The aim of this study is to clarify whether there is small area variation in the use of gastrostomy that is explained by hospital physician density, so as to detect the existence of supplier-induced demand (SID).The study design is a retrospective cohort using claim data of Fukuoka Late Elders’ Health Insurance, submitted from 2010 to 2013. Study participants included 51,785 older adults who had been diagnosed with eating difficulties. We designated use of gastrostomy as an event. Multilevel logistic analyses were then used to investigate the existence of SID.After controlling for patient factors, we found significant regional level variance in gastrectomy use (median odds ratio [MOR]: 1.72, 1.37–2.51). Hospital physician density was significantly positively related with gastrostomy (adjusted OR of hospital physician density: 1.75, 1.25–2.45; P < 0.001). MORs were largely reduced for the input variable of hospital physician density.We found that the small area variation in use of gastrostomy among older adults could be explained by hospital physician density, which might indicate the existence of SID.
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机译：这项研究的目的是弄清胃造口术的使用中是否存在小面积变化（由医院医师密度解释），以便检测供应商诱发需求（SID）的存在。 2010年至2013年提交的《福冈晚期老年人健康保险》索赔数据。研究参与者包括51,785名被诊断出饮食困难的老年人。我们指定使用胃造口术为事件。在控制了患者因素之后，我们发现胃切除术的使用存在显着的区域性水平差异（中位数优势比[MOR]：1.72，1.37–2.51）。医院医师密度与胃造口术呈显着正相关（医院医师密度调整后OR：1.75，1.25–2.45； P <0.001）。由于医院医师密度的输入变量，MORs大大降低了。我们发现，老年人在胃造口术中使用的面积变化很小可以由医院医师密度解释，这可能表明存在SID。
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