The economic benefits of community health centers in lowering preventable hospitalizations: a cost-effectiveness analysis

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• 作者：Md. Monir Hossain (1)
  James N. Laditka (2)
  Joseph C. Gardiner (3)
  
  1. Division of Biostatistics and Epidemiology ; Cincinnati Children鈥檚 Hospital Medical Center ; Cincinnati ; OH ; 45229 ; USA
  2. Department of Public Health Sciences ; University of North Carolina at Charlotte ; Charlotte ; NC ; 28223 ; USA
  3. Department of Epidemiology and Biostatistics ; Michigan State University ; East Lansing ; MI ; 48824 ; USA
  
• 关键词：Spatial data ; Hierarchical Bayesian models ; Propensity score ; Random effects ; Community health centers
• 刊名：Health Services and Outcomes Research Methodology
• 出版年：2015
• 出版时间：March 2015
• 年：2015
• 卷：15
• 期：1
• 页码：23-36
• 全文大小：311 KB
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• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Public Health
  Statistics
  Economics
  Methodology of the Social Sciences
  
• 出版者：Springer Netherlands
• ISSN：1572-9400

文摘

Research has suggested that accessible primary healthcare may help control hospitalization for certain conditions that are often considered either preventable or treatable through primary healthcare. However, only limited research has tested this widely accepted hypothesis. We extend research on preventable hospitalization in the framework of cost-effectiveness analysis. Using hospitalization data from South Carolina, we show how access to primary healthcare may affect the volume and cost of hospitalizations for ambulatory care sensitive conditions. Our statistical models for effectiveness and cost take advantage of spatial methods to adjust for neighborhood characteristics. This adjustment also addresses correlations among variables describing each given area, providing appropriate results despite those correlations. We also use propensity scores to adjust for county level variation in access to primary healthcare. We observe that the mean differential volume and cost of lower extremity amputation associated with diabetes was significantly lower in areas served by community health centers than in other areas. This result provides support for the hypothesis that increasing access to primary healthcare may help to control the volume and cost of preventable hospitalization for some conditions.