Skip to main content
PMC home page
American Journal of Public Health logoLink to American Journal of Public Health
. 1986 Jan;76(1):45–51. doi: 10.2105/ajph.76.1.45

Variations in physicians' hospitalization practices: a population-based study in Manitoba, Canada.

N P Roos, G Flowerdew, A Wajda, R B Tate
PMCID: PMC1646401  PMID: 3079630

Abstract

This paper uses claims data from a universal health care system to describe physicians' hospitalization styles after adjusting for case-mix characteristics of their primary patients. Patients were uniquely assigned to that physician (general or family practitioners, internist, general surgeon, or obstetrician/gynecologist) seen most frequently over each two two-year periods (1972-74 and 1974-76). Four indices were developed including: 1) percentage of primary patients hospitalized; 2) mean number of readmissions for such patients; 3) mean length of stay; and 4) total days of hospitalization per primary care patient (a summary measure combining the first three). Rates of admission, not length of stay, were shown to be strongly related to this summary measure. Marked variations in the hospitalization indices were observed across physicians; these variations cannot be explained by the health or sociodemographic characteristics of a physician's patients. Rural physicians practicing in areas with high bed-to-population ratios and low occupancy rates were particularly high users of hospitals. The economic implications of different practice styles are shown to be large; physicians who were high users of hospitals serve 27 per cent of the patients but their patients consume 42 per cent of the hospital days.

Full text

PDF
48

Selected References

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

  1. Branch L., Jette A., Evashwick C., Polansky M., Rowe G., Diehr P. Toward understanding elders' health service utilization. J Community Health. 1981 Winter;7(2):80–92. doi: 10.1007/BF01323227. [DOI] [PubMed] [Google Scholar]
  2. Connell F. A., Blide L. A., Hanken M. A. Clinical correlates of small area variations in population-based admission rates for diabetes. Med Care. 1984 Oct;22(10):939–949. doi: 10.1097/00005650-198410000-00006. [DOI] [PubMed] [Google Scholar]
  3. Diehr P. Small area statistics: large statistical problems. Am J Public Health. 1984 Apr;74(4):313–314. doi: 10.2105/ajph.74.4.313. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Eisenberg J. M. Sociologic influences on decision-making by clinicians. Ann Intern Med. 1979 Jun;90(6):957–964. doi: 10.7326/0003-4819-90-6-957. [DOI] [PubMed] [Google Scholar]
  5. Gornick M. Medicare patients: geographic differences in hospital discharge rates and multiple stays. Soc Secur Bull. 1977 Jun;40(6):22–41. [PubMed] [Google Scholar]
  6. KAHN R. L., GOLDFARB A. I., POLLACK M., PECK A. Brief objective measures for the determination of mental status in the aged. Am J Psychiatry. 1960 Oct;117:326–328. doi: 10.1176/ajp.117.4.326. [DOI] [PubMed] [Google Scholar]
  7. Knickman J. R., Foltz A. M. A statistical analysis of reasons for East-West differences in hospital use. Inquiry. 1985 Spring;22(1):45–58. [PubMed] [Google Scholar]
  8. Linn L. S., Yager J., Leake B. D., Gastaldo G., Palkowski C. Differences in the numbers and costs of tests ordered by internists, family physicians, and psychiatrists. Inquiry. 1984 Fall;21(3):266–275. [PubMed] [Google Scholar]
  9. List N. D., Fronczak N. E., Gottlieb S. H., Baker R. E. A cross-national study of differences in length of stay of patients with cardiac diagnoses. Med Care. 1983 May;21(5):519–530. doi: 10.1097/00005650-198305000-00005. [DOI] [PubMed] [Google Scholar]
  10. McCall N., Wai H. S. An analysis of the use of Medicare services by the continuously enrolled aged. Med Care. 1983 Jun;21(6):567–585. doi: 10.1097/00005650-198306000-00001. [DOI] [PubMed] [Google Scholar]
  11. McPherson K., Strong P. M., Epstein A., Jones L. Regional variations in the use of common surgical procedures: within and between England and Wales, Canada and the United States of America. Soc Sci Med A. 1981 May;15(3 Pt 1):273–288. doi: 10.1016/0271-7123(81)90011-0. [DOI] [PubMed] [Google Scholar]
  12. Mossey J. M., Shapiro E. Self-rated health: a predictor of mortality among the elderly. Am J Public Health. 1982 Aug;72(8):800–808. doi: 10.2105/ajph.72.8.800. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Roos L. L., Jr, Roos N. P., Cageorge S. M., Nicol J. P. How good are the data? Reliability of one health care data bank. Med Care. 1982 Mar;20(3):266–276. doi: 10.1097/00005650-198203000-00003. [DOI] [PubMed] [Google Scholar]
  14. Roos L. L., Jr Supply, workload and utilization: a population-based analysis of surgery in rural Manitoba. Am J Public Health. 1983 Apr;73(4):414–421. doi: 10.2105/ajph.73.4.414. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Roos N. P. Hysterectomy: variations in rates across small areas and across physicians' practices. Am J Public Health. 1984 Apr;74(4):327–335. doi: 10.2105/ajph.74.4.327. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Roos N. P., Shapiro E. The Manitoba longitudinal study on aging: preliminary findings on health care utilization by the elderly. Med Care. 1981 Jun;19(6):644–657. doi: 10.1097/00005650-198106000-00007. [DOI] [PubMed] [Google Scholar]
  17. Schroeder S. A., Showstack J. A., Roberts H. E. Frequency and clinical description of high-cost patients in 17 acute-care hospitals. N Engl J Med. 1979 Jun 7;300(23):1306–1309. doi: 10.1056/NEJM197906073002304. [DOI] [PubMed] [Google Scholar]
  18. Wennberg J. E., Barnes B. A., Zubkoff M. Professional uncertainty and the problem of supplier-induced demand. Soc Sci Med. 1982;16(7):811–824. doi: 10.1016/0277-9536(82)90234-9. [DOI] [PubMed] [Google Scholar]
  19. Wennberg J. E. Dealing with medical practice variations: a proposal for action. Health Aff (Millwood) 1984 Summer;3(2):6–32. doi: 10.1377/hlthaff.3.2.6. [DOI] [PubMed] [Google Scholar]
  20. Wennberg J., Gittelsohn A. Variations in medical care among small areas. Sci Am. 1982 Apr;246(4):120–134. doi: 10.1038/scientificamerican0482-120. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES