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ECONOMICS, EDUCATION, AND POLICY

Application of a Similarity Index to State Discharge Abstract Data to Identify Opportunities for Growth of Surgical and Anesthesia Practices

Ruth E. Wachtel, PhD, MBA^*, Elisabeth U. Dexter, MD, FACS, and Franklin Dexter, MD, PhD^*

From the *Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa 52242; Division of Thoracic Oncology, Department of Surgery, State University of New York Upstate, Syracuse, New York 13210; and Department of Health Management and Policy, University of Iowa, Iowa City, Iowa 52242.

Address correspondence to Franklin Dexter, MD, PhD, Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa 52242. Address e-mail to Franklin-Dexter{at}UIowa.edu. For more information visit www.FranklinDexter.net

Abstract

INTRODUCTION: Most surgical and anesthesia groups are interested in expanding their practices and recruiting more patients. Methods have been developed to help hospitals identify surgical specialties with the potential for growth by determining whether the hospital is performing fewer of certain types of procedures than expected in a given specialty. However, these methods are not appropriate for physicians who may practice at more than one hospital and want to determine the potential for growth in their regions.

METHODS: We examined potential markets for growth of surgical and anesthesia practices in Iowa and New York State using state discharge abstract data. Several patient demographic groups and several surgical specialties were examined. Each state was divided into regions, and data were analyzed three ways: (1) A similarity index compared each region to the rest of the state. (2) The number of procedures performed on patients who left their home regions for care was determined. (3) A similarity index compared procedures performed on patients who left their home regions for care with procedures performed on patients who remained within their home regions.

RESULTS: The methods successfully identified several geographic regions with previously unrecognized growth potential. Access to care was limited in these regions. The methods correctly showed few opportunities for growth in geographic regions where expansion was already known to be unlikely.

CONCLUSIONS: A count of the number of procedures performed on patients who left their home regions, in combination with the similarity index, is a useful method for screening state discharge abstract data to identify geographic regions where surgical and anesthesia practices could grow.

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