title: Variability in home mechanical ventilation prescription.
abstract: BACKGROUND
  Few studies have analyzed the prevalence and accessibility of home mechanical ventilation (HMV). The aim of this study was to characterize the prevalence of HMV and variability in prescriptions from administrative data.
  
  
  METHODS
  Prescribing rates of HMV in the 37 healthcare sectors of the Catalan Health Service were compared from billing data from 2008 to 2011. Crude accumulated activity rates (per 100,000 population) were calculated using systematic component of variation (SCV) and empirical Bayes (EB) methods. Standardized activity ratios (SAR) were described using a map of healthcare sectors.
  
  
  RESULTS
  A crude rate of 23 HMV prescriptions per 100,000 population was observed. Rates increase with age and have increased by 39%. Statistics measuring variation not due to chance show a high variation in women (CSV=0.20 and EB=0.30) and in men (CSV=0.21 and EB=0.40), and were constant over time. In a multilevel Poisson model, hospitals with a chest unit were associated with a greater number of cases (beta=0.68, P<.0001).
  
  
  CONCLUSIONS
  High variability in prescribing HMV can be explained, in part, by the attitude of professionals towards treatment and accessibility to specialist centers with a chest unit. Analysis of administrative data and variability mapping help identify unexplained variations and, in the absence of systematic records, are a feasible way of tracking treatment.
authors.affiliation: Hospital Clínic, Barcelona, España; Plan Director de las Enfermedades del Aparato Respiratorio (PDMAR), Barcelona, España; Observatorio de las Terapias Respiratorias (Obs TRD). Departamento de Salud, CatSalut, AQuAS, PDMAR y Fundació d'Osona per a la Recerca i Educació Sanitària (FORES), Vic, Barcelona, España; REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas), Barcelona, España. Electronic address: ESCARRABILL@clinic.ub.es.
authors.forename: Joan
authors.initials: J
authors.lastname: Escarrabill
authors.affiliation: Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España; REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas), Barcelona, España.
authors.forename: Cristian
authors.initials: C
authors.lastname: Tebé
authors.affiliation: Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España; REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas), Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, España.
authors.forename: Mireia
authors.initials: M
authors.lastname: Espallargues
authors.affiliation: Plan Director de las Enfermedades del Aparato Respiratorio (PDMAR), Barcelona, España; Departamento de Salud (Generalitat de Catalunya), Barcelona, España.
authors.forename: Elena
authors.initials: E
authors.lastname: Torrente
authors.affiliation: Plan Director de las Enfermedades del Aparato Respiratorio (PDMAR), Barcelona, España; Departamento de Salud (Generalitat de Catalunya), Barcelona, España.
authors.forename: Ricard
authors.initials: R
authors.lastname: Tresserras
authors.affiliation: Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Argimón
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation / Q000706:statistics & numerical data; D057225:Data Mining; D005260:Female; D006297:Health Services Accessibility; D006699:Home Care Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D006757:Hospital Units; D006801:Humans; D008297:Male; D008500:Medical Records Department, Hospital / Q000458:organization & administration; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010102:Oxygen Inhalation Therapy / Q000295:instrumentation; D016012:Poisson Distribution; D055656:Prescriptions / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D015272:Pulmonary Medicine / Q000458:organization & administration; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012138:Respiratory Therapy / Q000706:statistics & numerical data; D013030:Spain
keywords: Financiación; Home mechanical ventilation; Reimbursement; Variabilidad; Variability; Ventilación mecánica a domicilio