Ambery P, Donald I P
Elderly Care Unit, Gloucestershire Royal Hospital.
J Public Health Med. 2000 Sep;22(3):422-6. doi: 10.1093/pubmed/22.3.422.
Emergency medical admissions are rising, particularly in the elderly. Variation in admission rates between general practices has received little attention, and requires explanation.
A retrospective review was carried out of emergency medical admissions to the District General Hospital (DGH) and the Community Hospitals (CHs) in West Gloucestershire in subjects over 75 years of age during 3 years. A survey of general practitioner (GP) attitudes to emergency admissions was carried out.
A five-fold spread in DGH and CH admission rates for elderly medical emergencies was found, and a three-fold spread of overall admission rates. Rates were consistent within a practice each year. The spreads of practice mortality rates and myocardial infarction admission rates were smaller. The variation between practices was not explained by the Jarman Index or by attitudes identified in GPs. Practices with high admission rates had slighter higher annual hospital mortality rates, but lower episode fatality rates.
Admission rates show considerable variation between practices, which is only partly explained by morbidity rates, and consistency over 3 years.
急诊医疗入院人数在上升，尤其是在老年人中。全科医疗之间入院率的差异很少受到关注，需要对此进行解释。
对格洛斯特郡西部地区综合医院（DGH）和社区医院（CHs）在3年期间75岁以上患者的急诊医疗入院情况进行回顾性研究。对全科医生（GP）对急诊入院的态度进行了调查。
发现老年医疗急诊的DGH和CH入院率相差5倍，总体入院率相差3倍。每年各医疗机构内的入院率是一致的。各医疗机构的死亡率和心肌梗死入院率的差异较小。各医疗机构之间的差异无法用贾曼指数或全科医生的态度来解释。入院率高的医疗机构年度医院死亡率略高，但病死率较低。
各医疗机构之间的入院率存在很大差异，发病率和3年期间的一致性只能部分解释这种差异。
