
- Spatial Analysis
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) volume-outcome relationships traditionally justify territorial concentration.
- Emerging evidence highlights PTCA's superiority in acute myocardial infarction, necessitating increased service delivery points.
- Evaluating the optimal spatial distribution of PTCA facilities is crucial for healthcare policy.
Purpose of the Study:
- To develop analytical tools for policymakers to assess the spatial distribution of catheterization laboratories performing PTCA.
- To investigate spatial accessibility and patient referral patterns for PTCA procedures.
- To identify factors influencing patient flows to PTCA service providers.
Main Methods:
- Analysis of regional administrative hospital discharge data (SDO) from 2002.
- Utilizing entropy indexes to measure the spatial accessibility of the cardiology network.
- Employing a Bayesian-estimated gravity model to determine patient flow determinants.
Main Results:
- Patient destination choices appear to be processed hierarchically.
- Agglomeration forces significantly influence patient flows towards PTCA centers.
- While provincial self-sufficiency in PTCA provision is largely achieved, organizational efficiencies can be improved.
Conclusions:
- The study provides tools to support policy decisions regarding PTCA service location.
- Findings indicate that patient flow is influenced by hierarchical processing and agglomeration effects.
- Optimizing the organizational efficiency of the PTCA network remains a key objective for improved healthcare delivery.
Abstract:
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.
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