Geographic Variations in Utilization Rates in Veterans Affairs Hospitals and Clinics

Ashton, Carol M.; Petersen, Nancy J.; Souchek, Julianne; Menke, Terri; Yu, Huichuan; Pietz, Kenneth; Eigenbrodt, Marsha L.; Barbour, Galen L.; Kizer, Kenneth W.; Wray, Nelda P.

doi:10.1056/nejm199901073400106

Cited by 216 publications

(144 citation statements)

References 22 publications

Supporting

Mentioning

134

Contrasting

Unclassified

Order By: Relevance

“…[2][3][4][5][6] Some of the variation in care may be related to patientlevel differences in clinical presentation as well as to hospital-level factors, such as local availability of primary care physicians, hospital occupancy, or access to certain health care services. [7][8][9] The wide variation in clinical management raises concerns about whether every patient is receiving the optimal care and whether the lack of a standardized approach is contributing to unnecessary health care costs. [10][11][12] Additional testing and treatment have not necessarily been found to correlate with more effective care, improved patient outcomes, or higher patient satisfaction.…”

mentioning

confidence: 99%

Variation in Emergency Department Admission Rates in US Children’s Hospitals

et al. 2014

View full text Add to dashboard Cite

WHAT'S KNOWN ON THIS SUBJECT: There is substantial variation in the medical care provided to pediatric patients across diverse clinical settings. This variation raises concerns about whether every patient is receiving optimal care and whether more standardized approaches around clinical decisions are needed. WHAT THIS STUDY ADDS:We observed wide variation in admission rates for common pediatric conditions across US children' s hospitals. Our findings highlight the need for greater focus on the standardization of decisions regarding hospitalization of patients presenting to the emergency department.abstract OBJECTIVE: To measure the hospital-level variation in admission rates for children receiving treatment of common pediatric illnesses across emergency departments (EDs) in US children' s hospitals. METHODS:We performed a multi-center cross sectional study of children presenting to the EDs of 35 pediatric tertiary-care hospitals participating in the Pediatric Health Information System (PHIS). Admission rates were calculated for visits occurring between January 1, 2009, and December 31, 2012, associated with 1 of 7 common conditions, and corrected to adjust for hospital-level severity of illness. Conditions were selected systematically based on frequency of visits and admission rates.RESULTS: A total of 1 288 706 ED encounters (13.8% of all encounters) were associated with 1 of the 7 conditions of interest. After adjusting for hospital-level severity, the greatest variation in admission rates was observed for concussion (range 5%-72%), followed by pneumonia (19%-69%), and bronchiolitis (19%-65%). The least variation was found among patients presenting with seizures (7%-37%) and kidney and urinary tract infections (6%-37%). Although variability existed in diseasespecific admission rates, certain hospitals had consistently higher, and others consistently lower, admission rates. CONCLUSIONS:We observed greater than threefold variation in severityadjusted admission rates for common pediatric conditions across US children's hospitals. Although local practices and hospital-level factors may partly explain this variation, our findings highlight the need for greater focus on the standardization of decisions regarding admission. Pediatrics 2014;134:539-545 AUTHORS:

show abstract

mentioning

confidence: 99%

Variation in Emergency Department Admission Rates in US Children’s Hospitals

et al. 2014

View full text Add to dashboard Cite

show abstract

“…The most studied ones are small area variations (Wennberg andGittelsohn 1975, 1982;Ashton et al 1999). Researchers differ as to the attribution of this residual variation, some arguing that physicians prefer different practice styles, e.g., as a result of their education and professional socialization.…”

Section: Conclusion and Discussionmentioning

confidence: 99%

“…A persistent finding in health services research is that hospital utilization varies widely (Paul-Shaheen, Clark, and Williams 1987;Ashton et al 1999;Wennberg 1999). These variations have been observed between geographic areas, hospitals, and physicians.…”

mentioning

confidence: 99%

Variation in Hospital Length of Stay: Do Physicians Adapt Their Length of Stay Decisions to What Is Usual in the Hospital Where They Work?

