医疗保健服务区域定义在捕捉住院护理和健康社会决定因素差异方面的表现

IF 3.1 2区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Hannah Crook BSPH, Manuel Horta MEd, Kenneth A. Michelson MD, MPH, John A. Graves PhD
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引用次数: 0

摘要

目标量化医疗保健服务区 (HCSA) 的定义在多大程度上反映了住院情况以及健康的社会决定因素 (SDOH) 的异质性。数据来源和研究背景地理空间数据来自医疗保险和医疗补助服务中心、人口普查局和达特茅斯研究所。驾车时间等时线来自 MapBox。地区贫困指数(ADI)数据。来自亚利桑那州、佛罗里达州、爱荷华州、马里兰州、内布拉斯加州、新泽西州、纽约州和威斯康星州的 2017 年住院病人出院数据、州急诊科数据库和州住院病人数据库、医疗保健成本与利用项目、医疗保健研究与质量局;以及 48 个州的收费服务医疗保险数据。我们比较了不同人群和不同医院类型的每种 HCSA 定义的捕获率。我们使用每个 HCSA 内各邮政编码之间 ADI 的变异系数来衡量 SDOH 的异质性。主要研究结果HCSA 定义捕获的住院病人出院率范围很广,从公共使用微数据区 (PUMA) 的 20% 到 50% 到大都会统计区 (MSA) 的 93% 到 97%。四分之三的住院病人出院来自与病人居住地邮政编码相同的县内机构,近三分之二的住院病人出院来自相同的医院服务区。从医院角度来看,74.7% 的住院病人出院来自 30 分钟车程内的医院,90.1% 来自 60 分钟车程内的医院。教学医院的捕获率最低。PUMAs和基于车程的HCSAs涵盖的人口更为单一,而MSAs、通勤区和医院转诊区捕获的差异最大。此外,研究人员在决定使用哪个 HCSA 时,需要在捕获率和人口同质性之间进行权衡。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Performance of health care service area definitions for capturing variation in inpatient care and social determinants of health

Performance of health care service area definitions for capturing variation in inpatient care and social determinants of health

Objective

To quantify the degree to which health care service area (HCSA) definitions captured hospitalizations and heterogeneity in social determinants of health (SDOH).

Data Sources and Study Setting

Geospatial data from the Centers for Medicare and Medicaid Services, the Census Bureau, and the Dartmouth Institute. Drive-time isochrones from MapBox. Area Deprivation Index (ADI) data. 2017 inpatient discharge data from Arizona, Florida, Iowa, Maryland, Nebraska, New Jersey, New York, and Wisconsin, State Emergency Department Databases and State Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality; and Fee-For-Service Medicare data in 48 states.

Study Design

Cross-sectional, descriptive analysis.

Data Collection/Extraction Methods

The capture rate was the percentage of inpatient discharges occurring in the same HCSA as the hospital. We compared capture rates for each HCSA definition for different populations and by hospital type. We measured SDOH heterogeneity using the coefficient of variation of the ADI among ZIP codes within each HCSA.

Principal Findings

HCSA definitions captured a wide range of inpatient discharges, ranging from 20% to 50% for Public Use Microdata Areas (PUMAs) to 93%–97% for Metropolitan Statistical Areas (MSAs). Three-quarters of inpatient discharges were from facilities within the same county as the patient's residential ZIP code, while nearly two-thirds were within the same Hospital Service Area. From the hospital perspective, 74.7% of inpatient discharges originated from within a 30-min drive and 90.1% within a 60-min drive. Capture rates were the lowest for teaching hospitals. PUMAs and drive-time-based HCSAs encompassed more homogenous populations while MSAs, Commuting Zones, and Hospital Referral Regions captured the most variation.

Conclusions

The proportion of hospital discharges captured by each HCSA varied, with MSAs capturing the highest proportion of discharges and PUMAs capturing the lowest. Additionally, researchers face a trade-off between capture rate and population homogeneity when deciding which HCSA to use.

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来源期刊
Health Services Research
Health Services Research 医学-卫生保健
CiteScore
4.80
自引率
5.90%
发文量
193
审稿时长
4-8 weeks
期刊介绍: Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.
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