Skip to main content
NCBI home page
Health Services Research logoLink to Health Services Research
. 1998 Oct;33(4 Pt 1):929–945.

Hospitalizations for back and neck problems: a comparison between the Province of Ontario and Washington State.

V M Taylor 1, G M Anderson 1, B McNeney 1, P Diehr 1, J N Lavis 1, R A Deyo 1, C Bombardier 1, A Malter 1, T Axcell 1
PMCID: PMC1070294  PMID: 9776943

Abstract

OBJECTIVE: To examine back and neck hospitalizations in the Province of Ontario and Washington State. Because of their different organization and financing, there has been considerable interest in comparing healthcare systems in Canada and the United States. Features of healthcare systems might be expected to result in greater variations in care for elective than urgent conditions. DATA SOURCE: Automated hospital discharge databases. STUDY DESIGN: Previously developed algorithms were used to identify surgical and nonsurgical hospitalizations for back and neck problems in the administrative databases. We compared overall rates of hospitalization and lengths of hospital stay in Ontario and Washington as well as small area variations within the province and state. PRINCIPAL FINDINGS: Surgical back and neck hospitalizations were three times as common in Washington, but medical hospitalizations were twice as common in Ontario. Provincial lengths of stay were longer for both surgical and nonsurgical hospitalizations. Admission rates varied substantially and significantly among small areas in both Washington and Ontario. Variations in hospital length of stay were greater in Ontario, particularly for nonsurgical back and neck hospitalizations. CONCLUSION: The two jurisdictions had very different patterns of hospital utilization for one of the most common health problems seen by physicians. Our results suggest that the global controls on hospital budgets and access to technology in Ontario were associated with lower rates of surgery, higher rates of hospital-based medical care, and longer lengths of stay. They also indicate that the utilization review process in Washington was associated with lower small area variation rates for medical back care.

