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Results for “Small-Area Analysis”

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PubMed1991

Community health service utilisation and needs in an elderly population.

This study was carried out to determine community health service utilisation and needs of an elderly population living in a geographically defined area of Dublin. A random sample of 208 persons was taken from the 11,852 elderly persons living in the area. Activities of daily living and cognitive function were assessed in the person's own home. Whilst the community health services provided were less than comprehensive, they were targeted to those most in need; the very elderly, those living alone, and persons with a mental or physical disability. Objectively assessed need for further services far outweighed the demand for such services. Studies such as this are essential if the elderly are to receive their fair share of services in a demand based health service.

Aged↗
PubMed1992

Is magnitude of co-payment effect related to income? Using census data for health services research.

This study: (1) describes and evaluates a method for estimating household income using home addresses in conjunction with census data, and (2) uses this method in a study designed to determine if the introduction of copayments caused primary care office visit rates to decrease more for lower income enrollees than for higher income enrollees of a large health maintenance organization (HMO). Each step in the process of linking income estimates for small census units (block groups) to specific home addresses is described and the validity and precision of these estimates is assessed through comparisons of estimated income with self-reported income for residents of the Puget Sound area of Washington state. Although subject to considerable measurement error, this approach provided valid income estimates. This method was then used to estimate the incomes of over 20,000 households of HMO enrollees in a controlled study of the relationship between copayment effect on visit rates and enrollee income. Copayments were found to have a similar effect on higher and lower income enrollees.

Adult↗
PubMed1992

The Small Area Health Statistics Unit: a national facility for investigating health around point sources of environmental pollution in the United Kingdom.

STUDY OBJECTIVE: The Small Area Health Statistics Unit (SAHSU) was established at the London School of Hygiene and Tropical Medicine in response to a recommendation of the enquiry into the increased incidence of childhood leukaemia near Sellafield, the nuclear reprocessing plant in West Cumbria. The aim of this paper was to describe the Unit's methods for the investigation of health around point sources of environmental pollution in the United Kingdom. DESIGN: Routine data currently including deaths and cancer registrations are held in a large national database which uses a post code based retrieval system to locate cases geographically and link them to the underlying census enumeration districts, and hence to their populations at risk. Main outcome measures were comparison of observed/expected ratios (based on national rates) within bands delineated by concentric circles around point sources of environmental pollution located anywhere in Britain. MAIN RESULTS: The system is illustrated by a study of mortality from mesothelioma and asbestosis near the Plymouth naval dockyards during 1981-87. Within a 3 km radius of the docks the mortality rate for mesothelioma was higher than the national rate by a factor of 8.4, and that for asbestosis was higher by a factor of 13.6. CONCLUSIONS: SAHSU is a new national facility which is rapidly able to provide rates of mortality and cancer incidence for arbitrary circles drawn around any point in Britain. The example around Plymouth of mesothelioma and asbestosis demonstrates the ability of the system to detect an unusual excess of disease in a small locality, although in this case the findings are likely to be related to occupational rather than environmental exposure.

Asbestosis↗
PubMed1992

Hospital variations in adverse patient outcomes.

Careful review of the literature suggests that the conceptual problem in analyzing hospitals' quality of care is the difficulty of identifying problem domains of hospital care. An appropriate measurement model using multiple indicators of hospital quality problems is developed and evaluated. Adverse patient outcomes reflecting the quality problems are compiled from a peer review organization's generic screen indicators for 85 acute care hospitals. Predictor variables of adverse outcomes include bed size, number of high-technology services offered, case mix, severity of patients treated, ownership, case mix, severity of patients treated, ownership, net profit, market share, efficiency, teaching status, and metropolitan size. The findings show that hospital characteristics exert limited effects on adverse outcomes. Efficiency and average length of stay are the only statistically significant factors that explain the variation in adverse outcomes.

Hospital Mortality↗
PubMed1991

Further issues in small area variations analysis.

