Small-area analysis of gastrointestinal disease hospital discharge variation: are the poor at risk?
Small-area analysis of gastrointestinal disease hospital discharge variation: are the poor at risk?
复制标题
胃肠道疾病出院变异小区域分析：穷人面临风险吗？
DOI：
10.1097/00004836-199004000-00004
复制
发表时间：
1990
影响因子：
2.9
通讯作者：
McLaughlin,CG
中科院分区：
文献类型：
--
作者：
McMahonJr,LF;Tedeschi,PJ;Wolfe,RA;Griffith,JR;McLaughlin,CG
如果他们不根据病人的基本特征来调整不同的护理水平，人头分配计划可能会使他们的参保人面临配给服务的风险。为了评估基于人群的社会经济特征与医院使用的关联程度，本研究探讨了胃肠道和肝脏（GI）诊断相关组（DRGs）出院率的小区域变化。利用1980年密歇根150万例出院病例的数据库，我们构建了GI DRGs的年龄调整、基于人口的出院率。然后，我们评估了贫困的影响，以医院市场社区中低于贫困线的家庭百分比来定义。使用回归技术，我们发现贫困解释了27.5%的胃肠道医院出院变化，穷人住院的频率更高（p< 0.0001）。使用成本加权排放率作为因变量，我们发现贫困解释了20.3%（p= 0.0003）的成本加权排放变化。这些结果表明，贫困解释了出院率的显著差异，并对胃肠道疾病相关的小区域住院费用产生显著影响。执业胃肠病学家和外科医生需要意识到影响患者利用其服务的因素，以便在建议改变支付系统时保留他们作为患者倡导者的角色。
Capitation plans may place their enrollees at risk of rationed services if they do not adjust for underlying patient characteristics that dictate differing levels of care. To assess the degree to which population-based socioeco-nomic characteristics are associated with hospital use, this study explored small-area variation in hospital discharges for gastrointestinal and liver (GI) Diagnosis Related Groups (DRGs). Utilizing a 1980 Michigan database of 1.5 million discharges, we constructed age-adjusted, population-based discharge rates for the GI DRGs. We then evaluated the effect of poverty, defined by the percent of households in a hospital market community below the poverty line. Using regression techniques, we found that poverty explained 27.5% of the variation in GI hospital discharges, with the poor admitted more often (p< 0.0001). Using cost weighted discharge rates as the dependent variable, we found that poverty explained 20.3%(p= 0.0003) of the variation in cost weighted discharges. These results suggest that poverty explains a significant amount of variation in hospital discharges and has a significant effect on associated small-area hospitalization costs in GI diseases. Practicing gastroenterologists and surgeons need to be aware of factors that influence patients utilizing their services in order to retain their role as patient advocates as changes in payment systems are suggested.