The lack of effect of market structure on hospice use
The lack of effect of market structure on hospice use
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DOI：
10.1111/1475-6773.10562
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发表时间：
2002-12-01
影响因子：
3.4
通讯作者：
Christakis, NA
中科院分区：
文献类型：
--
作者：
Iwashyna, TJ;Chang, VW;Christakis, NA
目标。描述卫生保健市场结构和县级人口结构在决定卫生保健市场结构中的相对重要性。收容所使用率。数据来源。Medicare声称，1993年新诊断为肺癌、结肠癌、中风或心脏病发作的一批老年患者的数据，跟踪了长达五年的时间，并与人口普查和地区资源文件数据相关联。研究设计。在考虑了个人水平数据的差异后，使用分层线性模型检查了严重疾病患者的临终关怀使用率在市场之间的差异。比较了市场层次结构和地方人口变量的相对解释力。数据收集方法。队列是在联邦医疗保险医院索赔数据中定义的，使用经过验证的算法来检测疾病的事件病例，并进行三年的回顾。临终关怀的使用是通过在个人层面上与1997年临终关怀标准分析文件的联系来确定的。使用医疗保险索赔中存在的县标识符将个人级别的数据链接到地区资源文件。主要调查结果。临终关怀的使用在不同的市场上有很大的差异。这种差异不是由卫生保健基础设施的主要组成部分的差异来解释的：医院、疗养院或熟练的护理设施的可用性，也不是卫生保健组织、医生或全科医生的可用性。临终关怀使用的县间异质性很大，可能与医疗保健系统的建立无关。重要的当地因素可能是当地的偏好、当地临终关怀所提供的特定服务组合的差异，或者在临终问题上社区领导的差异；这些差异中的许多可能是教育努力的结果。
Objective. To describe the relative importance of health care market structure and county-level demographics in determining. rates of hospice use.Data Sources. Medicare claims data for a cohort of elderly patients newly diagnosed with lung cancer, colon cancer, stroke, or heart attack in, 1993, followed for up to five years, and linked to Census and Area Resource File data.Study Design. Variation between markets in rates of hospice use by patients with serious illness was examined after taking into account differences in individual-level data using hierarchical linear models. The relative explanatory power of market-level structure and local demographic variables was compared.Data Collection Methods. The cohort was defined within the Medicare hospital claims data using validated algorithms to detect incident cases of disease with a three-year lookback. Use of hospice was determined by linkage at an individual level to the Standard Analytic Files for Hospice through 1997. Individual-level data was linked to the Area Resource File using county identifiers present in the Medicare claims.Principal Findings. There is substantial variation in hospice use across markets. This variation is not explained by differences in the major components of health care infrastructure: the availability of hospital, nursing home, or skilled nursing facilities, nor by the availability of HMOs, doctors, or generalists.Conclusions. Intercounty heterogeneity in hospice use is substantial, and may not be related to the set-up of the medical care system. The important local factors may be local preferences, differences in the particular mix of services provided by local hospices, or differences in community leadership on end of life-issues; many of these differences may be amenable to educational efforts.