In this article, I examine Wennberg's "practice style" hypothesis and the literature on variations among small areas. According to Wennberg, geographic variations in rates of per capita use for many clinical procedures arise mainly from differences over what constitutes appropriate care. I show, however, that the role of practice style in explaining variations among areas has not been clearly demonstrated. I also argue that the practice style hypothesis can neither be established nor refuted by the methods traditionally used to study small areas and, moreover, that inferences about practice style variations cannot be drawn from differences among areas in their rates of use. I thus conclude that more research at the micro level in the practice patterns of the individual physician is needed before major health care initiatives based on small area methodology are undertaken.

Health Policy↗
PubMed1991

Income, race, and surgery in Maryland.

BACKGROUND: We describe common surgical and medical hospital admission rates for Maryland residents, exploring systematic effects of race and income. METHODS: The data comprise Maryland hospital discharges and population estimates for 1985 to 1987. Patient income is the race-specific median family income of residence zip code. Logistic regression is used to measure incidence by race, income, and residence for surgical and medical reasons for admission. RESULTS: Population rates for discretionary orthopedic, vascular, and laryngologic surgery tend to increase with community income levels. Coronary and carotid artery surgery rates are two to three times higher among Whites. The more discretionary the procedure, the lower is the relative incidence among Blacks. By contrast, admission rates for most medical reasons decline with increasing income levels and are elevated among Blacks. The affluent receive coronary artery procedures whereas the poor are hospitalized for coronary artery disease. CONCLUSIONS: Blacks and the poor appear to have higher illness burdens requiring hospital care. Discretionary surgeries have a White predominance and increase with income; medical admissions have a Black predominance and decline with income. Race and community income level are important factors in differential hospital utilization rates.

Adult↗
PubMed1992

Variations in asthma hospitalizations and deaths in New York City.

BACKGROUND: Recent reports have identified New York City as having asthma mortality rates that are substantially higher than expected based on US rates. This study investigates the problems of asthma morbidity and mortality in New York City. METHODS: Data on asthma hospitalizations (1982 to 1986) and deaths (1982 to 1987) among persons aged 0 to 34 years were studied. Descriptive and multivariate techniques were used to examine differences in rates among subgroups and across geographic areas. RESULTS: The average annual hospitalization rate was 39.2 per 10,000; the mortality rate was 1.2 per 100,000. Hospitalization and death rates among Blacks and Hispanics were 3 to 5.5 times those of Whites. Large geographic variations in hospitalizations and mortality occurred. Asthma hospitalization and mortality rates were highly correlated (r = .67), with the highest rates concentrated in the city's poorest neighborhoods. Household income, percentage of population Black, and percentage of population Hispanic were significant predictors of area hospitalization rates (adjusted R2 = .75). CONCLUSION: These findings provide a basis for focusing investigations of the causes of variations in asthma outcomes and targeting interventions to reduce the disproportionate morbidity and mortality borne by poor and minority populations.

Abstracting and Indexing↗
PubMed1992

Realizing the potential of practice pattern profiling.

In January 1992, the Physician Payment Review Commission held a conference to learn about the appropriateness of present uses of profiling of practice patterns, and to identify what will be required to realize the full potential of this technique in the future. The conference addressed the data needs of profiling, the development of valid and relevant profiles, the impact of profiles on medical practice, and controversies surrounding public access to profiling information and the uses to which profiling has been put. This paper, based in part on that conference, reviews the basic concepts that underlie profiling and describes the roles that profiling can play in quality improvement, assessment of provider performance, and utilization review. It uses case studies to illustrate the types of problems that have arisen in actual usage and discusses what will be required to resolve them. The final section describes the roles that profiling can play in achieving the goals of health care reform, and concludes with what is needed in data and infrastructure development to improve the quality and usefulness of profiling.

Data Collection↗
PubMed1992

Mortality of iron foundry workers. II. Analysis by work area.

Plantwide analyses of the mortality experience of 8147 foundrymen revealed excesses for several diseases including lung cancer. Using indirect measures of smoking, it appeared that most, if not all, of the excess of lung cancer deaths could be explained by smoking habits. To explore further the possible association between these mortality excesses and foundry exposures, jobs were grouped into six work areas on the basis of similarities in production processes. The findings of analyses by work areas support the inferences from plantwide observations. No evidence was found of a relationship between lung cancer and foundry exposures. The pattern of mortality from emphysema and cerebrovascular disease in the different work areas paralleled that of lung cancer, suggesting that mortality from these diseases may have been influenced by a common etiologic agent, probably tobacco smoke. The data also reveal possible associations between metal pattern-making and colon cancer, silica or metal dust and stomach cancer, and carbon monoxide and ischemic heart disease.

