Search tips
Search criteria 


Logo of hsresearchLink to Publisher's site
Health Serv Res. 1994 June; 29(2): 225–245.
PMCID: PMC1070000

Utilization patterns of cohorts of elderly clients: a structural equation model.


OBJECTIVE. To identify a model that takes into account the interrelationship of health services utilization variables, and that allows examination of the utilization patterns of health services for a cohort of elderly clients. DATA SOURCES AND STUDY SETTING. The data of each client in the study were taken from three computer databases maintained for administrative purposes by the Ministry of Health in British Columbia. Time frame for the utilization variables is one year before and one year after admission to the long-term care program in BC which occurred in 1981-1982. STUDY DESIGN. A basic model was fitted to the utilization data for the year before admission and patterns of utilization were assessed for each gender-age group for the year before admission and for the two periods, using LISREL. Fifteen utilization variables were included: number of GP and specialist visits in different settings (office, home, etc.) and number of other services such as lab tests, hospital stay, etc. DATA COLLECTION. The three files were linked to produce one record per client. PRINCIPAL FINDINGS. A model was identified that fits the data well. The total effect of GP emergency room visits on hospital stay is 0.30 compared to 0.19 direct effect. The additional impact is produced via the effect of specialist consultations on hospital stay. This and similar findings by age, gender, and period are consistent with the joint dependency of utilization variables. CONCLUSIONS. The analysis shows that males and females have different utilization patterns, while age has no effect on utilization of health services by male clients and only a small effect on utilization patterns by female clients. Admission to LTC causes more specialist contacts resulting from contact with a GP and generally a more intensive use of diagnostic and surgical procedures. However, there is significantly less acute care hospital services utilization.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.8M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Andersen AS, Laake P. A causal model for physician utilization: analysis of Norwegian data. Med Care. 1983 Mar;21(3):266–278. [PubMed]
  • Ayanian JZ, Epstein AM. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med. 1991 Jul 25;325(4):221–225. [PubMed]
  • Béland F, Lemay A, Philibert L, Maheux B, Gravel G. Elderly patients' use of hospital-based emergency services. Med Care. 1991 May;29(5):408–418. [PubMed]
  • Bentler PM. Comparative fit indexes in structural models. Psychol Bull. 1990 Mar;107(2):238–246. [PubMed]
  • Brody EM. The Donald P. Kent Memorial Lecture. Parent care as a normative family stress. Gerontologist. 1985 Feb;25(1):19–29. [PubMed]
  • Eisenberg JM, Nicklin D. Use of diagnostic services by physicians in community practice. Med Care. 1981 Mar;19(3):297–309. [PubMed]
  • Ellencweig AY, Stark AJ, Pagliccia N, McCashin B, Tourigny A. The effect of admission to long-term care program on utilization of health services by the elderly in British Columbia. Eur J Epidemiol. 1990 Jun;6(2):175–183. [PubMed]
  • Evans RG, Barer ML, Hertzman C, Anderson GM, Pulcins IR, Lomas J. The long good-bye: the great transformation of the British Columbia hospital system. Health Serv Res. 1989 Oct;24(4):435–459. [PMC free article] [PubMed]
  • Lane D, Uyeno D, Stark A, Kliewer E, Gutman G. Forecasting demand for long-term care services. Health Serv Res. 1985 Oct;20(4):435–460. [PMC free article] [PubMed]
  • Lane D, Uyeno D, Stark A, Gutman G, McCashin B. Forecasting client transitions in British Columbia's Long-Term Care Program. Health Serv Res. 1987 Dec;22(5):671–706. [PMC free article] [PubMed]
  • Rosenblatt RA, Cherkin DC, Schneeweiss R, Hart LG, Greenwald H, Kirkwood CR, Perkoff GT. The structure and content of family practice: current status and future trends. J Fam Pract. 1982 Oct;15(4):681–722. [PubMed]
  • Stark AJ, Gutman GM, McCashin B. Acute-care hospitalizations and long-term care: an examination of transfers. J Am Geriatr Soc. 1982 Aug;30(8):509–515. [PubMed]
  • Stark AJ, Kliewer E, Gutman GM, McCashin B. Placement changes in long-term care: three years' experience. Am J Public Health. 1984 May;74(5):459–463. [PubMed]
  • Stark AJ, Gutman GM. Client transfers in long-term care: five years' experience. Am J Public Health. 1986 Nov;76(11):1312–1316. [PubMed]
  • Steingart RM, Packer M, Hamm P, Coglianese ME, Gersh B, Geltman EM, Sollano J, Katz S, Moyé L, Basta LL, et al. Sex differences in the management of coronary artery disease. Survival and Ventricular Enlargement Investigators. N Engl J Med. 1991 Jul 25;325(4):226–230. [PubMed]
  • Wan TT. Functionally disabled elderly. Health status, social support, and use of health services. Res Aging. 1987 Mar;9(1):61–78. [PubMed]
  • Wolinsky FD, Arnold CL, Nallapati IV. Explaining the declining rate of physician utilization among the oldest-old. Med Care. 1988 Jun;26(6):544–553. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust