The analysis of a cardiological network in a regulated setting: a spatial interaction approach
研究了意大利艾米利亚-罗马涅大区PTCA手术的患者转诊模式，利用熵指数和贝叶斯重力模型分析空间可达性和患者流动决定因素，为政策制定者优化导管室空间布局提供工具。
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.