000060712 001__ 60712
000060712 005__ 20190709135447.0
000060712 0247_ $$2doi$$a10.1371/journal.pone.0170480
000060712 0248_ $$2sideral$$a98168
000060712 037__ $$aART-2017-98168
000060712 041__ $$aeng
000060712 100__ $$aLibrero, J.
000060712 245__ $$aApplying spatio-temporal models to assess variations across health care areas and regions: Lessons from the decentralized Spanish National Health System
000060712 260__ $$c2017
000060712 5060_ $$aAccess copy available to the general public$$fUnrestricted
000060712 5203_ $$aObjective 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.
000060712 536__ $$9info:eu-repo/grantAgreement/ES/ISCIII/PI08-90255$$9info:eu-repo/grantAgreement/ES/ISCIII/PI10-00494$$9info:eu-repo/grantAgreement/ES/ISCIII/PI14-00786
000060712 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/
000060712 590__ $$a2.766$$b2017
000060712 591__ $$aMULTIDISCIPLINARY SCIENCES$$b15 / 64 = 0.234$$c2017$$dQ1$$eT1
000060712 592__ $$a1.164$$b2017
000060712 593__ $$aAgricultural and Biological Sciences (miscellaneous)$$c2017$$dQ1
000060712 593__ $$aMedicine (miscellaneous)$$c2017$$dQ1
000060712 593__ $$aBiochemistry, Genetics and Molecular Biology (miscellaneous)$$c2017$$dQ1
000060712 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000060712 700__ $$aIbañez, B.
000060712 700__ $$aMartínez-Lizaga, N.
000060712 700__ $$aPeiró, S.
000060712 700__ $$0(orcid)0000-0002-0961-3298$$aBernal-Delgado, E.
000060712 773__ $$g12, 2 (2017), 0170480 [12 pp]$$pPLoS One$$tPloS one$$x1932-6203
000060712 8564_ $$s4525938$$uhttps://zaguan.unizar.es/record/60712/files/texto_completo.pdf$$yVersión publicada
000060712 8564_ $$s87257$$uhttps://zaguan.unizar.es/record/60712/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000060712 909CO $$ooai:zaguan.unizar.es:60712$$particulos$$pdriver
000060712 951__ $$a2019-07-09-11:38:45
000060712 980__ $$aARTICLE