title: Mobility trends of Patients across Italian Regions: implications for planning and evaluation of hospital services.
abstract: The study of patients' mobility is useful for health planning and identifying deficiencies in care supply. The Italian Health Service, with 21 different regional realities, can be considered as a macrocosmic test bench. Our study aims: (1) to describe the trend of patients' hospital mobility across the Italian Regions; (2) to offer an immediate visual approach for decision making; (3) to identify some factors involved in patient's mobility.
  
  
  
  Observational cross sectional study.
  
  
  
  We used ordinary and day hospital discharge data from 1998 to 2014. The study was carried out using: (1) the Gandy's Nomogram (GN), a graphical tool that assesses the power of attraction and the escape's containment of hospital regional networks; (2) the vector analysis; (3) the trend analysis with Cuzik's test; (4) the panel data analysis, with multiple logistic regression model.
  
  
  
  The mean number of annual admissions, in Italian hospitals, was 10,976,290, progressively decreasing from 2001 to 2014, and 7% of it occurred "in mobility". We have drawn the different paths of patients' mobility by Regions and observed critical situations almost in Regions of Southern Italy, compared with Regions of the Centre-North. Moreover we analyzed the factors implied in such mobility, highlighting that attraction is influenced by the hospitalization rate in private structures, by the percentage of graduates in the Regions, and by the number of hospital beds/10,000 inhabitants; while escapes are influenced by GDP per capita, by the number of hospital beds/10,000 inhabitants and by the sanitary expenses per capita of the Region.
  
  
  
  We have shown the potentialities of the GN, applicable at micro level but also on a large scale in the analysis of patients' hospital mobility; and this, together with panel data analysis, can lead to a more conscious and effective health planning.
authors.affiliation: Health Services Research Laboratory, University of Siena, Italy - Post Graduate School of Public Health, University of Siena, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Nante
authors.affiliation: Health Services Research Laboratory, University of Siena, Italy - Post Graduate School of Public Health, University of Siena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Messina
authors.affiliation: Ministry of Health, Roma, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Lispi
authors.affiliation: Post Graduate School of Public Health, University of Siena, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Serafini
authors.affiliation: Post Graduate School of Public Health, University of Siena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Prisco
authors.affiliation: Post Graduate School of Public Health, University of Siena, Italy - Health General Manager, Piedmont Region, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Moirano
mesh_terms: D003430:Cross-Sectional Studies; D003657:Decision Making; D006296:Health Services / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007558:Italy / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data* / Q000639:trends; D057240:Patient Preference / Q000706:statistics & numerical data*
keywords: Health planning; Health services accessibility; Hospital patients’ mobility,