Perrin J M, Homer C J, Berwick D M, Woolf A D, Freeman J L, Wennberg J E
Children's Service, Massachusetts General Hospital, Boston 02114.
N Engl J Med. 1989 May 4;320(18):1183-7. doi: 10.1056/NEJM198905043201805.
Hospitalization accounts for a large portion of the expenditures for child health care, and differences in the rate of hospitalization may produce important variations in the cost of that care. We studied the rates of hospitalization in Boston, Rochester (N.Y.), and New Haven (Conn.) in 1982. We assigned the risk of hospitalization in Rochester a score of 1.00. Boston children were hospitalized at more than twice the rate of Rochester children for most medical diagnostic categories (relative risk, 2.65; 95 percent confidence interval, 2.53 to 2.78), and the rate for the New Haven group was intermediate (relative risk, 1.80; 95 percent confidence interval, 1.68 to 1.93). Rates of inpatient surgery differed less (Boston relative risk, 1.12; New Haven relative risk, 0.93). The relative risks of hospitalization (as compared with Rochester children) for Boston and New Haven children, respectively, were 3.8 and 2.3 for asthma, 6.1 and 2.9 for toxic ingestions, and 2.6 and 2.7 for head injuries. Fractures of the femur, appendicitis, and bacterial meningitis (conditions uniformly treated in the hospital) had similar rates of hospitalization across the three cities, but the relative risk of hospitalization for aseptic meningitis was 3.7 in Boston. The rates of hospitalization of children in all three communities were below the national averages in 1982. Although this study does not define the reasons for the variation in rates of hospitalization, it is possible that they were related in part to differences in socioeconomic status or access to primary care. The implications of these data for the cost and quality of pediatric care therefore remain to be determined.
住院治疗占儿童医疗保健支出的很大一部分，住院率的差异可能会导致该保健成本产生重大变化。我们研究了1982年波士顿、罗切斯特（纽约州）和纽黑文（康涅狄格州）的住院率。我们将罗切斯特的住院风险评分为1.00。在大多数医疗诊断类别中，波士顿儿童的住院率是罗切斯特儿童的两倍多（相对风险为2.65；95%置信区间为2.53至2.78），纽黑文组的住院率处于中间水平（相对风险为1.80；95%置信区间为1.68至1.93）。住院手术率的差异较小（波士顿相对风险为1.12；纽黑文相对风险为0.93）。波士顿和纽黑文儿童相对于罗切斯特儿童的住院相对风险，哮喘分别为3.8和2.3，中毒分别为6.1和2.9，头部受伤分别为2.6和2.7。股骨骨折、阑尾炎和细菌性脑膜炎（均在医院进行治疗的病症）在三个城市的住院率相似，但波士顿无菌性脑膜炎的住院相对风险为3.7。1982年，这三个社区儿童的住院率均低于全国平均水平。尽管这项研究没有明确住院率差异的原因，但有可能部分与社会经济地位或获得初级保健的机会差异有关。因此，这些数据对儿科护理成本和质量的影响仍有待确定。
