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. 2003:3:e20.
doi: 10.5334/ijic.82. Epub 2003 Jun 26.

Vertical integration and contractual network in the cardiovascular sector: the experience of the Italian region Emilia Romagna

Cristina Ugolini  1 , Lucia Nobilio
Affiliations

Vertical integration and contractual network in the cardiovascular sector: the experience of the Italian region Emilia Romagna

Cristina Ugolini et al. Int J Integr Care. 2003.

Abstract

Objective: We analysed the integrated planning model adopted by the Italian region Emilia Romagna in year 2000 to cover the entire range of treatment of cardiovascular disease. This model, called "hub and spoke", provides for the transfer of patient care and treatment from peripheral units (the spokes) to central units (the hubs) once a certain complexity threshold has been reached.

Methods: We examined inter-temporal variations in patients flows for the selection/referral and follow-up phases between cardiac surgery and cardiology units during two periods characterised by different organisational set-ups, in order to reflect on the progress being made in the organisation of the network. The database consisted of regional records of hospital discharges during the 1997-2001 period.

Results: The investigation pointed to the achievement of a good degree of coordination between structures at different levels of specialisation in the case of cardiac surgery, for which six centres were selected already in 1996. On the other hand, the more recent introduction of a hierarchical system for interventional cardiology points to the prevalence of operations on patients previously treated within the same centre, to admissions by direct access, and to follow-up mainly conducted within the hub providing the initial service.

Conclusions: Despite the progress made towards the more effective rationalisation of the health care network, there is still room for improvement in relations between different centres, in particular with regard to the clearer definition of the roles and interdependence of those intermediate-level centres located between the hub centres and basic healthcare facilities.

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Figures

Figure 1
Figure 1
The hierarchical system of relations between cardiology units.
Figure 2
Figure 2
The hub and spoke model in Emilia Romagna.
Figure 3
Figure 3
An example of the territorial selective referral process examined.
See this image and copyright information in PMC

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