Association between Geographic Accessibility of Home Care Clinics and Hospitalization in Japan Using Geographic Information Systems and Insurance Claim Data
Association between Geographic Accessibility of Home Care Clinics and Hospitalization in Japan Using Geographic Information Systems and Insurance Claim Data
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使用地理信息系统和保险索赔数据在日本家庭护理诊所的地理可达性与住院之间的关联
DOI：
10.4236/health.2016.810102
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发表时间：
2016
期刊：
影响因子：
2.1
通讯作者：
S. Nagata
中科院分区：
文献类型：
--
作者：
T. Naruse;Hiroshige Matsumoto;N. Yamamoto;S. Nagata
衡量和改进家庭护理诊所资源量和地理分配是延长失能老年人家庭护理系统使用时间的一个重要公共卫生问题。这项研究调查了日本13个城市的失能老年人的诊疗量和可及性与住院时间的关系；此外，本研究还比较了诊疗量和可及性对这一人群中住院时间的解释能力。使用公共数据和地理信息系统计算了17个城市的家庭护理诊所的服务量和地理可及性。我们分析了2012年10月以来的医疗索赔数据；样本包括22,662人，他们年龄为≥75岁，被证明为日常生活残疾，居住在13个城市，有关所有检查的城市特征的数据都可以获得。采用随机截距的多水平Logistic模型，分别对城市、个人和市政府的自变量进行建模，以检验家庭护理诊疗量和可及性与住院天数的相关性。每万名老年人就诊量为0~9.53人次，就诊可达性为0~83%。就诊量和可达性与≥住院天数呈显著负相关(优势比分别为0.944和0.713；可信区间分别为0.914~0.974和0.553~0.921)。诊所的地理分布不均匀；诊所的可达性比诊疗量更能解释住院时间。诊所可达性可能比诊疗量更准确地反映护理诊所分配的适当性。
Measuring and improving home care clinic resource volume and geographic allocation are an important public health issue regarding prolonging home care system usage among disabled elderly people. This study examined clinic volume and accessibility’s association with hospitalization duration among disabled elderly people in 13 municipalities in Japan; additionally, this study compared clinic volume and accessibility’s ability to explain hospitalization duration in this population. Home care clinics’ service volume and geographic accessibility were calculated for 17 municipalities using public data and geographic information systems. We analyzed medical claim data from October 2012; the sample included 22,662 persons who were aged ≥75 years, certified as disabled in daily living, and lived in 13 municipalities regarding which data could be obtained for all examined municipality characteristics. Multilevel logistic models with random intercepts were constructed for municipalities and individual- and municipality-level independent variables in order to examine home care clinic volume and accessibility’s correlation with hospitalization duration. Clinic volume ranged from 0 to 9.53 per 10,000 elderly people; clinic accessibility ranged from 0% to 83%. Clinic volume and accessibility were both significantly negatively correlated with hospitalization duration of ≥10 days (odds ratios, 0.944 and 0.713; confidence intervals, 0.914 - 0.974 and 0.553 - 0.921, respectively). Clinics were not homogeneously geographically distributed; clinic accessibility explained hospitalization duration better than clinic volume. Clinic accessibility may more accurately indicate care clinic allocation appropriateness than clinic volume.