Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Health Administration Program, Faculty of Business & Management, Universiti Teknologi MARA, Selangor, Malaysia.
Int J Equity Health. 2021 Mar 16;20(1):80. doi: 10.1186/s12939-021-01415-4.
Variation in health care delivery among regions and hospitals has been observed worldwide and reported to have resulted in health inequalities. Regional variation of percutaneous coronary intervention (PCI) was previously reported in Japan. This study aimed to assess the small-area and hospital-level variations and to examine the influence of patient and hospital characteristics on the use of PCI.
Data provided by the Fukuoka Prefecture Latter-stage Elderly Insurance Association was used. There were 11,821 patients aged ≥65 years with acute coronary syndromes who were identified from 2015 to 2017. Three-level multilevel logistic regression analyses were performed to quantify the small-area and hospital variations, as well as, to identify the determinants of PCI use.
The results showed significant variation (δ = 0.744) and increased PCI use (MOR = 2.425) at the hospital level. After controlling patient- and hospital-level characteristics, a large proportional change in cluster variance was found at the hospital level (PCV 14.7%). Fixed-effect estimation results showed that females, patients aged ≥80 years old, hypertension and dyslipidemia had significant association with the use of PCI. Hospitals with high physician density had a significantly positive relationship with PCI use.
Patients receiving care in hospitals located in small areas have equitable access to PCI. Hospital-level variation might be originated from the oversupply of physicians. A balanced number of physicians and beds should be taken into consideration during healthcare allocation. A treatment process guideline on PCI targeting older patients is also needed to ensure a more equitable access for healthcare resources.
世界各地都观察到医疗保健服务在地区和医院之间存在差异，并报告称这导致了健康不平等。日本曾报道过经皮冠状动脉介入治疗（PCI）的区域差异。本研究旨在评估小区域和医院层面的差异，并研究患者和医院特征对 PCI 使用的影响。
本研究使用了由福冈县后期老年人保险协会提供的数据。从 2015 年到 2017 年，共确定了 11821 名年龄≥65 岁的急性冠状动脉综合征患者。采用三级多水平逻辑回归分析来量化小区域和医院层面的差异，并确定 PCI 使用的决定因素。
结果显示医院层面存在显著差异（δ=0.744）和 PCI 使用增加（MOR=2.425）。在控制了患者和医院层面的特征后，发现医院层面的聚类方差发生了较大的比例变化（PCV 为 14.7%）。固定效应估计结果表明，女性、≥80 岁的患者、高血压和血脂异常与 PCI 使用有显著关联。医生密度高的医院与 PCI 使用呈显著正相关。
在小区域内接受治疗的患者可以公平地获得 PCI。医院层面的差异可能源于医生的过度供应。在医疗资源分配中，应考虑到医生和床位的平衡数量。还需要制定针对老年患者的 PCI 治疗流程指南，以确保更公平地获得医疗资源。
