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Liu CF, Burgess JF, Manning WG, Maciejewski ML. Beta-binomial regression and bimodal utilization. Health services research. 2013 Oct 1; 48(5):1769-78.
OBJECTIVE: To illustrate how the analysis of bimodal U-shaped distributed utilization can be modeled with beta-binomial regression, which is rarely used in health services research. DATA SOURCES/STUDY SETTING: Veterans Affairs (VA) administrative data and Medicare claims in 2001-2004 for 11,123 Medicare-eligible VA primary care users in 2000. STUDY DESIGN: We compared means and distributions of VA reliance (the proportion of all VA/Medicare primary care visits occurring in VA) predicted from beta-binomial, binomial, and ordinary least-squares (OLS) models. PRINCIPAL FINDINGS: Beta-binomial model fits the bimodal distribution of VA reliance better than binomial and OLS models due to the nondependence on normality and the greater flexibility in shape parameters. CONCLUSIONS: Increased awareness of beta-binomial regression may help analysts apply appropriate methods to outcomes with bimodal or U-shaped distributions.