Rosenlund Ingvild Mathiesen, Leivseth Linda, Førde Olav Helge, Revhaug Arthur
a Department of Clinical Medicine , UiT The Arctic University of Norway , Tromsø , Norway.
b Centre for Clinical Documentation and Evaluation , Northern Norway Regional Health Authority , Tromsø , Norway.
Scand J Gastroenterol. 2018 Oct-Nov;53(10-11):1228-1235. doi: 10.1080/00365521.2018.1506047. Epub 2018 Sep 28.
To investigate the use of specialized health care services for diverticular disease in different hospital referral regions in Norway.
Nationwide cross-sectional study with data from the Norwegian Patient Registry and Statistics Norway. All Norwegian inhabitants aged 40 years and older in the years 2012-16 (2,517,938) were included. We obtained the rates (n/100,000 population) for hospitalizations, outpatient appointments, and surgery for diverticular disease for the population in each hospital referral region. We also quantified the use of lower gastrointestinal (LGI) endoscopy in hospitalizations and outpatient appointments for diverticular disease and the use of LGI endoscopy performed on any indication.
There were 131 hospitalizations and 381 outpatient appointments for diverticular disease per 100,000 population annually. Hospitalization rates varied 1.9-fold across regions from 94 to 175. Outpatient appointment rates varied 2.5-fold across regions from 258 to 655. Outpatient appointments were strongly correlated to hospitalizations (r=0.75, p < .001) and outpatient LGI endoscopy for any indication (r=0.67, p < .001). Hospitalization and surgery rates remained stable over the study period, while outpatient appointment rates increased by 37%. Concurrently, rates of outpatient LGI endoscopy performed on any indication increased by 35%.
There was considerable regional variation in both hospitalizations and outpatient appointments for diverticular disease. The extent of variation and the correlation with diagnostic intensity of LGI endoscopy indicate that the regional variation in health care utilization for diverticular disease to a large extent can be explained by regional differences in clinical practice rather than disease burden.
调查挪威不同医院转诊地区憩室病专科医疗服务的使用情况。
基于挪威患者登记处和挪威统计局的数据进行全国性横断面研究。纳入了2012 - 2016年所有年龄在40岁及以上的挪威居民（2,517,938人）。我们获取了每个医院转诊地区憩室病住院、门诊预约及手术的发生率（每10万人口中的病例数）。我们还对憩室病住院和门诊预约中低位胃肠道（LGI）内镜检查的使用情况以及任何适应证下LGI内镜检查的使用情况进行了量化。
每年每10万人口中憩室病住院病例有131例，门诊预约有381例。各地区住院率从94到175不等，相差1.9倍。各地区门诊预约率从258到655不等，相差2.5倍。门诊预约与住院（r = 0.75，p < 0.001）以及任何适应证下的门诊LGI内镜检查（r = 0.67，p < 0.001）密切相关。在研究期间，住院率和手术率保持稳定，而门诊预约率增加了37%。同时，任何适应证下门诊LGI内镜检查的使用率增加了35%。
憩室病的住院和门诊预约在地区间存在显著差异。差异程度以及与LGI内镜检查诊断强度的相关性表明，憩室病医疗服务利用的地区差异在很大程度上可由临床实践的地区差异而非疾病负担来解释。
