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Factors contributing to practice variation in post-stroke rehabilitation
A J Lee1, J H Huber, W B Stason
1Health Economics Research, Inc., Waltham, MA 02154, USA.
Health Services Research
|June 1, 1997
Summary
Geographic variations in post-stroke care costs and utilization are significant. Most of this variation is not explained by patient or market factors, indicating other unmeasured influences on healthcare practices.
Area of Science:
- Health Services Research
- Medical Economics
- Stroke Rehabilitation
Background:
- Post-stroke medical care utilization and costs exhibit considerable geographic variability.
- Understanding the drivers of this variation is crucial for healthcare policy and resource allocation.
Purpose of the Study:
- To analyze geographic variations in the utilization and cost of post-stroke medical care.
- To identify patient and market characteristics that explain these practice variations across Metropolitan Statistical Areas (MSAs).
Main Methods:
- Utilized a 20% random sample of Medicare beneficiaries hospitalized for stroke in 1991.
- Employed weighted least squares regression to analyze post-stroke costs, utilization, and length of stay across 151 MSAs.
- Regressed MSA-level averages of costs and utilization on patient and market characteristics.
Main Results:
- Patient characteristics explained less than one-third of practice variation across MSAs.
- Market variables were generally less important in explaining practice variations.
- One-half to two-thirds of the practice variation remained unexplained by measured patient and market factors.
Conclusions:
- A substantial portion of inter-MSA variability in post-stroke rehabilitation service utilization and intensity is not attributable to patient differences.
- Unmeasured factors likely account for a significant amount of the observed practice variations across different geographic areas.