Study objective

The COVID-19 pandemic in the United States has underscored the need to understand health care in a regional context. However, there are multiple definitions of health care regions available for conducting geospatial analyses. In this study, we compare the novel Pittsburgh Atlas, which defined regions for emergency care, with the existing definitions of regions, counties, and the Dartmouth Atlas, with respect to nonemergent acute medical conditions using pneumonia admissions.

Methods

We identified patients hospitalized with a primary diagnosis of pneumonia or a primary admitting diagnosis of sepsis with a secondary diagnosis of pneumonia in the Agency for Healthcare Research and Quality’s State Inpatient Databases. We calculated the percentage of region concordant care, the localization index, and market share for 3 definitions of health care regions (the Pittsburgh Atlas, Dartmouth Atlas, and counties). We used logistic regression identified predictors of region concordant care.

Results

We identified 1,582,287 patients who met the inclusion criteria. We found that the Pittsburgh Atlas and Dartmouth Atlas definitions of regions performed similarly with respect to both localization index (92.0 [interquartile range 87.9 to 95.7] versus 90.3 [interquartile range 81.4 to 94.5]) and market share (8.5 [interquartile range 5.1 to 13.6] versus 9.4 [interquartile range 6.7 to 14.1]). Both atlases outperformed the localization index (67.5 [interquartile range 49.9 to 83.9]) and market share (20.0% [interquartile range 11.4 to 31.4]) of the counties. Within a given referral region, the demographic factors, including age, sex, race/ethnicity, insurance status, and the level of severity, affected concordance rates between residential and hospital regions.

Conclusion

Because the Pittsburgh Atlas also has the benefit of respecting state and county boundaries, the use of this definition may have improved policy applicability without sacrificing accuracy in defining health care regions for acute medical conditions.

中文翻译：

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COVID-19 时代美国医疗保健区域新定义的实用性：使用肺炎入院验证匹兹堡地图集

学习目标

美国的 COVID-19 大流行凸显了在区域背景下了解医疗保健的必要性。但是，有多种医疗保健区域定义可用于进行地理空间分析。在这项研究中，我们比较了新的匹兹堡地图集，它定义了紧急护理的区域，与现有的地区、县和达特茅斯地图集的定义，关于使用肺炎入院的非紧急急性医疗条件。

方法

我们在医疗保健研究和质量局的州住院患者数据库中确定了初步诊断为肺炎或初步诊断为败血症并二次诊断为肺炎的住院患者。我们计算了 3 种定义的医疗保健区域（匹兹堡地图集、达特茅斯地图集和县）的区域协调护理百分比、本地化指数和市场份额。我们使用逻辑回归确定了区域一致性护理的预测因子。

结果

我们确定了 1,582,287 名符合纳入标准的患者。我们发现匹兹堡地图集和达特茅斯地图集的区域定义在本地化指数（92.0 [四分位距 87.9 至 95.7] 与 90.3 [四分位距 81.4 至 94.5]）和市场份额（8.5 [四分位距 5.1 至 13.6]）方面表现相似] 对比 9.4 [四分位间距 6.7 至 14.1]）。两个地图集的表现均优于各县的本地化指数（67.5 [四分位距 49.9 至 83.9]）和市场份额（20.0% [四分位距 11.4 至 31.4]）。在给定的转诊区域内，包括年龄、性别、种族/族裔、保险状况和严重程度在内的人口因素会影响居住区和医院区之间的一致性率。

结论

由于匹兹堡地图集还具有尊重州和县边界的优势，因此使用该定义可能会提高政策适用性，而不会牺牲为急性疾病定义医疗保健区域的准确性。