ArticleAnnals of family medicine
Variation in the ecology of medical care.
Article in Annals of family medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Interventions for improving older patients' involvement in primary care episodes.The Cochrane database of systematic reviews · 2007Pooled it
- The Ecology of Medical Care in Shanghai: Temporal Trends and International Comparisons.Risk management and healthcare policy · 2025Article
- The ecology of medical care: access points to the health care system in Austria and other developed countries.Scandinavian journal of primary health care · 2019Article
- Trends in the Types of Usual Sources of Care: A Shift from People to Places or Nothing at All.Health services research · 2018Article
- The ecology of medical care on the westernmost remote island, Yonaguni Island, Japan: A cross-sectional study.PloS one · 2018Observational
- The ecology of medical care on an isolated island in Okinawa, Japan: a retrospective open cohort study.BMC health services research · 2017Article
- The Ecology of Medical Care in Korea.Journal of Korean medical science · 2016Article
- The Autoimmune Ecology.Frontiers in immunology · 2016Review
- Contributors to primary care guidelines: What are their professions and how many of them have conflicts of interest?Canadian family physician Medecin de famille canadien · 2015Article
- Assessing methods for measurement of clinical outcomes and quality of care in primary care practices.BMC health services research · 2012Article
- The Ecology of Medical Care in Norway: Wide Use of General Practitioners may not Necessarily Keep Patients out of Hospitals.Journal of public health research · 2012Article
- Ecology of medical care in a publicly funded health care system: a registry study in Sweden.Scandinavian journal of primary health care · 2011Article
- The German health care system in international comparison: the primary care physicians' perspective.Deutsches Arzteblatt international · 2011Article
- Emergency department utilization among HIV-infected patients in a multisite multistate study.HIV medicine · 2010Article
- The ecology of medical care for adults in Alberta, 2002/03 to 2016/17: a retrospective cohort study.CMAJ openArticle
- Pursuing equity: contact with primary care and specialist clinicians by demographics, insurance, and health status.Annals of family medicineArticle
- Two cheers for ecology.Annals of family medicineArticle
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWe wanted to quantify how the location in which medical care is delivered in the United States varies with the sociodemographic characteristics and health care arrangements of the individual person.
methodsData from the 1996 Medical Expenditures Panel Survey (MEPS) were used to estimate the number of persons per 1,000 per month in 1996 who had at least 1 contact with physicians' offices, hospital outpatient departments, or emergency departments, hospitals, or home care. These data were stratified by age, sex, race, ethnicity, household income, education of head of household, residence in or out of metropolitan statistical areas, having health insurance, and having a usual source of care.
resultsPhysicians' offices were overwhelmingly the most common site of health care for all subgroups studied. Lacking a usual source of care was the only variable independently associated with a decreased likelihood of care in all 5 settings, and lack of insurance was associated with lower rates of care in all settings but emergency departments. Generally, more complicated patterns emerged for most sociodemographic characteristics. The combination of having a usual source of care and health insurance was especially related to higher rates of care in all settings except the emergency department.
conclusionFrequency and location of health care delivery varies substantially with sociodemographic characteristics, insurance, and having a usual source of care. Understanding this variation can inform public consideration of policy related to access to care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.