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Arch Bronconeumol. 2015 Oct;51(10):490-5. doi: 10.1016/j.arbres.2014.11.018. Epub 2015 Jan 21.

Variability in home mechanical ventilation prescription.

[Article in English, Spanish]

Author information

1
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.
2
Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España; REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas), Barcelona, España.
3
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.
4
Plan Director de las Enfermedades del Aparato Respiratorio (PDMAR), Barcelona, España; Departamento de Salud (Generalitat de Catalunya), Barcelona, España.
5
Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España.

Abstract

INTRODUCTION:

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.

KEYWORDS:

Financiación; Home mechanical ventilation; Reimbursement; Variabilidad; Variability; Ventilación mecánica a domicilio

PMID:
25618455
DOI:
10.1016/j.arbres.2014.11.018
[Indexed for MEDLINE]
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