到社区医疗服务机构的距离与住院可能性：距离越近就总是越好吗？
The distance to community medical care and the likelihood of hospitalization: is closer always better?
作者信息
Goodman D C, Fisher E, Stukel T A, Chang C
机构信息
Department of Pediatrics, Dartmouth Medical School, Hanover, NH 03755-3862, USA.
出版信息
Am J Public Health. 1997 Jul;87(7):1144-50. doi: 10.2105/ajph.87.7.1144.
OBJECTIVES
This study examined the influence that distance from residence to the nearest hospital had on the likelihood of hospitalization and mortality.
METHODS
Hospitalizations were studied for Maine. New Hampshire, and Vermont during 1989 (adults) and for 1985 through 1989 (children) and for mortality (1989) in Medicare enrollees.
RESULTS
After other known predictors of hospitalization (age, sex, bed supply, median household income, rural residence, academic medical center, and presence of nursing home patients) were controlled for, the adjusted rate ratio of medical hospitalization for residents living more than 30 minutes away was 0.85 (95% confidence interval [CI] = 0.82, 0.88) for adults and 0.78 (95% CI = 0.74, 0.81) for children, compared with those living in a zip code with a hospital. Similar effects were seen for the four most common diagnosis-related groups for both adults and children. The likelihood of hospitalization for conditions usually requiring hospitalization and for mortality in the elderly did not differ by distance.
CONCLUSIONS
Distance to the hospital exerts an important influence on hospitalization rates that is unlikely to be explained by illness rates.
目的
本研究探讨了居住地与最近医院的距离对住院可能性和死亡率的影响。
方法
对缅因州、新罕布什尔州和佛蒙特州1989年（成人）以及1985年至1989年（儿童）的住院情况进行研究，并对医疗保险参保者1989年的死亡率进行研究。
结果
在控制了其他已知的住院预测因素（年龄、性别、床位供应、家庭收入中位数、农村居住情况、学术医疗中心以及养老院患者的存在）后，与居住在有医院的邮政编码地区的居民相比，居住在距离医院超过30分钟路程的居民，成人的医疗住院调整率比为0.85（95%置信区间[CI]=0.82，0.88），儿童为0.78（95%CI=0.74，0.81）。成人和儿童的四个最常见诊断相关组均出现类似效果。通常需要住院治疗的疾病的住院可能性以及老年人的死亡率在不同距离之间没有差异。
结论
与发病率无关，距离医院的远近对住院率有重要影响。
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