Socioeconomic indicators of resource utilization among urban chronic obstructive pulmonary disease patients

It is the intent of this research to substantiate presumed associations between socioeconomic status and inpatient resource utilization among a homogeneous, disease specific, urban population, controlling for illness severity. A critical component of this research is the assessment of routinely produced socioeconomic and illness severity measures and their efficacy in predicting inpatient resource utilization. Underlying these investigative efforts is the broader intent to develop valid and reliable markers for the identification of socioeconomically disadvantaged patient groups and their interrelated patterns of healthcare use. Ultimately, it is anticipated that this research will positively affect the equitable distribution of clinical services and the consequent reduction of unnecessary resource utilization.;To examine the proposed hypothesis, eighteen months of retrospective encounter-level data was retrieved from hospital discharge records. All hospital discharges from July 1, 1997 through December 31, 1998 with the primary discharge diagnosis of COPD were evaluated for this analysis. Subject discharges were organized to create a data set consisting of unique geographic "block group" summaries of aggregate resource utilization.;Linear regression and path analysis techniques were used to perform the analysis. An examination of the results showed that while controlling for severity of illness, factored indicators of SES were significantly correlated with aggregate block group admissions, patient days, and total patient costs. While not significantly associated with an aggregate utilization index or aggregate procedures (presumed indicators of utilization), factored SES was highly correlated with valid utilization indicators in both direction and strength.;To evaluate the isolated effects of "high use" block groups, the data-base was again recast into quartiles, and recoded with the lower three quartiles identified as low-cost use block groups. The upper quartile was similarly recoded to represent the high-cost block groups. When patient admissions were evaluated, high-use block groups demonstrated disproportionate utilization. The high-use population was found to have 25.3% higher patient days, 40% greater number of procedures performed, 24.6% higher total costs and 25% higher variable costs, strongly suggesting that the majority of resource utilization was consumed by multiple admission block groups.