Geographic Variations in Hospital Discharge Rates and Discretionary Hospital Use
Geographic Variations in Hospital Discharge Rates and Discretionary Hospital Use
复制标题
出院率和医院酌情使用的地理差异
DOI：
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发表时间：
1999
影响因子：
2.4
通讯作者：
F. Porell
中科院分区：
文献类型：
--
作者：
F. Porell
目的：虽然过去的研究表明，有更大的地理差异，出院率的医疗条件，有较少的协议，适当的治疗，有很少的经验证据来支持的推论，即高医院使用在一个社区主要是一个更大的量，这种酌情住院的结果。本研究评估了酌情住院对社区医院使用率较高的贡献。研究方法：出院文件和医疗保险资格文件被用来估计调整后的出院率，护理天数和调整后的死亡率为样本的761个地理社区在美国的四个州。诊断信息用于将住院分为低、中、高三个自由裁量权类别。相关性和多元回归分析方法被用来测试系统之间的关系，一个社区的整体医院使用率和住院的自由裁量权级别的组合。结果如下：虽然约有一半的差异，在社区之间的医院使用的整体率被发现与自由裁量权水平的混合出院，只有一小部分的解释的方差可以归因于具体的社区差异，在患病率高的自由裁量权住院。结论：社区医院使用的高整体率在很大程度上不是由于高的自由裁量权医院使用。
Objectives: While past research has shown that there is greater geographic variability in hospital discharge rates for medical conditions where there is less agreement about proper treatment, there is little empirical evidence to support the corollary that high hospital use in a community is primarily the result of a greater volume of such discretionary hospitalizations. This study assesses the contribution of discretionary hospitalizations to higher overall rates of hospital use in communities. Methods: Hospital discharge files and Medicare eligibility files were used to estimate adjusted rates of hospital discharge, days of care and adjusted mortality for a sample of 761 geographic communities in four states in the USA. Diagnostic information was used to classify hospitalizations into low, moderate and high discretion categories. Correlation and multiple regression analysis methods were used to test for systematic relationships between a community's overall rate of hospital use and discretion-level mix of hospitalizations. Results: Although about half of the variance in overall rates of hospital use among communities was found to be related to the discretion-level mix of hospital discharges, only a small portion of the explained variance could be attributed specifically to community differences in the prevalence of high discretion hospitalizations. Conclusions: High overall rates of hospital use in communities were not found to be largely the result of high discretion hospital use.