Geographic variation in the use of post-acute care.
OBJECTIVE
To assess the extent and consistency of geographic differences in the use of post-acute care (PAC), and the stability of this pattern of variation.


METHODS
The 5 percent Medicare data sample for 1996, 1997, and the first eight months of 1998 were used.


METHODS
Patterns of PAC use for various Diagnosis-related Groups (DRGs) cross states (33 with enough cases per year) and census divisions were examined. The consistency of relative rankings for overall PAC use and use within defined DRGs was compared.


RESULTS
PAC use varied substantially across regions. For example, the extent of any PAC use for stroke patients varied by 12 percentage points among census regions in 1998. The pattern of PAC use was quite consistent across years; 30 of the 36 possible Spearman rank order correlations were statistically significant with coefficients ranging from 0.35 to 0.95 among the DRGs studied. The correlations among DRGs were generally high. For skilled nursing facility use, all the correlations were above 0.5 and were statistically significant; in general the patterns were highest within medical DRGs (0.65-0.93).


CONCLUSIONS
The variation in PAC use is not a statistical artifact. It is likely the result of several forces: practice styles, supply of services, and local regulatory practices.
Kane
Robert L
RL
University of Minnesota School of Public Health, Minneapolis 55455, USA.
Lin
Wen-Chieh
WC
Blewett
Lynn A
LA
D000203:Activities of Daily Living; D000208:Acute Disease; D000359:Aftercare / Q000458:organization & administration*; D000368:Aged; D000369:Aged, 80 and over; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D014481:United States / Q000453:epidemiology