An individual can be assigned to multiple ADG’s depending on their respective diagnoses. We collapsed the 32-category

variable into three categories, specifically: selleck screening library individuals falling into 0-5, 6-9 and greater than 9 ADG’s. This three level categorical variable was used as an indicator of comorbidity in all subsequent analyses. The Ambulatory Care Groups Case Mix Adjustment software also generates Resource Utilization Bands Inhibitors,research,lifescience,medical (RUB), which estimate expected resource utilization. Patient level RUB categorization is determined through consideration of age, sex, and disease diagnoses. Different categories of RUB are associated with different levels of expected resource use and overall cost to the health care system over Inhibitors,research,lifescience,medical a given period of time. RUB values vary from 0-5, with higher values associated with higher utilization levels. For this study, RUBs were categorized as ≥ 4 (very high), 3 (high), 2 (medium), and 0-1 (low). The ACG measures were determined using two years of diagnostic data (fiscal year 2003 and 2004) from physician and hospital-based claims. Predictors Individual-level Inhibitors,research,lifescience,medical variables that were included in the regression models were gender (male, female), age (20-44, 45-64, 65-79), total household income (low

less than $20,000, medium $20,000-$59,999, high more than $60,000), education (low not completed high school, medium high school completion and some post-secondary education and high university degree), number of chronic medical conditions (0, 1, >1) from the following list (asthma, fibromyalgia, arthritis/rheumatism, back problems, high blood pressure, diabetes, Inhibitors,research,lifescience,medical epilepsy,

heart disease, and cancer), perceived health status (poor/fair, good, very-good/excellent), number of ADG’s (0-5, 6-9, >9), RUB status (0-1, 2, 3, 4-5), access to a primary care physician Inhibitors,research,lifescience,medical in the community (no, yes), and location of primary residence (rural, urban). Analytic Methods Population studies which seek to estimate demand for emergency department services or hospitalization typically exhibit a large proportion of zeroes, representing the persons that do not use any of the services being investigated during the observational period of interest. Factors influencing Liothyronine Sodium the demand for these services are routinely modeled using Poisson or negative binomial regression. While the negative binomial regression model does not impose as stringent a set of restrictions on the conditional mean-variance relationship as the Poisson model, neither is ideal for handling data with a large proportion of zeroes. Failure to account for the mass of zeros that are occurring at a greater proportion than would be predicted by either the Poisson or negative binomial models may result in biased parameter estimates and misleading inferences.