Journal Article

Tracking pregnant women displacements in Sao Paulo, Brazil: a complex systems approach to regionalization through the emergence of patterns

Canelas, Tiago, Duarte, Geraldo, Mascarenhas, Sergio, Alves, Domingos, Rigoli, Felix

2019

Overview

Background The healthcare system can be understood as the dynamic result of the interaction of hospitals, patients, providers, and government configuring a complex network of reciprocal influences. In order to better understand such a complex system, the analysis must include characteristics that are feasible to be studied in order to redesign its functioning. The analysis of the emergent patterns of pregnant women flows crossing municipal borders for birth-related hospitalizations in a region of São Paulo, Brazil, allowed to examine the functionality of the regional division in the state using a complex systems approach and to propose answers to the dilemma of concentration vs. distribution of maternal care regional services in the context of the Brazilian Unified Health System (SUS). Methods Cross-sectional research of the areas of influence of hospitals using spatial interaction methods, recording the points of origin and destination of the patients and exploring the emergent patterns of displacement. Results The resulting functional region is broader than the limits established in the legal provisions, verifying that 85% of patients move to hospitals with high technology to perform normal deliveries and cesarean sections. The region has high independence rates and behaves as a “service exporter.” Patients going to centrally located hospitals travel twice as long as patients who receive care in other municipalities even when the patients’ conditions do not demand technologically sophisticated services. The effects of regulation and the agents’ preferences reinforce the tendency to refer patients to centrally located hospitals. Conclusions Displacement of patients during delivery may affect indicators of maternal and perinatal health. The emergent pattern of movements allowed examining the contradiction between wider deployments of services versus concentration of highly specialized resources in a few places. The study shows the potential of this type of analysis applied to other type of patients’ flows, such as cancer or specialized surgery, as tools to guide the regionalization of the Brazilian Health System.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Biomedicine / Brazil - epidemiology / Cesarean section / Cesarean Section - statistics & numerical data / Childrens health / Cities - epidemiology / Cities - statistics & numerical data / Complex systems / Complexity / Critical Pathways - organization & administration / Critical Pathways - standards / Critical Pathways - statistics & numerical data / Cross-Sectional Studies / Delivery of Health Care - organization & administration / Delivery of Health Care - standards / Delivery, Obstetric - methods / Delivery, Obstetric - standards / Delivery, Obstetric - statistics & numerical data / Displacement / Female / Funding / Health aspects / Health planning / Health services / High technology / Hospitalization - statistics & numerical data / Hospitals / Humans / Management / Maternal & child health / Maternal health services / Maternal Health Services - organization & administration / Maternal Health Services - standards / Maternal Health Services - statistics & numerical data / Maternal-child health services / Medical schools / Medicine / Medicine & Public Health / Methods / Municipalities / Patient Transfer - organization & administration / Patient Transfer - statistics & numerical data / Patients / Planning / Pregnancy / Pregnant women / Primary care / Public health / Public health systems research / Quality Indicators, Health Care / Recording / Redesign / Referral and Consultation - statistics & numerical data / Regional health planning / Research Article / Surgery / Systems Analysis / Technology / Transportation of Patients - statistics & numerical data / Understanding Complexity in Health Systems: International Perspectives / Unified health system / Womens health