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Italian Journal of Vascular and Endovascular Surgery 2004 March;11(1):25-33

Copyright © 2005 EDIZIONI MINERVA MEDICA

language: English

Variation of utilization of cardiovascular surgery in Marche Region

Panella M. 1, Demarchi L. M. 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


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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.

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