Tesi etd-09132024-155540
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Tipo di tesi
Dottorato
Autore
FERRARI, AMERIGO
URN
etd-09132024-155540
Titolo
Regional practice variation in pelvic organ prolapse surgery: from supply- to preference-sensitive factors.
Settore scientifico disciplinare
MED/40
Corso di studi
Istituto di Scienze della Vita - PHD IN MEDICINA TRASLAZIONALE
Commissione
relatore Prof.ssa VAINIERI, MILENA
Membro Prof. CANO, ANTONIO
Membro Prof. SAVARESE, GIANLUIGI
Membro Prof.ssa SEGHIERI, CHIARA
Membro Prof. CANO, ANTONIO
Membro Prof. SAVARESE, GIANLUIGI
Membro Prof.ssa SEGHIERI, CHIARA
Parole chiave
- administrative data
- choices
- gynecological surgery
- pelvic organ prolapse
- practice variation
- survey
Data inizio appello
22/01/2025;
Disponibilità
completa
Riassunto analitico
Pelvic organ prolapse (POP) is a common gynecological disorder affecting women after menopause. While being a benign pathology, it may significantly alter women’s quality of life and daily functionality. It can be managed either conservatively or surgically, with vaginal and abdominal minimally invasive surgery representing the recommended approaches.
Like for other elective nononcologic surgeries, variations in POP surgical practice patterns may be observed, leading to inequal access to health services, and thus conflicting with the mission of universal-coverage healthcare systems (like the Italian one). Practice variation in elective surgery is mainly driven by both preference-sensitive factors (patients’ choices or doctors’ prescriptions) and supply-sensitive factors (improper resource allocation causing over- or under-treatment). While variation due to patients’ preferences should be fostered as any healthcare user has the right to choose if, when, and how to be treated, variation depending on healthcare professionals’ attitudes or incorrect resource allocation is unwarranted and thus should be reduced.
Little information is available on practice variation in gynecological surgery, and even less on POP surgery. Thus, the aim of this dissertation is firstly to determine whether and to what extent variation patterns in the access to POP surgical services may be observed in Tuscany, Italy, and secondly to (at least partially) capture the underlying determinants of such patterns.
The first study employs regional administrative health data to compute surgical treatment rates for POP and assess the degree of practice variation in the access to POP surgery by the calculation of the Systematic Component of Variation.
The second study uses the same data source to build choice regression models and understand how impactful the effect of waiting times and travels distances is in shaping the between-hospital choice of women undergoing POP surgery in Tuscany.
The last study is based on a survey administered to women from the general population to define their decision-making process when asked whether they would prefer a conservative or surgical management of their condition (POP), and thus uncover the main factors influencing their choices.
Going beyond the mere description of practice variation patterns and trying to understand the determinants of them is essential to tackle unwarranted variation and ensure equitable access to health services across the territory. These three studies try to provide valuable insights into such determinants, thus supporting regional managers and policymakers in allocating resources and fostering a more uniform prescriptive behavior among health professionals.
Like for other elective nononcologic surgeries, variations in POP surgical practice patterns may be observed, leading to inequal access to health services, and thus conflicting with the mission of universal-coverage healthcare systems (like the Italian one). Practice variation in elective surgery is mainly driven by both preference-sensitive factors (patients’ choices or doctors’ prescriptions) and supply-sensitive factors (improper resource allocation causing over- or under-treatment). While variation due to patients’ preferences should be fostered as any healthcare user has the right to choose if, when, and how to be treated, variation depending on healthcare professionals’ attitudes or incorrect resource allocation is unwarranted and thus should be reduced.
Little information is available on practice variation in gynecological surgery, and even less on POP surgery. Thus, the aim of this dissertation is firstly to determine whether and to what extent variation patterns in the access to POP surgical services may be observed in Tuscany, Italy, and secondly to (at least partially) capture the underlying determinants of such patterns.
The first study employs regional administrative health data to compute surgical treatment rates for POP and assess the degree of practice variation in the access to POP surgery by the calculation of the Systematic Component of Variation.
The second study uses the same data source to build choice regression models and understand how impactful the effect of waiting times and travels distances is in shaping the between-hospital choice of women undergoing POP surgery in Tuscany.
The last study is based on a survey administered to women from the general population to define their decision-making process when asked whether they would prefer a conservative or surgical management of their condition (POP), and thus uncover the main factors influencing their choices.
Going beyond the mere description of practice variation patterns and trying to understand the determinants of them is essential to tackle unwarranted variation and ensure equitable access to health services across the territory. These three studies try to provide valuable insights into such determinants, thus supporting regional managers and policymakers in allocating resources and fostering a more uniform prescriptive behavior among health professionals.
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