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Index divergence also ranged widely among the 219 HSAs.
Index divergence is simply Medicare index minus pediatric index.
We computed Spearman's rho between pediatric per capita bed supply and index divergence.
For the majority of HSAs the Medicare index was higher than the pediatric index, resulting in a positive index divergence.
They spoke of the fit of discharge data to the area model and calculated an LI "index divergence" [ 7].
HSA-level index divergence was mapped for the entire state and the major metropolitan areas with ArcGIS 8.2 software to visually explore patterns over the urban-rural continuum.
The volume of pediatric cases did not appear to be associated with the magnitude of index divergence between the two age groups.
The correlation between pediatric volume and pediatric localization is very low (r = 0.10, p = 0.14), as is the correlation between pediatric volume and Medicare-pediatric index divergence (r = -0.03, p = 0.64).
Choropleth maps of HSAs, color-coded by Medicare-pediatric index divergence, did not reveal any obvious divergence patterns that might be related to areal size of ZIP codes or HSAs.
To determine if weak pediatric localization and lack of agreement between Medicare and pediatric indices might be due to a pediatric volume effect we computed index divergence for each HSA.
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The effect of the location of children's hospitals within an HSA was examined by noting the rank of those HSAs in the distribution of pediatric localization indices and in the distribution of index divergences.
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