Local Service Area Research Articles

Variation in Medical Practice: Implications for the Hospital Epidemiologist

Why do two physicians faced with similar patients make different decisions about the care their patients should receive? This area of health services research has been energized by recent concerns about rising healthcare costs. In 1982, Wennberg and Gittelsohn described the great variation in surgical procedure rates throughout the northeastern United States during the 1970s. Population rates of hysterectomy and prostatectomy varied fourfold between local service areas; tonsilectomy rates varied sixfold. Differences in patient populations could not explain the variation in rates. The authors concluded that a large portion of the variability was attributable to the personal preferences of the surgeons practicing in the various communities. Similar differences in procedure rates are easy to replicate and are evident at several levels of aggregation. On larger scales, regional and international differences can be documented easily. On a smaller scale, practice variation within individual hospitals is frequently evident.

“Life Values Assessment” Database and Profiles

Profiles of patients, caregivers, and the general population in a local hospice service area were developed using a “Life Values Assessment.” Explanation of the assessment with samples of these profiles to demonstrate its usefulness and sketches of the directions for future research are discussed.

Foreign Banks and US Loan Production Offices

Foreign commercial banks seeking to establish a multi‐state presence in the US have followed different approaches, including the use of loan production offices (LPOs) examined here. These are used primarily to facilitate off‐premise lending to borrowers outside the local service area, and are authorised to undertake all aspects of loan production except final approval and disbursement of funds. The policies regarding LPOs established by different states vary from complete prohibition to virtually unrestricted entry.

Probabilistic Design of Transmission Line Structures

For many years, electric transmission line structures in the U.S. have been designed in accordance with the minimum load and strength requirements given in the National Electrical Safety Code (NESC). Transmission line designers have recognized certain deficiencies in the NESC and usually specify increased design loading requirements based on conditions in local service areas. This practice has led to a lack of uniformity in design criteria for transmission line structures in the U.S. and points to the need for a uniform design approach based on probabilistic concepts. A load and resistance factor design format is recommended in which the design factors are probability‐based. The design point method for reliability analysis is reviewed and a computer program which applies this method to transmission line structures is described. A calibration example is presented which illustrates the use of this program for establishing the level of reliability in an existing structure and the corresponding design factors...

Context in Organizational Groups: The Case of Hospital Clusters

Although previous research has shown that the structure of groups or clusters of hospitals depends upon environmental characteristics of local service areas, little work has been done to demonstrate the importance of specifying the appropriate environmental framework for hospital clusters of varying composition. Clusters composed of only community general hospitals are affected primarily by the characteristics of the local community or service area, whereas clusters composed of both community hospitals and tertiary care hospitals (such as teaching hospitals or Veterans' Administration Hospitals) must respond to both local contingencies and extra-local constraints, such as the regional demands for specialized care and the teaching andlor research activities of other tertiary care hospitals. Thus, the presence of a tertiary care facility within a hospital cluster may alter significantly the context of the cluster. Using longitudinal data on national samples of tertiary and nontertiary care settings, I tested several hypotheses concerning the structure and environmental responsiveness of community hospital clusters in these different contexts.

Future Local Telephone Network Configurations

This paper presents the concept of dividing a local office service area under the present telephone network into blocks of switching areas to make up a local network with small, distributed switching nodes because switching costs will become much cheaper relative to cable laying costs due to LSI technology progress. In this paper, cable laying cost and switching cost are taken as the two main factors in determining future local network configurations. First, the cable laying cost is formulated using cable duct and circuit length. Next, the switching system cost is formulated based on the relation between capability and cost of components such as gates and memories. Finally, local telephone network cost is calculated, using the cost formulas obtained and data available at present. The conclusion is that from the cost-effective point of view, conventional local network office service areas should be divided into 9 to 16 blocks.

ANALYZING THE IMPACT OF LAND USE ON SEWER SERVICE AREA PLANNING1

ABSTRACT: The density and distribution of land uses has important consequences for the planning of sewerage systems and for the costs of these systems. This paper examines these consequences using a simplified service area model. The model determines the area to be served by a central waste treatment plant, where alternative on‐lot disposal systems are also available. The model is applied to various urban area configurations, which are summarized by their total populations and by their population density distributions. Both minimum regional cost and minimum local cost service area configurations are determined. In addition, the sensitivity of the model to the parameters of the cost and population density functions is assessed. It is found that the model is most sensitive to the parameters of the collection cost function.

Long-distance propagation in relation to television in the United Kingdom

A review is given of the effects of irregularities in the terrain and of non-standard refraction in the troposphere on radio field strength characteristics in the v.h.f. band. The results of an analysis of existing data on long-range transmission in this band in the United Kingdom are then applied to the problem of determining the spacing required between two transmitters working on a common frequency when the degree of interference in each local service area caused by signals from the more distant transmitter must not exceed various specified limits. The effects of non-standard tropospheric refraction, in particular, are such as to make this spacing much greater than it would be if such departures from standard did not exist.