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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2004 March;11(1):25-33
Variation of utilization of cardiovascular surgery in Marche Region
Panella M. 1, M. Demarchi L. 1, Kozel D. 1, Luparia M. 1, Marchisio S. 1, Renna M. 1, Sarasino D. 1, Di Stanislao F. 2
1 Unit of Hygiene and Public Health, Department of Medical Sciences, “A. Avogadro”, Univesity of Eastern Piedmont, Novara, Italy
2 Unit of Hygiene and Public Health, University of Ancona, Italy
Aim. To describe variation rates of cardiac and vascular surgical procedures in Marche Region and to find its determinants.
Methods. We collected data of the cardiovascular surgical procedures performed in the 13 Health Authorities (ASL) of the Marche Region during the period 1997-2000. First we quantified the level of variation for each procedure. Then we described the possible situations of underuse and overuse for each intervention and ASL. Finally we built multiple regression models in order to evaluate the effect of socio-economic and sanitary factors on the observed variations.
Results. We observed the highest levels of variation for discretionary procedures. In particular the Northern ASLs showed a prevalence of overuse, whereas underuse prevailed in the southern. We found a significant correlation between the underuse and overuse levels of the ASLs (r=-0.756; p=0.002). The multivariate models explained up to 58% of the observed variations.
Conclusion. We identified as possible determinants of variation in cardiac and vascular surgery: the different supply of Health Services; local socio-economic factors, passive mobility with respect to the bordering Regions and professional behaviour. However, once we have determined the presence of a strong variation in the analysed territory, we still need to interpret our results in relation to the real level of the appropriateness and of the outcomes of the analysed procedures, and to find strategies fit to control this phenomenon.