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How do our communities and our state compare with the rest of the U.S.?
This table helps put Maine in perspective. When we look at Maine as a whole, Maine does very well in the care of certain conditions such as:
We do hospitalize patients more often than the national benchmark for:
- COPD(Chronic Obstructive Lung Disease)
Although overall we compare well with the rest of the country, we still have work to do. We do poorly immunizing for pneumococcal pneumonia. Prevention of bacterial pneumonia with immunization reduces the rate of viral pneumonia. We must stop smoking. We must reduce our weight. We must become physically more active.
|Adjusted Rate per 100,000 , 2001|
|Adult admissions for diabetes with short term complications ||52.367||39.892†|
|Adult admission for diabetes with long term complications ||117.098||104.357†|
|Adult admissions for uncontrolled diabetes without complications||26.822||10.693†|
|Lower extremity amputations for adults with diabetes ||38.724||41.416†|
|Adult asthma admissions ||112.842||81.981†|
|Pediatric asthma admissions||188.601||106.210†|
|Adult admissions for COPD ||257.445||297.980†|
|Adult admissions for CHF ||494.972||410.285†|
|Adult admissions for angina ||58.694||82.185†|
|Immunization-preventable pneumococcal pneumonia admissions for elderly, age 65+ ||79.426||115.852†|
|Immunization-preventable influenza admissions for elderly, age 65+ ||13.357||15.117†|
Shaded values indicate areas where Maine performance may need improvement.
† p < .05. This means that the value shown for Maine is statistically different from that shown for the US, that is, the difference between the two values is not due to chance.
Variation Issues in Maine
Everyone Across The State Of Maine Does Not Receive The Same Quality Of Care:
- Citizens are Hospitalized Much More Frequently in Some Maine Communities than Others.
- Large variations require community study.
- Different Admission Rates are a Community Problem.
Is it possible to tell if hospital use is even across Maine? Is the care of chronic conditions the same in Aroostook and Cumberland counties?
We have two ways to look at outpatient care in Maine. The two ways are Ambulatory Care Sensitive Conditions and geographic variation data. Ambulatory Care Sensitive Conditions are a group of treatable medical problems. If the care is excellent, then it is less likely hospitalization will be necessary to care for patients with these problems. If you and your doctor keep your blood pressure under good control, then you will not have to be hospitalized to treat the complications of high blood pressure. If you and your doctor take good care of your asthma, then it is less likely that you will have to be hospitalized for complications of your asthma.
The figure titled “Ambulatory Care Sensitive Condition (ACSC) Discharges as a Percent of All Discharges by Hospital, Maine 2001-2002” (Chart 12) shows us this issue. The hospitals have been grouped by hospital determined hospital peer groups. We would expect that the percent of ACSC between peer groups would be different since larger hospitals that offer a wider variety of services have many other admissions such as for surgery. However, when we look within peer groups there are still large differences that may be of significance.
We can look at this another way using geographic variation data. Remember that variation data is based on the people that live in that community. In addition, the data is adjusted by age so that an unusual number of older citizens does not make the data wrong. When we look at the chart “Variation in Admissions Rates for Adult Medical Conditions” (Chart 8) we can see quite a difference between some communities and the state average... Pregnant women are not included in this study. The numbers come from five years of data combined. The orange bars mean that analysis strongly suggests that these results are not a matter of luck. The Greenville community has 41% more admissions that we would expect compared to the rest of the state. The differences are also wide for Caribou-Van Buren, Bar Harbor, Millinocket, Pittsfield, Fort Kent, Fort Fairfield, and Calais.
Is it likely that there are simply more chronically ill people in these towns in proportion to the total population?
Yes, some towns are different from the state average when it comes to some things such as number of people with diabetes. In addition, some towns are different from the state average for such things as high blood pressure, high cholesterol and asthma. However, those differences are not large enough to explain the difference we see in admission to hospitals. Chart 29 shows the prevalence of high blood pressure in hospital service areas in Maine in a chart also showing variation in admissions for medical conditions in those same hospital service areas. Prevalence means the number, rate or proportion of people in a community that have the condition. Charts 30, 31, and 32 correlate the burden of high cholesterol, asthma, and diabetes with admission rates.
These data are imperfect in that we have shown only a portion of the disease burden in these communities. The message here is that disease burden does vary across Maine but the variation of admissions for medical conditions varies even more. The admission rates for medical conditions appear to vary independently of the disease burden. We cannot find a clear link between the diagnosed amount of disease in a community and the number of times residents are hospitalized. We cannot demonstrate that there is not a small chance that this could have occurred by chance. However, we believe that the effect is unmistakable. Admission for medical conditions varies by community in Maine and appears unrelated to disease burden. What actually explains this variation is not clear. What is clear is that this is an issue that we should discuss in our communities.
Is there a lack of access to primary care providers?
When we look at fiscal year data from 2002 from the State of Maine Group Health Plan by geographic area we find that office visits for the Aroostook area are actually higher than the state average. The state average for this group of insureds is 3,698 per thousand where as the Aroostook area office visit rate is 3,820 per thousand. This data does not tell us about the adequacy of numbers of primary care providers, but does tell us that there seems to be enough providers to generate a greater rate of office visits than the state average. This data is not corrected for age or severity and therefore is not directly comparable. This data comes from a small part of the population in one health insurance plan. The data is provided for discussion.
Do primary care providers in these areas have the support they need in the form of electronic technology, physician extenders, nutritionists, health educators and patient involvement?
Since these are rural areas with limited resources the answer is likely no.
Is it the community habit to admit when in doubt? Unknown
Are community members unable to care for their ill relatives? Unknown
Is health insurance coverage lacking in some areas more than others? Health insurance coverage has been shown to be a factor in previous studies.
Certainly many factors are at work here.
There is not a right or wrong to this information. The information however concerns us all. State-wide leaders and community leaders must be concerned that people are not getting the care that they need. We need to be concerned that patients are not caring for themselves as they should. We need to be concerned that avoidable admissions are occurring, exposing patients to avoidable dangers and expense.
Click here to read the Maine Hospital Association’s view on this information.
Click here to read the Maine Medical Association’s view on this information.