Arora Sandeepa, Cheung C Ronny, Sherlaw-Johnson Christopher, Hargreaves Dougal S
Research team, The Nuffield Trust, London, UK.
Department of Medicine, Imperial College London, London, UK.
BMJ Open. 2018 Jul 10;8(7):e022339. doi: 10.1136/bmjopen-2018-022339.
To develop a method for calculating age-specific hospital catchment populations (HCPs) for children and young people (CYP) in England. To show how these methods allow geographical variation in hospital activity to be investigated and addressed more effectively.
Retrospective, secondary analysis of existing national datasets.
Inpatient care of CYP (0-18 years) in England.
Hospital Episode Statistics (HES) data were accessed for all inpatient admissions (elective and emergency) for CYP from birth to 18 years, 364 days, for 2011/2012-2014/2015. In 2014/2015, 857 112 admissions were analysed, from an eligible population of approximately 11.9 million CYP.
For each hospital Trust, the catchment population of CYP was calculated; Trust-level admission rates per thousand per year were then calculated for admissions due to (1) any diagnostic code, (2) primary diagnosis of epilepsy and (3) epilepsy listed as primary diagnosis or comorbidity.
Estimated 2014/2015 HCPs for CYP ranged from 268 558 for Barts Health NHS Trust to around 30 000 for the smallest acute general paediatric services and below 10 000 for many Trusts providing specialist services. As expected, the composition of HCPs was fairly consistent for age breakdown but levels of deprivation varied widely. After standardising for population characteristics, admission rates with a primary diagnosis of epilepsy ranged from 14.3 to 157.7 per 100 000 per year (11.0-fold variation) for Trusts providing acute general paediatric services. All-cause admission rates showed less variation, ranging from 4033 to 11 681 per 100 000 per year (2.9-fold variation).
Use of age-specific catchment populations allows variation in hospital activity to be linked to specific teams and care pathways. This provides an evidence base for initiatives to tackle unwarranted variation in healthcare activity and health outcomes.
开发一种计算英格兰儿童和青少年特定年龄组医院服务人口（HCP）的方法。展示这些方法如何更有效地调查和解决医院医疗活动中的地理差异。
对现有国家数据集进行回顾性二次分析。
英格兰0至18岁儿童和青少年的住院治疗。
获取了2011/2012 - 2014/2015年期间所有0至18岁儿童和青少年住院患者（包括择期和急诊）的医院事件统计（HES）数据，为期364天。2014/2015年，对857112例住院病例进行了分析， eligible人群约为1190万儿童和青少年。
计算每个医院信托基金的儿童和青少年服务人口；然后计算信托基金层面每年每千例中因（1）任何诊断代码、（2）癫痫的主要诊断和（3）列为主要诊断或合并症的癫痫的住院率。
2014/2015年儿童和青少年的估计HCP范围从巴茨健康国民保健服务信托基金的268558例到最小的急性普通儿科服务机构的约30000例，以及许多提供专科服务的信托基金的10000例以下。正如预期的那样，HCP的年龄构成在年龄细分上相当一致，但贫困程度差异很大。在对人口特征进行标准化后，提供急性普通儿科服务的信托基金中，癫痫主要诊断的住院率每年每10万人从14.3至157.7例（相差11.0倍）。全因住院率差异较小，每年每10万人从4033至11681例（相差2.9倍）。
使用特定年龄组的服务人口可将医院医疗活动的差异与特定团队和护理路径联系起来。这为解决医疗保健活动和健康结果中不必要的差异的举措提供了证据基础。