Jong

Westert²,

Lagoe³

et al. 2005

Health Services Research

View full text Add to dashboard Cite

Objective. To test the hypothesis that physicians who work in different hospitals adapt their length of stay decisions to what is usual in the hospital under consideration. Data Sources. Secondary data were used, originating from the Statewide Planning and Research Cooperative System (SPARCS). SPARCS is a major management tool for assisting hospitals, agencies, and health care organizations with decision making in relation to financial planning and monitoring of inpatient and ambulatory surgery services and costs in New York state. Study Design. Data on length of stay for surgical interventions and medical conditions (a total of seven diagnosis-related groups [DRGs]) were studied, to find out whether there is more variation between than within hospitals. Data (1999Data ( , 2000Data ( , and 2001) from all hospitals in New York state were used. The study examined physicians practicing in one hospital and physicians practicing in more than one hospital, to determine whether average length of stay differs according to the hospital of practice. Multilevel models were used to determine variation between and within hospitals. A t-test was used to test whether length of stay for patients of each multihospital physician differed from the average length of stay in each of the two hospitals. Principal Findings. There is significantly ( po.05) more variation between than within hospitals in most of the study populations. Physicians working in two hospitals had patient lengths of stay comparable with the usual practice in the hospital where the procedure was performed. The proportion of physicians working in one hospital did not have a consistent effect for all DRGs on the variation within hospitals. Conclusion. Physicians adapt to their colleagues or to the managerial demands of the particular hospital in which they work. The hospital and broader work environment should be taken into account when developing effective interventions to reduce variation in medical practice.

show abstract

Section: Introductionmentioning

confidence: 99%

“…In addition, regional variation in clinical care and prescribing has been described for several other chronic diseases [11,12] but has rarely been addressed in studies of antiretroviral use. With almost 23 000 HIV-infected veterans in care each year across the country, the Department of Veterans Affairs (VHA) represents the largest and most geographically diverse provider of healthcare to HIV-infected individuals in the United States.…”

mentioning

confidence: 99%

Trends in uptake of recently approved antiretrovirals within a national healthcare system

Belperio¹,

La²,

Boothroyd³

et al. 2010

HIV Medicine

View full text Add to dashboard Cite

ObjectiveThe aim of the study was to describe Veterans Healthcare Administration (VHA) system-wide uptake of three HIV protease inhibitors: atazanavir, darunavir and tipranavir. MethodsThis retrospective cohort study evaluated VHA uptake of three target antiretrovirals and lopinavir/ ritonavir in each complete 90-day quarter since approval to December 2007 using VHA HIV Clinical Case Registry data. We assessed uptake using number of new prescriptions, number of providers and facilities prescribing target agents, provider type, clinic type, facility size and location within four US regions. ResultsOverall, 6551 HIV-infected veterans received target antiretrovirals. Uptake was generally greatest within the first year after Food and Drug Administration (FDA) approval, and then slightly declined and plateaued. Geographically, early adoption of new antiretroviral drugs tended to occur in the Western USA, as evidenced by comparison of uptake patterns of new antiretrovirals to use of all antiretroviral agents. A small percentage of prescribers of all antiretrovirals were responsible for new prescriptions for target medications, particularly for darunavir and tipranavir. Providers at almost 50% of VHA facilities were prescribing these agents within the first year. ConclusionsUptake of new antiretrovirals in the VHA generally reflected overall prescribing of all antiretrovirals, suggesting a lack of VHA impediments to new antiretrovirals in the healthcare system. Some regional variation in uptake among the targeted antiretrovirals occurred over time but tended to resolve after the first several months. Providers responsible for early prescribing of the target medications were limited to a fraction of providers who tended to be physicians who practised in infectious disease (ID) clinics at medium-sized facilities.Keywords: antiretrovirals, HIV/AIDS, protease inhibitor, uptake, VA healthcare system Accepted 21 July 2009Introduction Antiretroviral selection depends on several factors, including patient characteristics such as disease severity and patient treatment experience and medication characteristics such as safety, tolerability, comparative efficacy and cost. How quickly a new antiretroviral disseminates throughout a healthcare system may further depend on additional factors such as provider experience, local practices, facility case load, pharmacy restrictions, accumulation of clinical data and revisions of treatment guidelines.Overall trends in antiretroviral use identified from observational databases, including trends in the use of different classes and combinations of antiretrovirals, have been described in the literature [1][2][3]. Information on the prescribing of individual antiretrovirals comes largely from reports from individual clinic settings or researchbased cohorts [3][4][5][6][7]. Although initiation of antiretroviral therapy has been assessed relative to treatment guideline development and sociodemographic subgroups [8][9][10] 209In addition, regional variation in clinical care and prescribing has be...

show abstract

Geographic Variations in Utilization Rates in Veterans Affairs Hospitals and Clinics

Cited by 216 publications

References 22 publications

Variation in Emergency Department Admission Rates in US Children’s Hospitals

Variation in Emergency Department Admission Rates in US Children’s Hospitals

Variation in Hospital Length of Stay: Do Physicians Adapt Their Length of Stay Decisions to What Is Usual in the Hospital Where They Work?

Trends in uptake of recently approved antiretrovirals within a national healthcare system

Contact Info

Product

Resources

About