Are degree of urbanisation and travel times to healthcare services associated with the processes of care and outcomes of heart failure? A retrospective cohort study based on administrative data

Autoři: Jacopo Lenzi aff001;  Vera Maria Avaldi aff001;  Dario Molinazzi aff003;  Carlo Descovich aff002;  Stefano Urbinati aff004;  Veronica Cappelli aff005;  Maria Pia Fantini aff001
Působiště autorů: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy aff001;  Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy aff002;  Department of Management Control and Administrative Data, Bologna Local Healthcare Authority, Bologna, Italy aff003;  Department of Cardiology, Bellaria Hospital, Bologna, Italy aff004;  Directorate of Assistance, Technology and Rehabilitation, Bologna Local Healthcare Authority, Bologna, Italy aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223845


A few studies have found that patients with heart failure (HF) living in less densely populated areas have reduced use of services and poorer outcomes. However, there is a lack of evidence regarding transport accessibility measured as the actual distance between the patient’s home and the healthcare facility. The aim of this study was to investigate if different urbanisation levels and travel times to healthcare services are associated with the processes of care and the outcomes of HF. This retrospective cohort study included patients residing in the Local Healthcare Authority of Bologna (2915 square kilometres) who were discharged from hospital with a diagnosis of HF between 1 January and 31 December 2017. Six-month study outcomes included both process (cardiology follow-up visits) and outcome measures (all-cause readmissions, emergency room visits, all-cause mortality). Of the 2022 study patients, 963 (47.6%) lived in urban areas, 639 (31.6%) in intermediate density areas, and 420 (20.8%) in rural communities. Most patients lived ≤30 minutes away from the nearest healthcare facility, either inpatient or outpatient. After controlling for a number of individual factors, no significant association between travel times and outcomes was present. However, rural patients as opposed to urban patients were more likely to see a cardiologist during follow-up (OR 1.42, 99% CI 1.03–1.96). These follow-up visits were associated with reduced mortality within 6 months of discharge (OR 0.53, 99% CI 0.32–0.87). We also found that multidisciplinary interventions for HF were more common in rural than in urban settings (18.8% vs. 4.0%). In conclusion, travel times had no impact on the quality of care for patients with HF. Differences between urban and rural patients were possibly mediated by more proximal factors, some of which are potential targets for intervention such as the availability and utilisation of follow-up cardiology services and multidisciplinary models of care.

Klíčová slova:

Allied health care professionals – Cardiology – Critical care and emergency medicine – Health care facilities – Heart failure – Hospitals – Inpatients – Outpatients


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