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  1. Geographic variations in utilization rates in veterans affairs hospitals and clinics.

    Article - En anglais

    Background In the United States, geographic variation in hospital use is common.

    It is uncertain whether there are similar geographic variations in the health care system of the Department of Veterans Affairs (VA), which differs from the private sector because it predominantly serves men with annual incomes below $20,000, has a central system of administration, and uses salaried physicians.

    Thus, it might be less likely to have geographic variations.

    Methods We used VA data bases to obtain information on patients treated for eight diseases (chronic obstructive pulmonary disease, pneumonia, congestive heart failure, angina, diabetes, chronic renal failure, bipolar disorder, and major depression).

    We analyzed their use of hospital and outpatient services by assessing the risk-adjusted numbers of hospital days (the average number of days a patient spent in the hospital per 12 months of follow-up, regardless of the number of hospital stays), hospital-discharge rates, and clinic-visit rates from 1991 through 1995 for the entire system and within the 22 geographically based health care networks.

    Results We found substantial geographic variation in hospital use for all eight cohorts of patients and all the years studied.

    Variations in the numbers of hospital days per person-year among the networks were greatest among patients with chronic obstructive pulmonary disease.

    (ranging from a factor of 2.7 to a factor of 3. (...)

    Mots-clés Pascal : Etats Unis, Amérique du Nord, Amérique, Utilisation, Service santé, Fréquentation, Ancien combattant, Hôpital, Clinique, Répartition géographique, Evaluation système, Etude comparative, Homme

    Mots-clés Pascal anglais : United States, North America, America, Use, Health service, Frequentation, Veteran, Hospital, Clinic, Geographic distribution, System evaluation, Comparative study, Human

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 99-0086802

    Code Inist : 002B30A01C. Création : 31/05/1999.