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

Librero, J. ; Ibañez, B. ; Martínez-Lizaga, N. ; Peiró, S. ; Bernal-Delgado, E.

Resumen: 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.

Idioma: Inglés

DOI: 10.1371/journal.pone.0170480

Año: 2017

Publicado en: PloS one 12, 2 (2017), 0170480 [12 pp]
ISSN: 1932-6203

Factor impacto JCR: 2.766 (2017)

Categ. JCR: MULTIDISCIPLINARY SCIENCES rank: 15 / 64 = 0.234 (2017) - Q1 - T1

Factor impacto SCIMAGO: 1.164 - Agricultural and Biological Sciences (miscellaneous) (Q1) - Medicine (miscellaneous) (Q1) - Biochemistry, Genetics and Molecular Biology (miscellaneous) (Q1)

Financiación: info:eu-repo/grantAgreement/ES/ISCIII/PI08-90255
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/PI10-00494
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/PI14-00786

Tipo y forma: Article (Published version)