Avoidable hospitalizations in Switzerland: a small area analysis on regional variation, density of physicians, hospital supply and rurality
| Autor: | Claudia Berlin, André Busato, Maud Maessen, Sima Djalali, Thomas Rosemann |
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| Přispěvatelé: | University of Zurich, Maessen, Maud |
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male 11035 Institute of General Practice medicine.medical_specialty Adolescent Small area variation analysis Context (language use) 610 Medicine & health Health Services Accessibility Health administration symbols.namesake Rurality Ambulatory care 360 Social problems & social services Physicians Health care Humans Medicine Poisson regression Small-Area Analysis Aged Quality Indicators Health Care Retrospective Studies Aged 80 and over business.industry Health Policy Primary care physician Middle Aged 2719 Health Policy Health services Hospitals Hospitalization Emergency medicine symbols Female Health Services Research Rural Health Services business Switzerland Research Article Demography |
| Zdroj: | BMC Health Services Research Berlin, Claudia; Busato, André; Rosemann, Thomas; Djalali, Sima; Maessen, Maud (2014). Avoidable hospitalizations in Switzerland: a small area analysis on regional variation, density of physicians, hospital supply and rurality. BMC health services research, 14, p. 289. BioMed Central 10.1186/1472-6963-14-289 |
| DOI: | 10.5167/uzh-97953 |
| Popis: | Background Avoidable hospitalizations (AH) are hospital admissions for diseases and conditions that could have been prevented by appropriate ambulatory care. We examine regional variation of AH in Switzerland and the factors that determine AH. Methods We used hospital service areas, and data from 2008–2010 hospital discharges in Switzerland to examine regional variation in AH. Age and sex standardized AH were the outcome variable, and year of admission, primary care physician density, medical specialist density, rurality, hospital bed density and type of hospital reimbursement system were explanatory variables in our multilevel poisson regression. Results Regional differences in AH were as high as 12-fold. Poisson regression showed significant increase of all AH over time. There was a significantly lower rate of all AH in areas with more primary care physicians. Rates increased in areas with more specialists. Rates of all AH also increased where the proportion of residences in rural communities increased. Regional hospital capacity and type of hospital reimbursement did not have significant associations. Inconsistent patterns of significant determinants were found for disease specific analyses. Conclusion The identification of regions with high and low AH rates is a starting point for future studies on unwarranted medical procedures, and may help to reduce their incidence. AH have complex multifactorial origins and this study demonstrates that rurality and physician density are relevant determinants. The results are helpful to improve the performance of the outpatient sector with emphasis on local context. Rural and urban differences in health care delivery remain a cause of concern in Switzerland. |
| Databáze: | OpenAIRE |
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