[The distribution and activities of hemodynamic laboratories in Italy: the implications for the quality of services].
BACKGROUND
The diffusion of cardiac catheterization laboratories in Italy has been increasing in the last decade, often without a rational planning process evaluating costs, safety, concentration and case loads.


METHODS
Data have been provided by the 1990 annual report of the Italian Group of Hemodynamic Studies and Interventional Cardiology which includes, following the best estimates, about 90% of public and private labs. These data include all cardiac catheterization visits. In analysis, PTCA's have been separately considered.


RESULTS
In 1990, 85 laboratories with 101 rooms were active. The distribution of the labs was 58% in the north, 14% in the middle and 28% in the south of the country. The number of labs per million inhabitants was 1.9, 1.1 and 1.2 respectively, with a national average of 1.5. The percentage of labs performing fewer than 300 visits per year was 33% in the country. Within the areas, such percentages were 33%, 17% and 42% respectively. A total of 48,518 exams were performed (61%, 18% and 21% in the three areas) with a rate per 100,000 of 115, 82 and 51 (national rate 86). 5,145 PTCA's were carried out in the same year, about 80% of which were in the north area.


CONCLUSIONS
Even if data could be underestimated, a great difference in geographical distribution of labs was confirmed. This might be explained by morbidity, population age and mobility of patients across the country. The percentage of labs performing fewer than 300 studies is relevant, in particular in the south and in the Isles. Planning for future requirements should include the amelioration of utilization rates (in a perspective of cost containment and patient safety), a thorough evaluation of demographic and morbidity trends, and an estimate of the proportion of inappropriate procedures.
Favaretti
C
C
Divisione di Cardiologia, Complesso Ospedale Università, Padova.
Stritoni
P
P
Mariotto
A
A
Bressan
M
M
Razzolini
R
R
D015906:Angioplasty, Balloon, Coronary / Q000592:standards / Q000706:statistics & numerical data; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D006439:Hemodynamics; D006801:Humans; D007558:Italy; D007755:Laboratories, Hospital / Q000592:standards / Q000706:statistics & numerical data / Q000600:supply & distribution*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data
La distribuzione e l'attività dei laboratori di emodinamica in Italia: implicazioni per la qualità dei servizi.