Javitt J C, Kendix M, Tielsch J M, Steinwachs D M, Schein O D, Kolb M M, Steinberg E P
Worthen Center for Eye Care Research, Department of Ophthalmology, Georgetown University Medical Center, Washington, DC 20007.
Med Care. 1995 Jan;33(1):90-105. doi: 10.1097/00005650-199501000-00008.
Cataract surgery is the most frequently performed surgical procedure on Medicare beneficiaries, with an annual cost to the Medicare program of more than $3.4 billion. In this study, the relationship between demographic, environmental, and provider-related factors, and the likelihood that cataract surgery will be performed on a Medicare beneficiary were assessed. The association between likelihood of cataract surgery and patient age, sex, race, income, and latitude of residence was examined, as was the association with the supply of ophthalmologists and optometrists in each region, and the allowed charge for cataract surgery and cost of practice in a region. This cross-sectional, population-based study used administrative data. Both regional models, using least-squares regression and person-based models, using logistic regression were employed. A random 5% sample of 1986 and 1987 Medicare beneficiaries, 65 years of age and older, were included in the study. Medicare beneficiaries who lacked continuous Part A and Part B coverage during 1986 and 1987, or who were enrolled in a health maintenance organization at any time during this 2-year period of observation were excluded from the study to make certain that complete utilization data were available for each individual. Rate of cataract surgery per 1,000 Medicare beneficiaries in each Bureau of Economic Analysis Economic Area (BEAEA) and the likelihood of an individual with particular characteristics undergoing cataract surgery were determined in separate regression models. The mean annual rate of cataract surgery during 1986 and 1987 in the 181 BEAEAs was 25.4 surgeries per 1,000 persons 65 years of age or older (standard deviation = 6.2, coefficient of variation = 0.24). Both the regional model and the person-based model detected an association between a higher rate of and personal likelihood of cataract surgery and female gender, more southerly latitude, higher concentration of optometrists per 1,000 Medicare beneficiaries, and higher allowed charge for cataract surgery, after adjusting for variation in practice expense. The person-based model additionally demonstrated that increased likelihood of undergoing cataract surgery was associated with increasing age from 65 to 94 years, white race, and living in a zip-code area with mean income greater than $15,000. Neither analysis detected a statistically significant association between the concentration of ophthalmologists per 1,000 Medicare beneficiaries and the regional rate of, or an individual's likelihood of, cataract surgery. Compared with the geographic variation in provision of other surgical procedures, the variation in cataract surgery across large geographic areas observed in this analysis was relatively low.(ABSTRACT TRUNCATED AT 400 WORDS)
白内障手术是医疗保险受益人中最常施行的外科手术，医疗保险项目每年为此花费超过34亿美元。在本研究中，评估了人口统计学、环境及与医疗服务提供者相关的因素，以及医疗保险受益人接受白内障手术可能性之间的关系。研究了白内障手术可能性与患者年龄、性别、种族、收入及居住纬度之间的关联，还研究了与各地区眼科医生和验光师供给量，以及白内障手术允许收费和地区医疗执业成本之间的关联。这项基于人群的横断面研究使用了行政数据。采用了两种模型，一种是使用最小二乘法回归的区域模型，另一种是使用逻辑回归的基于个体的模型。研究纳入了1986年和1987年65岁及以上医疗保险受益人的5%随机样本。将在1986年和1987年期间缺乏连续A部分和B部分保险，或在此2年观察期内任何时间加入健康维护组织的医疗保险受益人排除在研究之外，以确保可获得每个个体的完整利用数据。在单独的回归模型中确定了每个经济分析局经济区（BEAEA）每1000名医疗保险受益人中的白内障手术率，以及具有特定特征个体接受白内障手术的可能性。1986年和1987年期间，181个BEAEA地区的白内障手术年均率为每1000名65岁及以上人群中有25.4例手术（标准差=6.2，变异系数=0.24）。在调整了执业费用差异后，区域模型和基于个体的模型均发现，白内障手术率和个体接受白内障手术可能性较高与女性、更靠南的纬度、每1000名医疗保险受益人中验光师集中度较高，以及白内障手术允许收费较高之间存在关联。基于个体的模型还表明，接受白内障手术可能性增加与年龄从65岁至94岁增加、白人种族以及居住在平均收入超过15000美元的邮政编码地区有关。两种分析均未发现每1000名医疗保险受益人中眼科医生集中度与白内障手术区域率或个体接受白内障手术可能性之间存在统计学上的显著关联。与其他外科手术提供方面的地理差异相比，本分析中观察到的大地理区域间白内障手术差异相对较小。（摘要截选至400词）
