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Application of a weighted head-banging algorithm to mortality data maps

STATISTICS IN MEDICINE 1999年第23期18卷 3201-+页

作者： Mungiole, M Pickle, LW Simonson, KH Ctr Dis Control & Prevent Natl Ctr Hlth Stat Hyattsville MD 20782 USA Sandia Natl Labs Albuquerque NM 87185 USA

Smoothed data maps permit the reader to identify general spatial trends by removing the background noise of random variability often present in raw data. To smooth mortality data from 798 small areas comprising the contiguous United States, we extended the head-banging algorithm to allow for differential weighting of the values to be smoothed. Actual and simulated data sets were used to determine how head-banging smoothed spike and edge features in the data, and to observe the degree to which weighting affected the results. As expected, spikes were generally removed while edges and clusters of high rates near the U.S. borders were maintained by the unweighted head-banging algorithm. Incorporating weights inversely proportional to standard errors had a substantial effect on smoothed data, for example determining whether observed spikes were retained or removed. The process used to obtain the smoothed data, including the choice of head-banging parameters, is discussed. Results are considered in the context of general spatial trends, Published in 1999 by John Wiley & Sons, Ltd. This article is a U.S. Government work and is in the public domain in the United States.

关键词：算法卫生服务范围/统计学和数值数据计算机模拟肺肿瘤/死亡率死亡率前列腺肿瘤/死亡率小地区分析美国/流行病学人类男(雄)性

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Strategic Activity and Financial Performance of U.S. Rural Hospitals: A National Study, 1983 to 1988

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The Journal of Rural Health 1994年第3期10卷 150-167页

作者： Mick, Stephen S. Morlock, Laura L. Salkever, David de Lissovoy, Gregory Malitz, Faye Wise, Christopher G. Jones, Alison Department of Health Services Management School of Public Health University of Michigan in Ann Arbor Ann Arbor Michigan United States Department of Health Policy and Management School of Hygiene and Public Health Johns Hopkins University Baltimore Maryland United States Department of Health Policy and Management School of Hygiene and Public Health Johns Hopkins University Baltimore Maryland United States Department of Health Policy Management of Hygiene and Public Health Johns Hopkins University Baltimore Maryland United States Department of Health Policy Management the School of Hygiene and Public Health Johns Hopkins University in Baltimore Maryland United States Department of Health Services School of Public Health at the University of Michigan Ann Arbor Michigan United States Arizona State University Tempe Arizona United States

This study examines the effect of 13 strategic management activities on the financial performance of a national sample of 797 U.S. rural hospitals during the period of 1983‐1988. Controlled for environment‐market, geographic‐region, and hospital‐related variables, the results show almost no measurable effect of strategic adoption on rural hospital profitability and liquidity. Where statistically significant relationships existed, they were more often negative than positive. These findings were not expected;it was hypothesized that positive effects across a broad range of strategies would emerge, other things being equal. Discussed are possible explanations for these findings as well as their implication for a rural health policy relying on individual rural hospital strategic adaptation to environmental change. Copyright © 1994, Wiley Blackwell. All rights reserved

关键词：卫生服务范围/统计学和数值数据数据收集财务管理医院/统计学和数值数据卫生服务研究/方法医院乡村/经济学医院乡村/统计学和数值数据模型经济学所有权/统计学和数值数据回归分析美国

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A methodology for determining hospital service areas with marketing and planning applications

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Journal of Hospital Marketing 1988年第2期2卷 87-97页

作者： Humphrey, Alan B. Scherzer, Gary D. Marshall, Robert J. Buechner, Jay S. University of Rhode Island United States Health Services Management State University of New York College of Technology United States Office of Health Promotion and Disease Prevention United States Rhode Island Department of Health United States

No abstract available for this article.

关键词：卫生服务范围/统计学和数值数据医院计划卫生服务使用研究/方法模型统计学病人出院/统计学和数值数据人口动力学罗得岛

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Market Shares for Rural Inpatient Surgical Services: Where Does the Buck Stop?

