Mobility trends of Patients across Italian Regions: implications for planning and evaluation of hospital services.

BACKGROUND: The study of patients' mobility is useful for health planning and identifying deficiencies in care supply. The Italian Health Service, with 21 different regional realities, can be considered as a macrocosmic test bench. Our study aims: (1) to describe the trend of patients' hospital mobility across the Italian Regions; (2) to offer an immediate visual approach for decision making; (3) to identify some factors involved in patient's mobility. STUDY DESIGN: Observational cross sectional study. METHODS: We used ordinary and day hospital discharge data from 1998 to 2014. The study was carried out using: (1) the Gandy's Nomogram (GN), a graphical tool that assesses the power of attraction and the escape's containment of hospital regional networks; (2) the vector analysis; (3) the trend analysis with Cuzik's test; (4) the panel data analysis, with multiple logistic regression model. RESULTS: The mean number of annual admissions, in Italian hospitals, was 10,976,290, progressively decreasing from 2001 to 2014, and 7% of it occurred "in mobility". We have drawn the different paths of patients' mobility by Regions and observed critical situations almost in Regions of Southern Italy, compared with Regions of the Centre-North. Moreover we analyzed the factors implied in such mobility, highlighting that attraction is influenced by the hospitalization rate in private structures, by the percentage of graduates in the Regions, and by the number of hospital beds/10,000 inhabitants; while escapes are influenced by GDP per capita, by the number of hospital beds/10,000 inhabitants and by the sanitary expenses per capita of the Region. CONCLUSIONS: We have shown the potentialities of the GN, applicable at micro level but also on a large scale in the analysis of patients' hospital mobility; and this, together with panel data analysis, can lead to a more conscious and effective health planning.

Sex differences in use of interventional cardiology persist after risk adjustment.

BACKGROUND: Studies from several countries have documented gender disparities in the management of coronary artery disease. Whether such gender disparities are seen in Italy and, if so, whether they can be explained by factors such as age and severity of illness were investigated. METHODS: 77 974 Piedmontese patients, admitted between 1999 and 2002, with a primary diagnosis of myocardial infarction (ICD 410), angina (ICD 413), chronic ischaemia (ICD 414) and chest pain (ICD 786.5) were studied. The number of men and women undergoing surgical treatment was extracted and the male-female odds ratios calculated. Several risk factors and a risk adjustment technique (APR-DRG) were used to control for possible confounders. Backward stepwise multiple logistic regression was used to adjust for significant covariates. RESULTS: Crude analysis demonstrated that gender is a discriminating factor in the probability of surgery (OR 2.11, 95% CI 2.04 to 2.19), with similar findings among those with each main diagnosis. The odds ratios decreased after adjustment for age, co-morbidity and disease severity but remained significant. CONCLUSIONS: Men and women admitted to hospitals in a region of northern Italy with a diagnosis of cardiovascular disease are treated differently and this cannot be explained by age or severity of disease.