The "Hub and Spoke" model has no effect on mortality in acute upper gastrointestinal bleeding: A prospective multicenter cohort study

the lack of standardized pathways for patients with gastrointestinal bleeding may have led to differences in their management and inequity to medical care access. The "Hub & Spoke" model was adopted to fill this gap in many disciplines, but, to our knowledge, no data exist on its effic...

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Veröffentlicht in:	Digestive and liver disease 2021-09, Vol.53 (9), p.1178-1184
Hauptverfasser:	Marmo, Riccardo, Soncini, Marco, Bucci, Cristina, Zullo, Angelo, Amitrano, L, Anderloni, A, Andriulli, A, Annese, V, Baldassarre, G, Bargiggia, S, Bazzoli, F, Bennato, R, Bianco, MA, Bizzotto, A, Boarino, V, Bonanomi, AG, Borgheresi, P, Bresci, G, Buffoli, F, Buscarini, E, Castrignanò, G, Cavallaro, LG, Cesaro, P, Chirico, A, Cipolletta, F, Cipolletta, L, Conigliaro, R, Conte, D, Costamagna, G, Covello, F, D'Amico, G, De-Fanis, C, De-Filippo, FR, de-Franchis, R, Dell‘Era, A, De Nigris, F, De-Matthaeis, M, Di-Giorgio, P, Di-Giulio, E, Esposito, P, Ferraris, L, Filippino, A, Franceschi, M, Furio, L, Germana', B, Grassia, R, Imperiali, G, Lamanda, R, Lauri, A, Londoni, C, Mangiafico, S, Manno, M, Marmo, C, Merighi, A, Meroni, R., Metrangolo, S, Montalbano, LM, Napolitano, G, Nucci, A, Orsini, L, Parente, F, Parravicini, M, Paterlini, A, Pumpo, R, Purita, L, Repici, A, Riccioni, ME, Russo, A, Segato, S, Sorrentino, I, Spinzi, G, Spotti, D, Tortora, A, Tomba, C, Triossi, O, Zagari, RM, Zambelli, A
Format:	Artikel
Sprache:	eng
Schlagworte:	Acute gastrointestinal bleeding Aged Case-Control Studies Comorbidity Delivery of Health Care, Integrated - organization & administration Gastrointestinal Hemorrhage - mortality Gastrointestinal Hemorrhage - therapy Health care Hub and spoke network Humans Italy - epidemiology Length of Stay - statistics & numerical data Middle Aged Mortality Organizational setting
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Zusammenfassung:	the lack of standardized pathways for patients with gastrointestinal bleeding may have led to differences in their management and inequity to medical care access. The "Hub & Spoke" model was adopted to fill this gap in many disciplines, but, to our knowledge, no data exist on its efficacy on mortality in GI bleeding. We aimed to evaluate if the "Hub & Spoke" organizational model has an impact on mortality risk from UGIB. from January 2014 to December 2015, 3324 consecutive patients admitted for UGIB in 50 Italian hospitals were enrolled (1977 patients in hospitals within the "Hub & Spoke" network for digestive hemorrhagic emergency and 1347 in hospitals outside the "Hub & Spoke" network). Clinical, endoscopic and organizational data were recorded. we observed no differences in mortality between patients admitted to hospitals included or not included in the "Hub & Spoke" network (5.2% vs 6.1%, p = 0.3). On multivariate analysis, admission in gastroenterology wards (OR 0.61, p = 0.001) or an academic hospital (OR 0.65, p
ISSN:	1590-8658 1878-3562
DOI:	10.1016/j.dld.2021.04.004