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The Journal of Rural Health 1994年第2期10卷 70-79页

作者： Williamson, Harold A. Gary Hart, L. Pirani, Michael J. Rosenblatt, Roger A. University of Missouri-Columbia Columbia Missouri United States

Utilization of surgical services by rural citizens is poorly understood, and few data are available about rural hospitals’surgical market shares and their financial implications. Understanding these issues is particularly important in an era of financially stressed rural hospitals. In this study information about rural surgical providers and services was obtained through telephone interviews with administrators at Washington state's 42 rural hospitals. The Washington State Department of Health's Commission Hospital Abstract Recording System (CHARS) data were used to measure market shares and billed charges for rural surgical services. ZIP codes were used to assign rural residents to a hospital service area (HSA) of the nearest hospital, providing the geographic basis for market share calculations. “Total hospital expenses” from the American Hospital Association Guide were used as a proxy for hospital budget, and the surgical financial contribution was expressed as a ratio of billed surgical charges to total hospital expense. For rural hospitals as a whole, 21 percent of admissions and 43 percent of billed inpatient charges resulted from surgical services. In 1989, 27,202 rural Washington residents were hospitalized for surgery. Overall, 42 percent went to the closest rural hospital, 14 percent went to other rural hospitals, and 44 percent went to urban hospitals. The presence of surgical providers markedly increased local market shares, but a substantial proportion of basic surgical procedures bypassed available local services in favor of urban hospitals. For example, about one‐third of patients needing cholecystectomies, a basic general surgery of low complexity, bypassed local hospitals with staff surgeons. Thirty‐eight percent of hospitals had no general surgeon (classified as “minimal service” hospitals), 41 percent had at least one (“basic service” hospitals), and 21 percent had a comprehensive surgical staff consisting of general surgeons plus at least one ane

关键词：卫生服务范围/经济学卫生服务范围/统计学和数值数据经济竞争医院乡村/分类法医院乡村/经济学医院乡村/利用医院市区/经济学医院市区/利用采访病人记账和收款/统计学和数值数据生产线管理/经济学外科医院/经济学外科医院/利用华盛顿

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The Relationship of Farm Residency Status to Demographic and Service Characteristics of Agricultural Injury Victims in Central Wisconsin

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The Journal of Rural Health 1995年第2期11卷 98-105页

作者： Stueland, Dean Cleveland, David A. Rothfusz, Ron R. Zoch, Tom Jr., Peter Stamas Department of Emergency Medicine Marshfield Clinic Marshfield Wisconsin 54449‐5777 1000 N. Oak Ave. United States

Abstract: This study performed a surveillance of a defined population in central Wisconsin during a two‐year period that included six months of follow‐up. The study included those who worked and lived on farms and those who only worked on farms. The injury rate for farm residents was 3.15 injuries per 100 persons per year. However, 195 of the 510 injuries (38.2%) involved persons who were not farm residents. For nonfarm residents, 88.7 percent of the victims were male, whereas for farm residents 79 percent of the victims were male. More than one half of the farm residents who were injured were the owners and an additional 21 percent were juvenile children. Of those aged 18 to 29 years, 51.3 percent were nonfarm resident victims and 15.2 percent were farm resident victims. Of nonfarm residents, 41.1 percent were married;of farm residents, 65.3 percent were married. More than one half of all injured nonfarm residents were seen within two hours of injury while one quarter of the injured farm residents were seen more than 24 hours after the injury. Only 4 percent of the injured farm residents were self‐insured, but 15 percent of the nonfarm residents were self‐insured. However, the time of injury, actual injuries, diagnoses rendered, and services received were similar for injured farm residents and injured nonfarm residents. Effective attempts to intervene on agricultural injuries will need to consider different risk factors for injuries for nonfarm residents as compared to farm residents. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：事故职业/预防和控制事故职业/统计学和数值数据农业/统计学和数值数据卫生服务范围/统计学和数值数据卡方分布社区卫生服务/组织和管理综合保健/组织和管理数据收集人口统计学保险健康/统计学和数值数据居住特征/统计学和数值数据农村卫生病人转送/方法病人转送/统计学和数值数据威斯康星/流行病学创伤和损伤/流行病学成年人老年人儿童人类中年人

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The HMO industry: evolution in population demographics and market structures.

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Medical care review 1991年第1期48卷 3-46页

作者： Christianson, J.B. Sanchez, S.M. Wholey, D.R. Shadle, M. University of Minnesota Minneapolis United States

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Out-of-area travel from rural and urban counties: A study of ambulatory care sensitive hospitalizations for New York State residents

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JOURNAL OF RURAL HEALTH 2000年第2期16卷 129-138页

