Applying spatio-temporal models to assess variations across health care areas and regions: Lessons from the decentralized Spanish National Health System.

التفاصيل البيبلوغرافية
العنوان:	Applying spatio-temporal models to assess variations across health care areas and regions: Lessons from the decentralized Spanish National Health System.
المؤلفون:	Julián Librero, Berta Ibañez, Natalia Martínez-Lizaga, Salvador Peiró, Enrique Bernal-Delgado
المصدر:	PLoS ONE, Vol 12, Iss 2, p e0170480 (2017)
بيانات النشر:	Public Library of Science (PLoS)
سنة النشر:	2017
المجموعة:	Directory of Open Access Journals: DOAJ Articles
مصطلحات موضوعية:	Medicine, Science
الوصف:	OBJECTIVE:To illustrate the ability of hierarchical Bayesian spatio-temporal models in capturing different geo-temporal structures in order to explain hospital risk variations using three different conditions: Percutaneous Coronary Intervention (PCI), Colectomy in Colorectal Cancer (CCC) and Chronic Obstructive Pulmonary Disease (COPD). RESEARCH DESIGN:This is an observational population-based spatio-temporal study, from 2002 to 2013, with a two-level geographical structure, Autonomous Communities (AC) and Health Care Areas (HA). SETTING:The Spanish National Health System, a quasi-federal structure with 17 regional governments (AC) with full responsibility in planning and financing, and 203 HA providing hospital and primary care to a defined population. METHODS:A poisson-log normal mixed model in the Bayesian framework was fitted using the INLA efficient estimation procedure. MEASURES:The spatio-temporal hospitalization relative risks, the evolution of their variation, and the relative contribution (fraction of variation) of each of the model components (AC, HA, year and interaction AC-year). RESULTS:Following PCI-CCC-CODP order, the three conditions show differences in the initial hospitalization rates (from 4 to 21 per 10,000 person-years) and in their trends (upward, inverted V shape, downward). Most of the risk variation is captured by phenomena occurring at the HA level (fraction variance: 51.6, 54.7 and 56.9%). At AC level, the risk of PCI hospitalization follow a heterogeneous ascending dynamic (interaction AC-year: 17.7%), whereas in COPD the AC role is more homogenous and important (37%). CONCLUSIONS:In a system where the decisions loci are differentiated, the spatio-temporal modeling allows to assess the dynamic relative role of different levels of decision and their influence on health outcomes.
نوع الوثيقة:	article in journal/newspaper
اللغة:	English
تدمد:	1932-6203
Relation:	http://europepmc.org/articles/PMC5293276?pdf=render; https://doaj.org/toc/1932-6203; https://doaj.org/article/98ba82ca65794540803a647baf0f565a
DOI:	10.1371/journal.pone.0170480
الاتاحة:	https://doi.org/10.1371/journal.pone.0170480 https://doaj.org/article/98ba82ca65794540803a647baf0f565a
رقم الانضمام:	edsbas.43C7603D
قاعدة البيانات:	BASE

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الوصف
تدمد:	19326203
DOI:	10.1371/journal.pone.0170480