Westphal J R, Horswell R, Kumar S, Rush J
Department of Psychiatry, Louisiana State University Medical Center at Shreveport, LA 71130-3932, USA.
Convuls Ther. 1997 Dec;13(4):242-52.
The objective of this study was to quantify inpatient electroconvulsive therapy (ECT) utilization and its practice variation within the State of Louisiana using Medicare data for beneficiaries age 65 years and older. The Louisiana Medicare claims (MedPar) history and the Medicare beneficiary denominator files for fiscal years 1993 and 1994 were used for analysis. Statistical techniques used were: chi 2 to determine significance of the proposed null hypothesis, and the modified systemic component of variance (SCV) to determine the magnitude of variation between the individual parish utilization rates for ECT. The ECT utilization rate for the Louisiana Medicare population was found to be 2.38 per 10,000 person-years, falling well within the range of previous ECT utilization studies in the United States. The chi 2 value was 0.0003 when comparing parishes, indicating the presence of significant nonrandom variation. The SCVs of inpatient treatment for major depression and impatient ECT were 0.47 and 1.34, respectively. Inpatient ECT in this population demonstrates high geographic variability. Further research is required to determine and quantitate the factors responsible for the geographic variation in inpatient ECT utilization within the Louisiana Medicare population.
本研究的目的是利用65岁及以上受益人的医疗保险数据，对路易斯安那州住院患者的电休克治疗（ECT）使用情况及其实践差异进行量化。分析使用了1993年和1994财年路易斯安那州的医疗保险理赔（MedPar）历史记录和医疗保险受益人数分母文件。所使用的统计技术包括：卡方检验以确定所提出的零假设的显著性，以及修正的系统方差分量（SCV）以确定各教区ECT个体使用率之间的差异程度。路易斯安那州医疗保险人群的ECT使用率为每10000人年2.38例，完全处于美国此前ECT使用情况研究的范围内。比较各教区时，卡方值为0.0003，表明存在显著的非随机差异。重度抑郁症住院治疗和住院ECT的SCV分别为0.47和1.34。该人群中的住院ECT显示出较高的地理变异性。需要进一步研究以确定并量化导致路易斯安那州医疗保险人群住院ECT使用情况地理差异的因素。
