Patient mobility for cardiac problems: a risk-adjusted analysis in Italy

Area of Science:

• Health Services Research
• Healthcare Management
• Public Health

Background:

• The Italian National Health System's quasi-market structure allows patient choice, making patient mobility an indicator of hospital quality and regional financial flows.
• Previous research on patient mobility has not sufficiently considered the influence of patient condition severity.
• Cardiac surgery units in Tuscany, Italy, were examined to understand patient mobility dynamics.

Purpose of the Study:

• To describe patient mobility in cardiac surgery units within three Tuscan health areas (HAs).
• To analyze patient mobility stratified by disease severity using All Patient Refined Diagnosis Related Group (APR-DRG) levels.
• To assess the capacity of HAs to meet local healthcare demand and attract patients.

Main Methods:

• A retrospective observational study using hospital discharge records from the Tuscan Regional Health Agency (2001-2007).
• Stratification of 25,017 planned cardiac surgery hospitalizations into four APR-DRG severity levels.
• Application of Gandy's nomogram for demand assessment and Cuzick's test for trend analysis.

Main Results:

• Overall, HAs met their local healthcare demand.
• Severity stratification revealed that one HA (HA3) had a reduced capacity to manage moderate severity cases and attract patients.
• HA3 also showed a decrease in local resident admissions, indicating a potential decline in perceived quality or capacity for complex cases.

Conclusions:

• Disease severity stratification is crucial for uncovering significant differences in healthcare demand management between HAs.
• HA1 and HA2 demonstrated consistent ability to manage local demand across severity levels, unlike HA3.
• Severity-stratified data offers valuable insights for healthcare planners and researchers to improve comparisons and interventions in patient mobility.