title: Variations in clinical practice among the Hawaiian islands.
abstract: State health surveys and hospital discharge data suggest aspects of health care may vary by island in the state of Hawai'i. This study further examines the issue comparing O'ahu, Maui, Hawai'i, and Kaua'i on 15 indicators of recommended clinical care using data from a large insurer in Hawaii. The Hawaiian Islands differed to a statistically significant extent on 14 of the 15 indicators. O'ahu had the highest percentage of recommended care for six indicators, Maui for four, Kaua'i for three, and Hawai'i for two. In analyses adjusted for age, gender, morbidity, and health plan--and comparing the outer islands individually to O'ahu--O'ahu had more favorable care in 16 of 18 statistically significant comparisons. More focused geographic studies may be warranted to clarify where and why the variations in health care occur.
authors.affiliation: Department of Care Management, Hawai'i Medical Service Association, Honolulu 96814, USA. james_davis@hmsa.com
authors.forename: James W
authors.initials: JW
authors.lastname: Davis
authors.forename: Deborah
authors.initials: D
authors.lastname: Taira
authors.forename: Richard S
authors.initials: RS
authors.lastname: Chung
mesh_terms: D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005843:Geography; D006254:Hawaii; D019538:Health Care Surveys; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D019035:Rural Health Services / Q000592:standards; D012935:Social Justice; D019037:Urban Health Services / Q000592:standards