Full text

PDF
929

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson G. M., Grumbach K., Luft H. S., Roos L. L., Mustard C., Brook R. Use of coronary artery bypass surgery in the United States and Canada. Influence of age and income. JAMA. 1993 Apr 7;269(13):1661–1666. [PubMed] [Google Scholar]
  2. Anderson G. M., Pulcins I. R. High variation medical conditions as an explanation of regional and temporal differences in hospital utilization. Med Care. 1992 May;30(5):461–465. doi: 10.1097/00005650-199205000-00008. [DOI] [PubMed] [Google Scholar]
  3. Barnes B. A., O'Brien E., Comstock C., D'Arpa D. G., Donahue C. L. Report on variation in rates of utilization of surgical services in the Commonwealth of Massachusetts. JAMA. 1985 Jul 19;254(3):371–375. [PubMed] [Google Scholar]
  4. Barron M., Kazandjian V. A. Geographic variation in lumbar diskectomy: a protocol for evaluation. QRB Qual Rev Bull. 1992 Mar;18(3):98–107. doi: 10.1016/s0097-5990(16)30515-2. [DOI] [PubMed] [Google Scholar]
  5. Carlisle D. M., Valdez R. B., Shapiro M. F., Brook R. H. Geographic variation in rates of selected surgical procedures within Los Angeles County. Health Serv Res. 1995 Apr;30(1):27–42. [PMC free article] [PubMed] [Google Scholar]
  6. Cherkin D. C., Deyo R. A., Loeser J. D., Bush T., Waddell G. An international comparison of back surgery rates. Spine (Phila Pa 1976) 1994 Jun 1;19(11):1201–1206. doi: 10.1097/00007632-199405310-00001. [DOI] [PubMed] [Google Scholar]
  7. Cherkin D. C., Deyo R. A. Nonsurgical hospitalization for low-back pain. Is it necessary? Spine (Phila Pa 1976) 1993 Oct 1;18(13):1728–1735. doi: 10.1097/00007632-199310000-00003. [DOI] [PubMed] [Google Scholar]
  8. Cherkin D. C., Deyo R. A., Volinn E., Loeser J. D. Use of the International Classification of Diseases (ICD-9-CM) to identify hospitalizations for mechanical low back problems in administrative databases. Spine (Phila Pa 1976) 1992 Jul;17(7):817–825. doi: 10.1097/00007632-199207000-00015. [DOI] [PubMed] [Google Scholar]
  9. Cypress B. K. Characteristics of physician visits for back symptoms: a national perspective. Am J Public Health. 1983 Apr;73(4):389–395. doi: 10.2105/ajph.73.4.389. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Deyo R. A., Cherkin D. C., Loeser J. D., Bigos S. J., Ciol M. A. Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. J Bone Joint Surg Am. 1992 Apr;74(4):536–543. [PubMed] [Google Scholar]
  11. Deyo R. A., Cherkin D., Conrad D., Volinn E. Cost, controversy, crisis: low back pain and the health of the public. Annu Rev Public Health. 1991;12:141–156. doi: 10.1146/annurev.pu.12.050191.001041. [DOI] [PubMed] [Google Scholar]
  12. Diehr P., Cain K., Connell F., Volinn E. What is too much variation? The null hypothesis in small-area analysis. Health Serv Res. 1990 Feb;24(6):741–771. [PMC free article] [PubMed] [Google Scholar]
  13. Einstadter D., Kent D. L., Fihn S. D., Deyo R. A. Variation in the rate of cervical spine surgery in Washington State. Med Care. 1993 Aug;31(8):711–718. doi: 10.1097/00005650-199308000-00004. [DOI] [PubMed] [Google Scholar]
  14. Escarce J. J. Would eliminating differences in physician practice style reduce geographic variations in cataract surgery rates? Med Care. 1993 Dec;31(12):1106–1118. doi: 10.1097/00005650-199312000-00004. [DOI] [PubMed] [Google Scholar]
  15. Frymoyer J. W. Back pain and sciatica. N Engl J Med. 1988 Feb 4;318(5):291–300. doi: 10.1056/NEJM198802043180506. [DOI] [PubMed] [Google Scholar]
  16. Redelmeier D. A., Fuchs V. R. Hospital expenditures in the United States and Canada. N Engl J Med. 1993 Mar 18;328(11):772–778. doi: 10.1056/NEJM199303183281107. [DOI] [PubMed] [Google Scholar]
  17. Shepard D. S., Cooper G. S. Small-area variations in rates of hospitalization and surgery within Rhode Island. Am J Prev Med. 1987 Mar-Apr;3(2):101–109. [PubMed] [Google Scholar]
  18. Taylor V. M., Deyo R. A., Goldberg H., Ciol M., Kreuter W., Spunt B. Low back pain hospitalization in Washington State: recent trends and geographic variations. J Spinal Disord. 1995 Feb;8(1):1–7. [PubMed] [Google Scholar]
  19. Tu J. V., Pashos C. L., Naylor C. D., Chen E., Normand S. L., Newhouse J. P., McNeil B. J. Use of cardiac procedures and outcomes in elderly patients with myocardial infarction in the United States and Canada. N Engl J Med. 1997 May 22;336(21):1500–1505. doi: 10.1056/NEJM199705223362106. [DOI] [PubMed] [Google Scholar]
  20. Turner J. A., Ersek M., Herron L., Haselkorn J., Kent D., Ciol M. A., Deyo R. Patient outcomes after lumbar spinal fusions. JAMA. 1992 Aug 19;268(7):907–911. [PubMed] [Google Scholar]
  21. Welch W. P., Verrilli D., Katz S. J., Latimer E. A detailed comparison of physician services for the elderly in the United States and Canada. JAMA. 1996 May 8;275(18):1410–1416. [PubMed] [Google Scholar]
  22. Wennberg J. E., Freeman J. L., Culp W. J. Are hospital services rationed in New Haven or over-utilised in Boston? Lancet. 1987 May 23;1(8543):1185–1189. doi: 10.1016/s0140-6736(87)92152-0. [DOI] [PubMed] [Google Scholar]
  23. Zwanziger J., Anderson G. M., Haber S. G., Thorpe K. E., Newhouse J. P. Comparison of hospital costs in California, New York, and Canada. Health Aff (Millwood) 1993 Summer;12(2):130–139. doi: 10.1377/hlthaff.12.2.130. [DOI] [PubMed] [Google Scholar]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust

RESOURCES