DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark.
Department of Public Health, Aarhus University, 8000 Aarhus, Denmark.
Int J Environ Res Public Health. 2024 Jul 25;21(8):973. doi: 10.3390/ijerph21080973.
The complexity of variation in healthcare, particularly in mental health, remains poorly understood. However, addressing this issue presents an opportunity to opti-mise the allocation of scarce healthcare resources. To explore this, we investigated the variation in psychiatric care measured as the number of psychiatric hospitalisations. We estimated multiple-membership multiple-classification models utilising Danish register data for 64,694 individuals and their healthcare providers, including 2101 general practitioners, 146 community-based care institutions, 46 hospital departments, and 98 municipalities. This approach recognised that data are not strictly hierarchical. We found that, among individuals attending a single healthcare provider, 67.4% of the total variance in the number of hospitalisations corresponds to differences between individuals, 22.6% to differences between healthcare providers' geographical location, 7.02% to differences between healthcare providers, and 3% to differences between the geographical locations of the individuals. Adding characteristics to the model ex-plained 68.5% of the variance at the healthcare provider geographical level, but almost no explanation of the variation was found on the three other levels despite the nu-merous characteristics considered. This suggests that medical practice may vary un-warrantedly between healthcare providers, indicating potential for optimisation. Streamlining medical practices, such as adhering to clinical guidelines, could lead to more efficient supply of mental health resources. In conclusion, understanding and addressing variation in psychiatric care may impact resource allocation and patient outcomes, ultimately leading to a more effective healthcare system.
医疗保健的变异性十分复杂，尤其是在精神健康领域，目前人们对此仍缺乏了解。然而，解决这一问题为优化稀缺医疗资源的分配提供了机会。为了探究这一点，我们研究了精神科护理的变异性，具体表现为精神科住院人数。我们利用丹麦的登记数据，对 64694 名个人及其医疗保健提供者（包括 2101 名全科医生、146 个社区护理机构、46 个医院科室和 98 个市）进行了多次成员多分类模型的估计。这种方法认识到数据并不是严格分层的。我们发现，在只看一个医疗保健提供者的人群中，住院人数的总方差中，有 67.4%归因于个体间的差异，22.6%归因于医疗保健提供者地理位置的差异，7.02%归因于医疗保健提供者间的差异，3%归因于个体地理位置的差异。在模型中加入特征解释了医疗保健提供者地理位置水平上 68.5%的方差，但尽管考虑了许多特征，在其他三个水平上几乎没有发现变异的解释。这表明医疗实践在医疗保健提供者之间可能存在不必要的差异，这表明存在优化的潜力。简化医疗实践，例如遵循临床指南，可能会导致精神卫生资源的供应更有效率。总之，理解和解决精神科护理的变异性可能会影响资源分配和患者的结果，最终导致更有效的医疗保健系统。
