Journal of Public Health Medicine 22:435-438 (2000)
© 2000 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
Urban-rural differences in total hip replacements: the next stage
CE Willis0,z
F Kee1
D Beverland2
JD Watson3
0 Eastern Health and Social Services Board, Champion House, Linenhall Street, Belfast BT2 8BS, UK
1 The Queen's University of Belfast, Mulhouse building, the Royal Group of Hospitals, Grosvenor Road, Belfast BT12 6BB, UK
2 Greenpark Healthcare Trust, Stockman's Lane, Belfast BT9 7JB, UK
3 Northern Health and Social Services Board, 142 Galgorm Road, Ballymena BT42 1QB, UK
z Corresponding author
E-mail: simon.rankin@btinternet.com
Background.The aim of this study was to explore the differences in the incidence of primary elective total hip replacements between urban and rural communities and different age and sex groups in Northern Ireland, and to use this information to develop an equitable method for the allocation of surgical capacity among groups of general practices, in a system where referrals are matched to the contracted capacity.
Method.A retrospective review was performed of all cases of primary elective total hip replacement between 1 April 1994 and 31 March 1997. Incidence rates were calculated using direct standardization. Age, sex, and urban and rural specific rates for Northern Ireland were calculated and applied to each general practice population giving that practice's annual expected number of total hip replacements.
Results.A total of 4147 cases were analyzed. The age and sex standardized incidence of primary elective total hip replacement for the total population was 87.6 per 100 000. The incidence was significantly greater in rural populations (101.3 per 100 000), than in urban ones (77.6 per 100 000), p<0.001. The overall standardized ratio or males to females was 1:1 although it was 1:1.2 in urban and 1:0.9 in rural populations. Using a 3 year commissioning cycle, commissioning for a population of 130 000 allows a 10 per cent margin of error in the numbers of procedures required.
Conclusion.A system of calculating the expected need for a total hip replacement was developed based on the demography and rurality of individual general practices. This system allowed a method of commissioning to be instituted that could significantly reduce in-patient waiting lists for this procedure.
Keywords: total hip replacement, needs assessment, rural, commissioning
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