Sociodemographic and health characteristics, rather than primary care supply, are major drivers of geographic variation in preventable hospitalizations in Australia.
Sociodemographic and health characteristics, rather than primary care supply, are major drivers of geographic variation in preventable hospitalizations in Australia.
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DOI：
10.1097/mlr.0000000000000342
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发表时间：
2015-05
期刊：
影响因子：
3
通讯作者：
Leyland AH
中科院分区：
文献类型：
--
作者：
Falster MO;Jorm LR;Douglas KA;Blyth FM;Elliott RF;Leyland AH
补充数字内容可在正文中找到。可预防住院率在国际上被用作初级保健的可及性和质量的指标。许多研究已经将这一指标与初级保健服务的供应联系起来，但其他多种因素可能会影响这些入院人数。量化全科医生(GP)的供应和个人社会人口学和健康特征对可预防住院的地理差异的相对贡献。澳大利亚45岁及以上研究中267,091名参与者的自我报告问卷数据与行政医院数据相关联，以确定可预防的住院治疗。多水平泊松模型，参与者聚集在他们居住的地理区域，用来探索解释住院地理差异的因素。以全职工作量当量衡量的全科医生供应量不是可预防住院的重要预测因素，仅解释了住院率地理差异的一小部分(2.9%)。相反，超过三分之一(36.9%)的变异是由人口的社会人口构成、健康和行为驱动的。这些个人特征解释了慢性病(37.5%)比急性(15.5%)或疫苗可预防的疾病(2.4%)更大的差异。个人的社会人口和健康特征，而不是全科医生的供应，是可预防住院的主要驱动因素。他们的贡献因情况而异，如果用于绩效比较，则应根据个别情况或潜在的干预途径报告可预防住院的地理比率。
Supplemental Digital Content is available in the text. Geographic rates of preventable hospitalization are used internationally as an indicator of accessibility and quality of primary care. Much research has correlated the indicator with the supply of primary care services, yet multiple other factors may influence these admissions. To quantify the relative contributions of the supply of general practitioners (GPs) and personal sociodemographic and health characteristics, to geographic variation in preventable hospitalization. Self-reported questionnaire data for 267,091 participants in the 45 and Up Study, Australia, were linked with administrative hospital data to identify preventable hospitalizations. Multilevel Poisson models, with participants clustered in their geographic area of residence, were used to explore factors that explain geographic variation in hospitalization. GP supply, measured as full-time workload equivalents, was not a significant predictor of preventable hospitalization, and explained only a small amount (2.9%) of the geographic variation in hospitalization rates. Conversely, more than one-third (36.9%) of variation was driven by the sociodemographic composition, health, and behaviors of the population. These personal characteristics explained a greater amount of the variation for chronic conditions (37.5%) than acute (15.5%) or vaccine-preventable conditions (2.4%). Personal sociodemographic and health characteristics, rather than GP supply, are major drivers of preventable hospitalization. Their contribution varies according to condition, and if used for performance comparison purposes, geographic rates of preventable hospitalization should be reported according to individual condition or potential pathways for intervention.