Dealing with geographic variations in the use of hospitals. **The experience of the Maine Medical Assessment Foundation Orthopaedic Study Group
Orthopaedists and other physicians in Maine organized the Maine Medical Assessment Foundation to deal with the problem of variations in the rates of hospitalization for orthopaedic conditions. Five musculoskeletal injuries and five orthopaedic procedures were selected for study. The variation in decision-making by orthopaedists was least for fractures of the ankle and fractures of the hip and was greatest for fractures of the forearm, derangement of the knee, and lumbosacral sprain. The rates in an area tended to be consistently high or low for the same treatments. The major reasons for the variations appeared to be related to lack of agreement about optimum treatment. Feedback of data to physicians on variations in patterns of practice reduced the variations.
Available from: Alberto Argentiero
- "Variations in admitting practices and treatment protocols for the disease of interest might have occurred over time and by area. In few cases, this could have caused discrepancies between the hospital discharges and the actual occurrence of the disease considered
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Where population coverage is limited, the exclusive use of Cancer Registries might limit ascertainment of incident cancer cases. We explored the potentials of Nationwide hospital discharge records (NHDRs) to capture incident breast cancer cases in Italy.
We analyzed NHDRs for mastectomies and quadrantectomies performed between 2001 and 2008. The average annual percentage change (AAPC) and related 95% Confidence Interval (CI) in the actual number of mastectomies and quadrantectomies performed during the study period were computed for the full sample and for subgroups defined by age, surgical procedure, macro-area and singular Region. Re-admissions of the same patients were separately presented.
The overall number of mastectomies decreased, with an AAPC of −2.1% (−2.3 -1.8). This result was largely driven by the values observed for women in the 45 to 64 and 65 to 74 age subgroups (−3.0%, -3.4 -3.6 and −3.3%, -3.8 -2.8, respectively). We observed no significant reduction in mastectomies for women in the remaining age groups. Quadrantectomies showed an overall +4.7 AAPC (95%CI:4.5–4.9), with no substantial differences by age. Analyses by geographical area showed a remarkable decrease in mastectomies, with inter-regional discrepancies possibly depending upon variability in mammography screening coverage and adherence. Quadrantectomies significantly increased, with Southern Regions presenting the highest average rates. Data on repeat admissions within a year revealed a total number of 46,610 major breast surgeries between 2001 and 2008, with an overall +3.2% AAPC (95%CI:2.8-3.6).
In Italy, NHDRs might represent a valuable supplemental data source to integrate Cancer Registries in cancer surveillance.
Journal of Experimental & Clinical Cancer Research 11/2012; 31(1):96. DOI:10.1186/1756-9966-31-96 · 4.43 Impact Factor
Available from: Marcel Widmer
- "A direct comparison of our results with other data is therefore limited to THA. One study from Maine (US) (Keller et al., 1990) reported 1.1 discharges for THA per 1000 residents, for another study in Quebec this rate was 0.24 (Blais, 1993) and in a Finnish study the rate was 1.0 (Keskimaki et al., 1994). One Irish study showed differing THA rates between urban and rural regions (1.01 vs. 0.77 per 1000 residents) (Willis et al., 2000). "
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ABSTRACT: The study systematically describes the frequency and geographic variability of major surgical interventions for musculoskeletal disorders in Switzerland. Age- and sex-standardized rates for joint replacements, arthroscopies, spine surgery and hip fracture repair were calculated for hospital service regions. Various statistical analyses were used to measure the extent of variation. The authors argue that the surgery of hip fractures can be used as index surgery in the context of analyzing variations in orthopedic surgery. Temporal trends imply that patient demand and supply factors related to clinical ambiguity and non-medical incentives of providers are far more important components leading to increased use than the sole effect of an aging population.
Health & Place 02/2009; 15(3):761-8. DOI:10.1016/j.healthplace.2008.12.009 · 2.81 Impact Factor
Available from: Francesca Zanardi
- "The rate for Maine is rather similar to that of Umbria, but more than 2-fold higher than that of Alto-Adige/Südtirol. Such regional variations (reported also for small areas within Maine) can likely be attributed to socio-economic, occupational, environmental and health-care differentials , including access to care, diagnosis, and practice patterns (attitudes towards advising more conservative approaches, etc.) [6,15,16]. Age-related trends (Figure 2) were remarkably similar in most of the regions studied. In line with other reports [5-7], men displayed gradually increasing incidence until advanced age, whereas women showed a sharp perimenopausal peak (corresponding to the 50–54 year age group) after progressively increasing incidence during the fertile years. "
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ABSTRACT: Carpal tunnel syndrome (CTS) is a socially relevant condition associated with biomechanical risk factors. We evaluated age-sex-specific incidence rates of in-hospital cases of CTS in central/northern Italy and explored relations with marital status.
Seven regions were considered (overall population, 14.9 million) over 3-6-year periods between 1997 and 2002 (when out-of-hospital CTS surgery was extremely rare). Incidence rates of in-hospital cases of CTS were estimated based on 1) codified demographic, diagnostic and intervention data in obligatory discharge records from all Italian public/private hospitals, archived (according to residence) on regional databases; 2) demographic general population data for each region. We compared (using the chiscore test) age-sex-specific rates between married, unmarried, divorced and widowed subsets of the general population. We calculated standardized incidence ratios (SIRs) for married/unmarried men and women.
Age-standardized incidence rates (per 100,000 person-years) of in-hospital cases of CTS were 166 in women and 44 in men (106 overall). Married subjects of both sexes showed higher age-specific rates with respect to unmarried men/women. SIRs were calculated comparing married vs unmarried rates of both sexes: 1.59 (95% confidence interval [95% CI], 1.57-1.60) in women, and 1.42 (95% CI, 1.40-1.45) in men. As compared with married women/men, widows/widowers both showed 2-3-fold higher incidence peaks during the fourth decade of life (beyond 50 years of age, widowed subjects showed similar trends to unmarried counterparts).
This large population-based study illustrates distinct age-related trends in men and women, and also raises the question whether marital status could be associated with CTS in the general population.
BMC Public Health 02/2008; 8(1):374. DOI:10.1186/1471-2458-8-374 · 2.26 Impact Factor
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