Variability in home mechanical ventilation prescription.

Area of Science:

• Pulmonary Medicine
• Health Services Research
• Medical Informatics

Background:

• Limited research exists on the prevalence and accessibility of home mechanical ventilation (HMV).
• Understanding HMV prescription patterns is crucial for equitable healthcare delivery.

Purpose of the Study:

• To characterize the prevalence of HMV across different healthcare sectors.
• To analyze the variability in HMV prescriptions using administrative data.

Main Methods:

• Compared HMV prescribing rates in 37 Catalan Health Service sectors (2008-2011).
• Calculated crude accumulated activity rates using systematic component of variation (SCV) and empirical Bayes (EB) methods.
• Utilized standardized activity ratios (SAR) and mapping to visualize geographic variations.

Main Results:

• Observed a crude HMV prescription rate of 23 per 100,000 population, with a 39% increase over time.
• Identified significant variability in prescribing rates, particularly in women and men, which remained constant.
• Hospitals with chest units showed a higher association with HMV prescriptions (beta=0.68, P<.0001).

Conclusions:

• Variability in HMV prescribing is partly attributed to professional attitudes and access to specialized centers.
• Administrative data analysis and variability mapping effectively identify unexplained prescribing variations.
• This approach offers a feasible method for tracking HMV treatment in the absence of systematic records.