Evaluating the effectiveness of the Hospital Referral Region (HRR) boundaries: a pilot study in Florida

Figures & data

Figure 1. Flowchart for generating the contemporary Hospital Referral Regions (HRRs). LI – Localization Index.

Figure 2. Boundaries of the Dartmouth HRRs and the contemporary HRRs.

Table 1. Rates of and average hospital charges for invasive cardiovascular and neurological surgeries of the Dartmouth HRRs (Value*) and their variation within the Dartmouth HRRs (Variation**).

Dartmouth HRRs	Cardio surgery rate (unit: %)		Neuro surgery rate (unit: %)		Cardio hospital charge (unit: $1,000)		Neuro hospital charge (unit: $1,000)
	Value	Variation	Value	Variation	Value	Variation	Value	Variation
AL-Dothan	41	48–50	91	91–94	62	71–89	68	62–90
FL-Bradenton	57	49–57	88	87–95	102	86–110	110	107–124
FL-Clearwater	52	49–55	87	86–91	95	97–119	114	113–121
FL-Fort Lauderdale	51	48–58	91	86–97	115	105–131	110	88–139
FL-Fort Myers	54	50–57	96	88–98	89	82–140	69	61–148
FL-Gainesville	43	42–45	91	91–93	97	95–98	90	82–90
FL-Hudson	54	49–55	94	88–97	120	70–132	126	81–132
FL-Jacksonville	45	42–56	93	91–93	95	74–98	82	81–90
FL-Lakeland	45	46–57	93	82–95	92	86–114	147	109–138
FL-Miami	50	48–53	90	89–92	134	114–140	143	88–148
FL-Ocala	53	42–54	90	89–97	82	70–132	90	81–132
FL-Orlando	52	45–58	86	78–97	95	70–132	112	81–138
FL-Ormond Beach	56	45–56	91	87–93	74	74–95	78	81–104
FL-Panama City	52	48–51	95	91–94	73	71–89	86	62–90
FL-Pensacola	48	48–51	93	93–94	89	71–89	90	85–90
FL-Sarasota	58	52–57	89	87–95	97	86–110	110	107–124
FL-St. Petersburg	51	51–52	87	86–88	119	97–119	115	113–116
FL-Tallahassee	50	42–51	91	91–94	85	71–98	64	62–90
FL-Tampa	49	46–57	91	87–97	112	70–132	113	81–138

*The value of a given Dartmouth HRR unit was calculated based on all cardiovascular (cardio) and neurological (neuro) discharge records in 2011 assigned to that Dartmouth HRR unit.

**The variation within a given Dartmouth HRR unit was denoted by the lowest and highest values of the contemporary HRRs that cross that Dartmouth HRR unit, which was calculated based on all cardiovascular and neurological discharge records in 2011 assigned to the contemporary HRRs, and then overlaid with the Dartmouth HRRs.

Figure 3. Variations in cardiovascular and neurological surgery rates across and within the Dartmouth HRRs (calculated over the contemporary HRRs): (a) cardiovascular surgery rates across the Dartmouth HRRs; (b) cardiovascular surgery rates across the contemporary HRRs; (c) neurological surgery rates across the Dartmouth HRRs; (d) neurological surgery rates across the contemporary HRRs. Red and blue circles highlight statistically significant clusters of high and low values, respectively. The contemporary HRR boundaries are removed for a clearer visualization in (b) and (d). In (b) and (d), the blank areas in the north are outside of Florida, and the blank areas in Florida (‘holes’) are uninhabitable areas (e.g. water bodies, marsh).

Figure 4. Variations in average hospital charges for cardiovascular and neurological surgeries across and within the Dartmouth HRRs (calculated over the contemporary HRRs): (a) average hospital charges for cardiovascular surgeries across the Dartmouth HRRs; (b) average hospital charges for cardiovascular surgeries across the contemporary HRRs; (c) average hospital charges for neurological surgeries across the Dartmouth HRRs; (d) average hospital charges for neurological surgeries across the contemporary HRRs. Red and blue circles highlight statistically significant clusters of high and low values, respectively. The contemporary HRR boundaries are removed for a clearer visualization in (b) and (d). In (b) and (d), the blank areas in the north are outside of Florida, and the blank areas in Florida (‘holes’) are uninhabitable areas (e.g. water bodies, marsh).