作者： Basu, J Cooper, J Agcy Healthcare Res & Qual Rockville MD 20852 USA

Rural patients who are admitted to hospitals outside their residence county or who travel great distances for hospitalization deprive local rural hospitals of revenue. To provide more information about such rural residents, we studied their characteristics compared to those admitted in the same county. Characteristics studied included illness severity, demographics and county resources. To validate the findings and to provide a different analytic approach, characteristics of residents who travel long distances for admission were also studied. We studied admissions for ambulatory care sensitive conditions, as they might be most responsive to policy changes such as increasing recruitment of local primary-care physicians. Hospital discharges during 1994 for 248,656 New York State residents were studied. We constructed multivariate models using logistic regression and ordinary least squares methods. The models were applied to residents in three types of geographic location along an urban-rural continuum. Outside admissions were associated with younger age, higher illness severity and fewer county hospital resources. Same county admissions were associated with nonwhite race, and lack of insurance. Surprisingly, in rural counties, outside admissions were directly associated with increased primary-care providers. Results from the distance model generally supported findings from the outside admission model.

关键词：门诊医疗/利用卫生服务范围/统计学和数值数据康涅狄格卫生服务易得程度/统计学和数值数据住院医院乡村新泽西纽约宾夕法尼亚农村人口/统计学和数值数据疾病严重程度指数市区人口/统计学和数值数据人类中年人

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Medical outshopping intent: Profiling the health care consumer

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Journal of Hospital Marketing 1998年第2期12.0卷 53-68页

作者： Meadow, H.L. Rahtz, D.R. Spotts, H.E. School of Business and Technology University of Wisconsin-Parkside Kenosha WI 53141-2000 United States

The health care industry has been exposed to a tremendous upheaval in the last decade. The traditional practices have given way to new behaviors and structures. This is especially true for community hospitals that have long provided the major portion of health care services in their markets. Their traditional local service area, once thought of as fairly much their sole domain, is being redefined. Consumers are becoming more aware of alternative health delivery options, thus choosing to go outside of their local trading area for these alternatives. This study investigates consumer characteristics and influences driving this behavior. Implications for hospital marketing practices are discussed.

关键词：卫生服务范围/统计学和数值数据选择行为补充疗法人口统计学卫生服务研究卫生服务使用研究中大西洋地区病人接受卫生保健的程度/心理学病人满意度问卷调查社会经济因素成年人老年人女(雌)性人类男(雄)性中年人

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THE IMPACT OF PHYSICIAN CHARACTERISTICS IN CONDITIONAL CHOICE MODELS FOR HOSPITAL-CARE

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JOURNAL OF HEALTH ECONOMICS 1992年第1期11卷 43-62页

作者： BURNS, LR WHOLEY, DR UNIV ARIZONA COLL BUSINESS & PUBL ADMSCH PUBL ADMTUCSONAZ 85721 CARNEGIE MELLON UNIV DEPT SOCIAL & DECIS SCIPITTSBURGHPA 15213

Recent research has investigated the determinants of the specific hospitals to which patients are admitted. Data limitations have led researchers to examine the effects of patient and hospital characteristics while ignoring the role of physician characteristics. In this study we analyze the effects of all three sets of factors on hospital choice in the greater Phoenix area during 1989. Our results suggest that physician characteristics are strong determinants of hospital choice, accounting for much of the explained variation. Differences in hospital quality and cost, on the other hand, exert significant effects on hospital choice but explain relatively little variation.

关键词：亚利桑那卫生服务范围/统计学和数值数据选择行为诊断相关患者组/统计学和数值数据费用和收费/统计学和数值数据卫生服务研究/方法医院死亡率医院/分类医院/统计学和数值数据医院/利用模型统计学医师/分类医师/统计学和数值数据医师/利用专业场所/统计学和数值数据卫生保健质量/统计学和数值数据回归分析运输人类

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Geographic aggregation of health data: a comparison of alternatives for 1990 and beyond

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Health Marketing Quarterly 1993年第3-4期10卷 55-65页

作者： Humphrey, Alan B. Lewis, Robert F. University of Rhode Island Kingston RI United States University of South Carolina United States

Data analysis and graphics software for micro computers and main frames include components that will easily draw maps to the users' specifications. These components make it possible to apply data to a geographic base and to shade the map as desired. One of the major problems with computer mapping is the choice of geographic unit of aggregation and how information for local health policy and planning can be diluted and misleading by using geographically aggregated health statistics that are more appropriate for state and federal decision making. A study demonstrates the effects of choices of aggregation. Current developments affecting local policy and planning include geographic information system software designed to generate, analyze, and display mapped data.

关键词：偏倚(流行病学) 卫生服务范围/统计学和数值数据计算机制图/标准人口统计学地理学地图邮政/分类小地区分析南卡罗来纳/流行病学统计数据/标准梅毒/流行病学人类

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