Variation in hospital admissions among small areas. A comparison of Maine and Michigan.
Variation in hospital admissions among small areas. A comparison of Maine and Michigan.
复制标题
小地区住院人数的差异。
DOI：
10.1097/00005650-198906000-00005
复制
发表时间：
1989
期刊：
影响因子：
3
通讯作者：
Tedeschi,PJ
中科院分区：
文献类型：
--
作者：
McMahonJr,LF;Wolfe,RA;Tedeschi,PJ
对小地理区域中年龄调整后的住院情况进行的分析表明，从缅因州到马尼托巴的地区，手术和医疗病例的住院情况存在显著差异。大部分工作由约翰·温伯格领导，重点放在农村地区。本研究调查了密歇根州小地区住院率的变化程度，以确定那些在缅因州表现出高度变化的疾病是否在密歇根州也表现出相同程度的变化。Wennberg博士提供了缅因州111个改良诊断相关组（M-DRG）的变异程度数据。使用相同的M-DRGs，我们定义了1980年密歇根州下半岛60个先前定义的医院标记社区中年龄调整的、基于人口的住院率。将每个M-DRG中观察到的出院计数与60个社区中每个社区的预期计数进行比较，其中预期计数基于间接年龄调整。缅因州和密歇根州的小区域数据都表示为M-DRG的系统标准差，其中通过泊松概率模型考虑了随机变化。发现缅因州和密歇根州的M-DRG的系统标准差呈强相关，斯皮尔曼相关系数为0.71（P< 0.001）。这项研究表明，在不同的地理区域，城市，郊区和农村地区的不同组合，有显着的一致性之间的诊断组，显示出高度的变化，在入院和那些显示出低程度的变化。这些数据令人鼓舞;它们表明，对一个地区小面积变化原因的分析可以推广到其他地区。
Analysis of age-adjusted hospital admission profiles among small geographic areas has shown marked variation in hospital admissions for both surgical and medical cases in areas ranging from Maine to Manitoba. Much of the work has been led by John Wennberg and has focused on rural areas. This study examines the degree of variation in hospital admissions in small areas in the state of Michigan to determine whether those diseases that demonstrated high variation in Maine also demonstrated the same degree of variation in Michigan. The data on the degree of variation in 111 modified diagnosis-related groups (M-DRGs) from the state of maine were supplied by Dr. Wennberg. Using the same M-DRGs, we defined age-adjusted, population-based hospital admission rates for the lower peninsula of Michigan for 1980 among 60 previously defined hospital marked communities. The observed hospital discharge counts in each of the M-DRGs were compared to the expected counts in each of the 60 communities, where the expected count was based on an indirect age adjustment. Both the Maine and Michigan small area data were expressed by the M-DRG's systematic standard deviation in which random variation has been accounted for via a Poisson probability model. It was found that the systematic standard deviations of the M-DRGs in Maine and the M-DRGs in Michigan strongly correlated with a spearman correlation coefficient Of 0.71 (P< 0.001). This study demonstrates that across a variety of geographic areas with differing mixes of urban, suburban, and rural locations there is remarkable consistency among diagnostic groups that show a high degree of variation in hospital admissions and those that show a low degree of variation. These data are encouraging; they suggest that an analysis of the reasons for small area variation in one area may be transportable to others.