Influence of bed supply and health care organization on regional and local patterns of diabetes related hospitalization

Brown, Laurie; Barnett, Jon

doi:10.1016/0277-9536(92)90228-i

Cited by 22 publications

(7 citation statements)

References 38 publications

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“…We used the HRR density characteristic because demand is typically higher when travel distances are shorter (Goodman et al 1997). We used the number of hospitals, MDs, oncologists per MD, and percentage of hospitals with oncology facilities because demand increases when more facilities are available (Ginsburg and Koretz 1983;Rohrer 1990;Roemer 1991;Brown and Barnett 1992). We used both the number of hospitals and MDs and the more chemotherapy-relevant measure of percentage of hospitals with oncology facilities and percentage of oncologists.…”

Section: Datamentioning

confidence: 99%

Variation in Chemotherapy Utilization in Ovarian Cancer: The Relative Contribution of Geography

Polsky

Armstrong²,

Randall

et al. 2006

Health Services Research

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Objective. This study investigates geographic variation in chemotherapy utilization for ovarian cancer in both absolute and relative terms and examines area characteristics associated with this variation. Data Sources. Surveillance, Epidemiology, and End Results (SEER) Medicare data from 1990 to 2001 for Medicare patients over 65 with a diagnosis of ovarian cancer between 1990 and 1999. Chemotherapy within a year of diagnosis was identified by Medicare billing codes. The hospital referral region (HRR) represents the geographic unit of analysis. Study Design. A logit model predicting the probability of receiving chemotherapy by each of the 39 HRRs. Control variables included medical characteristics (patient age, stage, year of diagnosis, and comorbidities) and socioeconomic characteristics (race, income, and education). The variation among HRRs was tested by the w 2 statistic, and the relative contribution was measured by the o statistic. HHR market characteristic are then used to explain HRR-level variation. Principal Findings. The average chemotherapy rate was 56.6 percent, with a range by HRR from 33 percent to 67 percent. There were large and significant differences in chemotherapy use between HRRs, reflected by a w 2 for HRR of 146 (df 5 38, po.001). HRR-level variation in chemotherapy use can be partially explained by higher chemotherapy rates in HRRs with a higher percentage of hospitals with oncology services. However, an o analysis indicates that, by about 15 to one, the variation between patients in use of chemotherapy reflects variations in patient characteristics rather than unexplained variation among HRRs. Conclusions. While absolute levels of chemotherapy variation between geographic areas are large and statistically significant, this analysis suggests that the role of geography in determining who gets chemotherapy is small relative to individual medical characteristics. Nevertheless, while variation by medical characteristics can be medically justified, the same cannot be said for geographic variation. Our finding that density of oncology hospitals predicts chemotherapy use suggests that provider supply is positively correlated with geographic variation.

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Section: Datamentioning

confidence: 99%

Variation in Chemotherapy Utilization in Ovarian Cancer: The Relative Contribution of Geography

Polsky

Armstrong²,

Randall

et al. 2006

Health Services Research

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“…on the impact of poverty on levels of general practitioner (GP) use (Barnett 2000a, 2001), which suggested a need to explore the wider health system implications of such trends. There has also been very little research in New Zealand that has examined changes in hospital admission patterns (Brown & Barnett 1992, Jackson et al . 1998, Ministry of Health 1999, Tukuitonga et al .…”

Section: Introductionmentioning

confidence: 99%

Urban deprivation and public hospital admissions in Christchurch, New Zealand, 1990-1997

Barnett¹,

Lauer²

2003

Health &Amp; Social Care in the Community

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The present paper examines the relationship between deprivation and changing patterns of public hospital admissions in Christchurch, New Zealand, between 1992 and 1997, during a time of economic restructuring and rapid change in the health sector. The total set of admissions into Christchurch Hospital was geocoded according to the meshblock domicile of each patient. Domiciles were classified into 10 decile categories using the NZDep91 and NZDep96 measures of deprivation. Regression analysis was used to measure changes in the relationship between deprivation and different types of admissions. Differences between admission rates for people living in the most and least deprived areas increased over time, especially following the implementation of the 1993 health reforms. This was most marked for younger adults (ages = 25-44 years), day patients, and especially, acute day patients, ambulatory-care-sensitive admissions and re-admissions. The average length of stay also varied by deprivation and appeared to be an important cause of the increasingly high rate of re-admissions. On average, patients from more affluent areas are hospitalised longer than low-income patients, although the differences narrow over time. The results suggest that the widening social gap in hospitalisation rates is a result of the effects of poverty and problems of access to primary care. However, more research on different admission pathways and causes of admissions for different patients from different parts of the city is needed to confirm these observations.

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“…Although volume of outpatient care has received more attention over the past decade (Burgess and DeFiore 1994; McCarthy and Blow 2004), few studies have evaluated the impact of accessibility barriers on continuity (Holloway, Vanderbrug, and Bromberg 1990; Piette and Moos 1996; Druss and Rosenheck 1997; Schmitt, Phibbs, and Piette 2003). With few exceptions (Bindman, Keane, and Lurie 1990), availability barriers have been assessed only in terms of volume of institutional care (Ginsburg and Koretz 1983; Brown and Barnett 1992).…”

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confidence: 99%

Veterans Affairs Health System and Mental Health Treatment Retention among Patients with Serious Mental Illness: Evaluating Accessibility and Availability Barriers

McCarthy

Blow

Valenstein

et al. 2006

Health Services Research

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Objective. We examine the impact of two dimensions of access--geographic accessibility and availability--on VA health system and mental health treatment retention among patients with serious mental illness (SMI). Methods. Among 156,631 patients in the Veterans Affairs (VA) health care system with schizophrenia or bipolar disorder in fiscal year 1998 (FY98), we used Cox proportional hazards regression to model time to first 12-month gap in health system utilization, and in mental health services utilization, by the end of FY02. Geographic accessibility was operationalized as straight-line distance to nearest VA service site or VA psychiatric service site, respectively. Service availability was assessed using countylevel VA hospital beds and non-VA beds per 1,000 county residents. Patients who died without a prior gap in care were censored.Results. There were 32, 943 patients (21 percent) with a 12-month gap in health system utilization; 65,386 (42 percent) had a 12-month gap in mental health services utilization. Gaps in VA health system utilization were more likely if patients were younger, nonwhite, unmarried, homeless, nonservice-connected, if they had bipolar disorder, less medical morbidity, an inpatient stay in FY98, or if they lived farther from care or in a county with fewer VA inpatient beds. Similar relationships were observed for mental health, however being older, female, and having greater morbidity were associated with increased risks of gaps, and number of VA beds was not significant. Conclusions. Geographic accessibility and resource availability measures were associated with long-term continuity of care among patients with SMI. Increased distance from providers was associated with greater risks of 12-month gaps in health system and mental health services utilization. Lower VA inpatient bed availability was associated with increased risks of gaps in health system utilization. Study findings may inform efforts to improve treatment retention.

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Influence of bed supply and health care organization on regional and local patterns of diabetes related hospitalization

Cited by 22 publications

References 38 publications

Variation in Chemotherapy Utilization in Ovarian Cancer: The Relative Contribution of Geography

Variation in Chemotherapy Utilization in Ovarian Cancer: The Relative Contribution of Geography

Urban deprivation and public hospital admissions in Christchurch, New Zealand, 1990-1997

Veterans Affairs Health System and Mental Health Treatment Retention among Patients with Serious Mental Illness: Evaluating Accessibility and Availability Barriers

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