Fisher E S, Wennberg J E, Stukel T A, Skinner J S, Sharp S M, Freeman J L, Gittelsohn A M
Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover NH 03755, USA.
Health Serv Res. 2000 Feb;34(6):1351-62.
To explore whether geographic variations in Medicare hospital utilization rates are due to differences in local hospital capacity, after controlling for socioeconomic status and disease burden, and to determine whether greater hospital capacity is associated with lower Medicare mortality rates.
DATA SOURCES/STUDY SETTING: The study population: a 20 percent sample of 1989 Medicare enrollees. Measures of resources were based on a national small area analysis of 313 Hospital Referral Regions (HRR). Demographic and socioeconomic data were obtained from the 1990 U.S. Census. Measures of local disease burden were developed using Medicare claims files.
The study was a cross-sectional analysis of the relationship between per capita measures of hospital resources in each region and hospital utilization and mortality rates among Medicare enrollees. Regression techniques were used to control for differences in sociodemographic characteristics and disease burden across areas.
DATA COLLECTION/EXTRACTION METHODS: Data on the study population were obtained from Medicare enrollment (Denominator File) and hospital claims files (MedPAR) and U.S. Census files.
The per capita supply of hospital beds varied by more than twofold across U.S. regions. Residents of areas with more beds were up to 30 percent more likely to be hospitalized, controlling for ecologic measures of socioeconomic characteristics and disease burden. A greater proportion of the population was hospitalized at least once during the year in areas with more beds; death was also more likely to take place in an inpatient setting. All effects were consistent across racial and income groups. Residence in areas with greater levels of hospital resources was not associated with a decreased risk of death.
Residence in areas of greater hospital capacity is associated with substantially increased use of the hospital, even after controlling for socioeconomic characteristics and illness burden. This increased use provides no detectable mortality benefit.
在控制社会经济地位和疾病负担之后，探究医疗保险医院利用率的地区差异是否归因于当地医院容量的差异，并确定更高的医院容量是否与更低的医疗保险死亡率相关。
数据来源/研究背景：研究人群为1989年医疗保险参保者的20%样本。资源测量基于对313个医院转诊区域（HRR）的全国小区域分析。人口统计学和社会经济数据取自1990年美国人口普查。利用医疗保险理赔档案制定当地疾病负担测量指标。
本研究是对各区域人均医院资源测量指标与医疗保险参保者的医院利用率和死亡率之间关系的横断面分析。采用回归技术控制各地区社会人口特征和疾病负担的差异。
数据收集/提取方法：关于研究人群的数据取自医疗保险参保登记（分母档案）、医院理赔档案（MedPAR）和美国人口普查档案。
美国各地区医院病床的人均供应量相差两倍多。在控制社会经济特征和疾病负担的生态测量指标后，病床较多地区的居民住院可能性高出多达30%。在病床较多的地区，更大比例的人口在一年内至少住院一次；死亡也更有可能发生在住院环境中。所有影响在种族和收入群体中都是一致的。居住在医院资源水平较高的地区与死亡风险降低无关。
即使在控制了社会经济特征和疾病负担之后，居住在医院容量较大的地区仍与医院使用量大幅增加相关。这种使用量的增加并未带来可检测到的死亡率益处。
