Goodman D C, Fisher E S, Gittelsohn A, Chang C H, Fleming C
Department of Pediatrics, Dartmouth Medical School, Hanover, NH 03756.
Pediatrics. 1994 Jun;93(6 Pt 1):896-902.
Pediatric medical discharge rates vary widely across hospital service areas, beyond differences explained by chance or disease incidence alone. This study examines the relationship between the characteristics of local medical services and the likelihood of hospitalization.
Small area and population-based regression analysis.
The 72 hospital service areas of Maine, New Hampshire, and Vermont.
The 589,290 (1989) children of Maine, New Hampshire, and Vermont < 15 years of age with 120,806 discharges during 1985 through 1989.
Using logistic regression and controlling for community income, we found that children residing in zip codes with high per capita bed supply (4.0/1000) had 9% more discharges (odds ratio: 1.09; 99% confidence interval: 1.07, 1.11) compared with children in areas with low per capita bed supply (1.9/1000). Children living 30 minutes from the nearest hospital had 15% fewer medical discharges (odds ratio: 0.849; confidence interval: 0.830, 0.867) than those living in a zip code with a hospital. Residence in one of the three academic medical center hospital service areas resulted in 32% fewer discharges (odds ratio: 0.68; confidence interval: 0.66, 0.70). Similar and statistically significant (P < .01) results were noted for the most common nonperinatal diagnostic categories: asthma/bronchitis (diagnostic related group = 98) and gastroenteritis (diagnostic related group = 184). No effect was noted for femur fracture, a condition for which admission rates equal disease incidence.
The supply and character of medical care are important influences on the likelihood of hospitalization for pediatric medical conditions for which outpatient alternatives are available.
儿科医疗出院率在各医院服务区之间差异很大，这一差异超出了仅由偶然因素或疾病发病率所解释的范围。本研究探讨了当地医疗服务特征与住院可能性之间的关系。
基于小区域和人群的回归分析。
缅因州、新罕布什尔州和佛蒙特州的72个医院服务区。
1985年至1989年期间，缅因州、新罕布什尔州和佛蒙特州15岁以下的589,290名儿童（1989年数据），共有120,806次出院记录。
使用逻辑回归并控制社区收入后，我们发现，与人均床位供应低（1.9/1000）地区的儿童相比，居住在人均床位供应高（4.0/1000）邮政编码地区的儿童出院率高9%（比值比：1.09；99%置信区间：1.07, 1.11）。距离最近医院30分钟路程的儿童医疗出院率比居住在有医院的邮政编码地区的儿童低15%（比值比：0.849；置信区间：0.830, 0.867）。居住在三个学术医疗中心医院服务区之一的儿童出院率低32%（比值比：0.68；置信区间：0.66, 0.70）。对于最常见的非围产期诊断类别：哮喘/支气管炎（诊断相关组 = 98）和肠胃炎（诊断相关组 = 184），也观察到了类似且具有统计学意义（P < .01）的结果。对于股骨骨折未观察到影响，该疾病的入院率与疾病发病率相等。
医疗服务的供应和性质对有门诊替代方案的儿科疾病住院可能性有重要影响。
