title: Patient mobility for bone marrow transplant: the experience of the Perugia Hospital, years 2000-2013.
abstract: BACKGROUND
  Patient mobility, driven by patient preference is an indirect indicator of perception of hospital quality. Patients' choices depend on their previous healthcare experiences, the reputation of the hospital staff and the network of relationships between the patient, hospital doctors, general practitioners/reference specialists, etc. Therefore, the analysis of patient preferences provides an idea of hospital quality as well as qualitative and quantitative lack of services. The aim of the present research was to describe and analyze patient mobility for bone marrow transplantation regarding the Hospital of Perugia, which represents the second most important structure for bone marrow transplant in Italy.
  
  
  METHODS
  Data have been collected from hospital discharge records in the ordinary regime related to the Diagnosis Related Group 481 "bone marrow transplant" since 2000 to 2013. We included autologous and allogenic transplant, in the adult and the child. Analysis of escaped, attracted and resident patients flows was undertaken using Gandy's nomogram which detects, through repeated time investigations, patients' movement inside and outside their catchment area.
  
  
  RESULTS
  Between 2000 and 2013, 1782 patients were admitted to hospital with a DRG 481 "bone marrow transplant". Nine hundred and nineteen (51,5%) were resident in Umbria region, 799 (44,8%) in other regions, 64 (0,3%) abroad. Escapes were 158. The high percentage of admissions represented by patients that live out of Umbria, shows a high attractive power of the hospital. For "distant regions" this situation was maintained from 2000 to 2003, with a mild decrease from 2004 and, from 2010, the situation is stable. Only for "bordering regions" the attraction, which was stable up to 2010, seems to decrease. Gandy's nomogram shows also that the hospital was able to satisfy the health needs of the Umbria residents between 2004 and 2009 with a reductions in the escapes; then, in the last four years there is an increase in Umbria residents who seek care outside the catchment area and, in the last two years a reduction in the attraction power also.
  
  
  CONCLUSIONS
  During the analyzed period of time, the Hospital of Perugia has been a choice for patients needing a bone marrow transplant. In the last period of the analysis it seems that patients preferences have changed. The increased availability of new hematologic centers explains two phenomena: on the one hand patients tend to not move for the examined DRG, so that there is a reduction in incoming patients from bordering regions; on the other hand the competition to attract patients from the catchment area leads to an increase in the quality of the service.
authors.affiliation: Nurse, Health Service Research Laboratory University of Siena, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Pierini
authors.affiliation: Health Director, Hospital of Perugia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Pioppo
authors.affiliation: MD, Post Graduate School of Public Health, University of Siena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Troiano
authors.affiliation: Director, Health Mobility and Information and Social System management office, Umbria Region, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Casucci
authors.affiliation: Supervisor, Health Mobility and Information and Social System management office , Umbria Region, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Checconi
authors.affiliation: Supervisor, Management Control Office, Hospital of Perugia, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Ruffini
authors.affiliation: Professor, Health Service Research Laboratory and Post Graduate School of Public Health, University of Siena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Messina
authors.affiliation: Full Professor, Health Service Research Laboratory and Post Graduate School of Public Health, University of Siena, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Nante
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D002648:Child; D003625:Data Collection; D006301:Health Services Needs and Demand; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D049451:Nomograms; D057240:Patient Preference; D014182:Transplantation, Autologous / Q000379:methods / Q000706:statistics & numerical data; D014184:Transplantation, Homologous / Q000379:methods / Q000706:statistics & numerical data; D014195:Travel
keywords: Bone marrow transplantation; Cross-border healthcare; Nomogram