Maheswaran R
Department of Epidemiology and Public Health, Imperial College School of Medicine, St. Mary's Hospital, London.
Public Health. 1997 Nov;111(6):411-5. doi: 10.1038/sj.ph.1900403.
Geographical variation in the utilisation of in-patient medical services for elderly people in a health district in England was examined in relation to supply of in-patient geriatric medical care and indicators of need. An ecological study design based on electoral wards was used. The health district had a resident population of 67,919 aged 65 y or more and was divided into three localities, each with a different supply of in-patient medical services for elderly people. Locality A had a traditional model of geriatric medical care, Locality B an integrated model and Locality C an age-related model. Localities A and C also had a high provision of general practice hospital beds. The main outcome measure was the age and sex standardised hospital admission ratio for people aged 65 y or more admitted under geriatric medicine, general medicine or general practice in April 1991-March 1992. There were 8829 admissions in 1991/2, 48% in general medicine, 40% in geriatric medicine and 12% in general practice, giving an overall unadjusted admission rate of 130 per 1000 population aged 65 y or more for the three specialties combined. Locality A had the highest, and Locality B the lowest, unadjusted admission rate for the three specialties combined. This rate remained highest in Locality A if second and subsequent admissions in the same period were excluded. Lengths of stay in geriatrics were longest in this locality but lengths of stay for the three specialties combined were similar in the three localities. Multiple regression was used to examine the effect of three indicators of need, the Jarman score, standardised mortality ratio and prevalence of limiting long-term illness, on standardised admission ratios at the electoral ward level. Jarman score had a significant independent association with the standardised admission ratio but adjustment for this factor did not alter the ranking of the three localities, with the standardised admission ratio remaining highest in Locality A. Subject to the limitations of the study, the results suggest that factors related to the supply of in-patient medical services may be associated with geographical variation in medical admissions for elderly people.
针对英格兰某健康区老年住院医疗服务的利用情况的地域差异，研究了其与老年住院医疗护理供应及需求指标的关系。采用了基于选区病房的生态研究设计。该健康区有67919名65岁及以上的常住人口，分为三个地区，每个地区为老年人提供的住院医疗服务各不相同。地区A采用传统的老年医疗护理模式，地区B采用综合模式，地区C采用与年龄相关的模式。地区A和C还提供大量的全科医院病床。主要结局指标是1991年4月至1992年3月期间，65岁及以上因老年医学、普通医学或全科医学入院患者的年龄和性别标准化住院率。1991/1992年有8829例入院病例，其中48%为普通医学，40%为老年医学，12%为全科医学，三个专科综合的总体未调整住院率为每1000名65岁及以上人口130例。地区A的三个专科综合未调整住院率最高，地区B最低。如果排除同期的二次及后续入院病例，该比率在地区A仍然最高。老年医学的住院时间在该地区最长，但三个专科综合的住院时间在三个地区相似。采用多元回归分析选区层面需求的三个指标（贾曼评分、标准化死亡率和长期慢性病患病率）对标准化住院率的影响。贾曼评分与标准化住院率有显著的独立关联，但对该因素进行调整并未改变三个地区的排名，地区A的标准化住院率仍然最高。在研究的局限性范围内，结果表明与住院医疗服务供应相关的因素可能与老年人医疗入院的地域差异有关。
