title: Regional health care planning: a methodology to cluster facilities using community utilization patterns.
abstract: BACKGROUND
  Community-based health care planning and regulation necessitates grouping facilities and areal units into regions of similar health care use. Limited research has explored the methodologies used in creating these regions. We offer a new methodology that clusters facilities based on similarities in patient utilization patterns and geographic location. Our case study focused on Hospital Groups in Michigan, the allocation units used for predicting future inpatient hospital bed demand in the state's Bed Need Methodology. The scientific, practical, and political concerns that were considered throughout the formulation and development of the methodology are detailed.
  
  
  METHODS
  The clustering methodology employs a 2-step K-means + Ward's clustering algorithm to group hospitals. The final number of clusters is selected using a heuristic that integrates both a statistical-based measure of cluster fit and characteristics of the resulting Hospital Groups.
  
  
  RESULTS
  Using recent hospital utilization data, the clustering methodology identified 33 Hospital Groups in Michigan.
  
  
  CONCLUSIONS
  Despite being developed within the politically charged climate of Certificate of Need regulation, we have provided an objective, replicable, and sustainable methodology to create Hospital Groups. Because the methodology is built upon theoretically sound principles of clustering analysis and health care service utilization, it is highly transferable across applications and suitable for grouping facilities or areal units.
authors: Department of Geography, Michigan State University, East Lansing, MI 48824, USA. delamate@msu.edu.
authors: Paul L
authors: PL
authors: Delamater
authors: Ashton M
authors: AM
authors: Shortridge
authors: Joseph P
authors: JP
authors: Messina
mesh_terms: D003153:Community Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000458:organization & administration; D006301:Health Services Needs and Demand / Q000458:organization & administration / Q000706:statistics & numerical data; D006764:Hospitals, Community / Q000458:organization & administration / Q000600:supply & distribution; D006801:Humans; D008824:Michigan; D012040:Regional Health Planning / Q000379:methods*; D012041:Regional Medical Programs / Q000458:organization & administration*; D040841:Resource Allocation / Q000379:methods / Q000458:organization & administration
references: Inquiry. 1973 Dec;10(4):5-12
references: 4272487
references: Med Care. 1982 May;20(5):441-9
references: 7098588
references: J Rural Health. 2007 Winter;23(1):17-24
references: 17300474
references: Soc Sci Med. 2005 Jun;60(12):2715-27
references: 15820582
references: Health Serv Res. 1993 Jun;28(2):183-200
references: 8514499
references: Socioecon Plann Sci. 1990;24(2):81-95
references: 10108912
references: BMC Health Serv Res. 2005 May 09;5:33
references: 15882463
references: Health Serv Res. 2003 Feb;38(1 Pt 1):287-309
references: 12650392
references: Health Serv Res. 2004 Feb;39(1):207-20
references: 14965084
references: Neuroimaging Clin N Am. 2012 Aug;22(3):443-50
references: 22902112
references: Med Care. 1986 Apr;24(4):283-300
references: 3083160
references: Source Code Biol Med. 2010 Mar 25;5:4
references: 20338055
references: Health Serv Res. 1981 Summer;16(2):205-20
references: 7263274
references: Health Care Manag Sci. 2010 Mar;13(1):84-100
references: 20402285
references: Science. 1973 Dec 14;182(4117):1102-8
references: 4750608
references: Health Serv Res. 1987 Apr;22(1):69-89
references: 3570813
references: Med Care Res Rev. 2008 Aug;65(4):478-95
references: 18640951
references: Ann Intern Med. 2003 Feb 18;138(4):273-87
references: 12585825
references: Health Serv Res. 2006 Jun;41(3 Pt 1):618-28
references: 16704502
references: Br J Math Stat Psychol. 2006 May;59(Pt 1):1-34
references: 16709277
references: JAMA. 2012 Sep 26;308(12):1213-4
references: 23011709
references: Int J Health Geogr. 2012 May 15;11(1):15
references: 22587023
references: Health Serv Res. 1981 Summer;16(2):135-60
references: 7263271
references: JAMA. 2011 Mar 16;305(11):1113-8
references: 21406648
references: Health Serv Res. 1984 Jun;19(2):141-60
references: 6547418
references: Socioecon Plann Sci. 1979;13(6):321-6
references: 10297643
references: Health Serv Res. 1978 Winter;13(4):395-403
references: 570181
references: Psychol Methods. 2003 Sep;8(3):294-304
references: 14596492
references: Health Aff (Millwood). 2012 Apr;31(4):827-35
references: 22492900
references: Med Care. 1983 Jul;21(7):715-33
references: 6350744
references: Socioecon Plann Sci. 1981;15(2):45-51
references: 10250830