Variation in hospital use and avoidable patient morbidity.
OBJECTIVE
To determine whether geographical areas with relatively low overall hospitalization rates have higher population-based rates of admission of patients with advanced stages of disease.


METHODS
Age- and sex-standardized hospital admission rate were calculated for the residents of the 80 Local Health Units in Lombardia, Italy. Using the Disease Staging classification, advanced stage admissions were identified for six common medical and surgical conditions, which it was presumed would reflect untimely hospital admission. Standardized rates of advanced stage admissions were compared in areas with overall high hospitalization rates (high-use areas).


RESULTS
Hospitalization at advanced stages of disease in the low-use areas were significantly higher for the six conditions combined (55.9 vs 43.0 per 100,000; P = 0.005), and for external hernia, appendicitis and uterine fibroma, but not for bacterial pneumonia, diverticular disease and peptic ulcer. For the six study conditions combined, residents of overall low-use area were 30% more likely to be admitted with advanced stages of disease.


CONCLUSIONS
Low overall hospitalization rates were found to be associated with greater severity of illness at hospitalization and potentially avoidable morbidity for some conditions. Policies aimed at curbing unnecessary hospital admission should consider preserving access for appropriate treatment.
Taroni
F
F
Laboratorio di Epidemiologia e Biostatistica, Istituto Superiore di Sanità, Roma.
Repetto
F
F
Louis
D Z
DZ
Moro
M L
ML
Yuen
E J
EJ
Gonnella
J S
JS
D000208:Acute Disease / Q000145:classification; D002391:Catchment Area, Health; D002908:Chronic Disease / Q000145:classification; D003625:Data Collection; D005843:Geography; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D009017:Morbidity; D010343:Patient Admission / Q000706:statistics & numerical data*; D012720:Severity of Illness Index