Risk adjustment for hospital use using social security data: cross sectional small area analysis

Objectives: To identify demographic and socioeconomic determinants of need for acute hospital treatment at small area level. To establish whether there is a relation between poverty and use of inpatient services. To devise a risk adjustment formula for distributing public funds for hospital services using, as far as possible, variables that can be updated between censuses. Design: Cross sectional analysis. Spatial interactive modelling was used to quantify the proximity of the population to health service facilities. Two stage weighted least squares regression was used to model use against supply of hospital and community services and a wide range of potential needs drivers including health, socioeconomic census variables, uptake of income support and family credit, and religious denomination. Setting: Northern Ireland. Main outcome measure: Intensity of use of inpatient services. Results: After endogeneity of supply and use was taken into account, a statistical model was produced that predicted use based on five variables: income support, family credit, elderly people living alone, all ages standardised mortality ratio, and low birth weight. The main effect of the formula produced is to move resources from urban to rural areas. Conclusions: This work has produced a population risk adjustment formula for acute hospital treatment in which four of the five variables can be updated annually rather than relying on census derived data. Inclusion of the social security data makes a substantial difference to the model and to the results produced by the formula.

Reuse of construction waste: performance under repeated loading

The use of recycled aggregates has increased greatly over the last decade owing to enhanced environmental sensitivities. The level of performance required by such materials is dependent upon the applications for which they are used. Many recycled construction wastes have adequate shear strength in relation to various geotechnical applications. However, a possible drawback of these materials is the risk of crushing during repeated loading. The work reported in this paper examined two waste materials: crushed concrete and building debris, both regarded as construction wastes. Tests were also performed on traditionally used crushed rock, in this case basalt. The materials were subjected to repeated loading in a large direct shear apparatus. The amount of crushing was quantified by performing particle size analysis of the tested material. The results have shown that both recycled construction wastes were susceptible to particle crushing. The amount of crushing was influenced by both the vertical pressure and the number of loading cycles. This leads to a marked decrease in peak friction angle