Evaluating the effectiveness of the Hospital Referral Region (HRR) boundaries: a pilot study in Florida

Peng Jia, Fahui Wang, Imam M. Xierali

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


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 Nowadays, those outdated HRRs have still been chosen as analytical units in most if not all studies in the U.S. where large and high-level hospital service areas are needed.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.

Original languageEnglish (US)
Pages (from-to)251-260
Number of pages10
JournalAnnals of GIS
Issue number3
StatePublished - Jul 2 2020


  • GIS
  • HCUP
  • HRR
  • HSA
  • Hospital referral region
  • State Inpatient Database
  • health geography
  • hospital service area

ASJC Scopus subject areas

  • Computer Science Applications
  • Earth and Planetary Sciences(all)


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