The distance to community medical care and the likelihood of hospitalization: Is close always better?
The distance to community medical care and the likelihood of hospitalization: Is close always better?
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DOI：
10.2105/ajph.87.7.1144
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发表时间：
1997-07-01
影响因子：
12.7
通讯作者：
Chang, CH
中科院分区：
文献类型：
--
作者：
Goodman, DC;Fisher, E;Chang, CH
目标.本研究探讨了从居住地到最近医院的距离对住院和死亡可能性的影响。研究对象为1989年（成人）、1985年至1989年（儿童）期间的缅因州、新罕布什尔州和佛蒙特州的住院情况以及Medicare登记者的死亡率（1989年）。在其他已知的住院预测因素在控制了年龄、性别、床位供应、家庭收入中位数、农村居住、学术医疗中心和是否有疗养院病人等因素后，居住距离超过30分钟的居民调整后的医疗住院率比为0.85（95%置信区间{CI} = 0.82，0.88）的成人和0.78（95% CI = 0.74，0.81）的儿童相比，那些生活在邮政编码与医院。在成人和儿童的四个最常见的诊断相关组中观察到类似的效果。老年人因通常需要住院治疗的疾病而住院治疗的可能性和死亡率在距离上没有差异。到医院的距离对住院率有重要影响，但不太可能用患病率来解释。
Objectives. This study examined the influence that distance from residence to the nearest hospital had on the likelihood of hospitalization and mortality.Methods. Hospitalizations were studied for Maine, New Hampshire, and Vermont during 1989 (adults) and for 1985 through 1989 (children) and for mortality (1989) in Medicare enrollees.Results. After other known predictors of hospitalization (age, sex, bed supply, median household income, rural residence, academic medical center, and presence of nursing home patients) were controlled for, the adjusted rate ratio of medical hospitalization for residents living more than 30 minutes away was 0.85 (95% confidence interval {CI} = 0.82, 0.88) for adults and 0.78 (95% CI = 0.74, 0.81) for children, compared with those living in a zip code with a hospital. Similar effects were seen for the four most common diagnosis-related groups for both adults and children. The likelihood of hospitalization for conditions usually requiring hospitalization and for mortality in the elderly did not differ by distance.Conclusions. Distance to the hospital exerts an important influence on hospitalization rates that is unlikely to be explained by illness rates.