Bringing Responsibility for Small Area Variations in Hospitalization Rates Back to the Hospital
The Propensity to Hospitalize Index and a Test of the Roemer's Law
Bibliographic Data
| ID | 9099992 |
|---|---|
| Authors | Michael Shwartz (0000-0003-4840-1682, Boston University, corresponding author), Erol A Peköz (0000-0002-7459-7562, Boston University), Alan Labonte (VA Boston Healthcare System, corresponding author), Janelle Heineke (Boston University), Joseph D Restuccia (VA Boston Healthcare System, corresponding author) |
| Year | 2011 |
| Volume | 49 |
| Issue | 12 |
| Pages | 1062-1067 |
| Publication date | 2011-12-01 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0b013e3182353907 |
| PMID | 22002646 |
| OpenAlex | W2128349132 |
| Language | EN |
| Citations received | 1 |
| References cited | 17 |
OBJECTIVE: To assign responsibility for variations in small area hospitalization rates to specific hospitals and to evaluate the Roemer's Law in a way that does not artificially induce correlation between bed supply and utilization. DATA SOURCES/STUDY SETTING: We used data on hospitalizations and outpatient treatment for 15 medical conditions of nonmanaged care Part B eligible Medicare enrollees of 65 years and older in Massachusetts in 2000. STUDY DESIGN: We used a Bayesian model to estimate each hospital's pool of potential patients and the fraction of the pool hospitalized (its propensity to hospitalize, PTH). To evaluate the Roemer's Law, we calculated the correlation between hospitals' PTH and beds per potential patient. Patient severity was measured using All Patient Refined Diagnosis Related Groups. RESULTS: We show that our approach does not artificially induce a correlation between beds and utilization whereas the traditional approach does. Nevertheless, our approach indicates a strong relationship between PTH and beds (r=0.56). Eighteen (of 66) hospitals had a high PTH that differed significantly from 16 hospitals with a low PTH. Average patient severity in the high PTH hospitals was lower than in the low PTH hospitals. Although the difference was not statistically significant (P=0.12), there was a medium effect size (0.58). DISCUSSION: Variation across hospitals in the PTH index, the strong relationship between beds and the PTH, and the lack of relationship between severity and the PTH suggest the importance of policies that limit bed growth of high PTH hospitals and create incentives for high PTH hospitals to reduce hospitalizations
Correlation · Economics · Incentive · Emergency Medicine · Global Health Care Issues · Healthcare Policy and Management · Medicine · Primary Care and Health Outcomes
Variations in Medical Care among Small Areas
Small-Area Variations in the Use of Common Surgical Procedures
Hysterectomy
Hospitalization of medicaid children
Clinical Correlates of Small Area Variations in Population-based Admission Rates for Diabetes
Surgical Rate Variations
Small Area Variations in Hospitalization Rates
Variation in Hospital Admissions Among Small Areas
Is Hospital Competition Socially Wasteful
| Unique citing works | 1 |
|---|---|
| Citations per year | 0,09 |
| Citation span | 2015 - 2015 (1) |
| Citation velocity | historical |
| Highly cited | No |
| Citation types | Neutral: 1 |