Adult↗
PubMed1991

Health service areas for the United States.

The objectives of this report are to document methods used to identify health service areas for the United States and to describe and evaluate these areas. A health service area is defined as one or more counties that are relatively self-contained with respect to the provision of routine hospital care. Service areas that include more than one county are characterized by travel between the counties for routine hospital care.

Catchment Area, Health↗
PubMed1990

Changing patterns of asthma mortality. Identifying target populations at high risk.

Studies have suggested increases in hospitalization for asthma and in asthma mortality during the early 1980s. Using US Vital Records, we examined asthma mortality from 1968 through 1987 to describe the rates of change among children and young adults (aged 5 to 34 years) with time and in small geographic areas. During the 1970s, US asthma mortality declined by 7.8% per annum (+/- 1.0%), declining faster among women and nonwhites. During the 1980s, mortality increased by 6.2% per annum (+/- 1.2%), increasing faster among those aged 5 to 14 years than among those aged 15 to 34 years. Small-area geographic analysis revealed four areas with persistently high asthma mortality. Neither changes in International Classification of Diseases coding nor improved recognition of asthma, as demonstrated by trends in autopsy rates or rates of in-hospital deaths, seems to explain the increasing mortality of the 1980s.

Adolescent↗
PubMed1990

Changes in Connecticut hospital use rates: have small-area variations been affected?

This paper examines the extent to which changes (prospective payment, alternative delivery systems, etc.) in the hospital environment and the general decline in hospital days affect small-area variations in hospital use rates for 18 selected diagnoses in nine hospital service areas in Connecticut. After adjusting for coding changes between DRGs, we found that variation across the service areas did not, in general, differ for any one of the years 1981-86. In one instance (cardiac catheterization), however, we found that a DRG-specific change in knowledge and technology decreased the extent of small-area variation for that diagnosis.

Analysis of Variance↗
PubMed1991

Corrosion pattern of silver points in vivo.

The purpose of this study was to examine the electrochemical behavior of silver points in vivo. The apices of silver points removed from teeth with successful or failed endodontic treatments were subjected to complete surface characterization by small-area ESCA, scanning electron microscopy, and electron probe microanalyzer. Cross-sections of the points near the apex were examined with scanning electron microscopy and electron probe microanalyzer to identify the depth of corrosion involvement. According to the results, all silver points manifested evidence of corrosion attack. Electron probe microanalyzer showed no difference in the elemental distribution found on the points. ESCA analysis of the uppermost 5-nm point layer revealed the presence of N on silver points removed from failed treatments. The examination of cross-sections manifested deep S penetration in the bulk of the points removed from failed treatments. Considering the results of this study, no direct association seems to exist between the extent of the corrosion involvement and the prognosis of the treatment. Handling factors and the presence of bacteria are probably the parameters determining the outcome of a treatment.

Corrosion↗
PubMedDate not supplied

The relationship between elastomer opacity, colorimeter beam size, and measured colorimetric response.

The effect of opacity on the colorimetric responses of large-area and small-area colorimeters was determined using an elastomer intended for maxillofacial prosthetics use and containing various pigments at different concentrations. Opacity was determined by calculating the contrast ratio of 2-mm-thick specimens against black and white backings, using Kubelka-Munk analyses to correct for thickness and backing color variations. The measure of comparison of the two colorimeters was the relative difference in tristimulus reflectance, with the tristimulus reflectance of the large-area colorimeter as the basis of the relative difference. A significant quadratic relationship was found between contrast ratio and the relative difference in tristimulus reflectance. This relationship may be used to describe opacity without the need to make optical observations or measurements of a thin layer of material on contrasting backings. The small-area colorimeter produced color parameters that are a measure of the combined effects of both color and opacity. The importance of beam size considerations of optical measuring devices for translucent natural and prosthetic materials was emphasized.

Color↗