Maeda Toshiki, Babazono Akira, Nishi Takumi, Yasui Midori, Harano Yumi
From the Department of Healthcare Administration and Management, Graduate School of Healthcare Sciences, Kyushu University, Japan.
Medicine (Baltimore). 2016 Feb;95(5):e2519. doi: 10.1097/MD.0000000000002519.
The aim of this study is to clarify whether there is small area variation in the use of gastrostomy that is explained by hospital physician density, so as to detect the existence of supplier-induced demand (SID).The study design is a retrospective cohort using claim data of Fukuoka Late Elders' Health Insurance, submitted from 2010 to 2013. Study participants included 51,785 older adults who had been diagnosed with eating difficulties. We designated use of gastrostomy as an event. Multilevel logistic analyses were then used to investigate the existence of SID.After controlling for patient factors, we found significant regional level variance in gastrectomy use (median odds ratio [MOR]: 1.72, 1.37-2.51). Hospital physician density was significantly positively related with gastrostomy (adjusted OR of hospital physician density: 1.75, 1.25-2.45; P < 0.001). MORs were largely reduced for the input variable of hospital physician density.We found that the small area variation in use of gastrostomy among older adults could be explained by hospital physician density, which might indicate the existence of SID.
本研究的目的是阐明胃造口术的使用是否存在由医院医生密度所解释的小区域差异，以便检测供应商诱导需求（SID）的存在。研究设计为回顾性队列研究，使用2010年至2013年提交的福冈老年健康保险索赔数据。研究参与者包括51785名被诊断有进食困难的老年人。我们将胃造口术的使用指定为一个事件。然后使用多水平逻辑分析来调查SID的存在。在控制患者因素后，我们发现胃切除术使用存在显著的地区水平差异（中位数优势比[MOR]：1.72，1.37 - 2.51）。医院医生密度与胃造口术显著正相关（医院医生密度的调整后OR：1.75，1.25 - 2.45；P<0.001）。对于医院医生密度的输入变量，MOR大幅降低。我们发现老年人胃造口术使用的小区域差异可以由医院医生密度来解释，这可能表明存在SID。
