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Title: Evaluating the effectiveness of the Hospital Referral Region (HRR) boundaries : a pilot study in Florida
Authors: Jia, P 
Wang, F
Xierali, IM
Issue Date: 2020
Source: Annals of GIS, 2020, v. 26, no. 3, p. 251-260
Abstract: The nationwide tertiary hospital catchment areas, known as the Dartmouth Hospital Referral Regions (HRRs), were created based on the 1992–1993 Medicare data in the U.S., to reflect referral patterns of hospitals and hospitalization patterns of patients for specialized medical cares at that time. Nowadays, those outdated HRRs have still been chosen as analytical units in most if not all studies in the U.S. where large and high-level hospital service areas are needed. This pilot study aimed to evaluate whether the HRR boundaries have significantly varied over time in Florida. The Dartmouth method was replicated to construct the contemporary HRRs in Geographic Information Systems with 2011 Florida State Inpatient Database. The contemporary HRRs and Dartmouth HRRs were visually and statistically compared in several function-related aspects. The contemporary HRRs included 38 eligible units, twice the number of (19) Dartmouth HRRs, with a comparable level of self-containment (p = 0.634) on average. This reflects the diffusion of specialized medical services such as cardiovascular surgeries among hospitals in the past 2-3 decades The contemporary HRRs hold values for a variety of health policy themes, including hospital policy-making, optimization of healthcare systems, and measurement of competition in healthcare markets.
Keywords: GIS
health geography
Hospital referral region
hospital service area
State Inpatient Database
Publisher: Taylor & Francis
Journal: Annals of GIS 
ISSN: 1947-5683
EISSN: 1947-5691
DOI: 10.1080/19475683.2020.1798509
Rights: © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group, on behalf of Nanjing Normal University. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The following publication Peng Jia, Fahui Wang & Imam M Xierali (2020) Evaluating the effectiveness of the Hospital Referral Region (HRR) boundaries: a pilot study in Florida, Annals of GIS, 26:3, 251-260, is available at
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